Final Exam (5/7) Flashcards

Question

Review interventions for administration of milrinone (Primacor) IV

Answer 1

○ Do not stop abruptly- may experience sudden and severe symptoms of heart failure ○ Closely monitor vitals, I&O, evidence of hypokalemia, heart and breath sounds ○ Use dedicated IV line ○ Short term management of acute heart failure give loading dose over 10 minutes

Answer 2

○ PT: normal levels: 11-13 seconds ■ Therapeutic level: 1.5 times the normal value or 18 seconds ○ o INR: Normal levels: 1.1 or below ■ Therapeutic levels: 2.0-3.0 with average of 2.5 ■ Those with recurring clots 2.5-3.5 with an average of 3.0

Answer 3

○ Administer subQ in prefilled syringe ○ Don’t expel the air bubble from the syringe ○ One-time use syringe ○ Monitor for excessive bleeding and bruising

Answer 4

``` ○ Thins blood ○ Decreased platelet aggregation ○ Bleeding ○ GI bleeding ○ Internal bleeding (tachycardia, hypotension) ○ Bleeding around IV ○ Bleeding gums ```

Answer 5

``` ○ Interactions: warfarin & statins ○ Liver function test ■ ALT, AST ○ Kidney ■ BUN, creatinine ○ If they haven’t been able to eat greasy food, indicates needing to check gallbladder for gallstones ```

Answer 6

○ Pregnant or lactating women ○ Drug allergy ○ Liver disease ○ Elevated liver enzymes

Answer 7

○ Should not be given faster than 10 mEq/L ○ IV: max concentration 20-40 meq/l for peripheral line; up to 60 for central line ○ May cause burning during IV administration – slowly administer ○ IV pump only (NOT PUSH)

Answer 8

○ Oral anticoagulants (enhances their activity) | ○ Cholestryramine

Answer 9

○ CONTAGIOUS WHEN RECEIVING TREATMENT!! ○ Can contaminate others: saliva, urine ○ Avoid sexual contact, sleeping in same bed as others, having close contact with children or pregnant women, and sharing utensils/cups. ○ Contraindicated during pregnancy & lactation (cannot conceive for 6 months after treatment) ○ Usually only on it for a short period of time

Answer 10

○ Prevention of adrenal crisis/suppression ■ Monitor plasma drug levels to determine adrenal function ■ Corticosteroids make your adrenal glands stop- this leads to addison’s crisis. Tapering off= waking adrenal glands back up

Answer 11

``` ○ Linked to bone density loss (osteoporosis): Get bone density scanning regularly to monitor for bone loss ○ C-diff ○ Dementia ○ Pneumonia ○ Magnesium depletion ```

Answer 12

○ Chemical reaction that occurs in stomach to create gel coating (barrier between stomach and acid)- causes interference with absorption of other drugs ○ Give 4 times a day on empty stomach ■ 1 hour before usual 3 meals and again at bedtime ○ Do not give antacids within 30-60 minutes of administration ○ Take all other meds 2 hours before administration

Answer 13

○ Severe renal disease Okay to give with renal pts, but be very cautious ○ Bowel obstruction

Answer 14

○ Bulk forming: 1-3 days ○ Stool softener: several days ○ Stimulant: 6- 24 hours, suppository is 15 minutes-1 hour ○ Bisacodyl (dulcolax): semi-solid stools in 6-12 hrs with PO, 15-60 min with suppositories ○ Psyllium (metamucil): soft formed stools 1-3 days after beginning therapy ○ Docusate sodium (colace): stools will be softer several days after beginning therapy

Answer 15

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

Answer 16

○ Headache ○ N/D ○ Dehydration ○ Dizziness

Answer 17

○ 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 18

``` ○ 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 19

○ 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 tase 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 (PO)

Answer 20

○ Hypokalemia (monitor potassium level) | ○ diarrhea

Answer 21

Raise hemoglobin and stimulates RBC production ○ Used commonly with kidney disease, preoperative anemia, chemotherapy ○ Contraindications – uncontrolled HTN ○ Onset of action is days to weeks – not used for acute increases in Hgb ○ Given IV or SQ ○ Blackbox warning: increase risk of cardiovascular events, this is why it is contraindicated in patients with uncontrolled HTN

