Pharmacological And Parenteral Therapies Flashcards
Nursing actions prior to the administration of blood products
- assess for allergies or previous blood reaction
- type and cross match
Nursing interventions for administration of blood
- obtain baseline vitals
- use 18 gauge needle for access
- start with 0.9% NaCl
- run slowly (5 mL/min) for the first 15 min
- remain with client during first 15-30 min
- infuse blood in 4 hours or less
Allergic blood transfusion reactions result from
Hypersensitivity
Hemolytic blood transfusion reactions result from
Incompatibility
Febrile blood transfusion reactions result from
Antibodies to donor platelets or leukocytes
Bacterial blood transfusion reaction results from
Contaminated blood
S/S of allergic transfusion reaction
Urticaria, pruritis, fever, anaphylactic shock
S/S of hemolytic transfusion reaction
N/V, pain in lower back, hypotension, hematuria
S/S of febrile transfusion reaction
Fever, chills, nausea, headache, flushing, tachycardia
S/S of bacterial transfusion reaction
Tachycardia, hypotension, fever, chills, shock
Nursing interventions for blood transfusion reaction
- stop infusion, restart 0.9% NaCl
- PRIORITY: airway management
- administer diphenhydramine, aspirin
- return blood container to blood bank
- collect blood and urine sample
- monitor UO
Which type of transfusion is collected 4-6 weeks before surgery and prevents viral infection and transfusion reactions?
Autologous transfusion
Where is venipuncture performed with a PICC line?
Above or below the antecubital fossa
Where is the tip of the PICC line catheter placed?
In the superior vena cava
How often should the nurse change PICC line dressings?
2-3 times/week when wet or nonocclusive
PICC line nursing consideration
DO NOT take BP or draw blood from extremity with PICC line
Nontunneled, triple lumen catheter inserted through the subclavian vein for short-term IV therapy
Percutaneous central catheter (PCC)
The _________ lumen of a PCC is used to infuse or draw blood samples
Distal
The _________ lumen of a PCC is used for PN infusion
Middle
The _________ lumen of a PCC is used to infuse or draw blood and administer medication
Proximal
How often should the nurse change the catheter site for PCC?
Every 4 weeks
How often should the nurse change PCC tubing?
Every 72-96 hours
S/S of infiltration
Cool skin, swelling, pain, decreased flow rate
Nursing interventions for infiltration
- D/C IV
- apply warm compresses to site
- elevate arm
- start new IV proximal to infiltrated site
S/S of phlebitis/thrombophlebitis
Redness, warm, tender, swelling, leukocytosis
Nursing interventions for phlebitis/thrombophlebitis
- D/C IV
- apply warm, moist compresses
- restart IV at new site
S/S of hematoma
Ecchymosis, swelling, leakage of blood
Nursing interventions for hematoma
- D/C IV
- apply ice for 24 hr, followed by warm compress
- restart IV in opposite extremity
S/S of clotted IV
Decreased flow rate, backflow of blood into tubing
Nursing interventions for clotted IV
- D/C
- DO NOT: irrigate, milk, increase rate of flow, hang solution higher, aspirate cannula
- inject urokinase to dissolve clot
Examples of isotonic fluids
0.9% NaCl, LR, D5W (becomes hypotonic when glucose is metabolized)
Example of hypotonic fluids
0.45% NaCl
Example of hypertonic fluid
D10W
How often should IV tubing be changed?
Every 72 hours
How often should IV bag be changed?
