Term
|
Definition
| Chemical, Generic and Trade® or Brand Name |
|
|
Term
| Classifications for medications |
|
Definition
-Therapeutic Class
-Pharmacologic Class
-Other
*Pregnancy Category
*Controlled Substance Schedule |
|
|
Term
| Preparations for medications |
|
Definition
|
|
Term
|
Definition
Oral (PO)
Sublingual (SL)
Buccal
Topical
Enteral
Parenteral (IM, IV) |
|
|
Term
| Systems of Medication Distribution |
|
Definition
Unit-dose system
Automated medication-dispensing system
Bar code medication administration
Self-administered medication system |
|
|
Term
| Medication/Physician Orders: Types of Orders |
|
Definition
Routine or Standing Orders
PRN Orders
Standing Protocols
One-Time Orders
STAT Orders
Telephone and FAX Orders
Verbal Orders
Electronic Orders |
|
|
Term
| Medication Order: Components |
|
Definition
Patient, Date, Time
Medication Name
Medication Dosage
Route of Administration
Frequency
Time
Purpose or
Special Considerations
Signature |
|
|
Term
|
Definition
What the body does to the medication
What medication does to the body
Different forms of medications.
Different routes for administering medication. |
|
|
Term
| Principles of Drug Action |
|
Definition
Pharmacokinetics
Pharmacodynamics |
|
|
Term
|
Definition
Absorption
Distribution
Metabolism
Excretion |
|
|
Term
|
Definition
Movement of drug into the bloodstream
Affected by
Route of Administration
Form
Drug Solubility
Body Surface (Local vs. Systemic)
Food |
|
|
Term
|
Definition
Drug transport to sites of action
Factors affecting distribution:
Circulatory System
Amount bound to protein
Tissue specificity |
|
|
Term
|
Definition
Biotransformation: chemical conversion of drug into metabolites that can be excreted
The slower the metabolism, the greater the risk of toxicity
Factors affecting metabolism
Liver Function |
|
|
Term
|
Definition
Elimination of the drug
Primarily through the kidneys
Also through lungs, bowel, sweat, mammary glands |
|
|
Term
| Factors affecting Pharacokenetics |
|
Definition
Age
Weight
Environment
Pathological States
Genetic Factors
Psychological Factors |
|
|
Term
|
Definition
-Therapeutic Effects
*Indication
*Action
-Adverse Effects (Adverse Drug Event)
*Side Effects
*Tolerance
*Allergic Reactions
Anaphylactic
*Toxicity |
|
|
Term
|
Definition
MAO Inhibitors and Tyramine
Coumadin and Green Leafy Vegetables
Milk
Grapefruit
Potassium
Full or Empty Stomach |
|
|
Term
|
Definition
Information Collected During Initial Assessment
Medication History
Medication Reconciliation
Allergies and Intolerances
Medical History
Pregnancy and Lactation
Teratogens |
|
|
Term
|
Definition
Assessment before Medication Administration
Physician’s Orders
Medication Record
Diet and Fluid Orders
Laboratory Values
Physical Assessment
Ability to Swallow
Gastrointestinal Motility
Body System Assessment |
|
|
Term
|
Definition
TRAMP
Time
Route
Amount
Medication
Person
Evaluation
Documentation |
|
|
Term
| Medication Administration Safety |
|
Definition
Medication Reconciliation
Culture of Safety/Standardized Communication
Ask another nurse to check the order
Take vitals, check labs (don’t delegate)
Know and use your resources
Contact the physician for clarification, concerns, questions
Consult the pharmacist
Know what can be crushed, opened
Watch for drugs with similar names
Evaluate Response to Medication |
|
|
Term
|
Definition
Watch for HIGH ALERT medications
Watch for patients with similar names
Seven Rights
Three Checks
Identify patient using two Identifiers
Check for allergies
Honor patient’s concerns
Document |
|
|
Term
| What to do if you commit a Medication Error |
|
Definition
