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247 Cards in this Set
- Front
- Back
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When a client become short of breath while you are changing their central line the nurse should...
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place them in trendelenburg position to trap the air just in case an embolism is occuring
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Fluids should not hang for more than...
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24 hrs
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anticholinergic/mnemonic side effects:
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can't see can't pee
no stool no drool |
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aspirin's biggest adverse effect
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GI bleed
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6 rights of medication administration
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client
dose time med documentation route |
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When administering nasal drops, what position should the client be in?
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Supine with neck hyper extended
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How might a nurse administer eye drops to promote client safety?
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with her hand resting on the client's forehead so that she does not by accidently poke them in the eye
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What are some things the nurse needs to monitor for her client on TPN?
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daily weights, listen for crackles in lung, watch for fluid imbalances and allergic reactions
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What are the differences between CPN and PPN?
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CPN is diluted so quickly that more calories can be administered through it.
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What's a big problem associated with TPN?
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hyper/oglycemia
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anticoagulants are...
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heparin and warfarin
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When administering a dose of heparin the nurse must remember that she has to...
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get it double checked by another nurse
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How often should a nurse monitor the rate of a heparin infusion?
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q 30-60 min
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The antidote for heparin is..
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protamine sulfate
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Normal levels of PT and INR are...
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PT 18-24
INR 2-3 |
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The time it takes for the effects of Warfarin to be seen
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8-12 hrs
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The antidote for Warfarin is...
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vit K (.5-1 mg IV)
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Antiplatelets:
examples, action, and side effects |
aspirin, plavix, ticlid, aggrastat, reopro,
primary prevention of stroke and MI S.E. hemm stroke, GI bleed...always take with food |
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An important thing for a nurse to inform a client taking aspirin or plavix would be...
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always take the medication with food to decrease the chance of GI bleed
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What does a thrombolytic do and what are some examples?
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Thrombolytics dissolve clots that have already formed (alteplase, streptase -ase)
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If someone was having an ischemic stroke the medication prescribed would be..
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thrombolytics: alteplase
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Thrombolytics must be taken within what time frame of an event?
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4-6 hrs
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When would a nurse want to administer iron?
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Iron should be taken on an empty stomach so, an hour before a meal
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B12 activates what?
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Folic acid
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What foods contain folic acid?
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liver and green leafy vegetables
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What drugs increase the production of RBCs?
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Epogen/procrit epoetin
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What are some side effects of Epogen?
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hypertension and increased risk of a myocardial event
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Epogen is contraindicated for what type of client?
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Clients with uncontrolled HTN
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What is something that the nurse should be careful to monitor for a client who is on Epogen?
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Iron levels, without adequate iron the drugs effects are not great
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What medication increases your Neutrophil count? Why would this be used?
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Neupogen
used to decrease the chance of infection for clients with neutropenia (cancer) |
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What are some S.E. of Neupogen?
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bone pain and leukocytosis
d/c if WBC are >50,000 |
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How do you know if Neupogen has been effective?
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no infection
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What drug increases WBC production? For what patient would this be used?
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Leukine for the patient who is recovering after a bone marrow transplant
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What are some side effects of Leukine?
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Diarrhea, weakness, rash, malaise, bone pain, leukocytosis
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When is leukine contraindicated?
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When the client is allergic to yeast
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What drug increases platelet count?
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Neumega
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How does the nurse know if Neumega is effective?
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If the platelet count is above 50,000
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What are some side effects of Neumega?
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cardiac dyssrhythmias, fluid retention, and conjunctival infection
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What's a normal aPTT?
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30-36 seconds
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What type of anticoagulant would be used by a pregnant women?
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Heparin, NOT COUMADIN/WARFARIN
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autologous vs. homologous
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auto self donated blood homo not
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Packed cells
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centrifuged concentration of RBC
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What are the following compatible with?
A B AB O AB |
A-A
B-B AB-A,B,AB O universal donor AB universal recipient |
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Central venous lines may require what in order to prevent cardiac dysrhythmias?
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blood warmer--not refridgerated blood
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Change blood transfusion tubing q...
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4-6hrs per institution policy
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Dextrose and lactated ringers are contraindicated when...
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Blood transfusions are taking place because hypotonic solutions induce RBC hemolysis
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When administering blood how often should you check vital signs?
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q 5-15 min
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What should you prime the tubing you are going to use for a blood transfusion with?
