HESI NSG 219 Flashcards
Metformin
(Antidiabetic) PO Tab
–improving glycemic control, stabilizing body weight, and improving the lipid profile
-half life=5hrs, full=20hrs
**RISK Lactic Acidosis
**–>SX to NOTIFY DOC= hyperventilation, myalgia, malaise, and drowsiness
HOLD: sepsis, hypoxemia, dehydration, and hypoperfusion
S.E.: Diarrhea, abdominal bloating, and unpleasant metallic taste
Metformin
(Antidiabetic) PO
*Risk of Lactic Acidosis
**HOLD: sepsis, hypoxemia, dehydration, and hypoperfusion
Why admin Calcitonin to a pt. with Paget’s DZ?
Decrease Bone Reabsorption
–>Calcitonin works in conjunction with parathyroid hormone (PTH) to regulate calcium by decreasing the rate of bone resorption and regulating bone metabolism.
DISEASE of the bone is caused by the excessive breakdown and formation of bone; this is followed by disorganized bone remodeling. This causes affected bone to weaken; pain and fractures are a concern, and arthritis in the joints near the affected bones results.
Paget’s Disease
Pt. needs a subQ injection of regular insulin (short acting) and NPH. Which one do you draw up first?
Draw up the regular insulin FIRST, and then the NPH insulin in the same syringe.
**Roll med not shake to mix
***“clear before cloudy”
Hypothyroidism; thyroid supplement
Levothyroxine
–take in AM on EMPTY stomach @ same time each day to prevent insomnia; Takes 1-3 wks to work
–REPORT chest pain=may be an OD
S.E: GI= ^ appetite, nausea, diarrhea
–Adjust dose if pregnant or plan to be
**Don’t STOP suddenly= Addisonian Crisis
Hypothyroidism med
Levothyroxine
**take in AM on EMPTY stomach
*Don’t STOP suddenly=Addisonian Crisis
Topical glucocorticoids
Tx: skin conditions
S/E: anti-inflammatory, antimitotic (inhibits cell growth by stopping mitosis) ,immune-system suppressing actions
— can be absorbed in sufficient amounts to produce systemic toxicity.
*PRIMARY concerns are growth retardation (in children) and adrenal suppression in all age groups. Systemic toxicity is more likely under extreme conditions
Topical glucocorticoids
( anti-inflammatory skin tx)
*RISK of Systemic Toxicity=Adrenal Suppression
Fludrocortisone acetate
(long-acting PO med w/ mineralocorticoid and moderate glucocorticoid)
TX: long-term management of Addison’s disease. (Low cortisol levels from adrenal gland)
ACTION: act on the renal distal tubules to enhance the reabsorption of NA and CL and the excretion of K and H
**Do not STOP abruptly= hypotension and fluid & electrolyte imbalance
Fludrocortisone acetate
TX: Long-term for Addison’s DZ to promote electrolyte balance
Don’t STOP Suddenly
Vasopressin
(Vasoconstrictor/ antidiuretic)
USES: DI= Diabetes Insipidus (low ADH levels)
ACTION: directly stimulates contraction of smooth muscle, causes vasoconstriction, stimulates peristalsis and Decreases urinary output
Vasopressin
(Vasoconstrictor/ Antidiuretic)
*DI pt. = decreases urinary output and Bleeding
Glipizide
(Oral hypoglycemic agent)
that is taken AM
**Decreases Blood Glucose
Glipizide
(Oral Hypoglycemic)
*Lowers BG**
A client dx with DM receives 8 units of regular insulin subQ at 7:30 am. The nurse would be most alert to signs of hypoglycemia at what time during the day?
9:30-11:30
-Short-acting insulin
Peak: 2-4 hours
-onset 30min BG levels start to lower (pt. Needs to eats b4 the 30min)
Pioglitazone
(antidiabetic)
USES: type 2 diabetes mellitus
–Take 15-30 min before meals
Pioglitazone
(Antidiabetic)
*DM type 2
Desmopressin
(antidiuretic hormone).
USES: DI
The nurse monitors the client’s fluid balance to determine the effectiveness of the medication.
Desmopressin
(Antidiuretic hormone)
*DI pt.
*RN monitors DAILY wt.
