Pharmacology Test 1 Study Guide
Ch 1
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Understand the significance of the Nursing Process as a whole, as well as its significance in
pharmacology
Understand how to apply Nursing Process to pharmacology
Know the proper chronological order of a Nursing Process
Review examples for each step of the Nursing Process
1) Concept:
o Concepts focus on the patient-centered model of care instead of disease-centered model of
healthcare
o Concepts are related to the patient’s problems, the medications, or topics of care listed within
the nursing process
2) Assessment
o Nurse gathers information from the patient about the patient’s health and lifestyle.
o Paramount because the nurse will use the information gathered to form the basis of the
patients plan of care, which includes drug administration
o Encourages the patient’s success with the prescribed medication regimen
o Objective data:
 What the nurse directly observes about the patient’s health status
 Collecting patient’s information by using personal sense such as: seeing, hearing,
smelling, and touch
o Subjective data- verbal information provided by the patient, family, friends, or other sources.
3) Patient Problem (replaces diagnosis)
o The type of care the patient will receive
o The nurse formulates the patient’s problem, which guides the development of the plan of care
to provide patient-centered quality care
 Focuses on the individual patient’s care as related to actual problem derived from the
patient’s illness and not the actual disease process
4) Planning
o Goals are patient centered, describe a specific activity, and include a time frame for
achievement and reevaluation
o Developing patient centered goals and outcomes; collaboration with the patient and/or family
is necessary
 • The expected change is realistic, measurable, and includes reasonable deadlines.
 • The goal is acceptable to both the patient and nurse.
 • The goal is dependent on the patient’s decision making ability.
 • The goal is shared with other health care providers, including family or caregivers.
 • The goal identifies components for evaluation.
5) Implementation (nursing intervention)
o Nursing process in which the nurse provides education, drug administration, patient care, and
other interventions necessary to assist the patient in accomplishing the established medication
goals.
6) Evaluation
o Nurse determines whether the goals and teaching objectives have been meeting.
o Continues to use ongoing assessment data to evaluate the successful attainment of the
patient’s objectives and goals
 If goals are not met, revision of the objective, goals, and interventions
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Ch 2
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If the goals are met, documentation of the successful attainment in the nursing plan of
care
Identify the three core ethical principles.
Understand the definitions and examples within each of the core ethical principals
o 1) Respect for persons
 Autonomy
 In healthcare settings, health care personnel must respect the patient’s right to make
decision in their own best interest, even if the decision is not what the healthcare
personnel want, or think is best for the patient
 Informed consent
 It is a mutual sharing of information, a process of communication
 It expresses respect for the person
 It gains the patient’s active involvement in their care
 It respects the patient’s right to self-determination
o 2) Beneficence: is the duty to protect research subjects from harm
 Ensures the risks and possible benefits from participating in a research study are clearly
defined and ensuring the benefits are greater than the risk
o 3) Justice: requires that the selection of research subjects be fair
 Research must be conducted so that the distribution of benefits and burdens is
equitable (i.e., research subjects reflect all social classes and racial and ethnic groups)
Understand how informed consent and risk-benefit ratio is derived from the core ethical principles.
o Informed consent: has its roots in the 1947 Nuremberg Code
 The right to be informed and that participation is voluntary, without coercion
o Risk-Benefit Ratio: All possible consequences of a clinical study must be analyzed and balanced
against the inherent risks and the anticipated benefits
Describe the objectives of each phase of human clinical experimentation.
o Phase 1): Researchers test a new drug or treatment in a small group of people for the first time
to evalute its safety, determine a safe dosage range, and identify side effects. (20-100 health
individuals)
o Phase 2): The drug or treatment is given to a larger group of people to see if it is effective and
to further evaluate its safety. (100-300 people)
o Phase 3): The drug or treatment is given to larger groups of people to confirm its effectiveness,
monitor side effects, compare it with commonly used treatments, and collect information that
will allow the drug or treatment to be used safely (1000-5000 participants)
o Phase 4): Studies are done after the drug or treatment has been marketed to gather
inforamtion on the drug’s effects in various populations and to assess any side effects
associated with long-term use.
Understand the concept and purpose of controlled schedules for drugs.
o Based on their abuse potential and acceptable medical use practices
o Controlled substances are categorized in 5 schedules 1-5
 1 being not approved for medical use and having high abuse potential
 5 having acceptable medical use and decreasing potential for abuse leading to
psychological and/or physiological dependence
Differentiate between chemical, generic, and brand names of drugs, and the importance of each.
o Chemical name: describes the drugs chemical structure.
