immersion medpass drug cards

doxazosin mesylate (alpha blocker)

order: 4 mg PO daily, hold for SBP < 100

doxazosin indication

BPH (benign prostatic hyperplasia), HTN (hypertension, high blood pressure). It treats BPH by relaxing muscles of the prostate and bladder neck. It treats HTN by relaxing the blood vessels. Mr. Seymour has both these conditions.

doxazosin adverse effects

dizziness, drowsiness, fatigue, and orthostatic hypotension

labs to monitor when giving doxazosin

heart rate (HR), blood pressure (BP), liver function labs (ALT + AST), renal function labs (BUN + creatinine) & CBC.

doxazosin interactions

doxazosin interacts with other antihypertensives. this is important to take into consideration as patient is taking other medications that are treating his hypertension.

what to assess before administering doxazosin

it is important to assess patient’s blood pressure and the labs mentioned previously.

what to assess after administering doxazosin

monitor the patient’s WBC and see if there is any decrease. also monitor neutrophil count and any symptoms of hypotension or dizziness as there is now a risk of falls with patient taking this medication.

patient education for doxazosin

advise the patient to change/rise from positions slowly due to the side effect of orthostatic hypotension. it also may decrease the patients blood pressure (this is the result of the first-dose effect).

furosemide (loop diuretic)

order: 20 mg PO, daily

furosemide indication

treats HTN by reducing fluid overload.

furosemide adverse effects

hypokalemia (low potassium levels), dehydration, dizziness, and orthostatic hypotension.

interactions for furosemide

other diuretics and NSAIDs

what to assess before administering furosemide

blood pressure and potassium (K+) levels.

what to assess after administering furosemide

monitor patient’s blood pressure, hydration status, and potassium levels.

patient education for furosemide

advise patient to rise/change positions slowly because of the risk of orthostatic hypotension. advise patient to take the medication in the morning because if the patient takes it at night, it can lead to increased urination which could interrupt sleep or cause nocturia. there is an increased risk of photosensitivity, so warn patient to wear sunglasses when outside, wear layered clothing, and avoid overall sunlight exposure.

lisinopril (ACE inhibitor)

order: 5 mg PO, daily

lisinopril indication

treats HTN by relaxing blood vessels and DM (diabetes mellitus) by providing kidney protection.

lisinopril adverse effects

dry cough, dizziness, hyperkalemia, and angioedema (swelling in the tissues underneath the skin)

labs to monitor when giving lisinopril

potassium (K+), BUN + creatinine

what to assess before administering lisinopril

BP (hold if SBP < 100) and electrolytes (potassium)

what to assess after administering lisinopril

BP, potassium levels, and renal function (BUN + creatinine)

patient education for lisinopril

advise patients to report any swelling of the lips/tongue, a persistent dry cough, and avoid salty foods or salty substances/substitutes.

metoprolol (beta blocker)

order: 25 mg PO BID, hold for HR < 60 & SBP < 100

metoprolol indication

treats HTN by reducing the cardiac workload.

metoprolol adverse effects

bradycardia (slow heart rate), hypotension (low blood pressure), & fatigue.

labs to monitor when giving metoprolol

monitor patient’s blood pressure and heart rate.

what to asses before administering metoprolol

heart rate (HR), blood pressure (BP), hold if HR < 60 and SBP < 100

what to assess after administering metoprolol

heart rate (HR) + blood pressure (BP)

patient education for metoprolol

warn patient to not stop medication abruptly, the medication may also mask hypoglycemic (low blood sugar) symptoms.

heparin (anticoagulant)

order: 5000 units SQ, q12h

heparin indication

treats & prevents blood clots and post-operative deep vein thrombosis (DVT). it is a blood thinner.

heparin adverse effects

risk of bleeding, heparin-induced thrombocytopenia (low platelet count).

labs to assess when giving heparin

platelets, Hgb/Hct (hemoglobin + hematocrit)

what to assess before administering heparin

platelet count

what to assess after administering heparin

platelet count, along with bleeding & bruising.

