pharmacology
A nurse is reviewing a client's medication history and notes an allergy to sulfonamides. Which of the following medications are contraindicated due to this allergy? (Select all that apply.) A nurse is planning discharge teaching for a female client who has a new prescription for sulfamethoxazole-trimethoprim (Septra). Which of the following information should the nurse include in the teaching? A nurse is providing teaching to a client who has a new prescription for nitrofurantoin (Furadantin). Which of the following information should the nurse include in the teaching? (Select all that apply.) A nurse is teaching about ciprofloxacin (Cipro) to a female client who has a severe urinary tract infection. Which of the following information about adverse reactions should the nurse include in the teaching? (Select all that apply.) A nurse is planning to administer ciprofloxacin (Cipro) IV to a client who has cystitis. Which of the following is an appropriate action by the nurse?
Hydrochlorothiazide (Microzide) Tolbutamide (Orinase) Furosemide (Lasix) Take the medication on an empty stomach Observe for bruising on the skin. Take the medication with milk or meals. Expect brownish discoloration of urine. Observe for pain and swelling of the Achilles tendon. Monitor for a vaginal yeast infections Inspect the mouth for cottage cheese-like lesions. Infuse medication over 60 min.
viral infections, hiv and aids A nurse is caring for a client who has a new diagnosis of HIV infection and is beginning combination oral NRTIs (abacavir, lamivudine, and zidovudine [Trizivir]). The client asks how medications work to treat HIV. Which of the following responses by the nurse is appropriate? A nurse is teaching a client who is beginning highly active antiretroviral therapy (HAART) for HIV infection about ways to prevent medication resistance. Which of the following should the nurse teach the client about resistance? A nurse is caring for a client who takes several antiretroviral medications, including the NRTI zidovudine, to treat HIV infection. For which of the following adverse effects of zidovudine should the nurse monitor? (Select all that apply A nurse is caring for a client who is taking ritonavir (Norvir), a protease inhibitor, to treat HIV infection. For which of the following abnormalities in laboratory values should the nurse monitor? A nurse is caring for a client who is starting enfuvirtide (Fuzeon) to treat HIV infection. For which of the adverse reactions should the nurse monitor? (Select all that apply.) A nurse is administering IV acyclovir (Zovirax) to a client who has varicella and is immunocompromised. Which of the following nursing actions is appropriate?
"These medications work by inhibiting enzymes to prevent HIV replication." Taking medication at the same times daily without skipping doses minimizes resistance. Fatigue Hyperventilation Vomiting Hyperlipidemia Breath sounds for pneumonia Injection site for erythema blood pressure for hypersensitive reaction Administer acyclovir infusion over at least 1 hr
abstinence maintenance (following detox)
*Disulfiram (antabuse) *intended Effects›Disulfiram is a daily oral medication that is a type of aversion (behavioral) therapy. ›Disulfiram used concurrently with alcohol will cause acetaldehyde syndrome to occur. ›Effects include nausea, vomiting, weakness, sweating, palpitations, and hypotension. ›Acetaldehyde syndrome can progress to respiratory depression, cardiovascular suppression, seizures, and death. *Nursing interventions/ client Education ›Inform clients of the potential dangers of drinking any alcohol. ›Advise clients to avoid any products that contain alcohol (cough syrups, mouthwash, aftershave lotion). ›Monitor frequent liver function tests to detect hepatotoxicity. ›Encourage clients to wear a medical alert bracelet. ›Encourage clients to participate in a 12-step self-help program. ›Advise clients that medication effects (potential for acetaldehyde syndrome with alcohol ingestion) persist for 2 weeks following discontinuation of disulfiram. *naltrexone (vivtrol) *intended Effects ›Naltrexone is a pure opioid antagonist that suppresses the craving and pleasurable effects of alcohol (also used for opioid withdrawal). *Nursing interventions/client Education ›Take an accurate history to determine whether clients are also dependent on opioids. Concurrent use of naltrexone and opiates increases the risk for an opiate overdose. ›Advise clients to take the medication with meals to decrease gastrointestinal distress. ›Suggest monthly IM injections for clients who have difficulty adhering to regimen *acamprosate (campral) *intended Effects ›Acamprosate decreases unpleasant effects resulting from abstinence (anxiety, restlessness). *Nursing interventions/client Education ›Inform clients that diarrhea may result. ›Advise clients to maintain adequate fluid intake and to receive adequate rest. ›Advise clients to avoid use in pregnancy.
