NCSBN REVIEW
Schedule I - ANS-category of drugs with high abuse potential and no medical use (generally
unsafe), e.g., heroin, lysergic acid diethylamide (LSD), and marijuana
Schedule II - ANS-high risk for abuse or physical or psychological dependency but also have
safe and accepted uses, e.g., morphine, amphetamines, short-acting barbiturates, cocaine
Schedule III - ANS-less potential for abuse or addiction than Schedule II, e.g., paregoric, various
analgesic compounds containing codeine
Schedule IV - ANS-medically useful category of drugs with less potential for abuse or addiction
than Schedule II drugs, e.g., chloral hydrate, diazepam, meprobamate, phenobarbital
Schedule V - ANS-lowest potential for abuse of all categories, medically acceptable uses e.g.,
antidiarrheals and antitussives with opioid derivatives
peak - ANS-point in time after the administration when a medication exerts its strongest
therapeutic and adverse effects; a serum blood sample is drawn (about 1 hour) after the drug is
administered
trough - ANS-the lowest drug level that is needed to reach therapeutic range; a serum blood is
drawn (about 30 minutes) before medication administration
0.5-1ml - ANS-max deltoid muscle injection
depot injection - ANS-intramuscular injection of a drug in an oil suspension that results in a
gradual release of the medication over a period of time (from several days to weeks to months)
isotonic solution - ANS-Concentration of dissolved particles is similar to that of plasma
Infused solutions remain in the extracellular space and increase intravascular volume
ex. NS, LR, D5W, Ringer's solution
Hypotonic solution - ANS-Lower tonicity or solute concentration
,Fluids shift from the intravascular space to both the intracellular and interstitial spaces
Hypotonic fluids are used to treat conditions causing intracellular dehydration, including diabetic
ketoacidosis & hyperosmolar hyperglycemic state
ex. 0.45% nacl, 0.33% nacl, 0.2% nacl
2.5 dextrose in water
Hypertonic (crystalloid) solution - ANS-Higher tonicity or solute concentration
Water is drawn out of the intracellular space, increasing extracellular fluid volume
Hypertonic fluids are used as volume expanders for conditions such as severe hyponatremia &
cerebral edema
Typically administered only in high acuity areas with constant nursing surveillance
ex. 3% nacl, 5% nacl, 5% dextrose and 0.45% nacl,
5% dextrose and 0.9% nacl, D5LR, D10W, D20W
Hypertonic (colloid solutions) - ANS-Unlike crystalloids, colloids contain molecules too large to
pass through semipermeable membranes; they expand intravasular volume by drawing fluid
from the interstitial spaces into the intravascular compartment through their higher oncotic
pressure
Known as volume expanders or plasma expanders
Colloids are indicated for conditions such as hypoproteinemia and malnourished states and for
individuals who cannot tolerate large infusions of fluid
ex. albumin, dextrans (low-molecular weight dextran [LMWD] & high-molecular weight dextran
[HMWD])
hydroxyethylstarches (hetastarch and hespan)
collection chamber - ANS-- chest tube chamber that collects fluid
-monitor and document rate and nature of drainage (initially every 30 minutes in first few hours,
then every 1 to 4 hours)
water seal chamber - ANS-- chest tube chamber that provides a one-way valve so that air
leaves and cannot reenter chest
- bubbling is normal initial 48 to 72 hours
- tidaling (expected to rise with inspiration, fall with exhalation)
suction control chamber - ANS-- negative pressure transmitted to pleural space is determined
by the amount of solution in this chamber, not the setting on the wall suction
- expected finding is continuous bubbling in chamber
- used to enhance re-expansion of lung quickly
Buck's traction - ANS-- Simple horizontal traction
Unilateral or bilateral limb traction
- Used before repair of fractured hip or for lumbosacral muscle spasms
- remove every 2 to 4 hours to inspect skin integrity
,Donlop's traction - ANS-- Horizontal Buck's
Extension to humerus with vertical Buck's extension to forearm
- Used for supracondylar fractures of the humerus
Bryant's traction - ANS-- Vertical extension with bilateral traction to legs
Hips kept at 90-degree flexion
