Microsoft Word Oxygenation Handouts 2007 Nclex

CV, RESPI, BLOOD DISORDERS

REVIEW MATERIALS

SUPPLEMENTAL

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MI

• Chest pain radiating to arms, jaw, neck (which is unrelieved by rest or nitroglycerin)

• Dyspnea

• Indigestion

• Apprehension

• Low grade fever

• Elevated WBC (5-10, ESR, CK-MB, LDH)

Implementation for MI

• Thrombolytic therapy-streptokinase, t-PA

• Bedrest

• Beta-blockers, morphine sulfate, dysrhythmics, anticoagulants

• Do not force fluids (will give heart more to work with)

ANGINA Stable Unstable Variant Intractable Triggered by a predictable amount of effort or emotion.

Triggered by an unpredictable amount of exertion or emotion and may occur at night; the attacks increase in number, duration, and severity over time.

Triggered by coronary artery spasm; the attacks tend to occur early in the day and at rest.

Chronic and incapacitating and is refractory to medical therapy.

Defibrillation

• Start CPR first

• 1st attempt – 200 joules

• 2nd attempt – 200 to 300 joules

• 3rd attempt – 360 joules

• Check monitor between shocks for rhythm

• PULSE PRESENT = NO DEFIBRILLATION

Cardioversion

• Elective procedure, Informed Consent

• Valium IV

• Synchronizer on

• 25-360 joules

• Check monitor between rhythm

Left-Side CHF

• Dyspnea, orthopnea

• Cough

• Pulmonary edema

• Weakness/Changes in mental status

Right-Side CHF

• Dependent edema

• Liver enlargement

• Abdominal pain/Nausea/Bloating

• Coolness of extremities

CHF Implementations

• Administer digoxin, diuretics

• Low-sodium, low-calorie, low-residue diet

• Oxygen therapy

• Daily weight

• Teach about medications and diet CVP: measures blood volume and efficiency of cardiac work; tells us right side of heart able to manage fluid

• “0” on mamometer at level of right atrium at midaxilliary line

• Measure with patient flat in bed

• Open stopcock and fill manometer to 18-20 cm

• Turn stopcock, fluid goes to patient

• Level of fluid fluctuates with respirations

• Measure at highest level of fluctuation

• After insertion o Dry, sterile dressing o Change dressing, IV fluids, manometer, tubing q24 hours o Instruct patient to hold breath when inserted, withdrawn, tubing changed


REVIEW MATERIALS

SUPPLEMENTAL

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o Check and secure all connections

• Normal reading—3-11 cm water

• Elevated�>11, indicates hypervolemia or poor cardiac contractility (slow down IV, notify physician)

• Lowered�<3, hypovolemia

• Chest tray at bedside Arterial Peripheral Vascular Disease Assessments

• Rubor

• Cool shiny skin

• Ulcers

• Gangrene

• Intermittent Claudication (pain with exercise/walking relieved with rest)

• Impaired sensation

• Decreased peripheral pulses

Arterial Peripheral Vascular Disease Implementations

• Monitor Peripheral pulses

• Good foot care

• Stop smoking

• Regular exercise

• Medications—vasodilators, anticoagulants

Venous Peripheral Vascular Disease Assessments

• Cool, brown skin

• Edema

• Normal or decreased pulses

• Positive Homan’s sign

Venous Peripheral Vascular Disease Implementations

• Monitor peripheral pulses

• Elastic stockings

• Medications—anticoagulants

• Elevate legs

• Warm, moist packs

• Bedrest 4-7 days (acute phase)

ABO BLOOD TYPE COMPATIBILITY Blood Type

Can Receive from:

Can donate to:

O O O,A,B,AB A A,O A,AB B B,O B,AB AB O,A,B,AB AB

Autologous Transfusion:

• Collected 4-6 weeks before surgery

• Contraindicated—infection, chronic disease, cerebrovascular or cardiovascular disease

Anaphylaxis

• Symptoms o Hives o Rash o Difficulty breathing (first sign) o Diaphoresis

• Nursing care o Epinephrine 0.3 ml of 1:1000 solution

SQ o Massage site

o May repeat in 15-20 min. Delayed Allergic Reaction

• Symptoms: o Rash, Hives, Swollen Joints

• Nursing Care o Discontinue medication o Topical Antihistamines o Corticosteroids o Comfort measures

o Anemia Assessments (reduction in hemoglobin amount/erythrocytes)

• Palpitations

• Dyspnea

• Diaphoresis

• Chronic fatigue

• Sensitivity to cold

Anemia Implementations

• Identify cause

• Frequent rest periods

• High protein, high iron, high vitamin diet

• Protect from infection


REVIEW MATERIALS

SUPPLEMENTAL

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Iron Deficiency Anemia Assessments

• Fatigue

• Glossitis

• Spoon fingernails

• Impaired cognition

Iron Deficiency Anemia Implementations

• Increase iron-rich foods (liver, green leafy vegetables)

• Iron supplements (stains teeth)

Pernicious Anemia Assessments (gastric mucosa fail to secrete enough intrinsic factor for stomach to absorb)

