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69 Cards in this Set

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Adverse effects of Carvidopa/Levodopa

(Sinemet-anti Parkinsonian; dopaminergic)


Abnormal movements, psychiatric disorders


•Advise clients of potential side effects and to notify the provider if they occur.

Adverse effects of morphine, what are you monitoring for?

Respiratory depression


constipation


urinary retention


orthostatic hypertension


cough suppression


sedation


biliary colic


emesis


overdose triad: resp. depression, coma and pinpoint pupils

What drug would you administer for an anaphylactic reaction to penicillin?

Mild rashes and hives can be treated with diphenhydramine (Benadryl).
Anaphylactic reaction is a life-threatening, treat with epinephrine, bronchodilators, and antihistamines. Provide respiratory support and inform the provider.
client education for lovastatin

(Lipitor; statin)


advise clients to observe for symptoms of liver dysfunction (anorexia, vomiting, nausea, jaundice), and notify the provider if symptoms occur.


•advise clients to avoid alcohol.


advise clients to report symptoms of muscle aches, pain, and tenderness.


advise clients to observe for signs and symptoms of peripheral neuropathy, and to notify the provider if symptoms occur


advise clients to limit the amount of grapefruit juice consumed each day. Clients should not drink more than 1 qt a day.

If you are taking phenelzine - what foods would you avoid?

(MAOI; Nardine)




tyramine-rich foods include aged cheese, pepperoni, salami, avocados, figs, bananas, smoked fish, protein, some dietary supplements, some beers, and red wine.




Concurrent use with vasopressors (caffeine, phenylethylamine) may result in hypertension.


•advise the client to avoid foods that contain these agents (caffeinated beverages, chocolate, fava beans, ginseng)

procedure for wasting narcotic analgesics
• Dispose in waste receptacle with 2nd nurse observing
hydrocodone adverse effects
CNS effects (dizziness, lightheadedness, drowsiness, respiratory depression)-Narcan
GI distress (nausea, vomiting, constipation)-take with food
Potential for abuse-use for short duration
clonidine transdermal patch, nursing actions for side effects

(Catapres; Centrally acting alpha 2 agonist; HTN)


drowsiness and sedation


•drowsiness will diminish as use of medication continues.


•advise clients to avoid activities that require mental alertness until symptoms subside.


dry mouth


•advise clients to be compliant with medication regimen.


•reassure clients that symptoms usually resolve in 2 to 4 weeks.


•encourage clients to chew gum or suck on hard candy, and to take small amounts of water or ice chips.


rebound hypertension


•advise clients not to discontinue treatment without consulting the provider.


•should be discontinued gradually over the course of 2 to 4 days.




Avoid use of transdermal patch on affected skin in scleroderma and systemic lupus erythematosus (SLE).


Transdermal patches are applied every seven days. Advise clients to apply patch on hairless, intact skin on torso or upper arm.

teaching for clients who are newly prescribed estrogen and progesterone
r/f endometrial or ovarian cancer
-instruct clients to report persistent vaginal bleeding.
•advise clients to have a yearly pelvic exam.
r/f estrogen dependent breast caner
•encourage regular self-breast examinations and mammograms.
r/f dvt
•encourage clients to avoid all nicotine products.
•Monitor clients for pain, swelling, warmth, or erythema of lower legs
education of patients receiving morphine via pca
The client is the only person who should push the PCA button to prevent inadvertent overdosing
if going to be getting testing for allergies, education for medications not to takewithin 1 month of testing date
Instruct clients to avoid taking corticosteroids and antihistamines 5 days prior to the testing
triamterene lab values to monitor

(Dyrenium; K sparing diuretic)


Monitor potassium level.


initiate cardiac monitoring for serum potassium greater than 5 meq/L

epogen administration guidelines
(epogen administration guidelines; growth factor)
Administer by subcutaneous injection.
Do not agitate the vial of medication.
Use each vial for one dose and do not put the needle back into the vial when withdrawing the medication.
Do not mix medication with any other medication in syringe.
oral acycolvir for genital herpes, patient education

(Zovirax; antiviral)


Advise clients to refrain from sexual contact while lesions are present.




