A Critical Thinking and Application
NCLEX-RN
®
Review
R E S O U R C E M AT E R I A L S
HURST
REVIEW SERVICES
®
CHAPTER 1 - PHARMACOLOGY
Introduction
Herbal Supplements, Possible Side Effects, and Drug Interactions
Transfusing Blood and Blood Products
Medications by Body System
Analgesic Medications
Antibiotics - Antiinfectives Medications
Antineoplastic Medications
Cardiac Medications
Central Nervous System Medications
Dermatologic Medications
Endocrine Medications
Gastrointestinal Medications
Hematology Medications
Immune System Medications
Men’s and Women’s Health Medications
Renal Medications
Respiratory Medications
Vitamins, Minerals and Electrolytes
CHAPTER 2 - INFECTION CONTROL
Infection Control Chart
Infection Control Precautions
Isolation Precautions Exercise
CHAPTER 3 - MANAGEMENT OF CARE
Five Rights of Delegation and Prioritization/Assignment Principles
Emergency Department Triage Review
Emergency Department Triage Review Answer Key
Disaster Triage Review
CHAPTER 4 - PEDIATRICS
Asthma Handout
Immunizations
Specific Pediatric Heart Defects
Understanding Growth and Development: Infants
Understanding Growth and Development: Toddlers
Understanding Growth and Development: Preschoolers
Understanding Growth and Development: School - Age
Understanding Growth and Development: Adolescents
CHAPTER 5 - MISCELLANEOUS
ABG Interpretation Practice Problems - RN
ABG Interpretation Practice Problems with Answers - RN
12 Cranial Nerves
Critical Thinking Exercises with Answers
ECG Handout
Hurst Lab Values
Maslow’s Hierarchy of Needs
NCLEX® Strategy Questions with Answers - RN
Orthopedic Tips: Crutches, Canes and Walkers
Specific Types of Cancer: An Overview
Signs and Symptoms of Abuse
Types of Shock
Introduction to Pharmacology
Dear New Graduate,
Many of you have requested more pharmacology and we always listen to
your requests…so here it is!!! We want to caution you that there is no way that we
could include all medications nor could you learn all the medications that are on the
market. We want you to base your study on the core content and then incorporate
the medications into that thinking process: i.e. as you study cardiac, go to the cardiac
system medications. Remember, this is all about critical thinking, not memorization.
We have included medications outside the core content for your reference.
You need to determine how prepared you are in pharmacology from your nursing
school education and decide how much time you need to spend in these other areas.
You will note that Women’s Health covers some of the medications covered in
Maternity and Men’s Health covers some concepts in Oncology. Again, don’t spend
too much time in the pharmacology category because there are seven more areas
of the NCLEX® Exam you need to study.
I always get the question about “rounding off” math problems. Well, worry no
more because all the instructions that you need will be on each question. They will
tell you how they want the problem rounded and will even provide you with the
measurements at the end (mg, kg, and mL). You do have to remember to not round
off until the end and then provide the numbers and the decimal point that they
instruct you to use. If you try to write more than numbers in the box, they will stop
you with an error statement. Don’t stress about rounding off, you will be
given all the instructions you need.
Now, here is a MUST…before you take the test, go to www.vue.com/nclex/
and do the Online Tutorial and the online virtual tour of the Pearson Center. This is
going to help you relieve a lot of that anxiety about the computer and what is
going to happen the day of the test.
Go Pass that NCLEX® the first time!!
Herbal Supplements, Possible Side Effects, and Drug Interactions
*It is important to inform your primary healthcare provider about any herbal
supplement you are using. This helps to ensure safe and coordinated care.
Herbal Supplement
Possible Side Effect(s)
Drug Interactions
Chondroitin Sulfate
Diarrhea, constipation,
stomach pain
Daily ASA, blood thinners
(Coumadin®)
Echinacea
Upset stomach, diarrhea,
Steroids, other medications
constipation, rash, dizziness that will suppress the
immune system
Ginkgo
Upset stomach, diarrhea,
HA, bleeding, seizures,
muscle cramping, dizziness
ASA, NSAIDS, blood thinners,
clot-busting medications
(Ticlid® and Plavix®),
diuretics
Glucosamine
Upset stomach, heartburn,
gas, bloating, and diarrhea
Diuretics, insulin
Melatonin
Fatigue, headache, upset
stomach, depression
NSAIDS, steroids, anti-anxiety
medications, blood pressure
medication (especially beta
blockers)
Saw Palmetto
Upset stomach
Asthma medications(inhalers,
and bronchodilators),
hormonal medications
St John’s Wort
Upset stomach, dry mouth,
fatigue, dizziness, rash
confused/anxious,
headache, sunburn easily
Antidepressants, MAOIs, blood
thinners, Digoxin®, birth control
pills, anticonvulsants and
antiviral drugs, migraine
headache medications, any
medication that will depress the
immune system
Transfusing Blood and Blood Products
Points to Remember
•
Blood and Blood products are to be administered by the RN
•
Only NS may be used in conjunction with administering blood and blood
products
•
Product instructions will be on the packet stating the maximum number of
units that can be administered through a single filte .
•
Do not infuse any medication into the client via the blood IV tubing.
•
All blood products require a filte .
•
Most of the time, blood will be given via a pump.
•
Be sure to complete all vital signs and transfusion records. You will need a
set of baseline vital signs before administering the blood.
•
You may have a separate flo sheet for administering blood
products. See your facilities policy and procedure manual.
•
Each client must have a type and screen and crossmatch in the lab prior to
obtaining a blood product. Each type and screen is only good for 72 hours.
•
Verificatio occurs in the blood bank and on the floo . A designated person
in the blood bank verifie with the RN, and the RN verifie with another RN
at the bedside. See your hospital’s policy and procedure manual for specifi
details; however, the following verification must be made: the client’s name,
date of birth, blood bank number, unit number, expiration date of unit of
blood or blood product, blood type and group, primary healthcare provider’s
order.
•
Check blood product for any signs of abnormalities.
•
You will need a primary healthcare provider’s order to administer
blood or blood products.
•
Signed consent form from the client (or the next of kin if the client is
unable to sign the form). It is the primary healthcare provider’s
responsibility to have the consent form signed and to explain to the
client and/or family the need and possible side effects.
