ATI incorrect stuff?

What’s given for magnesium sulfate toxicity

Calcium gluconate

What should you always have nearby when giving magnesium sulfate by IV

A shot of calcium gluconate

When should you not take/give calcium supplements

• pts with hypercalcemia

• Pts with renal calculi (kidney stones)

• Pts with hypophosphatemia

• Pts with digoxin toxicity

• Pts with ventricular fibrillation

What Electrocardiogram (ECG) reading is specific to hypokalemia

Elevated U wave

What is neuroleptic malignant syndrome

Life threatening medical emergency

Symptoms are high grade fever, blood pressure fluctuations, dysrhythmias, muscle rigidity, diaphoresis, change in level of consciousness (LOC) develops into a coma

When should incident reports be filed

• medication errors

• Procedure/treatment errors

• Equipment related injuries/errors

• Needle stick injuries

• Client falls/injuries

• Visitor/volunteer injuries

• Threats made to clients or staff

• Loss of property (dentures, jewelry, personal wheelchair)

What is nephrotoxicity

High cumulative doses resulting in acute tubular necrosis [ATN - kidney injury] ( shows proteinuria, casts in urine, dilute urine, elevated BUN, elevated creatinine)

What must nurses do when a patient has nephrotoxicity (acute tubular necrosis - ATN - kidney injury)

Monitor I&O, BUN, Creatinine

Report hematuria (blood in urine) & cloudy urine

What should nurses do when a patient has neuroleptic malignant syndrome

• stop antipsychotic medication

• Monitor vital signs

• Apply cooling blankets

• Administer antipyretics

• Increase fluid intake

• Administer diazepam to control anxiety

• Administer dantrolene and bronchi tine to induce muscle relaxation

• Administer medication as prescribed to treat dysrhythmias

• Assist with immediate transfer to intensive care

• Wait 2 weeks before resuming therapy. Consider switching to an atypical agent

What to teach patients about transdermal patches

• apply patches as prescribed to ensure proper dosing

• Wash the skin with soap & water & dry thoroughly before applying new patch

• Place patch on a hairless area and rotate sites to prevent skin irritation

Steps for preventing IV infections

• perform hand hygiene before and after handling IV systems

• Use standard precautions

• Change IV sites according to facility policy (usually every 72 hours)

• Replacement of the IV set depends on type of infusion

• Remove catheters as soon as there’s no clinical need to prevent infections

• Replace catheters when suspecting breaks in surgical aseptic technique (during emergency insertions)

• Use sterile needle/catheter for each insertion attempt

• Avoid writing on IV bags with pens/markers because ink can contaminate solution

• Change tubing immediately for potential contamination

• Do not allow fluids to hang for more than 24 hours unless it’s a closed system (pressure bags for hemodynamic monitoring)

• Wipe all ports with alcohol or antiseptic swab before connecting IV lines or inserting a syringe to prevent the introduction of micro-organisms into the system

• Never disconnect tubing for convenience or to reposition client

Metabolic complications include:

• hyperglycemia

• Hypoglycemia

• Hyperkalemia

• Hypophosphatemia

• Hypocalcemis

• Dehydration (related to hyperomolar diuretics resulting from hyperglycemia)

• Fluid overload (shown through weight gain)

What is isotretinoin

A medication prescribed by dermatologists for severe acne (used only if other meds didn’t work)

Adverse effects of isotretinoin

• dry skin

• Dry mucus membranes

• Dry eyes

• Decreased night vision

• Headaches

• Photosensitivity

• Elevated cholesterol

• Elevated triglycerides

• Depression

• Suicidal ideation

• Violent behaviors

Who is isotretinoin contraindicated in?

