Comprehensive Nursing Guide: Liver Disease, Immunizations, Medications, and Emergency Care

Hepatitis and cirrhosis

Reinforcing teaching about chronic liver disease: avoid alcohol, OTC (Benadryl, Motrin) or herbal supplements, raw food, don't share personal items (razor and utensils), High-calorie, moderate fat diet, low sodium diet to prevent edema, low protein, small frequent meals, replacement and administration of vitamins B complex, C, K.

Contraindications to varicella immunization

Pregnant clients, hypersensitivity to neomycin and gelatin.

Identifying immunization administration

Influenza = protein/eggs, Varicella = gelatin/neomycin, Hep A = latex, Hep B = yeast.

Medication for alcohol withdrawal

Benzodiazepines (diazepam/lorazepam), chlordiazepoxide, disulfiram + alcohol = acetaldehyde syndrome causing nausea/vomiting, sweating, tachycardia, hypotension, respiratory depression, seizure, CVS suppression, death. Antidote = Flumazenil.

Priority findings for Sumatriptan

Used for clustered headache and migraine, adverse effect is chest tightness and heavy arms, if mixed with fluoxetine it causes tremors, confusion, and hallucination, if interacts with MAOI it causes serotonin syndrome.

Monitoring adverse effects of Filgrastim

Stimulates bone marrow to produce neutrophils (WBCs), adverse effect is bone pain and leukocytosis (excess WBCs), monitor it 2x/week during treatment.

Reinforcing teaching about long-term high dose Prednisone

It is a synthetic corticosteroid/steroid that treats inflammatory conditions, autoimmune diseases, cancer, causes hyperglycemia, weight gain, fluid retention, more hunger, long-term use and watch for infection.

Priority finding to report for Allopurinol

Used for gout, watch for Steven-Johnson Syndrome, emergency situation severe blistering, skin detachment, mucous membrane damage, rash, administer with food, if lab values are up, notify the provider.

Evaluating the efficacy of Diphenhydramine

Benadryl = antihistamine, improves allergy symptoms when taking it, reduces pain when combined with an opioid.

Identifying manifestations of an allergic reaction

Itching, rash, watery eyes, sneezing, rhinosinusitis, severe reaction - anaphylaxis (use epinephrine).

Adverse effects of Tobramycin

Treats severe bacterial infections, can cause hearing loss (ototoxicity), fetal harm (teratogenic).

Adverse effects of Spironolactone and Lisinopril

Spironolactone = potassium-sparing diuretic, hold if potassium is 5.5, hypotension, hypokalemia, dehydration. Lisinopril causes hypotension, coughing, hyperkalemia, angioedema, teratogenic.

Contraindication of Digoxin

Foxglove (flower) increases HR, antidote is digitalis.

Reinforcing teaching about Haloperidol

Treats schizophrenia, acute psychosis, Tourette syndrome and severe behavior problems, common symptoms: photophobia, blurred vision, dry mouth, constipation, wear sunglasses and sunscreen when going out.

Contraindications of antibiotic therapy

Penicillins contraindications pregnancy and lactation, Cephalosporins contraindications pregnancy and lactation (don't take it with another antibiotic).

Monitoring for medication interactions

Penicillin in the same IV solution as aminoglycosides inactivates the aminoglycoside (tobramycin), and don't combine both together.

Priority intervention for adverse effects of 5-sulfalazine

It reduces inflammation (GI), DMARD, don't take with furosemide, blood disorder.

Contraindication for furosemide

Contraindicated to Sulfamethoxazole-trimethoprim, pregnancy/lactation, clients who have anuria (no urine output), take before evening 1700, hypoproteinemia = ototoxicity.

Adverse effects of Antihistamines

Sedation, anticholinergic effects: dry mouth, urinary retention, constipation, chew gum, void every 4 hours.

Reversing the effects of Heparin

Antidote: Protamine-sulfate, monitor aPTT (50-70), subQ.

Nursing response to adverse effect of Rifampin

For Tuberculosis (TB), you get red orange sweat, urine, tears, no contacts, monitor ALT or AST (liver). Hepatotoxicity watch for jaundice, anorexia, fatigue, and avoid alcohol.