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Ch 3
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o Generic name: is the official, nonproprietary name for the drug
 This name is not owned by and drug company and is universally accepted
 Nearly 80% of all prescription drugs are ordered by their generic name
o Brand (Trade) Name: The Proprietary name, chosen by the drug company and is usually a
registered trademark
Understand the meaning of “over the counter” drugs.
o OTC drugs have been found to be safe and appropriate for use without the direct supervision of
a healthcare provider.
o Available for purchase without a prescription
Differentiate the two major phases of drug action.
o Pharmacokinetics: The process of drug movement throughout the body necessary to achieve
drug action
o Pharmacodynamics: The study of the effects of drugs on the body
Identify and describe the four processes of pharmacokinetics.
o Drug Absorption: the movement of the drug into the bloodstream after administration
 PO = enteral: first pass effect via the liver
 Parenteral drugs do not pass through the GI tract
 No first pass effect/first pass metabolism
o Increase in Bioavailability
o Drug Distribution: the movement of the drug from the circulation to body tissues
 Influenced by vascular permeability and permeability of cell membranes, regional blood
flow and pH, cardiac output, tissue perfusion, the ability of the drug to bind tissues and
plasma proteins, and the drugs lipid solubility
o Drug Metabolism/Biotransformation: the process by which the body chemically changes drugs
into a form that can be excreted in the form of metabolites
 Liver: primary site of drug metabolism
o Drug Excretion: elimination of drugs from the body
 Kidneys are the main route of drug excretion
 Free drugs, water soluble drugs, drugs that are unchanged
 It is important for nurses to know their patient’s kidney function to ensure correct and
sage drug dosage.
Understand the influence of protein binding and free drug on drug bioavailability.
o Protein binding: drug bound to protein cannot produce a therapeutic effect
 Increase affinity = increase bindingdecreased Bioavailability
o Free drugs: not bound to proteinincrease bioavailability
Understand the significance of the Blood Brain Barrier (BBB)
o BBB: Blood vessel in the brain that have special endothelial lining where the cells are pressed
tightly together (tight junctions)
 Protects the brain from foreign substances
 Roughly 98% of the drugs on the market
 Only Highly lipid soluble and low molecular weight drugs, free drugs, drugs that
target transport proteins are able to cross the BBB
Review the definition of prodrug, half-life, steady state, and loading dose, and its importance in
pharmacotherapy.
o Prodrugs: a compound that is metabolized into an active pharmacologic substance.
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Ch 4
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Improve drug bioavailability, improve pharmacokinetics (absorption, distribution,
metabolism, or excretion), decrease toxicity, or target a specific site of action
o Half-Life: the time it takes for the quantity
o of drug in the body to be reduced by half
 Dosage, amount of drug remaining from previous doses, metabolism, and elimination
affect the half life of a drug
o Steady State: the amount of drug being administered is the same as the amount of drug being
eliminated
 A steady state of drug concentration is necessary to achieve optimal therapeutic benefit
o Loading dose: Giving a large initial dose, loading dose, which is significantly higher than
maintenance dosing, therapeutic effects can be obtained while a stead state is reached
 After the loading dose is reached, small maintenance doses begin to maintain the drugs
concentration at a steady state (therapeutic window) when given repeatedly at
consistent doses and intervals.
Review potential unique responses to drugs based on biologic variations.
Differentiate the four types of drug interactions.
o Drug-Drug: an altered or modified action or effect of a drug because of interaction with one or
multiple drugs
o Drug-Nutrient (food, supplements, alcohol): Food may increase, decrease, or delay the body’s
pharmacokinetic response to drugs
o Drug-Disease
o Drug-Laboratory: drugs often interfere with clinical laboratory testing by cross-reaction with
antibodies, interference with enzymes reactions, or alteration of chemical reactions
 Lead to misinterpretation or invalidation of test results, resulting in additional
healthcare cost associated with unnecessary repeat laboratory testing or additional
testing
 Missed or erroneous clinical diagnosis
Explain the three mechanisms involved with drug-drug interactions.
o Additive effect: when two drugs are administered in combination, and the response is
increased beyond what either could produce alone
 The sum of the effects of the two drugs
 Can be desirable or undesirable
o Synergistic effect: clinical effect of the two drugs given together is substantially greater than
that of either drug alone
o Antagonistic effect: 1 drug reduces or blocks the effect of the other drug
Describe the nursing implications of pharmacokinetics and pharmacodynamics.