magnesium sulfate
*adverse effects Muscle weakness, flaccid paralysis, painful muscle contractions, cardiac disorders, and respiratory depression, Diarrhea
herbal supplements
*black cohosh Increases effects of antihypertensive medications ›May increase effect of estrogen medications ›Increases hypoglycemia in clients taking insulin or other medications for diabetes ›Some products contain St. John's wort and should be avoided because of drug interactions related to St. John's wort. *Echinacea action-Stimulates the immune system ›Decreases inflammation ›Topically heals skin disorders, wounds, and burns ›Possibly treats viruses (common cold, herpes simplex) ›Used to increase T-lymphocyte, tumor necrosis factor, and interferon production *interactions ›With chronic use (more than 6 months), echinacea can decrease positive effects of medications for tuberculosis, HIV, or cancer *Garlic action ›When crushed forms the enzyme allicin ›Blocks LDL cholesterol and raises HDL cholesterol; lowers triglycerides ›Suppresses platelet aggregation and disrupts coagulation ›Acts as a vasodilator (may lower BP) interactions ›Due to antiplatelet qualities, can increase risk of bleeding in clients taking NSAIDs, warfarin, and heparin ›Can increase hypoglycemic effects of diabetes medications ›Decreases levels of saquinavir, a medication for HIV treatment *Ginko biloba action ›Promotes vasodilation - Decreases leg pain caused from occlusive arterial disorders ›Decreases platelet aggregation - May decrease risk of thrombosis ›Decreases bronchospasm ›Increases blood flow to the brain - Improves memory (dementia, Alzheimer's disease interactions ›May interact with medications that lower the seizure threshold, such as antihistamines, antidepressants, and antipsychotics ›Can interfere with coagulation *st johns wort action ›Affects serotonin, producing antidepressant effects - Used for mild depression ›Used orally as an analgesic to relieve pain and inflammation ›Applied topically for infection interactions ›May cause serotonin syndrome when combined with other antidepressants, amphetamine, and cocaine ›Decreases effectiveness of oral contraceptives, cyclosporine, warfarin, digoxin, calcium-channel blockers, steroids, HIV protease inhibitors, and some cancer chemotherapy medications
detoxification (alc)
BENzodiAzEPiNEs *Examples ›Chlordiazepoxide (Librium), diazepam (Valium),lorazepam (Ativan) *intended Effects ›Maintenance of the client's vital signs within normal limits ›Decrease in the risk of seizures ›Decrease in the intensity of withdrawal manifestations Nursing interventions/client Education ›Administer around the clock or PRN. ›Use chlordiazepoxide only if the client is able to tolerate oral intake. Otherwise, use IV route for diazepam and lorazepam. The client may continue with diazepam and lorazepam orally. ›Obtain the client's baseline vital signs. ›Monitor the client's vital signs and neurological status on an ongoing basis. ›Provide for seizure precautions (padded side rails and suction equipment at bedside).
diuretics
A. Therapeutic Uses ●Used when there is an emergent need for rapid mobilization of fluid ●Pulmonary edema caused by heart failure ●Liver, cardiac, or kidney disease ●Hypertension ●Kidney stone formation B. Adverse Effects ●Dehydration ●Hypotension ●Ototoxicity ●Hypokalemia C. Nursing Interventions/Client Education ●Dehydration - Assess for dry mouth, increased thirst, low urine output, weight loss. ●Hypotension - Monitor orthostatic blood pressure and pulse; monitor for signs of postural hypotension. ●Ototoxicity - Assess for tinnitus; avoid administering ototoxic medications. ●Hypokalemia - Monitor laboratory values; offer potassium-rich foods; assess for general weakness, nausea, and vomiting
.A nurse is providing teaching to a client who has anemia and has a new prescription for an iron supplement. Which of the following should be included in the teaching? (Select all that apply.) A nurse is evaluating a group of clients at a health fair in relation to the need for folic acid therapy. Which of the following clients may benefit from folic acid therapy? (Select all that apply.) A nurse is preparing to administer potassium chloride IV to a client who has hypokalemia. Which of the following are appropriate actions by the nurse? (Select all that apply.) A nurse is caring for a client who has increased liver enzymes and is taking herbal supplements. The use of which of the following herbal supplements should be reported to the provider? A client requests information from a nurse on the use of the herbal supplement feverfew. Which of the following is an appropriate response by the nurse? A nurse is completing an assessment of a client's current medications. The client states she also takes gingko biloba. Which of the following medications is contraindicated for a client taking gingko biloba?
Add foods that are high in fiber to the diet. Rinse the mouth after taking the liquid formulation. Expect stools to be green or black in color Add additional red meat to the diet. A 24-year-old female with no health problems A 55-year-old female with alcohol use disorder Infuse medication no faster than 10 mEq/hr. Implement cardiac monitoring Administer the infusion using an IV pump. Kava- Chronic use of kava or high doses can cause liver damage, including severe liver failure. It decreases the frequency of migraine headaches. Warfarin (Coumadin)
A nursing is planning care for a client who is receiving furosemide (Lasix) IV for peripheral edema. Which of the following should the nurse include in the plan of care? (Select all that apply.) A nurse is providing information to a client who has a new prescription for hydrochlorothiazide (Hydrodiuril). Which of the following information should the nurse include? A nurse is monitoring a client who is receiving spironolactone (Aldactone). Which of the following findings should the nurse report to the provider? A client who has increased intracranial pressure is receiving mannitol (Osmitrol). Which of the following findings should the nurse report to the provider? A nurse is reviewing a client's medication history and notes that the client is taking digoxin (Lanoxin), an antihypertensive medication, and NSAIDs. The client has a new prescription for torsemide (Demadex). The nurse should plan to monitor for which of the following medication interactions? (Select all that apply.)
