ATI (chp 30) Flashcards
Potassium and magnesium regulate
body fluid volume
Iron preparations –> select prototype medications
◯ Oral: Ferrous sulfate (Feosol, FeroSul, Slow FE)
◯ Parenteral: Iron dextran (INFeD, DexFerrum)
Iron preparations provide
iron needed for RBC development and oxygen transport to cells.
treat iron-deficiency anemia
When is iron in high demand
times of increased growth (children and pregnancy) and after blood loss
poorly absorbed by the body
Ferumoxytol is limited to clients
with chronic kidney disease
requires only 2 doses every 3 to 8 days
■ Ferumoxytol requires only two doses over 3 to 8 days
compared with SFGC and iron sucrose,
which requires 3 to 10 doses over several weeks.
Iron sucrose and SFGC are used solely for clients
undergoing long-term hemodialysis (most common way to treat advanced kidney failure)
Adverse effects of Iron
-GI distress
-teeth staining (liquid form)
-anaphylaxis risk w/ iron dextran
-Hypotension, which may progress to
circulatory collapse
-fatal iron toxicity in children may offer with overdose (2 - 10 g)
What can be used parenthetically to treat toxicity from iron in children?
chelating agent deferoxamine
Desferal
Iron Preparations are contraindications for:
Hemolytic anemia
peptic ulcer disease
severe liver disease
Coadministration of ___________ and _____________
reduces absorption of iron.
antacids or tetracyclines
separate by atleast 2 hours
Vitamin C increases absorption, but also increases ____________
incidence of GI complications
Avoid taking Vitamin C while taking iron
Patient-Centered Care w/ iron
-eat on empty stomach to maximize absorption
-Instruct clients to space doses at approximately equal intervals throughout day to most efficiently
increase red blood cell production. Inform clients to anticipate a harmless dark green or black color
of stool.
Foods full of iron
(liver, egg yolks, muscle
meats, yeast, grains, green leafy vegetables)
Nursing evaluation on Iron EFFECTIVENESS:
Increased reticulocyte count is expected at least 1 week after beginning iron therapy
Increase in hemoglobin of 2 g/dL is expected 1 month after beginning therapy.
Fatigue and pallor (skin, mucous membranes) have subsided, and the client reports increased
energy level.
Vitamin B12
intranasal cyanocobalamin (Nascobal)
Vitamin B12 is necessary to convert
folic acid from its inactive form to its active form.
Folic Acid
All cells rely on folic acid for DNA production.
Vitamin B12 deficiency can result in
which results in megaloblastic
anemia (macrocytic) and can cause fatal heart failure if not corrected
-Damage to rapidly multiplying cells can affect the skin and mucous membranes, causing GI disturbances.
Neurologic damage, which includes numbness and tingling of extremities and
CNS damage caused by demyelination of neurons,
Vitamin B12 deficiency affects ALL ________ in ____________
blood cells in bone marrow
Loss of erythrocytes leads to heart failure, cerebral vascular insufficiency, and hypoxia.
■ Loss of leukocytes leads to infections.
■ Loss of thrombocytes leads to bleeding and hemorrhage.
Why would a patient need B12 prescribed for the rest of life?
Loss of intrinsic factor within the cells of the stomach make in impossible to absorb B12 naturally
Adverse effect of B12
Hypokalemia secondary to the increased
RBC production effects of vitamin B12
Nursing Interventions of B12 to prevent hypokalemia
Monitor potassium levels during the start of treatment.
› Observe clients for findings of potassium deficiency
(muscle weakness, abnormal cardiac rhythm).
› Clients may require potassium supplements.
Hypokalemia
Low potassium in your bloodstream. Potassium is a chemical (electrolyte) that is critical to the proper functioning of nerve and muscles cells, particularly heart muscle cells.
Normally, your blood potassium level is 3.6 to 5.2 millimoles per liter (mmol/L). A very low potassium level (less than 2.5 mmol/L) can be life-threatening and requires urgent medical attention.