•
Initially begin infusion slowly and observe client closely especially for
the firs 15 minutes of the infusion. If no reaction is observed,
infusion rate may be increased. The rate will depend on the condition
of the client. You will not want to infuse the blood quickly if you have
a client that is elderly, has any type of heart or kidney condition or
someone very young.
•
Infusion of the blood should be started within 30 minutes of receiving
the blood from the blood bank.
•
All blood from each unit must be completed within a 4 hour time frame. If the unit of blood is not completed in a 4 hour time frame
the blood must be discarded.
•
Dispose of blood tubing and blood or blood product bag according
to hospital policy.
•
Be sure to flus lines after transfusing blood or blood product with
0.9% normal saline.
•
Document administration of blood transfusion according to hospital
policy.
Signs of Transfusion Reaction
•
Chest pain
•
Hives or skin rash
•
Hypotension/Hypertension
•
Fever
•
Chills
•
Anxiety
•
Wheezing
•
Headache or muscle pain with fever
•
Flushing
•
Back pain
•
Dizziness
•
Itching
•
Urticaria
•
Tachycardia
•
Tachypnea
•
Dyspnea
•
GI symptoms: nausea and vomiting
If an adverse reaction occurs you should:
•
Discontinue the transfusion IMMEDIATELY.
•
Remove blood and blood tubing set.
•
Check your facility’s policies and procedure manual. You may
have to return the blood and tubing to the blood bank.
•
Start normal saline with new primed tubing at keep vein open
rate.
•
Check and document vital signs. Stay with client.
•
Notify primary healthcare provider and monitor client closely
for anaphylaxis.
•
Notify lab/ blood bank of transfusion reaction.
Potter and Perry, Clinical Nursing Skills and Techniques, 2010
Infusion Nursing Standards of Practice, 2011.
Class: Analgesics/Non-Opioid; Antipyretic
Agent(s)
Common Uses
Contraindications
Acetaminophen
(Tylenol)
Anti-fever drug of choice
(DOC) for children and
adolescents. Mild to
moderate pain, or fever.
Primary alternative to
NSAIDs
Liver disease or
alcohol consumption
Warfarin
Route
Onset of Action
Interactions
PO
PO: ½ to 1 hr
Rectal
Rectal: ½ to 1 hr
Increased hepatoxicity with
alcohol
Hypothrombinemia if taken
with warfarin
Caution in pregnancy and
breastfeeding
Decreases the effects of
barbiturates
Mechanism of Action
May block pain impulses peripherally and increasing the pain threshold. This causes the body to require a higher degree of pain before the
client feels it. Antipyretic action results from inhibition of prostaglandins in the CNS (Hypothalamic heat regulating center).
Advantages/Disadvantages
Easy to administer and obtain under many
brand names. Few side effects.
Side Effects
Adverse Effects
Drowsiness or stimulation, rash
or urticaria
Hepatotoxicity (nausea, upper stomach pain,
itching, loss of appetite, dark urine, clay
colored stools or jaundice), GI bleeding,
leukopenia, neutropenia, thrombocytopenia
Nursing Interventions
Client Education
Hepatotoxic in large doses.
Monitor renal function: BUN, urine creatinine, occult blood
Acetaminophen inhibits warfarin metabolism, which can cause warfarin to
accumulate to toxic levels.
Monitor hepatic function tests, ALT, AST, and bilirubin
Treat overdose with IV or oral N-acetylcysteine (Acetadote), or inhaled or
oral acetylcysteine (Mucomyst)
Do not exceed recommended dosage to prevent toxicity.
Do not use with alcohol or herbal medication without
physician approval.
Notify physician if pain and fever last more than 3 days.
Teach signs and symptoms of Hepatotoxicity (nausea,
upper stomach pain, itching, loss of appetite, dark urine,
clay colored stools or jaundice)
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: NSAID
Agent(s)
Common Uses
Contraindications
Ketorolac (Toradol)
Ibuprofen (Advil,
Motrin), Naproxen
sodium (Anaprox,
Aleve), Meloxicam
(Mobic)
MIld to
moderate pain
Pregnancy
Hypersensitivity
Asthma
Hepatic disease
Peptic ulcer disease
Route
Intranasal
PO
IM
IV
Onset of Action
30-60 minutes
30 minutes
10 minutes
Interactions
Increase toxicity with
methotrexate, lithium.
Increase bleeding risk with
anticoagulants, salicylates,
thrombolytics, SSRIs.
Increase renal impairment with
ACE inhibitors.
Mechanism of Action
Inhibits prostaglandin synthesis by decreasing an enzyme needed for biosynthesis. Anti-inflammator , antipyretic effects.
Advantages/Disadvantages
Side Effects
Dizziness
Tremors
Tinnitus
Nausea/vomiting
Diarrhea
Flatulence
Dry mouth
Adverse Effects
Drowsiness
Headache
Blurred vision
Anorexia
Constipation
Cramps
Seizures
MI
Stroke
GI bleeding
Hepatic failure
Nephrotoxicity
Hematuria
Angioedema
Nursing Interventions
Client Education
IM injection deeply and slowly in large muscle mass.
Monitor for signs of bleeding.
Monitor for hepatic dysfunction
Report blurred vision, tinnitus as toxicity may occurring
Avoid driving, other hazardous activities if dizziness/drowsiness occurs
Avoid alcohol, salicylates, other NSAIDS
Discard nasal bottle within 24 hours of opening.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Opioids
Agent(s)
Common Uses
Contraindications
Hydromorphone
(Dilaudid), Morphine
sulfate, Oxycodone,
Hydrocodone, Fentanyl
(Duragesic), Tramadol
(Ultram)
Moderate to severe
pain.
Cancer pain
Morphine: DOC - MI
GI obstruction
May mask
Gallbladder pain.
Route
PO
IM
IV
Onset of Action
Interactions
Varies
15-30 min
Rapid
Increases effect with
alcohol, tranquilizers,
antidepressants, kava
kava, St. John’s wort.
Mechanism of Action
Binds with the opiate receptor in the central nervous system. Suppresses pain impulses as well as respiration and coughing by
acting on the respiratory and cough centers of the medulla of the brainstem.
