Student Nurse Laura

Orem – "creative effort of one human being to help another human being."

Archive for December, 2009

Time to Study

Posted by Laura on December 31, 2009

Posted in Day-to-Day, Student Nurse Flo | 2 Comments »

Math Practice

Posted by Laura on December 31, 2009

To see the answer to the question, just hover your mouse over the ANSWER

1. Doctor orders carbamazepine 19 mg/kg/day to be divided into 2 doses. Your patient weighs 55 lbs. You have Carbamazepine of 50 mg on hand. How many mg of carbamazepine do you administer for each dose?

2. Doctor orders ceftibuten 270 mg PO. The nurse has 90 mg/5 mL suspension of ceftibuten available. How many mL of ceftibuten suspension does the nurse administer?

3. You need to know how many gtts/min are infusing by IV. The order was for LR at 85 mL/hr. The tubing factor is 20 gtts/mL.

4.  You need to infuse an IV of 1 L of D5NS over 6 hrs. The drip rate is 16 gtts/min. How many mL an hour do you administer the UV fluids?

5. The med chart says to give azithromycin 2 g PO once a day. You have  unscored tablets of 500 mg each. How many tablets do you give the patient?

These questions were modified from Taylor’s.

Posted in Math, Semester II | Comments Off on Math Practice

Chronic Medications

Posted by Laura on December 30, 2009

Module 1

Insulins: Be able to state onset, peak, duration, and required nursing actions for the following

*        Lispro (Humulog)                                
*        NPH (Humulin, Novolin)   
*        Aspart (Novolog)                               
*        Glargine (Lantus)
*        Regular                                            
*        Ultralente

Be able to state the purpose, action, adverse, side effects, and usual dosages of the following medications:

  • 1st generation sulfonylureas: Chlorpropamide (Diabinese
  • Alpha-Glucosidase Inhibitor:  acarbose(Precose)
  • 2nd generation sulfonylureas: glipizide(Glucatrol)
  • Non-Sulfonylureas:  repaglinide (Prandin), neteglide(Starlix)
  • Biguanides:  Metformin(Glucophage)
  • Thiazolidinediones(glitazones):  Pioglitazone(Actos), rosiglitazone(Avandia)
  • Glucogon 
  •   

    Module 4

    Be able to state the purpose, action, adverse, side effects, and usual dosages of the following medications:

    *           Isoniazid(INH)                                 
    *           Pyrazinamide(Myambutol)
    *           Rifampin(Rifidin)                            
    *           Rifapentine(Priftin)
    *           Rifabutin(Mycobutin)                     
    *           Streptomycin

    Module 5

    •           Solumedrol  
    •            Metaproterenol(Alupent)
    •           Prednisone  
    •           Salmeterol(Serevent Diskus)
    •           Montelukast(Singular)       
    •           Ipratropium bromide(Atrovent)
    •           Zafirlukast(Accolate)          
    •          Aminophylline(Phyllocontin)
    •           Zileuton(Zyflo)         
    •           Theophylline(Sloe-bid, Theo-Dur)
    •           Albuterol(Proventil, Ventolin, Volmax)   
    •          Advair Comb. (salmeterol/fluticasone)

    Module 6

             Pentoxifylline (Trental)      
            Warfarin (Coumadin)
             Clopidogrel (Plavix)
             Heparin
             Aspirin          
             Enoxaparin (Lovenox)
            Protamine Sulfate  
             Aquamephyton (Vit. K)
             Dipyridamole (Persantine, Aggranox)

    Module 7

    Thiazide diuretic Alpha blocker
    Hydrochlorothiazide Doxazosin
    Loop diuretic Prazosin
    Furosemide Terazosin
    Bumetanide Combined alpha and beta blocker
    Potassium sparing diuretic Carvedilol
    Spironolactone Labetalol
    Central alpha agonist Vasodilator
    Methyldopa Hydralizine
    Clonidine Minoxidil
    Beta blocker Angiotensin Conversion Enzyme-Inhibitor
    Atenolol Benazepril
    Propranolol Captopril
    Metoprolol Enalapril
    Nadolol Fosinopril
    Calcium Channel Blockers Lisinopril
    Amlodipine Ramipril
    Felodipine Angiotensin Receptor Blocker
    Nifedipine Irbesartan
    Nisoldipine Losartan
    Diltiaziem Olmesatrtan
    Verapamil Valsartan
       

     