Review the list of terminology related to pharmacogenetics.
o Pharmacogenetics- The study of variability in drug response due to heredity.
o Pharmacogenomics- The study of the combination of pharmacology and genomics to develop
effective and safe medications to compensate for genetic differences in patients that cause
varied responses to a single therapeutic regimen.
o Allele-One of two or more versions of a gene; an individual inherits two alleles for each gene,
one from each parent; if the two alleles are the same (e.g., CYP2C19∗1/∗1), the individual is
homozygous for that gene; if the alleles are different (e.g., CYP2C19∗1/∗2), the individual is
heterozygous.
o Extensive metabolizers- Have an ordinary response to drugs.
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o Gene- A region of DNA containing genetic information. Is the basic physical and functional unit
of heredity.
o Genome- The totality of genetic information found in an organism’s DNA and/or ribonucleic
acid (RNA).
o Genomics- The study of the combination of the environment, personal factors as well as all
genetic variation.
o Genotype- An individual’s collection of genes.
o Intermediate metabolizers- Decreased efficiency in drug metabolism and therefore an
increased concentration of the parent drug with decreased formation of metabolites and a
possible decrease in responsiveness.
o Personalized medicine- The tailoring of medical treatment to the individual characteristics of
each patient, which include genetic predisposition to disease, environmental and personal
factors, and pharmacogenetics tailored to improve patient outcomes.
o Phenotype- Clinical presentation or observable characteristics of an individual with a particular
genotype.
o Polymorphisms- Natural variations in a gene, DNA sequence, or chromosome that have no
adverse effects on the individual and occur with high frequency in the general population.
o Poor metabolizers- Significant decrease in drug metabolism, and as a result tend to have higher
levels of the parent drug but with little to no therapeutic benefit and an increased risk for
adverse drug responses.
o Ultrarapid metabolizers- Increased efficiency in drug metabolism resulting in a possible
decrease in effectiveness at established doses. Increased risk for adverse drug responses
because of increased metabolite or active drug production.
Define the role of pharmacogenetics in drug therapy.
o Pharmacogenetics is the study of how a patient’s genomes affect his or her response to
medications
o Using pharmacogenetics helps individualize drug treatment regimens to optimize therapy and
decrease adverse drug reactions, thus promoting adherence and reducing overall health care
costs.
Be aware of the legal and ethical concerns in regard to pharmacogenetics.
o Privacy
 Who has access to patient genetic information?
 Who owns the genetic information?
 Concerns about patient “labeling” based on genetic code
o Autonomy
 A patient may consent to or refuse genetic testing
 Patients may change their minds about obtaining genetic testing
o Justice
 Equal and fair treatment of all
 However, not everyone has access to the same level of care, nor can everyone afford
care
Review patients that will benefit most from pharmacogenetics
o Patients taking multiple prescription drugs.
o Patients on complex treatment regimens
o Patients who are not responding well to current therapy
o Patients who have had previous adverse drug reactions
o Patients taking drugs with black box warnings
Describe the nursing implications of pharmacogenetics
Ch 9
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Review the “Six Rights” of medication administration.
o Right Patient
 Verifying patient with 2 forms of identification
o Right Drug
 Read drug label 3x
o Right Route
 Check the medication administration record (MAR) for the correct route of
administration
o Right Dose
 Check the medication administration record (MAR) or EHR for the correct dosages and
proper calculation of medication
 Use clinical judgement to decide if the dosage is safe for the patient or not and use your
resources.
o Right Time
 Check the medication administration record (MAR)/EHR for when the medication is to
be administered; STAT, standing, PRN, Intervals, Depending on condition and blood
work
o Right Documentation
 Record drug administration or refusal of medication, dosage, time, location, signs or
symptoms of efficacy/ therapeutic effect
Understand the importance and implications of “Culture of Safety”
o Just Culture: encourages individuals to report drug errors, so the system can be repaired, and
the problems fixed. “Just Culture” does not hold individual practitioners responsible for a failing
system, although it does not tolerate disregard for patient or gross misconduct.
Review the importance of proper drug reconciliation
o Drug reconciliation is the process of identifying the most accurate list of all medications that the
patient is taking at transitions in care.
 Created to provide drug continuity during care transitions, thereby promoting patient
safety and proper patient care.
