Term
| How and when do you assess pain? |
|
Definition
During VS (5th VS)
have client rate on 1-10 scale
have client describe pain
Pain is subjective et personal (varies pt to pt) |
|
|
Term
| What are the different categories of pain? |
|
Definition
|
|
Term
|
Definition
recent onset, indicates that damage or injury has occurred
decreases as healing occurs
Duration Seconds to 6 months |
|
|
Term
|
Definition
Constant or intermittent pain that persists beyond the expected healing time.
poorly defined onset, difficult to treat because cause or origin is unclear
6 months or longer |
|
|
Term
| How do different cultures deal with pain? |
|
Definition
Beliefs about pain and how to respond to pain differently between cultures
different cultures express the same pain differently
some cultures moan, cry, or complain; some will complain but refuse meds; some are stoic, quiet.
recognize your beliefs and avoid evaluating based on them |
|
|
Term
| What are 2 analgesics and where do they work? |
|
Definition
Opioids (narcotic analgesic)- CNS
NSAUDs- peripheral system |
|
|
Term
| What are the actions of opioids? |
|
Definition
Produce analgesia and CNS depression
Stops the transmission of pain messages to the brain
Works int the brain to alter the sensation of pain. |
|
|
Term
| What are 3 common opioids and common dosages for them? |
|
Definition
Morphine 2-15mg
Hydromorphone (Dilaudid) 1.5-8mg
Meperidine (demerol) 50-150mg |
|
|
Term
| What are side effects of opioids? |
|
Definition
CNS depressant
Respiratory depression
Drowsiness, dizziness
Slows GI tract- nausea, constipation
Dysphoria
hallucinations |
|
|
Term
What nursing actions would be implemented when addressing opioid side effects?
Respiratory depression
Drowsiness, Dizziness
Slowing of GI tract
Dysphoria
Hallucinations |
|
Definition
Respiratory depression- Assess resp status; do not give if below 12 resps/min
Drowsiness, Dizziness- Safety needs
Slowing GI tract- Nausea, constipation; assess bowel function; provide anti-emetic
Dysphoria- Safety needs; Education to family of possible behavior changes
Hallucinations- Safety needs; validation |
|
|
Term
| What are some additional nursing actions that should be taken with opioids? |
|
Definition
o Document pain scale and non-verbal objective signs when administering prn
o Controlled substance
o Must sign out for the drug
o Monitor for physical/psychological dependency (pt reassessed every 3 days)
o Monitor liver function (liver panel)
o Monitor renal function (Creatnin)
o Document the therapeutic effects 30-60” following administration |
|
|
Term
| What are the interactions for opioids? |
|
Definition
o Immunologic reaction – ALLERGIES
o Echinacea with opioids cause liver damage
o Remember CNS Depressant
o Any and all drugs that affect the CNS will have a Potentiated action
• Opioid Antagonist – naloxone (Narcan) most common
• Opioid intoxication is a medical emergency
o Respiratory depression – respiratory arrest – cardiac arrest
• Prevent by assessing before administering
o With addicted clients
• Caution with use as withdrawal symptoms may occur
• Cramping, vomiting possible aspiration, HTN, anxiety |
|
|
Term
| What are the actions of non opioids? |
|
Definition
inhibits the pain mediators at the pain site.
• works by inhibiting an enzyme known as cyclooxygenase (COX), Blocks COX
• COX is a catalyst to substances known as prostaglandins which cause pain and inflammation after cell injury and affects the heat-regulating center of the hypothalamus.
• Acetaminophen reduces pain primarily in the CNS possibly in part by inhibiting a form of COX known as COX-3
• Non-opioid analgesics reduce both fever and inflammation |
|
|
Term
| What are common non opioid drugs and their dosages? |
|
Definition
Tylenol 4000 (3200)mg per 24hrs
APA (aspirin) 4000mg per 24 hrs
Ibuprofen 3600mg per 24hrs
Naproxen 1500mg per 24hrs
Celecoxib 200-400mg per 24hr (usually given once daily or BID) |
|
|
Term
| What are the side effects of non opioids? |
|
Definition
GI irritation – Gastric bleeding
Increase bleeding time (ASA)
Hepatotoxicity
Nephrotoxicity occasionally have creatnin checked
Ototoxicity |
|
|
Term
What are nursing implications for the side effects for non opioids
GI irritation – Gastric bleeding
Increase bleeding time (ASA)
Hepatotoxicity
Nephrotoxicity
Ototoxicity |
|
Definition
GI irritation – Gastric bleeding
Give with food*very important
Monitor for nausea, abdominal pain
educate to report change in stools (blood in stool colon or rectum)
Increase bleeding time (ASA)
Must with hold for 30 days prior to OR procedure
Hepatotoxicity
Monitor liver function studies
Nephrotoxicity
Encourage plenty of fluids
Monitor renal function studies
Educate to report edema
Ototoxicity
*Tinnitus, “ringing in the ears” early sign of toxicity can be permanent |
|
|
Term
| What are additional nursing actions for non opioids |
|
Definition
Document pain scale and non-verbal objective signs when administering prn
document the therapeutic effects 30-60” following administration
do not crush enteric coated or XR(extended release) forms
*Avoid concurrent use of COX2 with other forms
Educate to report changes in vision or tinnitus, edema (toxicity) |
|
|
Term
| What are interactions for non opioids? |
|
Definition
Immunologic reaction – ALLERGIES
ASA with anticoagulant therapy increase bleeding time
Alcohol, steroid use increases GI irritation
*No ASA to children or teens = Reyes syndrome risk almost always fatal |
|
|
Term
| What are the actions of local anesthetics? |
|
Definition
with nerve action there is a rapid shift of Na from extracellular to intracellular with the neuron. This allows us motor and sensory response to fire and be carried to the brain. Pg. 241
“-caine” family Lidicaine Novicaine
Anesthetic, blocks the Na which decreases the nerve firing.