Assess for tinnitus. Monitor serum potassium levels. Elevate the head of bed slowly before ambulation. Recommend eating a banana daily. Take the medication with food Serum potassium 5.2 mEq/L Dyspnea Hypokalemia Hypotension Low urine output Ventricular dysrhythmias
AdjUNCt MEdiCAtioNs (alc)
Examples ›Carbamazepine (Tegretol), clonidine (Catapres), propranolol (Inderal) intended Effects ›Decrease in seizures - carbamazepine ›Depression of autonomic response (decrease in blood pressure, heart rate) - clonidine and propranolol ›Decrease in craving - propranolol Nursing interventions/client Education ›Provide for seizure precautions (padded side rails, suction equipment at bedside). ›Obtain the client's baseline vital signs, and continue to monitor on an ongoing basis.
Antilipemic Agents Classifications •HMG CoA reductase inhibitors (statins) •Cholesterol absorption inhibitors •Bile -acid sequestrants •Nicotinic acid
Fibrates •Prototype- Gemfibrozil •Other medications-Fenofibrate •Expected action-Decrease in triglyceride levels, Increase in HDL levels •Therapeutic uses •Reduction of plasma triglycerides (VLDL) •Increase levels of HDL HMG CoA Reductase Inhibitors (Statins) •Prototype- Atorvastatin •Other medications Simvastatin Lovastatin Pravastatin sodium Rosuvastatin Fluvastatin •Expected action Decrease LDL cholesterol Decrease (VLDL) Increase (HDL) •Therapeutic uses Hypercholesterolemia Prevention of coronary events Protection against MI, stroke for clients who have diabetes mellitus *Adverse Effects Hepatotoxicity Increase in serum transaminase •Nursing interventions/client education Obtain baseline liver function. Monitor liver function test after 12 weeks and then every 6 month. Monitor for symptoms of liver dysfunction. (Anorexia, vomiting, nausea, jaundice) Avoid alcohol. Medications may be discontinued if tests are abnormal. **Grapefruit juice suppresses CYP3A4 and can increase levels of statins Nursing administration •Administer statins by oral route •Administer lovastatin with evening meal. •Other statins can be taken without food intake, but evening dosing is best •Advise clients to obtain baseline cholesterol levels, HDL, LDL, and triglycerides. Monitor periodically while taking medication
upper respiratory meds A nurse is caring for a client who states she has been taking phenylephrine (Neo-Synephrine) nasal drops for the past 10 days for her upper respiratory symptoms. For which of the following adverse effects should the nurse assess? A nurse is teaching a client to self-administer nasal drops for allergic rhinitis symptoms. The nurse should teach the client to lie in which of the following positions to obtain the best effect of the medication? A preschool child recently diagnosed with cystic fibrosis has a new prescription for acetylcysteine (Mucomyst). The nurse teaches the client and her family that the purpose of this medication is to do which of the following? An adult client is taking diphenhydramine (Benadryl) for symptoms of allergic rhinitis. For which of the following adverse reactions should the nurse teach the client to watch? (Select all that apply.) A nurse is evaluating a client's understanding of the teaching about the use of fluticasone (Flonase) to treat perennial rhinitis. Which of the following statements by the client indicate he understands the teaching? guaifenesin (Mucinex). A.Adverse Effects: Identify two adverse effects of this medication. B.Medication Effectiveness: Identify two findings that indicate that the medication is effective.
Nasal congestion Lateral with head in low position Loosen secretions Dry mouth Urinary hesitation "It may take as long as 3 weeks before the medication takes a maximum effect." Adverse Effects ●GI upset ●Drowsiness ●Dizziness ●Rash B.Medication Effectiveness ●Cough is more productive, mucous is easier to expectorate. ●Chest congestion is decreased.