    Module 9

    Statins Nicotinic Acid
    • Lovastatin
    • Niacin
    • Prevastatin
     
      Fibric acids
    • Simvastatin
    • Fenofibrate
    • Fluvastatin
     
      Bile acid sequestrants
    • Atorvastatin calcium
    • Cholestramine
    • Rosuvastatin
     
      Cardiac Glycosides
    Nitrates Lanoxin (Digoxin)
    • Ntiroglycerin,
    Digitalis
    • Isorbidinitrate
    Digibind (antagonist)

     

    Module 10

    Alkylating agents Hormonal agents
    Busulfan, carboplatin, chlorambucil, cisplatin, cyclophosphamide, dacarbazine, hexamethyl melamine, ifosfamide, melphalan, nitrogen mustard, oxaliplatin, thiotepa Androgens and anti-androgens, estrogens and anti-estrogens, progestins and anti-progestins, aromatase inhibitors, luteinizing hormone, steroids
    Nitrosureas Antimetbolites
    Carmustine, lomustine, semustine, streptozocin 5-Azacytadine, capecitabine, cytararbine, edatrexate fludarabine, 5-fluorouracil, hydroxyurea, methotrexate, pentostatin
    Mitotic spindle poisons Antitumor antibiotics
    Plant alkoloids: vinblastine, vincristine, Bleomycin, doxorubicin, mitomycin, mitoxantrone
    Misc: Asparaginase   
       

     

    Module 11

    • Benadryl       
    • Epinephrine             
    • Corticosteroids
    • Acetaminophen      
    • Furosemide 

     

    Module 12
              Folic acid      
              Prednisone
              Arginine        
              Decadron
              Hydrea-hydroxyurea          
             Imuran
             Ibuprophen (NSAID)          
              Heparin
              Neupogen    
              Enoxaparin
              Epogen         
              Cytoxan
              Warfarin

    Posted in Day-to-Day, Drugs, NS 122 - Med/Surg, Semester II | Tagged: | Comments Off on Chronic Medications

    Words

    Posted by Laura on December 29, 2009

    New Words:

    Oxytocic

    1 pertaining to a substance that is similar to the hormone oxytocin.

    2 any one of numerous drugs that stimulates the smooth muscle of the uterus to contract. The administration of an oxytocic can initiate and enhance rhythmic uterine contraction at any time, but relatively high doses are required for such responses in early pregnancy. Oxytocic agents commonly used include oxytocin, certain prostaglandins, and the ergot alkaloids. These drugs are used to induce or augment labor at term, control postpartum hemorrhage, correct postpartum uterine atony, produce uterine contractions after cesarean section or other uterine surgery, and induce therapeutic abortion. These drugs are used with extreme caution in parturients with severe hypotension and hypertension, partial placenta previa, cephalopelvic disproportion, or grand multiparity. The risk of using these agents is much higher in mothers who have undergone recent uterine surgery or who have suffered recent sepsis or trauma. The most serious adverse reaction is sustained tetanic contraction of the uterus, resulting in fetal hypoxia or rupture of the uterus. (Mosby’s Medical Dictionary, 8th edition. © 2009, Elsevier.)

     
    Ergotism 
     
     1 an acute or chronic disease caused by excessive dosages of medications containing ergot. Symptoms may include cerebrospinal manifestations such as spasms, cramps, and dry gangrene.
    2 a chronic disease caused by ingestion of cereal products made with rye flour contaminated by ergot fungus.
    (Mosby’s Medical Dictionary, 8th edition. © 2009, Elsevier)
    3 Davis – (signs include cold, numb figers and toes, chest pain, nausea, vomiting, headache, muscle pain,weakness)

    Posted in Day-to-Day, Semester II | Comments Off on Words

    Beers List

    Posted by Laura on December 29, 2009

    The Beers list, sometimes referred to as the Beers criteria, was developed by a group of 12 clinicians with expertise in geriatrics and led by Dr. Mark Beers (Editor in-Chief of Merck Manual).  First released in 1991, the Beers List was initially created to help clinicians determine which medications should be avoided in nursing home patients since seniors in nursing homes are particularly at risk for suffering medication-related problems.  Since then, the Beers List has been updated twice with the latest revision released in 2003.  The list has been broadened to encompass potentially inappropriate medications for the senior population regardless of where they reside or receive care.  In addition, the list has been divided into two primary groups: a list of medications considered potentially inappropriate independent of diseases/conditions, and a list of medications considered potentially inappropriate when used in seniors with certain diseases or conditions. The medications listed will link to Medline Plus by the US National Library of Medicine (NLM).