Add epinephrine, vessels constrict to area and this will delay return of function thus lengthen duration of the drug. |
|
|
Term
| What are the side effects of local anesthetics? |
|
Definition
Rare reactions
Localized burning or stinging
CNS stimulation restlessness and anxiety
CNS depression drowsiness or unresponsiveness
Spinal headache with epidural or spinal |
|
|
Term
| What are the nursing implications for local anesthetics? |
|
Definition
Localized burning or stinging
application of cool or ice to the area (used to numb)
monitor local area for irritation or rash
CNS stimulation restlessness and anxiety
Monitor VS
Report immediate cardiac palpitations, difficulty breathing or swallowing
CNS depression drowsiness or unresponsiveness
Monitor VS
*Maintain patent airway
safety needs
Spinal headache with epidural or spinal
encourage lying flat (raising the head increases the intracranial pressure)
increase fluids
blood patch by anesthetist (inject own blood when spinal tap + it clots so fluid won’t leak |
|
|
Term
| What are the interactions for local anesthetics? |
|
Definition
Immunologic reaction – ALLERGIES
anaphylactic reaction; difficulty breathing or swallowing, convulsions, respiratory arrest, cardiac arrest
Tramp Stamp – contraindication to an epidural |
|
|
Term
| What are the actions of general anesthetics? |
|
Definition
loss of sensation throughout the entire body with loss of consciousness.
Inhaled – prevent the flow of Na into the neurons of the CNS (commonly causes N&V)
IV – synergistic effect with inhaled to allow less inhaled meds
Barbiturates
Benzodiazepines
Opioids
Neuromuscular blockers – block acetylcholine by binding neuron receptor site causing total skeletal muscle relaxation
Need more than one drug and form of drugs for anesthesia |
|
|
Term
| What are the side effects of general anesthetics? |
|
Definition
Dizziness, drowsiness, hangover, sedation
Nausea, vomiting, GI disturbances
Hypotension, bradycardia, tachycardia
Blurred vision, dry mouth |
|
|
Term
| What are the nursing implications for general anesthetics? |
|
Definition
Dizziness, drowsiness, hangover, sedation
Safety needs NEVER let them get up alone the first time
Nausea, vomiting, GI disturbances
Sips of water or ice until no nausea and fully awake
Progressive diet if allowed
Hypotension, bradycardia, tachycardia, may have bradipnia
Monitor VS frequently (Q15min x 4, Q30min x 4, Q1hr x 4, every hr after that)
Deep breath and leg exercises in bed (have them move ft helps regain internal bodily functions)
Assistance of 2 first time out of bed
Blurred vision, dry mouth
Safety needs due to vision
ice chips or hard candy |
|
|
Term
| What are the interactions for general anesthetics? |
|
Definition
Excessive hypotension with antihypertensive
CNS depressants potentiates respiratory and CNS depression
Neuromuscular blockers multiple interactions of potentiation and cardiac involvement (arrhythmias notice pulse rate/rhythm) |
|
|
Term
| What are the actions of antimigraines? |
|
Definition
cause vasoconstriction of the cranial arteries
“triptans” *Imetrex (sumatriptan)
almo-, ele-, frova-, nara-, riza-, suma-, zolmi-
Ergot alkaloids
stimulate serotonin, decrease inflammation, and vasoconstriction.
Ergotamine tartate (Ergostat) |
|
|
Term
| What are the side effects of antimigraines? |
|
Definition
*dizziness, drowsiness
*vasoconstriction with hypertension |
|
|
Term
| What are the nursing actions for antimigraine side effects? |
|
Definition
dizziness, drowsiness
safety issues (usually like dark quiet room)
vasoconstriction with hypertension
cautiously use with post MI, monitor for chest pain
Monitor BP
Monitor for change in LOC (constriction of vessels to the brain), observe for seizures (fast change is vessel side might cause seizure; seizure precautions- suctions, airways) AURA- change in sensations: spots, zigzags, increase in smell, ring in hearing/hearing change |
|
|
Term
| What are the interactions for antimigraine drugs? |
|
Definition
Gingko, ginseng, Echinacea, St. John’s wort may cause triptan toxicity
Increase effect with MAO’s and SSRI’s
Do not use ergot alkaloids within 24 hours of taking triptans.