Advantages/Disadvantages
Gold standard for cancer pain.
There is no ceiling on the dose of an opioid
for a cancer client. It is client dependent.
May need larger doses to relieve increasing
pain to overcome drug tolerance. But the
medication is not withheld with cancer pain.
Side Effects
Adverse Effects
Constipation
Sleepiness
Nausea/Vomiting
Itching
Confusion
Anorexia
Respiratory depression
Orthostatic hypotension
Increased intracranial pressure
Nursing Interventions
Client Education
Administer before pain reaches its peak to maximize effectiveness.
Monitor vital signs for signs of hypotension and respiratory depression.
I&O
Check bowel sounds for decreased peristalsis.
Have naloxone (Narcan) available for overdose.
Do not crush extended release tablets.
Drink 8-10 (8 ounce) glasses of fluid each da .
Eat foods high in fiber or oughage.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Salicylate - Mild Analgesic
Agent(s)
Common Uses
Contraindications
Acetylsalicylic Acid
(Aspirin)
Platelet aggregation
to reduce risk of MI,
strokes.
Mild to moderate
pain relief, especially
associated with
inflamma ion.
Sensitivity
GI Bleeding
Vitamin K deficienc
Cerebral hemorrhage
Route
Onset of Action
Interactions
PO
30 minutes
Rectal
Rectal - erratic
Do not take with
other NSAIDS as it will
decrease blood level and
effectiveness of NSAID.
Coumadin taken with ASA
will increase anticoagulant
levels.
Mechanism of Action
Keeps the blood flowing because he platelets don’t stick together, so more blood flow and oxygen get to he heart muscle. This
leads to less pain. Inhibits prostaglandins to decrease inflamma ion and pain.
Advantages/Disadvantages
Inexpensive, readily available.
Indicated in initial treatment for clients
suffering from acute ischemic stroke who
are not candidates for fibrinoly ic therapy
Side Effects
Adverse Effects
GI distress
GI bleeding
Ulcer
Nursing Interventions
Client Education
Administer chewable tablet 160-325 mg orally at onset of chest pain
for quick absorption.
Observe for signs of bleeding
Take with food, milk or water to decrease GI upset.
Enteric coated can decrease gastric distress.
Do not crush enteric coated tablets.
Do not give to children with the flu or virus
Do not take with alcohol.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Aminoglycosides
Agent(s)
Common Uses
Contraindications
Route
Tobramycin (Nebcin),
Gentamycin (Garamycin),
Neomycin, Amikacin
(Amikin),
Streptomycin*
Serious gram (-)
infections
Given parenterally for
systemic use.
*Generally restricted
to TB treatment.
Renal disease
Hearing impairment
Pregnancy
Neomycin –
PO, topical
PO
IM, IV
Onset of Action
Interactions
Rapid
Increased risk of
ototoxicity with loop
diuretics.
Increased risk of
nephrotoxicity with
furosemide.
Mechanism of Action
Interferes with protein synthesis in bacterial cells.
Advantages/Disadvantages
Side Effects
Confusion
Numbness
Nausea/Vomiting
Adverse Effects
Depression,
Vertigo
Can cause irreversible ototoxicity and
nephrotoxicity.
Poorly absorbed from the GI tract.
Baseline hearing test recommended
Seizures
Ototoxicity
Nephrotoxicity
Renal failure
Anaphylaxis
Nursing Interventions
Client Education
Monitor peak and trough levels.
Monitor BUN and Creatinine levels.
Increase fluids to 1500-2000 mL per da .
I&O
Daily weight
Teach to report headache or dizziness.
Drink adequate fluids
Reference: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Class: Antibacterial/Antiprotozoal
Agent(s)
Common Uses
Contraindications
Route
Onset of Action
Interactions
Metronidazole (Flagyl)
H-pylori/GI tract
disorders
UTI
Septicemia
Meningitis
Hypersensitivity
Pregnancy
Hepatic disease
PO
IV
Topical
2 hours
Rapid
Avoid alcohol and alcohol
containing medications
for at least 48 hours after
treatment complete.
Mechanism of Action
Impairs DNA function of susceptible bacteria
Advantages/Disadvantages
Dual action on bacteria and protozoa
(parasites).
Side Effects
Adverse Effects
Dark/reddish brown urine
Nausea/vomiting
Metallic or bitter taste
Headache
Dizziness
Depression
Irritability
Insomnia
Thrombophlebitis
Bone marrow suppression
Neurotoxicity
Nursing Interventions
Client Education
Monitor urine output and color changes
Assess ECG and neuro changes during medication administration
Proper handwashing and hygiene after bowel cleansing.
DO NOT use alcohol or medications with alcohol for 48
hours after treatment complete.
Teach that urine may turn dark/reddish brown in color
May have metallic or bitter taste in mouth
Use proper hygiene with bowel movements and cleansing
Reference: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Class: Antibiotics: Vancomycin
Agent(s)
Common Uses
Contraindications
Route
Vancomycin (Vancocin)
DOC for MRSA
Cellulitis
Bone infections
Colitis
Meningitis
Hypersensitivity
Pregnancy
Renal disease
PO
IV
Onset of Action
Rapid
Interactions
Interacts with some
vitamins and herbal
products. Avoid use
when on Amikacin,
gentamicin or
streptomycin.
Mechanism of Action
It works by killing bacteria or preventing bacterial growth. Best for severe Gram + infections
Advantages/Disadvantages
Side Effects
Dry mouth
Diarrhea
Abdominal cramping
Headache
Hypotension
Adverse Effects
Muscles cramps
Nausea/vomiting
Flushing
Tachycardia
Blloody urine - Nephrotoxicity
Loss of hearing - Ototoxicity
Anaphylaxis
Nursing Interventions
Client Education
Monitor peak and trough levels.
Infuse over at least 60 minutes on an infusion pump.
Monitor BUN and Creatinine levels.
Increase fluids to 1500-2000 mL per da .
I&O, Daily weight
Baseline hearing test recommended
Teach to report headache or dizziness.
Drink adequate fluids
Report bloody urine or dizziness, ringing in the ears or loss
of hearing.
