NR341 Exam 1 Concept Review
CHAPTERS 1-5:
Informed Consent: The doctrine of informed consent is based on the principle of autonomy; competent adults have the right to self-
determination or to make decisions regarding their acceptance or rejection of treatment.
1. 3 primary elements: Must be present for a person’s consent or decline of medical treatment or research participation to be
consider valid.
a. Competence = A person’s ability to understand info regarding medical and nursing Tx.
b. Voluntariness
c. Disclosure of information
2. Basic Info considered necessary for decision making
a. A diagnosis of the pt’s specific health problem and condition
b. The nature, duration, and purpose of the proposed tx and procedures
c. The probable outcome of any medical or nursing intervention
d. The benefits of medical or nursing intervention
e. The potential risks that are generally considered common or hazardous
f. Alternative tx and their feasibility
g. Short term and long-term prognoses if the proposed tx or txs are not provided.
3. Nurses can serve as witnesses and provided additional pt edu to support decision making.
National Patient Safety Goals
1) Identify patients correctly
a) Use 2 ways to ID patient
2) Improve staff communication
a) Get important test results to the right staff person on time.
3) Use medicines safely
a) Label all MEDS and containers, take extra care of pt with blood thinners, and reconcile MEDS
4) Use alarms safely
a) Ensure the alarms are audible and respond to them in a timely matter.
5) Prevent infection
a) Use the hand cleaning guidelines
b) Implement evidence based guidelines to prevent
i) Infection with multidrug resistant organisms
ii) Central line associated bloodstream infections
iii) Surgical site infections
iv) Catheter associated urinary tract infection
6) Identify patient safely risks
a) Assess pt for suicide risk
7) Prevent mistakes in surgery
a) Conduct a preprocedure verification process to ensure that surgery is done on the correct pt and site.
b) Mark correct procedure site
c) Preform a “time out” before the procedure to ensure that the correct pt, site, and procedure are identified.
Ethical Principles
Autonomy: Respect for the individual and the ability of individuals to make decisions with regard to their own health and future (the
basis for the practice of informed consent)
Beneficence: Actions intended to benefit the patients or others
Nonmaleficence: Actions intended not to harm or bring harm to others
Justice: Being fair or just to the wider community in terms of the consequences of an action. In health care, justice is described as
the fair allocation or distribution of health care resources
Veracity: The obligation to tell the truth
Fidelity: The moral duty to be faithful to the commitments that one makes to others. (e.g. Promises)
Confidentiality: Respect for an individual’s autonomy and the right of individuals to control the information relating to their own
health
, Pain Medications
CHAPTER 7 AND 13
Cardiac Drugs (therapeutic effects, adverse effects)
Dopamine
o Use = hypotension not r/t hypovolemia; 2nd line for symptomatic bradycardia (after atropine)
o AE/SE = tachycardia, ↑ dysrhythmias. Myocardial ischemia, premature ventricular contractions.
o Nursing Int. = Extravasation may cause necrosis & sloughing. Administer through a central line if possible.
Nitroglycerin
o Use = Angina
o Action = vasodilates
o AE/SE = headache, flushing, tachycardia, dizziness, and orthostatic hypotension
o Nursing Int. = Instruct pt to call 911 if chest pain doesn’t subside after the third SL dose. For topical dosing, pt
should have a nitrate-free interval (10-12h/day) to avoid development of tolerance. Instruct pt not to combine
nitrate use w/ meds used for TRMT of erectile dysfunction (e.g. vardenafil, tadalafil, sildenafil).
If pt has used Viagra w/I 24-48hr do not give nitrate.
Atropine
o Use = ↑HR by decreasing vagal tone; indicated in pt w/ symptomatic bradycardia
o AE/SE = Tachycardia, headache, ↑Myocardial oxygen consumption & ischemia
o Nursing Int. = Consider transcutaneous pacing, dopamine infusion, or epinephrine if atropine is ineffective.