Acarbose
(an alpha-glucosidase inhibitor)
TX: Type 2 DM
ACTION: delays absorption of carbs from sm. Intestines
–Take W/ EACH MEAL w/ 8oz of water
S.E.: GI disturbances: flatulence, cramps, and abdominal distention
Acarbose
(Alpha-Glucosidase Inhibitor)
Tx: Type 2 DM
-similar to metformin
**can be used to help manage dumping syndrome and hypoglycemia
A client is reporting dyspepsia and pain that generally occurs about 90 minutes after eating. The pain worsened this afternoon about 3 hours after eating a large bowl of spaghetti with tomato sauce. Which medication therapy would the nurse anticipate being prescribed? What is the condition?
Duodenal Ulcer
-Triple Therapy
–>Esomeprazole (PPI) to decrease gastric acid secretions
–>Metronidazole & Clarithromycin (antibiotics) commonly used to treat H.Pylori
S/SX: pain occurs about 90 minutes after consuming food
Duodenal Ulcer
Lansoprazole
(proton-pump inhibitor)
USES: peptic ulcer disease, esophagitis, and gastroesophageal reflux disease (GERD).
Lansoprazole
(PPI)
**Decreases gastric secretions
**avoid Irritants to stomach
GASTRECTOMY
Complication: vit. B12 and folic acid def. B/C a deficiency of the intrinsic factor and/or inadequate absorption of food
—>food may enter the bowel too quickly after this type of surgery.
Gastrectomy Complications
*Often to tx stomach cancer
HEARTBURN
Intervention:
-high protein/ Low fat
-Sit up for >2hr after eating
-AVOID over eating = increases stomach pressure; NO fruit juices, to acidic
HEARTBURN: Intervention
Colorectal Cancer
Modifiable RISKs: implement a high-fat and low-fiber diet
RISK: age >40 years, first-degree relative with colorectal cancer, and hx of bowel problems such as ulcerative colitis or familial polyposis.
Colorectal Cancer
RISK factors
Esophagogastrostomy POST-OP
–Bed at semi-Fowlers or High-Fowlers (promotes ventilation and decreases reflux)
–Provide oral hygiene q2hr while NG tune in place
–Encourage Deep Breathing Exercises and use of Incentive Spirometer
–when diet is resumed Drink fluids in between meals not w/=risk for diarrhea
**AVOID irrigation of NG tube or repositioning=disturbs sutures
**No drainage from NG NOTIFY HCP
POST-OP INTERVENTIONS:
Esophagogastrostomy
–>the diseased portion of the esophagus and stomach (if involved) is removed, and remaining portions of the esophagus and stomach are anastomosed
Pernicious Anemia
(Aka Addisons Anemia: decrease in RBC r/t malabsorption of vit. B-12)
MAJOR RISK: gastric resection
Other RISK: Central nervous system and musculoskeletal disorders
Pernicious Anemia RISKS
**Major = Gastric Resection
EXPECTED OUTCOMES:
Peptic Ulcer DZ
–Pain meds is relieving discomfort.
–Client reports no pain before meals.
–Client eliminates foods that exacerbate the condition.
–Client reports ability to sleep through the night w/out pain.
EXPECTED OUTCOMES:
Peptic Ulcer DZ
Pt. with bleeding esophageal varices gets perscribed Vasopressin. Why?
-it restricts blood flow b/c it is a vasoconstrictor
VASOPRESSIN
(synthetic antidiuretic hormone)
ACTION: vasoconstrictor
USES: Administration of this hormone into the bloodstream reduces bleeding. It acts directly on gastrointestinal smooth muscle as a vasoconstrictor
Vasopressin is prescribed for a client with a diagnosis of bleeding esophageal varices. The nurse would prepare to administer this medication by which route?
IV infusion through central line
Which solution and amount would the nurse plan to use for periodic catheter irrigations prescribed by the primary health care provider?
To maintain catheter patency and drainage, the catheter is irrigated with 10 to 20 mL normal saline.
A client has cirrhosis complicated by ascites. Which expected but adverse laboratory result would the nurse monitor for?
Low Serum Albumin
Anal fistulas
–>abnormal openings or tunneling leading from the anus or from the rectum. *COMPLICATIONS associated with Crohn’s disease and occur as a result of the inflammatory changes in Crohn’s.
Crohn’s COMPLICATION
*Anal Fistulas
INTERVENTIONS: Hiatal Hernia
–elevation of the thorax after meals and during sleep
–intake of small, frequent, and bland meals
–use of histamine antagonists (H2 Blockers) and antacids.
INTERVENTIONS:
Hiatal Hernia
