JohnO-1610-4
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- Endogenous analgesia system -
- Pain suppression system of the CNS involving opiate receptors, ascending and descending pain pathways, enkephalins, dynorphins, and beta-endorphins
- The GOLGI COMPLEX
- stores hormones and other substances produced by the endoplasmic reticulum
- The limbic system borders and interconnects with the thalamus, hypothalamus, basal ganglia, hippocampus, amygdala, and septum
- Define Teaching
- an interactive process that promotes learning. It consists of conscious and deliberate set of actions that helps individuals gain new knowledge or perform new skills
- Symptoms of Withdrawal
-
* Anxiety * Aggressiveness
* Restlessness * Generalized body aches
* Insomnia * Lacrimation
* Rhinorrhea * Perspiration
* Pupil dilation
* Piloerection (goose flesh)
* Anorexia * Nausea
* Vomiting * Diarrhea
* Elevation of body temperature
* Elevation of respiratory rate
* Elevation of systolic blood pressure
* Abdominal and other muscle cramps
* Dehydration * Weight loss - Chronic inflammation may result from recurrent or progressive episodes of acute inflammation or from a low grade, smoldering type of tissue response to persistent irritants
- Metabolism
- after meds reach the site of action it is metabolized (i.e. broken down) - if not being metabolized correctly a build up of meds may cause toxicity
- Role of the nurse in teaching and learning
-
* Answering questions
* Providing information based on your patient's health needs and treatment plans
* Clarifying information - The chief clinical use of opioid antagonists is
- to relieve CNS and respiratory depression induced by therapeutic doses or overdoses of opioids
- Schedule IV
- drugs with some potential for abuse
- The cerebellum, which is connected with motor centers in the cerebral cortex and basal ganglia, coordinates muscular activity
- Define Learning
- the acquisition of new knowledge or skills through reinforced practice and experience
- Opioid analgesics are drugs that relieve moderate to severe pain by
-
* reducing the perception of pain sensation
* producing sedation
* decreasing the emotional upsets often associated with pain - Systemic effects
- are those resulting from absorption into the blood stream and circulated through the body
- Membrane Permeability
-
medications must pass through biological membranes of the organ
- Fat soluble meds pass through the blood brain barrier - Specific neuroendocrine functions include -
-
* producing oxytocin and ADH
* regulating body temperature
* assisting in regulation of arterial blood pressure by its effects on the vasomotor center
* regulating anterior pituitary hormones
* regulating food and water intake by the hypothalamic thirst, appetite, hunger, and satiety centers
* regulating the physical changes associated with emotions - Psychomotor Learning
-
Demonstration
Provides presentation of procedure or skills by nurse
Permits client to incorporate modeling of nurse's behavior
Allows nurse to control questioning during demonstration
Practice
Gives patient opportunity to perform skills using equipment
Provides repetition
Return Demonstration
Permits patient to perform skills while the nurse observes
Excellent source of feedback and reinforcement
Independent Project, Game
Requires teaching method that encourages adaptation and origination of psychomotor learning
Permits learner to use new skills
* learns with motor skills
* integration of mental and motor activity
* attempt to increase confidence - Opioid antagonists reverse or block analgesia, CNS and respiratory depression, and other physiologic effects of opioid agonists
- Prostaglandins =
- found in virtually all body tissues and act in the area where they are produced to regulate many cellular functions before being rapidly inactivated
- In general, the pathogenesis of excessive CNS stimulation may involve one or more of the following mechanisms -
-
1 - Excessive amounts of excitatory neurotransmitters (eg nor epinephrine)
2 - Increased numbers or sensitivity of excitatory receptors.
