Feb 22, 2011

Final comprehansive notes 2

Glomerulonephritis Assessment

· Fever, Chills

· Hematuria

· Proteinuria

· Edema

· Hypertension

· Abdominal or flank pain

· Occurs 10 days after beta hemolytic streptococcal throat infection

Glomerulonephritis Implementation

· Antibiotics, corticosteroids

· Antihypertensives, immunosuppressive agents

· Restrict sodium and water intake

· Bedrest

· I&O

· Daily weight

· High Calorie, Low protein

Urinary Diversion: Assessments

· Done for: Bladder t umors, birth defects, neurogenic bladder, interstitial cystitis

· Ileal Conduit

· Koch Pouch

Urinary Diversion Implementations

· Nephrostomy: flank incision and insertion of nephrostomy tube into renal pelvis; penrose drain after surgery; surgical dressing

· Ureterosigmoidostomy: urters detached from bladder and anastomosed to sigmoid colon; encourage voiding via rectum q 2-4 hours;no enemas or cathartics; complications—electrolyte imbalance, infection, obstruction; urine and stool evacuated towards anus.

· Cutaneous Ureterostomy: Stoma formed from ureters excised from bladder and brought to abdominal wall; stoma on right side below waist; assist with alteration in body image

· Illeal Conduit: Ureters replanted into portion of terminal ileum and brought to abdominal wall; check for obstruction; mucous threads in urine normal

· Koch Pouch (Continent Illeal Conduit): Ureters transplanted into pouch made from ileum with one-way valve; drainage of pouch by catheter under control of client; drain pouch at regular intervals

Acute Renal Failure Assessments: Oliguric Phase

· Output <400>

· Hypertension

· Anemia


· Confusion

· Increased K+, Ca+, Na+, BUN, Creatinine

Acute Renal Failure Assessments: Diuretic Phase

· Output 4-5 L/day

· Increased BUN

· Na+, K+ lost in urine

· Increased mental and physical activity

Acute Renal Failure Causes

· Prerenal—reduced blood volume

· Renal—nephrotoxic drugs, glomerulonephritis

· Postrenal--obstruction

Acute Renal Failure Implementations:

· Low-output stage: Limit fluids, Kayexalate, Dialysis

· High-output stage: Fluids as needed, K+ replacement, Dialysis

· I&O

· Daily Weight

· Monitor Electrolytes

· Bedrest during acute phase

· IV fluids

· Diet restrictions

· Oliguric phase: limit fluids, TPN maybe

· After Diuretic phase: high protein, high calorie diet

Hemodialysis Implementation

· Check for thrill and bruit q 8 hours

· Don’t use extremity for BP, finger stick

· Monitor vital signs, weight, breath sounds

· Monitor for hemorrhage

Peritoneal Dialysis

· Weight before and after treatment

· Monitor BP

· Monitor breath sounds

· Use sterile technique

· If problem with outflow, reposition client

· Side effects: constipation

Types of Peritoneal Dialysis

· Continuous ambulatory (CAPD)

· Automated

· Intermittent

· Continuous

Ego Defense Mechanisms

ü Denial—failure to acknowledge thought

ü Displacement—redirect feelings to more acceptable subject

ü Projection—attributing your feelings to someone else

ü Undoing—attempt to erase an act, thought or feeling

ü Compensation—attempt to overcome shortcoming

ü Symbolization—less threatening object used to represent another

ü Substitution—replacing unacceptable or unobtainable object to one that is acceptable or attainable

ü Introjection—symbolic taking into oneself the characteristics of another

ü Repression—unacceptable thoughts kept from awareness

ü Reaction formation—expressing attitude opposite of unconscious wish or fear

ü Regression—returning to an earlier developmental phase

ü Dissociation—detachment of painful emotional conflicts from consciousness

ü Suppression—consciously putting thought out of awarenessgui

Dying patient: Denial, Anger, Bargaining, Depression, Acceptance

Bipolar Disorder Assessments

· Disoriented, flight of ideas

· Lacks inhibitions, agitated

· Easily stimulated by environment

· Sexually indiscreet

· Affective disorder

· Maintain contact with reality

· Elation is defense against underlying depression

· Manipulative behavior results from poor self-esteem

Bipolar Disorder Implementations

· Meet physical needs first

· Simplify environment

· Distract and redirect energy

· Provide external controls

· Set limits: escalating hyperactivity

· Use consistent approach

· Administer Lithium (help Manic Phase of Bipolar, keep hydrated)

