NUR 226 HESI Final Exam Blueprint

Key concepts: to guide your studies

Nursing Process

1. Assessment

2. Analysis (Diagnosing)

3. Planning

4. Implementation

5. Evaluation

Client Needs

1. Safe/Effective Environment

a. Management of Care (RN)

b. Safety & Infection Control

2. Health Promotion & Maintenance

3. Psychosocial Integrity

4. Physiological Integrity

a. Basic care/Comfort

b. Pharmacology & Parenteral Treatment

c. Reduce Risk Potential

d. Physiological Adaptation

Medications: Know action, therapeutic levels where appropriate, adverse reactions, implications,

how to determine if the drug is effective; expected outcome, dietary concerns, when to call the

provider:

Albuterol (Proventil) AND Maxair (pirbuterol) (bronchodilator)

Albuterol = SABA, for acute asthma attack

Hit within 5-10 min

15 min before exercise

Dosed every 4 hours

Direct effect on the lungs allowing for bronchodilation (relaxation)

HR will go up but tell them it’s normal and it will slow down, feeling jittery is normal

Watch out for bronchospasm

Know efficient by seeing decrease serum K+

If 2 puffs needed, make sure 1-3 min in between each puff

Using glucocorticoid inhaler as well → 5-15 min before using inhaler containing steroids

Maxair = LABA

Management of reversible airway disease due to intermittent asthma or COPD quick-relief agent

Onset within 5 min

2 inhalations dosed every 4-6 hours

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Direct effect on the lungs allowing for bronchodilation (relaxation)

Both can cause tachycardia, restlessness, nervousness, jitters, palpitation → can be uncomfortable for

pt but they will go away

Monitor for Paradoxical bronchospasm

Can lead to hyperactivity in children

RINSE MOUTH

Check for cardiac dysrhythmias

Naloxone

Narcan

Opioid Antagonist

IV onset 1-2 min, IM onset 2-5 min, Intranasal onset 8-13 min

Action: prevent the effects of opioid agonists, block opioid activity by blocking mu and kappa receptors

Results/Adverse Reactions: Can result in BP increase, RR increase, N/V/drowsy/tremors

Implications: repeat Q 2-3mins until desired effect

Will need to monitor for recurrence CNS/Resp depression (repeated OD as med wears off), and might

need to re-administer naloxone again later d/t short half-life

Risk of hepatotoxicity

AE: ventricular arrythmias

Hesi Hint: For narcotic-induced respiratory depression, naloxone may be administered as

prescribed by the healthcare provider

Atorvastatin (Lipitor)

● Lipid lowering agent

● Lowers LDL reducing risk of MI, stroke, CAD

● HMG-CoA Reductase Inhibitor (enzyme needed in liver to produce cholesterol); Statin; Anticholesterol

● AE: rhabdomyolysis, angioneurotic edema

● May cause stomach upset

● Preferably taken at night-when sleeping, liver is making cholesterol

● Avoid grapefruit juice, pregnant/breast feeding

● Monitor liver enzymes

● Notify HCP if muscle pain, tenderness, or weakness occurs, especially if accompanied by fever or

malaise (indicative of rhabdomyolysis) (Brown Urine—due to effects on kidneys) [CK levels]

● Dose adjustment may be required

Miotic drops

Pilocarpine (Asorbocarpine) (cholinergic)

-Used in open-angle glaucoma which is unresponsive to other therapy due to the risk of toxicity.

-Mechanism of Action: Activate cholinergic receptors in the eye, causing constriction of the pupil, and

the ciliary muscle.

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-These actions stretch the trabecular meshwork allowing for increased outflow of the aqueous humor and

the lowering of IOP

-Adverse effects-headache, induced myopia, decreased vision in low light

-Applied topically to the eye

(just adding this section too b/c not sure if we should know all of the glaucoma eyedrops)

- increase outflow of aqueous humor

o pilocarpine, cholinergic, PNS effects

o latanoprost, prostaglandin, may change eye color and thicken eyelashes

- decrease aqueous humor production

o timolol, beta-blocker, hypotension, bronchoconstriction (not on lung pt), press down on inner

canthus to prevent systemic absorption (causes PNS effects)

o acetazolamide, carbonic anhydrase inhibitor, cross sensitivity with sulfa

→ also a weak diuretic

Dopaminergic medications

Dopamine agonist (carbidopa/ levodopa - combination drug of the two trade name: Sinemet). For

treatment of Parkinson’s disease. Aim to replace dopamine in CNS. Relief of tremors/ rigidity.