3 - Insufficient amounts of inhibitory neurotransmitters (eg GABA)
4 - Decreased numbers or sensitivity of inhibitory receptors - Social Services =
- help with depression, getting back into community, etc
- Opioid agonists
- morphine and morphine-like drugs
- Schedule V
- products containing moderate amounts of controlled substances. May be dispensed by a pharmacist without a physician's prescription
- Circulation
- enters bloodstream and carried through tissues and organs
- ST (speech therapy) =
- working on swallowing, cognitive things
- Pain occurs when tissue damage activates the free nerve endings (pain receptors or Nociceptors) or peripheral nerves
- Leukotrienes =
- help regulate cellular responses to injury, including inflammation
- The Thalamus receives impulses carrying sensations such as
- heat, cold, pain, and muscle position sense
- Basic Learning Principles
-
* motivation to learn
- internal impulses
- mental state
- allows learner to focus
* health beliefs
- pt. must be actively involved
* readiness to learn
- accept reality of disease process
- once a pt. has accepted that's the best time to teach
* ability to learn
- teaching must be done at the level of the patient's understanding
- pain levels must be conducive to learning
- body needs must be met in order for pt. to focus on learning
* developmental and physical capability
- does the patient have adequate psychomotor skills? - Factors that influence absorption
-
Route of administration -
- Oral Route (po)
- Sublingual Route (under tongue) (sl or subl)
- Buccal - in mouth (between cheek and gums)
- Parenteral Route - intramuscular (IM), intravenous (IV), subcutaneous (subq)
- Inhalation - breathing in; respiratory therapy
- Intraocular - eyedrops
* Ability of the mediation to dissolve - depends on form of preparation
* Blood flow in and to site of administration
* Body surface area - absorption in small intestine (large surface area)
* Lipid solubility - increased lipids cross cell membrane; absorbed more quickly on empty stomach - Schedule III
- drugs with less potential for abuse than those in Schedules I and II, however abuse may lead to psychological or physical dependence
- The reticular activating system is a network of neurons that extends from the spinal cord through the medulla and pons to the thalamus and hypothalamus
- Disability =
- usually the consequence of an impairment. Described in terms of altered functional ability
- Serum Half Life
- time it takes for excretion to lower the serum med. Concentration by half; this is when half of the med is out of your body. You want to know this in order to give regular fixed doses. You are supposed to give the next dos when the first dose reaches its half life
- WBC (granulocytes)
-
* neutrophils
* eosinophils
* Basophils - - Stimulants
-
Mild stimulation is characterized by wakefulness, mental alertness, and decreased fatigue.
Increasing stimulation produced produces hyperactivity, excessive talking, nervousness, and insomnia.
Excessive stimulation can cause convulsive seizures, cardiac arrhythmias - PT (physical therapy) =
- motor skills
- Sources of Drug Information
-
* Pharmacology text books
* Drug reference books
* PDR (Physician's Desk Reference)
* Drug Handbooks - basophils =
- release histamine, major chemical mediator in inflammatory and immediate hypersensitivity reactions
- The hypothalamus has extensive neurological and endocrine functions
- The hypothalamus is stimulated or inhibited by nerve impulses from different portions of the nervous system and by concentrations of nutrients, electrolytes, water, and hormones in the blood
- Rehab services include
-
PT
OT
ST
nursing
and social services - For a medication to be therapeutically useful, it must
-
- be taken into a patient's body
- absorbed and distributed to cells, tissues, or a specific organ
- and alter a physiological function - neutrophils =
- body's main defense against pathogenic bacteria; major leukocytes in the bloodstream
- Standards (the five rights)
-
Right Medication
Right Dose
Right Patient
Right Route
Right Time
- The cerebral cortex is involved in all conscious processes, such as
- learning, memory, reasoning, verbalization, and voluntary body movements
- Generally, teaching and learning begin when
- a person identifies a need for knowing or acquiring an ability to do something
- Distribution
- every medication has a specific site of action. After absorption it is distributed to tissues and organs and ultimately to its site of action
- Schedule II
- drugs that are medically used and have high abuse potentials
- The medulla oblongata contains groups of neurons that form the vital cardiac, respiratory, and vasomotor center
- OT (occupational therapy) =
- psychomotor skills (cleaning, cooking, etc.)