anesthesia
Nursing Actions ◯Ensure that consent has been signed by the client, because legal consent cannot be given by a adult who is medicated. ◯Have the client void before the medication is administered so he will not need to get out of bed. ◯Ensure that the bed is in the low position and that the side rails are raised for safety. ◯Monitor airway and oxygen saturation. ◯Monitor and report laboratory values (ABGs, CBC, and electrolytes) as appropriate. ◯Monitor cardiac status (rhythm, heart rate, blood pressure). ◯Monitor temperature. ◯Monitor drains, tubes, catheters, and IV access throughout anesthesia and surgery. ◯Assess level of sedation and anesthesia (level of consciousness, vital signs). ◯If hypotension occurs as an adverse effect of medication or dehydration, lower the head of bed, administer a prescribed IV fluid bolus, and monitor. ◯Notify the surgeon and anesthesiologist if abnormalities are noted
erythropoeitic growth factors ●Select Prototype Medication: epoetin alfa (Epogen, Procrit) ●Other Medications ◯Darbepoetin alfa (Aranesp) - long-acting erythropoietin ◯Methoxy polyethylene glycol (MGEG)-epoetin beta (Mircera) - very long-acting erythropoietin
Nursing administration ●Obtain baseline blood pressure. In clients who have chronic kidney injury, control hypertension before the start of treatment. ●Monitor blood pressure frequently, because adjustments in antihypertensive medication may also be required as treatment progresses. ●Administer by subcutaneous or IV bolus injection. Dosage is based on client's weight. ●Do not agitate the vial of medication. Use each vial for one dose, and do not put the needle back into the vial when withdrawing the medication. ●Do not mix medication with any other medication in syringe. ●Dosing is usually three times/week, but may be once per week with some types of chemotherapy. ●Monitor iron levels, and implement measures to ensure a normal iron level. RBC growth is dependent upon adequate quantities of iron, folic acid, and vitamin B12. Without adequate levels of these, erythropoietin is significantly less effective. ●Monitor Hgb and Hct twice a week until target range is reached. ●The longer-acting forms are administered less frequently (weekly or monthly), but can be prescribed for clients who have chronic kidney failure only.
Iron preparations
Patient-Centered Care ●Instruct clients to take iron on an empty stomach, such as 1 hr before meals to maximize absorption. Stomach acid increases absorption. ●Instruct clients to take with food if GI adverse effects occur. This may increase adherence to therapy even though absorption is also decreased. ●Instruct clients to space doses at approximately equal intervals throughout day to most efficiently increase red blood cell production. Inform clients to anticipate a harmless dark green or black color of stool. ●Teach clients to dilute liquid iron with water or juice, drink with a straw, and rinse the mouth after swallowing. ●Instruct clients to increase water and fiber intake (unless contraindicated) and to maintain an exercise program to counter the constipation effects. ●Advise clients that therapy may last 1 to 2 months. Usually, dietary intake will be sufficient after Hgb has returned to an appropriate level. ●Encourage concurrent intake of appropriate quantities of foods high in iron (liver, egg yolks, muscle meats, yeast, grains, green leafy vegetables).
A nurse is caring for a client who is receiving daily doses of oprelvekin (Interleukin-11). Which of the following laboratory values should the nurse monitor to determine effectiveness of this medication? A nurse is preparing to administer filgrastim (Neupogen) for the first time to a client who has just undergone a bone marrow transplant. Which of the following interventions is appropriate? A nurse is monitoring a client who is receiving epoetin alfa (Epogen) for adverse effects. Which of the following is an adverse effect of this medication? A nurse is assessing a client who has chronic neutropenia and who has been receiving filgrastim (Neupogen). Which of the following actions should the nurse take to assess for an adverse effect of filgrastim?
Platelet count Discard vial after removing one dose of the medication. Hypertension Assess for bone pain.
falls
Prevention of Falls ◯Complete a fall-risk assessment upon admission and at regular intervals on the client. ◯The plan for each client is individualized based on the fall-risk assessment. ■For example, if the client has orthostatic hypotension, instruct the client to avoid getting up too quickly, to sit on the side of the bed for a few seconds prior to standing, and to stand at the side of the bed for a few seconds prior to walking. ■General measures to prevent falls include the following: ☐Be sure the client knows how to use the call light, that it is in reach, and encourage its use. ☐Respond to call lights in a timely manner. ☐Use fall-risk alerts, such as ID wristbands per facility protocol. ☐Provide regular toileting and orientation of confused clients as needed. ☐Ensure adequate lighting. ☐Orient the client to the setting (grab bars, call light) to ensure he knows how to use all assistive devices and can locate necessary items. ☐Place clients at risk for falls near the nursing station. ☐Ensure that bedside tables and overbed tables and frequently used items (telephone, water, tissues) are within the client's reach. ☐Maintain the bed in the low position. ☐For clients who are sedated, unconscious, or otherwise compromised, the bed rails are kept up, and the bed is kept in the low position. ☐Avoid the use of full side bed rails for clients who get out of bed or attempt to get out of bed without assistance. ☐Provide the client with nonskid footwear and nonskid bath mats for use in tubs and showers. ☐Use gait belts and additional safety equipment, as needed, when moving clients. ☐Keep the floor free from clutter with a clear path to the bathroom (no scatter rugs, cords, furniture). ☐Keep assistive devices nearby after validation of safe use by the client and family (glasses, walkers, transfer devices). ☐Educate the client and family/caregivers on identified risks and the plan of care. Clients and family who are aware of risks are more likely to call for assistance. ☐Lock wheels on beds, wheelchairs, and carts to prevent the device from rolling during transfers or stops. ☐Use chair or bed sensors for clients at risk for getting up unattended to alert staff of independent ambulation.
