exam 2 meds - nur 236

peds

purpose of acetylsalicylic acid

used to treat pain in JIA and used at high doses in Kawaski disease to prevent blood clotting and treat inflammation

* also used at low dose for 6 months post op cardiac cath for ASD

side effects of aspirin

gastric upset, kidney disfunction, reye's syndrome, increased risk of bleeding, salicyclism (toxicity)

nursing considerations for Aspirin

monitor for bleeding

do not use if child has concurrent viral illness

monitor for GI bleeding

monitor kidney function

give with food

contraindications of aspirin

child with viral illness, bleeding disorders and within 1 week of surgery

symptoms of aspirin toxicity

tinnitus, dizziness, headache, confusion

antidote to

purpose of ibuprofen

used to treat pain related to JIA, mild to moderate pain related to sickle cell disease and other inflammatory disorders

age restriction for aspirin

not recommended in children under 18 except in specific medical conditions when the child does not have a concurrent viral illness

age restriction of ibuprofen

<6 months

side effects of ibuprofen

gastric upset, gi bleeding, thrombotic events and kidney dysfunction

nursing considerations for ibuprofen

monitor kidney and gi function

give with food

contraindications of ibuprofen

gi bleeding and children less than 6 months

purpose of naproxen

used to treat pain related to JIA and other inflammatory disorders

side effects of naproxen

gastric upset, gi bleeding, thrombotic events and kidney dysfunction

side effects of indomethacin

gastric upset, gi bleeding, thrombotic events and kidney dysfunction

purpose of indomethacin

used to treat pain related to JIA and other inflammatory disorders

nursing considerations for naproxen

monitor kidney and gi function

give with food

nursing considerations for indomethacin

monitor kidney and gi function

give with food

contraindication of indomethacin

child less than 14 and gi bleeding

age restriction of indomethacin

<14 years old

age restriction for naproxen

<2 years

contraindication for naproxen

child less than <2 and GI bleeding

purpose of methotrexate

treats JIA

What drug class is ibuprofen

nsaid

what drug class is ASA?

NSAID

what drug class is naproxen?

NSAID

what drug class is indomethacin?

NSAID

side effects of methotrexate

myelosuppression, oral and GI ulcers, liver damage and pulmonary fibrosis

nursing considerations for methotrexate

monitor CBC and LFTs

monitor for bleeding

neutropenic precautions (soft bristle toothbrush, avoid electric razor, etc.)

age restriction for methotrexate

no age restriction

what drug class is prednisone

Corticosteroid

what drag class is methotrexate

disease-modifying anti-rheumatic drugs

purpose of prednisone

decrease inflammation in diseases such as JIA, and DMD as well as decrease autoimmune response in ITP

side effects of prednisone

hyperglycemia, immunosuppression, weight gain, osteoporosis, mood swings,

nursing considerations for prednisone

monitor glucose levels

monitor for signs of infection

monitor for cushing-like effects

advise pt to take adequate calcium and vitamin d

do not give w/ milk

contraindications for prednisone

infection and recent live virus immunization

age restriction for prednisone

there is no age restriction

what drug class is infliximab

biological response modifier

what drug class is adalimumab

biological response modifier (biological therapy)

side effects of infliximab

infusion reactions (flu like, hypotension and anaphylaxis), injection site irritation, headache, SJS syndrome, heart failure, blood abnormalities, BLACK BOX WARNING immunosuppression (increased risk of infection and lymphoma)

nursing considerations for infliximab

given via IV q week, monthly or every few weeks

monitor injection site

monitor CBC

ensure child is up to date on immunizations and advise to avoid live vaccines

contraindications for infliximab

heart failure and children younger than 6

age restriction for infliximab

<6

age restriction for adalimumab

<2 years

side effects of adalimumab

injection site irritation, headache, SJS syndrome, heart failure, blood abnormalities, BLACK BOX WARNING: immunosuppression (increased risk of infection and lymphoma)

nursing considerations of adalimumab

administer via subq q week, monthly or every few weeks

monitor injection site

monitor CBC

ensure child is up to date on immunizations and advise to avoid live vaccines

contraindications for humira

children younger than 2 and heart failure

purpose of digoxin

treats heart failure by increasing efficacy of heart

side effects of digoxin

dysrhythmias, bradycardia, teeth decay (oral use) nausea, vomiting anorexia, fatigue, visual disturbances, and blurred vision

signs and symptoms of digoxin toxicity

early signs: nausea, vomiting, and anorexia

late signs: bradycardia, arrhythmias, blurring vision or rubbing eyes frequently

therapeutic range of digoxin

0.8-2

nursing interventions for digoxin

- take apical pulse for 1 full minute prior to administration

- hold medication if bradycardia (110=infant, 90=toddler/preschooler, 70=school aged, 60=adolescent)

- monitor drug serum levels

- monitor I&O and potassium

- low potassium increases risk of toxicity

- monitor heart rate and rhythm

- direct oral solution to back and side of mouth

- give water after administration

- do not give extra dose, or increase dose if missed - notify provider if missed 2 consecutive doses

