Exam 2 (3/29) Flashcards

Question

Identify contraindications of laxative use

Answer 1

● Bulk forming: Esophageal or GI obstruction, fecal impaction, dysphagia, N/V, appendicitis, undiagnosed abd pain ● Stool softener: GI obstruction, perforation, concurrent use of mineral oil, fecal impaction, N/V, undiagnosed abd pain ● Stimulant: Children younger than 1 year, GI obstruction/perforation, anal or rectal fissures, ulcerated hemorrhoids, fecal impaction, ileus, undiagnosed abdominal pain

Answer 2

● Give hard candy ● Give them water ● Monitor for lightheadedness when walking ● Recommend lowest dose possible for the shortest time possible ● Monitor for anticholinergic effects ○ Dry mouth, urinary retention/constipation, less sweating, increased HR, dilated pupils, blurred vision ● Monitor urinary elimination patterns ● Loperamide (Imodium A-D) ○ Initial dose of 4 mg, follow each loose stool with 2 more mg. Do NOT exceed 16mg/day ○ Stop after 48 hours if diarrhea persists ● Diphenoxylate w/ atropine: ○ Treat overdose with naloxone (Narcan) ○ Atropine in high doses can cause unpleasant effects- so this discourages recreational use

Answer 3

● Take 1-3 times daily with at least 8 oz of fluid- very important ● Taking before meals may reduce appetite ● Expect soft, formed stools 1-3 days after beginning therapy ● Monitor I&O and bowel function ● Monitor for severe diarrhea and dehydration

Answer 4

● Constipation ● Prevention of fecal impaction ● Straining during defecation ● Painful elimination of hard stools

Answer 5

● Bulk forming: 1-3 days ● Stool softener: several days ● Stimulant: 6- 24 hours, suppository is 15 minutes-1 hour

Answer 6

● Give IV push dose up to 8 mg over 2-5 mins ● 30 mins before end of surgery ● Administer 30 mins before chemo and 4-8 hours later

Answer 7

● sedation, dry mouth, diarrhea, extrapyramidal symptoms (dystonia, tremor, akathisia, parkinsonism, tardive dyskinesia) ○ FALL RISK ○ Monitor for diarrhea and dehydration ○ Water, gum, and hard candy for dry mouth ● Delayed gastric emptying

