NUR 125 Exam 2 with Accurate
Solutions
Total Parenteral Nutrition - ANS-A method of providing nutrients to the body by an IV
route. The nutrients are a complete admixture containing proteins, carbohydrates, fats,
electrolytes, vitamins, trace minerals and sterile water in a single container.
Goals:
- To improve nutritional status
- To establish a positive nitrogen balance
- To maintain muscle mass
- To promote weight maintenance/gain
- To enhance the healing process
When highly concentrated dextrose is given, caloric requirements are satisfied and the
body uses amino acids for protein synthesis rather than for energy. Electrolytes such as
calcium, phosphorous, magnesium and sodium chloride are added to the solution to
maintain proper electrolyte balance.
Implanted Port - ANS-Port is compromised of a small reservoir covered by a thick
septum
Insertion location: port is surgically implanted into chest wall pocket. The catheter is
inserted into the subclavian vein with the tip in the superior vena cava.
Indications: long term (1 year or more) need for vascular access; commonly used for
chemotherapy
Only specifically trained personell wearing a mask & aseptic technique should access
implanted ports.
- Apply a topical anesthetic cream to skin if indicated. Palpate skin to locate the port
body septum to ensure proper insertion of the needle.
- Access with a noncoring (huber) needle
- Check for a blood return prior to medication administration to confirm patency and
placement
- Flush with 5 mL heparin 100 units / mL after every use and atleast once per month
NG Tube - ANS-Plastic tube that goes through the nose into the belly. Short term use
only.
NG Tube may be put in to:
- give nutrients or drugs to pts who cannot swallow
- Remove liquids or air from belly
- Rest bowel after surgery
- Control bleeding in stomach or in the tube from the mouth to the stomach
Check tube for the correct placement
- Check pH of stomach contents. Use a syringe to draw back a small amount of fluid
from the tube. Place a drop of the fluid on a special pH test strip to check the pH of the
,stomach contents. If the pH is between 0 and 5.5 it safe to give a feeding or drug. If it is
higher than 5.5 call your Dr. before you give everything.
Give Feedings
- Attach a large syringe and pull back on plunger. You may see some greenish fluid that
helps break down your food. THis is normal. You may also see some of your last
feeding. This is called the residual. Your residual may be less than 3 ounces (90 mL) or
even up to 10 ounces (300 mL). Ask your doctor how much residual is OK for you to
have and to still give your feeding.
First, give back the residual. Then give your feeding.
- Feeding pump - attach the feeding pump to your NG tube and turn the feeding on to
the right rate.
- Bolus feeding - use a syringe and pour the feeding into the syringe. The feeding will
flow in by gravity. Your feeding should take about 45 min to finish.
- After your feeding is finished, flush your NG tube with 30 cc of water.
Blood Transfusion Reaction - ANS-Febrile Reaction
- Chills, Fever, Headache, Flushing, Tachycardia, Increased Anxiety
Allergic Reaction
-Mild: Hives, Pruritis, Facial Flushing
- Severe: Severe SOB, bronchospasm, anxiety
Hemolytic Reaction
- Low Back Pain, Hypotension, Tachycardia, Fever & Chills, Chest Pain, Tachypnea,
Hemoglobinuria, May have immediate onset
Nursing Implications
- Stop transfusion and notify physician
- Change IV tubing
- Treat sx if present - O2, fluids, epinephrine as ordered
- Recheck crossmatch record w. unit
- Evaluate serum calcium levels
- Monitor fluid/electrolyte balance
- Obtain first UA test for hemoglobinuria
- Obtain 2 blood samples distal to infusion site
Blood Administration - ANS-Determine clients: allergies, previous transfusion reactions,
administer within 30 min of receiving from blood bank, never add any meds to blood
product
Key Points
- Verify clients ID
- Check Dr, Order
- 18-20 gauge needle
- Check labels on blood bag and blood bank transfusion record
- Normal saline IV solution (isotonic)
- Blood administration set with filter - 25-30 mL rate for first 15 min
- Severe reactions most likely first 15 min & first 50 cc
- should take no more than 2 hours (125 mL / hour, 250 mL bag)
- No longer than 4 hours !