Check the patient
Consult a drug reference source for side effects to the medication
Identify type of error
Notify nurse manager or supervisor
Notify physician and obtain orders
Document
Incident Report
Full disclosure to patient |
|
|
Term
| The Elderly and Medications |
|
Definition
Physiologic Changes
Mechanical/Cognitive
Polypharmacy |
|
|
Term
|
Definition
Risk for injury related to reactions to drug therapy and impact of cultural, racial, and/or ethnic factors on pharmacokinetics
Assess for
Leaders in the family or community
Health beliefs and practices
Past use of medicine
Use of herbal treatments, folk remedies, or supplements
Dietary habits |
|
|
Term
|
Definition
Applied directly to body surface/body cavities
Skin, Instillation, Inhalation
Local Effects
Lotions, Creams, Ointments
Eye, Ear
Local and Systemic Effects
Inhalations, Vaginal, Rectal , Nasal
Systemic Effects
Transdermal Patches |
|
|
Term
| Over the Counter/Herbal Medications/ Dietary Supplements |
|
Definition
Over the Counter
Herbal Medications
Dietary Supplements
Alternative
Complementary/Integrative |
|
|
Term
|
Definition
Knowledge Deficit
Noncompliance
Ineffective Health Maintenance
Readiness for Enhanced Knowledge
Risk for Injury
Risk for Aspiration |
|
|
Term
| Cognitive-Perceptual Pattern |
|
Definition
“The cognitive-perceptual pattern deals with thought, thought processes, and knowledge as well as the way the patient acquires and applies knowledge.”
“The..pattern becomes the essential premise for all other patterns used in the practice of nursing.”
“…any failure in recognizing alterations in this pattern will hamper assessment and intervention in all the other patterns.” |
|
|
Term
|
Definition
| “Sensations are the first stages in the functioning of senses to represent stimuli from the environment, and perception is a higher brain function about interpreting events and objects in the world.” |
|
|
Term
| Normal Sensory Perception |
|
Definition
Special Senses
-Sight (Visual)
-Hearing (Auditory)
-Smell (Olfactory)
-Taste (Gustatory)
Somatic Senses
-Touch (Tactile)
-Kinesthetic (proprioception) [placement of action of our body parts]
-Visceral Senses [period cramps, stomach gases, etc.] |
|
|
Term
| Normal Sensory Perception |
|
Definition
~Sensory Receptors
-Stimuli is received by the senses and transmitted to the RAS
~Reticular Activating System (RAS)[arousal mech. makes you aware of world. overwhelmed or understimulated =problems]
-Multiple stimuli are converted by the RAS into an impulse and conducted to the cerebral cortex
~Functioning Nerve Pathways
~The cerebral cortex perceives the impulse |
|
|
Term
| Terms associated Normal S/P Function |
|
Definition
Sensoristasis
-State of optimum arousal (personal)
Adaptation
-Sensory receptors adapt to repeated stimulation by responding less and less
(live next to highway)(driiling becomes background) (don't smell after awhile) |
|
|
Term
| Factors Affecting Sensory Perception |
|
Definition
Environment
Previous Experience
Lifestyle
Culture
Illness
Medications
Age
Variations in Stimulation |
|
|
Term
| Sensory Function Changes with Aging |
|
Definition
Hearing Loss
Nerve degeneration
Low vision or Blindness
Diminished Proprioception (body awareness)
Physical and Psychological Factors
Polypharmacy
Nutritional Deficits |
|
|
Term
| Variations in Stimulation |
|
Definition
Sensory Overload (Hyperactive Delerium)
Sensory Deprivation (Hypoactive Delerium)
Sensory Deficits (vision, hearing, taste, smell, tactile, kinesthetic sense) |
|
|
Term
|
Definition
Environmental or Internal Stimuli is more than sensory system can process.
