NPN-109 Final Exam Review

Hyperthyroidism treatment

methimazole, propylthiouracil (preferred in pregnancy)

Radioactive iodine, Beta blockers

Hyperthyroidism

overactivity of the thyroid gland

Hypothyroidism

A disorder caused by a thyroid gland that is slower and less productive than normal; increased tolerance to cold, hair loss, weight gain, fatigue, dry flaky skin

Hypothyroidism treatment

levothyroxine; give early in the morning before breakfast

Risk factors for Type II diabetes

Family history, obesity, sedentary lifestyle, race/ethnicity, HTN, hypercholesterolemia, atherosclerosis, gestational diabetes

Hyperglycemia

excessive sugar in the blood; force fluids

Hypoglycemia

abnormally low level of sugar in the blood; give juice or candy to increase sugar

Antidiabetic Agents

Used to treat diabetes mellitus

2 types: insulin for parenteral use and oral antidiabetics

Monitor patient for hypoglycemic episodes

glucophage

Generic Name: Metformin

Drug Class: Oral Diabetes Medicine

Indication: Controls blood sugar levels (in Type 2 Diabetes as Type 1 needs insulin)

-HOLD prior to a CT scan and for 48 hours after

Humulin R, Novolin R

regular insulin; assess patient's blood glucose 30-60 minutes after giving

intestinal gas

bloating, distention, or feeling "full of gas" with excessive flatulence as a symptom of food intolerance or gallbladder disease; treat with charcoal or simethicone

diarrhea medications

Opiums - loperamide (Imodium) & diphenoxylate with atropine (lomotil)

Misc - pepto-bismol, probiotics, octreotide (Sandostatin)

*Administer after each loose bowel movement until diarrhea is resolved

H. pylori

bacteria that causes ulcers; treat with omeprazole or lansoprazole

magnesium oxide

antacid; adverse effects diarrhea, dehydration, hypotension

GI stimulants

Metoclopramide (Reglan)

Promethazine

Phenergan

Antiemetic

Monitor vital signs, especially respiratory rate

C. difficile

a bacterium that is spread by spores in feces that are difficult to kill; it causes symptoms such as diarrhea and nausea and can lead to serious inflammation of the colon

-patients will not be prescribed antidiarrheals due to the need to get the bacteria out of the gut

Zantac (ranitidine)

H2 antagonist; side effects include breast enlargement in men

Carafate and sulcrafate

Give on empty stomach 1 hour before meals and at bedtime -- remember these coat the GI tract and interfere with the absorption of other medications (give them by themselves)

NG medciations

meds given through a nasogastric tube and must be crushed and diluted into a liquid form

Fluid imbalances: prioritizing assessment findings

●● Subjective Data and Objective Data

◯◯ Vital signs - Hyperthermia, tachycardia, thready pulse, hypotension, orthostatic hypotension,

decreased central venous pressure, tachypneic (increased respirations), hypoxia

■■ Tachycardia occurs in an attempt to maintain a normal blood pressure.

◯◯ Neuromusculoskeletal - Dizziness, syncope, confusion, weakness, fatigue

◯◯ Gastrointestinal - Thirst, dry furrowed tongue, nausea/vomiting, anorexia, acute weight loss

◯◯ Renal - Oliguria (decreased production and concentration of urine)

◯◯ Other signs - Diminished capillary refill, cool clammy skin, diaphoresis, sunken eyeballs, flattened

neck veins, poor skin turgor, and tenting.

●● Subjective Data and Objective Data

◯◯ Vital signs - Tachycardia, bounding pulse, hypertension, tachypnea, increased central venous pressure

◯◯ Neuromusculoskeletal - Confusion, muscle weakness, headache

◯◯ Gastrointestinal - Weight gain, ascites

◯◯ Respiratory - Dyspnea, orthopnea, crackles, diminished breath sounds

◯◯ Other signs - Edema, distended neck veins, pale and cool skin.

