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Nursing 450 Med Exam > Critical Nursing Responsibilities > Flashcards

Critical Nursing Responsibilities Flashcards

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1
Q

critical nursing responsibilities for acetaminophen with codeine

A

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)

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2
Q

critical nursing responsibilities for albuterol

A

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

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3
Q

critical nursing responsibilities for amlodipine

A

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)

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4
Q

critical nursing responsibilities for acetylsalicylic acid

A

monitor for bleeding (may cause prolonged prothrombin time)

monitor for signs of toxicity: tinnitus, headache, hyperventilation, agitation, mental confusion, lethargy, diarrhea, and sweating

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5
Q

critical nursing responsibilities for atorvastatin

A

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

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6
Q

critical nursing responsibilities for budesonide

A

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

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7
Q

critical nursing responsibilities for cefazolin

A

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

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8
Q

critical nursing responsibilities for ceftriaxone

A

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

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9
Q

critical nursing responsibilities for ciprofloxacin

A

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

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10
Q

critical nursing responsibilities for digoxin

A

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

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11
Q

critical nursing responsibilities for diltiazem

A

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

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12
Q

critical nursing responsibilities for dimenhydrinate

A

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)

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13
Q

critical nursing responsibilities for diphenhydramine

A

monitor confusion and sedation, especially in older adults

monitor effectiveness in preventing/treating allergic reaction

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14
Q

critical nursing responsibilities for enoxaparin

A

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

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15
Q

critical nursing responsibilities for fentanyl patch

A

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

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16
Q

critical nursing responsibilities for fluoxetine

A

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)

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17
Q

critical nursing responsibilities for fluticasone

A

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

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18
Q

critical nursing responsibilities for furosemide

A

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

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19
Q

critical nursing responsibilities for gabapentin

A

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

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20
Q

critical nursing responsibilities for heparin

A

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

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21
Q

critical nursing responsibilities for humulin r

A

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

22
Q

critical nursing responsibilities for humulin n

A

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

23
Q

critical nursing responsibilities for hydromorphone

A

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

24
Q

critical nursing responsibilities for ibuprofen

A

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

25
Q

critical nursing responsibilities for insulin largine (lantus)

A

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

26
Q

critical nursing responsibilities for levothyroxine

A

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

27
Q

critical nursing responsibilities for lispro (humalog)

A

.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

28
Q

critical nursing responsibilities for lorazepam

A

regularly assess for continued need for treatment

assess mental status and degree and manifestations of anxiety

antidote is flumazenil (romazicon)

29
Q

critical nursing responsibilities for magnesium sulfate

A

high alert medication

monitor BP, pulse, respirations, and ECG frequently - respirations should be at least 16/minute before each dose

monitor neurological status

30
Q

critical nursing responsibilities for meropenem

A

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)

31
Q

critical nursing responsibilities for metformin

A

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,

32
Q

critical nursing responsibilities for metoprolol

A

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

33
Q

critical nursing responsibilities for metronidazole

A

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)

34
Q

critical nursing responsibilities for morphine

A

high alert medication
.
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

35
Q

critical nursing responsibilities for naproxen

A

assess pain and fever before and after administration

monitor BUN, serum creatinine, CBC, liver function periodically

36
Q

critical nursing responsibilities for nitroglycerin

A

assess location, duration, intensity, and precipitating factors of pt’s anginal pain

monitor BP and pulse before and after each administration

37
Q

critical nursing responsibilities for ondansetron

A

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

38
Q

critical nursing responsibilities for oxycodone

A

high alert medication

assess BP, pulse, pain, and respirations before administration. hold if RR less than 10 and pt sedate

monitor bowel function

39
Q

critical nursing responsibilities for pantoprazole

A

monitor bowel function for signs of CDAD (abdominal cramping, fever, bloody stools)

40
Q

critical nursing responsibilities for penicillin g

A

assess infection before onset of therapy

monitor bowel function for signs of CDAD

watch for signs of anaphylaxis

41
Q

critical nursing responsibilities for perinodpril

A

monitor BP and pulse

assess for signs of angioedema (swelling face, extremities, eyes, lips, tongue, difficulty swallowing or breathing)

42
Q

critical nursing responsibilities for phenobarbital

A

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

43
Q

critical nursing responsibilities for phenytoin

A

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

44
Q

critical nursing responsibilities for potassium chloride

A

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

45
Q

critical nursing responsibilities for prednisone

A

.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

46
Q

critical nursing responsibilities for ramipril

A

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)

47
Q

critical nursing responsibilities for rivaroxaban

A

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

48
Q

critical nursing responsibilities for spironolactone

A

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

49
Q

critical nursing responsibilities for tazocin

A

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

50
Q

critical nursing responsibilities for vancomycin

A

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

51
Q

critical nursing responsibilities for warfarin

A

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

Nursing 450 Med Exam (6 decks)

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