Every 24 hours
Hives, rash, difficulty breathing, and diaphoresis are all symptoms of
Anaphylaxis
Nursing interventions for anaphylaxis
- administer epinephrine IM
- massage site to speed absorption
- may repeat in 15-20 min
S/S of liver impairment
Fever, malaise, N/V, jaundice, light stools, dark urine, abdominal pain, elevated AST & ALT, altered PTT
S/S of renal impairment
Elevated BUN and creatinine, decreased Hct, altered electrolytes (K+, Na), altered urinary output, edema
Nursing interventions for renal impairment
- diet and fluid restriction
- electrolyte replacement
- dialysis
- rest
Anticholinergic side effects
Blurred vision, dry mouth, dysphagia, urinary retention, constipation, impotence, nasal congestion
Parkinson’s-like side effects
Akinesia, tremors, drooling, changes in gait, rigidity, akathisia, dyskinesia
Aluminum hydroxide, magnesium hydroxide, calcium carbonate, and aluminum/magnesium hydroxide are all examples of
Antacids
Key side effects of antacids
Constipation (calcium carbonate), diarrhea (magnesium), acid rebound
Antacid nursing considerations
- interferes with absorption of antibiotics, iron preparations, INH, oral contraceptives
- monitor bowel function
- use cautiously in clients with renal disease (particularly magnesium)
Chlordiazepoxide, alprazolam, lorazepam, and diazepam are all examples of
Benzodiazepines
Examples of non-benzodiazepines
Hydroxyzine and buspirone
Herbal supplements for anxiety
Kava and melatonin
Benzodiazepine side effects
Sedation, confusion, dizziness, hepatic dysfunction
Benzodiazepine nursing considerations
- potential for addiction/overdose
- for short-term use
- use cautiously in patients who are suicidal or with a history of addiction
- monitor liver function; use cautiously in patients with liver dysfunction
- not to be used in conjunction with MAOI
Benzodiazepine patient education
- avoid alcohol or other CNS depressants
- do not drive or operate heavy machinery
- gradually taper dose if changing or discontinuing med
Antibiotic nursing considerations
- obtain culture and sensitivity prior to initiation of antibiotic therapy
- assess for allergies
Antibiotic patient education
- take exactly as prescribed
- complete the full course of therapy
- increase fluid intake
- may decrease effectiveness of oral contraceptive
Gentamicin, neomycin, streptomycin, and tobrabycin are all examples of
Aminoglycosides
Aminoglycoside side effects
Ototoxicity, nephrotoxicity, anorexia, N/V, diarrhea
Aminoglycoside nursing considerations
- assess 8th cranial nerve (hearing — d/t ototoxicity)
- monitor BUN and creatinine
- encourage fluids
Cefaclor, cefazolin, cephalexin, ceftriaxone, and cefoxitin are all examples of
Cephalosporins
Cephalosporin side effects
GI disturbances, increased bleeding time, rash, superinfection
Cephalosporin nursing considerations
- administer with food
- educate pt to avoid alcohol
- assess for penicillin allergy
Ciprofloxacin an levofloxacin are examples of
Fluoroquinolones
Fluoroquinolones side effects
Diarrhea, decreased WBC and Hct, elevated liver enzymes, elevated alkaline phosphatase, Achilles tendon rupture
Nursing considerations for levofloxacin
- administer 2 hr before/after antacids & iron-containing products
- monitor theophylline levels (may increase theophylline levels)
- monitor glucose (can increase effect of oral hypoglycemics)
Erythromycin and azithromycin are examples of
Macrolides
Macrolide side effects
Diarrhea, confusion, hepatotoxicity, superinfections
Macrolide nursing considerations
- monitor liver function
- medication interactions: warfarin, verapamil
Side effects of penicillins
Stomatitis, diarrhea, allergic reactions, renal and hepatic changes
Penicillin nursing considerations
- check for hypersensitivity
- cross allergy with cephalosporins
Trimethoprim/sulfamethoxazole and Sulfasalazine are examples of
Sulfonamides
Sulfonamide side effects
Crystalluria, photosensitivity, GI upset, stomatitis, hypersensitivity, bone marrow depression, Steven Johnson syndrome
Sulfonamide nursing consideration
- encourage fluid (to prevent crystalluria)
- provide good mouth care (d/t stomatitis)
- interactions: oral hypoglycemia sulfonylurea, warfarin — increases effects of these meds
Tetracycline side effects
Discoloration of primary teeth, glossitis, rash, photosensitivity
Tetracycline nursing considerations
- client should not take with antacids, milk, or iron
- contraindicated in pregnancy
- monitor renal function
- educate client to avoid sunlight
Propantheline, atropine, scopolamine, and Benztropine are examples of
Anticholinergics
Anticholinergic MOA
- pupil dilation
- bronchodilation
- decreases secretions, mobility, and GI secretions
Anticholinergic nursing considerations
- monitor output
- contraindicated with glaucoma
- provide good mouth care (d/t dry mouth)
- abdominal assessment
- educate patient to consume plenty of fluids and fiber
Heparin nursing considerations
- monitor platelets and PTT
- administer SC or IV
- antidote: protamine sulfate