                                  Beers List  (Beers Criteria)

    A I
    alprazolam (Xanax) indomethacin (Indocin, Indocin SR)
    amiodarone (Cordarone) isoxsuprine (Vasodilan)
    amitriptyline (Elavil) K
    amphetamines ketorolac (Toradol)
    anorexic agents L
    B lorazepam (Ativan)
    barbiturates M
    belladonna alkaloids (Donnatal) meperidine (Demerol)
    bisacodyl (Dulcolax) meprobamate (Miltown, Equanil)
    C mesoridazine (Serintil)
    carisoprodol (Soma) metaxalone (Skelaxin)
    cascara sagrada methocarbamol (Robaxin)
    chlordiazepoxide (Librium, Mitran) methyldopa (Aldomet)
    chlordiazepoxide-amitriptyline (Limbitrol) methyldopa-hydrochlorothiazide (Aldoril)
    chlorpheniramine (Chlor-Trimeton) methyltestosterone (Android, Virilon, Testrad)
    chlorpropamide (Diabinese) mineral oil
    chlorzoxazone (Paraflex) N
    cimetidine (Tagamet) naproxen (Naprosyn, Avaprox, Aleve)
    clidinium-chlordiazepoxide (Librax) Neoloid
    clonidine (Catapres) nifedipine (Procardia, Adalat)
    clorazepate (Tranxene) nitrofurantoin (Microdantin)
    cyclandelate (Cyclospasmol) O
    cyclobenzaprine (Flexeril) orphenadrine (Norflex)
    cyproheptadine (Periactin) oxaprozin (Daypro)
    D oxazepam (Serax)
    dessicated thyroid oxybutynin (Ditropan)
    dexchlorpheniramine (Polaramine) P
    diazepam (Valium) pentazocine (Talwin)
    dicyclomine (Bentyl) perphenazine-amitriptyline (Triavil)
    digoxin (Lanoxin) piroxicam (Feldene)
    diphenhydramine (Benadryl) promethazine (Phenergan)
    dipyridamole (Persantine) propantheline (Pro-Banthine)
    disopyramide (Norpace, Norpace CR) propoxyphene (Darvon) and combination products
    doxazosin (Cardura) Q
    doxepin (Sinequan) quazepam (Doral)
    E R
    ergot mesyloids (Hydergine) reserpine (Serpalan, Serpasil)
    estrogens T
    ethacrynic acid (Edecrin) temazepam (Restoril)
    F thioridazine (Mellaril)
    ferrous sulfate (iron) ticlopidine (Ticlid)
    fluoxetine (Prozac) triazolam (Halcion)
    flurazepam (Dalmane) trimethobenzamide (Tigan)
    G tripelennamine
    guanadrel (Hylorel)  
    guanethidine (Ismelin)  
    H  
    halazepam (Paxipam)  
    hydroxyzine (Vistaril, Atarax)  
    hyoscyamine (Levsin, Levsinex)  

    Posted in Drugs, Semester II | Tagged: , | Comments Off on Beers List

    5 Pregnancy Category Ratings – A, B, C, D, X

    Posted by Laura on December 27, 2009

    According to the US Department of Health and Human Services, the FDA created pregnancy letter categories to help explain what is known about using medicine during pregnancy. This system assigns letter categories to all prescription medicines. The letter category is listed in the label of a prescription medicine. The label states whether studies were done in pregnant women or pregnant animals and if so, what happened.

    Over-the-counter (OTC) medicines do not have a pregnancy letter category. Some OTC medicines were prescription medicines first and used to have a letter category.

    OTC Medicines

    All OTC medicines have a Drug Facts label. The Drug Facts label is arranged the same way on all OTC medicines. This makes information about using the medicine easier to find. One section of the Drug Facts label is for pregnant women. With OTC medicines, the label usually tells a pregnant woman to speak with her doctor before using the medicine. Some OTC medicines are known to cause certain problems in pregnancy. The labels for these medicines give pregnant women facts about why and when they should not use the medicine. Here are some examples:

    • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil®, Motrin®), naproxen (Aleve®), and aspirin (acetylsalicylate), can cause serious blood flow problems in the baby if used during the last third of pregnancy (after 28 weeks). Also, aspirin may increase the chance for bleeding problems in the mother and the baby during pregnancy or at delivery.
    • The labels for nicotine therapy drugs, like the nicotine patch and lozenge, remind women that smoking can harm an unborn child. While the medicine is thought to be safer than smoking, the risks of the medicine are not fully known. Pregnant smokers are told to try quitting without the medicine first.