• Schilling’s Test

• Fatigue, Paresthesia in hands and feet

• Sore, red tongue

Pernicious Anemia Assessments

• Vitamin B12—IM

• Rest of life can’t be absorbed PO

Sickle Cell Anemia Assessments

• Pain /Swelling/Fever

• Scleral jaundiced

• Cardiac murmurs

• Tachycardia

Sickle Cell Anemia Implementations

• Check for signs of infection (prevent crisis)

• Check joint areas for pain and swelling

• Encourage fluids

• Provide analgesics with PCA pump c crisis

Hemophilia Assessments (female to male gene transmission)

• Easy bruising

• Joint pain

• Prolonged bleeding

Hemophilia Implementations

• Administer plasma or factor VIII

• Analgesics

• Cryoprecipitated antihemophilic factor (AHF)

• Teach about lifestyle changes

• Non contact sports Leukemia Assessments

• Ulcerations of mouth

• Anemia

• Fatigue

• Weakness

• Pallor

Leukemia Implementations

• Monitor for signs of bleeding: petechiae, ecchymosis, thrombocytopenia

• Infections

• Neutropenia (private room/limit # people, wbc done daily, no fruit, no flowers/plotted plants, clean toothbrush with weak bleach solution

• Good mouth care

• High calorie, high Vitamin diet (avoid salads/raw fruit/pepper/don’t reuse cup/don’t change litter box/digging in garden

Acyanotic Congenital Heart Anomalies Assessments

• Normal Color

• Possible exercise intolerance

• Small stature

• Failure to thrive

• Heart murmur

• Frequent respiratory Infections

Cyanotic Congenital Heart Anomalies Assessments

• Cyanosis

• Clubbing of fingers

• Seizures

• Marked exercise intolerance

• Difficulty eating

• Squat to decrease respiratory distress

• Small stature

• Failure to thrive

• Characteristic murmur

• Frequent respiratory infections


REVIEW MATERIALS

SUPPLEMENTAL

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Acyanotic Congenital Heart Anomalies Types:

• Ventricular Septal Defect (VSD)—abnormal opening between right/left ventricles; hole size of pinhole or absence of septum; hear a loud harsh murmur, at age of 3 hole may close otherwise surgery such as purse-string suture

• Atrial Septal Defect (ASD)—abnormal opening between the two atria; audible murmur (if defect is severe closure is done later in childhood)

• Patent Ductus Arteriosis (PDA)—failure of fetal structure to close after birth; ductus areteriosis in the fetus connects the pulmonary artery to aorta to shunt oxygenenated blood from the placenta to systemic circulation (which bypasses the lungs). Once the child is born that structure should close because it is no longer needed because blood passes through to lungs; vascular congestion, right ventricular hypertrophy; murmur, bounding pulse, tachycardia; surgical to divide or ligate the vessel.

• Coarctation of the Aorta—narrow of aorta; high blood pressure and bounding pulse in areas that receive blood proximal to the defect. Weak and absent blood distal to aorta. Surgical end-to-end anastomosis.

• Pulomonic Stenosis—narrowing at entrance to pulmonary artery; causes resistance to blood flow and right ventricular hypertrophy; surgery

• Aortic Stenosis—narrowing of aortic valve; causes decrease cardiac output; surgery Congenital Heart Anomalies Compensatory Mechanisms

• Tachycardia

• Polycythemia (increase formation of RBC’s)

• Posturing—squatting, knee-chest position Cyanotic Congenital Heart Anomalies Types:

• Tetralogy of Fallot—VSD, pulmonic stenosis, overriding aorta, right ventricular hypertrophy; squats/knee chest position to help breath; surgery needed

• Transposition of great vessels—pulmonary artery leaves left ventricle and aorta leaves right ventricle; oxygenated blood not going into systemic circulation

• Truncus arteriosus—failure of normal septation and embryonic division of the pulmonary artery and aorta; rather than two distinctly different vessels there is a single vessel that overrides both ventricles and gives rise to both pulmonary and systemic circulation; blood enters from both common artery and either goes to the lungs or to the body; cyanosis, murmur, difficult intolerance

• Total anomalous venous return—absence of direct communication between pulmonary veins and left atria; pulmonary veins attach directly to right atria or drains to right atria

Congenital Heart Anomalies Compensatory Mechanisms

• Tachycardia

• Polycythemia (increase formation of RBC’s)

• Posturing—squatting, knee-chest position Congenital Heart Anomalies Implementations

• Prevention

• Recognize early symptoms

• Monitor vital signs and heart rhythms

• Medications—digoxin, iron, diuretics, potassium

• Change feeding pattern


REVIEW MATERIALS

SUPPLEMENTAL

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i. second right ii. intercostal space - aortic area iii. second left intercostal space - pulmonic area iv. third left intercostal space - Erb's point v. fourth left intercostal space - tricuspid area vi. fifth left intercostal space - mitral (apical) area vii. epigastric area at tip of sternum

Range of Normal Blood Pressure

i. child under age two weighing at least 2700g: use flush technique,30-60mg Hg

ii. child over age two: 85-95/50-65 mm Hg iii. school age: 100-110/50-65 mm Hg iv. adolescent: 110-120/65-85 mm Hg v. adult: <130 mm Hg Systolic / <85 mm Hg diastolic

