ATI Capstone Study Guides

WBC (Leukocyte) Neutrophil Monocyte Eosinophil Basophil Lymphocyte T lymphocyte B lymphocyte Plasma cell RBC (Erythrocyte) Platelet (Thrombocyte) Fights infection Essential in preventing or limiting bacterial infection via phagocytosis Enters tissue as macrophage; highly phagocytic, especially against fungus; immune surveillance Involved in allergic reactions (neutralizes histamine); digests foreign proteins Contains histamine; integral part of hypersensitivity reactions Integral component of immune system Responsible for cell-mediated immunity; recognizes material as “foreign” (surveillance system) Responsible for humoral immunity; many mature into plasma cells to form antibodies Secretes immunoglobulin (antibody); most mature form of B lymphocyte Carries hemoglobin to provide oxygen to tissues; average lifespan is 120 days Fragment of megakaryocyte; provides basis for coagulation to occur; maintains hemostasis; average lifespan is 10 days Laboratory Findings Type of Anemia CBC Other hypoproliferative (Resulting from Defective RBC Production) Iron deficiency (microcytic) ↓ MCV, ↓ reticulocytes Vitamin B deficiency (megaloblastic) Folate deficiency (megaloblastic) Decreased erythropoietin production (e.g., from chronic kidney disease) ↑ MCV ↑ MCV Cancer/inflammation Normal MCV 12 Normal MCV ↓ Iron, % saturation, ferritin ↑ TIBC ↓ Vitamin B ↓ Folate ↓ Erythropoietin level ↑ Creatinine ↑ Ferritin, % saturation ↓ Iron, TIBC ↓ Erythropoietin level (usually) 12 Bleeding (Resulting in RBC Loss) ↓ Hgb and Hct (Note: Hgb and Hct may be Bleeding from gastrointestinal tract, epistaxis normal if measured soon after (nosebleed), trauma, bleeding from genitourinary tract bleeding starts) (e.g., menorrhagia) ↓ MCV (normal MCV initially) ↑ Reticulocytes Hemolytic (Resulting from RBC Destruction) ↓ MCV Altered erythropoiesis (sickle cell disease, ↑ Reticulocytes thalassemia, other hemoglobinopathies) Fragmented RBCs (various shapes) Hypersplenism (hemolysis) ↑ MCV ↓ Iron, % saturation, ferritin (later) Drug-induced anemia Autoimmune anemia Mechanical heart valve–related anemia ↑ Presence of spherocytes ↑ Presence of spherocytes Fragmented red cells A nurse is providing education to a client with polycystic kidney disease (PKD). What are the four (4) disease management areas to review with this client? High BP is a common complication: It can further damage kidneys and increase risk of heart disease and stroke if untreated, keep BP below 130/88 Have a low salt die Avoid contact sports Take medication as prescribed (ACE inhibitors) Feb 12, 2023 Pharmacology - Drug Endings I have attached several classification to use if you have a medication that you do not remember. It might be a good idea to put these on note cards as well. Drug Classification (Drugs “Endings” and their Classification) – Caine - Local Anesthetics Cillin - Antibiotics Dine - H2 Blockers (Anti-Ulcers) done -Opioid Analgesics ide - Oral Hypoglycemics lam - Anti-Anxiety Agents micin – Antibiotics arrow_back mycin - Antibiotics mide - Diuretics nium - Neuromuscular Blocking Agents olol - Beta Blockers oxacin –Antibiotics pam- Anti-Anxiety Agents pril - ACE Inhibitors sone - Steriods How to use suffixes. If you are unsure of a drug when you see it on an assessment, attempt to put it in a classification. Then remember the facts you know about that classification. If the answer options are medications, identify as many as possible and then return to the question, picking a med because you don't know what it is is not best practice. Remember not all meds follow the Suffix rules example aripiprazole - Abilify – is not a PPI, used for bipolar. 1) Tetracyclines Tetris Cycle Tetracyclines end in the suffix “-cycline.” Indications for these medications include things such as infectious diseases, acne, and periodontal disease. A commonly-tested education point to remember here is that they should not be given with milk, antacids, or iron. Now, moving on to side effects, important things to note are that tetracyclines cause bone deformities and teeth discoloration. For this reason, they shouldn’t be administered to children under the age of eight, or pregnant women. Boom! Easy! 2) Aminoglycosides Amigo Glider Aminoglycosides end in the suffix “-mysin.” Although there are other drugs that end in “-mysin,” you can remember the aminoglycosides by the mnemonic GNATS; standing for gentamicin, neomycin, amikacin (the tricky outlier), tobramycin, and finally, streptomycin. Remember, we love antibiotic mnemonics! Most importantly, these drugs have the potential to have toxic side effects, such as nephrotoxicity and ototoxicity. If a patient who is taking an aminoglycoside is complaining of ringing of the ears, it should clue you in as a red flag. Because of the toxic side effects, it is important to measure