Clients with healed herpetic lesions should continue to use condoms to prevent transmission of the virus

open angle glaucoma if taking pilocarpin 3% drops, what are you looking forwith systemic cholinergic toxicity
hold pressure on puncta and nasolacrimal sac at least 60 seconds after instillation

Instruct patient on correct instillation technique to minimize systemic effects

Instruct patient to report urinary urgency, slow heart rate, and wheezing to provider
fentanyl transdermal patch for chronic pain patient teaching

The first administration of a transdermal fentanyl patch will take several hours to achieve the desired therapeutic effect. Administer short-acting opioids prior to onset of therapeutic effects and for breakthrough pain.

medication interactions for hearing loss for lasix

(furosemide)


avoid use with other ototoxic medications, such as gentamicin

methylphenidate, side effects to report

(Ritalin; CNS stimulant)


insomnia, restlessness


dysrhythmias, chest pain, high blood pressure


psychotic symptoms such as hallucinations, paranoia

long term chorticosteroids for inflammatory bowel disease, nursinginterventions

use corticosteroids in low doses to minimize adverse effects.


•Monitor blood pressure.


•Reduce systemic dose slowly.


•Monitor electrolytes and glucose.


•this medication may slow healing.


•Advise the client to:


◯take oral dose with food.


◯Avoid discontinuing dose suddenly.


◯Report unexpected increase in weight or other signs of fluid retention.


◯Avoid crowds and other exposures to infectious diseases.

warfarin patient education

Be prepared to administer vitamin K for warfarin overdose.


●Teach clients to self-monitor PT and INR at home as appropriate.


●Advise clients to record dosage, route, and time of warfarin administration on a daily basis.


-use a soft-bristle toothbrush to prevent gum bleeding


-Advise clients to avoid alcohol and over-the-counter and non-prescription medications to prevent adverse effects and medication interactions, such as risk of bleeding.


-instruct clients to maintain a consistent intake of vitamin k to avoid sudden fluctuations that could affect the action of warfarin

clozapine 350 mg/ daily, side effects

(anti-psychotic)


Risk for fatal agranulocytosis


◯baseline and weekly monitoring of wbC recommended


◯Notification of the provider of signs of infection (fever, sore throat, mouth lesions) necessary




other adverse effects include:


sedation


orthostatic hypotension


anticholinergic effects

iv betamethazone, client 31 weeks gestation with premature labor, patienteducation

Betamethasone is a glucocorticoid that is administered IM and requires a 24-hr period to be effective. The therapeutic action is to enhance fetal lung maturity and surfactant production.

findings for salicylate (aspirin)
salicylism may occur with aspirin (tinnitus, sweating, headache and dizziness, and respiratory alkalosis)

iv nitropresside, know drip rates, mc/kg/min; increase .5 to maintain map

v/t X gtt=rate

elder adult with dehydration and acute renal failure, getting d5.45 NS @ 150ml/hr, what findings would you report to the provider immediately
fluid overload!
↓ urine output
Tachycardia, bounding pulse, hypertension, tachypnea, increased central venous pressure
Confusion, muscle weakness
Weight gain, ascites
Dyspnea, orthopnea, crackles
Edema, distended neck veins
rheumatoid arthritis and methotrexate, educate patient on what symptoms toreport to the provider

(DMARD; Rheumatrex)


fever and/or sore throat (r/f infection)


anorexia, abdominal fullness, and jaundice (r/f hepatic fibrosis)

neostigmine, muscarinic response; manifestations look like?