Contraindication of using folic acid to treat Vitamin B12 deficiency
Vitamin B12 deficiency should never be treated only with folic acid, which can result in neurological
damage. If folic acid is used for a client with vitamin B12 deficiency, ensure that dosage is adequate.
Oral and intranasal vitamin B12 are what pregnancy category?
Pregnancy Risk Category A
Parenteral formulation of Vitamin B12
is Pregnancy Risk Category C
signs of vitamin B12 deficiency
such as beefy red tongue, pallor, neuropathy
Which patients receive Vitamin B12 injections
loss of intrinsic factor (pernicious anemia), enteritis, and partial removal of the stomach
This type of Vitamin B12 medication should be taken atleast 1 hour before or after HOT food
Intranasal cyanocobalamin should be administered 1 hr before or after eating hot foods, which can cause the medication to be removed from nasal passages without being absorbed because of increased
nasal secretions.
irreversible malabsorption syndrome
(parietal cell atrophy or total gastrectomy)
Food group high in Vitamin B12
dairy products
Schillings test
to determine vitamin B12 absorption in the gastrointestinal tract.
Measurement of plasma B12 levels helps to determine need for therapy.
Prescribed Vitamin B12 tests
vitamin B12 levels should be monitored every 3 to 6 months
VITAMIN B12 Nursing Evaluation of Medication Effectiveness
◯ Improvement of megaloblastic anemia as evidenced by increased reticulocyte count, absence of
megaloblast in bone marrow, macrocytes in blood, and normal or increased Hgb and Hct levels.
◯ Improvement of neurologic symptoms such as absence of tingling sensation of hands and feet
and numbness of extremities. Improvement may take months, and some clients will never attain
full recovery.
Folic Acid is essential for
Folic acid is essential in the production of DNA and erythropoiesis (RBC, WBC, and platelets)
Treatment of megaloblastic (macrocytic) anemia ___________ to folic acid deficiency
secondary
Why is folic acid needed for all woman of child bearing age?
Prevention of neural tube defects during pregnancy
Malabsorption Syndrome
refers to a number of disorders in which the intestine’s ability to absorb certain nutrients, such as vitamin B12 and iron, into the bloodstream is negatively affected.
Folic acid can help treat which malabsorption syndrome
sprue
Alcohol Use Disorder needs FOLIC ACID supplementation because…
required due to poor dietary intake of folic acid and injury to the liver
Folate effect is antagonized by
chloramphenicol
chloromycetin sodium succinate
Folate may decrease
phenytoin serum levels because of increased metabolism
Assess patient for signs of megaloblastic anemia which may indicate folic acid deficiency
megaloblastic anemia (pallor, easy fatigability, palpitations, paresthesias of hands or feet).
Food sources of folic acid
green leafy vegetables, citrus fruits, and dried peas and beans. Monitor clients for risk factors
indicating that folic acid therapy may be needed, such as heavy alcohol use and child-bearing age.
Select Prototype Medication: potassium chloride (K-Dur, Klor-Con, Slow-K, KCl 5%)
Other Medications:
◯ Potassium gluconate
◯ Potassium phosphate
◯ Potassium bicarbonate
Potassium is essential for….
conducting nerve impulses
maintaining electrical excitability of muscle
regulation of acid/base balance
Potassium supplements are used to treat what???
hypokalemia (potassium less than 3.5 mEq/L
When are potassium supplements used?
- For clients receiving diuretics resulting in potassium loss, such as furosemide (Lasix)
-For clients with potassium loss due to excessive or prolonged vomiting, diarrhea, abuse of
laxatives, intestinal drainage, and GI fistulas
What to do if patient is getting a GI ulcer due to potassium supplement?
› Instruct clients to take the medication with meals or a full glass
of water to minimize GI discomfort and prevent ulceration.
› Teach clients not to dissolve the tablet in the mouth because
oral ulceration will develop.
Too much potassium is an adverse effect that can cause _______ when administered with an IV
Hyperkalemia
(potassium>5.0mEq/L)
Monitor clients receiving IV potassium for signs of
hyperkalemia, such as bradycardia, hypotension, ECG changes.