● First-generation NSAIDs (COX-1 and COX-2 inhibitors) ◯Aspirin ◯Ibuprofen (Motrin, Advil; IV preparations include Caldolor, NeoProfen) ◯Naproxen (Naprosyn); naproxen sodium (Aleve) ◯Indomethacin (Indocin) ◯Diclofenac (oral forms - Voltaren, Cataflam, Cambia, Zipsor; intradermal forms - Flector patch, Pennsaid, Voltaren gel) ◯Ketorolac (generic; Sprix, an intranasal form) ◯Meloxicam (Mobic) ●Second-generation NSAIDs (selective COX-2 inhibitor) ◯Celecoxib (Celebrex)
Purpose ●Expected Pharmacological Action ◯Inhibition of cyclooxygenase - Inhibition of COX-1 can result in decreased platelet aggregation and kidney damage. Inhibition of COX-2 results in decreased inflammation, fever, and pain. ●Therapeutic Uses ◯Inflammation suppression ◯Analgesia for mild to moderate pain, such as with osteoarthritis and rheumatoid arthritis ◯Fever reduction ◯Dysmenorrhea ◯Inhibition of platelet aggregation, which protects against ischemic stroke and myocardial infarction (aspirin) contraindications/Precautions ●Contraindications for aspirin and other first-generation NSAIDs ◯Pregnancy (Pregnancy Risk Category D) ◯Peptic ulcer disease ◯Bleeding disorders, such as hemophilia and vitamin K deficiency ◯Hypersensitivity to aspirin and other NSAIDs ◯Children and adolescents who have chickenpox or influenza (aspirin) ●Use NSAIDs cautiously in older adults, clients who smoke cigarettes, and in clients who have Helicobacter pylori infection, hypovolemia, asthma, chronic urticaria, and/or a history of alcoholism. ●Celecoxib is contraindicated in clients who have an allergy to sulfonamides. ●Ketorolac is contraindicated in clients who have advanced renal dysfunction. Use should be no longer than 5 days because of the risk for kidney damage. ●Second-generation NSAIDs should be used cautiously in clients who have known cardiovascular disease.
med error report
Report all errors, and implement corrective measures immediately. ☐Complete an unusual occurrence report within the specified time frame, usually 24 hr. This report should include: *The client's identification *The name and dose of the medication *An accurate and objective account of the event *The time and place of the incident *Who was notified *What actions were taken *The signature of the person completing the report ☐This report does not become a part of the client's permanent record, and the report should not be referenced in another part of the record.
A nurse is reviewing the health care record of a client who has a prescription for conjugated equine estrogens (Premarin). In which of the following conditions is the use of estrogens contraindicated A nurse is explaining the mechanism of action of combination oral contraceptives to a group of clients. The nurse should tell the clients that which of the following actions occur with the use of combination oral contraceptives? A nurse is providing teaching to a female client who is taking testosterone (Andronaq-50) to treat advanced breast cancer . The nurse should tell the client that which of the following are adverse effects of this medication? (Select all that apply.) A nurse is providing teaching to a client who is to start alfuzosin (Uroxatral) for treatment of benign prostatic hyperplasia. Which of the following is an adverse effect of this medication? A nurse is caring for a client who has angina and asks about obtaining a prescription for sildenafil (Viagra) to treat erectile dysfunction. Which of the following medications should not be taken concurrently with sildenafil? Expected Pharmacology ●Finasteride slows the production of testosterone, which reduces the size of the prostate and subsequently promotes urinary elimination.
Thrombophlebitis- Estrogen increases the risk of thrombolytic events. Estrogen used is contraindicated for a client who has a history of thrombophlebitis -Oral contraceptives cause thickening of the cervical mucus, which slows sperm passage. - Oral contraceptives alter the lining of the endometrium, which inhibits implantation of the fertilized egg. -Oral contraceptives prevent pregnancy by inhibiting ovulation. Deepening voice Male pattern baldness Facial hair hypotension Isosorbide (Isordil) Adverse Effects ●Decreased libido ●Decreased ejaculate volume ●Gynecomastia ●Orthostatic hypotension
leukopoietic growth factors ●Select Prototype Medication: filgrastim (Neupogen) ●Other Medication: pegfilgrastim (Neulasta)
adverse effects -bone pain -luekocytosis -splenomegaly and risk of splenic rupture with long-term use Nursing administration ●Administer filgrastim by intermittent IV bolus, continuous IV, subcutaneous infusion, or subcutaneous injection. ●Do not agitate the vial of medication. Use each vial for one dose, and do not combine with other medications. Do not put the needle back into the vial when withdrawing the medication. ●Monitor CBC two times per week. ●If client will be administering subcutaneous filgrastim at home, provide thorough instruction on self-administration procedures.