,Do NOT warm unless risk of hypothermic response THEN only by specific blood
warming equipment
- Check crossmatch record with 2 nurses: ABO - group, Rh type, clients name, Hospital
#, expiration date
PCA - ANS-A medication delivery system that allows clients to self-administer safe
doses of opioids
- Small, frequent dosing ensures consistent plasma levels
- Clients have less lag time between identified need & delivery of medication, which
increases their sense of control and can decrease the amount of medication they need
- Morphine and hydromorphone are typical opioids for PCA delivery
- Clients should let the nurse know if using the pump does not control the pain
- To prevent inadvertent overdosing, the client is the only person who should push the
PCA button
- Safety lockout mechanism on the PCA prevents pt from using too much medication
Leukotriene Modifiers - ANS-Meds that block the effect of leukotrienes or stop your
body from producing them
These drugs are used to prevent or lessen sx of;
allergies
allergic asthma
exercise-induced asthma
Examples: Montelukast, Zileuton, Zafirlukast
Can help you; breathe more easily, exercise, keep airway open, lessen mucuous in
chest & throat, reduce # and severity of rx attacks
Can cause SE: Cold symptoms, ear infection, flu like sx (fever), nausea, diarrhea, ear
infection, fatigue, tiredness, stomach pain, itchy skin or rash
Fluticasone - ANS-Anti-asthmatics, Corticosteroids
Treatment of pts with asthma not adequately controlled on a long term asthma control
medication such as inhaled corticosteroid or whose disease warrants initiation of tx eith
both ICS and LABA.
* Maintenance therapy for airflow obstruction in patients with COPD; to reduce
exacerbations of COPD in pts with a history of exacerbations.
Fluticasone is a synthetic corticosteroid with potent anti-inflammatory activity.
Salmeterol, an LABA relaxes bronchial smooth muscle and inhibits release of mediators
Drug Intercations;
Beta blockers, loop/thiazide diuretics, MAO inhibitors
Side Effects
CNS: headache, tremors, pain
CV: palpitations
EENT: pharyngitis, blood in nasal mucosa, congestion
GI: abdominal pain, constipation, diarrhea, etc.
, Enoxaparin - ANS-LOVENOX
Anticoagulants, low molecular weight heparins
* To prevent PE and DVT after hip or knee replacement surgery
To prevent PE and DVT after abdominal surgery
To Prevent PE and DVT in pts with acute illness who are at a high risk because of
decreased mobility
To prevent ischemic complications of unstable angina and non Q wave MI with oral
aspirin therapy and can be given IV or sub-cut
Adverse
CNS: confusion, fever, pain
CV: edema, peripheral edema
GI: NAusea, diarrhea
Hematologic: thrombocytopenia, hemmorhage,
Resp: dyspnea
Drug-drug
anticoagulants, antiplatelet drugs, NSAIDS. May increase risk of bleeding. SSRIs may
increase risk of bleeding
Accelerates formation of antithrombin 111 - thrombin complex and deactivates
thrombin, preventing conversion of fibrinogen to fibrin. Drug has a higher antifactor - Xa
- to antifactor II A activity ratio than heparin.
Outpatient tx of acute DVT without PE when given with warfarin sodium
Vitamin k - ANS-Warfarin can be reversed by vitamin k injjections (only effective
antidote for long term management)
Action: promote the hepatic biosynthesis of Vitamin k - dependent clotting factors.
Prevention & treatment of hypoprothrombinemia, which may be associated w/
excessible doses of oral anticoags
Therapeutic Use - used to treat Vitamin K deficiency and to treat certain bleeding or
blood clotting problems caused by other meds/medical conditions
Admin - injection into skin or IM
Adverse effects: pain, swelling or soreness at injection site may occur
Foods high in vitamin K; green leafy vegetables such as kale, collard greens, broccoli,
spinach, cabbage & lettuce
also kiwi, blackberries, blueberries
More vitamin k = blood clots
Less vitamin k = dangerous bleeding
Protamine Sulfate - ANS-Indications; heparin overdose, administered IV
Action
- Forms a physiologically inert complex with heparin sodium
When given to reverse heparin administered during surgical procedures, base dose on
coagulation studies, and repeat PTT 15 min after administration
Solutions
Total Parenteral Nutrition - ANS-A method of providing nutrients to the body by an IV
route. The nutrients are a complete admixture containing proteins, carbohydrates, fats,
electrolytes, vitamins, trace minerals and sterile water in a single container.