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0.9% normal saline
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What gauge should a needle administering blood be?
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19 gauge or bigger
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How long should a blood transfusion take?
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2-4 hrs
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What does fresh frozen plasma do?
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replace coagulation factors
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What does albumin do and what is it commonly used for?
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expand blood volume; used for burns, hypovolemia nephrosis
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What is a side of effect of albumin?
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Fluid volume overload...therefore contraindicated in clients with congestive heart failure
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For Pernicuous anemia what would you administer?
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B12
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What does angiotensin II do?
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vasoconstrictor
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What does aldosterone do?
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promotes sodium and water retention
it is a hormone that many antihypertensives work against |
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How can one typically see fluid volume overload?
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Edema, crackles, and jugular vein distention (JVD)
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Adrenergic Agonists are known as what drug names?
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Epinephrine, Dopamine, and Dobutamine
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What does Epinephrine do?
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works on alpha 1- vasoconstricts to increase BP, decreases congestion,
works on Beta 1which increases heart rate and treats AV block and cardiac arrest works on Beta 2- bronchodilation |
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What does Dopamine do?
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Works at different levels:
LEVEL 1: affects dopamine which dilates renal vessels LEVEL 2: does above plus affects Beta 1 and increases heart rate LEVEL 3: does above plus affects Alpha 1 which vasoconstricts |
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What does Dobutamine do?
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affects Beta 1 which increases heart rate, contractility, and increases the conduction over the AV node
used for heart failure |
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What does the alpha 1 receptor do?
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vasoconstricts veins, skin, viscera, mucous membranes
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What does Beta 1 do?
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Increases HR, contractility (CO), and conduction over the AV node also increases renal release so afffects the kidney
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What does Beta 2 do?
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bronchodilation, vasodilation, relax uterus
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What does dopamine do?
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causes renal blood vessels to dilate KIDNEY!
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What are some side effects of epinephrine?
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Hypertensive crisis, dysrhythmias, angina
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What are the alpha adrenergic blockers?
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Minipress and Cardura
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What is Minipress used for?
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BPH and HTN
selective alpha 1 block meaning vasodilation and sm. muscle relaxation |
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What should Minipress not be taken with?
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NSAIDS and other hypertensive medications
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Should Minipress be taken with food?
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Yes, and the initial does can be taken at bedtime to decrease the 1st does hypotensive effects
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Alpha 2 agonists are...
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Catapress
(Tenex and aldomet) |
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What does Catapress do?
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inhibits Alpha 2:
decreases CO bradycardia occurs this treats HTN and cancer pain |
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What are some side effects of Catapress?
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drowsy, dry mouth, and rebound HTN
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What does alpha 2 do?
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- Vasodilation of arteries[2]
- Vasoconstriction of arteries to heart (coronary artery)[3] however the extent of this effect may be limited and may be negated by the vasodilatory effect from β₂ receptors[4] - Vasoconstriction of veins[5] -Decrease motility of smooth muscle in gastrointestinal tract[6] - Contraction of male genitalia during ejaculation[c |
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How is Catapress given?
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usually in 2 doses, the bigger of the two directly before bed
also, if a transdermal patch is used, replace q 7 days |
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Beta Adronergic Blockers do what?
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Cardio selective: metoprolol
Non selective: propanolol -lol metoprolol blocks beta 1 so decreases HR, contractility, and conduction over the AV node propanolol blocks beta 2 so bronchoconstriction, vasoconstriction... |
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Use of Metoprolol
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angina, cardiac dysrhythmias, MI (gets more O2 to the heart) Heart failure
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Side effects of Metoprolol
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decreased CO, bradycardia (hold if under 60 bpm) ortho hypotension,
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Side effects of Propanolol/ Who is contraindicated?
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bronchoconstriction, glucogenolysis
contraindicated for clients with asthma and diabetes |
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What are drug interactions for meto and propanol ol ?
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Meto-CCB intensifies
prop- insulin |
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How do you know a Beta Adrenergic Blocker is effective?
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when there is no chest pain, there are normal blood pressure readings, no cardiac dyssrhythmias
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What drugs are ACE inhibitors?
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-ril captopril
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What do ACE inhibitors do? What is their action?
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block the production of angiotensin II and cause vasodilation, excretion of H2O and sodium,
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What is captopril used for?