cardiac glycosides ●Select Prototype Medication: digoxin (Lanoxin, Lanoxicaps, Digitek)
adverse effects ›Dysrhythmias (caused by interfering with the electrical conduction in the myocardium) ›Cardiotoxicity leading to bradycardia interventions ›Conditions that increase the risk of developing digoxin-induced dysrhythmias include hypokalemia, increased serum digoxin levels, and heart disease. Older adult clients are particularly at risk. ›Monitor serum levels of K+ to maintain a level between 3.5 to 5.0 mEq/L. ›Instruct clients to report signs of hypokalemia (nausea/vomiting, general weakness). Potassium supplements may be prescribed if clients are concurrently taking a diuretic. ›Teach clients to consume high-potassium foods (green leafy vegetables, bananas, potatoes). ›Monitor the client's digoxin level. »Therapeutic serum levels may vary, but usually range from 0.5 to 2.0 ng/mL. »Signs of toxicity may appear at levels less than 1.75 ng/mL. »Clients who have heart failure respond best with serum medication levels between 0.5 to 0.8 ng/mL. »Dosages should be based on serum levels and client response to medication. ›Teach clients to monitor pulse rate, and recognize and report changes. The rate may be irregular with early or extra beats noted. GI effects include anorexia (usually the first sign), nausea, vomiting, and abdominal pain. ›CNS effects include fatigue, weakness, vision changes (diplopia, blurred vision, yellow-green or white halos around objects). interactions medication/food ●Management of digoxin toxicity ◯Digoxin and potassium-sparing medication should be stopped immediately. ◯Monitor K+ levels. For levels less than 3.5 mEq/L, administer potassium IV or by mouth. Do not give any further K+ if the level is greater than 5.0 mEq/L. ◯Treat dysrhythmias with phenytoin (Dilantin) or lidocaine. ◯Treat bradycardia with atropine. ◯For excessive overdose, activated charcoal, cholestyramine, or Digibind can be used to bind digoxin and prevent absorption.
malignant hyperthermia
clinical Manifestations ›Acute life-threatening medical emergency. ›Inherited muscle disorder, chemically induced by anesthetic agents. ›Triggering agents include inhalation anesthetic agents, and the muscle relaxant succinylcholine ›Hyper metabolic condition causing an alteration in calcium activity in muscle cells (muscle rigidity, hyperthermia, and damage to the central nervous system). ›Tachycardia is a first manifestation, dysrhythmias, muscle rigidity, hypotension, tachypnea, skin mottling, cyanosis and protein in urine (myoglobinuria). ›Elevated temperature is a late manifestation - rising 1° to 2° C (2° to 4° F) every 5 min. treatment ›Terminate surgery ›Dantrolene (Dantrium) is a muscle relaxant to treat the condition ›100% oxygen, arterial blood gases ›Infuse iced IV 0.9% sodium chloride ›Apply a cooling blanket, ice to axillae, groin, neck and head, iced lavage
potassium supplements
nursing administration ●Oral formulations ◯Mix powdered formulations in at least 4 oz of liquid. ◯Advise clients to take potassium chloride with a glass of water or with a meal to reduce the risk of adverse GI effects. ◯Instruct clients not to crush extended-release tablets. ◯Instruct clients to notify the provider if they have difficulty swallowing the pills. Medication may be supplied as a powder or a sustained-release tablet that is easier to tolerate. ●IV administration ◯Never administer IV bolus. Rapid IV infusion can result in fatal hyperkalemia. ◯Use an IV infusion pump to control the infusion rate. ◯Dilute potassium and give no more than 40 mEq/L of IV solution to prevent vein irritation. ◯Give no faster than 10 mEq/hr. ◯Cardiac monitoring is indicated for serum potassium levels outside of normal parameters. ◯Assess the IV site for local irritation, phlebitis, and infiltration. Discontinue IV immediately if infiltration occurs. ◯Monitor the client's I&O to ensure an adequate urine output of at least 30 mL/hr.nursing evaluation of Medication effectiveness ●Depending on therapeutic intent, effectiveness may be evidenced by serum potassium level within expected reference range (3.5 to 5.0 mEq/L).
beta2 adrenergic agonists Select Prototype Medication: albuterol (Proventil, Ventolin) Other Medications: ◯Formoterol (Foradil Aerolizer) ◯Salmeterol (Serevent) ◯Terbutaline (Brethine)
therapeutic uses adverse effects complications interactions Nursing Administration ●Instruct clients to follow manufacturer's instructions for use of metered-dose inhaler(MDI), dry-powder inhaler (DPI), and nebulizer. ●When a client is prescribed an inhaled beta2-agonist and an inhaled glucocorticoid, advisethe client to inhale the beta2-agonist before inhaling the glucocorticoid. The beta2-agonist promotes bronchodilation and enhances absorption of the glucocorticoid. ●Advise clients not to exceed prescribed dosages. ●Ensure that clients know the appropriate dosage schedule (if the medication is to be taken on a fixed or a as-needed schedule). ●Formoterol and salmeterol are both long acting beta2-agonist inhalers. These inhalers are used every 12 hr for long-term control and are not used to abort an asthma attack, or exacerbation. These long-acting agents are not used alone but are prescribed in combination with an inhaled corticosteroid. ●A short-acting beta 2-agonist is used to treat an acute episode. ●Advise clients to observe for indications of an impending asthma episode and to keep a log of the frequency and intensity of exacerbations. ●Instruct clients to notify the provider if there is an increase in the frequency and intensity of asthma exacerbations.