· Increase awareness of feelings through reflection

Schizophrenia Assessments

· Withdrawal from relationships and world

· Inappropriate display of feelings

· Hypochondriasis

· Suspiciousness

· Inability to test reality, regression

· Hallucinations—false sensory perceptions

· Delusions—persistent false beliefs; grandeur (feel higher rank); persecutory (beliefs to be a victim); ideas of reference (see people talking think talking about them)

· Loose associations

· Short attention span

· Inability to meet basic needs: nutrition, hygiene

· Regression

Schizophrenia Types

· Disorganized—inappropriate behavior, transient hallucinations

· Catatonic—sudden onset mutism, stereotyped position, periods of agitation

· Paranoid—late onset in life, suspiciousness, ideas of persecution and delusions

Schizophrenia Implementations

· Maintain safety—protect from erratic behavior

· With hallucination—do not argue, validate reality, respond to feeling tone, never further discuss voices (don’t ask to tell more about voices)

· With delusions—do not argue, point out feeling tone, provide diversional activities

· Meet physical needs

· Establish therapeutic relationship

· Institute measures to promote trust

· Engage in individual, group, or family therapy

· Encourage client’s affect

· Accept nonverbal behavior

· Accept regression

· Provide simple activities or tasks

Paranoid Assessments

§ Suspiciousness

§ Cold, blunted affect

§ Quick response with anger or rage

Paranoid Implementations

§ Establish trust

§ Low doses phenothiazines for anxiety

§ Structured social situations

Schizoid Assessments

§ Shy and introverted

§ Little verbal interaction

§ Few friends

§ Uses intellectualization

Schizoid Implementations

§ Establish trust

§ Low doses phenothiazines for anxiety

§ Structured social situations

Schizotypal Assessments

§ Eccentric

§ Suspicious of others

§ Blunted affect

§ Problems with perceiving, communicating

Schizotypal Interventions

§ Establish trust

§ Low doses neuroleptics to decrease psychotic symptoms

§ Structured social situations

Antisocial Assessments

§ Disregards rights of others

§ Lying, cheating, stealing, promiscuous

§ Lack of guilt

§ Immature

§ Irresponsible

§ Associated with substance abuse

Antisocial Implementations

§ Firm limit-setting

§ Confront behaviors consistently

§ Enforce consequences

§ Group therapy


Borderline Assessments

§ Brief and intense relationships

§ Blames others for own problems

§ Impulsive, manipulative

§ Self-mutilation

§ Women who have been sexually abused

§ Suicidal when frustrated, stressed

Borderline implementations

§ Identify and verbalize feelings

§ Use empathy

§ Behavioral contract

§ Journaling

§ Consistent limit-setting

§ Group therapy

Narcissistic Assessments

§ Arrogant lack of feelings and empathy for others

§ Sense of entitlement

§ Uses others to meet own needs

§ Shallow relationships

§ Views self as superior to others

Narcissistic Implementations

§ Mirror what client sounds like

§ Limit-setting

§ Consistency

§ Teach that mistakes are acceptable

Histrionic Assessments

§ Draws attention to self

§ Somatic complaints

§ Temper tantrums, outbursts

§ Shallow, shifting emotions

§ Cannot deal with feelings

§ Easily influenced by others

Histrionic Implementations

§ Positive reinforcement for other centered behaviors

§ Clarify feelings

§ Facilitate expression of feelings

Dependent Assessments

§ Passive

§ Problem working independently

§ Helpless when alone

§ Dependent on others for decisions

§ Fears loss of support and approval

Dependent Implementations

§ Emphasize decision-making

§ Teach assertiveness

§ Assist to clarify feelings and needs

Avoidant Assessments

§ Socially uncomfortable

§ Hypersensitive to criticism, Lacks self-confidence

§ Fears intimate relationships

