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What are the elements of pharmacokinetics?
- route - how meds enter the body
- absorption - how it moves from site into blood
- distribution - moving from blood into cells, tissues, organs
- action - how a drug alters physiological functions
- metabolism - how it is changed to prepare for excretion
- excretion - how a drug exits the body
- action - how medications act
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What are factors that influence absorption?
- route of administration
- ability to dissolve
- blood supply to the site of administration
- body surface area (small intestine has more absorption because it has a greater area)
- lipid solubility of medication
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What does drug distribution depend on?
- circulation
- membrane permeability
- protein binding
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What are the main organs of metabolism and excretion?
- metabolism - liver
- excretion - kidneys
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how should the ear be moved for administration of medications?
- For children - down and back
- For adults - up and out
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How do you administer meds through an NG tube?
- need to be in liquid form (can't be enteric or time release)
- must be dissolved in 15-30ml of warm water
- flush tube with 15-30ml of warm water between medications
- flush after with 30-60ml
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What are the 7 rights?
patient, med, route, dose, time, documentation, refuse
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What are special concerns with pregnant, pediatric and geriatric patients?
- pregnant - medication crossing the placenta and affecting the fetus
- pediatric - dosing
- geriatric - polypharmacy
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How much fluid should oral meds be taken with?
60-100 ml
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What parts of the syringe are considered sterile?
tip, inside of barrel, inside of the hub, shaft of hte plunger, needle
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What gauge of syringe is recommended for blood products, IM, subQ, intradermal?
- 18-20 for blood
- 19-23 for IM
- 25-27 for sub Q
- 26-27 for ID
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How should insulins be mixed?
clear then cloudy!
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What is the length, gauge, dose size and angle for subQ injections?
- 3/8 - 5/8
- 25-27
- 1/2 to 1
- 90 or 45
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What is the length, gauge, dose size and angle for IM injections?
- 1-11/2 inches (child 5/8 to 1 1/4)
- 19-23 (child 25-27)
- 3ml (2ml if given in deltoid), child 1ml, infant 1/2
- angle 90 degrees with z track used
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What are the anatomical landmarks for the ventrogluteal site?
heel on greater trochanter, thumb towards groin, index finger on anterior iliac spine, middle finger towards buttock
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What are the anatomical landmarks for the deltoid site?
1-2 inches below acromion process or 3 fingerwidths
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What is the length, gauge and dose size for ID injections?
- length 1/4 to 1/2
- gauge 25-27
- dose size .1-.2 cc
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What are influencing factors for pain?
age, fatigue, genetic, neurologic, social, spiritual, psychological, cultural
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What is the goal of IV therapy?
To correct or prevent fluid or electrolyte imbalances
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What is an isotonic solution?
- same concentration as body fluids - used for volume replacement.
- examples - NaCl 0.9% (normal saline), D5W 5%
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What is a hypotonic solution?
- a concentration lower than body fluids, used to rehydrate the cells
- examples - 0.45% NaCl (1/2 normal saline) D5 0.45% NS
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What is a hypertonic solution?
- higher than body fluids - used to increase vascular volume
- examples - D10W, D5LR
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What are lactated ringers?
IV fluids with electrolytes and additives
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What is important to know about giving KCL?
- it is commonly added to IV solutions when patients are NPO because the body can't conserve K
- it must be administered slowly over several hours and diluted - if given as IV push it may be fatal!!!
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What should orders for IV therapy contain?
- the specific solution, any additives, time schedule.
- IV solution is a med
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What are butterflys and angiocaths used for?
Butterflys are used for drawing blood and angiocaths are used to start IVs.
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What is a heparin lock/saline lock?
It is an IV that is in place but not hooked up to a running solution, has a port to give other meds. It needs to be flushed with normal saline and must be replaced every 72 hours
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What is a central line?
A catheter that is placed into a larger vein (subclavian, jugular) by a physician. Can be used for months. Before it can be used an xray must be done.
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What is a PICC line?
it is placed in the upper arm and threaded into a larger vein by a physician. When it is removed pressure must be applied for at least 5 minutes.
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What are the steps for starting an IV?
- review the order
- gather supplies
- explain the procedure to the client
- find the best vein
- start distally
- perform venipuncture, secure, start fluids, transparent dressing
- document
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What are ways to assess client's fluid status?
- daily weight (best way)
- I&O
- labs (Na+, K+, Cl, glucose, BUN)
- skin turgor
- breath sounds
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What are phlebitis and infiltration?
- Phlebitis - inflammation/infection of the vein. Pain erythmea, heat and redness
- Infiltration - fluid entering the subcutanious tissue. Swelling, pallor and coolness, pain possible
With either one you have to discontinue IV and go to another site.
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What does a blood transfusion include?
- whole blood
- packed RBCs
- plasma
- platelets
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What are the purposes of blood transfusions?
- increase blood volume
- treat anemia
- replace blood componants
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What are the time frames that are needed when transfusing blood products?
- transfuse within 30 minuted of receiving from pharmacy
- administer slowly for first 15 minutes to monitor for reaction
- don't give longer than 4 hours
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What is an acute hemolytic reaction?
- incompatibility to antibodies causing RBC breakdown
- chills, fever, pain, tachycardia, tachypenia, flushing
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What is a febrile nonhemolytic reaction?
- sensitization to specific components
- chills, fever, headache, flushing
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What is a mild allergic reaction
- sensitivity to plasma proteins
- flushing, itching, hives
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What is an anaphylactic reaction to blood products?
anxiety, itching, wheezing, cyanosis
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What is circulatory overload?
- fluid given faster than circulation can accommodate
- cough, dyspnea, pulmonary congestion, headache, hypertension, tachycardia, distended neck veins
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