Critical Nursing Responsibilities Flashcards
critical nursing responsibilities for acetaminophen with codeine
high alert medication
assess BP, pulse, respiration rate and sedation before administration - hold if RR is less than 10
Make sure daily total less than 4g acetaminophen
assess pain prior to administration and at 60 minutes
for fever, assess temp before administration and after
monitor liver function and watch for signs of hepatotoxicity (increased serum bilirubin, LDH, AST, ALT, and prothrombin time)
antidote is naloxone (narcan)
critical nursing responsibilities for albuterol
monitor for paradoxical bronchospasm (wheezing)
assess lung sounds, pulse, and BP before and at 60-90 minutes
Have pt rinse mouth after use - helps avoid dry mouth
Wait 1 min between doses
Take bronchodilator before corticosteroid
critical nursing responsibilities for amlodipine
monitor BP and pulse before therapy, during dose adjustment, and periodically during therapy
monitor ins/outs, observing for peripheral edema
assess for signs of HF (peripheral edema, rales/crackles, dyspnea, wt gain, jugular venous distention)
critical nursing responsibilities for acetylsalicylic acid
monitor for bleeding (may cause prolonged prothrombin time)
monitor for signs of toxicity: tinnitus, headache, hyperventilation, agitation, mental confusion, lethargy, diarrhea, and sweating
critical nursing responsibilities for atorvastatin
monitor for muscle tenderness, if pt develops check CPK levels (if more than 10 times normal, d/c use)
monitor for signs of immune-mediated necrotizing myopathy (proximal muscle weakness and increased serum creatine kinase)
monitor serum cholesterol and triglyceride levels before and 2-4 weeks into therapy, periodically there after
critical nursing responsibilities for budesonide
monitor respiratory status and lung sounds
periodic monitoring of adrenal function using hypothalamic-pituitary-adrenal axis suppression for chronic therapy
advise pt to rinse mouth after use to decrease risk of candidiasis
Take after bronchodilator if taking both
critical nursing responsibilities for cefazolin
monitor bowel function for diarrhea, abdominal cramping, fever, and bloody stools which could indicate CDAD
assess pt for skin rash during therapy (SJS)
assess infection before and during therapy, including C and S
monitor for signs of anaphylaxis
critical nursing responsibilities for ceftriaxone
monitor bowel function for diarrhea, abdominal cramping, fever, and bloody stools which could indicate CDAD
assess infection before and during therapy, including C and S
monitor for signs of anaphylaxis
critical nursing responsibilities for ciprofloxacin
monitor bowel function for diarrhea, abdominal cramping, fever, and bloody stools which could indicate CDAD
monitor neurological/CNS changes/effects
watch for signs of hepatotoxicity
assess infection before and during therapy, including C and S
monitor for signs of anaphylaxis
critical nursing responsibilities for digoxin
high alert medication
take apical pulse for 1 full minute before administration, hold if HR is less than 60 for adult, 70 for child, 90 for infant
monitor ECG throughout IV administration and 6 hours after each dose
monitor respiration rate for bradycardia
monitor for signs of toxicity: abdominal pain, anorexia, nausea, vomiting, visual disturbances, bradycardia, arrhythmias
monitor serum electrolytes, especially calcium, magnesium, and potassium
critical nursing responsibilities for diltiazem
Monitor ins/outs and wt daily
monitor BP and pulse
assess for signs of HF (peripheral edema, rales/crackles, dyspnea, wt gain, jugular venous distention)
assess for rash (SJS)
monitor ECG continuously during administration for arrhythmias, report bradycardia or hypotension immediately
critical nursing responsibilities for dimenhydrinate
assess nausea, vomiting, bowel sounds, and abdominal pain before and after administrations
monitor ins and outs including emesis
watch for signs of dehydration (excessive thirst, dry skin and mucous membranes, tachycardia, increased specific gravity of urine, poor skin turgor)
critical nursing responsibilities for diphenhydramine
monitor confusion and sedation, especially in older adults
monitor effectiveness in preventing/treating allergic reaction
critical nursing responsibilities for enoxaparin
high alert medication
monitor for signs of bleeding or hemorrhage
assess for additional or increased thrombosis symptoms
assess PQRSTU for those with angina
monitor CBC, platelet count, clotting times (aPTT)
monitor injection site for hematoma, ecchymosis, inflammation
antidote is protamine sulfate
critical nursing responsibilities for fentanyl patch
high alert medication
assess BP, pulse and respiration before and periodically during use. hold or d/c if RR is less than 10
monitor LOC
wear gloves while handling patch