Avoidant Implementations

§ Gradually confront fears

§ Discuss feelings

§ Teach assertiveness

§ Increase exposure to small groups

Obssessive-compulsive Assessments

§ High personal standards for self and others

§ Preoccupied with rules, lists, organized

§ Perfectionists

§ Intellectualize

Obssessive-compulsive Implementations

§ Explore feelings

§ Help with decision-making

§ Confront procrastination

§ Teach that mistakes are acceptable

Manipulative behavior Assessments

§ Unreasonable requests for time, attention, favors

§ Divides staff against each other

§ Intimidates others

§ Use seductive or disingenuous approach

Manipulative Behavior Implementations

§ Use consistent undivided staff approach

§ Set limits

§ Be alert for manipulation

§ Check for destructive behavior

§ Help client to see consequences of behavior

Acute Alcohol Intoxication

§ Drowsiness

§ Slurred speech

§ Tremors

§ Impaired thinking

§ Belligerence

§ Loss of inhibitions

Acute Alcohol Implementations

§ Protect airway

§ Assess for injuries

§ Withdrawal assess

§ IV glucose

§ Counsel about alcohol use

Alcohol Withdrawal Assessments

§ Tremors

§ insomnia

§ anxiety

§ hallucinations

After WithdrawalàDelirium Tremens Assessments

§ Disorientation

§ Paranoia

§ Ideas of reference

§ Suicide attempts

§ Grand mal convulsions

Alcohol Withdrawal Implementations

§ Monitor vital signs, especially pulse

§ Administer sedation, anticonvulsants, thiamine (IM or IV), glucose (IV)

§ Seizure precautions

§ Quiet, well-lighted environment

§ Stay with patient

Chronic Alcohol Dependence Assessments

· Persistent incapacitation

· Cyclic drinking or “binges”

· Others in family take over client’s role

· Family violence

Chronic Alcohol Dependence Implementations

· Identify problems related to drinking

· Help client see problem

· Establish control of problem

· Alcoholics anonymous

· Antabuse

· Counsel spouse and children

Wernicke’s Syndrome Assessments

· Confusion

· Diplopia, nystagmus

· Ataxia

· Apathy

Wernicke’s Syndrome Implementations

· Thiamine (IM or IV)

· Abstinence from alcohol

Korsakoff’s Psychosis Assessments

· Memory disturbances with confabulation

· Learning problems

· Altered taste and smell

· Loss of reality testing

Korsakoff’s Psychosis Implementations

· Balanced diet

· Thiamine

· Abstinence from alcohol

Retinopathy of Prematurity Assessment

· Demarcation line with ridge

· Retinal detachment

Retinopathy of Prematurity Implementations

· Prevent by using minimum oxygen concentrations

· Monitor PO2

· Eye exam (premature infants)

Strabismus (cross-eyed) Assessments

· Deviation of eye

· Diplopia

· Tilts head or squints

Corrective lenses Implementations

· Eye exercises

· surgery

Detached Retina Assessments

· Flashes of light

· Loss of vision

· Particles moving in line of vision

· confusion

Detached Retina Implementations

· Bedrest, affected eye in dependent position

· Eye patched (one or both)

· Surgery

· Sedatives and tranquilizers

· Avoid stooping, straining at stool, strenuous activity 3 months

Cataracts Assessments

· Distorted, blurred vision

· Milky white pupil

Cataracts Implementations

· Postop: check for hemorrhage

· Check pupil—constricted with lens implanted, dilated without lens

· Eye drops

· Night shield

· Sleep on unaffected side

Glaucoma Assessments

· Abnormal increase in intraocular pressure that leads to blindness

· Blurred vision

· Lights with halos

· Decreased peripheral vision

· Pain

· Headache

Glaucoma Implementations

· Administer miotics (constrict pupil, allows more area for aqueous humor to flow), carbonic anhydrase inhibitors

· Surgery

· Avoid heavy lifting, straining of stool

· Mydriatics (dilates pupil, makes angle smaller and constrict aqueous flow) are contraindicated with glaucoma.

