Microsoft Word Oxygenation Handouts 2007 Nclex

CV, RESPI, BLOOD DISORDERS
REVIEW MATERIALS
SUPPLEMENTAL

MI Implementation for MI
Chest pain radiating to arms, jaw,
•
neck (which is unrelieved by rest or Thrombolytic therapy-streptokinase, t-PA
•
nitroglycerin) Bedrest
•
Dyspnea Beta-blockers, morphine sulfate, dysrhythmics,
• •
Indigestion anticoagulants
•
Apprehension Do not force fluids (will give heart more to work
• •
with)
Low grade fever
•
Elevated WBC (5-10, ESR, CK-MB,
•
LDH)

ANGINA
Stable Unstable Variant Intractable
Triggered by a Triggered by an Triggered by coronary Chronic and
predictable amount unpredictable amount of artery spasm; the attacks incapacitating and is
of effort or emotion. exertion or emotion and may tend to occur early in the refractory to medical
occur at night; the attacks day and at rest. therapy.
increase in number, duration,
and severity over time.

Defibrillation Cardioversion
• Start CPR first • Elective procedure, Informed Consent
• 1st attempt – 200 joules • Valium IV
• 2nd attempt – 200 to 300 joules • Synchronizer on
• 3rd attempt – 360 joules • 25-360 joules
• Check monitor between shocks for rhythm • Check monitor between rhythm
• PULSE PRESENT = NO
DEFIBRILLATION

Left-Side CHF Right-Side CHF
• Dyspnea, orthopnea • Dependent edema
• Cough • Liver enlargement
• Pulmonary edema • Abdominal pain/Nausea/Bloating
• Weakness/Changes in mental status • Coolness of extremities

CHF Implementations
• Administer digoxin, diuretics
• Low-sodium, low-calorie, low-residue diet
• Oxygen therapy
• Daily weight
• Teach about medications and diet

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o Instruct patient to hold breath when inserted, withdrawn, tubing changed
1 nionoveno@hotmail.com

REVIEW MATERIALS
SUPPLEMENTAL

o Check and secure all connections
• Normal reading—3-11 cm water
• Elevated >11, indicates hypervolemia or poor cardiac contractility (slow down IV, notify physician)
• Lowered <3, hypovolemia
• Chest tray at bedside

Arterial Peripheral Vascular Disease
Assessments
Venous Peripheral Vascular Disease
• Rubor
Assessments
• Cool shiny skin
• Cool, brown skin
• Ulcers
• Edema
• Gangrene
• Normal or decreased pulses
• Intermittent Claudication (pain with
• Positive Homan’s sign
exercise/walking relieved with rest)
• Impaired sensation
• Decreased peripheral pulses
Venous Peripheral Vascular Disease
Arterial Peripheral Vascular Disease
Implementations
Implementations
• Monitor peripheral pulses
• Monitor Peripheral pulses
• Elastic stockings
• Good foot care
• Medications—anticoagulants
• Stop smoking
• Elevate legs
• Regular exercise
• Warm, moist packs
• Medications—vasodilators, anticoagulants
• Bedrest 4-7 days (acute phase)

Autologous Transfusion:
ABO BLOOD TYPE COMPATIBILITY
Blood Can Receive Can donate • Collected 4-6 weeks before surgery
Type from: to: • Contraindicated—infection, chronic disease,
O O O,A,B,AB cerebrovascular or cardiovascular
A A,O A,AB disease
B B,O B,AB
AB O,A,B,AB AB

Anaphylaxis o May repeat in 15-20 min.
Delayed Allergic Reaction
• Symptoms
o Hives • Symptoms:
o Rash o Rash, Hives, Swollen Joints
o Difficulty breathing (first sign) • Nursing Care
o Diaphoresis o Discontinue medication
• Nursing care o Topical Antihistamines
o Epinephrine 0.3 ml of 1:1000 solution o Corticosteroids
SQ o Comfort measures
o Massage site
o

Anemia Assessments (reduction in hemoglobin Anemia Implementations
amount/erythrocytes) • Identify cause
• Palpitations • Frequent rest periods
• Dyspnea • High protein, high iron, high vitamin diet
• Diaphoresis • Protect from infection
• Chronic fatigue
• Sensitivity to cold

REVIEW MATERIALS
SUPPLEMENTAL

Iron Deficiency Anemia Assessments Iron Deficiency Anemia Implementations
• Fatigue • Increase iron-rich foods (liver, green leafy
vegetables)
• Glossitis
• Iron supplements (stains teeth)
• Spoon fingernails
• Impaired cognition

Pernicious Anemia Assessments (gastric mucosa Pernicious Anemia Assessments
fail to secrete enough intrinsic factor for stomach to • Vitamin B12—IM
absorb) • Rest of life can’t be absorbed PO
• Schilling’s Test
• Fatigue, Paresthesia in hands and feet
• Sore, red tongue

