Pharmacology ATI Remediation First Attempt Level 1 PDF

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ATI Pharm Remediation Level 1 First Attempt Remediation Level 1 transcript remediation...

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Psychosocial Integrity (1 item) Substance Use and Other Disorders and Dependencies (1 item) Substance Use Disorders: Client Teaching About Nicotine Replacement Options (RM Pharm RN 8.0 Chp 12 Substance Use Disorders, RM Pharm RN 8.0 Chp 12 Substance Use Disorders v2,Active Learning Template: Medication) Clients who have substance use disorder can experience tolerance and withdrawal. There are multiple pharmaceutical product substitutes for nicotine. Nicotine lozenge is a substitute used that slowly dissolves in the mouth. Nicotine gum is another substitute used but is recommended to not use for longer than six months. Varenicline is a nicotinic receptor agonist that aids in the release of dopamine to stimulate enjoyable effects of nicotine. This medication helps reduce cravings and withdrawal symptoms. By blocking the nicotine receptors, it reduces relapse as well. The nurse should monitor the patient’s BP through out use. It can also affect glycemic control and patients should take this medication after eating. The patient should notify the provider of N/V, insomnia, new-onset depression, and/or suicidal ideation. Nicotine patches are a replacement therapy used. They shout be applied to clean, dry skin to ensure adherence. If going in to have an MRI the patch should be removed and can be replaced once scan is done. Electronic cigarettes are another replacement therapy used by many. It is a battery powered device that releases a puff of vaporized nicotine. However, there is not much known on the true effectiveness of this method even though many patients may claim it helps. It is also not FDA approved and is recommended to be avoided. Bupropion is another medication used for the cessation of smoking. It lowers the cravings for nicotine but should be avoided in patients with increased risk of seizures. It can cause dry mouth and is suggested for patients to chew sugar free gum or suck on candies to alleviate this side effect. It is also important to avoid caffeine and other CNS stimulants while taking this drug to avoid insomnia associated with its consumption.

Pharmacological and Parenteral Therapies (16 items) Dosage Calculation (1 item) Dosage Calculation: Calculating Dosage for Potassium Elixir (RM Pharm RN 8.0 Chp 3 Dosage Calculation, RM Pharm RN 8.0 Chp 3 Dosage Calculation v2,Active Learning Template: Basic Concept) Nurses are responsible for giving precisely calculated medication amounts for if they give an incorrect amount, the consequence could be deadly. Nurses can use 3 different ways to calculate medication using: ratio and proportion, desired over have formula, and dimensional analysis. If an incorrect amount of potassium is administered to the patient, lethal dysrhythmias could occur which may result in injury or death of the client. Example: A nurse is getting ready to administer amoxicillin 0.25 g PO every 8 hours. The amount available is amoxicillin 250mg/5mL. How many mL should the nurse administer per dose? Change 0.25 g to 250 mg by moving the decimal three places to the right. Cross multiply 250 with 5 and 250 to x. 1250=250X and the divide by 250 and you 5 mL. The nurse should administer 5mL.

Adverse Effects/Contraindications/Side Effects/Interactions (5 items)

Antibiotics Affecting the Bacterial Cell Wall: Priority Finding to Report to Provider (RM Pharm RN 8.0 Chp 44 Antibiotics Affecting the Bacterial Cell Wall, RM Pharm RN 8.0 Chp 44 Antibiotics Affecting the Bacterial Cell Wall v2,Active Learning Template: Medication) It is important to find out if a patient has any antibiotic and other medication allergies. If allergies are unknown then the nurse should observe the patient for a reaction for at least 30 minutes after administration of antibiotic. The nurse should monitor the patient’s kidney function and I&O’s. High doses of penicillin G potassium can lead to hyperkalemia and dysrhythmias, and IV ticarcillin-clavulanate can lead to hypernatremia. It is important for the nurse to monitor the cardiac status and electrolyte levels. Cardiac Glycosides and Heart Failure: Risk Factors for Digoxin Toxicity (RM Pharm RN 8.0 Chp 21 Cardiac Glycosides and Heart Failure, RM Pharm RN 8.0 Chp 21 Cardiac Glycosides and Heart Failure v2,Active Learning Template: Medication) Digoxin is a prototype cardiac glycoside, the drug class of medications that increase the force of myocardial contraction to improve the heart’s pumping effectiveness. Quinidine use increases risk of dig toxicity by removing digoxin from its receptors and reducing kidney excretion. Those with heart disease and older adults are at increased risk for dig toxicity. Potassium and digoxin interact so it’s important to monitor potassium levels between 3.5-5.0mg/dL