- monitor for excessive bleeding and tissue irritation
Warfarin nursing considerations
- monitor PT/INR
- antidote: Vitamin K
- avoid foods high in vitamin K (leafy greens, dairy products)
- monitor for bleeding
- administer PO
- herbal supplement interactions: garlic, ginger, gingko, and ginseng
Phenytoin, phenobarbital, valproic acid, carbamazepine, and clonazepam are all examples of
Anticonvulsants
Anticonvulsants side effects
Respiratory depression, aplastic anemia, gingival hyperplasia (phenytoin), ataxia, sedation
Anticonvulsant nursing considerations
- implement seizure precautions
- teach client not to d/c abruptly; take daily as prescribed
- monitor serum levels
- monitor CBC (d/t risk for aplastic anemia)
Phenelzine, isocarboxazid, and tranylcypromine are examples of
MAOIs
MAOI side effects
Hypertensive crisis (d/t consumption of foods containing tyramine), photosensitivity, sexual dysfunction
MAOI nursing considerations
- teach client to avoid foods containing tyramine: aged cheese, bologna, pepperoni, salami, bananas, chocolate, raisins, beer, wine, pickled products
- monitor BP
- educate client that may take up to 4 weeks for therapeutic effect
Fluoxetine, paroxetine, and sertraline are examples of
SSRIs
Venlafaxine and duloxetine are examples of
SNRIs
SSRI side effects
Anxiety, GI upset, change in appetite and bowel function, urinary retention/dry mouth, sexual dysfunction
SSRI nursing considerations
- suicide precautions
- instruct client that it may take up to 4 weeks for therapeutic effects
- administer in a.m. (d/t insomnia)
Amytriptyline and imiprimine are examples of
Tricyclic antidepressants
Tricyclic antidepressant side effects
Sedation, anticholinergic effects, confusion, postural hypotension, photosensitivity, bone marrow depression
Tricyclic antidepressant nursing considerations
- suicide precautions
- takes 2-6 weeks for therapeutic effect
- administer at bedtime
- monitor vitals and labs
- do NOT abruptly d/c
Bupropion and trazodone are examples of
Atypical antidepressants
Side effects of atypical antidepressants
Dry mouth, nausea
Bupropion: insomnia & agitation
Trazodone: sedation & orthostatic hypotension
Atypical antidepressant nursing considerations
- client should avoid alcohol and CNS depressants
- wean off slowly
Bismuth subsalicylate, diphenoxylate/atropine, loperamide, and opium alkaloids are examples of
Antidiarrheals
Antidiarrheal side effects
Constipation, anticholinergic effects
Antidiarrheal nursing considerations
- do not use with abdominal pain
- monitor for urinary retention
- give 2 hr before or 3 hr after other meds
Quinidine, lidocaine, flecainide, propranolol, amiodarone, and verapamil are examples of __________ medications
Antidysrhythmic
Antidysrhythmic side effects
Lightheadedness, hypotension, bradycardia, urinary retention
Side effects of propranolol
Bradycardia, bronchospasm (use cautiously in patients with asthma)
Side effects of amiodarone
Photosensitivity, photophobia
Side effect of verapamil
Heart failure
Antidysrhythmic nursing considerations
- monitor BP and HR
- monitor cardiac rhythm
- prevent orthostatic hypotension (well hydrated, change positions slowly)
- assess HR prior to administration (beta blocker); hold if HR < 50
- DO not break, crush, or chew meds
Trimethobenzamide, prochlorperazine, Metoclopramide, meclizine, and Ondansetron are examples of
Antiemetics
Antiemetics side effects
Sedation, anticholinergic effects
Amphotericin B, nystatin, and fluconazole are examples of
Antifungals
Antifungal side effects
Hepatotoxicity, thrombocytopenia, leukopenia
Antifungal nursing consideration
- used cautiously in immunocompromised patients
- administer with food (unless swish and swallow)
- monitor liver function
- educate patient to complete prescription
Colchicine, probenecid, and allopurinol are examples of
Antigout medications
Antigout medication side effects
Agranulocytosis, aplastic anemia, GI upset, renal calculi
Antigout medication nursing considerations
- monitor for renal calculi
- increase PO fluid intake
- give with milk, food
- dietary restrictions: alcohol, caffeine, purines (increase uric acid levels) — organ meats, foods made from yeast
Diphenhydramine and promethazine are examples of
Antihistamines
Antihistamine side effects
Drowsiness, dry mouth (anticholinergic effects), GI upset, bronchospasm
Antihistamine nursing considerations
- give with food
- assess respirations
- client should avoid alcohol
Beta blocker nursing considerations
- take with meals
- do not d/c abruptly
- masks signs of hypoglycemia in clients with diabetes
- nonselective can cause bronchospasm
Candesartan, losartan, and eprosartan are examples of
ARBs
Doxazosin and prazosin are examples of
Alpha 1 adrenergic blockers
Cholestyramine and atorvastatin are examples of
Antilipidemics
Antilipidemic side effects
Constipation, fat-soluble vitamin deficiency, muscle cramps
Antilipemic nursing consideration
Monitor triglyceride and liver function tests
When should digoxin be held?