Answer 8

``` ● Sedation, drowsiness, dizziness ○ FALL RISK ● anticholinergic effects ○ Dry mouth, retention, blurry vision, dilated pupils, increased HR, less sweating ■ Watch bowel and elimination patterns ```

Answer 9

● Adverse effects – dry mouth, urinary retention, constipation ● Use gloves to administer and to take off ● Apply behind ear ○ Wash & dry area before applying ● Discontinue after 72 hours ● Recommend applying 4 hours prior to anticipated exposure to N/V

Answer 10

● Severe tissue damage can occur if given mistakenly intraarterial ● Dilute in at least 10 mL of fluid when giving IV ● Discontinue use if burning or pain occurs with IV administration

Answer 11

● Water soluble: Vitamin B1, B2, B3, B6, B12, C ○ Dissolve in water ○ Easily excreted in urine ○ Daily intake is necessary ○ Very rare to reach toxic amounts ● Fat soluble: Vitamin A, D, E, K ○ Dissolved in fat ○ Stored longer in liver and fatty tissues ○ Daily intake NOT needed unless deficient ○ Excreted via feces ○ Can reach toxic levels

Answer 12

● Calcium is needed for our bones and teeth. ○ treatment or prevention of calcium depletion ○ osteomalacia ○ hyperphosphatemia ○ osteoporosis in older adults ○ mostly women ○ muscle cramps ○ pregnancy and lactation ○ children. ● Give oral dose 1-3 hours after meals

Answer 13

● AE: Large doses can cause a yellow/orange discoloration of urine. Almost like a highlighter color.

Answer 14

● Interaction: Levodopa ○ When taking it with levodopa it can reduce the activity of levodopa. Levodopa is a Parkinson’s medication, so it can result in worsening Parkinson symptoms.

Answer 15

● Ferrous sulfate (Feosol)= PO form ○ Do not crush or chew ○ Dilute liquid form, but not in milk because calcium can decrease the absorption of iron, the best liquid is orange juice. ○ Give through a straw and then rinse mouth after as this can stain the teeth. ○ Educate the patient that they may have black tarry stools when taking an iron supplement. Let them know that this is normal. We also see black tarry stools with a GI bleed, so we need to know if they are taking an iron supplement. ○ Doses will be 300 mg 2-3 times a day, we want to spread the doses evenly across waking hours (maximizes production of RBC’s). ○ Provide hard candy or gum after taking the liquid form. ○ Iron toxicity symptoms: nausea, abdominal pain, vomiting, dizziness, hypotension, headache, coma, shock, seizures. ○ The tablets look like M&Ms and taste like sugar so we must keep these away from children or it can cause iron overdose and peds poisoning deaths. ○ Give on empty stomach for best absorption, but can be given with food to decrease GI upset

Answer 16

● Pernicious anemia: lack of intrinsic factor; vitamin B12 deficiency

Answer 17

● Major adverse effect: hypokalemia | ● Diarrhea

Answer 18

● IV form must be given SLOW (over 30-60 seconds) or add to an IV fluid infusion. ● Obtain baseline serum folate, Hgb, Hct, RBC and reticulocyte count ● Encourage daily intake of foods high in folate (green veggies, liver, some breakfast cereals, lentils) ● Teach patients to expect flushing and warmth following IV administration, yellow/orange discoloration of urine.

Answer 19

● Stimulates the production of RBC’s in the bone marrow. ● Used commonly with kidney disease, preoperative anemia, chemotherapy. ● It mimics our own body’s production of epoetin, helping us raise our hemoglobin and stimulating red blood cell production. ● Black Box Warning: Increased risk for cardiovascular events, this is why it is contraindicated in patients with uncontrolled HTN. ● It is not a quick fix, its onset of action is days to weeks.

Answer 20

● Central line or PICC used. ● Change tubing every 24 hours ● Watch for hyperglycemia, may need insulin replacement. ● Used for prolonged periods of time (longer than 7-10 days) ● AE:Most are associated with the use of the central vein for delivery. ○ Greater potential for infection ○ Serious catheter-induced trauma and related events. ○ Greater chance for metabolic complications such as hyperglycemia due to more concentrated volumes of nutritional supplements being delivered. ● Assessment: ○ Thorough nutritional assessment: ■ Weekly and daily food intake ■ Weight and height ○ Ask about any nutritional concerns: ■ Weight gain or loss ■ Nausea, vomiting, anorexia, loss of appetite ○ Consult with registered dietician to identify nutrients missing in patient’s diet ○ Total body metabolic rate, body mass index, and muscle mass may be assessed. ● Labs: ○ Total protein level, albumin level, BUN, RBC’s WBC’s, hemoglobin, hematocrit ○ Cholesterol level, electrolytes, lipid profile. ● Before giving Parenteral Nutrition: ○ Assess allergies ○ Determine appropriate solution (with help from a registered dietician) ○ Assess patient/caregiver knowledge of central line/peripheral line: provide education to prevent infection/phlebitis ● Nursing Interventions: ○ Check the patient for s/s of hyperglycemia frequently: polydipsia, polyuria, polyphagia, HA, N/V, dehydration, weakness ○ Insulin replacement may be needed with the increase in glucose intake ○ If parenteral nutrition is discontinued abruptly, rebound hypoglycemia may occur: ■ Prevent by providing infusions of 5% to 10% glucose or D5W/D10W ○ Monitor S/S of fluid overload ○ Measure I&O as ordered

Answer 21

● We want to keep the HOB elevated at least 30 degrees while feeding, pause feeding if laying patient flat. A side effect is dumping syndrome so we do not want to elevate them anymore. ● Before enteral nutrition: ○ Assess allergies ○ Assess cardiac and renal status (can a patient handle large amounts of fluid?) ○ Assess gag reflex, ability to swallow, bowel sounds ● Nursing Interventions: ○ Must have prescriber’s order BEFORE administering ○ Check for proper NG tube placement prior to each feeding ○ Aspirate gastric residual volumes BEFORE each feeding and BEFORE administration of each medication ○ Follow prescriber's orders infusion rate ○ Change tubing for parenteral feedings each time a new bag is added to the infusion and every 24 hours. ○ Adverse effect of dumping syndrome may decrease absorption of phenytoin ■ Hold tube feeding 2 hours before and 2 hours after administration of phenytoin

Answer 22

● Iv used- watch for phlebitis (vein irritation or inflammation of a vein) ○ Can lead to loss of a limb if it is not treated appropriately ● Other AE’s: Fluid overload and avoid in patients with renal or heart failure.

Answer 23

● Black Box Warning: Cigarette smoking increases the risk for serious cardiovascular events and cardiovascular disease ○ Risk increases with age >35 and the number of cigarettes smoke! ● Ensure understanding of how to take the drug and what to do if they miss doses. ● Importance of taking it the SAME time every day! ● If you forget to take a birth control pill, take it as soon as you remember. ● If you don't remember until the next day, go ahead and take two pills that day. ● If you forget to take your pills for 2 days, take two pills the day you remember and two pills the next day. ● Encourage smoking cessation!! ● Monitor BP and weight ● Assess for drug interactions

Answer 24

● Estrogen- dependent cancers ● Undiagnosed abnormal vaginal bleeding ● Pregnancy ● Active thromboembolic disorder or history

Answer 25

● Pitocin: Induce or enhance labor ○ Nursing Implications: ■ Careful monitoring, can cause uterine rupture if not followed closely. ■ Assess and document BP, pulse, and respirations ■ Continuous fetal monitoring (fetal HR and contraction related fetal HR) ■ ONLY give IVPB so oxytocin is diluted and on an infusion pump ■ Report any abnormal changes in fetal HR ● Methergine: Prevents postpartum uterine atony and hemorrhage ○ Nursing Implications: Limit use in hypertensive patients ● Cervidil and Prepidil: Induce labor ○ Nursing Implications: Monitor for uterine hyperstimulation

Answer 26

● Preterm labor | ● Pre-eclampsia and eclampsia

Answer 27

● Do not crush or chew tablet ● Do not lay down after taking this medication… sit or stand for at least 30 minutes ● Take on an empty stomach with a full glass of water

Answer 28

● Androderm ○ Transdermal patch ○ Mimic the normal circadian variation in testosterone concentrations, with maximum levels occurring in the early morning hours and minimum concentrations occurring in the evening ○ To be applied to back, stomach, upper arms, or thighs nightly every 24 hours ● Androgel ○ Topical gel ○ To be applied to upper arms and shoulders at the same time each morning ○ Avoid showering, bathing, or swimming for 2 hours after application

Answer 29

● Can cause hypotension: ○ Monitor BP ○ Advise clients to rise slowly from sitting to standing

Answer 30

● Nitrates (do not take within 24 hours)