Answer 22

○ Assessment: Total body metabolic rate, body mass index, and muscle mass ■ 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 ○ Labs: ■ Total protein level, albumin level, BUN, RBC’s, WBC’s, hemoglobin, hematocrit ■ Cholesterol level, electrolytes, lipid profile ○ BEFORE giving: ■ Assess allergies ■ Determine appropriate solution (with help from registered dietician) ■ Assess patient/caregiver knowledge of central line/peripheral line: provide education to prevent infection/phlebitis ○ Nursing Interventions: ■ Monitor BG levels even if pt is not diabetic (could lead to hyperglycemia) ■ 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 ■ Consult with registered dietician to identify nutrients missing in patient’s diet ■ Monitor weight ■ Give in PICC or central line ■ Whatever is on bag should be same as doctors orders ■ Use a filter Change tubing every 24 hours. ○ Used for prolonged periods of time (longer than 7-10 days)

Answer 23

○ 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 24

○ If you give someone a bolus, 30 minutes later the pt will feel nauseous, sweaty, tachycardia, feel they have to have a bowel movement ○ Hold tube feeding 2 hours before and 2 hours after administration of phenytoin, may decrease absorption of phenytoin ○ Nausea, weakness, sweating, heart palpitations, syncope, diarrhea ○ Keep HOB elevated at least 30 degrees while feeding, pause feeding if laying patient flat

Answer 25

○ 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 26

``` ○ Thromboembolic events ■ Do not give to pts who have hx of bleeding, stroke ○ Nausea ○ Photosensitivity ○ chloasma ```

Answer 27

○ Given in morning before taking any other meds ○ Sit up for 30-60 after taking meds ○ Drink 8 ounces of fluids ○ Do not administer with calcium supplements or antacids

Answer 28

○ Nitrates (do not take within 24 hours)

Answer 29

○ Takes longer to see therapeutic effect (6-12 months) ○ Pregnancy category x drug (put gloves on if pregnant; teratogenic) ○ Indicated for BPH & male pattern baldness

Answer 30

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

Answer 31

○ Exacerbates CHF | ■ S/S: Excessive, rapid weight gain, dyspnea, and or edema.

Answer 32

○ Pt’s who are diabetic and are taking insulin and beta blockers need to be careful with monitoring blood glucose carefully. ■ May not be aware of hypoglycemic effects as quickly.

Answer 33

○ They are both hard on kidneys, give CT contrast a chance to eliminate

Answer 34

``` ○ Benadryl ■ Drowsiness ■ Dizziness ■ Anticholinergic effects (dry mouth, urinary retention, changes in vision, constipation) ■ GI discomfort ``` ○ Acetadote ■ Bronchospasm ■ Aspiration of excessive secretions ■ GI distress

Answer 35

○ Opioid AEs: (have to take a lot of it) ■ CNS depression: sleepy, dizzy, slurry, constipation ○ Only take when needed and for a short-term time

Answer 36

○ Use short-acting preparations for acute exacerbations ○ Use long-acting preparations for long-term control ○ Inhale beta 2 adrenergic agonists BEFORE inhaling glucocorticoids ○ Follow dosage limits and schedules ○ Monitor and Report: ■ Tachycardia ■ Heart palpitations ■ Chest pain

Answer 37

o Albuterol

Answer 38

``` ○ Caffeine ○ Chocolate ○ Char-broiled foods ○ Smoking ○ Cimitidine ○ floroquinolones eat high carb, low protein ```

Answer 39

○ Don’t rely on WBC count | ○ Describing s/s of sore throat, tired, muscle ache, low grade fever

Answer 40

○ N/V | ○ Bone marrow suppression

Answer 41

○ Causes a lot of hypersensitivity reactions | ○ Pretreat with antihistamine and antipyretic

Answer 42

○ Can modify and suppress immune response ○ Avoid those who are sick or have an infection ○ Stay out of large crowds ○ Don’t give if they have an active infection or high WBC count

Answer 43

○ Allergy ○ Presence of more than 10% immature tumor cells in bone marrow ○ Do not administer to pt with an active infection

Answer 44

``` ○ OTC herbal supplements ■ St. johns wart ■ Gingko ○ Other immunosuppressant drugs (additive affect) ■ Monitor immune response ```

Answer 45

``` ○ Prevent infection o Avoid large crowds o Good hand hygiene o Stay away from sick o Lifelong therapy o Call doctor if you miss a dose, do not double up o Do not stop taking abruptly ```

Answer 46

o Pneumococcal ● Available to high risk for pneumonia (CF) ● Or to adults 65 or older ● Get it every 5 years o Influenza ● Recommended every year (bc strain changes) ● Only good for 1 flu season

Answer 47

o Monitor injection site reactions | o Kids may develop a low-grade fever (common): do NOT give ASPIRIN to KIDS (Tylenol- ok)