 Prevent discrepancies and errors in drug continuation during the transition of patient
care.
Understand acceptable abbreviation vs do not use abbreviations
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Identify high alert medications and look alike sound alike medications
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o High alert medications: Can cause significant harm to the patient if given in error, it can have a
major effect on the patient’s organ; this includes respiratory, vascular, and neurologic systems
 Epinephrine; Insulin; Magnesium sulfate injection; Potassium chloride injection;
Potassium phosphate injection
o Look-Alike and Sound-Alike Drug Names: Certain drug names sounds alike and are spelled
similarly
 The use of “tall man” or CAPS is used to call attention to differences in spelling of similar
sounding and spelling medications.
Understand the proper guidelines of medication administration
1. Perform hand hygiene
2. Access patient’s drug medication administration record (MAR) or EHR
3. Check the medication with the order for accuracy
4. Obtain drugs from automatic dispensing cabinet (ADC), remote stock, or pharmacy
while checking the drug label with the patient’s drug order for accuracy
5. Check drug allergies
6. Prepare drugs for only one patient at a time
7. Calculate proper drug dosages and double check calculations
8. Check the expiration date
9. Check the drug label against the MAR when preparing the drug for accuracy
10. If a unit does is prescribed, open the packet at the patient’s bedside
11. For liquid medication use syringe and put it into a drug cup
12. Never leave medication unattended
13. Only administer drugs that have been personally prepared
14. Identify patients by using at least two patient identifiers and compare with the
MAR/EHR
15. Help patient into proper position, depending on the route of drug administration
16. Before administering, compare label on medication with the MAR to complete the 3
checks
17. Explain each drug and its actions to the patient
18. Help patients place the drug cup to their lips if necessary
19. Stay with the patient until all drugs have been taken
20. Dispose of used supplies and perform hand hygiene
21. Evaluate the patient’s response to the drugs
22. Educate patients and family members about drug actions and side effects
23. Report any drug errors STAT to the patient’s provide and to the nurse manager;
complete an incident report
24. Record effectiveness and results of drugs administered
25. Record drugs that were refused and report refusal to the patient’s provider along with
the reason giving for the refusal
26. Record the amount of fluid taken with medications on an input and output chart
Describe the nursing process as it relates to medication administration
Ch 10
 Identify the different routes of drug administration.
o Sublingual- Medication that is placed under the tongue and allowed to dissolve and absorbed
into the vascular system
o Buccal- Medication that is placed in between the cheeks and gums to be absorbed directly into
the vascular system
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o Oral- most common method of drug administration (tablets, capsules, liquids, and elixirs)
 Medication experiences half-life and drug metabolism/biotransformation
o Transdermal- Patches that are placed on the skin for the drug to be absorbed via the skin to
produce a systemic effect.
o Topical- Cream or ointments applied on the surface of the skin to be absorbed
o Instillation- Liquid medication usually administered as drops, ointments, or sprays
 Eyedrops, eye ointment, eardrops, nose drops and sprays
o Inhalation- Metered Dose Inhalers (MDIs) devices used to deliver a fine mist of drugs to treat
asthma and bronchitis to the lower respiratory tract
o Nasogastric and Gastrostomy Tubes
o Suppositories- A solid medical preparation that is cone or spindle shaped for insertion into the
rectum, globular or egg=shaped for use in the vagina, or pencil-shaped for insertion into the
urethra
o Parenteral- Drugs that are administered via injection
 Intramuscular, Intradermal, Subcutaneous, Intravenous
Identify the difference between enteral and parenteral therapy
o Enteral therapy- substances entering orally and passing into the GI
 Liver, kidneys
 Longer to have affect
 Subjected to the First Pass Effect
o Parenteral Therapy- substances entering via injection route into the body
 Faster
 Increase risk of complications with injection sites and IV sites
 Does not go through the GI system
 By passes the liver
Explain the equipment and technique used in enteral therapy.
o Small measuring cup for liquids and a syringe to draw the liquid medication for maximum
accuracy
o Small paper cups to hold the capsules or table medication
Explain the equipment and technique used in parenteral therapy.
o Syringe size should be approximate to the volume of medication to be administered
o Filter needle to draw drugs from glass vile or ampule
o Correct needle gauge for the given technique and medication
o IV tubing, alcohol prep wipes, IV tape, Gauzes, PPE
Understand the various sites used in parenteral therapies.
