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N220 Study Guide for Final Exam

1. Heparin administration  It is an anticoagulant drug. (prevents blood clots)  It is monitored by aPTT; doesn’t need to be monitored if only used for flushing.  Antidote: Protamine sulfate  Adverse effect: heparin-induced thrombocytopenia (HIT)  Short ½ life (1-2 ½ hours)  Administration:  It is given subcutaneously ( ½ - 5/8 inch; 25-28 gauge needle);  Avoid any area within 2 inches of the umbilicus, open wounds, scars, open or abraded areas, incisions, drainage tubes, stomas, or areas of bruising or oozing.  Injection sites: upper, outer area of the arms, the thigh, and the subcutaneous fatty area across the lower abdomen and between the iliac crests  Always double-check that enoxaparin (Lovenox) and heparin are never given to the same patient.  Assess for allergy to benzyl alcohol  Lab values: aPTT 1.5-2.5 times the control/baseline; target therapeutic level: 45-70 seconds

2. Assessment of fluid volume status when receiving diuretic therapy 

Assess patient and medication history

 Assess baseline breath sounds, heart sounds, and neurological status  Check skin turgor (for edema), moisture levels of mucous membranes, and capillary refill  Assess baseline fluid volume status: vital signs, weight, and intake and output measurements  Assess postural blood pressures (lying, sitting, standing) bc diuretic use can lead to postural or orthostatic hypotension – drop in BP of 20 mm Hg or more upon standing  Assess lab values: BUN level (8-25mg/100mL), creatinine level (0.6-1.5mg/100mL), serum K+, Na+, Cl, Mg, Ca+, uric acid, and creatinine levels  Monitor serum potassium levels during drug therapy  Teach patient to maintain proper nutritional and fluid volume status

3. Administration of nitroglycerin 

It is an antianginal drug (treat chest pain).

 It has a large 1st pass effect w/oral forms (a large amount is removed before it is active in the body).  Long acting form: prevents angina episodes (oral or topical form)  Rapid acting form: treat acute angina episodes (IV or SL) (also translingual; spray on tongue then close mouth immediately)  Contraindication: erectile dysfunction drugs  Adverse effects: reflex tachycardia (increased HR)  Tolerance prevention: Transdermal patches are removed at night for 8 hours; new patch is applied in am  Administration: 

SL: Take at 1st sign of chest pain; allowed to take 3 tablets within 15 min, with a 5 min time difference in between each; call 911 after taking the 1 st dose if no relief occurs

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IV: must be given w/non-PVC tubing to protect it from light; good for 96 hours

 Nitroglycerin storage: 

Keep in amber(dark) colored container

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Once taken should burn or sting which means it’s still potent

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Change bottle every 3 months

4. Potassium sparing drugs 

Adverse effect: hyperkalemia; assess serum levels of potsssium

 Contraindications: potassium supplements, ACE inhibitors (end in ‘prils and an A/E of these drugs is hyperkalemia, and severe renal failure  Interactions: lithium toxicity may occur when given w/potassium sparing diuretics  S/S of hyperkalemia: n/v/d, with toxic levels manifested by cardiac rhythm abnormalities

5. Nursing considerations for digoxin 

It is a cardiac glycoside drug.

 It has a ½ life of 36 hours (given once daily).  ⬇ K+ level (less than 3.5) can cause digoxin toxicity  Assess apical pulse for 1 full minute; notify MD if apical pulse is less than 60 bpm or greater than 90 bpm and withhold the dose  Digoxin toxicity: bradycardia, headache, dizziness, confusion, nausea, and visual disturbances (yellowgreen halo or blurred vision)  Antidote: digoxin immune Fab (digifab)  Diet: avoid foods high in fiber; ok to take w/meals

 Don’t give with St. John Worts  Therapeutic levels: 0.5-2ng/mL  + inotropic (⬆ force of contraction), -chronotropic (⬇HR) , -dromotropic (slows conduction through the AV node)

6. Adverse effects of albumin  Distended neck veins (JVD)  SOB  Anxiety  Insomnia  Expiratory crackles  Frothy, blood-tinged sputum  Cyanosis (indication of fluid volume overload)

7. Indicators for epinephrine use  It is administered in emergency situations  May be D.O.C. for anaphylaxis  Treats acute asthma and shock

8. Antidote for atropine  It is an anticholinergic drug.  Antidote for atropine: Physostigmine (cholinergic drug)

9. Nursing assessment during postop period  Assess for malignant hyperthermia: s/s a rapid rise in body temperature, tachycardia, tachypnea, muscle rigidity, cyanosis, irregular heartbeat, mottling of the skin, diaphoresis, and an unstable BP.  Perform a respiratory assessment: assess respiratory rate, rhythm, and depth; breath sounds; oxygen saturation level), especially if the patient has a history of smoking or is currently a smoker  Treatment for malignant hyperthermia is Dantrolene

10. Nursing education for Lasix 

It is a loop diuretic. Loop diuretics cause you to loose potassium.