Safety, A, B, C

Propranolol

beta blocker; assess pulse rate prior to administration

Carvedilol (Coreg)

Antihypertensive; monitor BP prior to administration

Interventions for dizziness

move slowly when getting up, bed in lowest positions, use of mobility aides

Digoxin (Lanoxin)

class: antiarrhythmic, inotropics

Indication: CHF, A-fib, A-flutter

Action: Positive inotropic effect (increases force of myocardial contraction), prolongs refractory period, ↓ conduction through SA and AV nodes. Essentially digoxin is given to increase cardiac output and slow the rate.

Nursing Considerations:

- Excreted by kidneys

- Assess patient for hypersensitivity

- Contraindicated with uncontrolled ventricular arryhtmias

- Hypokalemia increase risk for toxcicity

- Hypercalcemia ↑ risk for toxicity

- Use caution with diuretic use as they may cause electrolyte abnormalities that can lead to

toxicity

- Assess patient for cardiac arrythmias including bradycardia

- Signs of toxicity include vision changes (blurred vision, yellow, green vision disturbances)

- Monitor pulse rate for 1 full minute prior to dosing patient (hold for pulse <60)

Digoxin normal levels

0.8-2.0 ng/mL

Nitroprusside

Nitropress, Nipride; given to treat hypertensive emergencies; monitor patient for significant hypotension

Diltiazem (Cardizem)

class: Ca Channel Blocker (Bezothiazepine), antianginals, antiarrhythmics, antihypertensive

Indication: hypertension, angina, SVT, a-fib, aflutter

Action: inhibits calcium transport resulting in inhibition of excitation and contraction, leads to depression of AV and SA node leading to decreased HR, leads to vasodilatation and decreased blood pressure.

Nursing Considerations:

- contraindicated in 2nd and 3rd AV block

- may cause arrhythmias, CHF, bradycardia, peripheral edema, gingival hyperplasia

- increases digoxin levels

- don't drink grapefruit juice

- assess for signs of CHF

- monitor EKG continuously

- tell patient to change positions slowly

- monitor serum potassium

- instruct pt on how to take blood pressure

-*HOLD for HR <60

Angiotensin Receptor Blockers

prevent angiotensin II from reaching its receptors, causing vasodilation

Losartan (cozaar)

valsartan (diovan)

Ventolin (albuterol)

Rescue medication

Adrenergic drug (beta-receptor agonist)

Bronchodilator (opens air passages)

Inhaler-can be used for immediate relief of bronchospasm

May cause insomnia

Mast Cell Stabilizers

Cromolyn

Antihistamine drugs

medications administered to block and control allergic reactions; dries up your mouth, throat and nose

Guaifenesin (Mucinex)

Category: Expectorant, Use: Productive and nonproductive cough, Precautions: Increase fluids if possible

Antibiotics

Drugs that block the growth and reproduction of bacteria; decreases the effectiveness of birth control

Ciprofloxacin

Fluoroquinolone; advise patient to stretch prior to exercise due to risk of tendon rupture

Colesevelam (Welchol)

Hypolipidemic, Bile Acid Sequestrant; used in patients with liver disease

Chlorothiazide

thiazide diuretic; monitor renal function, HOLD if BUN and creatinine are elevated

Corticosteroids

A group of hormones, including cortisol, released by the adrenal glands at times of stress; used in some respiratory illnesses, also in organ transplant to suppress the immune system to prevent rejection

-Do not stop taking abruptly, taper the dose

adrenal corticosteroids

•are produced by the adrenal glands located on the top of each kidney

•include aldosterone, which regulates electrolytes and water balance by the kidneys

•include cortisone, a glucocorticoid, which increases blood glucose level and stimulates the synthesis of glycogen in the liver

ex: methylprednisolone (Medrol)

anaphylactic reaction (anaphylaxis)

A life threatening allergic reaction that results in respiratory distress, redness, sweating, and sudden severe bronchospasm, and cardiovascular collapse. It is treated with vasopressors, bronchodilators, corticosteroids, oxygen therapy, intravenous fluids, and antihistamines.