Chronic Neurologic Disorders: Medications That Interact With Carbamazepine (RM Pharm RN 8.0 Chp 13 Chronic Neurologic Disorders, RM Pharm RN 8.0 Chp 13 Chronic Neurologic Disorders v2,Active Learning Template: Medication) Carbamazepine causes a decrease in the effects of oral contraceptives and warfarin due to stimulation of hepatic medication metabolizing enzymes. Phenytoin and phenobarbital decrease the effects of carbamazepine and should not be used concurrently. Valproic acid increases the level of phenytoin thereby requiring drug level monitoring. Grapefruit juice also increases the drug level. Chronic Neurologic Disorders: Assessing a Client's Response to Phenytoin (RM Pharm RN 8.0 Chp 13 Chronic Neurologic Disorders, RM Pharm RN 8.0 Chp 13 Chronic Neurologic Disorders v2,Active Learning Template: Medication) Antiepileptics control seizure disorders, with phenytoin being a first-generation AED. Phenytoin produces CN effect, gingival hyperplasia, skin rash, CV and endocrine effects. The nurse should instruct the client to consume calcium and Vitamin D and assess medication effectiveness by the patient’s ability to perform ADLs and absence of seizure activity. Medications Affecting Urinary Output: Reporting Adverse Effects of Furosemide (RM Pharm RN 8.0 Chp 19 Medications Affecting Urinary Output, RM Pharm RN 8.0 Chp 19 Medications Affecting Urinary Output v2,Active Learning Template: Medication)

Furosemide is a high-ceiling loop diuretic. The nurse should monitor for signs of dehydration such as dry mouth, increased thirst, and weight loss to name a few. The nurse should report urine output less than 30 mL per hour and notify then provider of headaches, chest, calf, and/or pelvic pain. Those signs can mean possible thrombosis or embolism. Adverse effects include hypokalemia, ototoxicity, hyperglycemia, hypernatremia, decrease in HDL cholesterol, increase in LDL cholesterol, and hypotension.

Expected Actions/Outcomes (2 items) Antilipemic Agents: Medications for High Cholesterol (RM Pharm RN 8.0 Chp 24 Antilipemic Agents, RM Pharm RN 8.0 Chp 24 Antilipemic Agents v2,Active Learning Template: Basic Concept) Antilipemic agents help lower low-density lipoprotein (LDL) cholesterol levels and elevate high0density lipoprotein (HDL) cholesterol levels. Atorvastatin, simvastatin, lovastatin, pravastatin, rosuvastatin, Fluvastatin, pitavastin, simvastatin and ezetimibe are all cholesterol lowering medications. These medications promote vasodilation, decrease in plaque site inflammation, thromboembolism, and risk of arterial fibrillation. Heart Failure and Pulmonary Edema: Priority Actions for a Client Who Has Heart Failure (RM AMS RN 11.0 Chp 32 Heart Failure and Pulmonary Edema,Active Learning Template: System Disorder) Heart failure happens when the heart muscle is no longer able to pump properly. This leads to inadequate cardiac output, myocardial hypertrophy, and pulmonary congestion. It is important to monitor daily weight, assess for SOB, and dyspnea. Position the patient in a high-fowler’s position to promote maximum ventilation. It is important for the patient to maintain an exercise routine and consume a diet low in sodium.

Medication Administration (2 items) Angina: Teaching About a Nitroglycerin Transdermal Patch (RM Pharm RN 8.0 Chp 22 Angina, RM Pharm RN 8.0 Chp 22 Angina v2,Active Learning Template: Medication) Transdermal patches have a slow onset but are used for long term to help against anginal attacks. It is important to not cut the patches to ensure the patient gets the full dose intended. When removing the patch, wash the skin with soap and water and dry the area thoroughly before applying a new patch. Remove the patch at night before going to sleep to lower the risk of developing a tolerance for nitroglycerin. It is important to be medication free for 10 to 12 hours of the day. Diabetes Mellitus: First Action When Mixing Insulins in One Syringe (RM Pharm RN 8.0 Chp 39 Diabetes Mellitus, RM Pharm RN 8.0 Chp 39 Diabetes Mellitus v2,Active Learning Template: Nursing Skill) Diabetes is a chronic illness that results from an absence or insufficiency of insulin produced in the body. Lispro is a long-acting insulin, regular insulin is short-acting, NPH is intermediate-acting, and glargine U100 is long-acting insulin and all these types of insulins having different peak times that aid the patient with their disease and what activities they are doing and what they are eating. That way the glucose does not build up in the body. When mixing two different insulins, the nurse should always draw up the short0acting insulin into the syringe first. This prevents accidently getting the long-acting insulin mixed into the short-acting insulin vial cause unwanted and unexpected effects that could potentially harm the patient.