Epinephrine
o (Adrenaline) Use = Cardiac Arrest, Asthma
o AE/SE = Hypertensive Crisis, dysrhythmia, angina
o Nursing Int = Causes bronchodilation, vasoconstriction (increased BP), increased HR/CO
Lidocaine
o Use = Alternative to amiodarone in cardiac arrest from VF & VT; suppression of ventricular ectopy (premature
ventricular contractions)
o AE/SE = neurologic toxicity (lethargy, confusion, tinnitus, muscle twitching, paresthesia, seizures), bradycardia if
serum lidocaine level is excessive
o Nursing Int. = lower dose if impaired hepatic blood flow
Beta Blockers
o Use = Decrease HR, BP, and cardiac contractility; TRMT angina, acute MI, dysrhythmias and HF
o AE/SE = bradycardia, hypotension, AV blocks, asthma attacks, fatigue, impotence; may mask hypoglycemic
episodes
o Nursing Int. = Teach patient to take pulse and blood pressure on a regular basis and to not abruptly stop taking
beta blockers. Close glucose monitoring is needed if diabetic. Patient should have ECG monitoring during IV
administration. Monitor for worsening signs of heart failure.
Digoxin
o Use = Heart Failure
Calcium Channel Blockers
o Drugs = Verapamil, amiodipine, felodipine, nicardipine, nifedipine, diltiazem
o Use = TRMT HTN, tachydysrhythmias, vasospasms, and angina
o AE/SE = Dizziness, flushing, headaches, bradycardia, atrioventricular blocks, hypotension
o Nursing Int. = Teach patient to monitor pulse and blood pressure, especially if taking nitrates or beta blockers.
Tablets cannot be crushed or chewed. Instruct patient to make position changes slowly. Avoid grapefruit juice
Pacemaker and AICD Care
Patient Education
o Preprocedural Teaching
Device and how it works
Lead and generator placement
Implantation procedure
Educational materials from the manufacturer
o Postprocedural Teaching
Site care and symptoms of complications
Hematoma at the site, most common when the patient takes anticoagulant or antiplatelet medications
CHAPTERS 1-5:
Informed Consent: The doctrine of informed consent is based on the principle of autonomy; competent adults have the right to self-
determination or to make decisions regarding their acceptance or rejection of treatment.
1. 3 primary elements: Must be present for a person’s consent or decline of medical treatment or research participation to be
consider valid.
a. Competence = A person’s ability to understand info regarding medical and nursing Tx.
b. Voluntariness
c. Disclosure of information
2. Basic Info considered necessary for decision making
a. A diagnosis of the pt’s specific health problem and condition
b. The nature, duration, and purpose of the proposed tx and procedures
c. The probable outcome of any medical or nursing intervention
d. The benefits of medical or nursing intervention
e. The potential risks that are generally considered common or hazardous
f. Alternative tx and their feasibility
g. Short term and long-term prognoses if the proposed tx or txs are not provided.
3. Nurses can serve as witnesses and provided additional pt edu to support decision making.
National Patient Safety Goals
1) Identify patients correctly
a) Use 2 ways to ID patient
2) Improve staff communication
a) Get important test results to the right staff person on time.
3) Use medicines safely
a) Label all MEDS and containers, take extra care of pt with blood thinners, and reconcile MEDS
4) Use alarms safely
a) Ensure the alarms are audible and respond to them in a timely matter.
5) Prevent infection
a) Use the hand cleaning guidelines
b) Implement evidence based guidelines to prevent
i) Infection with multidrug resistant organisms
ii) Central line associated bloodstream infections
iii) Surgical site infections
iv) Catheter associated urinary tract infection
6) Identify patient safely risks
a) Assess pt for suicide risk
7) Prevent mistakes in surgery
a) Conduct a preprocedure verification process to ensure that surgery is done on the correct pt and site.
b) Mark correct procedure site
c) Preform a “time out” before the procedure to ensure that the correct pt, site, and procedure are identified.