    Prescription Medicines

    The FDA chooses a medicine’s letter category based on what is known about the medicine when used in pregnant women and animals.

    Definition of Medicine Catogories
    Pregnancy Category Definition Examples of Drugs
    A In human studies, pregnant women used the medicine and their babies did not have any problems related to using the medicine.
    • Folic acid
    • Levothyroxine (thyroid hormone medicine)
    B In humans, there are no good studies. But in animal studies, pregnant animals received the medicine, and the babies did not show any problems related to the medicine.OrIn animal studies, pregnant animals received the medicine, and some babies had problems. But in human studies, pregnant women used the medicine and their babies did not have any problems related to using the medicine.
    • Some antibiotics like amoxicillin.
    • Zofran® (ondansetron) for nausea
    • Glucophage® (metformin) for diabetes
    • Some insulins used to treat diabetes such as regular and NPH insulin.
    • AVC OB Meds: Ampicillin, Ancef, Benadryl
    C In humans, there are no good studies. In animals, pregnant animals treated with the medicine had some babies with problems. However, sometimes the medicine may still help the human mothers and babies more than it might harm.OrNo animal studies have been done, and there are no good studies in pregnant women.
    • Diflucan® (fluconazole) for yeast infections
    • Ventolin® (albuterol) for asthma
    • Zoloft® (sertraline) and Prozac® (fluoxetine) for depression
    • AVC OB Meds: Demerol, Gentamycin, Darvocet-N, Vicodin, Morphine,
    D Studies in humans and other reports show that when pregnant women use the medicine, some babies are born with problems related to the medicine. However, in some serious situations, the medicine may still help the mother and the baby more than it might harm.
    • Paxil® (paroxetine) for depression
    • Lithium for bipolar disorder
    • Dilantin® (phenytoin) for epileptic seizures
    • Some cancer chemotherapy
    X Studies or reports in humans or animals show that mothers using the medicine during pregnancy may have babies with problems related to the medicine. There are no situations where the medicine can help the mother or baby enough to make the risk of problems worth it. These medicines should never be used by pregnant women.

    Posted in Drugs, NS 121 - OB, Semester II | Tagged: | Comments Off on 5 Pregnancy Category Ratings – A, B, C, D, X

    Certified Nursing Assistant

    Posted by Laura on December 27, 2009

    Being a Student Nurse, you can apply and test to be a Certified Nursing Assistant (CNA). 

    This is what I have learned about the testing for the CNA in California.

    For California, if you are presently in an RN program, you will not have to take further training and qualify to take the competency exam for an equivalency-trained nurse assistant. You must submit an original copy of your transcript of training (or a student nurses can substitute the transcript with a letter on official school letterhead listing equivalent training in at least “fundamentals of nursing”).

    Submit transcript or letter, along with fingerprints using live scan (available at the college), completed application form, and a $15 application fee.

    Cost of the exam is $90-105. Information of what is involved can be found in this brochure by California’s National Nurse Aide Assessment Program.

    This exam can be taken over the summer after the first year of student nursing. The exam is a written test of 70 questions and a skills performance test. 24 Skills have critical steps that must be completed to pass. Some of he skills tested include hand washing, applying knee-high elastic stockings, ambulate using transfer belt, cleans upper or lower dentures, counts and records radial pulse and respirations, and feeds client who cannot feed self. The whole list is in the brochure.

    Posted in Day-to-Day, Semester II | Tagged: , , , | Comments Off on Certified Nursing Assistant

    iPod touch Applications for Nursing

    Posted by Laura on December 26, 2009

    Applications  

      

    Nursing Central has:

    Davis Drug Guide     

    Davis’s Lab and Diagnostic Tests  

    Disease and Disorders  

    Medline Journals    

    Taber’s  

    And Favorites  This I can see using with each patient, I will just save the med or lab as a favorite and can refer back to it. Or I can save all my common OB meds to favorites….

    Posted in Semester II | Tagged: , , , , | 8 Comments »

    Second Semester

    Posted by Laura on December 16, 2009

    During the break before 2nd semester I am reading the book Essentials of Nursing Leadership and Management for Professional 120, and I am also reading Novice to Expert: Excellence and Power in Clinical Nursing Practice, as recommended by Mrs Beatty.

    I’m OB for the first 8 weeks, then Med Surg.

    OB Med List  To be reviewed, OB math, Postpartum Normals and Abnormals, and Assessments.