Internal Factors [anxious about procedure, meds, not feeling well, lack of sleep]
Information[too much info, giving diagnosis]
Environment[noise, nurses are loud, lights, invasive devices |
|
|
Term
|
Definition
A state of RAS depression caused by lack of meaningful stimuli. Causes include:
~Altered Sensory Reception [sensory deficit]
-dementia, depression, neurological injury, sensory losses or deficits, CNS depressants
~Environmental Conditions
-Non-stimulating
-Monotonous
-Isolation
-Restricted Mobility
[brain starts to stimulate itself=hallucination] [brain makes other senses more acute blind=hear better] |
|
|
Term
| Altered Sensory Perception Function |
|
Definition
Anxiety
Cognitive Dysfunction [disturbances in momory, reasoning, problem solving]
Hallucinations [har things see things]and Delusions [thoughts "poisoning me"]
Depression and Withdrawal
Restlessness, Sleeplessness
Decreased Appetite |
|
|
Term
| Assessment of Sensory/Perceptual Function |
|
Definition
-Normal pattern identification
-Risk identification
(Age
Culture and Language
Activity/Stimulation Level
Medical History
Medications
Experience with healthcare settings)
-Dysfunction identification (can't see) |
|
|
Term
|
Definition
Medical and Psychological History
Medications/Substance Use
Recent changes in sensory perception/stimulation
Use of sensory devices
Ability to perform ADL’s
Stress and Pain
Numbness, tingling, balance
Daily Activities and Socialization
Focused examination of vision, hearing, taste, smell, touch, and balance. (Subjective and Objective Data)
Diagnostic Tests and Procedures |
|
|
Term
|
Definition
~Disturbed Sensory Perception
-Sensory Deficit (specify)
-Sensory Overload
-Sensory Deprivation
~Unilateral Neglect |
|
|
Term
|
Definition
Health Promotion
-Patient teaching
-Procedure Preparation
-Nurse-Patient Interaction |
|
|
Term
| Terms Associated with Cognition |
|
Definition
Cognition
Consciousness
Attention
Memory
Learning
Communication |
|
|
Term
| Anatomic Structures involved in Cognition |
|
Definition
Sensory Organs
Nervous Pathways
Reticular activating system (RAS)
Cerebral Cortex
Motor Reflexes |
|
|
Term
| Normal Cognitive Function |
|
Definition
~Perception of Information
-Exteroceptors[hearing, vision, taste, smell, pain, touch]
-Proprioceptors[somatic sensors=body awareness inner ear, muscles, joints, tendons]
-Interoceptors[visera + organs]
~Consciousness[awareness]
~Thoughts
~Memory
~Speech |
|
|
Term
|
Definition
| Awareness -> RAS (if stimulated) + Cerebral Cortex (how we interpret what we do about it) |
|
|
Term
| Characteristics of Normal Cognition |
|
Definition
Intelligence [ability to concentrate, comprehend, meaning of stimuli]
Reality perception[aware interpretation of place, situation, and self]
Orientation[knowing who you are, where you are, what time it is]
Judgment[insight=process lots of infor and make a judgement]
Recall and Recognition [moemory,retrieving it, and relate to current situation]
Language[relationships w/ other people, say their thoughts] |
|
|
Term
| Normal Cognitive Patterns |
|
Definition
Attending[focus on a specific stimulit w/ out distraction]
Perceiving[receiving and interpreting sensory stimuli for understanding]
Thinking[sorting, organizing, and catogorizing info to form mental conecpts and perceptions]
Learning[aquiring knowledge that depends on abstract functions such as symbols, language, classifications, and concepts as well as concrete operations]
Remembering
Communicating |
|
|
Term
| Cognition and the older adult |
|
Definition
-Structural changes affect sensory organs
-Slower Processing and Reaction Time
-Decreased ability for rapid problem solving
-Slower voluntary movements
-Pathological Processes
-Polypharmacy
-Normal aging does not affect intelligence |
|
|
Term
| Physiologic Factors affecting… |
|
Definition
~Blood Flow[oxygen to work]
~Nutrition, Fluid and Electrolytes, Metabolism[iron, dehydration]
~Infections