- Distribution Systems
-
Unit Dose
Multi Dose
Computer Controlled Dispensing Units - Most drugs are given for their systemic effects
- Relatively few drugs act by mechanisms other than combination with receptor sites on cells - these include
-
* Antacids
* Osmotic diuretics
* Drugs that are structurally similar to nutrients required by body cells
* Metal chelating agents - Considerations when doing Group Learning
-
Make sure the environment is adequate.
Be aware of privacy needs.
Examples of when group learning is a POSITIVE - Lamaze classes
- Outpatient
- Parenting classes
- CPR classes
Example of when group learning might be a NEGATIVE -
Things that are individualized - perineal care - Absorption
- message of med molecule into the blood from the site of administration
- Schedule I
- drugs not approved for medical use and have high abuse potentials
-
Drugs affecting the CNS
- Depressants -
- antipsychotics
- narcotic analgesics
- sedative-hypnotics
Mild CNS depression is characterized by lack of interest in surroundings and inability to focus on a topic.
As depression progresses, there is drowsiness or sleep, decreased muscle tone, decreased ability to move, and decreased perception of sensations such as pain, heat, and cold.
- Teaching is most effective when it responds to a learner's needs
- Excretion
- how the drugs exit the body (kidneys, liver, bowels, lungs, and exocrine (sweat) glands; depends on the chemical makeup
- Characteristics of Synthetic drugs
-
* more standardized in their chemical characteristics
* more consistent in their effects
* less likely to produce allergic reactions - The basal ganglia are concerned with skeletal muscle tone and orderly activity
- Affective Learning
-
Role Play
Allows expression of values, feeling, and attitudes
Discussion (Group)
Allows patient to acquire support from others in group
Permits patient to learn from other's experiences
Promotes responding, valuing, and organization
Discussion (one on one)
Allows discussion of personal, sensitive topics of interest or concern.
* use values
* learner receives and responds
* strong sense of values
* values the teacher and what is being said - Medication measurements
-
* metric
* household (i.e. drops, tsp, Tbs, cups)
* solutions - injections, irrigations. Given mass of solid substance dissolved in a known volume of fluid - Chemical Mediators of Inflammation
-
* Prostaglandins
* Leukotrienes - The pyramidal and extrapyramidal systems are pathways out of the cerebral cortex
- Impairment =
-
a loss; abnormality of body structure or structures; alteration in body system or functioning
- temporary or permanent
- interferes with normal activity - Pharmokinetics
- The study of how meds enter the body; reach site of action; are materialized; and exit the body
- eosinophils =
- increase during allergic reactions and parasitic infections
- Glutamate is considered the most important excitatory neurotransmitter in the CNS
- Handicap =
-
disadvantage experienced by a person as a result of impairment and/or disability
- loss of ability to be self-sufficient
- limits/prevents fulfillment of a role - Types of Medication Action
-
* Therapeutic Effects = expected or predictable physiological response to med.
* Side Effects = Predictable unintentional secondary effects. May be harmless; may be severe.
- Side effects are the most common reason people stop taking a drug
* Adverse Effects = Severe response (unpredicted); usually reported to FDA
* Toxic Effects = may develop after prolonged intake of medication because medication has accumulated in the blood
* Idiosyncratic Reactions = Same as adverse effects
* Allergic Reactions = Unpredictable mild or severe (anaphylactic) shock or reaction.
- An anaphylactic shock results in constriction of bronchioles, edema in throat; shortness of breath, wheezing. GIVE IV Benadryl or anti-histamine.
* Medication Interactions = One med may modify or potentiate the action of another med - Guidelines for Effective Study
-
1 - Try to understand how the drug acts in the body.
2 - Concentrate your study efforts on major characteristics.
3 - Compare the drug with a prototype when possible.
4 - Keep an authoritative, up-to-date drug reference readily available, at work and home.
5 - Use your own words when taking notes or writing drug information cards.
