Study Guide 1
Study Guide 1 NSG 335
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This 11 page Study Guide was uploaded by Brieanna Phipps on Wednesday February 3, 2016. The Study Guide belongs to NSG 335 at University of North Carolina - Wilmington taught by Dr. Sauer in Spring 2016. Since its upload, it has received 62 views. For similar materials see Pathology and Pharmacology in Nursing and Health Sciences at University of North Carolina - Wilmington.
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Date Created: 02/03/16
Module 1 -Agonist: binds to a receptor to produce a response -Partial Agonist: binds the the receptor, but doesn’t have as strong as a response as an agonist -Antagonist: substance that interferes and blocks an agonist from binding -Acute Pain: protective mechanism that something is wrong. Lasts seconds to days. -Chronic Pain: lasts longer than 3-6 months than normal healing period -Tx of Pain: analgesics and anesthetics -Anesthetics involve loss of consciousness -when administering an opioid and they OD, stop the medication if IV, give Narcan, and call the provider -monitor RR when giving opioids, anything under 12 hold it -older adults are underserved for pain, increase in pain threshold -Tolerance: need a higher dose to receive the same effects -Pain Threshold: point at which stimulus is perceived as pain -Pain Tolerance: duration of time an individual will endure until pain stimulation Morphine -Agonist - PO, PCA, IV, IM, SQ, Spinal Injection -ADRs: Respiratory depression, mental cloudiness, constipation, sedation, orthostatic HoTN, urinary retention, cough suppression, N/V, increase ICP, euphoria/dysphoria. -Interactions: Do not give with other CNS depressants (Alcohol, Benzos, Barbituates), and drugs that decrease BP -Toxicity: Classic Triad coma, respiratory depression, pinpoint pupils -Overdose: Narcan (Naloxone) -Monitoring: -hold if respirations less than 10 -can compromised patients with impaired pulmonary function -can cause itching give Benadryl -**Monitor RR, BP and Pulse before and after dosing** Duragesic (Fentanyl Patch) -Agonist -ADRs: Respiratory depression, mental cloudiness, constipation, sedation, orthostatic HoTN, urinary retention, cough suppression, N/V, increase ICP, euphoria/dysphoria. -Interactions: “azoles”, metabolized in liver -Overdose: give Narcan (Nalaxone) -Monitoring: -releases medication over 48-72 hrs, peaks at 24 -PRN narcotics for breakthrough pain -absorption dependent on body temp (absorbs more quickly on warm skin), skin, body fat, patch placement -place in Sharps container or toilet Pentazocine -Agonist-Antagonist -SE: dry mouth, respiratory depression, hallucinations -Toxicity: YAWNING AND SWEATING Meperidine (Demerol) -Agonist -ADRs: Respiratory depression, mental cloudiness, constipation, sedation, orthostatic HoTN, urinary retention, cough suppression, N/V, increase ICP, euphoria/dysphoria. -Interactions: metabolized in KIDNEYS -Monitoring: -accumulation of metabolites toxicity seizures death -SHORT half life -can Tx post-anesthesia shivers Oxycodone -Agonist -PO, IR, CR, liquid -ADRs: Respiratory depression, mental cloudiness, constipation, sedation, orthostatic HoTN, urinary retention, cough suppression, N/V, increase ICP, euphoria/dysphoria. -Interactions: metabolized in liver -Monitoring: -mixed with Aspirin (Percodan) -mixed with Acetaminophen, Immediate Release (Percocet) -mixed with Acetaminophen, Controlled Release (OxyContin) -do not crush or chew Fentanyl -Agonist -Parenteral, transdermal, transmucosal, intranasal -ADRs: Respiratory depression, mental cloudiness, constipation, sedation, orthostatic HoTN, urinary retention, cough suppression, N/V, increase ICP, euphoria/dysphoria. -Interactions: “azoles”, metabolized in liver -Monitoring: -100x more potent than morphine -given in mcg Methadone -Agonist -PO ADRs: Respiratory depression, mental cloudiness, constipation, sedation, orthostatic HoTN, urinary retention, cough suppression, N/V, increase ICP, euphoria/dysphoria. -Interactions: metabolized in liver -used to treat opiate addiction -Elongates QT Interval -if crushed and snorted- respiratory depression and death Naloxone -Antagonist -used for opiate OD -reverse respiratory depression after surgery and after birth in neonates exposed -immediate withdrawal if taken with opioid Tramadol (Ultram) -Antagonist -PO -acts in 1 hr, duration is 6 hrs -ADRs: dry mouth, dizziness, HA, constipation, sedation, seizures -treats moderate to moderately severe pain -risk of suicide Lidocaine and Epinephrine prolongs effects of lidocaine Module 2 Types of Skin Cancer -Basal Cell Carcinoma (most common) -Squamous Cell Carcinoma (2 ndmost common) -Malignant Melanoma (most dangerous) st 1 degree burn: -epidermis damaged -bright red, no blisters (sunburn) -painful -fever, chills, HA, N/V -takes 3-5 days to heal, no scars nd 2 degree SUPERFICIAL burn: -epidermis and dermis damaged -bright red and blisters -MOST PAINFUL -takes 3-4 weeks to heal, depending on how deep nd 2 degree DEEP burn: -epidermis and dermis damaged -white and leathery -painless, because the nerves are damaged -takes weeks to heal -may need graft -there can be scarring or loss of fxn 3 degree burn: -epidermis, dermis and SQ -waxy, white, red to brown, leathery -secondary healing -grafting -skin is tighter lose flexion/extension, maybe amputation -systemic effects 4 degree burn: -epidermis, dermis, SQ, muscles, tendons, bone rd -same look as 3 degree, but more black -will not heal on it’s own Priorities for burns -IV fluids -BP drops because capillaries become more permeable and water moves into extracellular space. -this causes HR to increase to try to push the small amount of blood around (hypovolemic) -stop source of burn -remove clothing and jewelry -NG tube and foley -baseline labs -K is high, b/c of fluid loss -Hct is high, b/c of fluid loss Rule of 9’s -head & neck: 9% -anterior/posterior thoracic 18% (x2): 36% -arms: 9% each -legs: 18% each -perineum: 1% Cellulitis: -inflammation of SQ connective tissue -bacterial infection -can spread to blood and lymph nodes Cells responsible for immunity in skin: Langerhans Silver Sulfadiazine -antimicrobial -used to treat infections of 2dand 3 degree burns -ADRs: pain, burning, itching, leukocytopenia -stop on doctor’s orders Isotretinoin (Accutane) -used for severe acne -ADRs: nosebleed, depression, inflammation of lips, dry itchy face -Interactions: TERATOGENIC, DO NOT USE IF PREGNANT Tretinoin -retinoid derivative of vitamin A to treat acne and wrinkles -ADRs: increased sensitivity to sun, reddened skin, dry skin -Need sunscreen -SEVERE ADVERSE REACTION WITH TETRACYCLINE AND VITAMIN A Module 3 Rheumatoid Arthritis (RA) -chronic, systemic, inflammatory autoimmune disease -white women over 40 -morning stiffness that decreases as the day progresses -tender, warm swollen joints -bilateral -arthritis of more than 3 joints -joint fluid exudate -strong genetic predisposition -insidious onset -Tx with NSAIDS, glucocorticoids, and DMARDS (disease-modifying anti- rheumatic drugs) -start DMARD within 3 months of Dx -METHOTREXATE Gout -metabolic d/o where there is an excess amount of uric acid that crystalizes in joints -50% happen in the big toe joint -older males that have a high intake of alcohol, red meat, and fructose -severe pain at night -Tx Allopurinol, NSAIDS, cochicine, water, exercise, no foods high in purines SLE (Systemic Lupus Erythematous) -hyperactive immune system fighting normal cells -butterfly rash -fever and swelling joints -sensitivity to sunlight (wear sunscreen and protective clothing) AS (Ankylosing Spondylitis) -inflammatory disease of the spine -fusion of SI (sacroiliac) joint -affects males 15-40 Osteoporosis -decrease in bone mass and density -older white women b/c of lack of estrogen Fibromyalgia -joint pain, fatigue, and tender joints -absence of inflammation -women aged 30-50 -perhaps from central nervous system dysfunction -difficult to diagnose -diagnosed with 11 pairs of tender joints with diffused joint pain Fracture -pathologic: related to disease -greenstick: kids -bowing: when pressure bends bone, when pressure is released, it stays bowed -stress: repeated use -spiral: abuse -complete or incomplete: totally snapped the bone -open or closed: did it break through the skin Compartment Syndrome -swelling and inflammation and there is increased pressure with no where to go -pt will feel numbness and tingling with lack of blood supply then intense pain -have to perform a fasciotomy Methotrexate -DMARD -INTERFERES WITH FOLATE METABOLISM: DEATH TO RAPID- PRODUCING CELLS -used to treat RA -ADR: immune suppression, bone marrow suppression, PUD -Monitor CBC -Take 5mg of folate during Tx Azathioprine (Imuran) -immunosuppressant that alters antibody formation -used for RA and transplants -PO/IV -ADRs: anorexia, hepatotoxicity, N/V, anemia, leukopenia, malignancy, chills, fever, infection Allopurinol -decrease the amount of uric acid in the body -use cautiously in liver/kidney impairment -ADRs: joint swelling, rash Colchicine -treats gout attacks -PO -SE: N/V/D, stomach cramps -when combined with NSAIDS and simvastatin, cause muscle injury Etanercept (Enbrel) -TNF (Tumor Necrosis Factor) antagonist -Tx of RA, AS -ADR: HA, URI, injection site reaction (esp TB and Fungal) NSAIDS -symptom relief -does not prevent damage or slow progression Lab Values -UA (Uric Acid): 2.4-6 -WBC (White Blood Cells): 5K-10K -Hgb (Hemoglobin): 12.1-18 -Hct (Hematocrit): 36-50% -Plts (Platelets): 140K-350K
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