Reference: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Class: Antihelminthics
Agent(s)
Common Uses
Contraindications
Route
Onset of Action
Interactions
Mebendazole (Vermox)
Ivermectin (Stromectol)
Pyrantel pamoate (Pin-X)
Parasites: pinworms,
tapeworms,
hookworms,
roundworms
Trichinosis
Pregnancy
Children < 2 years
PO
<24 hours
Effectiveness
decreased by some
anticonvulsants.
Increased absorption
with high fat meal.
Mechanism of Action
Inhibits glucose uptake and degeneration of microtubules in the cell: parasite dies and is excreted.
Advantages/Disadvantages
Treament is easy and usually well tolerated
by all requiring medication.
Side Effects
Adverse Effects
Diarrhea
Abdominal pain
Nausea/vomiting
Dizziness
Headache
Seizures (rare)
Intestinal blockage as parasited die
Nursing Interventions
Client Education
Entire family and close contacts must be treated to prevent reinfestation
Proper handwashing and hygiene with bowel movements
Monitor stools for presence of worms/parasites
Monitor CBC, BUN, Creatinie and liver enzymes during treatment
Teach proper hygiene and cleansing of clothes and
linens to prevent reinfestation.
Infected person should sleep alone until treatment
complete.
Teach to wear shoes when out doors
Teach proper cleansing of fresh fruits and vegetables
Reference: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Class: Antivirals: HIV
Agent(s)
Common Uses
Contraindications
Route
Onset of Action
Interactions
Zidovudine or AZT
(Retrovir)
HIV/AIDS
Hypersensitivity
Pregnancy
PO
IV
30-60 minutes
Rapid
Bone marrow
depression with
antineoplastics.
Decreased platelets
and granulocytes
Unlabeled uses:
Epstein-Barr virus
Hepatitis B
Mechanism of Action
Inhibit viral replication and prevents synthesis of DNA of the HIV virus
Advantages/Disadvantages
Does not cure AIDS but will control
symptoms: compliance with treatment
required.
Side Effects
Nausea/vomiting
Anorexia
Rash
Headache
Dyspepsia
Adverse Effects
Diarrhea
Flatulence
Flushing
Dizziness
Insomnia
Seizures
Hepatomegaly
Anemia/Granulocytopenia
Anaphylaxis
Nursing Interventions
Client Education
Monitor Vital signs and signs of bleeding problems
Monitor CBC, BUN and creatinine closely
Teach that GI complaints and insomnia resolve after 3-4
weeks of treatment.
Report symptoms of suprainfections
Teach to not take with OTC products like Tylenol or aspirin.
Reference: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Class: Broad Spectrum Antibiotics: Clindamycin
Agent(s)
Common Uses
Contraindications
Route
Clindamycin (Cleocin)
Oral/Skin Infections
Hypersensitivity
Pregnancy
Breast feeding
Hepatic Disease
PO
IM
IV
Topical
Onset of Action
Interactions
Blocked by
erythromycin,
chloramphenicol.
Decreases absorption
of kaolin.
Mechanism of Action
Inhibition of bacterial protein synthesis. These drugs are bacteriostatic and suppress bacterial growth.
Advantages/Disadvantages
Can be used to treat MRSA
Side Effects
Dry mouth
Diarrhea
Abdominal cramping
Headache
Anorexia
Adverse Effects
Muscles cramps
Nausea/vomiting
Flushing
Rash
Pseudomembranous colitis
Stevens-Johson syndrome
Exfoliative dermatitis
Suprainfections
Nursing Interventions
Client Education
Culture before medication started for accurate results
Monitor Vital signs, urine output and stools
Monitor AST, ALT if on long term therapy
Assess for skin reactions frequently
Take with food to reduce GI upset
Complete entire course of medication
Take with full glass of water
Report any symptoms of suprainfections and extreme
diarrhea
Reference: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Class: Cephalosporins: 4 Generations
Agent(s)
Common Uses
Contraindications
Route
Onset of Action
Interactions
1st: cefazolin sodium
(Ancef); cephalexin
(Keflex
2nd: cefaclor (Ceclor)
3rd: cefixime (Suprax);
ceftriaxone (Rocephin)
4th: cefepime
(Maxipime)
Septicemia
UTI’s
Respiratory infections
Skin/bone infections
Hypersensitivity
PO
IM
IV
24-48 hours
Rapid
Some interact with
alcohol. Uricosurics
increase the excretion
rate of uric acid
and can decrease
the excretion of
cephalosporins
causing serum level
increase.
Mechanism of Action
Inhibit bacterial cell-wall synthesis and produce a bactericidal action.
Advantages/Disadvantages
Usually well tolerated when other
antibiotics cannot be administered
Frequent cross hypersensitivity to penicillins
Side Effects
Nausea/vomiting
Anorexia
Rash
Headache
Dyspepsia
Adverse Effects
Diarrhea
Flatulence
Flushing
Dizziness
Increased bleeding
Nephrotoxicity
Seizures
Anaphylaxis
Leukopenia/Neutropenia
Nursing Interventions
Client Education
Culture the infected area before medications are started.
Monitor for adverse reactions and/or super infections
Keep drugs out of reach of children
Report sign of superinfections like mouth ulcers or
anal discharge
Advise use of probiotics when taking medications.
Take medications with food if GI upset occurs.
Reference: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Class: Fluoroquinolones
Agent(s)
Common Uses
Contraindications
Route
Onset of Action
Interactions
Ciprofloxacin
(Cipro,Septra)
Gatifloxacin ( equin,
Zymar)
Levofloxacin (Levaquin
Moxifloxacin ( velox)
Broad spectrum
antibiotic
Anthrax
Respiratory infections
Cystic Fibrosis
Hypersensitivity
Pregnancy
Infants and young
children
PO
IV
Topical
Rapid
Antacids, minerals and multivitamins
interfere with absorption.
Concurrent use with amiodarone,
disopyramide. Erythromycin,
some antipsychotics and tricyclic
antidepressants increases risk of
torsade de pointes in susceptible
individuals. Concurrent use with
corticosteroids may increase risk of
tendon rupture.
Mechanism of Action
Prevention of bacterial DNA from duplication.
Advantages/Disadvantages
Used in the treatment of infectious
diseases in adults.