Do not use ergot alkaloids with other agents (Prozac), protein (Paxil), or *St. John’s wort. |
|
|
Term
| What are the complimentary & alternative medications? |
|
Definition
Herbal – botanical, useful as a food enhancer or medicine
Vitamin – organic compound required by the body for growth and for normal metabolic processes
Minerals – essential inorganic substances for metabolism
Robotic – live microorganisms, bacteria similar to normal flora of the gut
Natural does not mean “better” or “safer” |
|
|
Term
| What are the actions of complimentary & alternative meds? |
|
Definition
to maintain, enhance or alter cellular function
Replacement to conventional therapies
Vitamin and minerals are necessary for disorders of vitamin/mineral deficiencies such as:
Chronic liver and renal diseases
Aging
Pregnancy
Side effects of medications |
|
|
Term
| What are the side effects of complimentary & alternative meds? |
|
Definition
In recommended doses no effects but seen with hypervitaminosis and mineral overdose
Herbals have idiosyncratic effects per person and preparation
Probiotics may have mild gas and bloating |
|
|
Term
| What are the nursing actions for complimentary & alternative medication side effects? |
|
Definition
Well balanced diet
educate to follow-up with schedule labs
niacin and pyridoxine warmth/flush of skin will diminish with continued use
Take minerals as prescribed to avoid overdose
Calcium avoid large amounts of zinc to avoid impaired absorption (legumes, nuts, sprouts)
Take Ca+ with OJ to improve absorption
Iron supplements stain, use a straw & z-track injection
Iodine stains teeth, use a straw. |
|
|
Term
| What are interactions for complimentary & alternative medications? |
|
Definition
Some herbal products interact with prescription drugs asp; insulin, warfarin, digoxin
Always ask about herbal and OTC supplements when getting a medical history
Investigate all herbals taken
*St. Johns wort interacts with a great number or prescription medications |
|
|
Term
| What are the actions of antibacterials? |
|
Definition
| to kill enough bacteria or slow the growth of infection, so that natural body defenses can overcome the invading agent. |
|
|
Term
| What antibacterials disrupt the cell wall? |
|
Definition
|
|
Term
| Which antibacterials inhibit the cell-wall synthesis? |
|
Definition
| Cef-/ceph- antitubercular drugs |
|
|
Term
| Which antibacterial inhibits the protein synthesis within the cell? |
|
Definition
| -cyclines, -mycins, -floxacins, antitubercular |
|
|
Term
| What are the side effects of the antibacterials? |
|
Definition
Nausea, vomiting, diarrhea
Superinfections
Oto- and nephrotoxicity with aminoglycosides
ANAPHYLAXIS |
|
|
Term
| What are the nursing actions for the antibacterial side effects? |
|
Definition
Nausea, vomiting, diarrhea (NVD)
Take 2 hours after eating with a full glass of water
Consult to take Probiotics supplements and/or cultured dairy 3-6 million units.
Superinfections
Consult to take probiotic supplements and/or cultured dairy
Assess for diarrhea, vaginal infections
Oto- and nephrotoxicity with aminoglycosides (used in bone infections (oseomyalitis) usually on for 6 wks
Otic evaluation prior to start of therapy
Educate to report tinnitus, hearing loss, vertigo
Renal studies prior to start of therapy and periodic through out therapy.
Peak and trough values
ANAPHYLAXIS
Immediately report rash, breathing difficulties |
|
|
Term
| What are the interactions for antibacterials? |
|
Definition
All antibiotics complete the full course of treatment (parent’s don’t make children finish antibiotic)
Avoid fruit juice with penicillin and –mycins (alters composition of drug)
Avoid alcohol with cefs-, metronidazole (Flagyl) works like antibuse used for STD
Secondary family planning with –cyclines, tubercular lowers effectiveness of BC
No cyclines with pregnancy or children (turns children’s teeth yellow)
Photosensitivity with –cyclines, floxacins, sulfa (causes sun burns more easily)
Force fluids with sulfas (FF l-2 liters more per day)
Tubercular drugs are given in combination 2 or more over 6-12 months; treatment and chemoprophylaxis |
|
|
Term
| How do viruses enter the body? |
|
Definition
Enter body through mucous membrane and blood
Viruses are intracellular parasites |
|
|
Term
| What are the actions of antivirals? |
|
Definition
antivirals target the replication cycle (pg 528)
3 strategies to antiviral therapy
vaccines, prevent infection
interrupt replication cycle
boost immune response |
|
|
Term
| What are the side effects of antivirals? |
|
Definition
GI distress: anorexia, nausea, vomiting, dyspepsia (heart burn), diarrhea, abdominal pain
Toxicity of blood cells: anemia neutropenia, thrombocytopenia- bruising (RBC replicate every 52 days) Similar to sulfa drugs
Fatigue, weakness, headache
HIV clients should have blood work monitored regularly |
|
|
Term
| What are nursing interactions for antiviral side effects? |
|
Definition
GI distress: anorexia, nausea, vomiting, dyspepsia, diarrhea, abdominal pain
Administer c food
Avoid with fruit juices
Report severe symptoms
Assess for stomatitis (sores inside the mouth) Use ice when you feel a cold sore coming on. It will make the sore less severe.