Normal Range of Peripheral Pulses

• infants: 120 to 160 beats/minutes • toddlers: 90 to 140 beats/minutes • preschool/school-age: 75 to 110 beats/ minute • adolescent/adult: 60 to 100 beats/minute

Normal Rates of Respirations

• newborn: 35 to 40 breaths/minute • infant: 30 to 50 breaths/minute • toddler: 25 to 35 breaths/minute • school age: 20 to 30 breaths/minute • adolescent/adult: 14 to 20 breaths/minute • adult: 12 to 20 breaths/minute


REVIEW MATERIALS

SUPPLEMENTAL

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AIR EMBOLISM POSITIONING: Place the client on the left side in the trendelenburg position. Lying on the left side may prevent air from flowing into the pulmonary veins. The trendelenburg position increases intrathoracic pressure, which decreases the amount of blood pulled into the vena cava during inspiration.

Hypovolemic Decreased in intravascular volume

Cardiogenic Decreased cardiac output

Distributive Problem with blood flow to cells

Shock Signs and Symptoms

• Cool, clammy skin

• Cyanosis

• Decreased alertness

• Tachycardia

• Hypotension

• Shallow, rapid respirations

• Oliguria

Implementation for shock

• Monitor CVP: <3 inadequate fluid >11 too much fluid

Electroencephalogram (EEG) Preparation

• Test brains waves; seizure disorders

• Tranquilizer and stimulant meds withheld for 24-48 hours

• Stimulants (caffeine, cigarettes) withheld for 24 hours

• May be asked to hyperventilate during test

• Meals not withheld

• Kept awake night before test; want them to lie still

Electroencephalogram (EEG) Post-test

• Remove paste from hair

• Administer medications withheld before test

• Observe for seizure activity

• Seizure prodromal signs; epigastric distress, lights before the eyes


REVIEW MATERIALS

SUPPLEMENTAL

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Hyperkalemia on Electrocardiogram: Tall, peaked T waves; prolonged PR interval; widening QRS complex

Hypokalemia on Electrocardiogram: ST segment depression; Flat T wave

First-Degree Heart Block: Prolonged P-R interval

Bundle Branch Block: Widened QRS complex

Myocardial Necrosis in Area: Q waves present

Ventricular Fibrillation: No visible P waves or QRS complexes, no measurable rate. Irregular, chaotic undulations of varying amplitudes.

HypoCalcemia: Prolonged Q-T interval

Myocardial Ischemia: ST segment elevation or depression

Premature Ventricular Contractions: absence of P waves, wide and bizarre QRS complexes, and premature beats followed by a compensatory pause

Ventricular Tachycardia: absence of P waves, wide QRS complexes, rate between 100 and 250 impulses per minute. Regular rhythm

Atrial Fibrillation: no P waves; instead there are wavy lines, no PR interval. QRS duration is WNL and irregular ventricular rate can range from 60-160 beats/minute.

Hypokalemia Assessments

• K+ < 3.5 mEq/L

• Muscle weakness

• Paresthesias

• Dysrhythmias

• Increased sensitivity to digitalis

Hypokalemia Implementations

• Potassium Supplements

• Don’t give > 40 mEq/L into peripheral IV or without cardiac monitor

• Increase dietary intake – oranges, apricots, beans, potatoes, carrots, celery, raisins


REVIEW MATERIALS

SUPPLEMENTAL

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Hypercalcemia Assessments

• Ca+> 5.2 mEq/L

• Sedative effects on CNS

• Muscle weakness, lack of coordination

• Constipation, abdominal pain

• Depressed deep tendon reflexes

• Dysrhythmias

Hypercalcemia Implementations

• 0.4% NaCl or 0.9% NaCl IV

• Encourage fluids (acidic drinks: cranberry juice)

• Diuretics

• Calcitonin

• Mobilize patient

• Surgery for hyperparathyroidism Hypomagnesemia Assessments

� Mg+< 1.5 mEq/L � Neuromuscular irritability � Tremors � Seizures � Tetany � Confusion � Dysphagia

Hypomagnesemia Implementations � Monitor cardiac rhythm and reflexes � Test ability to swallow � Seizure precautions � Increase oral intake—green vegetables, nuts,

bananas, oranges, peanut butter, chocolate

Flail Chest Affected side goes down during inspiration and up during expiration

Sucking Chest Wound (Sucking Open Pneumothorax)

• Sucking sound with respiration

• Pain

• Decreased breath sounds

• Anxiety

Pneumothorax Collapse of lung due to alteration of air in intrapleural space

• Dyspnea

• Pleuritic pain

• Restricted movement on affected side

• Decreased/absent breath sounds

• Cough

• Hypotension

Implementation Monitor for shock Humidified oxygen Thoracentesis (aspiration of fluid from pleural space) Chest Tubes

COPD Assessments

• “Blue Bloaters”

• “Pink Puffers”

• Weakness

• Change in postured day and hs (don’t sleep laying down, have to stay erect)

• Use of accessory muscles of breathing

• Dyspnea

• Cough

COPD Implementations

• Assess airway clearance

• Listen to breath sounds

• Administer low-flow oxygen (1-2 L, not too much because your trying to prevent CO2 narcosis)


• Small frequent feedings

• Use metered dose inhalers (MDI)