Side Effects
Adverse Effects
Diarrhea Nausea/vomiting,
Abdominal pain
Dizziness
Drowsiness
Sleep problems Headache
Suprainfection
Phototoxicity
Cardiotoxicity
Tendon/joint toxicity (associated with a small risk of
tendon rupture
Nursing Interventions
Client Education
Monitor I&O
Monitor BUN and creatinine levels
Store medication away from heat, moisture, and direct sunlight
Take with a full glass of water. Do not take on an empty stomach.
Notify primary healthcare provider of swelling of the face and
throat, swallowing problems, shortness of breath, rapid heartbeat,
tingling of fingers or toes, itching or hives.
Stop taking the medicine immediately if swelling in tendon occurs.
Avoid being in direct sunlight and use a sunscreen; do not use
tanning beds.
Do not take antacids that contain aluminum, calcium or magnesium
Reference: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Class: Macrolides
Agent(s)
Common Uses
Contraindications
Route
Onset of Action
Interactions
Azithromycin (Z-Pak,
Zithromax)
Clarithromycin (Biaxin)
Erythromycin (Erythrocin)
Broad-spectrum
Antibiotic for
Pneumonia, pertussis,
diphtheria, chlamydia,
Group A strep
infections.
Hepatic disease
Hypersensitivity
PO
IM
IV
Topical
24 hours
Rapid
Increases the plasma levels of
theophylline, carbamazepine,
and warfarin. Conversely,
plasma levels of erythromycin
can be reduced when used
with verapamil, diltiazem,
HIV protease inhibitors
and azole antifungal
drugs. Contraindicated
with astemizole, cisapride,
pimozide or terfenadine.
Mechanism of Action
Inhibition of bacterial protein synthesis. These drugs are bacteriostatic and suppress bacterial growth and replication but do not
cause microbial death.
Advantages/Disadvantages
Good alternative for clients with penicillin
allergies.
Side Effects
Adverse Effects
Nausea/vomiting
Diarrhea
Abdominal pain
Suprainfections
Hepatotoxicity
Dysrhythmias (prolonged Q-T interval)
Ototoxicity
Anaphylaxis
Pseudomembranous colitis
Nursing Interventions
Client Education
Administer on an empty stomach -destroyed by gastric acids and acidic
fruit juice.
Notify primary health care provider if prolonged diarrhea
occurs.
For capsule administration, take 1-2 hours before meals.
Direct sunlight (UV) exposure should be minimized during
therapy.
Reference: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Class: Non-HIV Antivirals
Agent(s)
Common Uses
Contraindications
Route
Rimantacine HCL
(Flumadine)
Oseltamivir phosophate
(Tamiflu
Acyclovir (Zovirax)
Influenz
Herpes viruses
Cytomegalovirus
(CMV)
Hypersensitivity
Pregnancy
Hepatic disease
PO
IV
Topical
Onset of Action
Rapid
Interactions
Decreases effect of
phenytoin. Increases
nephro-neurotoxicity
with aminoglycosides,
probenecid and
interferon.
Mechanism of Action
Inhibit viral replication by interferring with viral cell synthesis
Advantages/Disadvantages
Cannot stop the viral infection but will
reduce the severity of symtoms and length
of infection.
Side Effects
Nausea/vomiting
Diarrhea
Agitation
Rash
Adverse Effects
Anorexia
Headache
Lethargy
Pruritis
Anemia
Crystalluria
Nephrotoxicity
Thrombocytopenia
Leukopenia
Nursing Interventions
Client Education
Monitor Vital signs and urine output closely
Monitor CBC, BUN, creatinine and liver enzymes
Increase fluid intake to 1500-2000 mL per da
Assess gums for bleeding
Teach proper hydration while taking medications
Report changes in urine output or signs of bleeding
Report CNS changes and safety related to orthostatic
hypotension
Reference: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Class: Penicillin
Agent(s)
Common Uses
Contraindications
Ampicillin (Principen),
Amoxicillin (Amoxil, Trimox),
Penicillin G (Bicillin), Penicillin V
(PenVK), Ampicillin/Sulbactam
(Unasyn), Amoxicillin/
Clavulanate (Augmentin),
Ticarcillin (Ticar), Peperacillin/
Tazobactam (Zosyn)
Meningitis
Gram (+) infections
Respiratory infections
Endocarditis
Septicemia
Otitis media
GI infections
GU infections
Hypersensitivity to
penicillin
Route
PO
IM
IV
Onset of Action
Interactions
Rapid
Rapid
Rapid
Give separately
from
aminoglycosides:
May inactivate
medication.
Mechanism of Action
Interferes with cell wall replication of susceptible organisms.
Advantages/Disadvantages
Generally, well tolerated
Monitor use in renal clients.
5-15% incidence of cross-sensitivity to
Cephalosporins.
Side Effects
Adverse Effects
Mild rash
Nausea/vomiting
Diarrhea
Stomatitis
Vaginitis
Anaphylaxis
Glomerulonephritis
Bone marrow depression
Leukopenia
Nursing Interventions
Client Education
Administer with water, not acidic juices.
Administer around the clock on empty stomach for better absorption.
I&O
Monitor CBC
Take medication with plenty of water 1-2 hours before
meals or 2-3 hours after meals).
Report sore throat, fever, fatigue, diarrhea as they may
indicate superinfection.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Sulfonamides
Agent(s)
Common Uses
Contraindications
Route
Onset of Action
Interactions
Trimethoprim/
Sulfamethoxazole
(Bactrim, Septra)
Sulfisoxazole (Gantrisin
UTI’s
Ear infections
Newborn eye
prophylaxis
Respiratory
infections
Hypersensitivity
Pregnancy
PO
IV
Topical
30-60 minutes
Rapid
Risk of
thrombocytopenia
with thiazide diuretics;
hyperkalemia with
other diuretics
Mechanism of Action
Bacteriostatic - inhibit bacterial synthesis of folic acid which is essential for bacterial growth.
Advantages/Disadvantages
Good for clients with penicillin allergy.