Sickle Cell Anemia Assessments Sickle Cell Anemia Implementations
• Pain /Swelling/Fever • Check for signs of infection (prevent crisis)
• Scleral jaundiced • Check joint areas for pain and swelling
• Cardiac murmurs • Encourage fluids
• Tachycardia • Provide analgesics with PCA pump c crisis

Hemophilia Assessments (female to male Hemophilia Implementations
gene transmission) • Administer plasma or factor VIII
• Easy bruising • Analgesics
• Joint pain • Cryoprecipitated antihemophilic factor (AHF)
• Prolonged bleeding • Teach about lifestyle changes
• Non contact sports

Leukemia Assessments Leukemia Implementations
• Ulcerations of mouth • Monitor for signs of bleeding: petechiae,
ecchymosis, thrombocytopenia
• Anemia
• Infections
• Fatigue
• Neutropenia (private room/limit # people, wbc
• Weakness
done daily, no fruit, no flowers/plotted plants,
• Pallor
clean toothbrush with weak bleach solution
• Good mouth care
• High calorie, high Vitamin diet (avoid salads/raw
fruit/pepper/don’t reuse cup/don’t change litter
box/digging in garden

Acyanotic Congenital Heart Anomalies Cyanotic Congenital Heart Anomalies Assessments
Assessments • Cyanosis
• Normal Color • Clubbing of fingers
• Possible exercise intolerance • Seizures
• Small stature • Marked exercise intolerance
• Failure to thrive • Difficulty eating
• Heart murmur • Squat to decrease respiratory distress
• Frequent respiratory Infections • Small stature
• Failure to thrive
• Characteristic murmur
• Frequent respiratory infections


REVIEW MATERIALS
SUPPLEMENTAL

Acyanotic Congenital Heart Anomalies Types:
• Ventricular Septal Defect (VSD)—abnormal opening between right/left ventricles; hole size of
pinhole or absence of septum; hear a loud harsh murmur, at age of 3 hole may close otherwise
surgery such as purse-string suture

Atrial Septal Defect (ASD)—abnormal opening between the two atria; audible murmur (if
•
defect is severe closure is done later in childhood)

Patent Ductus Arteriosis (PDA)—failure of fetal structure to close after birth; ductus
•
areteriosis in the fetus connects the pulmonary artery to aorta to shunt oxygenenated blood from
the placenta to systemic circulation (which bypasses the lungs). Once the child is born that
structure should close because it is no longer needed because blood passes through to lungs;
vascular congestion, right ventricular hypertrophy; murmur, bounding pulse, tachycardia; surgical
to divide or ligate the vessel.

Coarctation of the Aorta—narrow of aorta; high blood pressure and bounding pulse in areas
•
that receive blood proximal to the defect. Weak and absent blood distal to aorta. Surgical end-
to-end anastomosis.

Pulomonic Stenosis—narrowing at entrance to pulmonary artery; causes resistance to blood
•
flow and right ventricular hypertrophy; surgery

Aortic Stenosis—narrowing of aortic valve; causes decrease cardiac output; surgery
•

Congenital Heart Anomalies Compensatory Mechanisms
• Tachycardia
• Polycythemia (increase formation of RBC’s)
• Posturing—squatting, knee-chest position

Cyanotic Congenital Heart Anomalies Types:
• Tetralogy of Fallot—VSD, pulmonic stenosis, overriding aorta, right ventricular hypertrophy; squats/knee
chest position to help breath; surgery needed

Transposition of great vessels—pulmonary artery leaves left ventricle and aorta leaves right ventricle;
•
oxygenated blood not going into systemic circulation

Truncus arteriosus—failure of normal septation and embryonic division of the pulmonary artery and
•
aorta; rather than two distinctly different vessels there is a single vessel that overrides both ventricles and
gives rise to both pulmonary and systemic circulation; blood enters from both common artery and either
goes to the lungs or to the body; cyanosis, murmur, difficult intolerance
Total anomalous venous return—absence of direct communication between pulmonary veins and left
•
atria; pulmonary veins attach directly to right atria or drains to right atria

Congenital Heart Anomalies Compensatory Medications—digoxin, iron, diuretics,
•
Mechanisms potassium
• Tachycardia Change feeding pattern
•
• Polycythemia (increase formation of RBC’s)
• Posturing—squatting, knee-chest position

Congenital Heart Anomalies Implementations
• Prevention
• Recognize early symptoms
• Monitor vital signs and heart rhythms

REVIEW MATERIALS
SUPPLEMENTAL

i. second right
ii. intercostal space - aortic area
iii. second left intercostal space - pulmonic area
iv. third left intercostal space - Erb's point
v. fourth left intercostal space - tricuspid area
vi. fifth left intercostal space - mitral (apical) area
vii. epigastric area at tip of sternum

Range of Normal Blood Pressure

i. child under age two weighing at least 2700g: use flush
technique,30-60mg Hg
ii. child over age two: 85-95/50-65 mm Hg
iii. school age: 100-110/50-65 mm Hg
iv. adolescent: 110-120/65-85 mm Hg
v. adult: <130 mm Hg Systolic / <85 mm Hg diastolic