REVIEW MATERIALS

SUPPLEMENTAL

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• Adventitious breath sounds

Pneumonia Assessments

• Fever

• Leukocytosis

• Productive Cough (rust, green, yellow)

• Dyspnea

• Pleuritic pain

• Tachycardia

Pneumonia Implementations

• Check breath sounds

• Cough and deep breath q 2 hours

• Chest physiotherapy

• Antibiotics

• Incentive spirometer


• Suction PRN

• Provide oxygen

• Semi-Fowler’s position

• Bedrest

• Medications—mucolytics (Mucomyst), expectorants (Robitussin), Bronchodilators (Aminophylline), Antibiotics (Bacterim)

Chest Tubes Implementations

• Use to utilize negative pressure in lungs

• Fill water-seal chamber with sterile water to 2 cm

• Fill suction control chamber with sterile water to 20 cm

• Maintain system below level of insertion

• Clamp only momentarily to check for air leaks

• Ok to milk tubing towards drainage

• Observe for fluctuation in water-seal chamber

• Encourage patient to change position frequently

Chest Tube Removal:

• Instruct patient to do valsalva maneuver

• Clamp chest tube

• Remove quickly

• Occlusive dressing applied

Complications of Chest Tubes:

• Constant bubbling in water-seal chamber=air leak

• Tube becomes dislodged from patient, apply dressing tented on one side

• Tube becomes disconnected from drainage system, cut off contaminated tip, insert sterile connector and reinsert

• Tube becomes disconnected from drainage system, immerse end in 2 cm of sterile water

Chest Tubes

� Fill water-seal chamber with sterile water to 2 cm (middle chamber) � Fill suction control chamber with sterile water to 20 cm (chamber all the way to the

right) � Air-leak if bubbling in water-seal chamber (middle chamber) � Obstruction: “milk” tube in direction of drainage


REVIEW MATERIALS

SUPPLEMENTAL

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� Removal o chest tube: pt. does valsalva maneuver, clamp chest tube, remove quickly, apply occlusive dressing

� Dislodged: apply tented dressing � Tube becomes disconnected from drainage system, cut off contaminated tip, insert

sterile connector and reinsert � Tube becomes disconnected from drainage system, immerse in 2cm of water

Tracheostomy Tube Cuff

• Purpose—prevents aspiration of fluids

• Inflated o During continuous mechanical ventilation o During and after eating o During and 1 hour after tube feeding o When patient cannot handle oral secretions

Tracheostomy Tube Cuff

� Prevents aspiration of fluids/separates upper and lower airways � Inflated during continuous mechanical ventilation � Inflated during and after eating � Inflated during and 1 hour after tube feeding � Inflated when patient cannot handle oral secretions

• NCLEX-RN exam is a “here and now” test; take care of problem now to prevent harm to client.

• Do not ask “why” on the licensure exam

• Morphine Sulfate for pancreatitis causes spasms of the sphincter of Oddi; Meperidine is drug of choice.

• Normal Intraocular Pressure is 10-21 mm Hg

• Ecchymosis (faint discoloration) around the umbilicus or in either flank indicates retroperitoneal bleeding

Oxygen Administration: assess patency of nostril, apply jelly

• Face mask: 5-10 l/min (40-60%)

• Partial rebreather mask: 6-15 l/min (70-90%); keep reservoir bag 2/3 full during inspiration

• Non-rebreather mask: (60-100%); keep reservoir bag 2/3 full during inspiration

• Venturi mask: 4-10 l/min (20-50%); provides high humidity and fixed concentrations, keep tubing free of kinks

• Tracheostomy collar or T-piece: (20-100%); assess for fine mist; empty condensation from tubing’ keep water container full

• Croupette or oxygen tent: o Difficulty to measure amount of oxygen delivered o Provides cooled, humidified air o Check oxygen concentration with oxygen analyzer q4 hours


REVIEW MATERIALS

SUPPLEMENTAL


o Clean humidity jar and fill with distilled water daily o Cover patient with light blanket and cap for head o Raise side rails completely o Change linen frequently o Monitor patient’s temperature

Clear liquid � No milk � No juice

with pulp

Full liquid � No jam � No fruit � No nuts

Low-fat cholesterol restricted � Can eat lean meat � No avocado, milk,

bacon, egg yolks butter

Sodium restricted � No

cheese

High roughage, high fiber � No white

bread without fiber

Low-residue � Minimize intestinal activity � Buttered rice white processed food, no whole wheat corn bran

High protein diet � Restablish anabolism to raise albumin

levels � Egg, roast beef sandwich, � No junk food

Renal � Keeps protein,

potassium and sodium low

� No beans, no cereals, no citrus fruits

Low-phenylalanine diet � Prevents brain damage from

imbalance of amino acids � Fats, fruits, jams allowed � No meats eggs bread

Antiarrhythmics Action:

• Interfere with electrical excitability of heart

Used for:

• Atrial fibrillation and flutter

• Tachycardia

• PVCs

Antiarrhythmics Medications:

• Atropine sulfate

• Lidocaine

• Pronestyl

• Quinidine

• Isuprel

Antiarrhythmics Side effects:

• Lightheadedness

• Hypotension

• Urinary retention Antiarrhythmics Nursing Considerations:

• Monitor vital signs

• Monitor cardiac rhythm

Aminoglycosides (Antibiotics) Action:

• Inhibits protein synthesis in gram-negative bacteria

Used for:

• Pseudomonas, E.Coli

Aminoglycosides (Antibiotics) Medications:

• Gentamycin

• Neomycin

• Streptomycin

• Tobramycin

Aminoglycosides (Antibiotics) Side effects:

• Ototoxicity and Nephrotoxicity

• Anorexia

• Nausea

• Vomiting

• Diarrhea Aminoglycosides (Antibiotics) Nursing Considerations:


REVIEW MATERIALS

SUPPLEMENTAL


• Harmful to liver and kidneys

• Check 8th cranial nerve (hearing)

• Check renal function

• Take for 7-10 days


• Check peak/trough level

Cephalosporins (Antibiotics) Action:

• Inhibits synthesis of bacterial cell wall

Used for:

• Tonsillitis, otitis media, peri-operative prophylaxis

• Meningitis

Cephalosporins (Antibiotics) Medications:

• Ceclor

• Ancef

• Keflex

• Rocephin

• Cefoxitin

Cephalosporins (Antibiotics) Side effects:

• Bone marrow depression: caution with anemic, thrombocytopenic patients

• Superinfections

• Rash Nursing Considerations:

• Take with food

• Cross allergy with PCN

• Avoid alcohol

• Obtain C&S before first dose: to make sure medication is effective against disease/bacteria

• Can cause false-positive for proteinuria/glycosuria

Fluoroquinolones (Antibiotics) Action:

• Interferes with DNA replication in gram-negative bacteria

Used for:

• E.Coli, Pseudomonas, S. Aureus

Fluoroquinolones (Antibiotics) Medications:

• Cipro

Fluroquinolones (Antibiotics) Side effects:

• Diarrhea

• Decreased WBC and Hematocrit

• Elevated liver enzymes (AST, ALT)

• Elevated alkaline phosphatase Nursing Considerations:

• C&S before starting therapy


• Take 1 hour ac or 2 hour pc (food slows absorption)

• Don’t give with antacids or iron preparation

• Maybe given with other medications (Probenicid: for gout)


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SUPPLEMENTAL


Macrolide (Antibiotics) Action:

• Binds to cell membrane and changes protein function

Used for:

• Acute infections

• Acne

• URI

• Prophylaxis before dental procedures if allergic to PCN

Macrolide (Antibiotics) Medications:

• Erythromycin

• Clindamycin

Macrolide (Antibiotics) Side effects:

• Diarrhea

• Confusion

• Hepatotoxicity

• Superinfections Nursing Considerations:

• Take 1hr ac or 2-3 hr pc

• Monitor liver function

• Take with water (no fruit juice)

• May increase effectiveness of: Coumadin and Theophylline (bronchodilator)

Penicillin Action:

• Inhibits synthesis of cell wall

Used for:

• Moderate to severe infections

• Syphilis

• Gonococcal infections

• Lyme disease

Penicillin Medications:

• Amoxicillin

• Ampicillin

• Augmentin

Penicillin Side effects:

• Stomatitis

• Diarrhea

• Allergic reactions

• Renal and Hepatic changes Nursing Considerations:

• Check for hypersensitivity

• Give 1-2 hr ac or 2-3 hr pc

• Cross allergy with cephalosporins

Sulfonamides (Antibiotics) Action:

• Antagonize essential component of folic acid synthesis

Used for:

• Ulcerative colitis

• Crohn’s disease

• Otitis media

• UTIs

Sulfonamides (Antibiotics) Medications:

• Gantrisin

• Bactrim

• Septra

• Azulfidine

Sulfonamides (Antibiotics) Side effects:

• Peripheral Neuropathy

• Crystalluria

• Photosensitivity

• GI upset

• Stomatitis Nursing Considerations:

• Take with meals or foods


• Good mouth care

• Antacids will interfere with absorption


REVIEW MATERIALS

SUPPLEMENTAL


Tetracyclines (Antibiotics) Action:

• Inhibits protein sythesis

Used for:

• Infections

• Acne

• Prophylaxis for opthalmia neonatorum

TEtracyclines (Antibiotics) Medications:

• Vibramycin

• Panmycin

Tetracyclines (Antibiotics) Side effects:

• Discoloration of primary teeth if taken during pregnancy or if child takes at young age

• Glossitis

• Rash

• Phototoxic reactions Nursing considerations:

• Take 1 hr ac or 2-3 hr pc

• Do not take with antacids, milk, iron

• Note expiration date

• Monitor renal function

• Avoid sunlight

Anticholinergics Action:

• Inhibits action of acethylcholine and blocks parasympathetic nerves (affects heart, eyes, respiratory tract, GI tract and the bladder)

• Dilates pupil, causes bronchodilation and decreased secretions

• Decrease GI motility secretions

Used for:

• Opthalmic exam

• Motion sickness

• Pre-operative

Anticholinergic Medications:

• Pro-Banthine

• Atropine

• Scopolamine

Anticholinergic Side Effects:

• Blurred vision

• Dry mouth

• Urinary retention

• Chage in heart rate Nursing Consideration:

• Monitor output

• Contraindicated with glaucoma

• Give 30 min ac, hs, or 2hr pc

• Contraindicated: paralytic ileus, BPH


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SUPPLEMENTAL


Anticoagulants Action:

• Blocks conversion of prothrombin to thrombin

Used for:

• Pulmonary embolism

• Venous thrombosis

• Prophylaxis after acute MI

Anticoagulants Medications:

• Heparin

Anticoagulants (Heparin) Side Effects:

• Hematuria

• Tissue irritation Nursing Considerations:

• Monitor clotting time or Partial Thromboplastin Time (PTT)

• Normal 20-45 sec

• Therapeutic level 1.5-2.5 times control

• Antagonist—Protamine Sulfate

• Give SC or IV Anticoagulant Action:

• Interferes with synthesis of vitamin K-dependent clotting factors

Used for:



• Prophylaxis after acute MI

Anticoagulant Medication:

• Coumadin

Anticoagulant (Coumadin) Side Effects:

• Hemorrhage, Alopecia Nursing Considerations:

• Monitor Prothrombin Test (PT)

• Normal 9-12 sec

• Therapeutic level 1.5 times control

• Antagonist—Vitamin K (AquaMEPHYTON)

• Monitor for bleeding

• Give PO Thrombolytics Action:

• Dissolves or lyses blood clots Used for:

• Acute Pulmonary Emboli

• Thrombosis

• MI

• Contraindicated in: hemophilia, CVA, Trauma, not used in patients over 75 years old, not used in patients taking anticoagulants

Thrombolytics Medications:

• Streptokinase

• Urokinase

• Tissue Plasminogen Activator

Thrombolytics Side Effects:

• Bleeding

• Bradycardia

• Dysrhythmias Nursing Considerations:

• Monitor for bleeding

• Have Amino Caproic Acid Available

• Check pulse, color, sensation of extremities

• Monitor EKG


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SUPPLEMENTAL


Antiplatelet Agents Action:

• Interferes with platelet aggregation

Used for:



Antiplatelet Agents Medications:

• Aspirin

• Persantine

Antiplatelet Agents Side Effects:

• Hemorrhage

• Thrombocytopenia Nursing Considerations:

• Check for signs of bleeding

• Give with food or milk Antihistamines Action:

• Block effects of histamine

Used for:

• Allergic rhinitis

• Allergic reactions to blood

Antihistamines Medications:

• Chlor-Trimeton

• Benadryl

• Phenergan

Antihistamines Side Effects:

• Drowsiness

• Dry mouth

• Photosensitivity Nursing Considerations:

• Give with food

• Use sunscreen

• Avoid alcohol Antihyperlipidemic Agents Action:

• Inhibits cholesterol and triglyceride synthesis

Used For:

• Elevated cholesterol

• Reduce incidence of cardiovascular disease

Antihyperlipidemic Agents Medications:

• Questran

• Lipid

Antihyperlipidemic Agents Side Effects:

• Constipation

• Fat-soluble vitamin deficiency Nursing Considerations:

• Take at hs or 30 min ac

• Administer 1hr before or 4-6 hr after other meds

Antihypertensives Types: ACE Inhibitors Action:

• Blocks ACE in lungs Used for:

• Hypertension

• CHF

Antihypertensives (ACE Inhibitors) Medications:

• Capoten

• Vasotec

Antihypertensives (ACE Inhibitors) Side Effects:

• GI upset

• Orthostatic hypotension

• Dizziness Nursing Considerations:

• Give 1hr ac or 3hr pc

• Change position slowly


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SUPPLEMENTAL


A1-adrenergic receptors: found in the peripheral arteries and veins and cause a powerful vasoconstriction when stimulated

A2-adrenergic receptors: several tissues and contract smooth muscle, inhibit lipolysis, and promote platelet aggregation.

B1: Found in the heart and cause an increase in heart rate, atrioventricular node conduction, and contractility.

B2: Arterial and bronchial walls and cause vasodilation and bronchodilation.

Antihypertensives Type: Beta-Adrenergic Blockers Action:

• Blocks Beta-Adrenergic Receptors

• Decrease excitability/workload of heart, oxygen consumption

• Decrease Used for:

• Hypertension

• Angina

• SVT

Antihypertensives Type: Beta-Adrenergic Medications;

• Nadolol

• Propranolol

• Tenormin

• Timoptic

Antihypertensives Type: Beta-Adrenergic Side Effects:

• Changes in heart rate

• Hypotension

• Bronchospasm Nursing Considerations:

• Masks signs of shock and hypoglycemia

• Take with meals

• Do not discontinue abruptly

Antihypertensives Type: Calcium Channel Blockers Action:

• Inhibits movement of calcium across cell membranes

• Slow impulse conduction and depresses myocardial contractility

• Causes dilation of coronary arteries and decreases cardiac workload and energy consumption

Used for:

• Angina

• Hypertension

• Interstitial cystitis

Antihypertensives Type: Calcium Channel Blockers Medications:

• Procardia

• Calan

• Cardizem

Antihypertensives Type: Calcium Channel Blockers Side Effects:

• Hypotension

• Dizziness

• GI distress Nursing Consideration:


• Do not chew or divide sustained-release tablets


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Antihypertensives Type: Centrally acting alpha-adrenergics Action:

• Stimulates alpha receptors in medulla which causes a reduction in sympathetic in the heart

Used for:

• Hypertension

Antihypertensives Type: Centrally acting alpha-adrenergics Medications:

• Aldomet

• Catapres

Antihypertensives Type: Centrally acting alpha-adrenergics Side Effects:

• Sedation

• Orthostatic Hypotension Nursing Considerations:

• Don’t discontinue abruptly

• Monitor for fluid retention


Antipyretic Agents Action:

• Antiprostaglandin activity in hypothalamus

Used for:

• Fever

Antipyretic Agents Medications:

• Tylenol (Acetaminophen)

Antipyretic Agents Side Effects:

• GI irritation Nursing Considerations:

• Monitor liver function

• Aspirin contraindicated for younger than 21 years old due to risk of Reye’s syndrome

Antihypertensives Type: Direct-acting vasodilators Action:

• Relaxes smooth muscle

Used for:

• Hypertension

Antihypertensives Medications

• Hydralazine

• Minoxidil

Antihypertensives Side Effects:

• Tachycardia

• Increase in body hair Nursing Considerations:

• Teach patient to check pulse

Antihypertensives Type: Peripheral-acting alpha-adrenergic blockers Action:

• Depletes stores of norepinephrine in sympathetic nerve endings

Used for:

• Hypertension

Antihypertensives Medications:

• Reserpine

Antihypertensives Side Effects:

• Depression

• Orthostatic Hypotension

• Brachycardia Nursing Considerations:

• Give with meals or milk



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Antitubercular Agents Action:

• Inhibits cell and protein synthesis

Used for:

• Tuberculosis

• To prevent disease in person exposed to organism

Antitubercular Agents Medications:

• INH

• Ethambutol

• Streptomycin

• PAS

• PYZ

Antitubercular Agents Side Effects:

• Hepatitis

• Peripheral Neuritis Nursing Considerations:

• Check liver function tests

• Vitamin B6 given for peripheral neuritis (Pyridoxine)

• Used in combination

Antivirals Action:

• Inhibits DNA and RNA replication

Used for:

• Recurrent HSV

• HIV infection

Antivirals Medications:

• Zovirax

• AZT

• Videx

• Famvir

• Cytovene

Antivirals Side Effects:

• Headache

• Dizziness

• GI symptoms Nursing Considerations:


• Not a cure, but relieves symptoms Bronchodilators Action:

• Decreases activity of phosphodiesterase

Used for:

• COPD

• Preterm labor (Terbutaline)

Bronchodilators Medications:

• Aminophylline

• Atrovent

• Brethine

• Proventil

• Primatene

Bronchodilators Side Effects:

• Tachcyardia

• Dysrhythmias

• Palpitations

• Anticholinergic effects Nursing Considerations:

• Monitor BP and HR

• When used with steroid inhaler, use bronchodilator first

• May aggravate diabetes Cardiac Glycosides Action:

• Increases force of myocardial contraction, slows rate

Used for:

• Left-sided CHF

Cardiac Glycosides Medication:

• Lanoxin (Digoxin)

Cardiac Glycosides Side Effects:

• Bradycardia

• Nausea

• Vomiting

• Visual disturbances Nursing Considerations:

• Take apical pulse

• Notify physician if adult <60,


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child <90-110, <70 in older children

• Monitor potassium level

• Dose: 0.5-1 milligram IV or PO over 24 hr period

• Average: 0.25 mg Diuretics Action:

• Inhibits reabsorption of sodium and water

• Blocks effects of aldosterone

Used for:

• CHF

• Renal disease

Diuretics Medications:

• HydroDIURIL

• Diamox

• Aldactone

• Lasix

• Hygroton

Diuretics Side Effects:

• Dizziness

• Orthostatic Hypotension

• Leukopenia Nursing Considerations:

• Take with food or milk

• Take in a.m.

• Monitor fluid and electrolytes

Narcotics Action:

• Acts on CNS receptor cells

Used for:

• Moderate to severe pain

• Preoperative

• Postoperative

Narcotics Medications:

• Morphine Sulfate

• Codeine

• Demerol

• Dilaudid

• Percodan

Narcotics Side Effects:

• Dizziness

• Sedation

• Respiratory depression

• Hypotension

• Constipation Nursing Considerations:

• Safety precautions

• Avoid alcohol


• Use narcotic antagonist if necessary (Narcan)

Antianginals Action:

• Relaxes smooth muscle

• Decreases venous return

Used for:

• Angina

• Peri-operative

Antianginals Medications:

• Nitroglycerine

• Isosorbide

Antianginals Side Effects:

• Hypotension

• Tachycardia

• Headache

• Dizziness Nursing Considerations:

• Check expiration date

• Teach when to take


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hypertension

• CHF

medication

• May take Q5min x3 doses

• Wet with saliva and place under tongue

Herbs: Toxicities and Drug Interactions

Chamomile Uses: Chamomile is often used in the form of a tea as a sedative. Reactions: Allergic reactions can occur, particularly in persons allergic to ragweed. Reported reactions include abdominal cramps, tongue thickness, tightness in the throat, swelling of the lips, throat and eyes, itching all over the body, hives, and blockage of the breathing passages. Close monitoring is recommended for patients who are taking medications to prevent blood clotting (anticoagulants) such as warfarin. Echinacea Uses: Largely because white blood cells in the laboratory can be stimulated to eat particles, Echinacea has been touted to be able to boost the body's ability to fight off infection.