Goals:
- To improve nutritional status
- To establish a positive nitrogen balance
- To maintain muscle mass
- To promote weight maintenance/gain
- To enhance the healing process
When highly concentrated dextrose is given, caloric requirements are satisfied and the
body uses amino acids for protein synthesis rather than for energy. Electrolytes such as
calcium, phosphorous, magnesium and sodium chloride are added to the solution to
maintain proper electrolyte balance.
Implanted Port - ANS-Port is compromised of a small reservoir covered by a thick
septum
Insertion location: port is surgically implanted into chest wall pocket. The catheter is
inserted into the subclavian vein with the tip in the superior vena cava.
Indications: long term (1 year or more) need for vascular access; commonly used for
chemotherapy
Only specifically trained personell wearing a mask & aseptic technique should access
implanted ports.
- Apply a topical anesthetic cream to skin if indicated. Palpate skin to locate the port
body septum to ensure proper insertion of the needle.
- Access with a noncoring (huber) needle
- Check for a blood return prior to medication administration to confirm patency and
placement
- Flush with 5 mL heparin 100 units / mL after every use and atleast once per month
NG Tube - ANS-Plastic tube that goes through the nose into the belly. Short term use
only.
NG Tube may be put in to:
- give nutrients or drugs to pts who cannot swallow
- Remove liquids or air from belly
- Rest bowel after surgery
- Control bleeding in stomach or in the tube from the mouth to the stomach
Check tube for the correct placement
- Check pH of stomach contents. Use a syringe to draw back a small amount of fluid
from the tube. Place a drop of the fluid on a special pH test strip to check the pH of the
,stomach contents. If the pH is between 0 and 5.5 it safe to give a feeding or drug. If it is
higher than 5.5 call your Dr. before you give everything.
Give Feedings
- Attach a large syringe and pull back on plunger. You may see some greenish fluid that
helps break down your food. THis is normal. You may also see some of your last
feeding. This is called the residual. Your residual may be less than 3 ounces (90 mL) or
even up to 10 ounces (300 mL). Ask your doctor how much residual is OK for you to
have and to still give your feeding.
First, give back the residual. Then give your feeding.
- Feeding pump - attach the feeding pump to your NG tube and turn the feeding on to
the right rate.
- Bolus feeding - use a syringe and pour the feeding into the syringe. The feeding will
flow in by gravity. Your feeding should take about 45 min to finish.
- After your feeding is finished, flush your NG tube with 30 cc of water.
Blood Transfusion Reaction - ANS-Febrile Reaction
- Chills, Fever, Headache, Flushing, Tachycardia, Increased Anxiety
Allergic Reaction
-Mild: Hives, Pruritis, Facial Flushing
- Severe: Severe SOB, bronchospasm, anxiety
Hemolytic Reaction
- Low Back Pain, Hypotension, Tachycardia, Fever & Chills, Chest Pain, Tachypnea,
Hemoglobinuria, May have immediate onset
Nursing Implications
- Stop transfusion and notify physician
- Change IV tubing
- Treat sx if present - O2, fluids, epinephrine as ordered
- Recheck crossmatch record w. unit
- Evaluate serum calcium levels
- Monitor fluid/electrolyte balance
- Obtain first UA test for hemoglobinuria
- Obtain 2 blood samples distal to infusion site
Blood Administration - ANS-Determine clients: allergies, previous transfusion reactions,
administer within 30 min of receiving from blood bank, never add any meds to blood
product
Key Points
- Verify clients ID
- Check Dr, Order
- 18-20 gauge needle
- Check labels on blood bag and blood bank transfusion record
- Normal saline IV solution (isotonic)
- Blood administration set with filter - 25-30 mL rate for first 15 min
- Severe reactions most likely first 15 min & first 50 cc
- should take no more than 2 hours (125 mL / hour, 250 mL bag)
- No longer than 4 hours !