Potassium contraindications:
severe kidney disease
hypoaldosteronism
digitalis toxicity with AV block.
Concurrent use of potassium-sparing diuretics, such as spironolactone or ACE inhibitors (lisinopril)
INCREASES risk of HYPERkalemia
Potassium Oral Administration
◯ Mix powdered formulations in at least 4 oz of liquid.
◯ Advise clients to take potassium chloride with a glass of water or with a meal to reduce the risk of
adverse GI effects.
◯ Instruct clients not to crush extended-release tablets.
◯ Instruct clients to notify the provider if they have difficulty swallowing the pills. Medication may
be supplied as a powder or a sustained-release tablet that is easier to tolerate.
Potassium IV Administration
◯ Never administer IV bolus. Rapid IV infusion can result in fatal hyperkalemia.
◯ Use an IV infusion pump to control the infusion rate.
◯ Dilute potassium and give no more than 40 mEq/L of IV solution to prevent vein irritation.
◯ Give no faster than 10 mEq/hr.
◯ Cardiac monitoring is indicated for serum potassium levels outside of normal parameters.
◯ Assess the IV site for local irritation, phlebitis, and infiltration. Discontinue IV immediately if
infiltration occurs.
◯ Monitor the client’s I&O to ensure an adequate urine output of at least 30 mL/hr.
Normal Serum Potassium level is _________ and helps a nurse assess the effectiveness of medication
serum potassium level within
expected reference range (3.5 to 5.0 mEq/L).
Magnesium Sulfate Oral Name
Magnesium hydroxide (Milk of Magnesia [MOM]) and magnesium oxide (Uro-Mag, Maox), magnesium citrate (Citrate of Magnesia, Citroma, Citro-Nesia)
Magnesium hydroxide and magnesium oxide, when administered at a low does, act as what?
antacid –> act as laxative
Function of magnesium in the body:
activates many intracellular enzymes and plays a role in regulating skeletal muscle
contractility and blood coagulation.
Magnesium supplements are needed in
hypomagnesemia (magnesium level less than
1.3mEq/L).
What is used to stop preterm labor
IV magnesium sulfate is used to stop preterm labor and as an anticonvulsant during labor and delivery
Muscle weakness, flaccid paralysis,
painful muscle contractions,
cardiac disorders, and
respiratorydepression
Adverse effect of magnesium
neuromuscular blocking agents
should not be used when taking magnesium as it can can potentiate respiratory depression and apnea
Magnesium is what pregnancy category?
Category A
AV block, rectal bleeding, nausea/vomiting, and abdominal pain, renal and/or cardiac disease
use magnesium cautiously with these patients
Magnesium sulfate can decrease the absorption of which antibiotic?
tetracyclines
What to give with magnesium sulfate toxicity
Calcium gluconate
Foods with magnesium
(whole grain cereals, nuts, legumes, green leafy
vegetables, bananas).
Magnesium Patient-Centered Care:
Monitor serum magnesium, calcium, and phosphorus.
● Monitor the client’s blood pressure, heart rate, and respiratory rate when given intravenously.
● Assess for depressed or absent deep tendon reflexes as a sign of toxicity.
● Calcium gluconate is given for magnesium sulfate toxicity. Always have an injectable form of calcium
gluconate available when administering magnesium sulfate by IV.
● Teach clients about dietary
expected serum magnesium levels
serum magnesium levels within
expected reference range (1.3 to 2.1 mEq/L).
Aloe
topical antimicrobial, anti-inflammatory, analgesic, and cathartic
› Soothes pain, heals burns (aloe gel)
› Softens skin, laxative (aloe latex)
Aloe adverse effects
Skin preparations: possible hypersensitivity
› Laxative: Possible fluid and electrolyte imbalances
› Increases menstrual flow when taken during menses
› Avoid taking if the client has kidney disorders
Black cohosh
› Acts as an estrogen substitute
› Mechanism of action is unknown
› Treats symptoms of menopause
Black cohosh adverse effects
GI distress, lightheadedness, headache, rash, weight gain
› Avoid taking during the first two trimesters of pregnancy.
