Trach
Psych Meds
Route to be given
All Lithum
Med/Surg
Anything/Everything
Side effects
Nursing Interventions
100
Before suctioning, what should you assess on the patient?
Auscultate breath sounds and Respiratory Distress
100
What is the purpose of prescribing Typical Antipsychotic medications?
Block dopamine receptor D2è↓dopamine concentration
Treat the Positive Symptoms of schizophrenia: Hallucination & Delusion, & Bizarre Behavior
100
What medcations can be given transdermal?
Selegiline (MAOI) and Asenapine (Antipsychotic)
100
What is the therapeutic range for Lithium?
0.6 to 1.2 mEq/L
100
A nurse is preparing to insert an intravenous (IV) catheter into a client's arm. At which angle relative to the client's skin should the catheter be inserted?
10- to 15-degree angle
100
The nurse has assessed a client with a tracheostomy and decided that suctioning is needed. Which action will the nurse implement to help prevent complications?
Limit suctioning passes to no more than three per episode.
100
What are the side effects of the Typical Antipsychotics?
100
What are the nursing interventions for Typical Antipsychotics?
-Instruct the client the medication will take time to work
-Instruct clients to change positions slowly
-Advise the client to avoid alcohol.
-Monitor for S/S of extrapyramidal effects, Dystonia, Akathisia, TD
-Start with the lowest dosage possible then increase increments
-Use the AIMS test to screen for the presence of EPS.
-Chewing sugarless gum; Wearing sunglasses when outdoors
-Monitor for S/S of Neuroleptic malignant syndrome
200
What position should the patient be placed into during suctioning?
-Semi/high fowlers position, unless contraindicated (unstable spine fractures, pelvic fracture)
-Laying the person on their side
200
What are the classifications for Antidepressant Medications?
SSRI Selective serotonin reuptake inhibitors (Fluoxetine, Paroxetine, Sertraline, Citalopram)
SNRI Serotonin norepinephrine Reuptake Inhibitors (Venlafaxine, Duloxetine)
NDRI Norepinephrine Dopamine reuptake Inhibitors (NDRI) (Bupropion, Bupropion/dextromethorphan)
MAOI Monoamine Oxidase inhibitors (Phenelzine, selegiline, Isocarboxazid, Tranylcypromine)
TCA Tricyclic Antidepressant (Amitriptyline, imipramine, Nortriptyline, Doxepin, Mirtazapine
200
True or False
Antidepressant medications are given PO and Injection?
False.
Antidepressant medications (all classifications) are given PO, transdermal (Selegiline), or intranasal (esketamine)
*see Boyd's chapter 12 table 3
200
The drug class for lithium is Mood Stabilizer, what is the indication?
Treat and prevention of manic episodes in bipolar affective disorder
200
When hanging a new bag of IV fluid for a client, which action does the nurse perform first?
Close the roller clamp on the tubing
200
You walk into a client's room and he/she does not respond to you. What should you do first?
Assess the client.
200
What are some side effects for SSRI medicaitons?
Headache, dizziness; Insomnia, anxiety; dry mouth; GI upset; Weight gain
200
What are the nursing interventions for Atypical Antipsychotics?
·Monitor body weight
·Monitor glucose level
·Instruct the client to report signs and symptoms
·Advise the client to follow a healthy lifestyle
·Monitor cholesterol level
·Monitor WBC
·Instruct clients to change positions slowly
·Educate clients about measures to relieve dry mouth, such as sipping fluids or hard candy
300
When should suctioning be preformed?
Should only be performed when indicated; not routinely.
Suctioning Needed When:
-Weak cough – The person is unable to cough up the secretions themselves
-Visible or audible secretions
-Tachypnea (fast respirations)
300
List the Atypical Antipsychotics
Aripiprazole (Abilify), Olanzapine (Zyprexa), Quetiapine (Seroquel), clozapine (Clorazil), Risperidone (Risperdal), Paliperidone (Invega), Ziprasidone (Geodon), Lurasidone (Latuda)
300
Which Typical antipsychotic medications are given PO?
