NRS 115 - All Medications ATI PDF

Preview

Summary

Download NRS 115 - All Medications ATI PDF

Description

Antibiotics Affecting the Bacterial Cell Wall: Proper Injection Technique Narrow-spectrum Penicillin G benzathine (Bicillin) IM Antistaphylococcal Nafcillin (Unipen) for IM or IV Antibiotics Affecting Protein Synthesis: Understanding Teaching About Tetracycline Take on empty stomach with full glass of water. Taking any tetracyclines just before lying down increases the chance of esophageal ulceration and should be avoided Instruct clients to maintain a 2 hr interval between ingestion of chelating agents and medications Complete antimicrobial therapy even if symptoms may seem to be resolved Antibiotics Affecting the Bacterial Cell Wall: Priority Finding After a Penicillin Injection Report any signs of allergic response such as skin rash, itching or hives. Observe the patient for 30 mins following administration of parental penicillin. Monitor kidney function and I&O Antibiotics Affecting the Bacterial Cell Wall: Priority Finding After a Penicillin Injection-Adverse effects Allergies/anaphylaxis Renal impairment Hyperkalemia/dysrhythmias Antibiotics Affecting Protein Synthesis: Dietary Supplement Interactions With Tetracycline-(doxycycline (Vibramycin), minocycline (Minocin), demeclocycline (Declomycin) Interactions with milk products, calcium and iron supplements, laxatives containing magnesium and antacids Antibiotics Affecting Protein Synthesis: Dietary Supplement Interactions With Tetracycline-nursing interventions/education Tetracycline should be taken on an empty stomach with a full glass of water. Administer tetracyclines at least 1 hr before and 2 hr after taking food and supplements containing calcium and magnesium. Antibiotics Affecting the Bacterial Cell Wall: Priority Finding After a Penicillin Injection IM injection should be performed cautiously to avoid injection into the nerve or an artery Antibiotics Affecting the Bacterial Cell Wall: Identifying an Allergic Reaction to Ampicillin/Sulbactam skin rash, itching and hives Chronic Neurologic Disorders: Adverse Effects of Phenytoin CNS effects (nystagmus, sedation, ataxia, double vision, cognitive impairment) Gingival hyperplasia (softening and overgrowth of gum tissue, tenderness and bleeding gums) Skin rash Teratogenic (cleft palate, heart defects) Cardiovascular effects (dysrhythmias, hypotension)

2 Pharmacology ATI

Nurses are legally responsible for: -Having knowledge of federal, state (nurse practice act), & local laws, & health care facility policies that governs the prescribing, dispensing, & administration of medications -Preparing, administering, & evaluating client responses to medications -Developing & maintaining an up-to-date knowledge base of medications administered, including uses, mechanisms of action, and routes of administration, safe dosage range, side effects, adverse responses, precautions, contraindications -Maintaining knowledge of acceptable practice & skill competency -Determining accuracy of medication orders -Reporting all medication errors -Safeguarding & storing medications Evaluation -Evaluates client's response to medications, & document & report appropriately -Recognize side/adverse effects, & document & report immediately -Report all errors & implement corrective measures immediately: complete an unusual occurrence report within specified time frame, usually 24 hours. This report should include client's identification, the time & place of incident, an accurate account of even, who was notified, what actions were taken, & signature of person completing the report. This report does not become part of client's permanent record & report should NOT be referenced in another part of record!!**

Miscellaneous Central Nervous System Medications: Treatment for Muscarinic Poisoning (anticholinergic effects--constipation, dry mouth, blurred vision, photophobia, dry eyes) Instruct client to increase dietary fiber, consume 2-3 liters a day of fluid from beverage and food sources, sip fluids and avoid hazardous activities if vision is impaired Medications Affecting Blood Pressure: Adverse Effects of Abrupt Propranolol Withdrawal Bradycardia Decreased cardiac output AV block Orthostatic hypotension Rebound myocardial excitation Bronchconstriction Glycogenolysis is inhibited Nursing Implications know how to monitor therapeutic effects, prevent & treat adverse effects, provide for comfort, & instruct clients in safe use of medications Common medication errors include: Wrong medication or IV fluid -Incorrect dose or IV rate 2