Trigeminal Neuralgia Assessments

· Stabbing, burning facial pain

· Twitching of facial muscles

Trigeminal Neuralgia Implementations

· Medications—analgesics, Tegretol

· Surgery

Bell’s Palsy Assessments

· Inability to close eye

· Increased lacrimation

· Distorted side of face

Bell’s Palsy Implementations

· Isometric exercises for face

· Prevent corneal abrasions

Guillain-Barre Syndrome Assessments

· Paresthesia

· Motor losses beginning in lower extremities

· Altered autonomic function

· Classic symptoms are respiratory failure, flaccid paralysis and urinary retention d/t loss of sensation

Guillain-Barre Syndrome Implementations

· Medications—steroids

· Aggressive respiratory care

· Physical therapy

· Eye care

· Prevent complications: respiratory and aspiration

Meningitis Assessments

· Nuchal rigidity

· Kerning’s sign

· Brudzinski’s sign

· Seizures

· Bulging fontanels

· High-pitched cry

Meningitis Implementations

· Medications—antibiotics, antifungals

· Prevent complications: droplet precautions, contagious

Thoracentesis: no more than 1000cc taken at one time.

Electroencephalogram (EEG)


· Test brains waves; seizure disorders

· Tranquilizer and stimulant meds withheld for 24-48 hours

· Stimulants (caffeine, cigarettes) withheld for 24 hours

· May be asked to hyperventilate during test

· Meals not withheld

· Kept awake night before test; want them to lie still

Electroencephalogram (EEG)


· Remove paste from hair

· Administer medications withheld before test

· Observe for seizure activity

· Seizure prodromal signs; epigastric distress, lights before the eyes

CAT Scan—dye gives flushed, warm face and metallic taste during injection (if contrast dye is used)

Myelogram: Post-test

· Supine 8-24 hours (Pantopaque oil-based dye used)

· Head raised 30-45degrees 8-16 hours(metrizamide water-soluble dye used)

Liver Biopsy Preparation

· Administer vitamin K IM (decrease risk of hemorrhage)

· NPO 6 hours

· Given sedative

· Position supine, lateral with upper arms elevated

· Asked to hold breath for 5-10 seconds

Liver Biopsy Post-Test

· Position on operative side for 1-2 hours

· Gradually elevate head of bed 30 degrees (1st hour) and then 45 degrees (2nd 2 hours)

· Bedrest for 24 hours

· Check Vital signs

· Check clotting time, platelets, hematocrit

· Report severe abdominal pain


GI Series Barium Swallow: stool white from barium

Tracheostomy Tube Cuff

·Purpose—prevents aspiration of fluids


o During continuous mechanical ventilation

o During and after eating

o During and 1 hour after tube feeding

o When patient cannot handle oral secretions

Oxygen Administration: assess patency of nostril, apply jelly

· Face mask: 5-10 l/min (40-60%)

· Partial rebreather mask: 6-15 l/min (70-90%); keep reservoir bag 2/3 full during inspiration

· Non-rebreather mask: (60-100%); keep reservoir bag 2/3 full during inspiration

· Venturi mask: 4-10 l/min (20-50%); provides high humidity and fixed concentrations, keep tubing free of kinks

· Tracheostomy collar or T-piece: (20-100%); assess for fine mist; empty condensation from tubing’ keep water container full

·Croupette or oxygen tent:

o Difficulty to measure amount of oxygen delivered

o Provides cooled, humidified air

o Check oxygen concentration with oxygen analyzer q4 hours

o Clean humidity jar and fill with distilled water daily

o Cover patient with light blanket and cap for head

o Raise side rails completely

o Change linen frequently

o Monitor patient’s temperature

Chest Tubes Implementations

· Use to utilize negative pressure in lungs

· Fill water-seal chamber with sterile water to 2 cm

· Fill suction control chamber with sterile water to 20 cm

· Maintain system below level of insertion

· Clamp only momentarily to check for air leaks

· Ok to milk tubing towards drainage

· Observe for fluctuation in water-seal chamber

· Encourage patient to change position frequently

Chest Tube Removal:

· Instruct patient to do valsalva maneuver

· Clamp chest tube

· Remove quickly

· Occlusive dressing applied

Complications of Chest Tubes:

· Constant bubbling in water-seal chamber=air leak

· Tube becomes dislodged from patient, apply dressing tented on one side

· Tube becomes disconnected from drainage system, cut off contaminated tip, insert sterile connector and reinsert

· Tube becomes disconnected from drainage system, immerse end in 2 cm of sterile water

CVP: measures blood volume and efficiency of cardiac work; tells us right side of heart able to manage fluid

· “0” on mamometer at level of right atrium at midaxilliary line

· Measure with patient flat in bed

· Open stopcock and fill manometer to 18-20 cm

· Turn stopcock, fluid goes to patient

· Level of fluid fluctuates with respirations

· Measure at highest level of fluctuation

· After insertion

o Dry, sterile dressing

o Change dressing, IV fluids, manometer, tubing q24 hours

o Instruct patient to hold breath when inserted, withdrawn, tubing changed

o Check and secure all connections

· Normal reading—3-11 cm water

· Elevatedà>11, indicates hypervolemia or poor cardiac contractility (slow down IV, notify physician)

· Loweredà<3,>

· Chest tray at bedside

Eye irrigation: tilt head back and toward affected side

Eye drops: drop in center of conjunctival sac; prevent systemic absorption, press on inner angle of eye; don’t allow drops to go from one eye to the other; don’t squeeze eyes

Nasogastric Tubes:

· Levin-single—single-lumen, used for decompression or tube feeding

· Salem sump—double-lumen, used for decompression or tube feeding

· Sengstaken-Blakemore—triple-lumen, used for bleeding esophageal varices

· Linton-Nachlas—4-lumen, used for bleeding esophageal varices

· Keofeed/Dobhoff—soft silicone, used for long-term feedings

· Cantor—single lumen with mercury-filled balloon and suction port

· Miller-Abbott—double-lumen with mercury-filled balloon and suction port

· Harris—single lumen with mercury-filled balloon and suction port

NG tube placement:

BEST WAY” to check is to aspirate for gastric contents and check for pH of aspirate <4

Implementation of feeding:

· Check residual before intermittent feeding, reinstall residual

· Check residual Q4 hours with continuous feeding, reinstall residual

· Hold feeding if >50% residual from previous hour (adults) or >25% (children)

· Flush tube with water before and after feeding

· Use pump to control rate of tube feeding

· Administer fluid at room temperature

· Change bag Q8 hours for continuous feeding

· Elevate head of bed while feeding is running

· Check patency Q4 hours

· Good mouth care

NG Irrigation Tubing:

· Verify placement of tube

· Insert 30-50 cc of normal saline into tube

· If feel resistance, change patient position, check for kinks

· Withdraw solution or record amount as input

NG removal:

· Clamp tube

· Remove tape

· Instruct patient to exhale

· Remove tube with smooth, continuous pull

Intestinal Tubes (Cantor, Mill-Abbott, Harris)

· Implementations

o After tube is in stomach, have patient lie on right side, then back in Fowler’s position, then left side

o Gravity helps to position tube

o Coil excess tube loosely on bed, do not tape

o Position of tube verified by x-ray

o Measure drainage QShift

· Removal

o Clamp tube

o Remove tape

o Deflate balloon or aspirate contents of intestinal tube balloon

o Instruct patient to exhale

o Remove 6” every 10 min. until reaches the stomach, then remove completely with smooth, continuous pull

T-Tube: 500-1000 cc/day, bloody first 2 hours

Penrose: expect drainage on dressing

Enema Implementation

· Position on left side

· Use tepid solution

· Hold irrigation set no more than 18” above rectum

· Insert tube no more than 4”

· Do not use if abdominal pain, nausea, vomiting, suspected appendicitis

Catheter insertion: 2-3” into urethra then 1” after urine flows

Male catheter: insert 6-7”

Catheter Urine Drainage bag: do not remove more than 700 cc at one time, clamp prior to removal

Ileostomy: post-op has loose, dark green, liquid drainage from stoma

Tonsillectomy: post-op frequently swallowing indicates hemorrhage

External contact lenses: need fine motor movements (rheumatoid arthritis prevents this).

Object in eye: never remove visible glass; apply loose cover and remain quiet.