o Intradermal (ID)- locations are chosen so an inflammatory reaction can be observed. Preferred
areas are lightly pigmented, free of lesions, and hairless, such as the ventral mid-forearm,
clavicular area of the chest, or scapular area of the back
o Subcutaneous (Subcut)- areas with adequate fat-pad size such as: upper outer aspect of the
arms, the abdomen, at least 2 inches from the umbilicus, and the anterior thighs
o Intramuscular (IM)- Ventrogluteal, Deltoid, Vastus lateralis
o Intravenous (IV)- Peripheral veins: cephalic or cubital vein of antecubital fossa, dorsal vein of
hand
 Newborns: veins of the feet, lower legs, and head
Understand the z-track method.
o Recommended when administering IM injections to help minimize local sink irritation by sealing
the medication in the muscle tissue
Ch 12
 Define osmolality and tonicity.
o Osmolality- Refers to the number of particles dissolved in the serum primarily sodium, Urea
(blood urea nitrogen), and Glucose
 Iso-Osmolar: fluid has the same weight proportion of particles
 Hypo-Osmolar: fluid contains fewer particles than water
 Hyper-Osmolar: fluid contains more particles than water
o Tonicity- Primarily as a measurement of the concentration of IV solution compared with the
osmolality of body fluids
 Understand the different electrolytes in ECF and ICF
Intracellular Fluid (ICF)
Extracellular Fluid (ECF)
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Potassium- Major intracellular
cation
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Magnesium
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Sodium- Major ECF cation
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Potassium
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Calcium
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Magnesium
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Sodium
Discuss the functions of major electrolytes, and the signs of deficient or excess electrolytes.
o Potassium (K+): is the primary intracellular cation, and 98% of the body’s potassium is found
within the cells. Potassium is necessary for transmission and conduction of never impulses and
for contraction of skeletal, cardiac, and smooth muscles.
 Normal Levels: 150-160 mEq/L
 Deficient (Hypokalemia) 3.5 mEq/L or less:
 Early signs and symptoms: Muscle weakness, Fatigue, anorexia, nausea,
vomiting,
 Severe signs and symptoms: paresthesia, leg cramps, decreased bowl motility
and paralytic ileus, confusion, rhabdomyolysis, and myoglobinuria atrial and
ventricular dysrhythmias and cardiac arrest, ECG changes
 Excess (Hyperkalemia): serum potassium levels above 5.0 mEq/L
 Sign and symptoms: cardiac dysrhythmias that include characteristics changes on
the ECG, Tachycardia, Bradycardia, paresthesia of the face, tongue, hands, feet,
and GI hyperactivity
o Sodium (Na+): is the major cation in the ECF. It plays a major role in fluid volume balance and is
the primary determinant of plasma osmolality. Sodium and chloride imbalances typically occur
together
 Normal Levels: 135 – 145 mEq/L
 Deficient (Hyponatremia) 135 mEq/L or less: loss of sodium containing fluids, deficient
intake, or excess water gain
 Results from vomiting, diarrhea, nasogastric suctioning, burns, wound drainage,
trauma, renal failure, heart failure, third spacing, syndrome of inappropriate
antidiuretic hormone (SIADH), excessive hypertonic IVF, surgery, and thiazide
diuretics.
 Signs and symptoms: Cerebral edema, altered mental status, confusion, seizures,
, muscle weakness, decreased deep tendon reflexes, headaches, lethargy,
confusion, tachycardia and hypotension
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Excess (Hypernatremia) 145 mEq/L or more: sodium gain, sodium retention, or water
loss. Sodium intake, deficient water intake, hypertonic tube feeding, hypertonic IVF,
acute kidney failure
 Rapid decrease occurs in intracellular water to the brain, which results in
cerebral dehydration, seizure, and coma
 Signs and Symptoms: flushed and dry skin, elevated body temperature, nausea
and vomiting, tachycardia, hypertension, muscle twitching, hyperreflexia,
seizures, and coma
2+
Calcium (Ca ): is the most abundant mineral in the body, accounting for approximately 40% of
all body minerals and 2% of body weight. Calcium promotes normal never and muscle
contraction and plays a role in cardiac excitability. This cation also maintains normal cellular
permeability and promotes blood clotting by converting prothrombin into thrombin.