- keep medication locker

purpose of digoxin immune fab

antidote for digoxin toxicity

antidote for digoxin toxicity

digoxin immune fab

purpose of furosemide

diuretic used to treat symptoms such as edema caused by heart failure

side effects of furosemide

electrolyte imbalances (hyponatremia, hypokalemia), hypotension, ototoxicity, hyperglycemia, and hyperuricemia

nursing considerations for furosemide

- encourage diet high in potassium (Especially if concurrent use with digoxin)

- monitor I&O

- monitor weights daily

- monitor glucose and uric acid levels

- monitor hearing

- report signs of worsening HF

age restriction for digoxin

no age restriction

age restriction for furosemide

no age restriction

adverse effects of digoxin immune fab

worsening arrhythmias, worsening HF, hypokalemia

nursing considerations for digoxin immune fab

- monitor cardiac functioning and potassium levels closely

- given via IV

purpose of IVIG

used in Kawaski disease to decrease the incidence of coronary aneurysm as well as used in ITP

side effects of IVIG

headache, nausea, diarrhea, injection site reaction, flushing, chest tightness, fever, chills, hypotension

nursing considerations for IVIG

- advise pt to hydrate before and during treatment

- administer within 10 days of kawasaki disease onset

- administer over 1-2 days for ITP

- adminiser viaa IV infusion

- monitor VS and signs of allergic rxn

- avoid live vaccines

age restrictions for IVIG

no age restriction

purpose of prostaglandin (PGE1)

used to reopen the ductus arterious in COA and TOF and promote blood flow to the kidney and legs in COA

side effects of PGE1

fever, seizures, bradycardia, hypokalemia, apnea sepsis

nursing considerations for PGE1

- administer via iV

- monitor respiratory status and BP

purpose of morphine sulfate

used to relieve symptoms r/t hypercyanotic episodes related to TOF as well as severe pain seen in sickle cell disease

side effects of morphine sulfate

respiratory depression, sedation, constipation, nausea, orthostatic hypotension, urinary retenion, dependence

nursing considerations for morphine sulfate

- administer via IV, IM, or subq

- monitor respiratory rates, bowel function, VS

- monitor I&O

- have naloxone on hand in case on overdose

purpose of propanolol

used to relieve symptoms of hypercyanotic spells in TOF

side effects of propanolol

bradycardia, heart failure, rebound excitation, confusion and rauynaud's

nursing considerations for propanlol

- administer via IV

- monitor heart rate and worsening signs of heart failure

age restriction for morphine sulfate

no age restriction

age restriction for propanolol

no age restriction

purpose of penicillin

used as a prophylactic abx to prevent rheumatic fever

side effects of penicillin

nausea, vomiting, diarrhea, super infection, thrush

nursing considerations for penicillin

- given once a month IM for prophylaxis of RF

- if allergy to PCN use erythromycin

- monitor GI effects and signs of allergic rxn

age restriction of penicillin

no age restriction

purpose of ferrous sulfate

used to treat iron deficiency anemia by mouth

side effects of ferrous sulfate

GI upset, constipation, tarry green stools, teeth staining, iron toxicity

nursing considerations for ferrous sulfate

- administered via PO

- dosage is based on amount of elemental iron and will vary depending on severity of anemia

- give 1 hour before or 2 hours after milk, tea or antacid

- if tolerated, give on empty stomach if not tolerated give with meals until the child can tolerate on empty stomach

- can be tapered off once dietary intake can supply needed iron

- can be taken with foods/drinks high in vitamin c to increase absorption

iron dextran/imferon

used to treat iron deficiency by IM injection or IV

nursing considerations on iron dextran/imferon

- can be administered via IV or IM

- use z-track method for deep muscle injections (inject into deltoid or vastus lateralis using 23-25 gauge needle 1-1.25 length)

- do not massage injection site after

- monitor for pain can be painful transfusion

- give 1 hour before or 2 hours after milk, tea or antacid

- can be taken with foods/drinks high in vitamin c to increase absorption

z-track method

1. pull skin to one side

2. inject medication

3. withdraw needle

4. release skin

side effects of iron dextran/imferon

GI upset, constipation, tarry green stools, anaphylaxis, iron toxicity

age restriction of ferrous sulfate

no age restriction

age restriction for iron dextran/imferon

<4 months old

purpose of deferoxamine

used to treat iron toxicity

side effects of deferoxamine

Headache, Upset stomach, Muscle spasm, Irritation where the shot is given.

nursing considerations of deferoxamine

- given parentally to remove excess iron

age restriction of deferoxamine

no age restriction

purpose of hydroxyurea

used to treat and prevent formation of sickle cells

side effects of hydroxyura

nausea, vomiting, and myelosuppression (low wbc and neutropenia)

nursing considerations for hydroxyurea

- administer via po

- monitor for bleeding or signs of infection

- give antiemetic for nausea or vomiting

- monitor nutritional intake

age restriction for hydroxyurea

<6 months

purpose of ketorolac

used to treat mild to moderate pain in sickle cell disease and other inflammatory disorders

nursing considerations for ketorolac

- can be administer via iV but not longer than 5 days

- monitor for pain and kidney function

- can be used with opioids to allow for lower dosages of opioids

side effects of ketorolac

GI upset, impaired kidney function, increased risk of heart attack and stroke