123
each liter of fluid weighs
2.2 pounds or 1 kilogram
safe acetaminophen dose
4000 in 24 hr 2000 g 24 hr for geriatrics and liver disease/impairment
nursing considerations of aspirin
GI bleed risk w/ patient 60 yr older have stomach ulcers or bleeding problems
magnesium sulfate supplement
PO and IV
non opioid analgesic
acetaminophen
what is a safe alternative to NSAID to reduce risk of GI bleed
acetaminophen
which medication is safe to take for pain in the week before a surgical procedure
acetaminophen, it does not affect platelet function
MOA furosemide
acts on loop of henle
MOA spironolactone
aldosterone antagonist causes increased amounts of sodium and water to be excreted in distal convoluted tubules while K is retained
the nurse is taking care of a client who has chronic back pain. which nursing considerations would be made when determining the clients plan of care
ask client about acceptable level of pain administer pain meds regularly around the clock
which medication increases the risk for upper GI bleeding
aspirin ibuprofen methylprednisolone
nursing considerations tramadol
assess LOC BP HR RR bowel function safety! fall risk change positions slowly avoid alcohol
nursing considerations for kayexalate
assess bowel sounds and movement patient ability to form BM monitor I&O labs: CMP (k and na)
nursing considerations of calcitonin
assess for fish/salmon allergy patency of nares alternate nares monitor for s/s hypo/hypercalcemia
nursing considerations of magnesium sulfate supplements
assess neuro, DTR, and vitals assess mg levels and I&O s/s hypomagnesia foods: nuts, fish, chocolate
nursing considerations for morphine sulfate
assess pain 1 hr (PO) and 20 min (IV) assess loc, BP, HR, RR prior to admin assess bowel function assess I&O monitor respiratory status safety! fall risk
nursing considerations of ibuprofen
assess renal function GI bleed give with food or milk do not combine with other nsaids do not take with alcohol
when is ibuprofen contraindicated
asthma cardiac disease peptic ulcer disease
which food would nurse instruct client to include in the diet when being prescribed furosemide
bananas
morphine sulfate MOA
binds to opioid receptors in the CNS to prevent neurons to signal to eachother, decreasing and eliminating pain leads to CNS depression
MOA hydrocodone w/apap
binds to opioid receptors to prevent neurons from signaling to eachother
tramadol MOA
binds to selective opioid receptor inhibits reuptake of serotonin and norepinephrine in the CNS
child with juvenile idiopathic arthritis (JIA) is started on a nonsteroidal antiinflammatory drug (NSAID). what nursing consideration should be included
blood in urine -hematuria may result from use of NSAID b/c they may cause nephrotoxicity
calcium carbonate is essential for
bone formation and blood coagulation -reduces stomach acid
which sensation reported by the client would the nurse consider when determining that furosemide is being administered too quickly
buzzing ears -rapid administration of furosemide can cause tinnitus, loss of hearing and ear pain
antidote for magnesium sulfate
calcium gluconate
kayexalate is a
cationic exchange resin removes K via stool, exchanges potassium ions for sodium ions in the GI tract (intestine)
tramadol is a
centrally acting non opioid
potassium sparing diuretics act on
collecting duct in the kidney
side effects of naproxen
confusion GI ulcer/bleeding
side effects of hydrocodone w/ apap
constipation N/V drowsiness/dizziness respiratory depression
methylprednisolone
corticosteroid that is known to cause medication induced GI bleeding by causing irritation and erosion of the gastric mucosal barrier
which action would the nurse take before administering each dose in a client who takes oxycodone every 3 hours for pain after surgery
count respiratory rate ask client to rate level of pain assess client LOC -oxy depresses the CNS, resulting in depressed respirations and decreased LOC
NSAIDs inhibit
cox-1 and cox-2 which inhibit the production of prostaglandins thereby contributing to analgesia
MOA of calcitonin
decreases osteoclast activity allows osteoblasts to outwork osteoclasts and build bones
side effects of furosemide
dehydration hypokalemia ototoxicity (tinnitus)
thiazides act on
distal convoluted tubule
fluid volume overload signs
edema bounding pulse distended neck veins HR, BP, RR, WT go up fine crackles in lungs heart failure
hyponatremia causes
fatigue headache confusion seizures
indications for spironolactone
fluid management HF needs diuretic but also needs to spare potassium
indications for magensium sulfate
hypomagnesia constipation bronchspasm
which meds are contraindicated for clients undergoing surgery
naproxen aspirin ketorolac NSAIDs
side effects of aspirin
nephrototoxic GI bleed/ulcer epistaxis (bleeding gums) stomach pain tinnitus cramping
weakest diuretic
potassium sparing often combined with loop or thiazide
aldosterone receptor diuretic
spironolactone
which mechanism of action explains how diuretics reduce BP