Normal Range of Peripheral Pulses

infants: 120 to 160 beats/minutes
•
toddlers: 90 to 140 beats/minutes
•
preschool/school-age: 75 to 110 beats/ minute
•
adolescent/adult: 60 to 100 beats/minute
•

Normal Rates of Respirations

newborn: 35 to 40 breaths/minute
•
infant: 30 to 50 breaths/minute
•
toddler: 25 to 35 breaths/minute
•
school age: 20 to 30 breaths/minute
•
adolescent/adult: 14 to 20 breaths/minute
•
adult: 12 to 20 breaths/minute
•


REVIEW MATERIALS
SUPPLEMENTAL

AIR EMBOLISM POSITIONING: Place the client on the left side in the trendelenburg
position. Lying on the left side may prevent air from flowing into the pulmonary veins. The
trendelenburg position increases intrathoracic pressure, which decreases the amount of
blood pulled into the vena cava during inspiration.

Hypovolemic Cardiogenic Distributive
Decreased in intravascular Decreased cardiac Problem with blood flow to
volume output cells

Shock Signs and Symptoms
• Cool, clammy skin
• Cyanosis
• Decreased alertness
• Tachycardia
• Hypotension
• Shallow, rapid respirations
• Oliguria

Implementation for shock
• Monitor CVP: <3 inadequate fluid >11 too much fluid

Electroencephalogram (EEG) Electroencephalogram (EEG)
Preparation Post-test
• Test brains waves; seizure disorders • Remove paste from hair
• Tranquilizer and stimulant meds • Administer medications withheld before test
withheld for 24-48 hours • Observe for seizure activity
• Stimulants (caffeine, cigarettes) withheld • Seizure prodromal signs; epigastric distress,
for 24 hours lights before the eyes
• May be asked to hyperventilate during
test
• Meals not withheld
• Kept awake night before test; want them
to lie still


REVIEW MATERIALS
SUPPLEMENTAL

Hyperkalemia on Electrocardiogram: Tall, peaked T
waves; prolonged PR interval; widening QRS complex

Hypokalemia on Electrocardiogram: ST segment
depression; Flat T wave

First-Degree Heart Block: Prolonged P-R interval

Bundle Branch Block: Widened QRS complex

Myocardial Necrosis in Area: Q waves present

Ventricular Fibrillation: No visible P waves or QRS
complexes, no measurable rate. Irregular, chaotic
undulations of varying amplitudes.

HypoCalcemia: Prolonged Q-T interval

Myocardial Ischemia: ST segment elevation or
depression

Premature Ventricular Contractions: absence of P waves,
wide and bizarre QRS complexes, and premature beats
followed by a compensatory pause

Ventricular Tachycardia: absence of P waves, wide QRS
complexes, rate between 100 and 250 impulses per
minute. Regular rhythm

Atrial Fibrillation: no P waves; instead there are wavy
lines, no PR interval. QRS duration is WNL and
irregular ventricular rate can range from 60-160
beats/minute.

Hypokalemia Assessments Hypokalemia Implementations
• K+ < 3.5 mEq/L • Potassium Supplements
• Muscle weakness • Don’t give > 40 mEq/L into peripheral IV
or without cardiac monitor
• Paresthesias
• Increase dietary intake – oranges, apricots,
• Dysrhythmias
beans, potatoes, carrots, celery, raisins
• Increased sensitivity to digitalis


REVIEW MATERIALS
SUPPLEMENTAL

Hypercalcemia Assessments Hypercalcemia Implementations
• Ca+> 5.2 mEq/L • 0.4% NaCl or 0.9% NaCl IV
• Sedative effects on CNS • Encourage fluids (acidic drinks: cranberry
juice)
• Muscle weakness, lack of
coordination • Diuretics
• Constipation, abdominal pain • Calcitonin
• Depressed deep tendon reflexes • Mobilize patient
• Dysrhythmias • Surgery for hyperparathyroidism

Hypomagnesemia Assessments Hypomagnesemia Implementations
Mg+< 1.5 mEq/L Monitor cardiac rhythm and reflexes
Neuromuscular irritability Test ability to swallow
Tremors Seizure precautions
Seizures Increase oral intake—green vegetables, nuts,
bananas, oranges, peanut butter, chocolate
Tetany
Confusion
Dysphagia

Flail Chest Sucking Chest Wound Pneumothorax Implementation
Affected side (Sucking Open Collapse of lung due to Monitor for shock
goes down during Pneumothorax) alteration of air in intrapleural Humidified
inspiration and space oxygen
• Sucking sound
up during Thoracentesis
with respiration • Dyspnea
expiration (aspiration of fluid
• Pain • Pleuritic pain
from pleural
• Decreased • Restricted movement
space)
breath sounds on affected side
Chest Tubes
• Anxiety • Decreased/absent
breath sounds
• Cough
• Hypotension