Toxicity of blood cells: anemia neutropenia, thrombocytopenia
Monitor variety of lab work: CD4 count, CBC, electrolytes, liver and renal profiles, glucose
Monitor VS especially Temp
Monitor for skin rash
Fatigue, weakness, headache
Establish environment for rest, nutrition, hydration, relaxation
Provide emotional support |
|
|
Term
| What are the interactions for antivirals? |
|
Definition
Hypersensitivity- ALLERGIES
Do not take with juices
Acylovir- Drug for herpesvirus 200-400mg 3-4 times of day
Clients with hepatic disease need to be assessed and use with caution; toxic levels
Multiple drug interactions with this class |
|
|
Term
| What are additional nursing actions for antivirals? |
|
Definition
Education to viral transmission and methods to employ infection control procedures
Need for reliable contraception, antivirals, decrease oral contraception effectiveness
Compliance with meds
Maintain Hydration |
|
|
Term
| What are the actions of antitubercular meds? |
|
Definition
| act on the cell wall to destroy the cell function |
|
|
Term
| What arte the side effects of antitubercular meds? |
|
Definition
GI distress: anorexia, nausea, vomiting, dyspepsia, diarrhea, abdominal pain
Headache
Peripheral neuropathy (first line)
Hepatotoxicity |
|
|
Term
| What are the nursing actions for antitubercular medications side effects? |
|
Definition
GI distress
Administer 1 hr before or 2 hrs after eating
Report severe symptoms
Headache
Avoid tyramine foods with INH
Educate to food choices
Peripheral neuropathy
Encourage the intake of B6 foods, or supplement (grains and pastas)
Assess for neuropathy, checking feet
Hepatotoxity
Assess skin/sclera for jaundice
Monitor hepatic blood profiles |
|
|
Term
| What are additional nursing actions for intitubercular meds? |
|
Definition
Educate to compliance with TB drugs
Most TB drugs are supplied free of charge thru the health department
Educate to report
Yellowing of skin, sclera, light colored stool (clay colored stool)
Report unresolved N&V
Report fever > 100°
Educate to compliance with lab work
Hepatic studies
Renal studies
Education to food choices
Increase B6
No tyramine with INH
Educate to 2-3 L fluid intake per day |
|
|
Term
| what are the interactions for intitubercular meds? |
|
Definition
No alcohol with therapy
Use secondary birth control
Rifampin can cause body fluids to turn reddish-orange, may need to avoid hydrophilic contact lenses |
|
|
Term
| what are the actions of antifungals? |
|
Definition
fungi are single and multicellular organisms, decomposers of dead plants and animals to return their elements to the soil for recycling
Antifungals work on the fungal cell membrane causing it to leak and become porous, impairs growth of the fungi |
|
|
Term
| What are the 3 groups of antifungals? |
|
Definition
systemic (amohotericin) must be taken IV
Azoles (conazoles) diflucin
Superficial |
|
|
Term
| What are the side effects of antifungals? |
|
Definition
Fever, chills, vomiting, headache, phlebitis, with systemic antifungals
NVD with oral forms
Minor skin irritation usually due to the preservatives in the med
Hard on the liver |
|
|
Term
| What are the nursing actions for the antifungals side effects? |
|
Definition
Fever, chills, vomiting, headache, phlebitis, with systemic antifungals
Monitor VS before, during, after infusion
Administer antiemetic before infusion
Monitor renal function, electrolytes
Hypatic function
Monitor IV site
Assess for hypersensitivity
NVD with oral forms
Take med with food
Monitor renal function, electrolytes and hepatic function with ketoconazole
Encourage compliance
Minor skin irritation usually due to the preservatives in the med
Monitor skin for irritation or hypersensitivity
No occlusive dressings
Infection control practices |
|
|
Term
| What are the interactions for antifungals? |
|
Definition
Most all systemic antifungals should be avoided with other medications
Increases the bioavalability of drugs making them toxic |
|
|
Term
| What are the actions of antiprotozoals? |
|
Definition
single cell animal, acquired infection in areas of poor sanitation and personal hygiene
Interrupts the life cycle. Disrupts DNA, inhibiting nucleic acid synthesis |
|
|
Term
| What are the side effects of antiprotozoals? |
|
Definition
Nausea, diarrhea, anorexia
Dizziness, headache
With higher doses may have toxicity= confusion, convulsions, hyporeflexia., hypotension, dysrhythmias |
|
|
Term
| What are the nursing actions for antiprotozoals? |
|
Definition
Nausea, diarrhea, anorexia
Give with food
Monitor electrolytes
Dizziness, headache
Safety needs
In treating malaria, 2 weeks before travel, during and them 4-6 weeks after |
|
|
Term
| What are the interactions for antiprotozoals? |
|
Definition
Aluminum and magnesium in drugs will decrease absorption with chloroquine (millanta malox)
Metronidaxole (flagal) potentiates oral anticoagulants
Metronidazole avoid alcohol = disulfiram reaction works like antibuse |
|
|
Term
| What are the actions for Anti-helminthic? |
|
Definition
helminthes are parasitic worms:
Roundworms, flukes, tapeworms
Medication acts to kill the parasites both in the intestine and organs
Single dose to 3 day therapy, pinworms repeat in one week for eggs |
|
|
Term
| What are the side effects of Anti-helminthics? |
|
Definition
No systemic effects
When worms die, abdominal distention and diarrhea |
|
|
Term
| What are the nursing actions for Anti-helminthic side effects? |
|
Definition
No systemic effects
Hen worms die, abdomen distention and diarrhea
Access to bathroom
Do not give anti diarrheal
Take med with a high fat meal and chew med
Close contacts should also be treated
Pregnancy C- utilize reliable contraception |
|
|
Term
| What are the interactions for Anti-helminthics? |
|
Definition
Only contraindication is hypersensitivity
Carbamezepine and phenytoin (anticonvulsants) increase metabolism of mebendazole (Vermox) |
|
|
Term
| What are the actions of the autonomic meds? |
|
Definition
| Mimic involuntary body functions |
|
|
Term
| What is triggered in the sympathetic nervous system? |
|
Definition
|
|
Term
What are the sympathetic effects on the following body tissues?
eyes
lungs
heart
blood vessels
GI
bladder
uterus |
|
Definition
eyes- dilate pupils
lungs- dilates bronchioles
heart- increases heart rate
blood vessels- constrict
GI- relaxes smooth muscles of GI tract
bladder- relaxes bladder muscles
uterusrelaxes uterine muscles
salivary gland |
|
|
Term
What are the parasympathetic effects on the following body tissues?