they reduce circulating blood volume by blocking reabsorption of sodium in the renal tubules thus promoting fluid loss and reducing arterial pressure
sodium chloride tabs patient education
they taste bad, make sure you eat balance diet
MOA hydrochlorothiazide
works in early part of distal convoluted tubule to inhibit sodium chloride transporter
vitamin D supplement side effects
hypercalcemia
nursing considerations for furosemide
s/s of dehydration and hypokalemia measure BP and HR monitor foods high in K weigh self change position slowly
indications for vitamin d supplement
vitamin d deficiency osteoporosis hypocalcemia hypoparathyroidism
which instructions would the nurse include when providing teaching to the parent of a child prescribed diuretics
fluid intake should be adequate diuretics should be taken same time each day diuretics may interfere with normal lab test values
indications for furosemide
fluid volume overload heart failure hypertension pulmonary edema ascites
a child with pulmonary edema is treated with opioids and furosemide. Which nursing interventions would the nurse perform to promote safe medication administration
follow principal of atraumatic care administer oral drugs with food or snacks document child age weight and height
which drugs generally cause hypokalemia
furosemide and hydrochlorthiazide
most powerful diuretic
furosemide, loop diuretic
which symptom in a client receiving hydrochlorothiazide would cause a nurse to notify the provider
generalized weakness -symptom of significant hypokalemia
nursing considerations for naproxen
give with food or milk may increase risk for stroke or MI
kayexalate must be
given with no other med for up to 6 hours
side effects of acetaminophen
hepatotoxic jaundice GI bleed N/V fatigue
side effects of calcium carbonate
hypercalcemia -muscle weakness -arrhythmias -high BP -chronic bone pain -N/V/D -hypoactive bowels -constipation -positive chvostek and trousseau sign
side effects of potassium chloride
hyperkalemia -arrhythmias -tetany -N/V/D -abdominal cramps -muscle weakness/cramps
which adverse medication effect will a nurse monitor for in a client with cirrhosis of the liver who develops ascites and is prescribed spironolactone
hyperkalemia b/c it is a potassium sparing diuretic that is used to treat patients with ascites
side effects of spironolactone
hyperkalemia gynecomastia dehydration (BP decreases, HR and temp increase)
side effects of magnesium sulfate
hypermagnesia -decreased DTR -flushed skin -decrease in BP, HR and RR
side effects of sodium chloride tablets
hypernatremia -confusion -low BP -high HR and RR -orthostatic hypotension -FVO
indications for hydrochlorothiazide
hypertension heart failure edema renal calculi
indications for calcium carbonate
hypocalcemia GERD heartburn/indigestion
side effects of calcitonin
hypocalcemia hypercalcemia rhinitis
side effects of hydrochlorothiazide
hypokalemia -muscle cramps -muscle weakness/spasms -arrhythmias -fatigue
which adverse effect would a nurse monitor for when caring for a client receiving furosemide to relieve edema
hypokalemia b/c it causes depletion of electrolytes like potassium and sodium
side effects of kayexalate
hypokalemia hypernatremia low serum electrolye levels except for sodium
sodium chloride tablets indication
hyponatremia
which client statement indicates teaching about furosemide is understood
i need to change position slowly i should eat more foods high in potassium
which statement by a client receiving diuretic therapy indicates that the teaching about potassium supplements is understood
i will report any abdominal distress -potassium supplements may cause GI ulceration and bleeding
best NSAID for children
ibuprofen
first generation nsaids
ibuprofen naproxen aspirin
nursing considerations for celecoxib
increases risk of VTE monitor BP renal and liver function s/s GI bleed increases risk of MI, CVA, and thrombosis
antidote for potassium chloride
kayexalate
indications for potassium chloride supplements
low k-hypokalemia on loop diuretic
furosemide may do what to BP
may cause hypovolemia which can result in orthostatic hypotension with sudden changes in position
indication of aspirin
may lower risk of heart attack and stroke reduce fever mild to moderate pain relief muscle ache headache tooth ache
which conclusion would the nurse make regarding a clients response to pain medication when a client using a pain scale of 1-10 rates the pain as a 8 before receiving a analgesic and a 7 after being medicated
medication is not adequately effective -expected effect should be more than one point decrease in the pain level
indication of acetaminophen
mild-moderate pain fever, but no affect on inflammation
indications for tramadol
moderate to severe pain
indications for morphine sulfate
moderate to severe pain respiratory issues (tachypnea)
indications for hydrocodone w/apap
moderate to severe pain in post op patient, cancer patient or patient with trauma
nursing considerations for vitamin d supplement
monitor BMP: calcium take with calcium s/s hypercalcemia
nursing considerations for potassium chloride supplement