Buttocks kept one hand-level off the bed
-Used in infants or children weighing less than 35 to 40 pounds for fractured femur or congenital
hip dysplasia
Cotrel traction - ANS-- Head halter and pelvic belt pulling in opposite directions
- Preoperative treatment for spinal curvatures
Pelvic Belt - ANS-- Girdle-type belt that fits around lumbosacral area
- Used for low back pain, muscle spasms, and ruptured nucleus pulposus
Pelvic Sling - ANS-- Hammock-like sling that cradles pelvis
- Used for fractured pelvis
Cervical Halter - ANS-- A strap under the chin
- Used for degenerative or arthritic conditions of cervical vertebrae
Russell's Traction - ANS-- Modified Buck's extension with sling under knees; note risk of
impaired circulation in lower leg
- Used for fractures of femur, hip, or knee disorders
Preanesthetic medications - ANS-- sedatives/hypnotics - calming effect
- narcotics - to relieve pain, calming effect
- anticholinergics - to dry secretions, tranquilizers and antianxiety agents - to decrease
nervousness, promote relaxation
- H1-receptor antagonists - to prevent nausea and vomiting, e.g., promethazine (Phenergan)
- proton pump inhibitors - to decrease acid production in stomach
- possibly an antibiotic - to reduce risk of infection
malignant hyperthermia - ANS-- complication of general anesthesia
- a hypermetabolic state
- rapid progressive rise in body temperature (may exceed 102 degrees Fahrenheit)
- fatal if not treated
- s/sx: tachycardia, tachypnea, unstable BP, diaphoresis, muscle rigidity
- tx: dantrolene (Dantrium)
somatic pain - ANS-- the nerves (nociceptors) that detect pain are located in the skin and deep
tissues, picking up sensations related to temperature,
- tissues such as skin, muscle, joints, bones, and ligaments
, - "musculoskeletal pain"
- sharp and well-localized; tends to be intense
- Examples: fibromyalgia, tension headaches, chronic back pain (not caused by nerve damage),
arthritis
visceral pain - ANS-- comes from the internal organs
- specific receptors for stretch, inflammation, and oxygen starvation (ischemia) are involved
- often poorly localized
- vague, deep ache that involves a cramping sensation
- referred pain to the back (but it is not in a direct nerve distribution), e.g., gallbladder pain can
radiate to the scapula
- Examples: irritable bowel syndrome, cystitis, endometriosis pain, prostate pain
neuropathic pain - ANS-- caused by damage to or dysfunction of the nerves, spinal cord, or
brain (the central nervous system)
- often coexists with nociceptive pain
- follows nerve distribution path
- "pinched nerve"
- shooting, burning or hypersensitive
- numbness, tingling and weakness involved in the area of referred pain
- nerve compression, as with a tumor or ruptured intervertebral disk
- nerve damage, as occurs in metabolic disorders such as diabetes mellitus
- abnormal or disrupted processing of pain signals by the brain and spinal cord
- Examples: diabetic neuropathy, trigeminal neuralgia, postherpetic zoster pain, thalamic pain
syndrome, sciatica, phantom limb pain
sympathetic pain - ANS-- due to possible over-active sympathetic nervous system and
central/peripheral
- extreme hypersensitivity in the skin and around the injury and also peripherally in the limb
- the limb is usually so painful that the client will refuse to use it, which can cause secondary
problems like muscle wasting and joint contractures
- occurs more commonly after a fracture and soft tissue injuries of the arms and legs, and these
injuries may lead to Complex Regional Pain Syndrome (CPRS), which is also called Reflex
Sympathtic Dystrophy (RSD)
- Examples: neuropathy, neuralgia, neuritis
paralytic ileus - ANS-- severely diminished or absent peristalsis
- caused by stress response to surgery and anesthesia, trauma or manipulation of abdominal
contents, electrolyte imbalance such as low potassium, anesthetics and pain medications,
wound infections and immobility
- occurs to some degree after all abdominal surgeries
- bowel sounds should return gradually within 48 to 72 hours after the surgery
- s/sx: decreased or absent bowel sounds; abdominal distention with tight, tense abdomen;
feeling of fullness, pain of abdomen with activity
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