*name at least 3*
Chlorpromazine, Haloperidol, Fluphenazine, Trifluoperazine,Thiothixene, nonphenothiazine, pimozide
300
Plasma Level is <1.5 mEq/L
What are the mild signs of toxicity?
Metallic taste, fine tremor, nausea, vomiting, polyuria, diarrhea, fatigue, weight gain, edema, memory impairments
300
How would you waste medication?
•Follow your facility policy
•Facilities will have some sort of policy about wasting within the hour
•Always draw up any narcotic and squirt it out in the appropriate receptacle
•You will need to waste in the pyxis/omnicell with another RN
•You may return narcotics that have not been opened -There is a receptacle on the side of the pyxis; It requires two RNS
300
Which client is most likely to need the administration of pain medication before being suctioned via the tracheostomy?
client who had abdominal surgery
300
What are the side effects of Atypical Antipsychotics?
-Agranulocytosis
-Increase blood sugar
-Weight gain
-Hypercholesterolemia
-Orthostatic hypotension
-Anticholinergic effects: Urinary retention, dry mouth, agitation, dizziness, sedation, weight gain, and sleep disruption
-Mild EPS
-Tremor
300
What are the nursing interventions for SSRI medications?
Suicide precautions; Takes 4 weeks for full effect; Monitor weight; Good mouth care, use of mouth guard, do not take it with MAOI, take as ordered, do not stop/discontinue use abruptly and take it as ordered, Watch for S/S of medication.
400
What pressure whould you use for suctioning?
100-150 mmHg is the acceptable suction pressure for an adult
400
What are the reasons a Atypical Antipsychotic medication would be prescribed?
Block serotonin, dopamine, and norepinephrine receptors.
To treat both Positive and Negative symptoms of schizophrenia
400
Which Atypical antipsychotic medications are given IM?
*name at least 2*
Aripiprazole (Abilify), Risperidone (Risperdal), Olanzapine (Zyprexa), Ziprasidone (Geodon), Paliperidone (Invego)
400
Plasma levels 1.5-2.5 mEq/L
What are the moderate signs of toxicity?
Dry mouth, nausea, vomiting, ataxia, dizziness, vertigo, slurred speech, tinnitus, blurred vision, increasing tremors, muscle irritability or twitching
400
What is the nurse's role in the medication verification process?
*hint* how would you obtain the medications the patient is taking and what would you check before the patient discharging
- Medication list: obtaining current med list from outpatient/external pharmacy system, call the outpatient pharmacy, call the skilled nursing facility, chart the dose, route, and frequency, last date/time taken
-Pharmacy: documenting the person's pharmacy (part of the admission process), ensuring the prescriptions when discharges are sent electronically by the physician to the pharmacy, taking into consideration the time of day of the patient is discharged (is it a 24 hour pharmacy)
400
What is the action for SNRI medications?
↑serotonin and ↑norepinephrine in the brain by blocking the reabsorption (reuptake) of serotonin & norepinephrine
400
What are some side effects for MAOI's?
Orthostatic hypotension, edema, dizziness, headache, drowsiness, and sleep disturbance
400
What is the nursing intervention for TCA's?
•Administer at bedtime to minimize the sedative effect
•Take 2-6 wks to achieve therapeutic effects
•Instruct to avoid alcohol
•Evaluate suicidal risk
500
The nurse is inserting the suction catheter into a client's tracheostomy and suddenly meets resistance. Which action would be most appropriate?
Withdraw the catheter at least 0.5 in (1.25 cm)
500
List the names of the Typical Antipsychotics
Chlorpromazine, Haloperidol, Fluphenazine, Trifluoperazine, Pimozide, Loxapine
500
What medications can be given IV?
Valproic acid (Depakote), Lorazepam (Ativan)
500
Plasma level > 2.5 mEq/L
What are the severe signs of toxicity?
Cardiac arrhythmias, blackouts, nystagmus, confusion, coarse tremors, fasciculations, hallucinations, oliguria, renal failure, cardiovascular collapse, seizures, coma, and death
500
Name 2 High risk medications
Insulin, Heparin
500
The nurse is preparing to suction the tracheostomy of a client. The nurse would place which client in the lateral position, facing the nurse?
unconscious client, after abdominal surgery
500
What are some side effects for SNRI's?
nausea, insomnia, weight gain, diaphoresis, GI distress, drowsiness, dizziness, & headache
500
What are some of the nursing interventions for Lithium?
