Transcript B261_REVIEW QUESTIONS FOR EXAM

B261 Pathophysiology &
Pharmacology
EXAM 4 Review
Charlie
Charlie is a 45 year old man admitted for severe
bacterial pneumonia. He has an IV running and you
have just started a piggyback of Penicillin G
infusing.
Charlie complains of pain and itching at the IV site.
What is the priority nursing action?
First, the nurse should assess the IV site for
patency and to make sure it has not infiltrated.
The Nursing Process
1. ASSESS…ASSESS…ASSESS
2. Determine priority problems.
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ABC’s of CPR
SAFETY… SAFETY…SAFETY
Maslow’s Hierarchy of Basic Needs
Stop the spread of infection
Patient Education
3. Determine outcomes to tell you when the
problem is solved.
4. Determine interventions and implement them
5. Evaluate: Determine if interventions worked
6. Re-assess and make a new plan
Charlie
Charlie’s IV site was infiltrated so you start a
new IV and re-hang the Penicillin infusion. He
puts on his call light and says his chest feels tight
and he is having trouble getting his breath.
What is the priority nursing action?
Stop the infusion due to signs of allergy and
notify the provider.
Charlie
Charlie was allergic to the penicillin so he is put
on Vancomycin IV. While it is infusing, he
pushes his call button to say that he feels dizzy
and is having trouble hearing.
What is now the priority nursing action?
Stop the infusion due to signs of ototoxicity
and notify the provider.
Charlie
Charlie’s pneumonia finally improves and he is
discharged to home with a prescription for
ciprofloxacin (Cipro). What adverse reaction do
you tell him to watch out for?
Pain and swelling in the joints. This is called
arthropathy.
Charlie
Charlie says he understands, and wants to know
if he can stop taking the Cipro when his
coughing clears up.
You advise him to:
Take the medication until its gone. Don’t stop
taking it early unless advised by the provider
due to adverse effects.
Charlie
You note from Charlie’s chart that he has a
history of kidney stones. Since you know that
Cipro can sometimes cause crystals to form in
the urine, you advise Charlie to:
Drink 1 to 2 liters of water daily while taking
this medication.
Charlie
Charlie comes back to the emergency room a
month later and his pneumonia symptoms have
returned. This time a chest x-ray shows a
shadow area of infiltrate and tuberculosis is
suspected but it needs to be confirmed.
What is the most confirmatory test for TB?
A sputum culture
Charlie
While waiting for the suspected TB to be
confirmed, Charlie is admitted to the hospital.
As the charge nurse, you need to decide what
room to place him in.
Because TB is an airborne organism, you choose:
A private room with a negative air-flow system
Charlie
The sputum culture confirms the TB diagnosis.
Charlie is put on Isoniazid (INH) and Rifampin. He
has some questions about these medications
including any precautions he must take and how
long he will be taking them.
You tell him:
You cannot drink alcohol with the INH, you
should not take it if you have liver disease, and
you can expect to take these medications for 6-9
months
Charlie
Charlie is not concerned about the restriction on
alcohol as he doesn’t really drink anyway. He asks
if there is anything else he should know about the
medications.
You tell him two more things:
You will need to have liver enzymes checked
periodically as the INH can be hepatotoxic, and
the Rifampin will probably turn your urine and
tears reddish or orange in color… but this is
harmless!
Charlie
Charlie has been taking his INH and Rifampin
now for 5 months. He comes back for a checkup,
and during your assessment he tells you that he
is fatigued, vaguely nauseated all the time and
his stomach hurts. You notice a sallow cast to his
skin and his eyes look yellow. What is your
assessment?
Charlie has developed a liver inflammation
called hepatitis induced by his medications.
Charlie
Charlie’s provider does liver enzymes and a biopsy
and confirms a diagnosis of Hepatitis A. He stops
the INH and Rifampin and orders a injection of
Interferon alpha-2b weekly as an outpatient.
What side effects do you tell Charlie to expect
from the injection, and how can he manage these
at home?