3 Pharmacology ATI

-Wrong client, route, or time -Administration of known allergic medication -Omission of dose -Incorrect discontinuation of medication or IV fluid To Prevent Medication Errors Ensure knowledge of medication to be administered. Use appropriate resources -Health care providers including nurses, physician & pharmacist -Poison control centers -Sales representatives from drug companies -Nursing pharmacology textbooks & drug handbooks -Physicians Desk Reference -Newsletters including the Medical Letter on Drugs & Therapeutics -Professional journals -Professional Web Sites What does cocaine affect? Dopamine and serotonin release and reuptake How can cocaine be consumed? Snorted, Inhaled, Smoked, Oral, Injected or Suppository Cocaine Intoxication: Dx Criteria Recent use of cocaine Maladaptive behaviors (euphoria, fighting, persecutory ideation, agitation) Two of the following -Tachycardia -Pupillary dilation -Elevated BP -Perspiration/chills -Nausea/vomiting -Visual or tactile hallucinations Not due to other general medical or mental disorder Cocaine Intoxication: Tx Reassurance Other drugs? Benzodiazepines if needed for agitation Restraints seldom necessary Explore treatment options for dependence Cocaine Withdrawal: Symptoms 3

4 Pharmacology ATI

Behavioral syndrome ("crash"): -Dysphoric mood -Fatigue -Hypersomnia, decreased appetite -Psychomotor agitation -Delusions in heavy users or vulnerable persons Duration of several days to several weeks Intense craving Cocaine Withdrawal: Tx -Consider controlled environment -Benzodiazepines for agitation -Antidepressants if depressed mood persists -Tricyclics and bromocriptine may help in reducing craving

Miscellaneous Pain Medications: Teaching About Adverse Effects of Ergotamine For GI discomfort- administer metoclopramide (Reglan) For Ergotism (muscle pain, paresthesias in fingers and toes; cold pale extremities)- stop medication and immediately notify provider For physical dependence- advise client to not exceed prescribed dose, inform clients regarding symptoms of withdrawal (headache, N/V, restlessness) notify provider For fetal abortion- avoid using medication during pregnancy, use adequate contraception Miscellaneous Pain Medications: Adverse Effects of Ergotamine (migraine medication) -gastrointestinal discomfort such as nausea and vomiting -Ergotism (muscle pain, paresthesias in fingers and toes, cold pale extremities) -Physical dependence -Fetal abortion Miscellaneous Pain Medications: Priority Adverse Effect of Epidural Anesthesia Monitor for hypotension, anaphylaxis, seizure and dura puncture, respiratory depression, sedation, insertion site for hematoma, signs of infection, Miscellaneous Pain Medications: Teaching About Adverse Effects of Ergotamine For GI discomfort- administer metoclopramide (Reglan) For Ergotism (muscle pain, paresthesias in fingers and toes; cold pale extremities)- stop medication and immediately notify provider For physical dependence- advise client to not exceed prescribed dose, inform clients regarding symptoms of withdrawal (headache, N/V, restlessness) notify provider For fetal abortion- avoid using medication during pregnancy, use adequate contraception Miscellaneous Pain Medications: Teaching About a Prescription for Antigout Medication-Colchicine 4

