Pharmacological And Parenteral Therapies Flashcards
(148 cards)
1
Q
Nursing actions prior to the administration of blood products
A
- assess for allergies or previous blood reaction
- type and cross match
2
Q
Nursing interventions for administration of blood
A
- 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
3
Q
Allergic blood transfusion reactions result from
A
Hypersensitivity
4
Q
Hemolytic blood transfusion reactions result from
A
Incompatibility
5
Q
Febrile blood transfusion reactions result from
A
Antibodies to donor platelets or leukocytes
6
Q
Bacterial blood transfusion reaction results from
A
Contaminated blood
7
Q
S/S of allergic transfusion reaction
A
Urticaria, pruritis, fever, anaphylactic shock
8
Q
S/S of hemolytic transfusion reaction
A
N/V, pain in lower back, hypotension, hematuria
9
Q
S/S of febrile transfusion reaction
A
Fever, chills, nausea, headache, flushing, tachycardia
10
Q
S/S of bacterial transfusion reaction
A
Tachycardia, hypotension, fever, chills, shock
11
Q
Nursing interventions for blood transfusion reaction
A
- 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
12
Q
Which type of transfusion is collected 4-6 weeks before surgery and prevents viral infection and transfusion reactions?
A
Autologous transfusion
13
Q
Where is venipuncture performed with a PICC line?
A
Above or below the antecubital fossa
14
Q
Where is the tip of the PICC line catheter placed?
A
In the superior vena cava
15
Q
How often should the nurse change PICC line dressings?
A
2-3 times/week when wet or nonocclusive
16
Q
PICC line nursing consideration
A
DO NOT take BP or draw blood from extremity with PICC line
17
Q
Nontunneled, triple lumen catheter inserted through the subclavian vein for short-term IV therapy
A
Percutaneous central catheter (PCC)
18
Q
The _________ lumen of a PCC is used to infuse or draw blood samples
A
Distal
19
Q
The _________ lumen of a PCC is used for PN infusion
A
Middle
20
Q
The _________ lumen of a PCC is used to infuse or draw blood and administer medication
A
Proximal
21
Q
How often should the nurse change the catheter site for PCC?
A
Every 4 weeks
22
Q
How often should the nurse change PCC tubing?
A
Every 72-96 hours
23
Q
S/S of infiltration
A
Cool skin, swelling, pain, decreased flow rate
24
Q
Nursing interventions for infiltration
A
- D/C IV
- apply warm compresses to site
- elevate arm
- start new IV proximal to infiltrated site
25
S/S of phlebitis/thrombophlebitis
Redness, warm, tender, swelling, leukocytosis
26
Nursing interventions for phlebitis/thrombophlebitis
- D/C IV
- apply warm, moist compresses
- restart IV at new site
27
S/S of hematoma
Ecchymosis, swelling, leakage of blood
28
Nursing interventions for hematoma
- D/C IV
- apply ice for 24 hr, followed by warm compress
- restart IV in opposite extremity
29
S/S of clotted IV
Decreased flow rate, backflow of blood into tubing
30
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
31
Examples of isotonic fluids
0.9% NaCl, LR, D5W (becomes hypotonic when glucose is metabolized)
32
Example of hypotonic fluids
0.45% NaCl
33
Example of hypertonic fluid
D10W
34
How often should IV tubing be changed?
Every 72 hours
35
How often should IV bag be changed?
Every 24 hours
36
Hives, rash, difficulty breathing, and diaphoresis are all symptoms of
Anaphylaxis
37
Nursing interventions for anaphylaxis
- administer epinephrine IM
- massage site to speed absorption
- may repeat in 15-20 min
38
S/S of liver impairment
Fever, malaise, N/V, jaundice, light stools, dark urine, abdominal pain, elevated AST & ALT, altered PTT
39
S/S of renal impairment
Elevated BUN and creatinine, decreased Hct, altered electrolytes (K+, Na), altered urinary output, edema
40
Nursing interventions for renal impairment
- diet and fluid restriction
- electrolyte replacement
- dialysis
- rest
41
Anticholinergic side effects
Blurred vision, dry mouth, dysphagia, urinary retention, constipation, impotence, nasal congestion
42
Parkinson’s-like side effects
Akinesia, tremors, drooling, changes in gait, rigidity, akathisia, dyskinesia
43
Aluminum hydroxide, magnesium hydroxide, calcium carbonate, and aluminum/magnesium hydroxide are all examples of
Antacids
44
Key side effects of antacids
Constipation (calcium carbonate), diarrhea (magnesium), acid rebound
45
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)
46
Chlordiazepoxide, alprazolam, lorazepam, and diazepam are all examples of
Benzodiazepines
47
Examples of non-benzodiazepines
Hydroxyzine and buspirone
48
Herbal supplements for anxiety
Kava and melatonin
49
Benzodiazepine side effects
Sedation, confusion, dizziness, hepatic dysfunction
50
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
51
Benzodiazepine patient education
- avoid alcohol or other CNS depressants
- do not drive or operate heavy machinery
- gradually taper dose if changing or discontinuing med
52