~Degenerative Processes
-Dementia[chronic confussion=gradually gets worse]
=Alzheimers[form of dementia= dee on an MRI large area not functioning, degeneration of neurons]
~Head Trauma |
|
|
Term
|
Definition
Sleep and Rest[REM sleep]
Pharmacologic[medications that alter consciousness]
Environmental[new enviornment, etc]
Culture[meanings of words]
Psychological[self concept if poor =depressed can effect cognition] |
|
|
Term
| Altered Cognitive Function |
|
Definition
~Disorganized Thinking [disturbed thought processes=schizophrenia, bipolar, can't reason w/ them b/c thought process not logical]
~Impaired Though Processes
-Altered Level of Arousal[reactivity to incoming stimuli]
-Altered Attention[inability to focus easily distracted]
-Memory Impairment
~Impaired Communication[Function of altered cognitive function] |
|
|
Term
|
Definition
-Gradually gets worse
-older person no chenge in level of consciousness, disturbed memory, lost, lack of orientation. |
|
|
Term
|
Definition
-Acute confusion
-increased or decreased psychomotor activity.
-Altered sleep, see/hear things not there |
|
|
Term
|
Definition
-Nocturnal delirium
-@ Night time becomes more agitated/confused. |
|
|
Term
|
Definition
-Thought disorder
-Disturbance in reality perception |
|
|
Term
|
Definition
|
|
Term
|
Definition
| -Nursing notes don't just say confused, must say what's occuring, impaired judgement, inappropriate behavior/speach, etc. |
|
|
Term
|
Definition
~Expressive Aphasia
~Receptive Aphasia
~Anomic Aphasia
~Global Aphasia
~Dysarthria |
|
|
Term
|
Definition
| brain problem, limited speach that is slow and halteding with great effort, reduced grammar, and poor articulation |
|
|
Term
|
Definition
-speech that is well articulated and has good melody and normal or slightly faster rate
-inparied auditory comprehension and feedback
-difficulty understanding spoken and writen word. |
|
|
Term
|
Definition
| -word finding problems=milder than expressive aphasia |
|
|
Term
|
Definition
-severe and extensive damage to all language barriers
-can't speak or understand speach, can't read or write.
-some have meaningless recurent sounds as speach. |
|
|
Term
|
Definition
-motor problem, being able to make the sounds.
-physically unable |
|
|
Term
|
Definition
| Language disability caused by brain injury (stroke) |
|
|
Term
| Assessment of Mental Status |
|
Definition
~Level of Consciousness
-Hypervigilant, Alert, Lethargic, Obtunded, Comatose
~Orientation
-person, Place, Time
~Ability to pay attention |
|
|
Term
|
Definition
~Behavior and Appearance [appropriate, bizare]
-Affect[flat affect=doesn't smile, cry, emotionless]
~Language, Memory, Reasoning, Problem Solving
-Verbal, Written and Nonverbal Expression
-Comprehension
~Functional Status[sleep+rest, problem solving, safety awareness] |
|
|
Term
|
Definition
Physical Assessment
Diagnostic Tests and Procedures
Tests of Cognitive Function
Behavioral Observation Scales |
|
|
Term
| Outcome Identification and Planning |
|
Definition
Identify patients at risk for acute confusion
Reverse contributing factors
Provide an environment with appropriate stimulation
Facilitate Communication
Assist with ADL’s
Protect from physical injury |
|
|
Term
|
Definition
~Health Promotion
-Encouraging healthy lifestyles
-Improving Memory
-Identifying patients at risk for acute confusion |
|
|
Term
| Intervention for Impaired Cognitive Function |
|
Definition
Orientation to surroundings
Alternative communication methods
Environmental restrictions
Fluid Intake and Nutrition
Mobility
Safety
Therapeutic communication
Reality orientation
Socialization therapies
Family support |
|
|
Term
| T/F? The cerebral cortex coordinates consciousness, thought, memory, learning, and communication. |
|
Definition
|
|
Term
| T/F? Interoceptors are located in the inner ear, muscles, tendons, and joints. |
|
Definition
|
|
Term
Which of the following is an example of perceiving?