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heart failure, HTN, MI, nephropathy
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What are some side effects of Captopril?
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cough (dry cough) and hyperkalemia
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What drug increases lithium levels?
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-pril ACE inhibitors
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When should Captopril be taken?
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at least one hour before meals
or it will make you IL! |
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What type of drugs end in -sartan?
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ARBs
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What do ARBs do?
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same as ACE vasodilate and excretee water and sodium except no cough or hyperkalemia
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What is a difference between ARBs and ACE?
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ARBs are fatal to the fetal and can be taken with or without food
ACE not with food |
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Sodium Nitroprusside is used for...
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rapid lowering of the BP (vsodilation) and can decrease bleeding by producing controlled hypotension
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When angina is not responding to other medications _________ is typically used.
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Nitroglycerine (imdur)
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What is the action of Nitro?
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decrease oxygen and preload to the heart during angina and increase oxygen by preventing spasms during variant angina
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What are some side effects of Nitro?
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reflex tachycardia, tolerance, H/A, ortho hypo
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Nitro should never be taken with...
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alcohol, other antihypertensives, VIAGRA!
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Nitro is contraindicated for what type of client?
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Clients who had trauma to the head because it can increase intracranial pressure (ICP)
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What is the action of Digoxin?
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increase the force of contraction and decrease the heart rate (this allows the ventricles more time to fill)
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When is Digoxin used?
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heart failure, atrial fibrillation
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What is a therapeutic level of Digoxin?
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0.5-2
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If a client reports seeing a halo around someone's head what should the nurse's initial reaction be?
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CNS side effect of digoxin. Dig toxicity is probably occuring and dig should not be administered maybe admin digibind or active charcoal
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What should the nurse check before administering digoxin?
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that the heart rate is above 60 bpm or med should be withheld and primary care provider contacted
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A client who is experiencing dig toxicity feels symptoms like...
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fatigue, muscle weakness, anorexia
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What is a sodium channel blocker used for dysrhythmias? What is it's action?
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Lidocaine
action: decrease electrical conduction, increase repolarization, short term for vent dysrhythmias |
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How long should lidocaine be used?
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never more than 24 hrs. can cause CNS (seizure dilantin should be given) or resp arrest
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What are -statins used for?
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Lipitor atorvastatin
used to decrease LDL and increase HDL pulls LDL out of the blood which decreases plaque and increases vasodilation their primary use: preventing coronary events and hypercholesterolemia |
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What does gemfibrozil do?
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increases VLDL which are the precursor to HDLs
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What is a side effect of gemfibrozil?
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gall bladder stones
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Gemfibrozil and Zetia cannot be taken with what medication?
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Cholestyramine
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Gemfibrozil should be taken...
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30 min before breakfast or dinner
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What does Zetia do and what are it's side effects?
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Zetia inhibits the absorption of cholesterol and has no side effects
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Cholestyramine
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bile acid sequestriant: increases the LDL receptors in liver cells so LDL gets out of blood
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What is cholestyramine's side effect?
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constipation
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What does Cholestyramine interact with?
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Dig, Warfarin, Thiazide, Tetracycline
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What is important for a nurse to remember when administering cholestyramine?
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to dissolve it in at least 4-8 oz of water or applesauce
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What does verapamil do?
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CCB: for angina, hypertension, and dysrhythmias
due to vasodilation and decreased HR and force of contraction because calcium can't get through the channels in the myocardium |
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CCB's can be picked out by what...
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-dipine
nifidipine amlodipine felodipine and they all work on angina and HTN |
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A client is on a CCB and is experiencing constipation. Which CCB would you guess the client was on?
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verapimil
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A client has been diagnosed with HTN and prescribed propanolol. If the client had this condition it would be contraindicated.
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Asthma
use cautiously with diabetes though. |
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When a client starts verapamil it is important for the nurse to tell them this about there diet.
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CCBs can often cause constipation and so an increase in fiber and fluid will prevent this effect.
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How do you prevent first dose hypotension?
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Take medication at bedtime
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Myopathy is seen in clients recieving...
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statins and fibrates
myopathy is muscular weakness |
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What is the most common cause of dysrhytmias in clients receiving dig?
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Hypokalemia secondary to diuretics.
chances for increased toxicity because dig and K bind to the same site so with less K dig can have higher levels |
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Beta 2 agonists terbutaline and albuterol have the following actions.