Pharmacological Pain Management (2 items) Individual Considerations of Medication Administration: Risk Factors for Adverse Reactions in Older Adult Clients (RM Pharm RN 8.0 Chp 6 Individual Considerations and Medication Administration, RM Pharm RN 8.0 Chp 6 Individual Considerations of Medication Administration v2,Active Learning Template: Growth and Development) Older adults have reduced liver and kidney function requiring proportionately smaller medication doses to compensate for their heightened sensitivities to medications. Multiple comorbidities in older adults often affect medication therapy along with poor adherence or polypharmacy. Physiologic changes can include increased gastric pH, decreased GI motility, hepatic enzyme function and lean body mass.

Opioid Agonists and Antagonists: Administering Medication for Breakthrough Pain (RM Pharm RN 8.0 Chp 36 Opioid Agonists and Antagonists, RM Pharm RN 8.0 Chp 36 Opioid Agonists and Antagonists v2,Active Learning Template: Medication) Opioids are medications used to treat moderate to severe pain. The nurse should assess the patient’s pain level on a regular basis. Opioid dose should be double checked by another nurse to ensure the right dosing. Administer IV opioids at a rate of 4 to 5 minutes and always naloxone and resuscitation equipment on hand when administering opioids. Opioid agonist and other morphine-like drugs act on the MU receptor. Activating MU receptors produces analgesia, respiratory depression, euphoria, and sedation. They are used for pain relief, sedation, reduction of bowel movement, and cough suppression. These medications are known to cause respiratory suppression and it is important to monitor vital signs and is respiratory rate goes lower than 12 to discontinue the medication. Also, avoid the use of opioids with CNS depressants such as barbiturates and benzodiazepines. Other complications are constipation, orthostatic hypotension, urinary retention, cough suppression, sedation, biliary colic, N/V, and opioid toxicity triad (coma, respiratory depression, and pinpoint pupils). These medications are contraindicated for patients who are pregnant and are a category risk C. Some can be contraindicated for patients with kidney failure due to the accumulation of normeperidine leading to seizures and neurotoxicity. Patients should avoid drinking alcohol when using opioids. The nurse should look for evidence of effectiveness of medication such as relief of pain, cough suppression, and resolution of diarrhea.

Parenteral/Intravenous Therapies (4 items) Electrolyte Imbalances: Findings Indicating Effective Hypertonic Infusion (RM Fund 10.0 Chp 58 Electrolyte Imbalances,Active Learning Template: Basic Concept) Hyponatremia is when sodium levels fall below 136 mEq/L in the body. It is an excess of water in the plasma or from loosing too much sodium-rich fluids. Findings of effective hypertonic infusion include headache relief and sodium levels rising back to the normal range of 136-145 mEq/L. Vital signs should stabilize such as an elevated heart rate lowering back down, pulse rate slowing back down to normal, and the patient’s blood pressure rising back up to normal. Intravenous Therapy: Actions for an IV Infusion Infiltration (RM Pharm RN 8.0 Chp 4 Intravenous Therapy, RM Pharm RN 8.0 Chp 4 Intravenous Therapy v2,Active Learning Template: Nursing Skill)

Infiltration is local swelling at the IV site. The temperature of the skin is cooler around the site and the infusion is slowed. The first thing the nurse should do is stop the infusion and remove the catheter. Then elevate the extremity and encourage active range of motion. Depending on the type of fluid that infiltrated the tissue, apply a warm or cold compress. Extravasation is infiltration of a tissue damaging medication. The site will be painful, red, swollen, and usually have a burning sensation. Typical protocols involve withdrawing the solution from the IV and infusing an antidote before removal of the catheter. Intravenous Therapy: Nursing Actions for IV Infiltration (RM Pharm RN 8.0 Chp 4 Intravenous Therapy, RM Pharm RN 8.0 Chp 4 Intravenous Therapy v2,Active Learning Template: Nursing Skill) Infiltration is local swelling at the IV site. The temperature of the skin is cooler around the site and the infusion is slowed. The first thing the nurse should do is stop the infusion and remove the catheter. Then elevate the extremity and encourage active range of motion. Depending on the type of fluid that infiltrated the tissue, apply a warm or cold compress. Extravasation is infiltration of a tissue damaging medication. The site will be painful, red, swollen, and usually have a burning sensation. Typical protocols involve withdrawing the solution from the IV and infusing an antidote before removal of the catheter.

