Content Review Flashcards
isotonic
same concentration as body fluids (0.9% NaCl, LR, D5W)
hypotonic
solute concentration less than body fluids (0.45% NaCl)
hypertonic
solute concentration greater than body fluids (D10W, D15W, 3% NaCl, Sodium bicarb 5%)
infiltration
LEAKAGE INTO SURROUNDING TISSUE –cool skin, swelling (edema), pain, decrease in flow rate (give warm compress, elevate, new IV) **apply tourniquet above IV site and if it continues to drip it has infiltrated
phlebitis
redness, pain, heat, swelling (give warm compress)
Precaution w/ PICC line
do not take BP or draw blood on that extremity
Triple lumen percutaneous central catheter
Change q4wks distal (16) infuse or draw blood middle (18) TPN proximal (18) infuse or draw blood, admin meds
Agents used to tx hypovolemic shock, cardiac arrest, and anaphylaxis
norepinephrine (infuse with dextrose): vasocontrict (incr BP) which can cause reflex bradycardia; need to watch UO dopamine
dopamine **(must infuse): low dose dilates renal and coronary arteries; high dose vasocontricts increasing myocardial oxygen consumption (h/a early sign of drug excess)
**epinephrine: **stimulates alpha and beta (heart and lungs), aspirate before IM and subQ
**isoproterenol: **stimulates beta 1 and 2, used for heart block, Ventricular arrythmias, bradycardia; bronchodilator for asthma and bronchospams (don’t give at night, disturbs sleep pattern)
phenylephrine: potent alpha 1, used for hypotension
dobutamine (must infuse): stimulates beta 1 receptors; cannot infuse with other meds, need large IV
milrinone: positive inotropic agent (strengthen the force of the heart beat, pumping more blood with fewer beats) to *tx severe heart failure; *
**sodium nitroprusside: **dilates cardiac veins and arteries, decrease preload and afterload helping myocardial perfusion
**diphenhydramine: **blocks the effects of histamine on bronchioles, GI tract, and blood vessels
Antianxiety agents
for: anxiety d/o, insomnia, petit mal seizures, panic attacks, acute manic
- hypotension s/e for all
- should avoid alcohol
- DO NOT STOP ABRUPTLY
chlordiazepoxide (Librium) and Diazepam (valium): CNS depressant, potential for addiction and overdose (can build toxic in elderly)
**alprazolam (xanax), clonazepam (klonopin), lorazepam (ativan), oxazepam (serax): **CNS depressant, check renal/hepatic function, don’t take other depressants like alcohol, addictive potential
**midazalam (versed): **preop sedation abd conscious sedation for endoscopic procedures, CNS depressant
**buspirone (BuSpar): **no abuse potential, so given to pt with previous addiction, REQUIRES 3WK TO BE EFFECTIVE, avoid ETOH and grapefruit juice, monitor for worsening depression
**hydroxyzine (Vistaril, Atarax): **no dependence, tolerance or intoxication so can be used long-term (but may cause leukopenia and ataxia)
**kava: **suppresses emotional excitability and produces mild euphoria, DON’T TAKE WITH CNS DEPRESSANTS, or prego and lacting women or childres < 12y
**meltonin: **used to prevent and tx “jet lag” and insomnia; use cautiously w/ benzo and CNS depressants. Contraindicated in hepatic insufficiency, hx of CVA, depression or neuro d/o
Antacid Meds
for: peptic ulcer, indigestion, reflex esophagitis, prevent stress ulcers
aluminum hydroxide gel and **calcium carbonate: **contains Na so will affect sodium restricted diets, encourage fluid to prevent constipation (careful use for renal dysfxn)
calcium carbonate: monitor for phospate deficiency–malaise, weakness, tremors, bone pain (careful use for renal dysfxn)
aluminum hydroxide/magnesium trisilicate: interferes w/ tetracycline absorption (careful use for renal dysfxn)
**magnesium hydroxide (milk of Mg): **excessive does N/V and diarrhea, frequent use and lead to dependence, (caution w/ renal dz)
**Aluminum hydroxide and magnesium hydroxide (Maalox): **has slight laxative effect, (caution w/ renal dz)
Antidysrhythmics
Class 1A type
procainamide (Pronestyl)
Disopryarmine (Norpace)
side effects:
- hypotension, heart failure
nursing considerations:
- monitor BP
- monitor for widening of the PR, QRS or QT intervals
Antidysrhythmics
Class 1B drugs
Lidocaine (xylocaine)
Mexiletine hydrochloride (Mexitil)
Tocainide hydrochloride (Tonocard)
side effects:
- slurred speech, confusion, drowsiness, seizures, hypotension and bradycardia
nursing considerations:
- monitor for CNS side effects
- monitor BP and heart rate and cardiac rhythm
Antidysrthythmics
Class 1C drugs
Flecainide (Tambocor)
Propafenone hydrochloride (Rythmol)
side effects:
- bradycardia, hypotension, dysrthythmias, CNS: anxiety, insomnia, confusion, seizures
nursing considerations:
- monitor for increasing dysrhythmias, monitor HR and BP and CNS effects
Class II drugs
propanolol (inderal)
acebutolol (Sectral)
Esmolol hydrochloride (Brevibloc)
Sotalol hydrochloride (Betapace)
side effects:
- bradycardia and hypotension, bronchospasm, increase in heart failure, fatigue and sleep disturbances
nursing considerations:
- assess apical HR 1 min before admin
- monitor apical HR, cardiac rhythm and BP
- assess for SOB and wheezing
- assess for fatigue, sleep disturbance
Class III drugs
amiodarone hydrochloride (Cordarone)
Ibutilide fumarate (Corvert)
Dofetilide (Tikosyn)
side effects:
- hypotension, bradycardia and AV block
- muscle weakness, tremors
- photosensitivity and photophobia
- liver toxicity
nursing considerations:
- continuous monitoring of cardiac rhythm during IV admin
- monitor QT interval during IV admin
- monitor HR, BP during initiation of therapy
- instruct client to wear sunglasses and sunscreen