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terbutaline- oral long term
albuterol inhaled short term bronchodilation, histamine inhibition |
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When taking albuterol how long should the client inhale?
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3 seconds and hold breath for 10
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How long should the client take in between puffs of medicine?
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1 full min
5 minutes in between two different types of inhalers to get best effect |
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What does theophylline do?
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Bronchodilation; for long term/chronic asthma
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What does theophylline react with?
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Caffeine; causes increased effects
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If a client misses a dose of theophylline, what should the nurse advise?
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do not double the next dose. just resume at next scheduled time
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Spiriva and Atrovent are used for...
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COPD and exercise/allergen induced asthma
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An asthmatic client with a peanut allergy should not take this medication for bronchodilation.
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Spiriva or Atrovent are created in a soy
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What do glucocorticoids do for the respiratory system and what are the commonly used medications?
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decreases inflammation and prevent airway mucus
names are QVAR, pulmicort, flovent |
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Why would you use pulmicort?
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to decrease the frequency and severity of exacerbations (or flovent or QVAR)
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What a side effect of a gluccocorticoid? What can a nurse advise a client do to prevent this from occurring?
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boneloss
a nurse can encourage weight bearing exercise and adequate amounts of calcium and vitamin D in the client's diet other side effects include myopathy and PUD |
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What is an important teaching point for a client who is embarking on a gluccocorticoid regimen?
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do not take longer than 3-10 days after an acute attack. not meant to be a long term medicine
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What are a couple examples of mast cell stabilizers? What do they do?
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Indal and Tilade
they inhibit mast cells which secrete histamine (anti-inflammation) |
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What is the safest medication for asthma?
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Indal or Tilade (mast cell stabilizers)
typically used for exercise induced asthma or chronic asthma |
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What are the contraindications for Indal?
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dysrhytmias, coronary artery disease
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When should a mast cell stabilizer be taken for best effect?
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15 min before exposure to an allergen
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How does Singulair work and what are it's actions/uses?
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Singulair is a leukotrien inhibitor which means it:
decreases inflammation, decreases bronchoconstriction and airway edema, and decreases mucous production |
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When does a client take Singulair?
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at bedtime (1x daily)
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What drug is used for cough supression?
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Codeine (hydrocodone)
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What are some side effects of codeine?
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addicting, GI (take with food), CNS (resp decrease)
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What are contraindications for Codeine?
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head trauma, acute asthma, and alcoholic
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What does Mucomyst do?
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enhances the flow of secretions in the upper respiratory; used for cystic fibrosis clients
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What medication smells like rotten eggs?
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Mucomyst; mix with juice
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Ephedrine, phenylephrine action and use?
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action: decrease inflammation of nasal membranes
use; common cold do not take for more than 3-5 days due to rebound congestion |
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What are the two types of asthma medications?
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bronchodilators and anti-inflammatory medications
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When advising a client on how to use Salmeterol what does the nurse want to teach?
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To use the inhaler every 12 hrs. (beta agonist)
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Pulmonary edema caused by heart failure would most likely be treated by this diuretic.
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Lasix
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What diuretic comes with the risk of ototoxicity?
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Lasix
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What is often the first med of choice for HTN?
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hydrochlorothiazide
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What does HCTZ interact with?
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NSAIDS, Lithium, Digoxin, Potassium
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What is a Potassium sparing diuretic?
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Aldactone
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What are some side effects of aldactone?
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hyperkalemia, impotence in men, mentstrual irreg in woman,
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What is an osmotic diuretic and what can it be used for?
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Mannitol
used for decreasing ICP and IOP |
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What are some side effects of Mannitol?
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heart failure and renal failure
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Mannitol is most effective when administered in what way?
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as a bolus
and should be filtered so that no crystals come through |
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What is amphojel?
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A phosphate binder
used as an antacid and for clients with kidney disease; falls under same category as tums |
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Normal level of phosphate
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3.0-4.5
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Kayexalate
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promotes potassium excretion
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K dur administration?
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never give faster than 10 mEq/hr
never give IV push only by controlled pump |
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What is Reglan used for?
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N&V, GERD and decrease in emesis
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What is lomotil used for?
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Diarrhea,
it takes the water out of the intestine and decreases intestinal motility |
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What should a nurse think to advise for a client struggling with diarrhea?