Total Parenteral Nutrition: Initiating Therapy (RM Nutrition 7.0 Chp 10 Total Parenteral Nutrition,Active Learning Template: Therapeutic Procedure) Parenteral nutrition (PN) is used when a patient’s gastrointestinal tract does not work properly or when a patient cannot physically get enough nutrients orally. Before starting PN the nurse should review the patient’s weight, BMI, nutritional status, diagnosis, and current labs. Labs include CBC, blood chemistry profile, PT/aPTT, iron, iron-binding capacity, lipid profile, liver function test, electrolyte panel, BUN, prealbumin and albumin level, creatine, blood glucose, and platelet count. An electronic infusion device can help prevent accidental overload of solution. It is very important to talk to the patient about any food allergies such as soybeans, safflower, or eggs especially when lipids are prescribed. TPN provides a nutritionally complete solution to the patient. It is used for when caloric needs are high, long-term therapy is needed, or when a solution that is supposed to be given is hypertonic. TPN is given only in a central vein. Carbohydrate or dextrose solutions are available in concentrations up to 70 percent for TPN. Administering any IV medication through a PN IV or port is contraindicated. TPN is used for patients going through cancer treatment, bowel disorders, critically ill, and patients suffering major traumas or burns. Typically, the patient will have a tunneled catheter and feedings can be given while the patient is asleep. Ongoing care includes checking the patient’s I&O’s, daily weights, vital signs, lab value like electrolytes, and evaluation of the patient’s underlying condition. The nurse should monitor the blood and urine glucose too. The flow rate should be monitored carefully. Too slow of a rate will fail to meet the client’s nutritional needs and too fast can cause hyperosmolar diuresis which can cause dehydration, hypovolemic shock, seizures, coma, and death. Monitor for “cracking” of the TPN solution which happens when the calcium or phosphorus content is high or if poor-salt albumin is added. The solution will have an oily appearance or a layer of fat on top and should n not be used. If the solution was refrigerated, let it get to room temperature for one hour prior to giving. Use aseptic technique when setting up the IV tubing, changing site dressing, and accessing or de-accessing the IV site. Change the PN bag and tubing set every 24 hours or per facility protocol.

Reduction of Risk Potential (1 item)

Changes/Abnormalities in Vital Signs (1 item) Medications Affecting Coagulation: Monitoring for Adverse Effects of Heparin (RM Pharm RN 8.0 Chp 25 Medications Affecting Coagulation, RM Pharm RN 8.0 Chp 25 Medications Affecting Coagulation v2,Active Learning Template: Medication) Heparin is an anticoagulant that prevents clotting activating by antithrombin thereby inactivating both thrombin and factor Xa. Side effects of Heparin toxicity include decreased platelet counts, an aPTT of >2, bleeding, bruising, black tarry stools, increased heart rate and decreased blood pressure. The nurse should monitor vital signs, and if hemorrhage occurs, stop the heparin medication and administer protamine sulfate.

Physiological Adaptation (2 items) Fluid and Electrolyte Imbalances (2 items) Fluid Imbalances: Identifying Manifestations of Fluid Volume Deficit (RM Fund 10.0 Chp 57 Fluid Imbalances,Active Learning Template: System Disorder) Dehydration is a lack of fluid in the body due to loss or in adequate consumption. Vomiting, diarrhea, and kidney disease can lead to fluid volume deficit. Expected findings to watch out for are weakness, dizziness, dry mucus membrane, oliguria, and flattened neck veins. Some labs to look for are elevated Hct, increased urine concentration and elevated specific gravity greater than 1.030, hypernatremia, and an increased BUN of greater than 25. Intravenous Therapy: Manifestations of Fluid Volume Excess (RM Pharm RN 8.0 Chp 4 Intravenous Therapy, RM Pharm RN 8.0 Chp 4 Intravenous Therapy v2,Active Learning Template: System Disorder) Infiltration is local swelling at the IV site. The temperature of the skin is cooler around the site and the infusion is slowed. The first thing the nurse should do is stop the infusion and remove the catheter. Then elevate the extremity and encourage active range of motion. Depending on the type of fluid that infiltrated the tissue, apply a warm or cold compress. Circulatory fluid overload can happen if the infusion is too large and infusing too fast. With edema in extremities apply pressure over selected vein with fingers to displace edema. It is important to inspect IV site when infusing saline or a medication to make sure the is no infiltration....