,Do NOT warm unless risk of hypothermic response THEN only by specific blood
warming equipment
- Check crossmatch record with 2 nurses: ABO - group, Rh type, clients name, Hospital
#, expiration date
PCA - ANS-A medication delivery system that allows clients to self-administer safe
doses of opioids
- Small, frequent dosing ensures consistent plasma levels
- Clients have less lag time between identified need & delivery of medication, which
increases their sense of control and can decrease the amount of medication they need
- Morphine and hydromorphone are typical opioids for PCA delivery
- Clients should let the nurse know if using the pump does not control the pain
- To prevent inadvertent overdosing, the client is the only person who should push the
PCA button
- Safety lockout mechanism on the PCA prevents pt from using too much medication
Leukotriene Modifiers - ANS-Meds that block the effect of leukotrienes or stop your
body from producing them
These drugs are used to prevent or lessen sx of;
allergies
allergic asthma
exercise-induced asthma
Examples: Montelukast, Zileuton, Zafirlukast
Can help you; breathe more easily, exercise, keep airway open, lessen mucuous in
chest & throat, reduce # and severity of rx attacks
Can cause SE: Cold symptoms, ear infection, flu like sx (fever), nausea, diarrhea, ear
infection, fatigue, tiredness, stomach pain, itchy skin or rash
Fluticasone - ANS-Anti-asthmatics, Corticosteroids
Treatment of pts with asthma not adequately controlled on a long term asthma control
medication such as inhaled corticosteroid or whose disease warrants initiation of tx eith
both ICS and LABA.
* Maintenance therapy for airflow obstruction in patients with COPD; to reduce
exacerbations of COPD in pts with a history of exacerbations.
Fluticasone is a synthetic corticosteroid with potent anti-inflammatory activity.
Salmeterol, an LABA relaxes bronchial smooth muscle and inhibits release of mediators
Drug Intercations;
Beta blockers, loop/thiazide diuretics, MAO inhibitors
Side Effects
CNS: headache, tremors, pain
CV: palpitations
EENT: pharyngitis, blood in nasal mucosa, congestion
GI: abdominal pain, constipation, diarrhea, etc.
, Enoxaparin - ANS-LOVENOX
Anticoagulants, low molecular weight heparins
* To prevent PE and DVT after hip or knee replacement surgery
To prevent PE and DVT after abdominal surgery
To Prevent PE and DVT in pts with acute illness who are at a high risk because of
decreased mobility
To prevent ischemic complications of unstable angina and non Q wave MI with oral
aspirin therapy and can be given IV or sub-cut
Adverse
CNS: confusion, fever, pain
CV: edema, peripheral edema
GI: NAusea, diarrhea
Hematologic: thrombocytopenia, hemmorhage,
Resp: dyspnea
Drug-drug
anticoagulants, antiplatelet drugs, NSAIDS. May increase risk of bleeding. SSRIs may
increase risk of bleeding
Accelerates formation of antithrombin 111 - thrombin complex and deactivates
thrombin, preventing conversion of fibrinogen to fibrin. Drug has a higher antifactor - Xa
- to antifactor II A activity ratio than heparin.
Outpatient tx of acute DVT without PE when given with warfarin sodium
Vitamin k - ANS-Warfarin can be reversed by vitamin k injjections (only effective
antidote for long term management)
Action: promote the hepatic biosynthesis of Vitamin k - dependent clotting factors.
Prevention & treatment of hypoprothrombinemia, which may be associated w/
excessible doses of oral anticoags
Therapeutic Use - used to treat Vitamin K deficiency and to treat certain bleeding or
blood clotting problems caused by other meds/medical conditions
Admin - injection into skin or IM
Adverse effects: pain, swelling or soreness at injection site may occur
Foods high in vitamin K; green leafy vegetables such as kale, collard greens, broccoli,
spinach, cabbage & lettuce
also kiwi, blackberries, blueberries
More vitamin k = blood clots
Less vitamin k = dangerous bleeding
Protamine Sulfate - ANS-Indications; heparin overdose, administered IV
Action
- Forms a physiologically inert complex with heparin sodium
When given to reverse heparin administered during surgical procedures, base dose on
coagulation studies, and repeat PTT 15 min after administration