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To avoid plain water and drink things with electrolytes in it
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What does Metamucil do?
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Bulk forming laxative; works like fiber
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What is colace used for and how does it work?
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Colace is a surfactant; it decreases surface tension and is often used short term
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What is Dulcolax used for and how does it work?
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Dulcolax is a stimulant that increases peristalsis and is often used before surgery
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What is Milk of Magnesia? How does it help constipation?
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Milk of Mag is an osmotic that draws H2o in and can be used in a low or high dose
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When taking antiemtics, what is something important a nurse should think of when administering meds?
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It is better to PREVENT N&V rather than try to treat it
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What are some antiemtics?
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Zofran, compazine, decadron,
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How does Carafate work?
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stiks to ulcer for 6 hrs so that other acids can not get to it used for acute duodenal ulcers
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When would Carafate be taken?
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4x a day before meals and then before medtime
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What are some antacids and how do they work?
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Amphojel and Milk of Mag which neutralize gastric acid and are used in PUD and GERD
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When progesterone levels drop...
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Menstruation begins
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What is a uterine stimulant ocytocic?
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Oxytocin pitocin methergine
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What does oxytocin do?
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stimulates and increases the strength of uterine contractions
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If a pregnant woman was experiencing sever postpartum hemmorhage what medication would be administered?
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Methergine
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If a woman needed to be induced into labor what drug would you guess would be administered?
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Oxytocin
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If a woman was experiencing postpartum bleeding what drug would you think they could give her to cease this/
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Oxytocin
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When a client has been given oxytocin the nurse wants to monitor the length, strength, and duration of contractions and keep a close eye because of what serious side effect?
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uterine rupture
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If a client was having severe bleeding and a nurse administered methergine, what else would she be wanting to keep an eye out for?
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Hypertensive crisis--headache, nausea, vomiting, increase in BP
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What are some contraindications for the drug oxytocin?
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fetal-immaturity, presentation, distress
mother- unripened cervix, genital herpes |
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How is oxytocin administered?
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by IV pump gradually, increase in 1mu/min q 30 min
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Uterine hyperstimulation
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contractions lasting longer than 60 sec occuring more frequently than every 2-3 min STOP INFUSION OF OXYTOCIN
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what does a tocolytic medication do and what is an example?
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Brethine- activates Beta 2 receptors which makes uterine smooth muscle relax
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What can Brethine be used for?
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To delay preterm labor for up to 48 hrs
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What are some side effects of Brethine?
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tachycardia (not entirely selective beta 2...sort of effects beta 1)
tremors- beta 2 stiumlant side effects |
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How is Brethine administered?
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IV or SC because of it's high first pass effect with oral administration
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If Brethine is administered and contractions decreased what would the nurse do?
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know that the medication is taking an effect; if contractions continued or increased in freq/duration you would call the provider
it can be used in between 20-36 weeks |
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What are androgens and what are some names of medications prescribed?
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Androgens are needed for maturation of sex organs. They promote skeletal muscle growth
Some names are Delatestryl, Halotestin, Oreton Methyl... |
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Uses of androgens include:
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hypogonadism, delayed puberty, palliative treatment of androgen-responsive breast cancer
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What are some side effects of androgens?
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males-gynecomastia, acne, facial hair
females- deeper voice, unusual hair growth acne heptatotoxicity cholesterol irregularities hypercalcemia |
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What are estrogens and their names?
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Premarin, Estrace, Vagifem
hormones needed for maturation of female repro tract and sex characteristics. block bone resorption and reduce low density levels (LDL) at high levels release FSH for conception |
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Estrogens many uses include:
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contraception
relief of hot flashes, mood changes prevention of postmenopausal osteoporosis treatment of prostate cancer treatment of uterine bleeding |
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What are the contraindications of Estrogen?
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pregnancy
history of heart disease breast cancer |
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What is an instruction for the administration of Estrogen?
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take at the same time each day
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what drugs would be used to treat increased ICP?
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Mannitol (osmotic diuretic) and Furosemide (loop)
The first would take water out of everywhere and the second would decrease the rate of production of the CSF |
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Avg CCP
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85 mm Hg.
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What are signs and symptoms of increased intracranial pressure?