5 Pharmacology ATI

Colchicine should be taken with food. If GI distress occurs stop and notify provider. Miscellaneous Pain Medications: Teaching About a Prescription for Antigout Medication— Probenecid drink 3 L of fluid daily Miscellaneous Pain Medications: Teaching About a Prescription for Antigout Medication-Allopurinol Give with food. Monitor liver enzymes Intake 2-3 L fluids daily monitor I&O, BUN and creatinine If giving IV and fever or rash occur stop infusion Angina: Client Teaching for a New Prescription of Sublingual Nitroglycerin store in dark container what types of seizures does phenytoin treat? simple partial, complex partial, generalized, tonic clonic what is the therapeutic use of phenytoin? a hydantoin med that suppresses partial seizures and primary generalized seizure activity in the affected neurons what adverse effects will the nurse MR for w/ a pt taking phenytoin* CNS (double vision, nystagmus, ataxia) skin rash, teratogenic, CV effects, endocrine, interference w/ vit K dependent clotting factors causing bleeding in newborns stimulation of hepatic drug-metabolizing enzymes Tetracycline interactions milk products, calcium/iron supplements, magnesium, antacids -1 hr before or 2 hrs after meal or supplements Tetracycline decreases the efficacy or: oral contraceptives What are the clinical signs of Malignant Hyperthermia? Clinical signs of MH: hypercarbia tachycardia markedly increased in minute ventilation muscle rigidity (difficult to ventilate, increased peak pressures) skin mottling hyperthermia (may be a late sign - d/t inc in muscle metabolism = heat production) 5

6 Pharmacology ATI

brown urine DIC What are some steps for treatment of Malignant Hyperthermia? Steps for treating MH: - Once MH crises is indentified, call for help and get the MH cart - Discontinue inhalational agent or Succ - Hyperventilate with 10L/min 100% O2 - Instruct surgeon to finish or abort surgery (if emergent change to non-triggering agent) - Call MHAUS for assistance - Start mixing the Dantrolene Medications Affecting Urinary Output: Effects of Diuretics--loop diuretics Loop diuretics block reabsorption of sodium and chloride and prevent reabsorption of water. Causes extensive diuresis even with severe renal impairment Medications Affecting Urinary Output: Effects of Diuretics--loop diuretics therapeutic uses Emergent need for rapid mobilization of fluid--pulmonary edema caused by heart failure, conditions not responsive to other diuretics such as edema caused by liver, cardiac or kidney disease or hypertensions These medications may be used to treat hypercalcemia Medications Affecting Urinary Output: Effects of Diuretics--loop diuretic medications furosemide (Lasix) Ethacrynic acid (Edecrin) Bumetanide (Bumex) Torsemide (Demadex) Medications Affecting Urinary Output: Effects of Diuretics--Thiazide diuretics Thiazide diuretics block reabsorption of sodium and chloride, and prevent reabsorption of water. Promotes diuresis when renal function in not impaired Medications Affecting Urinary Output: Effects of Diuretics--Thiazide diuretics therapeutic uses Often 1st choice medications for essential hypertension. May be used for edema of mild-to-moderate heart failure and liver and kidney disease. Often are used in combination with antihypertensive agents for BP control Medications Affecting Urinary Output: Effects of Diuretics--Thiazide diuretic medications hydrochlorothiazide (Hydrodiuril) Chlorothiazide (Diuril) Methychothiazide (Enduron) Indapamide (Lozide, Lozol) Chlothalidone (Hygroton) Metoazone (Zaroxolyn) Medications Affecting Urinary Output: Effects of Diuretics--Potassium-sparing diuretics 6