6 - Mentally practice applying drug acknowledge in nursing care - Glycine is an inhibitory neurotransmitter found in the brain stem and spinal cord
- Rehab services are TEAM approach
- Nurses role regarding meds
-
1 - knowledge
2 - patient and family education
3 - administration
4 - assessment of client's ability to use medication on their own after discharge
5 - critical thinking skills - Route of Administration
-
* For rapid drug action, IV is most effective
* For many drugs, the IM produces drug action within a few minutes because muscles have a large blood supply.
* Oral route is usually slower than parenteral routes - Protein Binding
- some meds are designed to bind to proteins and some are designed not to bind to proteins
- Definitions/Considerations of Rehabilitation
-
Restoration of person to fullest physical, mental, social, vocational, and economic usefulness as possible.
Idea of rehab is to restore someone to pre-condition so that they may go back to living as before.
Rehabilitation - gets person to highest functioning level they may achieve - Drugs injected IV do not need to be absorbed because
- they are placed directly into the bloodstream
- Define Pharmacology
- study of drugs that alter functions of living organisms
- Using the example of insulin injection with each Domain of Learning
-
Cognitive -
The pt. must understand why the injection is needed; the proper location; and the importance of using sterile technique.
Affective -
Pt. must be willing to overcome fears and distrusts and accept need for injection.
Psychomotor -
Giving themselves injection. - Bladder Training IG (p 131)
-
* Facilitating or triggering techniques
* Intermittent catheterization
* Consistent scheduling of toileting routines
- Therapeutic effects -
- desired responses
- IM starts to work in
- 30 minutes
- Nurses =
- have the opportunity to do all and reinforce what other therapists are teaching
- IV starts to work in
- 10-20 minutes
- Passive diffusion =
- most common. Movement of a drug from an area of higher concentration to an area of lower concentration
- PO starts to work in
- 40-50 minutes
-
Group Learning
"learning occurs when behavior changes as a result of experience or growth" - Epidural starts to work
- immediate
- SC starts to work in
- 60-90 minutes
- Cognitive Learning
-
Discussion -
may involve nurse and client or nurse with several clients.
Promotes active participation and focuses on topics of interest to client.
Allows peer support.
Enhances application and analysis of new information
Lecture
Is more formal method of instruction because it is controlled by teacher.
Helps learner acquire new knowledge and gain comprehension.
Question and answer session
Designed specifically to address patient's concerns
Assists client in applying knowledge
Role Play, Discovery
Allows patient to actively apply knowledge in controlled situation
Promotes synthesis of information and problem solving
Independent Project
Allows patient to assume responsibility for completing learning activities at own pace.
Promotes analysis, synthesis, and evaluation of new information and skills.
* understanding learning
* all intellectual
* acquisition of knowledge
* use abstract ideas for concrete concepts
* evaluation
* analysis
* organized
* synthesis - Drugs injected into subcutaneous or intramuscular tissues are usually absorbed more rapidly than oral drugs because they move directly from the injection site to the bloodstream
- The main disadvantage of the oral route is
- that it is slower and may cause irritation to the GI mucus
- Active transport =
- Drug molecules are moved from an area of lower concentration to one of higher concentration
- Absorption is rapid from IM sites because
- muscle tissue has an abundant blood supply
- The term parenteral refers to
- any route other than GI (enteral), however is commonly used to indicate SC, IM, and IV injections
- The mechanisms of drug movement are
-
* Passive diffusion
* Facilitated diffusion
* Active transport - Facilitated diffusion =
- Drug molecules combine with a carrier substance, such as an enzyme or protein
- The _____ synapse is more commonly used to communicate with other neurons or target cells
- chemical
- Aspartate is an excitatory neurotransmitter found in high concentrations in the brain
- Disadvantages of IV
-
* Time and skill required for venipuncture
* Difficulty of maintaining an IV line
* Greater potential for adverse reactions from rapid drug action
* Possible complications of IV therapy (ie, bleeding, infection, fluid overload) - Adverse effects
- - any undesired responses to drug administration