a. The idea of beauty
b. Organizing information in memory
c. Hearing a phone ring
d. Facial expressions |
|
Definition
c. Hearing a phone ring
Rationale: Hearing a phone ring is an example of perceiving, which includes receiving and interpreting sensory stimuli that function as a basis for understanding, knowing, or learning. The idea of beauty is an example of thinking. Organizing information in memory is a process of learning. Facial expressions are a form of communicating. |
|
|
Term
|
Definition
The physiologic process by which information about tissue damage is communicated to the Central Nervous System.
Involves four processes:
-Transduction
-Transmission
-Perception
-Modulation |
|
|
Term
|
Definition
(reception of pain)
~Nociceptors
-Mechanical, Chemical, Thermal
~Neurochemicals/Neurotransmitters
-Bradykinin, Histamine, Prostaglandins
~Two types of peripheral nerve cells:
-A-delta fibers – fast and large (sharp, localized pain/pleasurable skin receptors).
-C fibers – smaller, slow (dull, diffuse, achy, persistent) |
|
|
Term
|
Definition
| From site of transduction to the spinal cord and on to the brain. |
|
|
Term
|
Definition
| -The pain is recognized, defined and responded to by the individual experiencing the pain.[social factors, individual=effect perception of pain] |
|
|
Term
|
Definition
~Changes the perception of pain by inhibiting the pain signal [brain send down signals to inhibit pain from getting to brain] (opiod receptors)
=Endogenous opioids[produced by body]
=Exogenous opioids[administered to person] |
|
|
Term
|
Definition
Acute Pain [signal=potential/actual tissue injury. Diminishes over time. treat underlying cause, give pain medication]
Persistent (chronic) pain [longer than 3-6 months, percists even after healing]
Intractable Pain[nothing is working]
Nociceptive pain[damage of tissue outside CNS, skin, bones, visceral receptors. Aching, deep, throbbing, cramping]
Neuropathic pain [Damage to peripheral of CNS nerves. Phantom pain, tumors on nerves. Tingling, burning, itching] |
|
|
Term
| Factors Affecting Pain Perception and Pain Response |
|
Definition
~Enviornment=light/dark
~Behavioral
~Emotional
~Congnitive
~Physical |
|
|
Term
|
Definition
~Prevalence of chronic pain in elderly ranges from 45% to 80%.
~May falsely believe that pain and suffering come with age.
~May have multiple conditions presenting with vague symptoms.
~May withhold complaints because of fear of the treatment, of a lifestyle change, or of becoming dependent.
~Fear being a burden or “bad patient” if they express pain or that nothing can be done about pain.
~High prevalence of cognitive, sensory-perceptual, and motor problems that infere with a person’s ability to process info and communicate.
~More likely to use words “aching,” “soreness,” or “discomfort.”
~Treatment complicated by increased sensitivity and polypharmacy |
|
|
Term
|
Definition
~Asian and Pacific Islander patients are often reluctant to express their pain because they believe that the pain is God’s will or punishment for past sins.
~Native Americans use massage, heat/cold and herbal remedies for pain relief.
~In Arab cultures, patients are expected to openly express their pain and anticipate immediate relief, preferably through injections or IV.