7 Pharmacology ATI

Potassium-sparing diuretics block the action of aldosterone (sodium and water retention), which results in potassium retention and secretion of sodium and water Medications Affecting Urinary Output: Effects of Diuretics--Potassium-sparing diuretics therapeutic uses Paired with other diuretics for potassium-sparing effects. Administered for heart failure. Therapeutic effects may take 12-48 hours Medications Affecting Urinary Output: Effects of Diuretics--Potassium-sparing diuretics Medications spironolactone (Aldactone) triamterene (Dyrenium) amiloride (Midamor) Infection Process Mode of Transmission: Contact 1) Direct physical contact - person to person 2) Indirect contact with a vehicle of transmission - inanimate object, water, food, blood 3) Fecal-oral transmission - handling food after using a restroom and failing to wash hands Infection Process Mode of Transmission: Droplet Large droplets travel through the air up to 3 to 6 ft - sneezing, coughing, and talking Infection Process Mode of Transmission: Airborne Small droplets remain in the air and can travel extended distances depending on airflow sneezing and coughing Infection Process Mode of Transmission: Vector borne Animals or insects as intermediaries (ticks transmit Lyme disease; mosquitoes transmit West Nile virus and malaria) Endocrine Disorders: Adverse Effects of Thyroid Hormone Overmedication can result in indication of hyperthyroidism (anxiety, tachycardia, palpitations, altered appetite, abdominal cramping, heat intolerance, fever, diaphoresis, weight loss, menstrual irregularities) A client is making an appointment for allergy testing. The nurse instructs the client not take what class of medications at least 4 days before allergy testing? -Antihistamines An allergist will usually recommend discontinuation of antihistamine drug therapy at least 4 days before allergy testing. Vericella Adverse Effects: Local or generalized rash, vesicles on body. Fever, malaise, & anorexia. Vericella Contraindications: 7

8 Pharmacology ATI

Pregnancy-pregnant women should avoid recently vaccinated children. Allergy to gelatin or neomycin. Severe immunodeficiency. Recent transfusion with antibody-containing blood products. Medications Affecting Coagulation: Laboratory Results to Report aPTT 1.5-2 times the baseline Platelet count less than 100,000 Medications Affecting Coagulation: Reviewing Laboratory Findings for a Client Receiving Heparin Monitor activated partial thromboplastin time (aPTT), keep value at 1.5 to 2 times the baseline. Stop heparin if platelet count is less than 100,000/mm3. Medications Affecting Coagulation: Adverse Effects of Clopidogrel Prolonged bleeding time gastric bleeding thrombocytopenia GI effectsdiarrhea dyspepsia pain Medications for psychotic disorders, reportable findings in a patient taking clozapine. Atypical antipsychotic, notification of provider (fever, sore throat, mouth lesions), r/t risk of agranualocytosis. Wt gain, diabetes, dyslipidemia, Other Adverse effects are sedation, orthostatic hypotension, anticholinergic effects. A nurse is providing instruction to a client who has a new prescription for ondansetron (Zofran). The nurse should advise the client that which of the following is an adverse effect of the medication? A. Headache B. Urinary retention C. Tachycardia D. Black stools A. Headache Headache is a common adverse effect of ondansetron. The patient may require a nonopioid analgesic to treat the headache. Other common adverse effects include dizziness and diarrhea. Penicillin Adverse Effects -Anaphylactic/Allergy: interview for allergy, observe for 30 min after admin of parental penicillin 8

9 Pharmacology ATI

-Renal Impairment: monitor I&O's and kidney function -Hyperkalemia/hypernatremia: monitor cardiac status and electrolyte levels Cephalosporin Allergic reactions -Anaphylaxis- if rash, hives, hypotension occur STOP and notify provider -NO giving if allergic to penicillins -Bleeding tendencies: avoid if bleeding disorder and taking anticoags -Diarrhea - notify provider and stop using USE CAUTION in for renal impairment and bleeding tendencies Common Side Effects of Rifampin: ● Heartburn. ● Upset stomach and cramps. ● Gas. ● Diarrhea. ● Headache. ● Drowsiness. ● Fatigue. ● Dizziness.