Antibiotic nursing considerations
- obtain culture and sensitivity prior to initiation of antibiotic therapy
- assess for allergies
53
Antibiotic patient education
- take exactly as prescribed
- complete the full course of therapy
- increase fluid intake
- may decrease effectiveness of oral contraceptive
54
Gentamicin, neomycin, streptomycin, and tobrabycin are all examples of
Aminoglycosides
55
Aminoglycoside side effects
Ototoxicity, nephrotoxicity, anorexia, N/V, diarrhea
56
Aminoglycoside nursing considerations
- assess 8th cranial nerve (hearing — d/t ototoxicity)
- monitor BUN and creatinine
- encourage fluids
57
Cefaclor, cefazolin, cephalexin, ceftriaxone, and cefoxitin are all examples of
Cephalosporins
58
Cephalosporin side effects
GI disturbances, increased bleeding time, rash, superinfection
59
Cephalosporin nursing considerations
- administer with food
- educate pt to avoid alcohol
- assess for penicillin allergy
60
Ciprofloxacin an levofloxacin are examples of
Fluoroquinolones
61
Fluoroquinolones side effects
Diarrhea, decreased WBC and Hct, elevated liver enzymes, elevated alkaline phosphatase, Achilles tendon rupture
62
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)
63
Erythromycin and azithromycin are examples of
Macrolides
64
Macrolide side effects
Diarrhea, confusion, hepatotoxicity, superinfections
65
Macrolide nursing considerations
- monitor liver function
- medication interactions: warfarin, verapamil
66
Side effects of penicillins
Stomatitis, diarrhea, allergic reactions, renal and hepatic changes
67
Penicillin nursing considerations
- check for hypersensitivity
- cross allergy with cephalosporins
68
Trimethoprim/sulfamethoxazole and Sulfasalazine are examples of
Sulfonamides
69
Sulfonamide side effects
Crystalluria, photosensitivity, GI upset, stomatitis, hypersensitivity, bone marrow depression, Steven Johnson syndrome
70
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
71
Tetracycline side effects
Discoloration of primary teeth, glossitis, rash, photosensitivity
72
Tetracycline nursing considerations
- client should not take with antacids, milk, or iron
- contraindicated in pregnancy
- monitor renal function
- educate client to avoid sunlight
73
Propantheline, atropine, scopolamine, and Benztropine are examples of
Anticholinergics
74
Anticholinergic MOA
- pupil dilation
- bronchodilation
- decreases secretions, mobility, and GI secretions
75
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
76
Heparin nursing considerations
- monitor platelets and PTT
- administer SC or IV
- antidote: protamine sulfate
- monitor for excessive bleeding and tissue irritation
77
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
78
Phenytoin, phenobarbital, valproic acid, carbamazepine, and clonazepam are all examples of
Anticonvulsants
79
Anticonvulsants side effects
Respiratory depression, aplastic anemia, gingival hyperplasia (phenytoin), ataxia, sedation
80
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)
81
Phenelzine, isocarboxazid, and tranylcypromine are examples of
MAOIs
82
MAOI side effects
Hypertensive crisis (d/t consumption of foods containing tyramine), photosensitivity, sexual dysfunction
83
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
84
Fluoxetine, paroxetine, and sertraline are examples of
SSRIs
85
Venlafaxine and duloxetine are examples of
SNRIs
86
SSRI side effects
Anxiety, GI upset, change in appetite and bowel function, urinary retention/dry mouth, sexual dysfunction
87
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)
88
Amytriptyline and imiprimine are examples of
Tricyclic antidepressants
89
Tricyclic antidepressant side effects
Sedation, anticholinergic effects, confusion, postural hypotension, photosensitivity, bone marrow depression
90
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
91
Bupropion and trazodone are examples of
Atypical antidepressants
92
Side effects of atypical antidepressants
Dry mouth, nausea
Bupropion: insomnia & agitation
Trazodone: sedation & orthostatic hypotension
93
Atypical antidepressant nursing considerations
- client should avoid alcohol and CNS depressants
- wean off slowly
94
Bismuth subsalicylate, diphenoxylate/atropine, loperamide, and opium alkaloids are examples of
Antidiarrheals
95
Antidiarrheal side effects
Constipation, anticholinergic effects
96
Antidiarrheal nursing considerations
- do not use with abdominal pain
- monitor for urinary retention
- give 2 hr before or 3 hr after other meds
97
Quinidine, lidocaine, flecainide, propranolol, amiodarone, and verapamil are examples of __________ medications
Antidysrhythmic
98
Antidysrhythmic side effects
Lightheadedness, hypotension, bradycardia, urinary retention
99
Side effects of propranolol
Bradycardia, bronchospasm (use cautiously in patients with asthma)
100
Side effects of amiodarone
Photosensitivity, photophobia
101