He will have flu-like symptoms. Schedule the
injection on a Friday and take ibuprofen and
anti-nausea medications PRN over the weekend.
Charlie
Charlie wants to know how he got Hepatitis A
and why everyone taking care of him wears
gloves all the time.
What do you tell him?
Hepatitis A is usually gotten from eating
contaminated food or water. It can be spread
through the feces to other people so its
important that healthcare providers wear gloves
and everyone should practice very good
handwashing before and after care.
Charlie
Finally, after nearly a year, Charlie is testing
negative for tuberculosis in his sputum and his
liver enzymes have returned to normal. He also
tested negative for all bloodborne pathogens,
e.g. Hepatitis B and C, and HIV and the Hepatitis
A titer is negligible. He is given a clean bill of
health and sent home.
Samantha
Samantha is a 22 year old college student who
presents with burning and itching on urination
and a constant need to void. A urine for culture
& sensitivity is obtained, but while waiting for
the results she is put on Bactrim DS as empiric
therapy.
What does this mean?
Empiric therapy is simply prescribing an
antibiotic, usually broad-spectrum, before the
pathogen is identified.
Samantha
In addition to the trimethoprim/sulfamethosazole
(Bactrim DS), the provider also puts Samantha on
phenazopyridine (Pyridium). What do you tell her
about each of these medications?
Bactrim DS should be taken with a full glass of
water and you should drink a lot of fluids
throughout the day.
Pyridium will turn your urine orange to red in color
but this is harmless. It’s not an antibiotic but its an
anesthetic that will help with the burning
sensation.
Samantha
When Samantha’s C&S comes back, the Bactrim
DS is stopped and she is put on azithromycin
(Zithromax). She asks why she can’t just stay on
the initial medication.
You tell her:
The best care is to match the organism in your
urine with the antibiotic that is most selective
for it.
Broad-spectrum antibiotics can increase multidrug resistance!
Samantha
Samantha calls the office about day 3 of taking
Zithromax and says she is a little queasy and is
having diarrhea.
You tell her:
GI upset and diarrhea are pretty common with
antibiotics including Zithromax. I’ll check with
the provider to see if it’s okay to try some overthe-counter medications to stop the diarrhea
like pepto-bismol or immodium.
Samantha
After taking the Zithromax for the prescribed 10days, Samantha notices a white, fuzzy coating
on the inside of her mouth and she has vaginal
itching and a whitish vaginal discharge.
These symptoms point to:
A fungal (yeast) infection
Samantha
Because of the fungal infection, Samantha is
prescribed metronidazole (Flagyl). Your
education should include:
Do not drink alcohol while taking this
medication or for at least 1 day after stopping
it.
Samantha
Samantha is feeling better and both her UTI and
fungal infection seem to be gone. She wants to
get a Flu Vaccine but is concerned that she may
be allergic to it.
You ask her:
Are you allergic to eggs? You should not get the
flu vaccine if you are severely allergic to eggs.
Samantha
Samantha is not allergic to eggs so she gets her
Flu vaccine. You notice on her chart that she only
has had 1 MMR vaccine and she wants to start
nursing school in the spring. Since this is a live
virus vaccine, she asks you if she can take it. You
tell her that the 3 contraindications for taking a
live virus vaccine are:
1. Advanced age (not approved over age 60)
2. Pregnancy
3. Immunocompromised health condition
Joey
Joey is a 15 year old male who comes into the
office with severe acne vulgaris. He is
embarrassed by his acne and nothing else has
helped. His provider puts him on erythromycin
but he has a severe GI upset and diarrhea, so he
is prescribed tetracycline instead.
Joey’s mother asks when he should take it. You
tell her:
He should take this medication on an empty
stomach and definitely not with milk or any
antacids!
Joey
Joey’s family has planned a spring break trip to
Florida. His mother asks if he needs to do
anything special because of his prescription
tetracycline.
You tell her:
This medication can cause photosensitivity and
a rash, so it’s important that Joey wear
sunscreen whenever he is outside.