(Rx Myasthenia Gravis)


increased gastrointestinal motility, increased GI secretions, bradycardia, and urinary urgency

morphine for cancer pain, symptoms to address

give around the clock in addition to a non-opioid and adjuvant

after administering a pain medication, what is your next action

• Monitor/assess pt. pain level on a regular basis


• Notify provider if resp <12 min

what does an allergic reaction to cefaclor look like?

urticaria, rash, hypotension, and/or dyspnea

acetaminophne/hydrocodone prn order, see they are getting q4 what do youdo?
(liver toxicity)
acute toxicity that results in liver damage with early symptoms of nausea, vomiting, diarrhea, sweating, and abdominal discomfort progressing to hepatic failure, coma, and death

take acetaminophen as prescribed and not to exceed 4 g/day
tetracycline for young adult female
decreases the efficacy of oral contraceptives

Use of tetracycline during pregnancy after the fourth month can cause staining of the deciduous teeth, but will not have a permanent effect on permanent teeth. In general, tetracyclines should not be given to women who are pregnant or to young children
lab values for continued use of warfarin
Depending on therapeutic intent, effectiveness may be evidenced by:

PT 1.5 to 2 times control

INR of 2 to 3 for treatment of acute myocardial infarction, atrial fibrillation, pulmonary embolism, venous thrombosis, and/or tissue heart valves

INR of 3 to 4.5 for mechanical heart valve or recurrent systemic embolism

No development or no further development of venous thrombi
levothyroxine, adverse reactions

(Synthroid; thyroid hormone)


overmedication can result in signs of hyperthyroidism (anxiety, tachycardia, palpitations, altered appetite, abdominal cramping, heat intolerance, fever, diaphoresis, weight loss, and menstrual irregularities)

education about the use of mdi's
Remove the cap from the inhaler.■Shake the inhaler five to six times.■Hold the inhaler with the mouthpiece at the bottom.■Hold the inhaler with the thumb near the mouthpiece and the index and middle fingers at the top.■Hold the inhaler approximately 2 to 4 cm (1 to 2 in) away from the front of the mouth.■Take a deep breath and then exhale
Tilt the head back slightly, and press the inhaler. While pressing the inhaler, begin a slow, deep breath that lasts for 3 to 5 seconds to facilitate delivery to the air passages.■Hold the breath for 10 seconds to allow the medication to deposit in the airways.■Take the inhaler out of the mouth and slowly exhale through pursed lips.■Resume normal breathing

wait the length of time directed before administering the second puff.

◯Instruct the child to remove the canister and rinse the inhaler, cap, and spacer once a day with warm running water. Instruct the child to dry the inhaler before using it again.
bumetanide for heart failure, patient teaching

(Bumex; high ceiling loop diuretic; same class as Lasix)




Advise clients to get up slowly to minimize postural hypotension. If faintness or dizziness occurs, instruct clients to sit or lie down




Teach clients to report significant weight loss, lightheadedness, dizziness, GI distress, and/or general weakness




Encourage clients to consume foods high in potassium, such as avocados and strawberries.




●Instruct clients with diabetes to monitor for elevated blood glucose levels.




●Instruct clients to observe for signs of low magnesium levels such as muscle twitching and tremors




Avoid administering the medication late in the day to prevent nocturia



if giving penicillin IM administration guidelines
IM injection should be done cautiously to avoid injection into a nerve or an artery

Do not mix penicillin and aminoglycosides (gentamicin, tobramycin, etc.) in the same IV solution

Probenecid may be added to penicillin therapy to prolong action
nicotinic transdermal system, patient instructions

(Nicotrol)


-Clients should apply a nicotine patch to an area of clean, dry skin each day.


-advise clients to avoid using any nicotine products while the patch is on.


-advise clients to stop using patches and to notify the provider if local skin reactions occur.


-remove the patch prior to mri scan and replace when the scan is completed.

DI, patient receiving desmopressin, patient education
For an intranasal dose, teach the client to clear nasal passage and sit up-right prior to nasal inhalation.

Instruct the client to monitor weight and notify the provider of a gain > 2lb/24 hr.