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Lasix should be taken in the early in the morning because it causes diuresis.

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Diet: eat foods high in potassium such as bananas, oranges, apricots, dates, raisins, broccoli, green beans, potatoes, tomatoes, meats, fish, wheat bread, and legumes.

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Encourage patients to change positions slowly and to rise slowly after sitting or lying down to prevent dizziness and possible fainting (syncope).

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Monitor weights daily.

11. Contraindication for beta blocker  Uncompensated heart failure  Cardiogenic shock  Heart block or bradycardia  Pregnancy  Severe pulmonary disease  Raynaud’s disease

12. How to administer inhalers  Administer bronchodilator 1st to open the airway then wait 2-5 minutes and administer corticosteroid.  Take every day regardless of whether you feel better or not.  After administration, rinse mouth to prevent irritation or infection.

13. Nitroglycerin therapy  Routes: IV, ointment, spray, sublingual, patch. These routes avoid first past effect.  Instruct patients in proper technique and guidelines for taking sublingual nitroglycerin for anginal pain  Instruct patients never to chew or swallow the sublingual form  Instruct patients that a burning sensation felt with sublingual forms indicates that the drug is still potent  Instruct patients in the proper application of nitrate topical ointments and transdermal forms, including site rotation and removal of old medication  To reduce tolerance, the patient may be instructed to remove topical forms at bedtime and apply new doses in the morning, allowing for a nitrate-free period  Instruct patients to take prn nitrates at the first hint of anginal pain  Monitor vital signs frequently during acute exacerbations of angina and during IV administration  If experiencing chest pain, the patient taking sublingual nitroglycerin should lie down to prevent or decrease dizziness and fainting that may occur because of hypotension  If anginal pain occurs: o Stop activity and sit or lie down o Take a sublingual tablet, and call 911/Emergency Services immediately! o If no relief in 5 minutes, take a second sublingual tablet

o If no relief in 5 minutes, take a third sublingual tablet o Do not try to drive to the hospital  IV forms of nitroglycerin must be given with special non-PVC tubing and bags  Discard parenteral solution that is blue, green, or dark red  Follow specific manufacturer’s instructions for IV administration

14. Nursing education on beta blockers 

- chronotropic (decrease the HR) and – inotropic (decrease contractility)

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Count the apical pulse for 1 full minute.

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Withhold dose if systolic BP is lower than 100 or the pulse is lower than 60bpm.

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Daily weights are important. Report weight gain of 2lbs or more in a 24hr period or 5lbs or more within 1 week.

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Don’t stop taking meds abruptly, patient must be weaned off the drug slowly to prevent rebound HTN or chest pain.

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Avoid alcohol because it may cause vasodilation.

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Avoid CNS stimulants and caffeine.

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Nonselective BB- assess for history of asthma

15. Know captopril (Capoten) 

ACE inhibitor

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It has a short ½ life; it can be 3-4 times daily

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It can be given to patients w/liver problems because it isn’t metabolized in the liver.

16. Know about drug’s half-life  Drug ½ life- time required for one ½ of a given drug to be removed from the body or the time it takes for the blood level of a drug to be reduced by 50%

17. Know drug that stimulate platelet cell production (Ch 54) p880  Epogen (Epoetin Alfa) is a colony-stimulating factor that is responsible for erythropoiesis, or formation of red blood cells 18. Nursing education on phenytoin (Dilatin)  Therapeutic levels: 10-20mcg/mL  Adverse effect: gingival hyperplasia; Scrupulous dental care can help prevent gingival hypertrophy.  Its long ½ life allows twice or even once a day dosing.  IV form: must be diluted in NS, administered slowly by IV push, implement fall precautions, and take VS up to 2 hours after infusion, pH of 12

19. Adverse effects of Cyclosporine  It is an immunosuppressant drug indicated for the prevention of organ rejection.  A/E: moderate HTN, hepatotoxicity (cholestasis and hyperbilirubinemia), neurotoxicity (tremors), nephrotoxicity, posttransplant DM, gingival hyperplasia, and hirsutism

20. Nursing administration of antiemetic  Antiemetics are usually given 30-60min before chemo  Ondanestron (Zofran)- usually given 30min before chemo  Dronabinol (marinol)- admin 1-3hrs before chemo  Relief of nausea should occur w/i 15min of oral drug administration.  Scopolamine transdermal patch: is applied behind the ear at least 4 hours before traveling  Administration: tell patients to change positions slowly, avoid driving and using heavy machinery while taking these meds. They may cause hypotension and drowsiness.