eyes
lungs
heart
blood vessels
GI
bladder
salivary gland |
|
Definition
eyes- constrict pupils
lungs- Constrict bronchioles and increases secretions
heart- decreases HR
blood vessels- dilates blood vessels
GI- increases peristalsis
bladder- constricts bladder
salivary gland- increases salivation |
|
|
Term
| What nerves and neurotransmitters are used in the sympathetic nervous system? |
|
Definition
adrenergic postganglionic neuron
norepinephrine |
|
|
Term
| What are the adrenergic receptors for norepinephrine in the sympathetic system? |
|
Definition
|
|
Term
| What is triggered in the parasympathetic nervous system? |
|
Definition
|
|
Term
| What nerves and neurotransmitters are used in the parasympathetic nervous system? |
|
Definition
cholinergic postganglionic neuron
acetulcholine |
|
|
Term
| What are the adrenergic receptors for norepinephrine in the parasympathetic system? |
|
Definition
| cholinergic receptors for acetylcholine |
|
|
Term
| How are autonomic meds used on the autononic nervous system? |
|
Definition
Drugs are used to stimulate or inhibit target organs of the autonomic nervous system, such as the heart, lungs, glands, or digestive tract
Drugs are not give to correct the autonomic nervous system |
|
|
Term
| What are the actions of adrenergic agents? |
|
Definition
(sympathomimetics) work fast
Stimulates sympathetic nervous system
Stimulate the sympathetic nervous system
Induce fight/flight response
parasympatholitic, cholinergic blocker or anti cholinergic works the same but slower, more predictable |
|
|
Term
| What are the side effects of adrenergics? |
|
Definition
Remember the drugs have stimulated fight/flight
CV- tachycardia, HTN, disrhythmias
CNS- excitement, seizures
Dry mouth, NV, Anorexia
Hypoglycemia (glucose is used up by the cells) |
|
|
Term
| What are the nursing actions to the side effects of adrenergics? |
|
Definition
*Accurate Dosing!
CV- tachycardia, HTN, disrhrythmias
Monitor VS, urinary output, cardiac output
CNS- excitement, seizures
Monitor for nervousness, shakiness (cant relax) tubutalin
Support and educate (temporary till the body gets used to it)
Dry mouth, NV, Anorexia
Hard candies for dry mouth, ice chips
Hypoglycemia
Monitor blood sugars with diabetics |
|
|
Term
| What are the interactions for the sympathetic nervous system? |
|
Definition
*Parenteral administration can cause tissue injury make sure you’re in a vain and give slow
MAO inhibitors can cause hypertensive crisis > 200
Increase effects with antidepressants |
|
|
Term
| How are parasympathomimetics/cholinergics used in the parasympathetic system? |
|
Definition
| Used on specific organs; usually eye glocoma pilocarpine; Urecholine to stimulate unation; Cevimeline treats dry mouth; increases Ach, inhibites Ach esterase |
|
|
Term
| What are the actions of the parasympathomimetics/cholinergics meds? |
|
Definition
Stimulate the parasympathetic system
Induce rest and digest (clams pt)
Adrenergic blockers, anti-adrenergic or adrenergic antagonist inhibit the signals of epinephrine and norepinephrine
Wide therapeutic application for HTN, relaxes vessel |
|
|
Term
| What are the side effects of the Parasympathomimetics/Cholinergic meds? |
|
Definition
Increased salivation, respiratory secretions
Abdominal cramping, NVD
Hypotension |
|
|
Term
| What are the nursing actions for the side effects of the Parasympathomimetics/Cholinergic meds? |
|
Definition
Increased salivation, respiratory secretions
Assess for increase salivation and sweating as s/s of overdose (use atropine)
Atropine sulfate antidote
Assess resp status, lung sounds (resp secretions increase)
Educate client to report dyspnea
Abdominal cramping, NVD
Take on an empty stomach
Assess bowel function, including BMs
*Hypotension
Monitor B/P
Educate to change position slowly (orthostatic hypotension)
Assess Urinary output
Use with caution in men with BPH |
|
|
Term
| What are the interactions for the Parasympathomimetics/Cholinergic meds? |
|
Definition
Decrease effect of anticholinergic meds
Cholinesterase inhibitors may increase effects/toxicity |
|
|
Term
| What are antiglaucoma drugs used for and what are examples of theses drugs? |
|
Definition
drugs used to decrease IOP
Prostaglandins- increases outflow of aqueous humor
Miotics-adrenergic antagonist, decreases production of aqueous humor
Osmotic diuretics- decrease formation of aqueous humor; pulls fluid from eye to reduce size to relieve pressure |
|
|
Term
|
Definition
dilate the pupil, to visualize the inner eye
Dilate the pupil D= dilation |
|
|
Term
|
Definition
| dilate and paralyze ciliary muscle to prevent lens movement during the exam |
|
|
Term
|
Definition
constrict the pupil C= constriction
adrenergic antagonist, decreases production of aqueous humor |
|
|
Term
| What are the side effects of ophthalmic drugs? |
|
Definition
Local irritation (redness, burning, tearing)
Photosensitivity |
|
|
Term
| What are the nursing actions for the side affects of opthalmic drugs? |
|
Definition
Local irritation (redness, burning, tearing)
Temporary and transient
Cool packs to eye
Monitor for advancing conjuctivitis
Photosensitivity
Use of sunglasses
Adrenergic and cholinergic drops can enter into circulation via lacrimal duct with systemic effects (heart rate increase shakiness)
Apply pressure to inner canthus of the eye x1” avoid systemic effects |