make sure to remove previous patch and dispose of properly (sharps)
Place patch on flat, nonirritated, nonirradiated area of skin. If needed, clip hair (don’t shave)
Antidote is Narcan /naloxone
critical nursing responsibilities for fluoxetine
monitor mental status, especially suicidal tendencies and mood changes
watch for signs of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, seizures, diaphoresis, arrhythmias, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, loss of bladder control)
watch for signs of serotonin syndrome: mental changes (agitation, hallucinations or coma), autonomic instability (tachycardia, labile BP, hyperthermia), neuromuscular aberrations (hyperreflexia, incoordination), and GI symptoms (nausea, vomiting, diarrhea)
critical nursing responsibilities for fluticasone
watch for signs of adrenal insufficiency (anorexia, nausea, weakness, fatigue, hypotension, hypoglycemia)
monitor respiratory status and lung sounds
monitor bone mineral density
monitor growth rate in children
advise pt to flush mouth with water after use
critical nursing responsibilities for furosemide
monitor ins/outs and daily weights
monitor location and amount of edema
monitor lung sounds, skin turgor and mucous membrane
monitor BP and pulse before and during
monitor pt for tinnitus and hearing loss, using audiometry for pts receiving prolonged or large dose IV therapy
watch for skin rash
critical nursing responsibilities for gabapentin
monitor closely for changes in behaviour that could indicate worsening of suicidal thoughts or behaviour or depression
in those with seizures, assess location, duration, and characteristics of seizure activity
critical nursing responsibilities for heparin
high alert medication
assess for signs of bleeding and hemorrhage
monitor platelet count, watching for Heparin-induced thrombocytopenia which will mean low thrombocyte levels that persist
Antidote is protamine sulfate
critical nursing responsibilities for humulin r
high alert medication
monitor for symptoms of hypoglycemia (or hyperglycemia)
monitor blood glucose Q6H and as needed
overdose symptoms are hypoglycemia - mild may be treated with oral glucose, severe should be treated with IV glucose, glucagon, or epinephrine
critical nursing responsibilities for humulin n
high alert medication
monitor for symptoms of hypoglycemia (or hyperglycemia)
monitor blood glucose Q6H and as needed
overdose symptoms are hypoglycemia - mild may be treated with oral glucose, severe should be treated with IV glucose, glucagon, or epinephrine
critical nursing responsibilities for hydromorphone
high alert medication
assess BP, pulse and respirations before administration and at 15min, 30min and 1 hr for IV and at 30 min, 1 hr for PO
monitor LOC
hold if RR below 10 or unable to rouse
assess pain before and after administration
critical nursing responsibilities for ibuprofen
assess for symptoms of GI bleeding (tarry stools, light-headedness, hypotension), renal dysfunction (elevated BUN and serum creatinine levels, decreased urine output), and hepatic impairment (elevated liver enzymes, jaundice)
monitor BUN, serum creatinine, CBC, and liver function tests periodically
critical nursing responsibilities for insulin largine (lantus)
high alert medication
assess for symptoms of hypoglycemia
monitor blood glucose q6h or more frequently
K
antidote is oral glucose for mild hypoglycemia and IV glucose, glucagon, or epinephrine
critical nursing responsibilities for levothyroxine
assess apical pulse and BP prior to and periodically during therapy
assess for tachyarrhythmias and chest pain
antidote to acute overdose is induction of emesis or gastric lavage
critical nursing responsibilities for lispro (humalog)
.high alert medication
assess for symptoms of hypoglycemia
monitor blood glucose q6h or more frequently
A1C may be monitored q3-6months
overdose symptoms are hypoglycemia - mild may be treated with oral glucose, severe should be treated with IV glucose, glucagon, or epinephrine
critical nursing responsibilities for lorazepam
regularly assess for continued need for treatment
assess mental status and degree and manifestations of anxiety
antidote is flumazenil (romazicon)
critical nursing responsibilities for magnesium sulfate
high alert medication
monitor BP, pulse, respirations, and ECG frequently - respirations should be at least 16/minute before each dose
monitor neurological status
critical nursing responsibilities for meropenem
monitor bowel function
periodically monitor BUN, AST, ALT, AST, LDH, serum alkaline phosphatase, bilirubin, and creatinine as measure of hepatic and renal function
monitor hematological function via hemoglobin and hematocrit (may drop)
critical nursing responsibilities for metformin
monitor for hypoglycemia
monitor for ketoacidosis or lactic acidosis by assessing serum electrolytes, ketones, glucose, and if indicated conduct further investigation.