-Avoid alcohol and other CNS depressant drugs.
-Do not abruptly discontinue use.
-In acute phase: serum levels x2 per week.
-For maintenance: serum levels every 2 to 3 months
600
Place in order, from first to last, the actions the nurse will perform when preparing to suction an alert client via tracheostomy using an open system.
1)Explain the procedure to the client.
2)Adjust the bed and position the client.
3)Adjust the wall suction to the appropriate level.
4)Open sterile packages and set up a sterile field.
5)Don sterile gloves.
6)Auscultate the client’s lung sounds for evaluation of the intervention.
600
What are the names of medications for mood stabilizers
Lithium salt or Lithium Carbonate; Valproate, Carbamazepine, lamotrigine
*Valproate acid (Depakote), Carbamazepine (Tegretol), lamotrigine (Lamictal) are anticonvulsants medications
600
How is Lithium given?
PO (capsules/tablet/tablet ER)
600
What are specific patient and family education for lithium?
- Avoid alcohol and other CNS depressant drugs
-Notify your prescriber if pregnancy is possible or planned. Do not breastfeed while taking this medication
-Notify your prescriber before taking any other prescriptions, OTC medications, or herbal supplements
-May impair judgement, thinking, or motor skills; avoid driving or other hazardous tasks
-Do not abruptly discontinue use
600
What is the process to get a medication list for a patient?
●Look up in outpatient/external pharmacy system
●Call their outpatient pharmacy
●Call the skilled nursing facility
●Chart dose, route, and frequency
●Last Date and Time taken (compliance)
600
When should medication be wasted?
Immediately upon/after administering the dose of medication.
600
What are some side effects for TCA medications?
Orthostatic hypotension, edema, dizziness, headache, drowsiness, sleep disturbance, palpitations, tachycardia, ↑ appetite, diaphoresis
600
What is the nursing interventions for MAOI's?
•Restriction on food rich in tyramine as Aged cheese, pepperoni, salami
•Should not given to cardiac condition
•Contraindicated or Do not use in pregnancy
700
When preparing to suction a client's tracheostomy, which action by the nurse best helps to prevent the introduction of microorganisms into the respiratory tract?
using only the dominant hand to handle and manipulate the catheter
700
what is the generic name for Cymbalta?
duloxetine
700
Which Typical antipsychotic medications are given IM?
Fluphenazine (Prolixin), Haloperidol (Haldol)
700
What is the mechanism of action for lithium?
influences the reuptake of neurotransmitters;
alters sodium transport in nerve and muscle cells
↑ Serotonin; ↓ dopamine and norepinephrine
700
The nurse has just flushed a peripheral venous access site and notices fluid leaking from the insertion site. Which action is most appropriate?
Remove the IV catheter and restart the venous access site in a new location
700
The nurse observes and palpates a client's veins to determine a suitable site for initiating peripheral venous access. If the nurse cannot palpate a vein, which action would be most appropriate?
Massage the client's arm from proximal to distal end.
700
What is the reversal medication for benzodiazepine?
Flumazenil
700
Nurse is assessing a patient who recently began taking Haldol. Which is the highest priority?
Neck spasms
800
What can result if you use high pressure for suctioning?
Hypoxia, tissue trauma & atelectasis
800
What generation is Typical Antipsychotics?
First Generation
800
What medications can be given sublingually (SL)?
Asenapine (antipsychotic/antidepressant); lorazepam (anxiolytics)
800
True or False
Lithium is the first line of treatment for Bipolar Disorder
True
800
Why would Metoclopramide (Reglan) be ordered?
Nausea or Gastroparsis
800
What is Aricept prescribed for and what is the mechanism of action?
Dementia; increases the action of acetylcholine
800
With which antidepressant medications should you avoid foods containing tyramine?
Monoamine oxidase inhibitors (MAOI'S)
800
Chewing motions and lip smacking are cues of what adverse drug reaction?
Tardive Dyskinesia