 Normal Levels: 8.6 – 10.2 mg/dL
 Hypocalcemia 8.6 mg/dL or less: Causes calcium to leave bone to maintain a normal
serum calcium level leading to demineralization of the bones. Common causes are acute
pancreatitis, hypoparathyroidism, diarrhea, alcoholism, malnutrition, use of loop
diuretics, vitamin D deficiency, and multiple blood transfusions
 Signs and symptoms: Nerve transmission and heart and muscle function.
Neurologic and neuromuscular symptoms include anxiety, irritability, and tetany;
twitching; Cardiovascular manifestations including decrease cardiac output,
dysrhythmias, and ECG changes
 Hypercalcemia 10.2mg/dL or more: May be a result of hyperparathyroidism,
malignancy, hypophosphatemia, excessive calcium intake, prolonged immobilization,
multiple fractures, thiazide diuretics and steroids
 Signs and symptoms: Nausea, vomiting, constipation, and kidney stone of
calcium composition. The patient may experience ECG changes and exhibit
decreased heart rate and dysrhythmias
Magnesium (Mg+2): Most plentiful in the ICF and plays a role in maintaining normal calcium and
potassium balance. Magnesium promotes transmission of neuromuscular activity and is and
important mediator for neural transmission in the CNS. Alterations in serum Mg levels
profoundly affect neuromuscular excitability and contractility.
 Normal Levels: 1.5 – 2.5 mEq/L
 Hypomagnesemia 1.5 mEq/L or below: Probably the most undiagnosed electrolyte
deficiency because it is asymptomatic until the serum magnesium level approaches 1
mEq/L
 Hypermagnesemia 2.5mEq/L or higher:
Chloride (Cl-): Chloride ion is a major contributor to acid-base balance, gastric juice acidity, and
the osmolality of ECF
 Normal Serum Levels: 96 – 106 mEq/L
 Hyperchloremia
 Sign and symptoms: weakness; lethargy; dee, rapid breathing; and eventual
unconsciousness.
 Hypochloremia:
 Sing and symptoms: Tremors, twitching, and slow, shallow breathing; decreased
blood pressure is seen.
-3
Phosphorus (P )/Phosphate: The primary anion in ICF and is the second most abundant
element in the body. Essential in bone and teeth formation and for neuromuscular activity.
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Important component of nucleic acids (DNA and RNA) and assists in energy transfer in cells,
helps maintain cellular osmotic pressure, and supports the acid-base balance of body fluids
 Normal Serum Levels: 2.4 to 4.4 mEq/L
 Hypophosphatemia:
 Signs and symptoms: Muscle weakness, tremors, paresthesia, bone pain,
hyporeflexia, seizures, hyperventilation, anorexia, and dysphagia
 Hyperphosphatemia
 Signs and symptoms: hyperreflexia, tetany, flaccid paralysis, muscular weakness,
tachycardia, nausea, diarrhea, and abdominal cramps
Apply the nursing process to fluid volume deficit and fluid volume excess.
Review therapies to address electrolyte abnormalities.
Review various crystalloids, colloids, and blood product, and their associated functions.
o Crystalloids: Solutions contain fluids and electrolytes and freely cross capillary walls. A volume
expander necessary to maintain the colloidal oncotic pressure that prevents water from leaving
the intravascular space
 Isotonic solutions: have the same approximate osmolality as ECF or plasma because of
the osmotic equilibrium, water does not enter or leave the cell; therefore, there is no
effect on RBCs.
 Hypotonic solutions: exert less osmotic pressure than ECF, which allows water to move
into the cell. IV infusions oh hypotonic solutions result in an increased solute
concentration in the intravascular space, causing fluid to move into the intracellular and
interstitial spaces.
 Hypertonic Solution: exert greater osmotic pressure than ECF, resulting in a higher
solute concentration than the serum. When administered, hypertonic IVF fluids pull
water from the interstitial space to the ECF via osmosis and causing cell shrinkage.
o Colloids Solution: contain protein or other large molecular substances that increase osmolarity
without dissolving in the solution. Because of their size, the particles are unable to pass through
the semipermeable membranes of the capillary walls and stay within the intravascular
compartment
 Plasma/Protein expanders: work by increasing the colloidal oncotic pressure and pulling
fluids from the interstitial space into the plasma, increasing the blood volume.
o Blood Products: include packed red blood cells (PRBCs), plasma, platelets, and cryoprecipitate.
o IV fat emulsion (Lipid emulsion)- component of parenteral nutrition for patients who are unable
t oget nutrition through an oral diet
Ch 13
 Differentiate between water-soluble and fat-soluble vitamins.
o Water soluble vitamin: are the vitamin B complex and vitamin C. This group of vitamins is not
usually toxic unless taken in extremely excessive amounts. Water soluble vitamins are not
stored by the body, thus the difficult nature of toxicity and requires steady supplementation.
