BMS Surgical Meds

dantrolene (Dantrium)

Skeletal muscle relaxant meds?

Malignant hyperthermia

What is the indication for dantrolene?

• Assess patient

• S/S of Malignant hyperthermia

• Notify surgeon and anesthesiologist

• Assess liver function tests (LFTs)

What are the nursing considerations for dantrolene?

Clinical manifestations subside or eliminated

How do you know dantrolene is working?

• Hepatotoxicity

• Elevated liver function tests

• Jaundice

What are the adverse reactions for both acetaminophen and dantrolene?

• promethazine (Phenergan)

• metoclopramide (Reglan)

• prochlorperazine (Compazine)

• ondansetron (Zofran)

Antiemetics meds?

Nausea and vomiting (N/V)

What is the indication for antiemetics?

• Assess for N/V

• IV patency

• Effectiveness of parenteral admin 30 min after

• I&O

• Document quantity of emesis

What are the nursing considerations for antiemetics?

• Decrease or absence of N/V

• Increased activity and food/fluid intake

How do you know the antiemetic is working?

• Excessive sedation

• Respiratory depression

What are the adverse reactions of antiemetics?

• Surfactant

• Stimulant

• Osmotic

Types of Laxatives?

Surfactant laxative

Decreases surface pressure of stool, draws water into it

Stimulant laxative

Causes muscle in intestines to contract and push stool through digestive tract

Osmotic laxative

Draws water into stool from body, making it easier to pass

docusate sodum (Colace)

Surfactant laxative meds?

bisacodyl (Dulcolax)

Stimulate laxative meds?

polyethylene glycol (Miralax)

Osmotic laxative meds?

• Surgical/procedural prep

• Constipation

What is the indication for laxatives?

• Assess

  • Allergies

  • Bowel sounds

  • Bowel movements

  • Abdominal pain

• Encourage oral fluids

• Contradicted in bowel obstruction or fecal impaction

What are the nursing considerations for laxatives?

In bowel obstruction or fecal impaction

When are laxatives contradicted?

• Good bowel prep

• Pt. free of constipation

How do you know a laxative is working?

• Dehydration

• Diarrhea

• Electrolyte imbalance

What are the adverse reactions to laxatives?

• prednisone (Sterapred)

• methylprednisolone (Solumedrol)

Glucocorticoids meds?

• Thromboembolism

• Hyperglycemia

• Decreased wound healing

• Infection

• Fluid/electrolyte imbalance

• Osteoporosis

What are adverse reactions to glucocorticoids?

• Rheumatoid arthritis

• Autoimmune disorder

• IBS

• Lupus

• COPD exacerbation

• Respiratory distress syndrome

• Transplant recipients

• Cancer

• Dermatologic disorders

What are the indications for glucocorticoids?

• Strong

• Moderate to strong

What are the types of opioids?

• Morpine

• hydromorphone (Dilaudid)

Strong opioid agonist meds?

Severe pain (7-10)

What type of pain are strong opioid agonists indicated?

• Monitor VS

• Monitor I/O

• Monitor sedation level

• Bowels

• LOC

• Pt edu: no chewing pills

What are nursing coniderations for strong opioid againsts?

No chewing pills

What is the pt. education for those taking strong opioid meds?

• Reports of decreased pain

• Fewer non-verbal pain indicators

• Increased activity level

How do you know if a opioid med or NSAID is working?

• RESPIRATORY DEPRESSION

• Change in LOC/sedation level

• Constipation

• Urinary retention

What are the adverse reactions to strong opioid agonists?

• oxycodone/acetaminophen (Percocet)

• hydrocodone/acetaminophen (Lortab)

Moderate to strong opioid agonist + acetaminophen meds?

Moderate pain (4-6)

What type of pain is moderate to strong opioids indicated?

• Asses pain level 60 mins after oral admin

• Monitor VS

• Monitor I/O

• Sedation level

• Bowels

• LOC

• Pt. education

• Note dosing of acetaminophen

• Give with food (GI upset)

What are the nursing considerations for moderate to strong opioids meds?

4g or 4000mg

What is the max amount of acetaminophen that you can give a patient?

• Respiratory depression

• Constipation

• Urinary retention

• COUGH suppression

• Change in LOC/sedation level

What are the adverse reactions to moderate to strong opioids meds?

naloxone (Narcan)

Opioid antagonist meds?

Opioid overdose

What is the indication for naloxone?

Reverses most effects of opioid agonist, including respiratory depression, from an analgesic

What are the effects of naloxone?

• Monitor VS

• Asses LOC

• Assess pain

What are the nursing considerations for naloxone?

IV, IM, or SQ

How is naloxone administered?

Immediately and lasts for 30-90 mins

When are the effects of naloxone seen?

Yes, several times to maintain effects since drugs has short half-life

Will naloxone be given many times throughout the day?

• Pt will be less sedated

• Pt. clinical status will improve

How do you know naloxone is working?

Withdrawal symptoms in dependent patients

What are the adverse reactions to naloxone?

acetaminophen (Tylenol)

Analgesic/antipyretic meds?

Mild pain (1-3)

What pain type is acetaminophen or ibuprofen indicated?

• DO NOT EXCEED 4g/4000mg a day

• Give with food (GI upset)

• Pt. education

What are the nursing considerations for acetaminophen?

• ibuprofen (Motrin)

• ketorolac (Toradol)

NSAID meds?

• VS

• Labs: H/H

• Pt. education

• Give with food (GI upset) (ibuprofen)

What are the nursing considerations for ibuprofen and ketorolac?

• Gastric ulcer

• Bleeding

• Renal impairment (elevated BUN/Cr)

What are the adverse reactions for ibuprofen and ketorolac?

Moderate-severe pain (4+)

What pain type is indicated for ketorolac?

Less adverse reactions

Why give ketorolac instead of opioids?