patient education for heparin

inform patient to rotate injection sites and to brush teeth gently with soft-britstled toothbrush. they should also use an electric razor when shaving. advise them to report any unusual bleeding.

insulin glargine (lantus + long-acting insulin)

order: 10 units SQ, daily

lantus indication

manages blood sugar levels and is long-acting insulin for diabetics.

lantus adverse effects

hypoglycemia (low glucose/sugar levels in the blood) & lipodystrophy (complete or partial loss of and/or abnormal distribution of adipose tissue)

labs to monitor when giving lantus

look over patient’s blood glucose levels.

what to assess before administering lantus

assess patient’s blood glucose levels.

what to assess after administering lantus

continue monitoring patient’s blood glucose levels.

patient education for lantus

advise patient to monitor their fasting blood glucose levels. instruct them to take their medication at the same time each day, rotate their injection sites. they also need to immediately report symptoms of low blood glucose and DO NOT mix with other insulins.

insulin lispro (humalog, sliding scale, + rapid-acting insulin)

order: per sliding scale before meals & at bedtime.

scale:

BS < 70 — call MD, BS > 350 — call MD

< 140 — 0 units

141 to 200 — 2 units

201 to 249 — 4 units

250 to 299 — 6 units

300 to 350 — 8 units

humalog indications

manages blood sugar levels

humalog adverse effects

hypoglycemia (low glucose/sugar levels in the blood)

labs to monitor when giving humalog

monitor patient’s blood glucose

what to assess before administering humalog

blood glucose, check to ensure meal is available right after administration.

what to assess after administering humalog

continue to monitor patient’s blood glucose levels.

patient education for humalog

remind patient to eat right after administering injection, and warn the patient of signs/symptoms of low blood sugar (shakiness, sweating, fast heartbeat, irritability, sudden hunger, blurred vision, weakness/fatigue).

ceftriaxone (cephalosporin antibiotic)

order: 2 g in 100 mL IVPB, daily

ceftriaxone indication

treats pneumonia

ceftriaxone adverse effects

diarrhea, rash, C, diff, & allergic reactions

labs to monitor when giving ceftriaxone

WBC, BUN + creatinine, and ALT + AST

what to assess before administering ceftriaxone

just look over patient labs

what to assess after administering ceftriaxone

GI symptoms (upset stomach, n/v, any other issues) & WBC count

nursing consideration when administering ceftriaxone

caution with penicillin allergy (how tf am i supposed to do this? idk!)

patient education for ceftriaxone

advise patient to report rash/severe diarrhea

levofloxacin (fluoroquinolone antibiotic)

order: 500 mg in 100 mL IVPB, daily

levofloxacin indication

treats pneumonia

levofloxacin adverse effects

GI upset, tendion rupture, & QT prolongation

labs to monitor when giving levofloxacin

renal function (BUN + creatinine) & WBC.

what to assess before administering levofloxacin

look over patient’s labs.

what to assess after administering levofloxacin

assess patient for any allergic reactions, renal function, and QT interval (ECG).

patient education for levofloxacin

advise patient to avoid antacids/dairy two hours before and after medication is given. tell them to report tendon pain or diarrhea.

potassium chloride

order: 10 mEq/100 mL IVPB, NOWWWWWWWWWW

potassium chloride indication

treats hypokalemia (may be from furosemide)

potassium chloride adverse effects

irritation + arrhythmias (irregular heartbeat).

labs to monitor when giving potassium chloride

potassium (K+)

what to assess before administering potassium chloride

K+ levels

what to assess after administering potassium chloride

monitor patient’s ECG & K+ levels.

nursing consideration for potassium chloride

NEVER IV PUSH! give SLOWLY via IVPB

patient education for potassium chloride

warn patient to report muscle cramps, weakness, and palpitations.

the eight (8) rights of medication administration

1. patient

2. medication

3. dose

4. route

5. time

6. documentation

7. reason

8. response

“With administering this medication, I am confirming that I have the right patient, have the right medication with the right dose, will be administering it through the right route at the right time for the right reason. I will continue to monitor and look after the patient for the right response and also provide the right documentation.”