peak and trough levels for patients taking these drugs. Woo, got that one down! 3) Macrolides Macaroni Lights Next batter up; macrolides. Macrolides are broad-spectrum antibiotics that end in “-thromysin.” To help you remember the macrolide antibiotics, just remember the acronym “ACE,” for azithromycin, clarithromycin, and erythromycin. Another mnemonic for antibiotics? Sure! These drugs are commonly given for respiratory infections and are often used as an alternative for patients with a penicillin allergy. As a warning here: these drugs can cause dysrhythmias from QT segment prolongation, and they also have an association with C. difficile overgrowth (especially clarithromycin). When these drugs are indicated for an IV infusion, remember that the medication should be diluted and administered slowly to prevent the common problem of thrombophlebitis. 4) Cephalosporins Chef Spore Head Moving on to number four: cephalosporins. Instead of having a common ending, the drugs in this class have a prefix, which is “cef-,” with the exception of cephalexin. The important exam point to remember here is that cephalosporins are the drugs that we give when a patient is allergic to penicillin. Educate the patient to especially avoid alcohol with these drugs, as their concurrent use can induce a state of alcohol intolerance. Easy enough, right? 5) Fluoroquinolones Flower Queen Last but not least, our dear friends, are the fluoroquinolone antibiotics. These drugs end in “-floxacin.” Important commonly-tested teaching points: avoid taking these drugs with milk or antacids. Notably, GI distress is a common side effect of these drugs. Additionally, another commonly tested fact here, although rare, is that fluoroquinolones can cause Achilles tendon rupture. With this in mind, if the patient complains of tendon pain, inflammation or swelling, the medication should be immediately discontinued. s: assess respiratory status, look for rise and fall of the chest, and check the pulse. Ensure a safe environment for possible seizure activity. Establish a large bore peripheral IV access, and administer a 50% glucose bolus over 10 minutes while placing the client on their side. Monitor respiratory status, vital signs, and any seizure activity. When the client awakens, nausea and vomiting are common, so keep them on their side to avoid aspiration. Assess LOC, gag reflex, and swallowing ability. When the patient is AAOx3 and the gag reflex is intact, administer oral carbohydrates/and a meal. Encourage fluid intake. Educate patient on s/s of hypoglycemia, dietary needs for DM management, carry a glucagon pen and wear a medical alert bracelet. Answer Key Glucagon is administered as emergency management for hypoglycemic reactions to increase blood glucose levels by increasing the breakdown of glycogen into glucose. ATI Educator Feedback Make sure you also review what foods would be a good snack if an alert patient had a hypoglycemia occurrence. The 15 Gram rule is always helpful for the nurse. If the blood sugar is low, the nurse should give the patient 15 grams of Carbohydrates and recheck in 15 minutes until it returns to an acceptable range.. Pharmacological and Parenteral Therapies Medications Affecting the Reproductive Tract: Indications for Terazosin Therapy fiber_manual_recordCorrect Question A home health nurse is evaluating the client's knowledge of the medication terazosin. Which statement by the client alerts the nurse the client needs further education on this medication? 1. "I will take my medication at bedtime". 2. "This medication will help my urinary output." 3. "I will get out of bed slowly when waking." 4. "I will take this medication after eating." Your Answer 1. \" I will take my medicine at bedtime.\" The action of terazosin works as an alphaadrenergic antagonist and causes both arterial and venous dilation and is prescribed for hypertension. A main side effect especially with starting terazosin is orthostatic hypotension which can cause dizziness upon sudden movement, especially getting up from a sitting or lying position. Terazosin is also used for BHP and generally, most men with BHP are approximately 60> yrs old which means that already there are age-related changes in gait, balance, and vision. Since the medication helps promote urination and if the male patient takes it at night, he is at risk for falls, due to: 1. Not fully awake, and feeling the urge to go to the bathroom, could quickly get up and get dizzy. 