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H/A pupillary changes pulse pressure widening weaker puleses seizures
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Rapid Acting Insulin
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Humalog onset 15 min lasts 4 hrs
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Short Acting Insulin
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Humulin Novolin onset 30-60 min lasts 5-7 hrs
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Intermediate Acting Insulin
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NPH onset 1-3 hrs
Lente lasts18-24 |
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Long acting
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Supralente 24-36 onset 4-8
Lantus 24 hrs no peaks onset- 1 hr |
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Oral hypoglycemics are used for clients with...
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type II DM
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This oral hypoglycemic is taken 30 min before each meal
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Pradin (glucophage)
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PTU is used to treat what disease?
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Graves
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What oral hypoglycemic do you take 30 min before a meal?
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Prandin
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This medication works to vasoconstrict and reabsorb water by the kidneys. It is used in diabetes insipidus and cardiac arrest
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Vasopressin
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What is Lugol's solution?
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a medication that inhibits thyroid hormone production and release of it into the bloodstream
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What would you use to treat myxedema coma?
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synthroid
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What can you administer if a client is unconcious and had an insulin overdose?
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glucagon
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What are some side effects of glucophage?
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b12 and folic acid not absorbed well, lactic acidosis
hypoglycemia is not an issue because it does not promote insulin release |
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What oral hypoglycemic does not cause hypoglycemia?
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glucophage--because it reduces glucose production but it does not increase insulin release
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What hypoglycemic should be taken with the first bite of food?
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Precrose--it slows the absorption of carbs
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what is the the only insulin that can be given IV?
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REGULAR!
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What is the long acting insulin?
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Lantus no peak and 24 hour action takes one hour to onset
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What is rapid acting insulin?
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Lispro/humalog onset 15 min lasts 4 hrs
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What is something important to teach your client to eliminate from the diet if they are prescribed sylfonylureas?
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alcohol-can cause disulfaram reaction--extreme N&V
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What action do penicillins do?
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destroy the bacteria cell wall
gram + |
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What are examples of broad and narrow penicillins?
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broad: amoxicillin
narrow: nafcillin |
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when should a penicillin be administered?
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not with food hour before or two after
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what are some side effects of penicillins?
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renal impairment allergies (could have cross allergy to cephalosporins)
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What is the action of a cephalosporin?
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kill bacteria cell wall gram -
broad drugs that are often used for UTI, post op infection meningitus etc |
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What are the four generations of cephalosporins? What do we know about them?
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1. Keflex
2. Ceclor 3. Rocephin 4. Maxipime the generations get stronger |
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When should cephalosporins be administered?
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with food
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What are some examples of Carbapenems?
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impenem
meropenem |
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what is impenem used for?
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serious infections! UTI pneumonia, peritonitus
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What is the prototype monobactum?
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vancomycin (azactum, monurel_
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What is Vancomycin most often used for?
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infections by staph aureaus and c. diff
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What are some side effects of vancomycin?
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ototoxicity, thrombophlebitus
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The VAN CAN deal with...
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C. DIFF and staph aureus.
vancomycin |
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What are som examples of tetracyclines?
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Sumycin, doxycycline
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What are tetracyclines used for?
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rickettsia chlamydia, helicobactor pylori
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How do tetracyclines work?
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do not allow bacteria to synthesize protein
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What are some side effects of tetracyclines?
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tooth discoloration, photosensitivity, supra infection of the bowel, hepatotoxicity
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What are some examples of Bacteriostatic drugs?
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Erythromycin, azithromycin, clindamycin
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What is ezythromycin used for?
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clients with infections that are allergic to penicillins
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A client was just diagnosed with pertussis, what antibiotic would you guess would be prescribed?
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Ezythromycin
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What are examples of aminoglycosides?
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Gentamycin; work on anaurobic gram - like E. coli
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What are some side effects of gentamycin?
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ototoxicity, nephrotoxicity
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What is Microdantin used for?
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UTI
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What is a side effect of Microdantin that would be important to inform your client about before leaving the hospital?
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brown urine discoloration
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What does Bactrim do?
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inhibits folic acid which is used in UTI
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What is an example of Cholinesterase inhibitor?
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Prostigmin
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What is Prostigmin's use?
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myasthenia gravis; activates muscles
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What is an example of a Neuromuscular blocking agent?
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Tubarine, Anectine, Pavulon
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What are the uses of a neuromuscular blocking agent?
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relax bronchials for the insertion of mechanical ventilation, relaxing during the administration of anesthesia, endoscopy, seizure control
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