Retina detached: sleep prone with affected side down; avoid jarring movements; avoid pin point movement with eye (sewing); high fluid and roughage (prevents constipation=no straining); make light sufficient for needs (75watt+); no hairwashing

Glaucoma medications: Epinephrine hydrochloride (Adrenalin Chloride) and Pilocarpine Hydrochloride (Pilocar): give Pilocar (therapeutic) first then wait 2-10minutes and instill adrenalin to increase absorption of adrenalin).

Tympanoplasty: remain in bed 24 hours position flat in bed with the affected ear up (helps to promote insertion).

Triglycerides elevation can falsely elevate glycosalated hemoglobin test.

Laparoscopic Cholecystectomy post: encourage to walk to eliminate acute right shoulder pain.

Impetigo: 2 year old; honey-colored crusts, vesicles, and reddish macules around mouth; don’t need to isolate; watch contact precautions.

Only patient we use distractions on the NCLEX are manic patients and toddlers not for pain.

Rhinoplasty (nose surgery) position post-op: want to promote drainage of oral secretions is to position on her right side.

1 cup= 240cc

Pregnancy is a contraindication to an MRI.

Raynaud’s disease have decreased vascularity in the extremities.

Post-Parecentesis most important assessment is to obtain the blood pressure, weight the client, measure the client’s abdominal girth, and check dressing in that order.

Tracheostomy tube: use pre-cut/pre-made gauze pads.

Suction is always intermittent never continuous.

O universal donor/AB universal recipient.


Blood Type

Can Receive from:

Can donate to:













Autologous Transfusion:

· Collected 4-6 weeks before surgery

· Contraindicated—infection, chronic disease, cerebrovascular or cardiovascular


Hypotonic Solution

· ½ NS (0.45% Saline)

Isotonic Solution

· 0.9% NaCl (Normal Saline)

· 5% D/W (Dextrose in Water)

· Lactated Ringer’s

· 5% D/ ¼ NS (5% Dextrose in 0.225% Saline )

Hypertonic Solution

· 10% D/W (10% Dextrose in water)

· D15W

· 5% D/NS (5% Dextrose in 0.9% Saline)

· 5% D/ ½ NS (5% Dextrose in 0.45% Saline)

· 3% NaCl

· 5% Sodium Bicarbonate

Change tubing Q72 hours

Change bottle Q24 hours


· Assessment: cool skin, swelling, pain, decrease in flow rate

· Implementation: discontinue IV, warm compresses, elevate arm, start new site proximal to infiltrated site

IV Phlebitis, Thrmobophlebitis

· Assessment—redness, warm, tender, swelling, leukocytosis

· Implementation—discontinue IV, warm moist compresses, start IV in opposite extremity


· Assessment—ecchymosis, swelling, leakage of blood

· Implementation—discontinue IV, apply pressure, ice bag 24 hours, restart IV in opposite extremity

IV Clotting

· Assessment—decreased flow rate, back flow of blood into tubing

· Implementation—discontinue, do not irrigate, do not milk, do not increase rate of flow or hang solution higher, do not aspirate cannula, inject Urokinase, D/C and start on other site.

Insertion of Percutaneous Central Catheters:

· Placed supine in head-low position

· Turn head away from procedure

· Perform Valsalva maneuver

· Antibiotic ointment and transparent sterile dressing

· Verify position with x-ray

· Change tubing Q24 hours

· Nurse/patient both wear mask when dressing change 2-3x/week



· Stimulate the sympathetic nervous system: increase in peripheral resistance, increase blood flow to heart, bronchodilation, increase blood flow to skeletal muscle, increase blood flow to uterus

· Stimulate beta-2 receptors in lungs

· Use for cardiac arrest and COPD

Adrenergic Medications

· Levophed

· Dopamine

· Adrenalin

· Dobutrex

Adrenergics Side effects:

· Dysrhythmias

· Tremors

· Anticholinergic effects

Adrenergics Nursing Considerations:

· Monitor BP

· Monitor peripheral pulses

· Check output



· Affect neurotransmitters

Used for:

· Anxiety disorders, manic episodes, panic attacks



· Librium, Xanax, Ativan, Vistaril, Equanil


Side effects:

· Sedation

· Confusion

· Hepatic dysfunction


Nursing Considerations:

· Potention for addiction/overdose

· Avoid alcohol

· Monitor Liver Function AST/ALT

· Don’t discontinue abruptly, wean off

· Smoking/caffeine decreases effectiveness



· Neutralize gastric acids

Used for:

· Peptic ulcer

· Indigestion, reflex esophagitis

Antacids Medications

· Amphojel

· Milk of Magnesia

· Maalox


Side effects:

· Constipation

· Diarrhea

· Acid rebound


Nursing Considerations:

· Interferes with absorption of antibiotics, iron preps, INH, Oral contraceptives

· Monitor bowel function

· Give 1-2 hours after other medications

· 1-3 hours after meals and at HS

· Take with fluids



· Interfere with electrical excitability of heart

Used for:

· Atrial fibrillation and flutter

· Tachycardia

· PVCs



· Atropine sulfate

· Lidocaine

· Pronestyl

· Quinidine

· Isuprel


Side effects:

· Lightheadedness

· Hypotension

· Urinary retention


Nursing Considerations:

· Monitor vital signs

· Monitor cardiac rhythm

Aminoglycosides (Antibiotics)


· Inhibits protein synthesis in gram-negative bacteria

Used for:

· Pseudomonas, E.Coli

Aminoglycosides (Antibiotics)


· Gentamycin

· Neomycin

· Streptomycin

· Tobramycin

Aminoglycosides (Antibiotics)

Side effects:

· Ototoxicity and Nephrotoxicity

· Anorexia

· Nausea

· Vomiting

· Diarrhea

Aminoglycosides (Antibiotics)

Nursing Considerations:

· Harmful to liver and kidneys

· Check 8th cranial nerve (hearing)

· Check renal function

· Take for 7-10 days

· Encourage fluids

· Check peak/trough level

Allergy: 1st symptom SOB

Cephalosporins (Antibiotics)


· Inhibits synthesis of bacterial cell wall

Used for:

· Tonsillitis, otitis media, peri-operative prophylaxis

· Meningitis

Cephalosporins (Antibiotics)


· Ceclor

· Ancef

· Keflex

· Rocephin

· Cefoxitin

Cephalosporins (Antibiotics)

Side effects:

· Bone marrow depression: caution with anemic, thrombocytopenic patients

· Superinfections

· Rash

Nursing Considerations:

· Take with food

· Cross allergy with PCN

· Avoid alcohol

· Obtain C&S before first dose: to make sure medication is effective against disease/bacteria

· Can cause false-positive for proteinuria/glycosuria

Fluoroquinolones (Antibiotics)


· Interferes with DNA replication in gram-negative bacteria

Used for:

· E.Coli, Pseudomonas, S. Aureus




· Cipro



Side effects:

· Diarrhea

· Decreased WBC and Hematocrit

· Elevated liver enzymes (AST, ALT)

· Elevated alkaline phosphatase

Nursing Considerations:

· C&S before starting therapy

· Encourage fluids

· Take 1 hour ac or 2 hour pc (food slows absorption)

· Don’t give with antacids or iron preparation

· Maybe given with other medications (Probenicid: for gout)

Macrolide (Antibiotics)


· Binds to cell membrane and changes protein function

Used for:

· Acute infections

· Acne


· Prophylaxis before dental procedures if allergic to PCN

Macrolide (Antibiotics)


· Erythromycin

· Clindamycin

Macrolide (Antibiotics)

Side effects:

· Diarrhea

· Confusion

· Hepatotoxicity

· Superinfections

Nursing Considerations:

· Take 1hr ac or 2-3 hr pc

· Monitor liver function

· Take with water (no fruit juice)

· May increase effectiveness of: Coumadin and Theophylline (bronchodilator)



· Inhibits synthesis of cell wall

Used for:

· Moderate to severe infections

· Syphilis

· Gonococcal infections

· Lyme disease



· Amoxicillin

· Ampicillin

· Augmentin


Side effects:

· Stomatitis

· Diarrhea

· Allergic reactions

· Renal and Hepatic changes

Nursing Considerations:

· Check for hypersensitivity

· Give 1-2 hr ac or 2-3 hr pc

· Cross allergy with cephalosporins

Sulfonamides (Antibiotics)


· Antagonize essential component of folic acid synthesis

Used for:

· Ulcerative colitis

· Crohn’s disease

· Otitis media

· UTIs

Sulfonamides (Antibiotics)


· Gantrisin

· Bactrim

· Septra

· Azulfidine

Sulfonamides (Antibiotics)

Side effects:

· Peripheral Neuropathy

· Crystalluria

· Photosensitivity

· GI upset

· Stomatitis

Nursing Considerations:

· Take with meals or foods

· Encourage fluids

· Good mouth care

· Antacids will interfere with absorption




· Inhibits protein sythesis

Used for:

· Infections

· Acne

· Prophylaxis for opthalmia neonatorum




· Vibramycin

· Panmycin

Tetracyclines (Antibiotics)

Side effects:

· Discoloration of primary teeth if taken during pregnancy or if child takes at young age

· Glossitis

· Rash

· Phototoxic reactions

Nursing considerations:

· Take 1 hr ac or 2-3 hr pc

· Do not take with antacids, milk, iron

· Note expiration date

· Monitor renal function

· Avoid sunlight


· Medication:

o Furadantin

· Action:

o Anti-infective

· Side effects:

o Asthma attacks

o Diarrhea

· Nursing Considerations:

o Give with food or milk

o Monitor pulmonary status


· Medication

o Mandelamine

· Action:

o Anti-infective

· Side effects:

o Elevated liver enzymes

· Nursing Considerations:

o Give with cranberry juice to acidify urine

o Limit alkaline foods: vegetables, milk, almonds, coconut


· Medication

o Pyridium

· Side effects:

o Headache

o Vertigo

· Action

o Urinary tract analgesic

· Nursing Consideration

o Tell patient urine will be orange



· Inhibits action of acethylcholine and blocks parasympathetic nerves (affects heart, eyes, respiratory tract, GI tract and the bladder)

· Dilates pupil, causes bronchodilation and decreased secretions

· Decrease GI motility secretions

Used for:

· Opthalmic exam

· Motion sickness

· Pre-operative

Anticholinergic Medications:

· Pro-Banthine

· Atropine

· Scopolamine


Side Effects:

· Blurred vision

· Dry mouth

· Urinary retention

· Chage in heart rate

Nursing Consideration:

· Monitor output

· Contraindicated with glaucoma

· Give 30 min ac, hs, or 2hr pc

· Contraindicated: paralytic ileus, BPH



· Blocks conversion of prothrombin to thrombin

Used for:

· Pulmonary embolism

· Venous thrombosis

· Prophylaxis after acute MI



· Heparin

Anticoagulants (Heparin)

Side Effects:

· Hematuria

· Tissue irritation

Nursing Considerations:

· Monitor clotting time or Partial Thromboplastin Time (PTT)

· Normal 20-45 sec

· Therapeutic level 1.5-2.5 times control

· Antagonist—Protamine Sulfate

· Give SC or IV



· Interferes with synthesis of vitamin K-dependent clotting factors

Used for:

· Pulmonary embolism

· Venous thrombosis

· Prophylaxis after acute MI



· Coumadin

Anticoagulant (Coumadin)

Side Effects:

· Hemorrhage, Alopecia

Nursing Considerations:

· Monitor Prothrombin Test (PT)

· Normal 9-12 sec

· Therapeutic level 1.5 times control

· Antagonist—Vitamin K (AquaMEPHYTON)

· Monitor for bleeding

· Give PO



· Decreases flow of calcium and sodium across neuronal membranes

Used for:

· Seizures



· Dilantin

· Luminal

· Depakote

· Tegretol

· Klonopin


Side effects:

· Respiratory depression

· Aplastic anemia

· Gingival hypertrophy

· Ataxia

Nursing Considerations:

· Don’t discontinue abruptly

· Monitor I&O

· Caution with use of medications that lower seizure threshold: MAO inhibitors & anti-psychotics

· Good mouth care

· Take with food

· May turn urine pinkish-red/pinkish-brown