rifampin (Rifadin) antibiotic, antitubercular drug. May turn all body fluids orange-red (such as tears, sweat, saliva, and urine) but is a harmless side effect. Opioid Indications: Moderate to severe pain, sedation, Effects: respiratory depression, orthostatic hypotension, urinary retention, constipation, and opioid overdose (coma, respiratory depression, and pinpoint pupils) What is the reversal agent: naloxone Contraindications: asthma, emphysema (ANY respiratory disease) Interactions: CNS depressants, anticholinergic agents, and antihypertensives Key Actions: assess pain level, double check opioid doses (PINCH meds), don't DC abruptly, closely monitor PCA pump hydrochlorothiazide MEDICATION/FOOD INTERACTIONS Digoxin (Lanoxin) toxicity (ventricular dysrhythmias) can occur in presence of hypokalemia -Monitor cardiac status, potassium and digoxin levels Concurrent use of antihypertensives can have additive hypotensive effect Lithium carbonate (Eskalith) serum levels can increase which may lead to toxicity, if hyponatremia occurs due to loop diuretic 9

10 Pharmacology ATI

-Monitor lithium levels NSAIDs decrease blood flow to kidneys, reducing diuretic effect -Watch for decrease in effectiveness of diuretic (decrease in urine output)

Expected Actions/Outcomes: Endocrine Disorders: Identifying a Need for a Dosage Increase of Levothyroxine: May need to be increased if many antiseizure and antidepressant medications including carbamazepine (Tegretol), phenytoin (Dilantin), phenobarbital and sertraline (Zoloft) can increase levothyroxine metabolism Urinary Tract Infections: Evaluating Client Response to an Analgesic Relieves manifestations of burning on urination, pain, frequency and urgency Urinary Tract Infections: Evaluating Client Response to an Analgesic—medications phenazopyridine (Pyridiate, Pyridium,Urogesic) Urinary Tract Infections: Evaluating Client Response to an Analgesic--nursing considerations - contraindicated for a client who has acute kidney injury or chronic kidney disease - medication turns urine orange/red color - instruct the client that urine may stain clothes - administer with or after meals to prevent mild GI upset Growth Factors: Evaluating Client Response Absence of infection and WBC and differential within expected reference ranges Hgb level of 10-11 g/dL Max Hct of 33% Platelet greater than 50,000 Medications Affecting Labor and Delivery: Priority Action for a Client Receiving Oxytocin —contraindications: - Maternal factors include sepsis, an unripe cervix, genital herpes, hx of multiple births, and/or uterine surgery - Fetal factors include immature lungs, cephalopelvic disproportion, fetal malpresentation, prolapsed umbilical cord, fetal distress, and threatened spontaneous abortion Medications Affecting Labor and Delivery: Priority Action for a Client Receiving Oxytocin--nursing administration: - Use an infusion pump to administer IV oxytocin. Gradually increase the flow rate per prescribed parameters, such as increase by 1 mcg/min every 30 min - Continuously monitor BP and pulse - Carefully monitor uterine contractions (goal is contractions that last 1 min or less every 2-3 min) - Monitor for uterine hyperstimulation (contractions lasting longer than 60 sec, occurring more frequently than every 2-3 min, resting uterine pressure greater than 15 mm Hg) Stop infusion and notify provider - Continuously monitor fetal HR and rhythm. Report finding of fetal distress Medications Affecting Labor and Delivery: Priority Action for a Client Receiving Oxytocin--Therapeutic uses: - Induction of labor ( postterm pregnancy, premature rupture of membranes, pre-eclampsia) 10

11 Pharmacology ATI

- Enhancement of labor, such as dysfunctional labor - Delivery of placenta (postpartum, miscarriage) - Management of postpartum hemorrhage - Stress testing Airflow Disorders: Evaluating Understanding of Teaching-- Beta2-adrenergic agonists-albuterol (Proventil, Ventolin), Formoterol (Foradil, Aerolizer), Salmeterol (Serevent), Terbutaline (Brethine): -advise client to observe for chest, jaw or arm pain or palpitations and notify MD if they occur -check pulse and report an increase of greater than 20-30 beats/min -avoid caffeine -dosage may need to be reduced -tremors usually resolve with continued use -beta-adrenergic blockers should not be used concurrently -report changes in HR and chest pain Airflow Disorders: Evaluating Understanding of Teachin...