Instruct the client to restrict fluids if directed and notify provider of headache or confusion. (r/f water intoxication)

With IV administration, monitor the client’s IV site carefully because extravasation can lead to gangrene

notify the provider of chest pain, tightness, diaphoresis (r/f myocardial ischemia)
urinary tract infection, allergic to thiazide diuretic, what medications are contradindicated?
Do not administer TMP-sMZ [Trimethoprim-sulfamethoxazole (Bactrim)]to clients who have allergies to Thiazide diuretics [hydrochlorothiazide (HcTZ)]=stevens-Johnson syndrome
adverse effects of school age child receiving benadryl
excitation, hallucinations, in-coordination and seizures
hypertension receiving Aldactone, (k sparing) patient education

(spironolactone)


-Teach clients to avoid salt substitutes that contain potassium.


●Teach clients to self-monitor blood pressure.


●Instruct clients to keep a log of blood pressure and weight

captopril, patient education
(Capoten; ACE)
Instruct clients to take captopril at least 1 hr before meals

Advise clients to notify the provider if cough, rash, dysgeusia (lack of taste), and/or signs of infection occur (r/f neutropenia)

r/f angioedema (swelling of the tongue and oral pharynx)-administer epinephrine
patient receiving anti tb meds for past 3 months, side effects and patient education
Due to the resistance that is developing against the anti-tb meds, combination therapy of up to four medications at a time is presently recommended

Isoniazid-Advise the client not to drink alcohol because it may increase the risk for hepatotoxicity

Rifampin-Inform the client that urine and other secretions will be orange.
Advise the client to report yellowing of the skin, pain or swelling of joints, loss of appetite, or malaise immediately.
Inform the client this medication may interfere with the efficacy of oral contraceptives.

Pyrazinamide-Instruct the client to drink a glass of water with each dose and increase fluids during the day.
Advise the client to report yellowing of the skin, pain or swelling of joints, loss of appetite, or malaise immediately.
Advise the client to avoid using alcohol

Ethambutol-Instruct the client to report changes in vision immediately
k rider, dosage and rate when not in icu, how to administer
Never IV bolus (high risk of cardiac arrest).

The maximum recommended rate is 5 to 10 mEq/hr
infliximab, adverse reactions
(Remicade; biologic DMARD)
subcutaneous injection-site irritation (redness, swelling, pain, itching)
risk of infection, especially tb-assess for sore throat, etc.
severe skin reactions
heart failure-assess for jvd, crackles, dyspnea
blood dyscrasias-monitor for bleeding
total hip, getting enoxaparin , administration guidelines
(lovonox; anticoagulant)
subcutaneously every 12 hr for 2 to 8 days

Deep subcutaneous injections should be administered in the abdomen, ensuring a distance of 2 inches from the umbilicus. Do not aspirate

Apply pressure for 1 to 2 min after the injection. Rotate and record injection sites


acute angina, nitro, administration guidelines
Instruct the client to stop activity.
The client should take a dose of rapid-acting nitroglycerin immediately.
If pain is unrelieved in 5 min, the client should call 9-1-1 or be driven to an emergency department.
The client can take up to two more doses at 5 min intervals

tablets should be stored in original bottles, and in a cool, dark place.
discard tablets after 24 months unless indicated on the package
Tylenol is contraindicated in what diseases?

(acetaminophen; anlagesic, anitpyretic)


Use cautiously in clients who consume three or more alcoholic drinks per day and those taking warfarin (interferes with metabolism)




Acute toxicity results in liver damage

have cancer, with fentanyl transdermal patch, having breakthough pain, whatdrug would you administer

morphine iv (rapid acting)

tobramycin, getting it daily, what lab values to monitor
(Nebcin; aminoglycoside)
monitor i&o, bun, and creatinine levels (r/f nephrotoxicity)
which of these meds is contraindicated with asthma; lasix, gliburide,propranolol, digoxin
propranolol; r/f respiratory depression
whats the lithium therapeutic range?
Maintenance level range is between 0.4 to 1.0 mEq/L