monitor K level do not crush or dilute IV dosage: peripheral 5-10 CVAD: up to 20
nursing considerations of calcium carbonate
monitor calcium levels s/s of hyper/hypo calcemia no medications ` hour before and 2 hours after
nursing considerations of acetaminophen
monitor liver function avoid alcohol do not use on patients with liver issues
nursing considerations for spironolactone
monitor weight monitor I&O s/s dehydration and hyperkalemia avoid salt substitutes
side effects of ibuprofen
nephrotoxic GI bleed/ulcer tinnitus bronchospasm
side effects of celecoxib
nephrotoxic GI ulcers/bleeds increase stroke and heart attack risk BP increase
magnesium is important for
neurotransmission and muscle excitability
indications of kayexalate
non life threatening hypokalemia (5.0-6.5) constipation
aspirin MOA
nonselective inhibition cox-1 and cox-2
ibuprofen MOA
nonselective inhibition of cox-1 and cox-2
naproxen MOA
nonselective inhibition of cox-1 and cox-2
potassium supplements should be taken
not on an empty stomach because they are irritating
which action will the nurse take in a client hospitalized for uncontrolled hypertension and chest pain on a daily diuretic for 2 days whose potassium level this morning was 2.7
notify HCP potassium level is below normal
which principle explains how loop diuretics promote diuresis
osmosis
indications for calcitonin
osteoporosis hypercalcemia hyperparathyroidism pagets disease
indications for ibuprofen
pain fever inflammation disorders
which therapeutic outcome is expected after administering ibuprofen
pain relief temperature reduction reduced inflammation
aspirin is contraindicated in
patients with asthma rhinitis can cause renal and liver impairment
which action will the nurse take when a client who had a MI complains of feeling dizzy 15 min after receiving 15 mg of morphine sulfate for chest pain
place client in supine position and take vitals -dizziness is a symptom of hypotension, a side effect of morphine -supine position increases venous return, cardiac output and blood flow to the brain
KCL
potassium chloride supplement PO & IV
hydrochlorothiaze is a
potassium wasting diuretic thiazide
vitamin D
promotes absorption of calcium
what accumulates at the site of injury causing pain
prostaglandins
loop diuretics inhibit
reabsorption of sodium and water in the ascending loop of Henle
after orthopedic surgery patient reports pain 5/10, nurse administers 5 mg of oxycodone every 3 hours as needed. two hours after med was given, patient reports pain 10/10, what action would the nurse take
request the provider to evaluate the need for additional medication
which adverse effect of morphine indicates need for narcan
respiratory depression
side effects of tramadol
respiratory depression euphoria bradypnea hypotension constipation drowsiness/dizziness
indications of naproxen
rheumatoid arthritis acute gout osteoarthritis
nursing considerations for sodium chloride tablets
s/s hyper/hypo natremia fvo precaution=seizures, falls
side effects of morphine sulfate
sedation drowsiness bradypnea hypotension bradycardia constipation urinary retention euphoria respiratory depression N/V
acetaminophen MOA
selective inhibition of cox-2 in CNS
MOA celecoxib
selective inhibitor of cox-2
after surgery a patient has a PCA that is set to allow morphine delivery every 6 min, which statement indicates to the nurse that the family understands instructions about the pump
she needs to push the pca button whenever she needs pain medication
diuretics may interfere with which labs
sodium potassium magnesium chloride
calcitonin is used
to treat osteoporosis
indications for celecoxib
treat pain redness swelling osteoarthritis
calcium carbonate
tums antacid
which clinical finding in a client receiving morphine warrant immediate follow up by the nurse
unconsciousness bradycardia bradypnea
the primary nurse, leaving for lunch, provides a verbal report for covering nurse. the report included one clients prescription for morphine: 2 mg IV every 3 hours for abdominal pain secondary to major abdominal surgery that morning. during the primary nurses lunch, the client complains of pain at 8/10 level on pain scale. which action would the covering nurse perform first
verify the written prescription matches the administration record
hydrocodone w/apap
vicodin norco
nursing considerations of hydrochlorothiazide
vitals I&O weight monitor labs: potassium, GFR, creatinine, BUN
hydrochlorothiazide increases excretion of
water sodium, potassium chloride
which response would a nurse monitor for when a client is receiving furosemide to relieve edema
weight loss excessive loss of potassium ions
how should diuretics be taken
with food or milk, same time every day in the AM
which action will the nurse take when a client is prescribed morphine sulfate via IV route every 3 hours as needed for pain requests medication for pain given that preoperative BP was 128/76 and postoperative assessment reveal BP ranges between 90/60 and 100/70
withhold morphine until BP stabilizes -morphine may decrease BP further so it should be withheld