Reactions: The most common side effect is an unpleasant taste. Echinacea can cause liver toxicity. It should be avoided in combination with other medications that can affect the liver (such as ketaconazole, leflunomide (Arava), methotrexate (Rheumatrex), isoniazide (Nizoral). St. John's Wort Uses: St. John's Wort is popularly used as an herbal treatment for depression, anxiety, and sleep disorders. It is technically known as Hypericum perforatum. Chemically, it is composed of at least 10 different substances that may produce its effects. The ratios of these different substances varies from plant to plant (and manufacturer). Studies of its effectiveness by the National Institutes of Health are in progress.

Reactions: The most common side effect has been sun sensitivity which causes burning of the skin. It is recommended that fair- skinned persons be particularly careful while in the sun. St. John's wort may also leave nerve changes in sunburned areas. This herb should be avoided in combination with other medications that can affect sun sensitivity (such as tetracycline/Achromycin, sulfa- containing medications, piroxicam (Feldend). St. John's wort can also cause headaches, dizziness, sweating, and agitation when used in combination with serotonin reuptake inhibitor medications such as fluoxetine (Prozac) and paroxetine (Paxil). Garlic


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Uses: Garlic has been used to lower blood pressure and cholesterol (Dr. Lucinda Miller notes that there is "...still insufficient evidence to recommend its routine use in clinical practice.")

Reactions: Allergic reactions, skin inflammation, and stomach upset have been reported. Bad breath is a notorious accompaniment. Studies in rats have shown decreases in male rats' ability to make sperm cells. Garlic may decrease normal blood clotting and should be used with caution in patients taking medications to prevent blood clotting (anticoagulants) such as warfarin /Coumadin. Feverfew Uses: Most commonly used for migraine headaches.

Reactions: Feverfew can cause allergic reactions, especially in persons who are allergic to chamomile, ragweed, or yarrow. Nonsteroidal anti-inflammatory drugs (NSAIDs such as ibuprofen (Advil), naproxen (Aleve) or Motrin) can reduce the effect of feverfew. A condition called "postfeverfew syndrome" features symptoms including headaches, nervousness, stiffness, joint pain, tiredness, and nervousness. Feverfew can impair the action of the normal blood clotting element (platelets). It should be avoided in patients taking medications to prevent blood clotting (anticoagulants) such as warfarin (Coumadin).

Ginko Biloba Uses: This herb is very popular as a treatment for dementia (a progressive brain dysfunction) and to improve thinking.

Reactions: Mild stomach upset and headache have been reported. Ginko seems to have blood thinning properties. Therefore, it is not recommended to be taken with aspirin, nonsteroidal anti-inflammatory drugs (Advil), naproxen (Aleve) or Motrin), or medications to prevent blood clotting (anticoagulants) such as warfarin (Coumadin). Ginko should be avoided in patients with epilepsy taking seizure medicines, such as phenytoin (Dilantin), carbamazepine (Tegretol), and phenobarbital. Ginseng Uses: Ginseng has been used to stimulate the adrenal gland, and thereby increase energy. It also may have some beneficial effect on reducing blood sugar .in patients with diabetes mellitus. (Dr. Miller emphasized that there is substantial variation in the chemical components of substances branded as "Ginseng.")

Reactions: Ginseng can cause elevation in blood pressure, headache, vomiting, insomnia, and nose bleeding. Ginseng can also cause falsely abnormal blood tests for digoxin level. It is unclear whether ginseng may affect female hormones. Its use in pregnancy is not


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recommended. Ginseng may affect the action of the normal blood clotting element (platelets). It should be avoided in patients taking aspirin, nonsteroidal antiinflammatory drugs (such as ibuprofen (Advil), naproxen (Aleve) or Motrin), or medications to prevent blood clotting (anticoagulants) such as warfarin (Coumadin). Ginseng may also cause headaches, tremors, nervousness, and sleeplessness. It should be avoided in persons with manic disorder and psychosis. Ginger Uses: Ginger has been used as a treatment for nausea and bowel spasms.

Reactions: Ginger may lead to blood thinning. It is not recommended to be taken with medications that prevent blood clotting (anticoagulants) such as warfarin (Coumadin). Saw Palmetto Uses: Saw palmetto has been most commonly used for enlargement of the prostate gland. (Dr. Miller emphasized that studies verifying this assertion are necessary.) Saw palmetto has also been touted as a diuretic and urinary antiseptic to prevent bladder infections.

Reactions: This herb may affect the action of the sex hormone testosterone, thereby reducing sexual drive or performance. Dr. Miller states that "While no drug-herb interactions have been documented to date, it would be prudent to avoid concomitant use with other hormonal therapies (e.g., estrogen replacement therapy and oral contraceptives...")

Black Cohosh Claims, Benefits: A natural way to treat menopausal symptoms. Bottom Line: Little is known about its benefits and its risks.

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