|
|
Term
| What otic drugs are used on the external ear? |
|
Definition
| antibiotics, steroids, emulsifiers- softens earwax |
|
|
Term
| What otic drugs are used in the middle ear? |
|
Definition
| antibiotics, antihistamines, decongestants |
|
|
Term
| What otic drugs are used in the inner ear? |
|
Definition
| antivertigo (meclezine, scapolomine), diuretics (to much fluid in the ear), steroid |
|
|
Term
| *How is the pinna positioned when administering otic medications to adults and children? |
|
Definition
Adults- up and back
Children- down and back |
|
|
Term
| What are the side effects of the otic meds? |
|
Definition
Local irritation (outer)
Allergic Rx c antibiotics (middle)
Drowsiness (inner) |
|
|
Term
| What are the nursing actions for the side effects of the otic meds? |
|
Definition
Local irritation
Assess external ear skin integrity
Allergic reaction c antibiotics
Monitor for skin rashes, NVD
Educate to take full Rx if no reaction
Drowsiness
Safety needs |
|
|
Term
| What are the actions of antihypertensives? |
|
Definition
Lowers blood pressure by:
Decreasing blood volume (diuretic)
Slows the heart rate
Relaxes the blood vessels
*Always begin with lifestyle changes |
|
|
Term
| What are the different types of antihypertensives and how do they work? |
|
Definition
ALPHA 2 agonists (slows heart, vasodilatation lowers impulses to heart; clonidine, methyldopa; check HR
ALPHA 1 BLOCKERS (azosin’s) inhibits sympathetic activation in arterioles, causing vasodialation drugs: carvedilol, labetalol SVR
DIRECT VASODILATORS lowers B/P; nitroglycerin SVR
Ca+ CHANNEL BLOCKERS (dipines) block calcium ion channels in arterial smooth muscle, causing vasodilation drugs: amlodipine, nifedipine, nisoldipine SVR
BETA BLOCKERS decrease the heart rate and myocardial contractility, reducing cardiac output; affects SV
ANGIOTENSION RECEPTOR BLOCKERS prevent angiotension II from reaching its receptors, causing vasodilation; block angiotension cycle
ACE INHIBITORS Lacinapril block formation of angiotension II, causing vasodilatation and block aldosterone secretion, decreasing fluid vol; decrease blood vol SV & SVR
DIURETICS increase urine output and decrease fluid vol; Pulls of vol SV |
|
|
Term
| What are the side effects of antihypertensives? |
|
Definition
Othostatic hypotension
Draducardia or reflex tachycardia
Persistant cough, angioedema
Hyporkalemia diuretics pull of K+
Fatigue and activity intolerance |
|
|
Term
| What are the nursing actions to the side effects of antihypertensives? |
|
Definition
Othostatic hypotension
Monitor B/P
Educate to change position slowly
Assess for dizziness and report
Safety needs
Bradycardia or reflex tachycardia
Monitor VS, apical pulse
Educate client to report chest pain, palpitations or “racing heart”
Persistant cough, angioedema
Educate to call for help with dyspnea, swelling of tongue face or hoarseness
Hard candy for cough, report if productive (pril’s)
Hyperkalemia vs. hypokalemia
No salt substitutes or sport drinks with K+ sparing diuretics
K-dur K-lite
No grapefruit juice
Monitor K+ blood levels
HCTZ K+ sparing; no K+ supplements
Fruits like banana’s canalope
Fatigue and activity intolerance
Encourage a balance with rest and activity |
|
|
Term
| What are the interactions to antihypertensives? |
|
Definition
When multiple antihypertensives are given will cause a synergistic effects
NO grapefruit juice- contraindicates meds
African-Americans do not dip with B/P at night need to give HTN drugs at night; hypertension is #1 cause of death
Give diuretics in AM to prevent nocturia; not past 1400 |
|
|
Term
|
Definition
| acute chest pain caused by insufficient oxygen to a portion of the myocardium |
|
|
Term
| What is the action of antianginals? |
|
Definition
| slow heart rate, dilate vessels, decrease contraction of the heart, lower B/P |
|
|
Term
| Name the 3 types of antianginals |
|
Definition
| Nitrates, Beta-adreneergic blockers, Calcium channel blockers |
|
|
Term
| What are the side effects of antianginals? |
|
Definition
| headache, hypotension, fatigue, weakness, bradycardia |
|
|
Term
| Vasodilators act in two ways...... |
|
Definition
| in the veins and in the arterioles |
|
|
Term
| What are the nursing actions for antianginals? |
|
Definition
1. Headache - educate that normal s/s that resolves and use gloves when handling meds
2. Hypotension - monitor VS, especially B/P; postural changes slowly; report dizziness; safety needs
3. Fatigue and weakness-safety needs; balance of work and rest
4. Bradycardia - assess apical pulse daily and if below 60 hold til contact HCP; peripheral edema is common, elevate feet |
|
|
Term
| What are the interactions of antianginals? |
|
Definition
1. concourrent use with anti-HTN may cause additive hypotension
2. Do not crush sustained release forms
3. Do not use alcohol |
|
|
Term
| What does alcohol do when used with antianginals? |
|
Definition
|
|
Term
| What is the action of antidysrhythmics? |
|
Definition
| alter specific electrophysiologic properties of the heart |
|
|
Term
| What are the two mechanisms of antidysrhythmics? |
|
Definition
1. block ion channels-slow conduction by preventing-Sodium, Calcium, Potassium
2. Alter autonomic activity - beta-adrenergic blockers |
|
|
Term
| What is the action of Sodium Channel blocker of antidysrhythmics? |