Monitor renal function, d/c if on fluid restriction,
critical nursing responsibilities for metoprolol
high alert medication
Take apical pulse before administration, hold if heart rate is less than 50 or arrhythmia ocurs
monitor BP and pulse
intake/output ratios
monitor for HF symptoms
critical nursing responsibilities for metronidazole
assess neurological status during and after IV infusions
monitor ins/outs
assess for rash
monitor infection (take C and S before, watch for signs throughout treatment)
critical nursing responsibilities for morphine
high alert medication
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assess level of consciousness, BP, pulse, and respiration rate before - holding medication if respiration rate is less than 10 and pt is sedate. reassess at peak
monitor bowel function
assess pain before and during treatment
Reassess at 5//15//30
critical nursing responsibilities for naproxen
assess pain and fever before and after administration
monitor BUN, serum creatinine, CBC, liver function periodically
critical nursing responsibilities for nitroglycerin
assess location, duration, intensity, and precipitating factors of pt’s anginal pain
monitor BP and pulse before and after each administration
critical nursing responsibilities for ondansetron
assess for nausea, vomiting abdominal distention and bowel sounds
assess for extrapyramidal effects (involuntary movements, facial grimacing, rigidity, shuffle walking, trembling hands)
monitor for signs of serotonin syndrome
critical nursing responsibilities for oxycodone
high alert medication
assess BP, pulse, pain, and respirations before administration. hold if RR less than 10 and pt sedate
monitor bowel function
critical nursing responsibilities for pantoprazole
monitor bowel function for signs of CDAD (abdominal cramping, fever, bloody stools)
critical nursing responsibilities for penicillin g
assess infection before onset of therapy
monitor bowel function for signs of CDAD
watch for signs of anaphylaxis
critical nursing responsibilities for perinodpril
monitor BP and pulse
assess for signs of angioedema (swelling face, extremities, eyes, lips, tongue, difficulty swallowing or breathing)
critical nursing responsibilities for phenobarbital
monitor respiratory status, pulse, and BP
watch for signs of angioedema (swelling of lips, face, throat, dyspnea)
symptoms of toxicity include confusion, drowsiness, dyspnea, slurred speech, staggering
critical nursing responsibilities for phenytoin
monitor for change in behavior, suicidal thoughts/behaiviours
watch for signs skin reactions and d/c at first sign due to risk of of Stevens-Johnson or toxic epidermal necrolysis
monitor CBC, serum calcium, albumin and hepatic function tests before and for first several months of thearpy
encourage oral hygiene to avoid gingival hyperplasia
critical nursing responsibilities for potassium chloride
monitor pulse, BP, and ECG during therapy; monitor for signs of hyperkalemia
antidote: sodium bicarbonate to correct acidosis, dextrose and insulin to facilitate passage of potassium into cells, calcium salts to correct cardiac rhythm effects, sodium polystyrene
critical nursing responsibilities for prednisone
.assess for signs of adrenal insufficiency (hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness); monitor for edema, wt gain, rales/crackles, or dyspnea
critical nursing responsibilities for ramipril
monitor BP and pulse,
monitor for angioedema
in HF patients monitor wt and assess for fluid overload (peripheral edema, rales/crackles, dyspnea, wt gain, jugular venous distention)
critical nursing responsibilities for rivaroxaban
monitor for signs of bleeding and hemorrhage, INR and PT; advise pt not to take OTC especially those with aspirin, NSAIDs, or St.John’s wort
antidote: prothrombin concentrate complex to reverse bleeding
critical nursing responsibilities for spironolactone
assess BP before and during therapy
monitor ins/outs
watch for signs of hyperkalemia, especially those with DM or kidney disease or elderly pts
assess for skin rash which can be a sign of SJS or TEN
monitor serum potassium levels
critical nursing responsibilities for tazocin
assess infection before and during therapy, including culture and sensitivity
watch for signs of anaphylaxis, CDAD, and SJS or TEN
monitor serum potassium, CBC, renal and hepatic function, bleeding times
critical nursing responsibilities for vancomycin
Obtain culture and sensitivity sample before beginning treatment
Monitor for signs of infection and super infection
Monitor IV site for irritation, necrosis, and pain
Monitor ins/outs
Mmmmmore
critical nursing responsibilities for warfarin
high alert medication
Monitor for signs of bleeding or hemorrhage
monitor for tarry stools
monitor aPPT and INR,
assess for additional or increased thrombosis
advise pt not to have alcohol or OTC like aspirin or NSAIDs
antidote: Vitamin K and whole blood plasma