COPD Assessments COPD Implementations
• “Blue Bloaters” • Assess airway clearance
• “Pink Puffers” • Listen to breath sounds
• Weakness • Administer low-flow oxygen (1-2 L, not too
much because your trying to prevent CO2
• Change in postured day and hs
narcosis)
(don’t sleep laying down, have to
stay erect) • Encourage fluids
• Use of accessory muscles of • Small frequent feedings
breathing • Use metered dose inhalers (MDI)
• Dyspnea
• Cough


REVIEW MATERIALS
SUPPLEMENTAL

Adventitious breath sounds
•

Pneumonia Pneumonia Implementations
Assessments • Check breath sounds
• Fever • Cough and deep breath q 2 hours
• Leukocytosis • Chest physiotherapy
• Productive • Antibiotics
Cough (rust, • Incentive spirometer
green, yellow) • Encourage fluids
• Dyspnea • Suction PRN
• Pleuritic pain • Provide oxygen
• Tachycardia • Semi-Fowler’s position
• Bedrest
• Medications—mucolytics (Mucomyst), expectorants (Robitussin),
Bronchodilators (Aminophylline), Antibiotics (Bacterim)

Chest Tubes Chest Tube Removal: Complications of Chest Tubes:
Implementations • Instruct patient to • Constant bubbling in water-seal
• Use to utilize negative do valsalva chamber=air leak
pressure in lungs maneuver • Tube becomes dislodged from
• Fill water-seal chamber • Clamp chest tube patient, apply dressing tented on one
with sterile water to 2 cm side
• Remove quickly
• Fill suction control • Tube becomes disconnected from
• Occlusive dressing
chamber with sterile water drainage system, cut off contaminated
applied
to 20 cm tip, insert sterile connector and
reinsert
• Maintain system below
level of insertion • Tube becomes disconnected from
drainage system, immerse end in 2 cm
• Clamp only momentarily
of sterile water
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 Tubes
Fill water-seal chamber with sterile water to 2 cm (middle chamber)
Fill suction control chamber with sterile water to 20 cm (chamber all the way to the
right)
Air-leak if bubbling in water-seal chamber (middle chamber)
Obstruction: “milk” tube in direction of drainage


REVIEW MATERIALS
SUPPLEMENTAL

Removal o chest tube: pt. does valsalva maneuver, clamp chest tube, remove quickly,
apply occlusive dressing
Dislodged: apply tented dressing
Tube becomes disconnected from drainage system, cut off contaminated tip, insert
sterile connector and reinsert
Tube becomes disconnected from drainage system, immerse in 2cm of water
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

Tracheostomy Tube Cuff
Prevents aspiration of fluids/separates upper and lower airways
Inflated during continuous mechanical ventilation
Inflated during and after eating
Inflated during and 1 hour after tube feeding
Inflated when patient cannot handle oral secretions

NCLEX-RN exam is a “here and now” test; take care of problem now to prevent
•
harm to client.
Do not ask “why” on the licensure exam
•
Morphine Sulfate for pancreatitis causes spasms of the sphincter of Oddi;
•
Meperidine is drug of choice.
Normal Intraocular Pressure is 10-21 mm Hg
•
Ecchymosis (faint discoloration) around the umbilicus or in either flank indicates
•
retroperitoneal bleeding

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


REVIEW MATERIALS
SUPPLEMENTAL

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

Clear liquid Full liquid Low-fat cholesterol Sodium High Low-residue
No jam restricted restricted roughage,
No milk Minimize
high fiber
Can eat lean meat No intestinal
No juice No fruit
cheese activity
No white
with pulp No avocado, milk,
No nuts
bread
bacon, egg yolks Buttered
without fiber
butter rice white
processed
food, no
whole wheat
corn bran

High protein diet Renal Low-phenylalanine diet
Restablish anabolism to raise albumin Keeps protein, Prevents brain damage from
levels potassium and imbalance of amino acids
sodium low
Egg, roast beef sandwich, Fats, fruits, jams allowed
No beans, no cereals,
No junk food No meats eggs bread
no citrus fruits

Antiarrhythmics Antiarrhythmics Antiarrhythmics
Action: Medications: Side effects:
• Interfere with electrical excitability • Atropine • Lightheadedness
of heart sulfate • Hypotension
Used for: • Lidocaine • Urinary retention
• Atrial fibrillation and flutter • Pronestyl Antiarrhythmics
• Tachycardia Nursing Considerations:
• Quinidine
• PVCs • Monitor vital signs
• Isuprel
• Monitor cardiac rhythm

Aminoglycosides Aminoglycosides Aminoglycosides (Antibiotics)
(Antibiotics) (Antibiotics) Side effects:
Action: Medications: • Ototoxicity and Nephrotoxicity
• Inhibits protein • Gentamycin • Anorexia
synthesis in gram- • Neomycin • Nausea
negative bacteria • Streptomycin • Vomiting
Used for: • Tobramycin • Diarrhea
• Pseudomonas, E.Coli Aminoglycosides (Antibiotics)
Nursing Considerations:


REVIEW MATERIALS
SUPPLEMENTAL

Harmful to liver and kidneys
•
Check 8th cranial nerve (hearing)
•
Check renal function
•
Take for 7-10 days
•
Encourage fluids
•
Check peak/trough level
•

Cephalosporins (Antibiotics) Cephalosporins Cephalosporins (Antibiotics)
Action: (Antibiotics) Side effects:
Medications:
• Inhibits synthesis of • Bone marrow depression: caution
• Ceclor
bacterial cell wall with anemic, thrombocytopenic
Used for: patients
• Ancef
• Tonsillitis, otitis media, • Superinfections
• Keflex
peri-operative prophylaxis • Rash
• Rocephin
• Meningitis Nursing Considerations:
• Cefoxitin
• 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 Fluoroquinolones Fluroquinolones
(Antibiotics) (Antibiotics) (Antibiotics)
• Interferes with DNA • Cipro • Diarrhea
replication in gram- • Decreased WBC and Hematocrit
negative bacteria • Elevated liver enzymes (AST,
Used for: ALT)
• E.Coli, Pseudomonas, • Elevated alkaline phosphatase
S. Aureus 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)


REVIEW MATERIALS
SUPPLEMENTAL

Macrolide Macrolide (Antibiotics) Macrolide (Antibiotics)
(Antibiotics) Medications: Side effects:
Action: • Erythromycin • Diarrhea
• Binds to cell • Clindamycin • Confusion
membrane and • Hepatotoxicity
changes protein • Superinfections
function Nursing Considerations:
Used for:
• Take 1hr ac or 2-3 hr pc
• Acute infections
• Monitor liver function
• Acne
• Take with water (no fruit juice)
• URI
• May increase effectiveness of:
• Prophylaxis Coumadin and Theophylline
before dental (bronchodilator)
procedures if
allergic to PCN

Penicillin Penicillin Penicillin
• Inhibits synthesis of cell • Amoxicillin • Stomatitis
wall • Ampicillin • Diarrhea
Used for: • Augmentin • Allergic reactions
• Moderate to severe • Renal and Hepatic changes
infections Nursing Considerations:
• Syphilis • Check for hypersensitivity
• Gonococcal infections • Give 1-2 hr ac or 2-3 hr pc
• Lyme disease • Cross allergy with
cephalosporins

Sulfonamides (Antibiotics) Sulfonamides Sulfonamides (Antibiotics)
Action: (Antibiotics) Side effects:
Medications:
• Antagonize essential • Peripheral Neuropathy
• Gantrisin
component of folic • Crystalluria
acid synthesis • Bactrim • Photosensitivity
Used for: • Septra • GI upset
• Ulcerative colitis • Azulfidine • Stomatitis
• Crohn’s disease Nursing Considerations:
• Otitis media • Take with meals or foods
• UTIs • Encourage fluids
• Good mouth care
• Antacids will interfere with
absorption


REVIEW MATERIALS
SUPPLEMENTAL

Tetracyclines TEtracyclines Tetracyclines (Antibiotics)
(Antibiotics) (Antibiotics) Side effects:
Action: Medications: • Discoloration of primary teeth
• Inhibits protein • Vibramycin if taken during pregnancy or if
sythesis child takes at young age
• Panmycin
Used for: • Glossitis
• Infections • Rash
• Acne • Phototoxic reactions
• Prophylaxis for Nursing considerations:
opthalmia • Take 1 hr ac or 2-3 hr pc
neonatorum • Do not take with antacids, milk,
iron
• Note expiration date
• Monitor renal function
• Avoid sunlight

Anticholinergics Anticholinergic Anticholinergic
Action: Medications: Side Effects:
• Inhibits action of • Pro-Banthine • Blurred vision
acethylcholine and blocks • Atropine • Dry mouth
parasympathetic nerves (affects • Scopolamine • Urinary retention
heart, eyes, respiratory tract, GI • Chage in heart rate
tract and the bladder) Nursing Consideration:
• Dilates pupil, causes • Monitor output
bronchodilation and decreased
• Contraindicated with
secretions
glaucoma
• Decrease GI motility
• Give 30 min ac, hs, or
secretions
2hr pc
Used for:
• Contraindicated:
• Opthalmic exam
paralytic ileus, BPH
• Motion sickness
• Pre-operative


REVIEW MATERIALS
SUPPLEMENTAL

Anticoagulants Anticoagulants Anticoagulants (Heparin)
• Blocks conversion of • Heparin • Hematuria
prothrombin to • Tissue irritation
thrombin Nursing Considerations:
Used for: • Monitor clotting time or Partial
• Pulmonary embolism Thromboplastin Time (PTT)
• Venous thrombosis • Normal 20-45 sec
• Prophylaxis after acute • Therapeutic level 1.5-2.5 times
MI control
• Antagonist—Protamine Sulfate
• Give SC or IV