Plasma levels > 1.5 mEq/L can result in toxicity
administration guidelines for inactivated influenza administration for an adult
•allergy to eggs
nitro sublingual patient teaching
Instruct the client to stop activity.
The client should take a dose of rapid-acting nitroglycerin immediately.
If pain is unrelieved in 5 min, the client should call 9-1-1 or be driven to an emergency department.
The client can take up to two more doses at 5 min intervals

tablets should be stored in original bottles, and in a cool, dark place.
discard tablets after 24 months unless indicated on the package
amantadine patient education
(Symmetrel; antiretroviral therapy)
Phlebitis and inflammation at the site of infusion
nephrotoxicity- Increase fluids
GI –N,V,D.
Thrombocytopenia
complications of tpn administration
●Infection and sepsis are evidenced by a fever or elevated WBC count. Infection can result from contamination of the catheter during insertion, contaminated solution, or a long-term indwelling catheter.
●Metabolic complications include hyperglycemia, hypoglycemia, hyperkalemia, hypophosphatemia, hypocalcemia, hypoalbuminemia, dehydration, and fluid overload (as evidenced by weight gain greater than 1 kg/day and edema).
●Mechanical complications include catheter misplacement, pneumothorax (evidenced by shortness of breath, diminished or absent breath sounds), subclavian artery puncture, catheter embolus, air embolus, thrombosis, obstruction, and bolus infusion
repaglinide, patient education
(Prandin; meglitinides-oral hypoglycemic)
Instruct clients to eat within 30 min of taking a dose of the medication, 3 times/day

avoid concurrent use of repaglinide and gemfibrozil

Monitor for signs of hypoglycemia.
Instruct clients to self-administer a snack of 15 g of carbohydrate (4 oz orange juice, 2 oz grape juice, 8 oz milk, glucose tablets per manufacturer’s suggestion to equal 15 g)

if your patient in svt is getting procainimide, pharmacological action of the drug,what would you expect to see after administration
(Pronestyl, Procanbid; antidysrhythmic)
-decrease electrical conduction
•increase automaticity
•decrease rate of repolarization
nitro ointment for angina, administration guidelines
(Nitro-Bid)
-Remove the prior dose before a new dose is applied. Measure specific dose with applicator paper and spread over 2.5 to 3.5 inches of the paper.
•Apply to a clean, hairless area of the body, and cover with clear plastic wrap.
•Follow same guidelines for site selection as for transdermal patch.
•Avoid touching ointment with the hands.
patient with life threatening ventricular arrhythmia, what medication would you give first
Amiodarone, lidocaine, and epinephrine
pt has leukemia, and getting chemo, why are they taking allopurinol

(Zyloprim; agent for hyperuricemia)


therapeutic use-hyperuricemia due to chronic gout or secondary to cancer chemotherapy

fondaparinux, administration guidelines
(Arixtra; Activated factor X (Xa) inhibitor; anticoagulant)
-No monitoring is required. Therefore, these medications are acceptable for home use
-Provide instruction regarding correct self-administration. Medications may be available in pre-filled syringes.
-For subcutaneous injections, use a 20 to 22 gauge needle to withdraw medication from the vial. Then, change to a small needle (gauge 25 or 26, 1/2 to 5/8 in length).
-Deep subcutaneous injections should be administered in the abdomen, ensuring a distance of 2 inches from the umbilicus. Do not aspirate.
-Apply pressure for 1 to 2 min after the injection. Rotate and record injection sites.
-Instruct clients to monitor for signs of bleeding such as bruising, gums bleeding, abdominal pain, nose bleeds, coffee-ground emesis, and tarry stools.
-Instruct clients not to take over-the-counter NSAIDs, aspirin, or medications containing salicylates.
-Advise client to use an electric razor for shaving and a soft toothbrush
influenza vaccine allergies
eggs
rheumatiod arthritis, long term prednisone, long term effects

(Glucocorticoid)


increased risk of infection (fever and/or sore throat)


osteoporosis


adrenal suppression



patient receiving vancomycin, start getting rash and flushed face, what to do?
administer slowly over 60 min
heart failure, have a dry cough, which of the folloowing medications would you stop: htcz, isosorbide, lisinopril, niphedipine
lisinopril
Pyridium, expected client outcomes
(phenazopyridine; bladder analgesic used to treat UTIs)

short-term relief of UTI manifestations
calculate drip rates with drop factors of tubing

V/T X GTT=Rate