Side Effects
Nausea/vomiting
Anorexia
Rash
Headache
Dyspepsia
Adverse Effects
Diarrhea
Crystalluria
Flushing
Dizziness
Photosensitivity
Nephrotoxicity
Hyperkalemia
Stevens-Johnson syndrome
Anaphylaxis
Nursing Interventions
Client Education
Increase fluids to 2000-3000 mL per da
Assess I&O, BUN and creatinine regularly
Monitor Vital signs closely
Assess for early signs of anemia or superinfections
Drink lots of fluid daily when taking me ications
Take 1 hour before or 2 hours after meals
Wear sunglasses and avoid direct sunlight
Report any excess bruising or bleeding
Reference: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Class: Tetracyclines
Agent(s)
Common Uses
Contraindications
Route
Onset of Action
Interactions
Doxycycline (Vibramycin)
Tetracycline (Sumycin)
Broad spectrum use
Respiratory infections
Skin infections
STD/STI’s
Hypersensitivity
Pregnancy
Hepatic/Renal disease
PO
IM
IV
1-2 hours
Rapid
Do not take with antacids
or calcium products
Mechanism of Action
Bacteriostatic and inhibit protein synthesis.
Advantages/Disadvantages
Side Effects
Adverse Effects
Nausea/vomiting
Diarrhea
Abdominal pain
Stains teeth
Color vision changes
Nephrotoxicity
Hepatotoxicity
Suprainfections
Anaphylaxis
Severe Photosensitivity
Hyperglycemia
Nursing Interventions
Client Education
Monitor Vital signs and urine output closely
Monitor liver and renal function lab tests
Avoid antacids and calcium products when taking medication
Teach whether medication prescribed should be taken
with food or without and time frame for best absorption.
Avoid sun and use sunglasses
Do not take with milk products, iron or antacids
Take liquid forms via straw to prevent staining of teeth
Reference: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Class: Alkylating Agents (Chemotherapy)
Agent(s)
Common Uses
Contraindications
Route/Dosage
Onset of Action
Interactions
Cyclophosphamide
(Cytoxan)
Breast cancer
Leukemia
Lymphoma
Hodgkin Disease
Multiple myeloma
Hypersensitivity
Myelosuppression
Pregnancy
Liver or kidney disease
PO
7 days
Garlic and ginko
increase antiplatelet
effect. Echinacea
decreases effects of
immunosuppressive drugs.
Ginseng and kava kava
alters bleeding times.
IV
Mechanism of Action
Directly damages DNA (the genetic material in each cell) to keep the cell from reproducing. These drugs work in all phases of the cell cycle.
Advantages/Disadvantages
Especially useful for Hodgins’s disease if
resistant to other drug combinations.
Severe vesicant that can cause tissue
necrosis if it infi trates into the tissues.
Can cause long term damage to the
bone marrow.
Side Effects
Nausea
Diarrhea
Hematuria
Impotence
Ovarian fib osis
Dizziness
Adverse Effects
Vomiting
Weight loss
Alopecia
Sterility
Headache
Leukemia
Vesicant: Tissue necrosis
Hemorrhagic cystitis
Cardiotoxicity
Hepatotoxicity
Nursing Interventions
Client Education
Monitor IV site for extravasation: Cold compresses
Assess need for IV hydration. The client should be well hydrated
(2L/day) to prevent hemorrhagic cystitis.
Observe for s/s of hematuria.
Monitor BUN and creatinine
Avoid direct skin, eye, and mucus membrane contact with drug
Take medication early in the day to prevent accumulation of
drug in the bladder.
Report signs of infection.
Do not visit anyone who has a respiratory infection
Emphasize protective precautions.
Rationale for chemotherapy.
Teach importance of birth control while receiving therapy
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Anthracyclines (Chemotherapy)
Agent(s)
Common Uses
Contraindications
Route/Dosage
Onset of Action
Interactions
Doxorubicin
(Adriamycin)
Breast cancer
Ovarian cancer
Lung cancer
Bladder cancer
Leukemia
Pregnancy
Severe cardiac
disease
IV
7-10 days
Calcium channel
blockers increase risk of
cardiotoxicity.
Green tea may enhance
effects.
Garlic, St John’s wart
may decrease effects of
chemo
Mechanism of Action
These drugs are not like the antibiotics used to treat infections. They work by altering the DNA inside cancer cells to keep them
from growing and multiplying.
anti-tumor antibiotics that interfere with enzymes involved in DNA replication. These drugs work in all phases of the cell cycle.
They are widely used for a variety of cancers.
Advantages/Disadvantages
Severe cardiotoxic side effects can occur.
Potent vesicant.
Cannot exceed lifetime dose of 550mg/m2
Side Effects
Stomatitis
Nausea/Vomiting
Diarrhea
Rash
Alopecia
Adverse Effects
Anorexia
Vesicant
Esophagitis
Thrombocytopenia
Cardiotoxicity
Anaphylaxis
Anemia
CHF
Nursing Interventions
Client Education
Give through large bore IV needle.
Monitor IV site for extravasation: Apply ice pack. Notify MD.
Dexrazoxan IV.
Assess cardiac status.
Signs/symptoms of cardiac dysfunction
Drug causes urine to turn pink or red
Report signs of infection or bleeding
Protective precautions
Do not visit anyone with a respiratory infection
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Anti-Estrogens (Hormone Therapy)
Agent(s)
Common Uses
Contraindications
Tamoxifen (Nolvadex)
Palliative treatment
of advanced breast
cancer positive
lymph nodes in
postmenopausal
women
Pregnancy
Breastfeeding
Hypersensitivity
Route
Onset of Action
Interactions
Increased risk of
bleeding with
anticoagulants
PO
Mechanism of Action
This male hormone (androgen) promotes regression of tumors by competing with estradiol at estrogen receptor sites. Decreases
DNA synthesis. Reduces risk of breast cancer in postmenopausal women.
Advantages/Disadvantages
Prevents tumor recurrence in both
pre-menopausal and postmenopausal
women
Side Effects
Adverse Effects
Masculine secondary sexual characteristics.
Hot flashe
Irregular menses
Fatigue
Headaches
Impotence
Decreased interest in sexual activity.
Increases risk of developing uterine
cancer.
Stroke
Pulmonary embolism
Thrombocytopenia
Nursing Interventions
Client Education
Monitor CBC, platelet count weekly.
Monitor for allergic reactions.
Avoid use of St. John’s wart, dong qui, black cohosh.
Use nonhormonal contraception during and for 2 months
after discontinuing treatment.