Drug metabolism

the process of getting rid of medications in the bloodstream, partly in the liver

dosage calculation formula

Desired/Have X Quantity

pounds to kg formula

kg= pounds/2.2

Anti-tussive drugs

decreases cough, ex Robitussin, Benzonatate (Tessalon perles)

Phenelzine (Nardil)

MAOI antidepressant, avoid foods high in tyramine

Warfarin (Coumadin)

Anticoagulant, Vitamin K Antagonist

Foods high in tyramine

Fermented, smoked, aged foods, foods with yeast, beer, wine, chocolate, Ginseng, medications (cough meds)

Carbidopa/Levodopa

Sinemet (CR) Antiparkinson Agent; monitor patient for jerky, tremor-like movements, dry mouth, and anorexia

photophobia

sensitivity to light; dim overhead lights, pull curtains

Photosensitivity

increased reaction of the skin to exposure to sunlight; wear sun screen, protective clothing

Adrenergic Nervous System

Also known as sympathetic nervous system. Responsible for the body's "fight or flight" response.

Alpha and Beta receptors

Amytriptyline

Elavil; monitor for adverse effects: sedation, dry mouth, dry eyes

Anxiety Signs and Symptoms

Increased BP, lump in throat, butterflies, rapid pulse, respirations, dry mouth, sweating, nausea, diarrhea, urine frequency, poor attention span, difficulty sleeping, loss of appetite

Alzheimer's disease

a progressive and irreversible brain disorder characterized by gradual deterioration of memory, reasoning, language, and, finally, physical functioning

-ensure a calm environment

-provide redirection

opioiod analgesic agents

provide significant pain relief, that may allow pt to tolerate more aggressive tx.

tx. sessions should be scheduled to coincide with peak effectiveness of the drug.

side effects that may affect interventions include:

sedation and respiratory depression

Assess vital signs including pain, past medication history, and current medications prior to administration

PCA infusion pump

Patient-controlled analgesia (PCA)

Delivers prescribed amount of analgesia according to patient's demand upon activation of a button

Lithium toxicity

2 or greater, tremors, metallic taste, severe diarrhea, number one intervention, give fluids, if sweating give electrolytes too; 0.6-1.2mEq/L

-withhold next dose and draw a new lithium level

Benzodiazepines

The most common group of antianxiety drugs, which includes Valium and Xanax, temazepam and triazolam

benzodiazepine overdose treatement

Flumazenil

SSRIs

Selective serotonin reuptake inhibitors for depression; fluoxetine, sertraline

delirium

an acutely disturbed state of mind that occurs in fever, intoxication, and other disorders and is characterized by restlessness, illusions, and incoherence of thought and speech, sensory impairment

Donepazil (Aricept)

cholinesterase inhibitor; used to treat Alzheimer's; monitor patients for anorexia, headache, and fatigue

Adderall, Adderall XR

amphetamine/dextroamphetamine; used to treat ADHD, monitor frequent weight

Cross sensitivity of cephalosporins

between 5 and 10 percent

if patient is allergic to penicillin there is a chance theyre allergic to cephalosporins too (only give to those with mild allergies)

Cephalosporins

-Structurally and functionally similar to penicillins

-Broad-spectrum antibiotics that can be used by most patients that are allergic to penicillin

-used to treat UTI

Parenteral drug routes

1. IV (intravenous) 2. IM (intramuscular) 3. ID (intradermal) 4. SQ (subcutaneous) 5. IA (intraarterial ) 6. IP (intraperitoneal)

Trade name

The commercial name given to a drug product by its manufacturer; also called the proprietary name.

Generic name

name assigned by the manufacturer who first develops a drug; it is often derived from the chemical name

Sildenafil (Viagra)

erectile dysfunction; avoid nitrates