|
Definition
| prevent or slow the depolarization or contractions across the myocardium |
|
|
Term
| What is the action of calcium channel blockers of antidysrhythmics? |
|
Definition
| Reduce the automatic response of the SA node and slow the conduction thru the AV node |
|
|
Term
| What is the action of Potassium channel blocker of antidysrhythmics? |
|
Definition
| delay repolarization, lengthening the refractory period (time before the next contraction begins) |
|
|
Term
| What is the effect of the sodium channel blocker of the antidysarhythmics? |
|
Definition
| Potential to creat new dysarhythmias, or worsen existing, bradycardia leading to hypotension, dizziness, syncope |
|
|
Term
| What is the effect of calcium channel blockers of antidysarhythmics? |
|
Definition
| Bradycardia leading to hypotension, taken with beta-adrenergic blockers increase risk for sever bradycardia and heart failure |
|
|
Term
| What is the effect of potassium channel blockers of antidysrhythmics? |
|
Definition
| bradycardia leading to hypotension, worsening dysarhythmias |
|
|
Term
| What are the side effects of antidysrhythmics? |
|
Definition
| anorexia, N/V/D, fatigue, drowsiness, lethargy, dizziness, headache, dry mouth, urinary retention, bradycardia, peripheral edema |
|
|
Term
| What are the nursing actions of antidysrhythmics? |
|
Definition
1. anorexia, N/V/D - take medication with meals; monitor bowel function; monitor electrolytes
2. Fatigue, drowsinesss, lethargy - balance activity with rest; assess sleep patterns
3. dizziness, headache - safety needs
4. dry mouth - hard candies
5. Urinary retention - assess urinary output
6. bradycardia, peripheral edema - assess AP pulse prior to administration, hold if below 60 notify HCP, evaluate lower extremities |
|
|
Term
| What are the interactions of antidysrhythmics? |
|
Definition
| additive effects if utilized with antihypertensives or digoxin; NO grapefruit juice; restrict use of caffeine and tobacco |
|
|
Term
| What does an antilipidemic do? |
|
Definition
| lowers lipid levels, thus reducing the risk for CV disease |
|
|
Term
| What are the three types of lipids? |
|
Definition
Triglycerides - Energy source
Phospholipids - builds plasma membranes
Steriods - cholesterole |
|
|
Term
| What are the blood values to measure lipids? |
|
Definition
HDL >60
LDL <100
VLDL
triglycerides <150 |
|
|
Term
|
Definition
| inhibit cholesterol production |
|
|
Term
| What does bile-acid binding agents do? |
|
Definition
| bind the bile acids that contain high concentrations of cholesterol and eliminate thru the feces |
|
|
Term
| What does nicotinic acid do? |
|
Definition
| Niacin, reduces VLDL which causes reduction of LDL, reduces triglycerides and increase HDL |
|
|
Term
| What does fibric acid agents do? |
|
Definition
| action unknown, lower triglycerides and VLDL |
|
|
Term
| What does cholesterol absorption inhibitors do? |
|
Definition
| blocks absorption of cholesterol in the small intestine, combination with a statin |
|
|
Term
| What are the side effects of antilipidemics? |
|
Definition
| liver dysfunction, gi distress, N/V/D, heartburn dyspepsia, abd. cramping, flushing with niacin |
|
|
Term
| What are the nursing actions of antilipidemics? |
|
Definition
1. liver dysfunction - baseline liver profile prior to beginning med; monitor liver function studies thru out course of med; no alcohol
2. GI - administer at bedtime
3. Flushing with niacin - take with meals, recommend ASA 30 min before taking |
|
|
Term
| What are the interactions of antilipidemics? |
|
Definition
| -statins interact with many drugs; no grapefruit juice; fibric acid agents (gemfibrozil) may potentiate warfarin |
|
|
Term
| What is the action of Cardiac Glycosides? |
|
Definition
| increase the contraction strength and beat more slowly to improve cardiac output |
|
|
Term
| What are the side effects of cardiac glycosides? |
|
Definition
dysrhythmias, bradycardia
Classic symptom of toxicity
N/V/D, anorexia; shortness of breath; vision changes; leg cramps |
|
|
Term
| What are the nursing actions of Cardiac Glycosides? |
|
Definition
Dysrhythmias - monitor HR and rhythm; apical pulse prior to admin, if below 60 hold and contact HCP
Symptoms of toxicity - monitor GI status, resp status, vision changes, digoxin levels (1.8ng/mL), electrolyte levels |
|
|
Term
| What are the interactions of cardiac glycosides? |
|
Definition
1. concurrent use with diuretics may cause hypokalemia and dysrhythmias
2. concurrent with beta-blockers additive effects of bradycardia
3. hyperkalemia will reduce effects (ACE inhibitors, K+ supplements)
4. ginseng increase toxicity
5. mahuang and ephedra may cause dysrythmias |
|
|
Term
| What is the antidote for digitalis |
|
Definition
|
|
Term
| What is the action of vasodialators? |
|
Definition
| open or dilate a vessel; increaseing blood flow; peripheral vessels or coronary vessels; utilized with hypertension, angina, peripheral vascular disease |
|
|
Term
| What are the side effects of vasodilators? |
|
Definition
| Headaches, lightheadedness, dizziness, orthostatic hypotension, GI distress, nausea |
|
|
Term
| What are the vasodilator nursing actions? |
|
Definition
Headaches - educate to possible headaches, nursing staff do not touch as will experience headache
Lightheadedness - monitor B/P, slow position changes, safety needs