Side effect of verapamil
Heart failure
102
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
103
Trimethobenzamide, prochlorperazine, Metoclopramide, meclizine, and Ondansetron are examples of
Antiemetics
104
Antiemetics side effects
Sedation, anticholinergic effects
105
Amphotericin B, nystatin, and fluconazole are examples of
Antifungals
106
Antifungal side effects
Hepatotoxicity, thrombocytopenia, leukopenia
107
Antifungal nursing consideration
- used cautiously in immunocompromised patients
- administer with food (unless swish and swallow)
- monitor liver function
- educate patient to complete prescription
108
Colchicine, probenecid, and allopurinol are examples of
Antigout medications
109
Antigout medication side effects
Agranulocytosis, aplastic anemia, GI upset, renal calculi
110
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
111
Diphenhydramine and promethazine are examples of
Antihistamines
112
Antihistamine side effects
Drowsiness, dry mouth (anticholinergic effects), GI upset, bronchospasm
113
Antihistamine nursing considerations
- give with food
- assess respirations
- client should avoid alcohol
114
Beta blocker nursing considerations
- take with meals
- do not d/c abruptly
- masks signs of hypoglycemia in clients with diabetes
- nonselective can cause bronchospasm
115
Candesartan, losartan, and eprosartan are examples of
ARBs
116
Doxazosin and prazosin are examples of
Alpha 1 adrenergic blockers
117
Cholestyramine and atorvastatin are examples of
Antilipidemics
118
Antilipidemic side effects
Constipation, fat-soluble vitamin deficiency, muscle cramps
119
Antilipemic nursing consideration
Monitor triglyceride and liver function tests
120
When should digoxin be held?
Adult: HR < 60
Older Children: HR < 70
Infants and Young Children: < 90-110
121
Key side effects of Acetazolamide (carbonic anhydrase inhibitor for open-angle glaucoma)
- pulmonary edema
- decreased K+ level
- blurred vision
- lethargy
- depression
122
Herbal supplement that works on the immune system to prevent and treat colds/flu/UTI and promotes wound healing
Echinacea
123
Echinacea side effects
Allergic reaction, N/V, unpleasant taste with tingling on tongue
124
Echinacea nursing considerations
- decreases effectiveness of immunosuppressants
- contraindication in autoimmune diseases
- avoid if allergic to ragweed/daisies
125
Herbal supplement that is anti-microbial, -lipidemic, -thrombotic, -tumor, and -inflammatory
Garlic
126
Garlic side effects
Flatulence, heartburn, irritation of mouth, esophagus, and stomach, allergic reaction
127
Garlic nursing considerations
- may potentiate anticoagulants, antiplatelets, antidiabetics, antihyperlipidemics, antihypertensives
- avoid if allergy to Lillie’s
- may decrease effectiveness of oral contraceptives
128
Herbal supplement that provides analgesia, improves circulation, and alleviates nerve pain
Capsicum/Cayenne Pepper
129
Capsicum side effects
GI discomfort, self-defense — pain/burning in eye, skin, cough, bronchospasm
130
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
131
Herbal supplement that acts as an antidepressant, sedative, antiviral, and antimicrobial
St John’s Wort
132
Side effects of St John’s Wort
Photosensitivity, fatigue, allergic reaction, restlessness
133
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
134
What medication can be used to control bleeding related to thrombolytics?
Aminocaproic acid
135
Which iron preparation is exclusively administered IM or IV when the client cannot tolerate PO administration?
Iron dextran
136
How should clients take iron?
On an empty stomach, with orange juice (vitamin C increases absorption)
137
Foods high in iron
Cereals, dried beans/legumes, dried fruit, green leafy vegetables, lean red meat and organ meats
138
What can decrease the absorption of iron?
Antacids, coffee, tea, milk, and eggs
139
Lithium nursing considerations
- monitor serum levels (2-3 times/week when starting, monthly for maintenance)
- monitor sodium levels (risk for hyponatremia)
140
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
141
Clients taking rapid-acting insulins (lispro, aspart, glulisine) need to eat within ___-___ minutes of injection time
5-15
142
Clients taking regular insulin need to eat within ___-___ minutes of injection time
20-30
143
What medications decrease insulin needs?
MAOIs, aspirin, and anticoagulants
144
Ingestion of alcohol during metformin therapy can lead to
Lactic acidosis
145
Medications that can elevate glucose levels necessitating higher doses of insulin
Thiazide diuretics, glucocorticoids (cortisone), thyroid medications, estrogen
146
Laxative/stool softeners contraindications
Symptoms of acute abdominal pain, N/V, and fever
147
What electrolyte imbalance can result from chronic use of stool softeners/laxatives?
Hypokalemia
148
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