2. Low lighting in a combination of dizziness and confusion could create a slip and fall. The patient would need to be educated about the possible situation as listed above. Answer Key 4: Medication is to be taken at bedtime due to the possibility of dizziness. Pharmacological and Parenteral Therapies Endocrine Disorders: Evaluating Client Understanding of Levothyroxine fiber_manual_recordCorrect chatFeedback Question A nurse has provided education to a client with hypothyroidism who has a new prescription for levothyroxine. What statements by the client would indicate they understand the instructions? Your Answer I will take this medication first thing in the morning at least 30 minutes before breakfast. This medication works best if taken at the same time every day. I'll have to take this medication for the rest of my life and I should not stop taking it abruptly. I'll need frequent lab work done to check my TSH and T4 levels. This medication can cause me to lose weight. I will be mindful and report any chest pain or cardiac changes. This medication can interact with many other medications I may be taking and will need to tell my doctor about any other medications I am taking. This medication will take 6-8 weeks to start to have effects. Answer Key The following client statements indicate understanding of the nurse education concerning their levothyroxine prescription: take the medication daily on an empty stomach 30 to 60 min before breakfast; will verbalize the importance of lifelong replacement (even after improvement of symptoms) and will not to discontinue the medication without checking with the provider; will check with the provider before switching to another brand of levothyroxine; will monitor and report signs of cardiac excitability (angina, chest pain, palpitations, dysrhythmias); and will have T4 and TSH levels drawn as directed by their provider. ATI Educator Feedback Make sure you pay attention to the T4 and TSH. Always remember the brain is smarter than the thyroid, therefore you will see an improvement in the TSH with medication. Pharmacological and Parenteral Therapies Bone Disorders: Identifying Contraindications for Raloxifene fiber_manual_recordCorrect Question A nurse is caring for a client who has a new prescription for raloxifene. What are contraindications for this medication that the nurse should discuss with the client? Your Answer Raloxifene is a selective estrogen receptor modulator, agonist/antagonist. This means that it works like estrogen in helping maintain the bone matrix by helping calcium and phosphorus stay in the trabeculae by depressing osteoclast activity, thus creating less reabsorption of bone. The contraindications for use of Raloxifene are impaired mobility or use before surgery due to the risk of DVT, including long distance traveling. A negative pregnancy test should be obtained before starting treatment because this medication is category X for a fetus. Do not use if any history of thrombosis or clotting disorders. Answer Key Raloxifene is Pregnancy Risk Category X. This medication is contraindicated in clients who have a history of venous thrombosis. The medication should be stopped 3 days before periods in which risk of DVT is high (such as before surgical procedures). Physiological Adaptation Medications Affecting Urinary Output: Findings to Report for a Client Who is Taking Spironolactone fiber_manual_recordCorrect Question The nurse is caring for a client taking spironolactone. Identify the adverse effects of spironolactone and what findings should be reported to the provider. Your Answer Spironolactone is a potassium-sparing diuretic that is an aldosterone antagonist and promotes the excretion of sodium and water and retains potassium. Potassium is a major electrolyte in the regulation of acid-base balance, water and sodium balance, and action potentials in neuromuscular functions. Potassium is also very important in the cardiac cycle and an imbalance can be very serious. Adverse effects are: 1. Gynecomastia ( male breast enlargement.) 2. Hirsutism ( excess facial hair in women and in paradoxical places.) 3. Impotence for males. 4. Irregular menstrual cycle/ changes in baseline cycle. 5. Change in voice ( deeper tone.) 6. Hyperkalemia: heart palpitations, chest pain, SOB, arrhythmia, muscle weakness, weak pulse, tingling of hands and feet, confusion. Answer Key Adverse effects to be reported to provider: Hyperkalemia, Endocrine effects (impotence in males, irregular menstrual cycles in females), drowsiness, metabolic acidosis. Client teaching to avoid these adverse effects: The use of ACE inhibitors increases the risk of hyperkalemia.Teach clients to avoid potassium containing salt substitutes 28.4 Dysrhythmia treatments Medication Bradycardia (any rhythm less than 60/min) Atropine; dopamine or epinephrine infusion if Electrical Management Pacemaker Treat if the client is symptomatic Atrial fibrillation Supraventricular tachycardia Ventricular tachycardia with pulse Ventricular tachycardia without pulse or ventricular fibrillation unresponsive to atropine Amiodarone, adenosine, and verapamil Synchronized cardioversion Amiodarone, lidocaine, and epinephrine Defibrillation