GI - take with food, take at HS |
|
|
Term
| What are the vasodilator interactions? |
|
Definition
| do not take concurrently with alcohol as with increase hypotensive symptoms, avoid smoking causes vasoconstriction |
|
|
Term
| What is the action of Diuretics? |
|
Definition
| increase the volume of urine thus decrease vascular and extra-vascu |
|
|
Term
| What is the action of Diuretics? |
|
Definition
| increase the volume of urine thus decrease vascular and extra-vascular fluids |
|
|
Term
| What are the 4 types of diuretics? |
|
Definition
| osmotic, loop, thiazide, K+ sparing |
|
|
Term
| What are the side effects of diuretic? |
|
Definition
dehydration; thirst, dry mouth, weight loss, headache
Electrolyte imbalances; hypokalemia vs. hyperkalemia
Hypotension, dizziness, fainting
Rare ototoxicity |
|
|
Term
| What are the diuretic interactions? |
|
Definition
| concurrent use with antihypertensives may cause additive effects; hyperkalemia will occur with K+ intake and K+ sparing diuretics; loop and aminoglycosides additive effect to ototoxicity; thiazide and K+ sparing may cause diabetic meds to be less effective; licorice and aloe may increase K+ loss |
|
|
Term
| What is the action of Coagulation-modifying drugs? |
|
Definition
| Hemostasis complex process involving a number of clotting factors, series of sequential steps, referred to as a cascade; vit K is necessary for liver to make the clotting factors |
|
|
Term
| What are the types of drugs affecting coagulation? |
|
Definition
| antiplatelets, anticoagulants, thrombolytics, hemostatics |
|
|
Term
| What is the action of antiplatelets? |
|
Definition
| platelet aggregation, decrease of the stickiness, decrease thombbosis formation |
|
|
Term
| What is the action of anticoagulants? |
|
Definition
| lengthen clotting time, decrease thombosis formation and thrombi growth in size |
|
|
Term
| What is the action of thrombolytics? |
|
Definition
| "clot buster", promotes fibrinolysis |
|
|
Term
| What is the action of hemastatics? |
|
Definition
| in surgery, used to prevent and treat excessive bleeding, prevents fibrin from dissolving |
|
|
Term
| What are the side effects of coagulation-modifying drugs? |
|
Definition
| bleeding, platelet aggregates- nausea (ASA), flu-like s/s with clopidogrel (plavix) |
|
|
Term
| What are the nursing actions of coagulation-modifying drugs? |
|
Definition
Bleeding - monitor lab values, assess prior to admin of drugs; PT, INR, PTT, platelet values; monitor skin, mucouse membranes for superficial bleeding, safety needs
Bleeding with ASA-give with food, enteric coated forms |
|
|
Term
| What are the interactions of coagulation-modifying drugs? |
|
Definition
| platelet aggregates increase effects with anticoagulants; nicotine dig, -cyclines, histamines inhibit anticoagulation; Warfarin multiple drug and herbal interactions with additive effects; hemostatics with OC will increase coaulation effects |
|
|
Term
| What is the antidote for warfarin |
|
Definition
|
|
Term
| What is the antidote for heparin? |
|
Definition
|
|
Term
|
Definition
| bontanical, useful as a food enhancer or medicine |
|
|
Term
|
Definition
| organic compound required by teh body for growth and for normal metabolic processes |
|
|
Term
|
Definition
| essential inorganic substances for metabolism |
|
|
Term
|
Definition
| live microorganisms, bacteria similar to normal flora of the gut |
|
|
Term
| What is the action of complimentary and alternative medications? |
|
Definition
| to maintain, enhance or alter cellular function; replacement to conventional therapies; necessary for disorders of deficiencies such as: chronic liver and renal disease, aging, pregancy, side effects of medications |
|
|
Term
| What are the side effects of complimentary and alternative medications? |
|
Definition
| in recommeded doses no effects but seen with hypervitaminosis and mineral overdose; herbals have idiosyncratic effects per person and preparation; probiotics may have mild gas and bloating |
|
|
Term
| What are the interactions of complimentary and alternative medications? |
|
Definition
| some herbal products interact with prescription drugs esp; insulin, warfarin, digoxin; always ask about herbal and OTC supplements when getting a medical history, investigate all herbals taken, St. Johns wort interact with a great number of prescription medications |
|
|
Term
| What is the action of nutritional supplements? |
|
Definition
| provide nutritional supplementation for client that are undernourished; enteral feedings |
|
|
Term
| What are the side effects of nutritional supplements? |
|
Definition
| nausea, vomiting, diarrhea; aspiration |
|
|
Term
| What are the nursing actions of nutritional supplements? |
|
Definition
N/V/D - start with small amounts and gradually increase; maintain upright position; monitor bowel status; monitor weight
Aspiration - delayed gastric emptying and additional feeding may lead to reflux; check for residual prior to feeding; maintain head elevation at lease 30 degrees |
|
|
Term
| What are the interactions of nutritional supplements? |
|
Definition
| feeding tubes have a small lumen and become clogged; change tubing every 24-48 hrs; flush with water before and after medications; no bulk laxatives down tube |
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