It is a teratogenic so women of child bearing by age who are NOT taking oral contraceptives

(Women who take this medication and are of child bearing age must take two forms of contraceptives 1 month before and during treatment and one month following treatment)

What meds decrease the effectiveness of oral contraceptives

• carbamazepine

• Phenobarbital

• Ritonavir

• Rifampin

• St. John Wort

• Antibiotics

• Warfarin

• Oral hypoglycemics

What medications do oral contraceptives increase the effects on

• theophylline

• Imipramine

• Tricyclic

• Antidepressants

• chlordiazepoxide

• Diazepam

Nurses must monitor for indications of toxicity

What reverses muscarinic stimulation

Atropine

What client education would a nurse give for Achilles tendon rupture

• observe for and report pain, swelling, and redness at the Achilles tendon site

• Stop taking ciprofloxacin and avoid exercise until inflammation subsides

Anticholinergic effects

• constipation

• Dry mouth

• Blurred vision

• Photophobia

• Dry eyes

• Tachycardia

• Anhidrosis (body doesn’t sweat - can’t return to homeostasis)

Client education for someone taking anticholinergic

• increase dietary fiber

• Consume 2-3 L/day from beverage or food source

• Sip fluids

• Avoid driving or other activities if vision impaired

What is mannitol

Osmotic diuretic reduces intracranial pressure and intraocular pressure by raising serum osmolality & drawing fluid back into the vascular and extra vascular space

Therapeutic uses of mannitol

• prevent kidney failure in situations like hypovolemic shock and severe hypotension

• Decrease intracranial pressure (ICP) that’s caused by cerebral edema

• Decreases intraocular pressure by drawing ocular fluid into bloodstream

• Promote sodium retention and water excretion in clients who have hyponatremia and fluid volume excess

• Administered for oliguria (lack of urine) phase of acute kidney injury

Complications of mannitol

• heart failure (Dyspnea, weakness, fatigue, distended neck veins, weight gain) STOP MED IMMEDIATELY & notify provider

• pulmonary edema

• Watch for rebound increased intracranial pressure

Nursing actions for a patient who has constipation

• educate client to increase fiber & fluid intake

• Educate client to increase physical activity

• Administer laxative (bisacodyl) to counteract decreased bowel motility or stool softener (docusate sodium) to prevent constipation

• For clients with end stage disorders (cancer or AIDS) administer opioid antagonist (methylnaltrexone) designed to treat severe constipation in opioid dependent clients

What is akathisia

A movement disorder where client cannot sit or stand still (consistently pacing and agitated)

Nursing action for akathisia

• observe for akathisia within 2 months of the initiation of treatment

• Manage effects with beta blockers, benzodiazepine, or anticholinergic medication

What is the first line of treatment for alcohol withdrawal

Benzodiazepines examples:

• Chlordiazepoxide

• Diazepam

• Lorazepam

Intended effects of benzodiazepines

• maintain vital sides within expected limits

• Decrease risk of seizures

• Decrease intensity of withdrawal cravings

• Substitution therapy during alcohol withdrawal

What’s an example of mucosal protectant

Sucralfate the acidity of the stomach will change it into a protective barrier that sticks to the ulcer (sticks up to six hours)

Nursing actions of transdermal patches

• ensure appropriate dose & that patches should not be cut

• Place patch on hairless area of skin

• Rotate sites of patches to prevent irritation

• Remove old patch & wash skin with soap & water & dry thoroughly prior to applying new patch

• Remove patch at night to reduce risk of developing tolerance to nitroglycerin

• Be patch (medication) free for 10-12 hrs/day

What should you always have nearby when administering IV opioids

Nalaxone and resuscitation equipment (must administer slowly over 4-5 min)

Prophylaxis

Taking action to prevent disease or spread of infection

Anti-inflammatory agents that decrease airway inflammation

• corticosteroids: fluticasone, prednisone

• Leukotriene antagonists: montelukast

• Mast cell stabilizers: cromolyn

• Monoclonal antibodies: omaizumab

What is medication reconciliation

Process of nurses identifying the most accurate list of a patients current list of medications (name, dose, route, frequency) also prevents medication error

Surfactant laxatives: docusate sodium

Lower surface tension of stool to allow penetration to water so that’s tool softens and can be passed more easily