Anticoagulant Anticoagulant Anticoagulant (Coumadin)
Action: Medication: Side Effects:
• Interferes with • Coumadin • Hemorrhage, Alopecia
synthesis of vitamin K- Nursing Considerations:
dependent clotting • Monitor Prothrombin Test (PT)
factors • Normal 9-12 sec
Used for: • Therapeutic level 1.5 times control
• Pulmonary embolism • Antagonist—Vitamin K
• Venous thrombosis (AquaMEPHYTON)
• Prophylaxis after acute • Monitor for bleeding
MI • Give PO

Thrombolytics Thrombolytics Thrombolytics
• Dissolves or lyses blood clots • Streptokinase • Bleeding
Used for: • Urokinase • Bradycardia
• Acute Pulmonary Emboli • Tissue • Dysrhythmias
• Thrombosis Plasminogen Nursing Considerations:
Activator
• MI • Monitor for
bleeding
• Contraindicated in: hemophilia,
CVA, Trauma, not used in patients • Have Amino
over 75 years old, not used in Caproic Acid
patients taking anticoagulants Available
• Check pulse, color,
sensation of
extremities
• Monitor EKG


REVIEW MATERIALS
SUPPLEMENTAL

Antiplatelet Agents Antiplatelet Agents Antiplatelet Agents
• Interferes with • Aspirin • Hemorrhage
platelet aggregation • Persantine • Thrombocytopenia
Used for: Nursing Considerations:
• Venous thrombosis • Check for signs of bleeding
• Pulmonary embolism • Give with food or milk

Antihistamines Antihistamines Antihistamines
• Block effects of • Chlor- • Drowsiness
histamine Trimeton • Dry mouth
Used for: • Benadryl • Photosensitivity
• Allergic rhinitis • Phenergan Nursing Considerations:
• Allergic reactions to • Give with food
blood • Use sunscreen
• Avoid alcohol

Antihyperlipidemic Antihyperlipidemic Antihyperlipidemic Agents
Agents Agents Side Effects:
Action: Medications: • Constipation
• Inhibits • Questran • Fat-soluble vitamin deficiency
cholesterol and • Lipid Nursing Considerations:
triglyceride • Take at hs or 30 min ac
synthesis • Administer 1hr before or 4-6 hr
Used For: after other meds
• Elevated
cholesterol
• Reduce incidence
of cardiovascular
disease

Antihypertensives Antihypertensives Antihypertensives
Types: ACE Inhibitors (ACE Inhibitors) (ACE Inhibitors)
• Blocks ACE in lungs • Capoten • GI upset
Used for: • Vasotec • Orthostatic hypotension
• Hypertension • Dizziness
• CHF Nursing Considerations:
• Give 1hr ac or 3hr pc
• Change position slowly


REVIEW MATERIALS
SUPPLEMENTAL

A1-adrenergic receptors: found in the peripheral arteries and veins and cause a powerful
vasoconstriction when stimulated

A2-adrenergic receptors: several tissues and contract smooth muscle, inhibit lipolysis, and
promote platelet aggregation.

B1: Found in the heart and cause an increase in heart rate, atrioventricular node conduction,
and contractility.

B2: Arterial and bronchial walls and cause vasodilation and bronchodilation.

Type: Beta-Adrenergic Blockers Type: Beta-Adrenergic Type: Beta-Adrenergic
Action: Medications; Side Effects:
• Blocks Beta-Adrenergic • Nadolol • Changes in heart rate
Receptors • Propranolol • Hypotension
• Decrease • Tenormin • Bronchospasm
excitability/workload Nursing Considerations:
• Timoptic
of heart, oxygen • Masks signs of shock and
consumption hypoglycemia
• Decrease • Take with meals
Used for: • Do not discontinue abruptly
• Hypertension
• Angina
• SVT

Type: Calcium Channel Blockers Type: Calcium Channel Type: Calcium Channel
Action: Blockers Blockers
Medications: Side Effects:
• Inhibits movement of calcium
across cell membranes • Procardia • Hypotension
• Slow impulse conduction and • Calan • Dizziness
depresses myocardial contractility • Cardizem • GI distress
• Causes dilation of coronary arteries Nursing Consideration:
and decreases cardiac workload • Monitor vital signs
and energy consumption • Do not chew or
Used for: divide sustained-
• Angina release tablets
• Hypertension
• Interstitial cystitis


REVIEW MATERIALS
SUPPLEMENTAL

Type: Centrally acting Type: Centrally acting alpha- Type: Centrally acting alpha-adrenergics
Side Effects:
alpha-adrenergics adrenergics
Action: Medications: • Sedation
• Stimulates alpha • Aldomet • Orthostatic Hypotension
receptors in • Catapres Nursing Considerations:
medulla which • Don’t discontinue abruptly
causes a • Monitor for fluid retention
reduction in
sympathetic in
the heart
Used for:
• Hypertension