Managing an allergic reaction

Discontinue the medication and contact the provider.

Monitor lenient response following medication error

Check on the client's status.

Reinforcing teaching about Lithium

Is a mood stabilizer, produces neurochemical change in the brain, treats bipolar disorder, normal value is 0.6 - 1.2, maintain a consistent sodium intake, administer with food and milk, adverse effects: gastric upset, tremors, thirst, hypothyroidism.

Antithyroid medication expected outcome

Methimazole reduces thyroid hormone production, therapeutic effect is decreased T4, agranulocytosis, any symptoms of hypo means it's too much. PTU lowers HR back to normal to treat Grave's disease, effectiveness is elevated blood glucose.

Counteracting adverse effects of furosemide

Adverse effect: low fluid volume, hypotension. Complications: dehydration, dry mouth, increased thirst, minimal urine output and weight loss.

Furosemide/Spironolactone

Pulmonary edema caused by heart failure, hypertension.

Hydrochlorothiazide

Medication taken for hypertension that increases urine output.

Mannitol

Used to increase ICP caused by cerebral edema.

Epoetin Alfa

Monitoring for hypertension (high BP), bone pain, increased seizure risk, increased HGB, RBC count, adequate iron, caution for thromboembolism.

Tuberculin skin test results

Test is read 48-72 hours; normally less than 5mm is negative, greater means positive and requires a chest x-ray.

ACE inhibitors (Prils)

Causes angioedema, dry cough, hypotension, teratogenic effects, and no food restrictions.

Beta blockers (Olols)

Can cause sexual dysfunction, bronchospasm, heart failure, and bradycardia.

Sartan

Similar to ACE inhibitors but without cough; may cause insomnia and headache.

Calcium channel blockers (Dipine, Mil, Zem)

Can cause peripheral edema, dizziness, constipation, and fatigue.

Statin

Can cause hepatotoxicity, myopathy, and muscle pain.

Clonidine

Anti-hypertensive; should not be taken with anticoagulants; may cause drowsiness, dizziness, dry mouth, and rebound hypertensive crisis.

Anticholinergics (Scopolamine)

Administered for nausea and vomiting; apply 4 hours before travel.

Erythromycin

Inhibits protein synthesis in susceptible microorganisms, usually gram-positive bacteria.

Vaginal suppository administration

Supine position, lubricate, insert 3-4 inches, remain supine for 10 minutes.

Peptic Ulcer Disease care

Watch for bleeding, avoid spicy food, alcohol, caffeine; check lab values for Hgb and Hct, BUN; smoking cessation.

Heparin therapy

Avoid aspirin and the 3 Gs (ginger, ginkgo, ginseng).

Enteral feeding tube medication administration

Check gastric residual (<500 mL), pH 7.35-7.45; do not crush EC meds; flush before and after with 30 mL.

Nitroglycerin ointment administration

Use measurement paper 2.5-3.5 inches; apply to clean, hairless skin; monitor for orthostatic effects and headache.

Enoxaparin subcutaneous administration

Do not expel air bubble; pinch site; insert needle at 90-degree angle; monitor for bleeding.

Nitroglycerin sublingual teaching

3 tabs max, every 5 minutes; call 911 after the first tab.

Rifampin

Inhibits protein synthesis; anti-TB medication; causes orange-red discoloration of bodily fluids; avoid alcohol.

PCA pump management

Monitor pain levels regularly; only the client should push the button; verify settings with 2 nurses.

Monitoring patient-controlled analgesia

Monitor respiratory rate (<12/min), oxygen saturation; assess pain using a scale of 0 to 10.

Asthma priority actions

Assess airway (ABCs); administer albuterol; monitor for tachycardia, chest pain, anxiety, tremors.

Diarrhea priority care

Report severe diarrhea to provider; maintain hydration; assess for C. diff.

Anaphylaxis manifestations

Use epinephrine; monitor for anxiety, weakness, itching, hives, respiratory distress, and hypotension.

Epilepsy care

Monitor CBC for agranulocytosis; check for hepatotoxicity and pancreatitis; use gabapentin, phenytoin, or Keppra.

Sumatriptan teaching

Used for migraines; immediate onset for angina; caution with MAOIs.