HESI PN PHARMACOLOGY PROCTORED EXAM

HESI PN PHARMACOLOGY PROCTORED EXAM

VERSION 4

Chapter 1: Pharmacokinetics and Routes of Administration

 Absorption  Route of admin affects the rate and amount of absorption

o Oral:

 GI pH and emptying time  Presence of food in the stomach or intestines  Form of meds (liquid/XR)

• Sublingual/buccal

 Quick absorption systemically through highly vascular mucous membranes

• Inhalation via mouth/nose

 Rapid absorption through alveolar capillary networks

• Intradermal, topical

 Slow, gradual absorption

• SQ/IM

 Highly soluble meds have rapid absorption (10-30min), poorly soluble have slower absorption  Blood perfusion at site of injection affect absorption

• IV

 Distribution

 Immediate and complete

• Transportation of meds to sites of action by body fluids 1 / 4

• Plasma binding protein: meds compete for protein binding sites within bloodstream,

primarily albumin. The ability of med to bind to protein can affect how much med will leave and travel to target tissues. Metabolism

• Primarily occurs in the liver but can take place in the kidney

o Factors that influence metabolism:

 Age (infants/older adults require smaller doses)  First pass effect: liver inactivates some meds on first pass through and thus require sublingual or IV route (may need higher dose)

 Excretion:

• Eliminated through the kidneys.
• Kidney dysfunction can result in elevated levels of medications.

 Med Response

• Maintain plasma levels between minimum effective concentration and the toxic

concentration:

 Therapeutic index (TI)

• High TI has a wide safety margin.
• Low TI requires monitoring of serum levels.

o Tough levels: obtain immediately before next dose.

 Half-life:

• Time it takes a medication level to drop in the body by 50%.
• Short vs long half-life: long half-life has greater risk for med accumulation in body.

 Agonist: enhance

 Antagonist: blocks

 Routes of admin:

o Oral/Enteral:

 90 degrees upright  do not mix with large amounts of food  lean chin in to help facilitate swallowing

• Sublingual/buccal

 Keep med in place until completely dissolved

• Transdermal

 Wash skin with soap and water then dry it thoroughly before placing patch. Place patch on hairless area and rotate sites to prevent irritation.

o Drops:

 Place drop in center of sac.  Avoid placing directly on cornea.  If blink repeat process.  Apply gentle pressure with finger and a clean facial tissue on the nasolacrimal duct for 30-60 seconds to prevent systemic absorption.

o Ears:

 Have client lay on unaffected side.  Up and out for adults  Down and back for children

o Inhalation:

 MDI

 Shake vigorously 5-6 times  Take a deep breath and then exhale  Slow deep breath for 3-5 seconds from MDI  Hold breath for 10 seconds after

 DPI 2 / 4

 DO NOT SHAKE DEVICE

 Place mouthpiece between lips and take a deep breath  Hold breath for 5-10 seconds

• NG/Gastrostomy tubes

 To prevent clogging flush tube before and after each med with 15-30ml of warm sterile water.

o Suppositories:

 Left lateral sims position.  Insert beyond internal sphincter  Remain flat or left lateral for 5 min after insertion.

o Intradermal:

 Used for allergy testing  Used for tb testing  Small amount of solution (no more than 0.1ml)  10-15-degree angle bevel up.

o Z-track: for iron

Chapter 2: Safe Med Admin and Error Reduction

 Types of Prescriptions:

o Routine/standard: regularly scheduled meds

o Single/one time: asap or a specific time

o Stat: once and immediately

o PRN: as needed

• Standing: specific circumstances or specific units: ex: heparin protocol

 Taking a phone prescription:

• Have 2

nd nurse on line if possible

• Read-back prescription
• Verify and sign within 24 hours

 Med rec:

• Take place at admission, transfer of clients, and discharge.

 RIGHTS OF SAFE MED ADMIN:

• Right client
• Right med
• Right dose
• Right time
• Right route
• Right documentation
• Right client education
• Right to refuse
• Right assessment
• Right evaluation

 Evaluation

• Report all errors and implement corrective measures immediately

 Complete incident report within time frame the facility specifies (usually 24 hours) and it should include  Client id, name and dose of med, time and place of incident, accurate and objective account of event, who you notified, what actions you took, your signature.  Do not reference or include report in clients medical record  Med errors relate to systems, procedures, product design, or practice patterns.Report all errors to help avoid similar errors in future. 3 / 4

Chapter 3: Dosage Calculation

 1kg=1000mg  1oz=30mL  1L=1000mL

Chapter 4: IV Therapy

 Rapid and precise  Circulatory overload is possible if too large or too rapid of an infusion  Admin can irritate vein  Can lead to sepsis if aseptic technique is broken  Distal veins on nondominant hand first  Write date/time, document size/site/appearance  Flush every 8-12 hours when not in use  Avoid tourniquets in older adults  Hold hand below heart  Change every 72 hours  Change tubing every 24 hours  Changes fluids every 24 hours  Wipe all ports with alcohol before using or inserting a syringe  Complications

o Infiltration:

 Findings: pallor, local swelling at site, decreased skin temp around site, damp dressing

 Treatment: stop infusion and remove catheter, elevate extremity, encourage

active range of motion, apply a cold or warm compress depending on type of solution that infiltrated, check with provider to determine whether the IV is still needed.  Prevention: carefully select site and size of catheter, secure the catheter.

• Extravasation

 Findings: pain, burning, redness, and swelling.

 Treatment: stop infusion, place antidote before removing catheter if there is one, notify provider.

o Hematoma:

 Elevate extremity, use warm compress

o Catheter embolus:

 Missing catheter tip after discontinuation. Place tourniquet high on extremity, surgical removal.

o Phlebitis/thrombophlebitis:

 Red line up the arm with palpable band at vein site

• Cellulitis
• Fluid overload

Chapter 6: Individual Considerations of Medication Administration

 Pediatric doses based on weight or body surface area  Most medications are potentially harmful to the fetus  Pregnancy is a contraindication for live-virus vaccine  Pregnant women should get the inactivated flu vaccination

Chapter 7: Anxiety and trauma- and stressor-related disorders

 Benzodiazepines

• Chlordiazepoxide, alprazolam

 Decrease activity of neurons by enhancing inhibitory effects of GABA

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