Excreted in the urine.
o Fat soluble vitamin: A, D, E, and K, they are metabolized slowly; can be stored in fatty tissues,
liver, and muscle in significant amounts; and are excreted in the urine in a slow rate.
 Can lead to toxicity faster and easier
 Relate food sources associated with each vitamin.
 Explain the uses and food sources of the major minerals.
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o Vitamin A (retinol and beta-carotene): is essential for bone growth and for maintenance of
epithelial tissues, skin, eyes, and hair. Vitamin A has antioxidant properties. Aids in the
formation of the visual pigment needed for night vision.
 Food source: Dark colored fruits and vegetables; Dairy products, meat, fish oil, and fish
 Carrots, mangos, spinach, sweet potatoes
o Vitamin D: Has a major role in regulating calcium and phosphorus metabolism and is needed for
calcium absorption from the intestines.
 Food sources: Fortified milk, cereal, eggs, fatty fish, animal liver
o Vitamin E: Antioxidant properties that protect cellular components from being oxidized and
protect red blood cells (RBCs) from hemolysis.
 Food Sources: Whole grain cereals, wheat germ, sunflower seeds, avocados, broccoli,
spinach
o Vitamin K: Needed for prothrombin and clotting factors VII, IX, and X synthesis; Antidote for
oral anticoagulant overdose; Prevent and treat hypoprothrombinemia
 Food Sources: Leafy green vegetables, Liver, Cheese, Egg yolk
o Vitamin B Complex deficiency
 B1-Thiamine: Polyneuritis, cardiac pathology, edema, neurological disorders, ataxia,
diplopia
 Food Sources: Enriched fortified whole grain products, legumes, cereal grain,
pork
 B2-Riboflavin: Sore throat, cheilosis, skin cracks at corners of mouth
 Food Sources: Milk, enriched flour, green vegetables, yogurt, eggs, nuts, meats
(liver and kidneys)
 B3- Nicotinic acid or Niacin: Pellagra, headache, memory loss, insomnia, GI upset
 Food Sources: Animal and plant protein, liver, peanuts, mushrooms, whole
wheat, enriched grains
 B6-Pyridoxine: Neuritis, seizure, anemia, depression, confusion, seborrheic dermatitis
 Food Sources: Cereal grains, meat, fish, vegetables, legumes, white potatoes
 Vitamin C: Free radical antioxidant, essential for tissue repair and growth, required for
formation of collagen; Carbohydrate metabolism and protein and lipid synthesis.
 Food Sources: Citrus fruits, cantaloupe, tomatoes, leafy green vegetables, green
peppers, potatoes
 Folic Acid (Folate): Essential for body growth, and DNA synthesis, and without folic acid,
cellular division is disrupted
 Food Sources: Leafy greens, whole grain, seafood, animal liver
 Vitamin B12: essential for DNA synthesis. Also needed for normal hematopoiesis
(development of RBCs in bone marrow) and to maintain nervous system integrity,
especially of the myelin.
 Food Sources: Fortified milk, cereal, eggs, fatty fish, animal liver
Identify pathophysiology of iron transport in body
o Therapeutic effect/uses: To prevent and treat iron-deficiency anemia
o Mechanism of Action: Enables RBC development and oxygen transport via hemoglobin.
Increases hemoglobin and hematocrit levels.
Identify the nursing process related to vitamins and minerals.
o Nursing Process: Patient Centered Collaborative Care (Vitamins)
 Concept: Health, Wellness, and Illness
 Assessment:
 Obtain 24 and 48 hour diet history analysis;
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 Obtain laboratory results to assess serum blood levels
Patient Problem: Weight loss; Hypokalemia; Need for health teaching
Planning: The patient will verbally understand the importance of a well-balanced diet
Nursing Intervention:
 Monitor serum blood levels for deficiency
 Administer vitamins with the proper route and dosage
 Educate patients about nutrient rich foods
 Store vitamins in light resistant containers
Education/Patient Teaching
Evaluation:
 Did the intervention work by check serum blood levels
 Does the patient show understanding of the importance of well-balanced
nutrition containing vitamins and minerals