Notify prescriber of signs of stroke.
Increase fluids to 2 iters/day unless contraindicated.
Protect from sun.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Antimetabolites (Chemotherapy)
Agent(s)
Common Uses
Contraindications
Route/Dosage
Onset of Action
Interactions
5-Fluorouracil (5-FU)
(Adrucil),
Leukemias
Breast cancer
Ovarian cancer
Intestinal tract cancer
Pregnancy
Severe infection
IV
1-9 days
Cimetidine increases
effect of F-FU
Methotrexate: ASA,
phenytoin increase
toxicity of the drug.
Methotrexate
(Rheumatrex)
IM
IV
Mechanism of Action
Interfere with DNA and RNA growth by substituting for the normal building blocks of RNA and DNA. These agents damage cells
during the S phase, when the cell’s chromosomes are being copied.
Methotrexate acts as a substitute for folic acid, which is needed for the synthesis of proteins and DNA.
Advantages/Disadvantages
Clients receiving methotrexate must
receive leucovorin calcium to “rescue”
normal cells from the adverse effects of
the drug.
Side Effects
Adverse Effects
Bone marrow suppression
Stomatitis
Nausea/Vomiting
Anorexia
Alopecia
Rash
Photosensitivity
Erythema
Hematic and renal dysfunction
Bone marrow suppression
Thrombocytopenia
Hemorrhage
Renal failure
Extravasation
Nursing Interventions
Client Education
Monitor IV site for extravasation: Apply ice pack. Notify MD.
Avoid direct skin contact with medication.
Administer antiemetic 30-60 minutes before therapy
I&O
Monitor blood counts. Encourage mouth rinses every 2 hours with
normal saline
Report signs of infection
Examine mouth daily/ report signs of stomatitis
Do not visit anyone with a respiratory infection
Use sunscreen when outdoors
Maintain protective precautions
Good oral care with soft toothbrush
Encourage small, frequent meals. Encourage cool, bland foods.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Gonadotropin-Releasing Hormone
Agent(s)
Common Uses
Contraindications
Route/Dosage
Onset of Action
Interactions
Leuprolide (Lupron),
Goserelin (Zoladex)
Advanced Breast
cancer
Prostate cancer
Pregnancy
Breastfeeding
IM
SubQ
1-2 weeks
Increased antineoplastic
action with megestrol.
Black cohosh may interfere
with treatment.
Mechanism of Action
Suppress the secretion of follicle-stimulating hormone and luteinizing hormone from the pituitary gland. Initially an increase in testosterone
levels is seen. However, with continued use the pituitary gland becomes insensitive to this stimulation, leading to a reduction in the production
of androgens and estrogens..
Advantages/Disadvantages
Side Effects
Memory impairment
Peripheral edema
Anorexia
Hot flashes
Nausea/vomiting
Adverse Effects
Depression
Alopecia
Diarrhea
Impotenc
Seizures
MI
PE
Dysrhythmias
GI bleeding
Nursing Interventions
Client Education
Assess for increased bone pain.
Monitor for allergic reaction.
Notify prescriber if menstruation continues – menstruation
should stop.
Bone pain should disappear after 1 week.
Monitor weight. Report weight gain of > 2 lbs (0.9 kg)/day.
How to administer SubQ/IM medication.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Plant Alkaloids - Mitotic Inhibitors (Chemotherapy)
Agent(s)
Common Uses
Contraindications
Route/Dosage
Paclitaxel (Taxol)
Breast cancer
Lung cancer
Myelomas
Lymphomas
Leukemias
Pregnancy
Hypersensitivity
IV
Onset of Action
Interactions
Increased bleeding
risk with NSAIDS,
anticoagulants
Mechanism of Action
Mitotic inhibitors are often plant alkaloids and other compounds derived from natural products. They work by stopping mitosis
in the M phase of the cell cycle but can damage cells in all phases by keeping enzymes from making proteins needed for cell
reproduction.
Advantages/Disadvantages
These medications can cause nerve
damage.
Side Effects
Adverse Effects
Peripheral neuropathy
Bradycardia
Nausea/Vomiting
Mucositis/stomatitis
Alopecia
Arthralgia
SVT
Neutropenia
Thrombocytopenia
Tissue necrosis
Pulmonary edema
Hypotension
Diarrhea
Leukopenia
Anemia
Nursing Interventions
Client Education
ECG monitoring.
Monitor for hypotension
Assess for paresthesias.
Premedicate with antiemetics.
VS during first
Monitor IV site for extravasation: Apply ice pack.
Report signs of infection: fever, sore throat, flu ike
symptoms.
Report signs of anemia: fatigue, headache, faintness, SOB,
irritability.
Report bleeding.
Bleeding precautions.
Avoid vaccinations.
Reference: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Class: Plant Alkaloids - Topoisomerase Inhibitor (Chemotherapy)
Agent(s)
Common Uses
Contraindications
Route/Dosage
Topotecan
(Hycamtin),
Irinotecan
(Camptosar, CPT-11)
Leukemia
Lung cancer
Ovarian cancer
GI cancer
Pregnancy
Breastfeeding
Bone marrow
depression
PO
Onset of Action
Interactions
Increased bleeding
risk with NSAIDS,
anticoagulants,
platelet inhibitors
IV
Mechanism of Action
These drugs interfere with enzymes called topoisomerases, which help separate the strands of DNA so they can be copied
during the S phase. (Enzymes are proteins that cause chemical reactions in living cells.)
Advantages/Disadvantages
Side Effects
Adverse Effects
Alopecia
Constipation
Diarrhea
Nausea
Vomiting
Damage peripheral nerve fiber
Motor instability
Leukopenia
Hypersensitivity
Neurotoxicity
Loss of DTRs
Bone marrow suppression
Nursing Interventions
Client Education
Monitor IV site for extravasation: Apply ice pack. Notify MD.
Assess liver and renal function studies.
Increase fluid intake to 2-3 L/day unless contrain icated.
Rinse mouth 3-4 times/day with water; Brush teeth with soft
toothbrush for stomatitis.
Teach that total alopecia may occur. Hair grows back but is
different in color and texture.
Avoid foods with citric acid or hot and rough texture if
stomatitis is present.
Avoid vaccines, toxoids.