Bone marrow suppression (low WBC count or neutropenia, bleeding caused by thrombocytopenia or low platelet count, and anemia or low RBCs
›Monitor WBC, absolute neutrophil count, platelet count, Hgb, and Hct. ›Assess clients for bruising and bleeding gums. ›Instruct clients to avoid crowds and contact with infectious individuals.
Taking a telephone prescription
■If possible, have a second nurse listen on an extension. ■Ensure that the prescription is complete and correct by reading back to the provider: the client's name, the name of the medication, the dosage, the time of administration, frequency, and route. ■Remind the provider that the prescription must be signed within the specified amount of time. ■Enter the prescription in the client's health record.
medications to support withdrawal abstinence from nicotine Burpropion (zyban) nicotine replacement therapy varenicline (chantix)
●Abstinence syndrome is evidenced by irritability, nervousness, restlessness, insomnia, and difficulty concentrating
medications to support withdrawal/abstinence from opioids methadone (dolophine) Clonidine (catapres) Buprenorphine (subutex)
●Characteristic withdrawal syndrome occurs within 1 hr to several days after cessation of substance use. ●Clinical findings include agitation, insomnia, flulike manifestations, rhinorrhea, yawning, sweating, and diarrhea. ●Manifestations are non-life-threatening, although suicidal ideation may occur.
alcohol withdrawal
●Effects of withdrawal usually start within 4 to 12 hr of the last intake of alcohol, peak after 24 to 48 hr, and subside within 5 to 7 days, unless alcohol withdrawal delirium occurs. ●Manifestations include nausea; vomiting; tremors; restlessness and inability to sleep; depressed mood or irritability; increased heart rate, blood pressure, respiratory rate, and temperature; and tonic-clonic seizures. Illusions are also common. ●Alcohol withdrawal delirium may occur 2 to 3 days after cessation of alcohol, may last 2 to 3 days, and is considered a medical emergency. Findings include severe disorientation, psychotic manifestations (hallucinations), severe hypertension, and cardiac dysrhythmias that may progress to death
fire Safety
●Fires in health care facilities are usually due to problems related to electrical or anesthetic equipment. Unauthorized smoking also may be the cause of a fire. ●All staff must be instructed in fire response procedures, which includes the following: ◯Knowing the location of exits, alarms, fire extinguishers, and oxygen turn-off valves ◯Ensuring fire doors are not blocked with equipment ◯Knowing the evacuation plan for the unit and facility ●The fire response in the health care setting always follows this sequence (RACE): ◯R - Rescue: Rescue and protect clients in close proximity to the fire by evacuating them to a safer location. Ambulatory clients can walk unattended to a safe location. ◯A - Alarm: Activate the facility alarm system, and then report fire details and location per facility protocol. ◯C - Contain: Contain the fire by closing doors and windows as well as turning off any sources of oxygen and electrical devices. Clients who are on life support are ventilated with a bag-valve mask. ◯E - Extinguish: Extinguish the fire if possible using an appropriate fire extinguisher. ■There are three classes of fire extinguisher: ☐Class A is for paper, wood, upholstery, rags, or other types of trash fires. ☐Class B is for flammable liquids and gas fires. ☐Class C is for electrical fires. ■To use a fire extinguisher, use the PASS sequence: ☐P - Pull the pin. ☐A - Aim at the base of the fire. ☐S - Squeeze the levers. ☐S - Sweep the extinguisher from side to side, covering the area of the fire.