21. Know about insulin therapy 

Administration: 

It is given subcutaneously ( ½ in inch; 29 gauge needle);

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Injection sites: upper, outer area of the arms, the thigh, and the subcutaneous fatty area across the lower abdomen and between the iliac crests. Avoid any area within 2 inches of the umbilicus, open wounds, scars, open or abraded areas, incisions, drainage tubes, stomas, or areas of bruising or oozing.

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Administer SQ at 90 degree or if the patient is emaciated (skinny) give it at a 45 degree angle

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Double check w/another nurse

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Insulin syringe: orange caps, calibrated in units

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Rotate sites within the same general location for about 1 week before moving to a new site

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w/D clear (regular or rapid acting) 1st then w/D intermediate or NPH insulin.

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Regular insulin (Humulin R)- short acting; can be given IV bolus, IV infusion, or IM. Only insulin given IV.

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Rapid acting: give 15 minutes before eating (TQ answer was 5 minutes)

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Long acting: insulin glargine (Lantus) & insulin detemir (levemir) lasts 24 hours

22. Effects of SSRI antidepressants 

Educate patients that antidepressant drugs commonly must be taken for several weeks before full therapeutic effects are realized. (maybe 4-6 weeks)

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Adverse effects: insomnia, weight gain, and sexual dysfunction. Serotonin syndrome: agitation, tachycardia, hyperreflexia, and tremors

23. Adverse effects of adrenergic drugs  Hypertensive crisis, chest pain, palpitations, headaches, or seizures (treated w/Valium) 24. Drug used for opioid withdrawal  Methadone or Clonidine (Catapres) 25. Drug of choice for status epilepticus  Diazepam (Valium) 26. Education on hypertension 

Taken meds as prescribed. Don’t stop abruptly taking because it may lead to rebound HTN!

 Change positions slowly to avoid orthostatic hypotension.  Withhold dose if systolic BP is lower than 100 or the pulse is lower than 60bpm.  Daily weights are important. Report weight gain of 2lbs or more in a 24hr period or 5lbs or more within 1 week.  Don’t stop taking meds abruptly, patient must be weaned off the drug slowly to prevent rebound HTN or chest pain.  Avoid alcohol because it may cause vasodilation.  Avoid CNS stimulants and caffeine.  Avoid heat because it may precipitate vasodilation and lead to worsening of hypotension.  Scheduling of eyes is recommended every 6 months d/t the need to evaluate treatment effectivenesss.  Avoid salt substitutes and limit salt intake.  Report dizziness, palpitations, and orthostatic hypotension immediately to physician.

27. Nursing outcome of somatropin  Increased growth 28. Ritalin therapy  It is indicated for the treatment of ADHD.  Medications are usually taken 1st thing in the morning to minimize interference w/sleep.  It is recommended that these drugs not be taken w/I 4-6 hours of sleep.  Monitor patient for continued physical growth, with specific attention to height and weight.  Therapeutic responses: ⬆ attention span and concentration, ⬇ hyperactivity, improved behavior, and for adults ⬆ effectiveness at work

29. Folic acid treatment

 Recommended that use begin 1 month before pregnancy & continued through early pregnancy to prevent fetal neural defects.

30. Antidote for cholinergic drug  Atropine

31. Which medication form is fastest?  The parenteral route is the fastest route by which a drug can be absorbed. Intravenous drugs are absorbed the fastest then IM and SQ.

32. Characteristics of opioid overdose  Respiratory depression (most serious), decreased urinary output, pinpoint pupils, respiratory rate less than 10 indicates respiratory depression, dizziness, low BP, excessive sleeping (sedation), confusion, or loss of memory

33. Nursing education antineoplastic drug therapy 

Avoid intake of alcohol, tobacco, spicy and high fiber foods, citrus fruit or juices or foods, and foods that are too hot or too cold or have a rough texture

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Stress that daily mouth care is needed. Instruct the patient to report mouth sores, pain, or white patches to the prescriber immediately.

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Instruct patients to avoid OTC meds such as aspirin, ibuprofen, and any meds containing these drugs.

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Antineoplastics may cause alopecia so discuss options for hair and scalp care.

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Advise the patient to avoid alcohol, salicylates, NSAIDs, and exposure to sunlight or UV light.