› Limit use to no longer than 6 months due to lack of information regarding
long-termeffects.
Echinacea
› Stimulates the immune system
› Decreases inflammation
› Topically heals skin disorders, wounds, and burns
› Possibly treats viruses (common cold, herpes simplex)
› Used to increase T-lymphocyte, tumor necrosis factor, and interferon production
With chronic use, this herbal can decrease positive effects ofmedications for tuberculosis, HIV, or cancer.
Echinacea
Feverfew
Can block platelet aggregation
› May block a factor that causes migraines
› May decrease the number and severity of migraine headaches (does not treat an
existing migraine)
Garlic
When crushed forms the enzyme allicin
› Blocks LDL cholesterol and raises HDL cholesterol; lowers triglycerides
› Suppresses platelet aggregation and disrupts coagulation
› Acts as a vasodilator (may lower BP)
› Due to antiplatelet qualities, can increase risk of bleeding in clients taking NSAIDs,
warfarin, and heparin
› Can increase hypoglycemic effects of diabetes medications
› Decreases levels of saquinavir, a medication for HIV treatment
Garlic
ginger root
› Relieves vertigo and nausea › Increases intestinal motility › Increases gastric mucous production › Decreases GI spasms › Produces an anti-inflammatory effect › Suppresses platelet aggregation › Used to treat morning sickness, motion sickness, nausea from surgery › Can decrease pain and stiffness of rheumatoid arthritis
Ginger root interacts with what drugs?
interfere with coagulation (NSAIDS, warfarin,
andheparin)
Ginkgo Biloba
› Promotes vasodilation – Decreases leg pain caused from occlusive arterial disorders
› Decreases platelet aggregation – May decrease risk of thrombosis
› Decreases bronchospasm
› Increases blood flow to the brain – Improves memory (dementia, Alzheimer’s disease)
Seizure patients should take which herb with caution?
Ginkgo Biloba
Glucosamine
› Stimulates cells to make cartilage and synovial fluid
› Suppresses inflammation of the joints and cartilage degradation
» Treats osteoarthritis of the knee, hip, and wrist
Which herb should be used with caution if you have a shellfish allergy?
Glucosamine
Kava
SHOULD BE AVOIDED - causes liver damage
causes liver injury
› Possibly acts on GABA receptors in the CNS
› Promotes sleep
› Decreases anxiety
› Promotes muscle relaxation without affecting concentration
Ma Huang
› Stimulates the CNS
» Suppresses the appetite
» Used for weight loss
› Constricts arterioles – Increases heart rate and BP
› Bronchodilates – Treats colds, influenza, and allergies
St. John’s Wort
› Affects serotonin, producing antidepressant effects – Used for mild depression
› Used orally as an analgesic to relieve pain and inflammation
› Applied topically for infection
Avoid longterm sun exposure when taking which herb?
St. John’s Wort
Interactions w/ St. John’s Wort
› May cause serotonin syndrome when combined with other antidepressants,
amphetamine, and cocaine
› Decreases effectiveness of oral contraceptives, cyclosporine, warfarin, digoxin,
calcium-channel blockers, steroids, HIV protease inhibitors, and some cancer
chemotherapy medications
Valerian
› Increases gamma-aminobutyric acid (GABA) to prevent insomnia (similar to
benzodiazepines)
» Reduces anxiety-related restlessness
» Drowsiness effect increases over time
Herbal that is FDA Pregnancy Risk Category X
saw palmetto
Fiber is recommended when taking _____
iron
Potassium should be infused no faster than _____ to prevent vein irritation,
phlebitis, and infiltration.
10 mEq/hr
Should Cardiac monitoring be implemented to detect cardiac dysrhythmias in a client
receiving IV POTASSIUM?
YES
With Potassium IV administration, to prevent fatal hyperkalemia due to a rapid infusion rate
infusion pump