Joey
After returning from Florida, Joey’s mother calls
the office to report that the family has had a
head lice outbreak. She bought some of the
shampoo, but wants to know how to use it.
You tell her:
You must use it at least twice. Initially, and then
after about 10-days as any eggs remaining
hidden in the hair will be hatching out them.
Joey
At the next office visit, Joey says he is tired of
taking medication and will he have to be on the
tetracycline for the rest of his life?
You tell him that we don’t prescribe tetracycline
long-term because:
Long-term use can cause permanent gray
staining of the enamel of the teeth.
Bertha
Bertha is a 52-year old woman who is admitted
to the hospital for fatigue, whole body pain, and
swelling in her joints. On your admission
assessment, you find evidence of body lice
(scabies) infection. You ask the charge nurse to
place Bertha in what type of room?
A private room
Bertha
Bertha is treated for her scabies, and then she is
diagnosed with a flare-up of her chronic
rheumatoid arthritis. In addition to an NSAID, her
provider puts her on methotrexate. You are
concerned about this prescription because of the
risk of adverse effects that include:
• Bone marrow suppression (red blood cell
anemia)
• Thrombocytopenia (platelet anemia)
• Lymphocyte suppression – white blood cells
Bertha
Even though Berta is age 52, the provider orders
a urine pregnancy test. You know that this is
because:
Methotrexate is a pregnancy category X and
can cause fetal harm
Bertha
Because methotrexate is so toxic to the human
body, you advise Bertha to do what to protect
her kidneys?
Drink lots of water
Bertha
Bertha is discharged to home and she calls the
office to say that she has “picked up a cold” and
wants to take some of the herbal Echinacea
because she has heard it is good for colds.
What do you know about Echinacea and immunity,
and how will this work with the methotrexate and
its affect on immunity?
Echinacea can boost the immune system while
methotrexate is suppressing an immune response.
They may antagonize one another. She should not
take Echinacea.
Bertha
Bertha also mentions that in addition to the
“cold” symptoms, her gums are bleeding a lot
when she brushes her teeth.
You advise her to:
Come into the office for an appointment for a
blood test to check her platelet count and her
white blood cells.
Bertha
Bertha’s lymphocyte count and her platelet
count are low and she feels awful, so the
provider stops the methotrexate. She feels
increasing worse, and is diagnosed with
Influenza. The provider gives her oseltamavir
(Tamiflu). For this medication to be effective, her
flu type must be:
Influenza Type A & B, H5N1 or H1N1
Robert
Robert, a 34 year old man, came to the office
with a sensitive upper left abdomen and an
enlarged spleen. He is diagnosed with an HIV
infection. He claims that he doesn’t know how he
got it, but then he admits to a history of
indiscriminate and unprotected sexual intercourse
with “girls at parties” in his late 20’s.
Which one of the white blood cells are most
affected by HIV?
CD4 receptors on T-lymphocyte cells (or T-cells)
Robert
Robert agrees to begin treatment with
zidovudine (AZT, Retrovir) while waiting to get
insurance for the newer drugs. In doing patient
education, you advise Robert that the most
serious adverse risks he could have is:
Severe blood disorders, like aplastic anemia
from suppressed bone marrow functioning, and
seizures
Robert
Robert does not do well. The HIV proliferates and
his CD4 count drops to 120. He is admitted to the
ICU with a high fever and severe headache, and
he has a seizure. An opportunistic fungal infection
is diagnosed and he is put on IV amphotericin B
(Fungizone).
The provider orders a daily BUN, Creatinine and
glomerular filtration rate (GFR). Why?
Amphotericin B is nephrotoxic and this will help
to identify a problem before it advances too far.
Robert
After several weeks in the hospital, Robert’s
systemic fungal infection clears up and he is able
to return home. He now has several highly
active antiretroviral treatment drugs (HAART)
and his CD4 count comes up to 320 while his HIV
viral titer goes down.
He is referred to the Damien Center in
Indianapolis for follow-up counseling and
medication services.