Adult: HR < 60
Older Children: HR < 70
Infants and Young Children: < 90-110
Key side effects of Acetazolamide (carbonic anhydrase inhibitor for open-angle glaucoma)
- pulmonary edema
- decreased K+ level
- blurred vision
- lethargy
- depression
Herbal supplement that works on the immune system to prevent and treat colds/flu/UTI and promotes wound healing
Echinacea
Echinacea side effects
Allergic reaction, N/V, unpleasant taste with tingling on tongue
Echinacea nursing considerations
- decreases effectiveness of immunosuppressants
- contraindication in autoimmune diseases
- avoid if allergic to ragweed/daisies
Herbal supplement that is anti-microbial, -lipidemic, -thrombotic, -tumor, and -inflammatory
Garlic
Garlic side effects
Flatulence, heartburn, irritation of mouth, esophagus, and stomach, allergic reaction
Garlic nursing considerations
- may potentiate anticoagulants, antiplatelets, antidiabetics, antihyperlipidemics, antihypertensives
- avoid if allergy to Lillie’s
- may decrease effectiveness of oral contraceptives
Herbal supplement that provides analgesia, improves circulation, and alleviates nerve pain
Capsicum/Cayenne Pepper
Capsicum side effects
GI discomfort, self-defense — pain/burning in eye, skin, cough, bronchospasm
Capsicum nursing considerations
- may decrease effectiveness of antihypertensives
- increase risk of cough with ACE inhibitors
- potentiate antiplatelet meds
- hypertensive crisis with MAOIs
- increase theophylline absorption
Herbal supplement that acts as an antidepressant, sedative, antiviral, and antimicrobial
St John’s Wort
Side effects of St John’s Wort
Photosensitivity, fatigue, allergic reaction, restlessness
St John’s Wort nursing considerations
- decreases effectiveness of digoxin, Antineoplastic, antivirals, AIDS meds, antirejection meds, theophylline, Coumadin, oral contraceptives
- contraindicated in SSRIs, MAOIs, and major depression
What medication can be used to control bleeding related to thrombolytics?
Aminocaproic acid
Which iron preparation is exclusively administered IM or IV when the client cannot tolerate PO administration?
Iron dextran
How should clients take iron?
On an empty stomach, with orange juice (vitamin C increases absorption)
Foods high in iron
Cereals, dried beans/legumes, dried fruit, green leafy vegetables, lean red meat and organ meats
What can decrease the absorption of iron?
Antacids, coffee, tea, milk, and eggs
Lithium nursing considerations
- monitor serum levels (2-3 times/week when starting, monthly for maintenance)
- monitor sodium levels (risk for hyponatremia)
S/S of lithium toxicity
Initial: persistent N/V/D, ataxia, blurred vision, slurred speech
Progression: worsening tremors, mental confusion, stupor
Severe: seizure, coma, cardiac dysrhythmias, circulatory collapse
Clients taking rapid-acting insulins (lispro, aspart, glulisine) need to eat within ___-___ minutes of injection time
5-15
Clients taking regular insulin need to eat within ___-___ minutes of injection time
20-30
What medications decrease insulin needs?
MAOIs, aspirin, and anticoagulants
Ingestion of alcohol during metformin therapy can lead to
Lactic acidosis
Medications that can elevate glucose levels necessitating higher doses of insulin
Thiazide diuretics, glucocorticoids (cortisone), thyroid medications, estrogen
Laxative/stool softeners contraindications
Symptoms of acute abdominal pain, N/V, and fever
What electrolyte imbalance can result from chronic use of stool softeners/laxatives?
Hypokalemia
Ulcer medication (H2 blockers, PPI) nursing considerations
- do not administer along with antacids
- best administered at bedtime (suppresses nocturnal acid secretions)
- can cause confusion in the elderly
- caffeine, ASA, smoking, and alcohol increase stomach acid inhibiting absorption