Type: Peripheral-acting alpha-adrenergic Medications: Side Effects:
blockers • Reserpine • Depression
Action: • Orthostatic Hypotension
• Depletes stores of • Brachycardia
norepinephrine in Nursing Considerations:
sympathetic nerve endings • Give with meals or milk
Used for:
• Hypertension

Antipyretic Agents Antipyretic Agents Antipyretic Agents
• Antiprostaglandin • Tylenol • GI irritation
activity in (Acetaminophen Nursing Considerations:
hypothalamus ) • Monitor liver function
Used for: • Aspirin contraindicated for
• Fever younger than 21 years old due to
risk of Reye’s syndrome

Type: Direct-acting Medications Side Effects:
vasodilators • Hydralazine • Tachycardia
Action: • Minoxidil • Increase in body hair
• Relaxes smooth Nursing Considerations:
muscle • Teach patient to check pulse
Used for:
• Hypertension


REVIEW MATERIALS
SUPPLEMENTAL

Antitubercular Agents Antitubercular Agents Antitubercular Agents
• Inhibits cell and • INH • Hepatitis
protein synthesis • Ethambutol • Peripheral Neuritis
• Streptomycin
• Tuberculosis • Check liver function tests
• PAS
• To prevent disease in • Vitamin B6 given for peripheral
• PYZ
person exposed to neuritis (Pyridoxine)
organism • Used in combination

Antivirals Antivirals Antivirals
• Inhibits DNA and • Zovirax • Headache
RNA replication • AZT • Dizziness
Used for: • Videx • GI symptoms
• Recurrent HSV Nursing Considerations:
• Famvir
• HIV infection • Encourage fluids
• Cytovene
• Not a cure, but relieves symptoms

Bronchodilators Bronchodilators Bronchodilators
• Decreases activity of • Aminophylline • Tachcyardia
phosphodiesterase • Atrovent • Dysrhythmias
Used for: • Brethine • Palpitations
• COPD • Proventil • Anticholinergic effects
• Preterm labor Nursing Considerations:
• Primatene
(Terbutaline) • Monitor BP and HR
• When used with steroid inhaler,
use bronchodilator first
• May aggravate diabetes

Cardiac Glycosides Cardiac Glycosides Cardiac Glycosides
Action: Medication: Side Effects:
• Increases force of • Lanoxin • Bradycardia
myocardial (Digoxin) • Nausea
contraction, slows • Vomiting
rate • Visual disturbances
• Left-sided CHF • Take apical pulse
• Notify physician if adult <60,


REVIEW MATERIALS
SUPPLEMENTAL

child <90-110, <70 in older
children
Monitor potassium level
•
Dose: 0.5-1 milligram IV or PO
•
over 24 hr period
Average: 0.25 mg
•

Diuretics Diuretics Diuretics
• Inhibits • HydroDIURIL • Dizziness
reabsorption of • Diamox • Orthostatic Hypotension
sodium and • Aldactone • Leukopenia
water Nursing Considerations:
• Lasix
• Blocks effects • Take with food or milk
• Hygroton
of aldosterone • Take in a.m.
Used for:
• Monitor fluid and electrolytes
• CHF
• Renal disease

Narcotics Narcotics Narcotics
• Acts on CNS • Morphine • Dizziness
receptor cells Sulfate • Sedation
Used for: • Codeine • Respiratory depression
• Moderate to severe • Demerol • Hypotension
pain • Dilaudid • Constipation
• Preoperative • Percodan Nursing Considerations:
• Postoperative • Safety precautions
• Avoid alcohol
• Monitor vital signs
• Use narcotic antagonist if
necessary (Narcan)

Antianginals Antianginals Antianginals
• Relaxes smooth • Nitroglycerine • Hypotension
muscle • Isosorbide • Tachycardia
• Decreases venous • Headache
return • Dizziness
• Angina • Check expiration date
• Peri-operative • Teach when to take


REVIEW MATERIALS
SUPPLEMENTAL

hypertension medication
CHF May take Q5min x3 doses
• •
Wet with saliva and place
•
under tongue

Herbs: Toxicities and Drug Interactions

Chamomile

Uses: Chamomile is often used in the form of a tea as a sedative.

Reactions: Allergic reactions can occur, particularly in persons allergic to ragweed. Reported
reactions include abdominal cramps, tongue thickness, tightness in the throat, swelling of the
lips, throat and eyes, itching all over the body, hives, and blockage of the breathing passages.
Close monitoring is recommended for patients who are taking medications to prevent blood
clotting (anticoagulants) such as warfarin.

Echinacea

Uses: Largely because white blood cells in the laboratory can be stimulated to eat particles,
Echinacea has been touted to be able to boost the body's ability to fight off infection.

Reactions: The most common side effect is an unpleasant taste. Echinacea can cause liver
toxicity. It should be avoided in combination with other medications that can affect the liver
(such as ketaconazole, leflunomide (Arava), methotrexate (Rheumatrex), isoniazide (Nizoral).