Seclusion and Restraints
●In general, seclusion and/or restraints should be ordered for the shortest duration necessary and only if less restrictive measures are not sufficient. It is for the physical protection of the client or the protection of other clients or staff. ●A client may voluntarily request temporary seclusion in cases in which the environment is disturbing or seems too stimulating. ●Restraints can be either physical or chemical, such as sedatives and neuroleptic or psychotropic medications to calm the client. ●Seclusion and/or restraint must never be used for the following: ◯Convenience of the staff ◯Punishment for the client ◯Clients who are extremely physically or mentally unstable ◯Clients who cannot tolerate the decreased stimulation of a seclusion room ●Restraints should ◯Never interfere with treatment ◯Restrict movement as little as is necessary to ensure safety ◯Fit properly and be as discreet as possible ◯Be easily removed or changed to decrease the chance of injury and to provide for the greatest level of dignity ●When all other less restrictive means have been tried to prevent a client from harming self or others, the following must occur in order for seclusion or restraint to be used: ◯The treatment must be prescribed by the provider in writing, based on a face-to-face assessment of the client. ■In an emergency situation in which there is immediate risk to the client or others, the nurse may place a client in restraints. The nurse must obtain a prescription from the provider as soon as possible in accordance with agency policy (usually within 1 hr). ◯The prescription must include the reason for the restraint, the type of restraint, the location of the restraint, how long the restraint may be used, and the type of behaviors demonstrated by the client that warrant use of the restraint. ◯The prescription and the renewal are limited to 4 hr for an adult, 2 hr for clients ages 9 to 17, and 1 hr for clients younger than 9 years of age. Prescriptions may be renewed, if needed, with a maximum of 24 consecutive hours. ◯PRN prescriptions for restraints are not allowed. ◯Nursing responsibilities ■Assess skin integrity, and provide skin care per facility protocol, usually every 2 hr. ■Offer food and fluid. ■Provide with means for hygiene and elimination. ■Monitor for vital signs. ■Offer range of motion of extremities. ◯Always explain the need for the restraint to the client and family, emphasizing that the restraint is needed to ensure the safety of the client and will be used only as long as it is necessary. ◯Obtain signed consent from client or guardian, if required. ◯Review the manufacturer's instructions for correct application. ◯Remove or replace restraints frequently to ensure good circulation to the area and allow for full range of motion to the limb that has been restricted. ◯Pad bony prominences. ◯Use a quick-release knot to tie the restraint to the bed frame (loose knots that are easily removed) where it will not tighten when the bed is raised or lowered. ◯Ensure that the restraint is loose enough for range of motion and with enough room to fit two fingers between the device and the client to prevent injury. ◯Regularly assess the need for continued use of the restraints to allow for discontinuation of the restraint or limiting the restraint at the earliest possible time while ensuring the client's safety. ◯Never leave the client unattended without the restraint. ◯Document ■Precipitating events and behavior of the client prior to seclusion or restraint ■Alternative actions taken to avoid seclusion or restraint ■The time restraints were applied and removed (if discontinued) ■Type of restraint used and location ■Client's behavior while restrained ■Type and frequency of care (range of motion, neurosensory checks, removal, integumentary checks) ■Condition of the body part being restrained ■Client's response when the restraint is removed ■Medication administration ◯An emergency situation must be present for the nurse to use seclusion or restraints without first obtaining a provider's written prescription. If this treatment is initiated, the nurse must obtain the written prescription within a specified period of time (usually within 1 hr).
6 rights of safe medication administration
●Right Client ◯Verify the client's identification each time a medication is given. The Joint Commission requires that two client identifiers be used when administering medications. ■Acceptable identifiers include the client's name, an assigned identification number, telephone number, birth date, or another person-specific identifier. ■Check identification bands for name, identification number, and/or photograph. ■Check for allergies by asking the client, looking for an allergy bracelet, and reviewing the medication administration record. ■Bar code scanners may be used to identify clients. ●Right Medication ◯Correctly interpret the medication prescription (verify completeness and clarity). ■Read the label three times: when the container is selected, when removing the dose from container, and when the container is replaced. ■Leave unit-dose medication in its package until administration. ■When using automated medication dispensing systems, the same checks are required and can be adapted. ●Right Dose ◯Calculate the correct medication dose. ◯Check a drug reference to ensure the dose is within the usual range. ●Right Time ◯Administer medication on time to maintain a consistent therapeutic blood level. ■It is generally acceptable to administer the medication 30 min before or after the scheduled time. However, refer to the drug reference or institution policy for exceptions. ●Right Route ◯The most common routes of administration are oral, topical, subcutaneous, IM, and IV. ◯Select the correct preparation for the ordered route (for example, otic versus ophthalmic topical ointment or drops). ◯Know how to administer medication safely and correctly. ●Right Documentation ◯Immediately record medication, dose, route, time, and any pertinent information, including the client's response to the medication. ◯For some medications, in particular those to alleviate pain, the client response will be evaluated and documented later, perhaps after 30 min.
Seizure Precautions
●Seizure precautions (measures to protect the client from injury should a seizure occur) are taken for clients who have a history of seizures that involve the entire body and/or result in unconsciousness. ◯Ensure rescue equipment is at the bedside, including oxygen, an oral airway, and suction equipment and padding for the side rails of the bed. A saline lock may be inserted for intravenous access if the client is at high risk for experiencing a generalized seizure. ◯Inspect the client's environment for items that may cause injury in the event of a seizure, and remove items that are not necessary for current treatment. ◯Assist the client at risk for a seizure with ambulation and transferring to reduce the risk of injury. ◯Advise all caregivers and family not to put anything in the client's mouth (except in status epilepticus, where an airway is needed) in the event of a seizure. ◯Advise all caregivers and family not to restrain the client in the event of a seizure, ensure the client's safety by lowering him to the floor or bed, protect his head, remove nearby furniture, provide privacy, put the client on his side with his head flexed slightly forward if possible, and loosen clothing to prevent injury. ●In the event of a seizure ◯Stay with the client, and call for help. ◯Administer medications as prescribed. ◯Note the duration of the seizure and the sequence and type of movement. ◯After a seizure, assess mental status, oxygenation saturation, and vital signs of the client. Explain what happened to the client, and provide comfort, understanding, and a quiet environment for the client to recover. ◯Document the seizure in the client's record with any precipitating behaviors and a description of the event (movements, any injuries, length of seizure, aura, postictal state), and report it to the provider