~Non-Hispanic white adults reported pain more often than adults of other races. |
|
|
Term
|
Definition
| "Pain is whatever the experiencing person says it is, existing whenever and wherever the person says it does………” |
|
|
Term
|
Definition
-On admission
-At rest and during activity
-When patient complains of pain
-Before implementing pain management and 30 to 45 (P.O.) minutes later
-Before and after each potentially painful treatment or procedure
-As the 5th Vital Sign |
|
|
Term
|
Definition
Location
Quality
Intensity, Strength and Severity
Timing: Onset, Duration, Frequency
Aggravating/Relieving Factors
Associated Symptoms[anxiety, fatigue, depression. |
|
|
Term
|
Definition
-Effect on ADL’s
-Meaning of Pain
-Past pain experiences
-Pain relief goals
-Coping resources
-Assess for knowledge deficits, fear of addiction
-Non-verbal signs! |
|
|
Term
|
Definition
Observation
Behavioral Responses
Verbal
Non-verbal
Inspection
Palpation |
|
|
Term
|
Definition
| Increased amount for same effect |
|
|
Term
|
Definition
| Physiologically dependent=>Will withdraw (taper them off) |
|
|
Term
|
Definition
| Psycologically=>Euphoric effect, crave it, despite harm causing them. |
|
|
Term
|
Definition
Used inappropriately
=take too much laxatives, too much tylenol |
|
|
Term
|
Definition
Used inappropriately
=drive after taking sedative |
|
|
Term
|
Definition
|
|
Term
| Multimodal Pain Management |
|
Definition
~Nonopioid analgesics
-Mild to Moderate Nociceptive Pain
~Opioid Analgesics
-Moderate to Severe Pain
~Adjuvant Analgesics
-Enhance the effects of opiates and alleviate symptoms that aggravate pain; also alleviates neuropathic pain
~Adjuvants
-Drugs without analgesic properties
~Non-pharmacological Methods |
|
|
Term
|
Definition
~Tylenol (Acetaminophen): analgesia and antipyretic effects. Toxic to liver in large doses.
~NSAID’s (Non-Steroidal Anti-Inflammatories): broad class of drugs with varying efficacy: interfere with the production of prostaglandin
-aspirin (acetylsalicylic acid or ASA): effective for mild pain, but limited use due to side effects, including gastric upset, platelet dysfunction, bleeding, tinnitis, decreased hearing acuity.
-ibuprofen (Motrin, Advil):. Side effects can be serious and include renal failure, cardiovascular thrombotic events and GI bleed. |
|
|
Term
|
Definition
-Bind with opiates receptor sites to block the pain response.
-Most opioids are Mu Agonists: Morphine, oxycodone,codeine, methadone, Dilaudid (hydromorphone), fentanyl, Demerol (meperidine), methadone
-Oral Opioids are commonly prescribed with a non-opioid analgesic: Tylenol # 3, Vicodin, Percocet or Percodan.
-Antagonist – naloxone (Narcan) |
|
|
Term
| Side Effects of Opioid Analgesics |
|
Definition
-Most common include: constipation, pruritus, orthostatic hypotension, urinary retention, nausea/vomiting, sedation, and respiratory depression.
-Diminishes with continued use except constipation.
-Many side effects are treated with other medications. |
|
|
Term
| Sedation/Respiratory Depression |
|
Definition
-Excessive sedation will precede respiratory depression.
-Patients at risk for respiratory depression include those who are opioid naïve, elderly, have underlying lung disease or are receiving other CNS depressants.
-Always assess the patient for level of alertness and respiratory status before and after administering opioid.
-Reduce dose or administer an opioid agonist such as Naloxone (Narcan) |
|
|
Term
| Principles of Nonpharmacologic Pain Medication |
|
Definition
~Basic Comfort Measures
~Cutaneous Stimulation
-Heat
-Cold
-Massage
-Trancutaneous Electrical Nerve Stimulation (TENS) |
|
|
Term
|
Definition
| rest,ice, compression, elevation |
|
|
Term
| Non-pharmacologic continued |
|
Definition
~Cognitive and Behavioral Strategies
-Distraction
-Breathing and Relaxation
-Imagery
-Biofeedback
~Complementary and Alternative Medicine
-Prayer
-Acupuncture
-Meditation
-Chiropractry |
|
|