MOA: restores dopamine in extrapyramidial areas of the brain. Levodopa is a precursor to dopamine

-caution in cardiac, psychiatric or ulcer pts. Do not use with MAOI’s.

A/E: depression/anxiety, involuntary movements, drowsiness/ hallucinations/psych problems, orthostatic

hypotension.

Toxicity s/s: Facial grimacing, muscle spasms, behavioral changes.

How to monitor Effectiveness: reduction in movement abnormalities, improved functioning (can they

feed themselves, get dressed, cook, eat, etc.)

-avoid a high protein diet within 2 hours of administration

Slows GI motility

Imitrex (Sumatriptan)

· 5-HT1 agonist; acute migraine, vascular headache suppressants

Vasoconstriction in large intracranial arteries

· Treats severe headaches; migraines; no angina/previous MI/ CAD pt

· Take 2 in 24 hours (60 mins apart)

· AE: coronary artery vasospasm, MI, myocardial ischemia, V-Fib, VT

· Use only during migraine attack; Lay down in dark environment

· May cause drowsiness or dizziness

· Avoid with pregnancy/breastfeeding; alcohol

· Notify HCP prior to next dose if pain / tightness in chest or pain does not subside

Ibuprofen (non-opioid analgesic)

· NSAIDS, inhibits Cox 1 and Cox 2

· Anti-inflammatory; antipyretic; SULFA ALLERGY

· AE: GI bleeding, hepatitis, dermatitis, Steven-Johnson syndrome, epidermal necrolysis

· WITH food; remain upright for 30 mins; avoid alcohol

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· May cause drowsiness or dizziness, most common SE is N/V so hydrate!

· Report abdominal / stomach pain / red-black stools / rash / sore throat

· Assess for rhinitis, asthma, and urticaria (hypersensitivity)

· No more than 2400 mg per day

Contraindicated in pts with ulcers, pregnant pts, pts with kidney damage

Antacids

-These are oldest drugs used to control gastric acidity; can be sodium bicarbonate based (Tums, alka

seltzer) or can be aluminum and/or magnesium hydroxide based (Maalox, Mylanta)

-Generic: Aluminum hydroxide

-MOA: Weak bases that neutralize the acids in stomach

-Tend to affect absorption of most drugs by binding or altering drug solubility ** take 1-2 hours apart

from other drugs

-Take between meals, or at bedtime (works best on empty stomach), take with full glass of water-Need

frequent dosing which is a down-side to these drugs

-Adverse Effects: constipation

-Nursing considerations: hypermagnesium—caution w/renal insufficiency; some antacids may cause

diarrhea

Baclofen

* Therapeutic class: antispasticity agents, skeletal muscle relaxant

* Used to treat muscle spasms, spinal cord injuries, and MS

* Gradually increase dose and decrease dose (titrating)

* Patient teaching: take missed dose within one hour, do not double doses, avoid abrupt withdrawal

(may cause hallucinations, seizures, mental status changes, increased spasticity), discontinue over a 2-

week period

* Don’t consume ETOH or other CNS depressants

* Side Effect: frequent urge to urinate, dysuria, GI symptoms, HA, insomnia, restlessness, confusion,

tinnitus

* Evaluate: improvement in spasticity

Tetracycline (Sumycin)

● Antiinfective, inhibits bacterial protein synthesis

● Used to treat RMSF; H.Pylori; STI; acne

● WITH FOOD

● DO NOT take with calcium / iron (no dairy)

● DO NOT give to pregnant women - risk to fetal bone growth/teeth formation

● Don’t give to child < 8—stains teeth

● Risk of superinfection is high

● Photophobia

● Hepatotoxic if pt has liver disease

● NEVER use outdated pills → causes nephrotoxicity

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