| 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 · CHF · 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) Preparation · 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) Post-test · 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 |
Upper
GI Series Barium Swallow: stool white from barium
Tracheostomy Tube Cuff
·Purpose—prevents aspiration of fluids
·Inflated
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
·
· 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:
“
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.
| ABO BLOOD TYPE COMPATIBILITY | ||
| Blood Type | Can Receive from: | Can donate to: |
| O | O | O,A,B,AB |
| A | A,O | A,AB |
| B | B,O | B,AB |
| AB | O,A,B,AB | AB |
Autologous Transfusion:
· Collected 4-6 weeks before surgery
· Contraindicated—infection, chronic disease, cerebrovascular or cardiovascular
disease
| 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
Infiltration
· 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
Hematoma
· 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
| Adrenergics Actions: · 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 |
| Anti-Anxiety Action: · Affect neurotransmitters Used for: · Anxiety disorders, manic episodes, panic attacks | Anti-Anxiety Medications: · Librium, Xanax, Ativan, Vistaril, Equanil | Anti-Anxiety Side effects: · Sedation · Confusion · Hepatic dysfunction Anti-Anxiety Nursing Considerations: · Potention for addiction/overdose · Avoid alcohol · Monitor Liver Function AST/ALT · Don’t discontinue abruptly, wean off · Smoking/caffeine decreases effectiveness | |
| Antacids Actions: · Neutralize gastric acids Used for: · Peptic ulcer · Indigestion, reflex esophagitis | Antacids Medications · Amphojel · Milk of Magnesia · Maalox | Antacids Side effects: · Constipation · Diarrhea · Acid rebound Antacids 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 | |
| Antiarrhythmics Action: · Interfere with electrical excitability of heart Used for: · Atrial fibrillation and flutter · Tachycardia · PVCs | Antiarrhythmics Medications: · Atropine sulfate · Lidocaine · Pronestyl · Quinidine · Isuprel | Antiarrhythmics Side effects: · Lightheadedness · Hypotension · Urinary retention Antiarrhythmics Nursing Considerations: · Monitor vital signs · Monitor cardiac rhythm |
| Aminoglycosides (Antibiotics) Action: · Inhibits protein synthesis in gram-negative bacteria Used for: · Pseudomonas, E.Coli | Aminoglycosides (Antibiotics) Medications: · 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) Action: · Inhibits synthesis of bacterial cell wall Used for: · Tonsillitis, otitis media, peri-operative prophylaxis · Meningitis | Cephalosporins (Antibiotics) Medications: · 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) Action: · Interferes with DNA replication in gram-negative bacteria Used for: · E.Coli, Pseudomonas, S. Aureus | Fluoroquinolones (Antibiotics) Medications: · Cipro | Fluroquinolones (Antibiotics) 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) Action: · Binds to cell membrane and changes protein function Used for: · Acute infections · Acne · URI · Prophylaxis before dental procedures if allergic to PCN | Macrolide (Antibiotics) Medications: · 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) |
| Penicillin Action: · Inhibits synthesis of cell wall Used for: · Moderate to severe infections · Syphilis · Gonococcal infections · Lyme disease | Penicillin Medications: · Amoxicillin · Ampicillin · Augmentin | Penicillin 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) Action: · Antagonize essential component of folic acid synthesis Used for: · Ulcerative colitis · Crohn’s disease · Otitis media · UTIs | Sulfonamides (Antibiotics) Medications: · 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 |
| Tetracyclines (Antibiotics) Action: · Inhibits protein sythesis Used for: · Infections · Acne · Prophylaxis for opthalmia neonatorum | TEtracyclines (Antibiotics) Medications: · 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 |
UTIs
· 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
UTIs
· 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
UTIs
· Medication
o Pyridium
· Side effects:
o Headache
o Vertigo
· Action
o Urinary tract analgesic
· Nursing Consideration
o Tell patient urine will be orange
| Anticholinergics Action: · 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 | Anticholinergic 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 |
| Anticoagulants Action: · Blocks conversion of prothrombin to thrombin Used for: · Pulmonary embolism · Venous thrombosis · Prophylaxis after acute MI | Anticoagulants Medications: · 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 |
| Anticoagulant Action: · Interferes with synthesis of vitamin K-dependent clotting factors Used for: · Pulmonary embolism · Venous thrombosis · Prophylaxis after acute MI | Anticoagulant Medication: · 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 |
| Anticonvulsants Action: · Decreases flow of calcium and sodium across neuronal membranes Used for: · Seizures | Anticonvulsant Medications: · Dilantin · Luminal · Depakote · Tegretol · Klonopin | Anticonvulsant 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 |