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If patient’s WBC counts are low, caution the patient to avoid individuals who are ill. Immediately report any easy bleeding, bruising, difficulty breathing, fever, sore throat, or chills.

34. Know about good cholesterol     

(HDL): ◾Men: ⬇ 40mg/dL ◾Women: ⬇ 50mg/dL Total cholesterol: 180-200 mg/dL (⬇ 200) LDL: ⬇ 100 mg/dL Triglycerides: ⬇ 150 mg/dL Fasting serum: ⬇ 110 mg/dL

35. Know the med rights  RIGHT patient, route, dose, time, drug, and documentation 36. Administration of antacid  Give other drugs 1-2 hours before its administration

37. Nursing education on insulin administration o

Rapid Acting Insulins (insulin lispro)

     

o

o

o

o

o

Most rapid onset of action: roughly 15 minutes. Peak: 1-2 hr Elimination Half life: 80 min Short duration of action: 3-5 hr Route: Subcut Often used within 15 minutes of mealtime. It is ESSENTIAL to eat a meal after injection.  After a meal, the glucose that is ingested stimulates the pancreas to screte insulin. Short Acting Insulin: (regular insulin)  Regular insulin (Humulin R) is currently the only insulin that is classified as a short-acting insulin.  Faster onset of action, shorter time to peak plasma level, shorter duration of action.  Route: Subcut  Onset: 30-60 min  Peak: 2.5 hr  Elimination half life: unknown  Duration of action: 6-10 hr Intermediate-acting insulins (insulin isophane suspenisn (NPH))  NPH insulin is currently the only available intermediate-acting insulin product.  Appears cloudy or opaque  Route: Subcut  Onset of Action: 1-2 hr  Peak: 4-8 hr  Duration of action: 10-18 hr Long-Acting Insulins (insulin glargine and insulin detemir)  Insulin glargine is usually dosed once daily, but the drug may be dosed every 12 hours, depending on glycemic response. Insulin glargine provides a more prolonged, consistent blood glucose level, it is sometimes referred to as a basal insulin.  2 insulins should NOT be considered interchangeable Fixed Combination Insulins (Humulin, Novolin, Humalog, NovoLog)  Each contains 2 different insulins, one intermediate-acting type and either one rapid-acting type of one short-acting type. Used to optimize glycemic control  Maintain constant blood glucose levels after and between meals.  Route: Subcut  Onset: 1-2 hr  Peak: None  Duration: 24 hr Slide-Scale Insulin Dosing  An important method for dosing insulin  Typically used in hospitalized diabetic patients whose insulin requirements may vary drastically because of stress, inactivity, variable caloric intake, etc.  Blood glucose concentrations are determined several times a day.  Research and institutions are moving away from sliding-scale coverage.

38. Nursing action for extravasation of antineoplastic drug  Stop the infusion immediately while leaving the catheter in place.

 Leave the IV cannula in place (for possible use of antidotes through cannula to access affected area).  Use of hot or cold packs to the site.

39. Antinausea drug to stimulate appetite  Dronabinol (Marinol)- antiemetic drug used for the treatment of n/v and is used to stimulate appetite and weight gain in patients w/ AIDs and chemo patients

40. Know inotropic, chronotropic, and dromotropic  Inotropic- affects the force of contraction of the heart muscle  Chronotropic- affects the heart rate (HR)  Dromotropic- affects conduction through the AV node

41. Cardiovascular effects of cholinergic drugs  decreased heart rate and vasodilation (⬇ BP)

42. Nursing education on guafenesin (Mucinex)  It is an expectorant. It is beneficial in the treatment of productive coughs because it thins mucus in the respiratory tract that is difficult to cough up.  Encourage intake of fluids, unless contraindicated.  Avoid alcohol and products containing alcohol and should not use these products for longer than 1 week.

43. Know digoxin and digifab If the patient does not respond to treatment of digoxin, they can be given phosphodiesterare inhibitors. Digoxin is the prototype for cardiac glycosides Digoxin has a very narrow therapeutic window, so the drug levels must be monitored  0.5 to 2 ng/mL Low potassium levels increase its toxicity Electrolyte levels must be monitored Adverse Effects of Digoxin:  Dysrhythmias (bradycardia or tachycardia), headaches, fatigue, malaise, confusion, convulsions, colored vision (seeing green, yellow, purple), halo vision, flickering lights, anorexia, nausea, vomiting, diarrhea Digoxin Toxicity:  Treated by digoxin immune Fab (Digibind) therapy  Hyperkalemia (serum potassium greater than 5 mEq/L) in a digitalis-toxic patient  Life-threatening cardiac dysrhythmias  Life-threatening digoxin overdose Conditions that predispose to Digox...