Ethical Principles
Autonomy: Respect for the individual and the ability of individuals to make decisions with regard to their own health and future (the
basis for the practice of informed consent)
Beneficence: Actions intended to benefit the patients or others
Nonmaleficence: Actions intended not to harm or bring harm to others
Justice: Being fair or just to the wider community in terms of the consequences of an action. In health care, justice is described as
the fair allocation or distribution of health care resources
Veracity: The obligation to tell the truth
Fidelity: The moral duty to be faithful to the commitments that one makes to others. (e.g. Promises)
Confidentiality: Respect for an individual’s autonomy and the right of individuals to control the information relating to their own
health
, Pain Medications
CHAPTER 7 AND 13
Cardiac Drugs (therapeutic effects, adverse effects)
Dopamine
o Use = hypotension not r/t hypovolemia; 2nd line for symptomatic bradycardia (after atropine)
o AE/SE = tachycardia, ↑ dysrhythmias. Myocardial ischemia, premature ventricular contractions.
o Nursing Int. = Extravasation may cause necrosis & sloughing. Administer through a central line if possible.
Nitroglycerin
o Use = Angina
o Action = vasodilates
o AE/SE = headache, flushing, tachycardia, dizziness, and orthostatic hypotension
o Nursing Int. = Instruct pt to call 911 if chest pain doesn’t subside after the third SL dose. For topical dosing, pt
should have a nitrate-free interval (10-12h/day) to avoid development of tolerance. Instruct pt not to combine
nitrate use w/ meds used for TRMT of erectile dysfunction (e.g. vardenafil, tadalafil, sildenafil).
If pt has used Viagra w/I 24-48hr do not give nitrate.
Atropine
o Use = ↑HR by decreasing vagal tone; indicated in pt w/ symptomatic bradycardia
o AE/SE = Tachycardia, headache, ↑Myocardial oxygen consumption & ischemia
o Nursing Int. = Consider transcutaneous pacing, dopamine infusion, or epinephrine if atropine is ineffective.
Epinephrine
o (Adrenaline) Use = Cardiac Arrest, Asthma
o AE/SE = Hypertensive Crisis, dysrhythmia, angina
o Nursing Int = Causes bronchodilation, vasoconstriction (increased BP), increased HR/CO
Lidocaine
o Use = Alternative to amiodarone in cardiac arrest from VF & VT; suppression of ventricular ectopy (premature
ventricular contractions)
o AE/SE = neurologic toxicity (lethargy, confusion, tinnitus, muscle twitching, paresthesia, seizures), bradycardia if
serum lidocaine level is excessive
o Nursing Int. = lower dose if impaired hepatic blood flow
Beta Blockers
o Use = Decrease HR, BP, and cardiac contractility; TRMT angina, acute MI, dysrhythmias and HF
o AE/SE = bradycardia, hypotension, AV blocks, asthma attacks, fatigue, impotence; may mask hypoglycemic
episodes
o Nursing Int. = Teach patient to take pulse and blood pressure on a regular basis and to not abruptly stop taking
beta blockers. Close glucose monitoring is needed if diabetic. Patient should have ECG monitoring during IV
administration. Monitor for worsening signs of heart failure.
Digoxin
o Use = Heart Failure
Calcium Channel Blockers
o Drugs = Verapamil, amiodipine, felodipine, nicardipine, nifedipine, diltiazem
o Use = TRMT HTN, tachydysrhythmias, vasospasms, and angina
o AE/SE = Dizziness, flushing, headaches, bradycardia, atrioventricular blocks, hypotension
o Nursing Int. = Teach patient to monitor pulse and blood pressure, especially if taking nitrates or beta blockers.
Tablets cannot be crushed or chewed. Instruct patient to make position changes slowly. Avoid grapefruit juice
Pacemaker and AICD Care
Patient Education
o Preprocedural Teaching
Device and how it works
Lead and generator placement
Implantation procedure
Educational materials from the manufacturer
o Postprocedural Teaching
Site care and symptoms of complications
Hematoma at the site, most common when the patient takes anticoagulant or antiplatelet medications