St. John's Wort

Uses: St. John's Wort is popularly used as an herbal treatment for depression, anxiety, and
sleep disorders. It is technically known as Hypericum perforatum. Chemically, it is composed
of at least 10 different substances that may produce its effects. The ratios of these different
substances varies from plant to plant (and manufacturer). Studies of its effectiveness by the
National Institutes of Health are in progress.

Reactions: The most common side effect has been sun sensitivity which causes burning of
the skin. It is recommended that fair- skinned persons be particularly careful while in the
sun. St. John's wort may also leave nerve changes in sunburned areas. This herb should be
avoided in combination with other medications that can affect sun sensitivity (such as
tetracycline/Achromycin, sulfa- containing medications, piroxicam (Feldend). St. John's wort
can also cause headaches, dizziness, sweating, and agitation when used in combination with
serotonin reuptake inhibitor medications such as fluoxetine (Prozac) and paroxetine (Paxil).

Garlic


REVIEW MATERIALS
SUPPLEMENTAL

Uses: Garlic has been used to lower blood pressure and cholesterol (Dr. Lucinda Miller
notes that there is quot;...still insufficient evidence to recommend its routine use in clinical
practice.quot;)

Reactions: Allergic reactions, skin inflammation, and stomach upset have been reported. Bad
breath is a notorious accompaniment. Studies in rats have shown decreases in male rats'
ability to make sperm cells. Garlic may decrease normal blood clotting and should be used
with caution in patients taking medications to prevent blood clotting (anticoagulants) such as
warfarin /Coumadin.

Feverfew

Uses: Most commonly used for migraine headaches.

Reactions: Feverfew can cause allergic reactions, especially in persons who are allergic to
chamomile, ragweed, or yarrow. Nonsteroidal anti-inflammatory drugs (NSAIDs such as
ibuprofen (Advil), naproxen (Aleve) or Motrin) can reduce the effect of feverfew. A
condition called quot;postfeverfew syndromequot; features symptoms including headaches,
nervousness, stiffness, joint pain, tiredness, and nervousness. Feverfew can impair the action
of the normal blood clotting element (platelets). It should be avoided in patients taking
medications to prevent blood clotting (anticoagulants) such as warfarin (Coumadin).

Ginko Biloba

Uses: This herb is very popular as a treatment for dementia (a progressive brain dysfunction)
and to improve thinking.

Reactions: Mild stomach upset and headache have been reported. Ginko seems to have
blood thinning properties. Therefore, it is not recommended to be taken with aspirin,
nonsteroidal anti-inflammatory drugs (Advil), naproxen (Aleve) or Motrin), or medications
to prevent blood clotting (anticoagulants) such as warfarin (Coumadin). Ginko should be
avoided in patients with epilepsy taking seizure medicines, such as phenytoin (Dilantin),
carbamazepine (Tegretol), and phenobarbital.

Ginseng

Uses: Ginseng has been used to stimulate the adrenal gland, and thereby increase energy. It
also may have some beneficial effect on reducing blood sugar .in patients with diabetes
mellitus. (Dr. Miller emphasized that there is substantial variation in the chemical
components of substances branded as quot;Ginseng.quot;)

Reactions: Ginseng can cause elevation in blood pressure, headache, vomiting, insomnia, and
nose bleeding. Ginseng can also cause falsely abnormal blood tests for digoxin level. It is
unclear whether ginseng may affect female hormones. Its use in pregnancy is not


REVIEW MATERIALS
SUPPLEMENTAL

recommended. Ginseng may affect the action of the normal blood clotting element
(platelets). It should be avoided in patients taking aspirin, nonsteroidal antiinflammatory
drugs (such as ibuprofen (Advil), naproxen (Aleve) or Motrin), or medications to prevent
blood clotting (anticoagulants) such as warfarin (Coumadin). Ginseng may also cause
headaches, tremors, nervousness, and sleeplessness. It should be avoided in persons with
manic disorder and psychosis.

Ginger

Uses: Ginger has been used as a treatment for nausea and bowel spasms.

Reactions: Ginger may lead to blood thinning. It is not recommended to be taken with
medications that prevent blood clotting (anticoagulants) such as warfarin (Coumadin).

Saw Palmetto

Uses: Saw palmetto has been most commonly used for enlargement of the prostate gland.
(Dr. Miller emphasized that studies verifying this assertion are necessary.) Saw palmetto has
also been touted as a diuretic and urinary antiseptic to prevent bladder infections.

Reactions: This herb may affect the action of the sex hormone testosterone, thereby
reducing sexual drive or performance. Dr. Miller states that quot;While no drug-herb interactions
have been documented to date, it would be prudent to avoid concomitant use with other
hormonal therapies (e.g., estrogen replacement therapy and oral contraceptives...quot;)

Black Cohosh

Claims, Benefits: A natural way to treat menopausal symptoms.
Bottom Line: Little is known about its benefits and its risks.


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