NCLEX review pharm

Infiltration

elevate extremity, apply cold compress

Catheter embolus

Apply tourniquet to limit venous flow

Extravasation

leakage from a vessel into the tissue aspirate drug if possible

Hematoma

a solid swelling of clotted blood within the tissues. apply light pressure

Phlebitis

vein inflammation apply warm compress

Central lines

sterile technique nurse is specially trained for dressing change

PICC or central line

hypertonic solution (because it contains glucose) prepared daily (based on daily labs)

TPN

if TPN bag unavialable, infuse dextrose 10%

TPN Monitoring

monitor blood glucose every 4-6 hours

TPN Maintenance

new TPN bad and filter hung every 24 hrs

-pril

antihypertensive

ACE inhibitors

A- angioedema C-cough E- extra potassium (hyperkalemia) monitor for angioedema (swelling of tongue)

Losartan, valsartan, irbesartan

ARBS

ACE/ARB side effects

persistent non-productive cough (ACEI) angioedema hypertension

ACE/ARB nursing interventions

take captorpil one hour before meals monitor for angioedema administer EPI

Nefedipine, amlodipine

calcium channel blockers

Verapamil, dilitizem

treat HTN

CCBS

verapamil/dilitzem can be used for A-fibb/A-flutter, SVT

CCB Precautions

contraindicated in patients with heart failure, heart block, bradycardia avoid grapefruit juice

Beta blockers

-olol B-bronchoconstriction (caution in patients with asthma)

Beta blockers (B-side)

B-bradycardia

Vasodilators

rapidly drops BP

Alpha 2 agonists

contraindicated w/ anticoagulants Clonidine - Methyldopa

Alpha adrenergic blockers

treat hypertension and BPH -tamulosin

Class 1 anti dysrythmics

slow conduction

Anti dysrythmics nursing

monitor vitals, ECG

Class 2 anti dysrythmics

beta blockers used to treat a flutter

Class 2 drug example

• propanolol check pulse before (hold < 60)

Class 3 drug example

• amiodarone

Class 3 anti dysrythmics

• sotalol used for v-fib, v-tachy

Class 3 teaching

patient should wear sunscreen and protective layers

Atropine

treats bradycardia monitor for dry mouth, blurry vision, photophobia, urinary retention, constipation

Class IV anti arryhtmics

calcium chanell blockers. - verapamil - dilitiazem

Class IV monitoring

monitor for hypotension, heart failure, constipation, apical pulse

Digoxin / therapeutic digoxin levels

used to treat heart failure monitor BNP decreased HR (hold for pulse <60) monitor potassium, apical pulse, medication level 0.8-2.0

S/S digoxin toxicity

anorexia fatigue seeing halos around images

Digoxin antidote

Digoxin immune Fab (Digibind)

Cholesterol lowering agents (statins)

avoid grapefruit juice monitor for rhabdomyolysis (report muscle aches) administer at night

MDI administration 1-2

1. remove mouthpiece cover 2. shake MDI

MDI administration 3

3. Inhale and exhale completely

MDI administration 4

4. place between teeth, seal lips around inhaler

MDI administration 5-6

5. inhale and depress canister simultaneously 6. hold breath 10 seconds, exhale

Beta 2 agonists / methyxanthines

promote gas exchange end in "teral" bronchodilators treat asthma and COPD Theophylline avoid caffeine

Theophylline monitoring

avoid toxicity (draw levels)

S/S theophylline toxicity

seizures dysrhythmias Gl distress

Inhaled anticholinergics

Ipratropium Used for asthma or COPD causes drymouth/hoarseness

Glucocorticoids

promote gas exchange - prednisone (oral) - beclomethasone (inhaled, can cause difficulty speaking, hoarseness, candidiasis; rinse mouth after using) long term use leads to cushings syndrome risk for adisonian crisis (if stopped without weaning)

Leukotrine modifiers

montelukast used for long term asthma management, excersise induced bronchospasm monitor for depression, suicidal ideation

Oral antidiabetics

treat type 2 diabetes stimulate pancreas to produce more insulin pregnant woman cannot take

Inhaled insulins are acting

rapid

Dose dependent insulin

insulin detemir

Draw up insulin first, then

regular nph

IV regular insulin lowers

serum potassium

Meds used to treat hypothyroidism

levathyroxine thyroids USP liatrix

Hypothyroid med instructions

take on an empty stomach 30 mins - 1 hr before bed start on low dose, can be gradually increased

Meds to treat hyperthyroidism

methymazole propylthiouracul

ADH hormone function

helps our body hold onto fluid

Overproduction of ADH =

fluid retention- SIADH

Underproduction of ADH =

excess urine excretion -> diabetes insipidus

ADH medications

vasopressin desmopressin - monitor for signs of water intoxication (sleepiness, headache) treat hemophilia, DI, nocturnal enuresis

Insufficient adrenal hormone leads to

addisons disease

Too much adrenal hormone leads to

cushings disease - increased Steroids

Cushings disease (labs)

• increased Sugar - increased Sodium

Adrenal hormone replacement therapy

prednisone hydrocortisone

Blood administration prep

verify labs, prescription, and consent verify parent IV access for N.S obtain unit of PRBCs from blood bank

Blood administration verification

verify client ID and compatabilit verify blood with second nurse obtain baseline vitals

Blood administration procedure

initiate transfusion slowly, monitor for 15 minutes complete blood transfusion within four hours after patient leaves unit

Hemolytic reaction

low back pain stop infusion immediately

Anaphylactic reacton symptoms

wheezing uritcaria shock cardiac arrest

Anaphylactic reaction treatment

Stop infusion, N.S IV, CPR, EPI

Mild allergic reaction

urticaria flushing itching stop infusion -> N.S V give antihistamines, steroids

Febrile reaction

fever chills headache stop infusion --> N.S.IV give acetaminophen and leukocyte washed blood

EPO function

stimulates RBC production

EPO usage

treats anemia d/t CKD, chemo patients

EPO monitoring

monitor for HTN, headache, bodyaches

Ferrous sulfate / gluconate / fumurate

iron preparations

Iron liquid administration

liquids with straw

Iron preparation administration

parenteral using Z track avoid dairy, antacids, caffeine 1 hr before and after give with food and vitamin C

Heparin / enoxaparin / warfarin

anticoagulants

Anticoagulants

prevent blood clot formation work in the veins patient on bleeding precautions conistent vitamin K intake

Anticoagulant precautions

avoid NSAIDS, aspirin warfarin not safe during pregnancy

Heparin antidote

protamine sulfate

Warfarin antidote

Vitamin K

Heparin lab monitoring

APIT

Normal aPTT

30-40 seconds

Expected aPTT for patient on heparin therapy

60-80 seconds

Warfarin lab monitoring

INR and PT

Normal INR

0.8-1.1

Normal PT

11-12.5 sec

Aspirin / abciximab

antiplatelets

Clopidogrel / ticlopidine

antiplatelets

Pentoxifylline

antiplatelets

Dipyrdamole

antiplatelets

Antiplatelet action

work in arteries

Antiplatelet administration

do not crush/chew

Antiplatelet precautions

D/C 10 days prior to surgery give aspirin 325 mg during acute MI contraindicated in thrombocytopenia client should report tarry stool, ecchymosis

Alteplase

thrombolytics

Tenecteplase / reteplase

thrombolytics

Thrombolytics

dissolve blood clots that have already formed give within 4-6 hours of event onset monitor for hernorrhage, hypotension, and anaphylaxis pt. will begin anticoagulant therapy to prevent repeat thrombotic event

Halperidol / chlorpromazine

typical antipsychotic