    OB Math

    I also changed up the bog theme a little… 🙂

    Posted in NS 121 - OB, Semester II | 4 Comments »

    Cultural Diversity Video

    Posted by Laura on December 11, 2009

     

    Posted in Day-to-Day, NS111 - Fundamentals | 2 Comments »

    Osmolality

    Posted by Laura on December 10, 2009

    Posted in Concepts, NS111 - Fundamentals | Comments Off on Osmolality

    Metabolic by Electrolytes

    Posted by Laura on December 10, 2009

    You can tell if a person has Metabolic Acidosis by using the Anion Gap.

    The Anion Gap is a difference between the cations and anions. The anion gap indicator # you look at is > 20 mEq for Metabolic Acidosis. Cations are the positive ions in the serum. Anions will are the negatives. Na and K (sodium, potassium) are positive (cations). Cl and HCO3 (chloride and bicarbonate) are negatives (anions).

    So here’s the math:

    Now the Question is –

    Is metabolic acidosis present (anion gap > 20 mEq/L) ?

    Answer – Yes, metabolic acidosis is present with an anion gap of 24.

    Posted in Concepts, NS111 - Fundamentals | Comments Off on Metabolic by Electrolytes

    Affecting Fluids and Electrolytes

    Posted by Laura on December 8, 2009

    Fluid and Electrolytes

    Hormones regulating water retention and loss

    ADH (anti-diuretic hormone) * regulates WATER excretion from the kidneys.  As serum osmolality rises (>300), it stimulates osmoreceptors that stimulate thirst to ↑ H2O intake & stimulate ADH release to allow more water reabsorption in the kidney causing dilution of body fluids.  

    1. water only, urine will be dark, scant, amber-colored, 
    2. alcohol consumption turns ADH off and you are dehydrated the next day
    3. ADH & Aldosterone activate in ↓ BP

    ADH keeps water from being loss through urination.

    Aldosterone * Renin-Angiotensin System * regulates electrolyte balance from the kidneys by promoting Na+ & water retention and K+ loss

    1. with low blood volume such as internal bleeding or cut arm, kidneys kick in to reabsorb water
    2. this system works with salt to counteract effects of low blood volume & low BP to try to increase BP (water & salt reabsorbed)

    Aldosterone, Renin-Angiotensin System keeps water and sodium  from being loss through urination, though Potasium is loss.

    ANP (atrial natriuretic peptide) * cardiac hormone found in atria & released when atria are stretched by increasing blood volume or BP (CHF) works to lower BP/volume through vasodilation & suppression of RAS (rennin-angiotensin system)

    ANP  is a marker found through testing, signifying CHF. ANP tries to lower BP/Volume that ADH and ARAS creates.

     

    Posted in Day-to-Day, NS111 - Fundamentals | Comments Off on Affecting Fluids and Electrolytes

    Respiratory or Metabolic Acidosis or Alkalosis?

    Posted by Laura on December 8, 2009

     This is the way I see it.

    pH  norm = 7.4  +/-  0.05

    PaCO2 norm = 40  +/-  5

    HCO3 norm = 24  +/-  2

     

    • If your pH is low and your PaCO2 is high (inverse) you have RESPIRATORYacidosis.  
    • If your pH is high and your PaCO2 is low (inverse) you have RESPIRATORY alkalosis
    • If your pH is low and your HCO3 is low, (and your PaCO2 is normal or low) you have Metabolic acidosis
    • If your pH is high and your HCO3 is high, (and your PaCO2 is normal or high) you have Metabolic alkalosis

    Posted in Concepts, NS111 - Fundamentals | Comments Off on Respiratory or Metabolic Acidosis or Alkalosis?

    Daily 5 – Say What?

    Posted by Laura on December 6, 2009

    Starting Monday I will do a Daily 5, well… maybe starting today. My study schedule is pretty much in the order of the modules we have 1-14 (minus the last 4 tested on), so the questions will come from these areas. If you find this helpful, you must add questions of your own. Please put them in the comments so everyone can try them!

    Questions & Answers

    Set 1 Questions  Set 1 Answers 

    Set 2 Questions  Set 2 Answers

    Set 3 Questions   Set 3 Answers

    Set 4 Questions   Set 4 Answers

    Set 5 Questions   Set 5 Answers

    Bonus

    Drug Questions   Drug Answers

    Posted in Day-to-Day, NS111 - Fundamentals | 2 Comments »

    Pot Luck Images!

    Posted by Laura on December 4, 2009

       

    And The Winner Is……..

    Yea Lisa!

     Fund Raising is Great!!!!

    Posted in Images | Comments Off on Pot Luck Images!