Report signs of anemia: fatigue, headache, faintness, SOB,
irritability.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Platinum Drugs (Chemotherapy)
Agent(s)
Common Uses
Contraindications
Route/Dosage
Cisplatin
Advanced bladder
cancer
Metastatic testicular
cancer
Metastatic ovarian
cancer
Pregnancy
Breastfeeding
Preexisting hearing
impairment
Bone marrow suppression
IV
Onset of Action
Interactions
ASA, NSAIDS, Alcohol
increase bleeding risk.
Bumetanide, furosemide
increase ototoxicity risk.
Loop diuretics increase
nephrotoxicity risk.
Mechanism of Action
Alkylates DNA, RNA; Inhibits enzymes that allow for the synthesis of amino acids in proteins; activity not cell-cycle-phase specific
Advantages/Disadvantages
Less likely to cause leukemia later than
alkylating agents.
Extravasation can occur damaging
tissue
Side Effects
Tinnitus
Altered color perception
Diarrhea
Impotence
Alopecia
Adverse Effects
Blurred vision
N/V
Weight loss
Amenorrhea
Extravasation
Bone marrow depression
Renal toxicity
Bleeding
Ototoxicity
Nursing Interventions
Client Education
Monitor IV site for extravasation: Sodium Thiosulfate. Cold
compresses.
Monitor CBC, platelet count weekly. Hold drug for WBC < 4000 or
platelet <100,000.
Monitor BUN, creatinine.
Monitor for signs of anaphylaxis.
Monitor temperature q4h
Monitor for bleeding.
Increase fluid intake to 2-3 L/d to p event calculi and promote
elimination of medication.
Report s/s of infection.
Report s/s of anemia.
Report bleeding, bruising, petechiae
Bleeding precautions.
Report decreased urine output/flank pain
Do not receive vaccinations during treatment
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Seizures
Class: Progestins
Agent(s)
Common Uses
Contraindications
Medroxyprogesterone
acetate (Depo-Provera),
Megestrol acetate (Megace)
Breast cancer
Endometrial
carcinoma
Renal cancer
Stimulate appetite
Pregnancy
Hypersensitivity
Route
Onset of Action
Interactions
PO
Mechanism of Action
Act by shrinking the cancer tissues. Thought to bring about cell death
Advantages/Disadvantages
Megace stimulates appetite by unknown action.
Side Effects
Mood swings
Depression
Diarrhea
Flatus
Nausea/vomiting
Adverse Effects
Insomnia
Indigestion
Weight gain
Fluid retention
Thrombotic disorders
Nursing Interventions
Client Education
Assess PSA levels in men with prostate cancer.
Monitor for thrombophlebitis.
Report vaginal bleeding
Teach signs of fluid etention.
Monitor glucose if diabetic.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Selective Estrogen Receptor Modulators (SERMS)
Agent(s)
Common Uses
Contraindications
Raloxifen (Evista),
Toremifene (Fareston)
Breast cancer
prophylaxis in
postmenopausal
women
Pregnancy
Breastfeeding
Hypersensitivity
Route
Onset of Action
Interactions
Decrease action of
anticoagulants.
PO
Mechanism of Action
Act like antiestrogens to slow tumor growth, but have fewer side effects than tamoxifen.
Advantages/Disadvantages
Fewer side effects than tamoxifen
Side Effects
Insomnia
Hot flashes
N/V
Dyspepsia
Weight gain
Adverse Effects
Depression
Peripheral edem
Diarrhea
Vaginitis
Stroke
Thromboembolism
Pulmonary embolism
Nursing Interventions
Client Education
Bone density test at baseline and throughout treatment.
Take calcium supplements, Vitamin D if intake is inadequate.
Increase exercise with weights.
Report fever, acute migraine, emotional distress.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Alpha2-Adrenergic Agonists
Agent(s)
Common Uses
Contraindications
Clonidine (Catapres)
Methyldopa
(Aldomet)
Hypertension
Management of
opioid withdrawal
Narrow-angle
Glaucoma
Cardiogenic Shock
Dysrhythmias
Route
Onset of Action
Interactions
PO
30 min - 2 hours
Transdermal
patch
(Clonidine)
2-3 days
Do not give with Beta
Blockers – accentuates
bradycardia and rebound
hypertension of therapy
discontinuation.
Mechanism of Action
Decreases the release of norepinephrine from sympathetic nerves and decreases peripheral adrenergic receptor activation.
Produce vasodilation which decreases blood pressure.
Advantages/Disadvantages
Methyldopa can be used in PIH
Can cause sodium and water retention.
Often given with diuretics for this reason.
Side Effects
Adverse Effects
Sedation
Dizziness
Headache
Nausea/Vomiting
Urinary retention
Dry mouth
Orthostatic hypotension
Pulmonary edema
Dyspnea
Nursing Interventions
Client Education
Monitor vital signs
Monitor liver enzymes
I&O
Daily weight
Do not stop abruptly: rebound hypertension can occur.
Instruct on how to take BP
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Angiotensin-converting Enzyme (ACE) Inhibitors
Agent(s)
Common Uses
Contraindications
Captopril (Capoten),
Enalapril (Vasotec),
Lisinopril (Zestril,
Prinivil),
Moexipril (Univasc),
Ramipril (Altace)
DOC for Heart failure
Hypertension
MI
Do not give during
pregnancy
Route
Onset of Action
Interactions
PO
1-2 hours
IV
15-30 minutes
Hyperkalemia can result if
taken in combination with
potassium-sparing diuretics
or eating salt substitutes.
Mechanism of Action
Suppress the Renin Angiotensin System (RAS). Prevents the conversion of Angiotensin I to Angiotensin II. This results in arterial
dilation and increased stroke volume. ACE inhibitors block aldosterone so the client loses sodium and water and retains potassium.
Advantages/Disadvantages
Effective in treating heart failure.
African Americans and older adults do
not respond to ACE inhibitors with the
desired reduction in blood pressure
without the addition of a diuretic.
Side Effects
Adverse Effects
Dizziness
Hyperkalemia
Hypermagnesemia
Fatigue
Headache
Dry, nonproductive cough
Angioedema
Orthostatic hypotension
Nursing Interventions
Client Education
Monitor BP and HR.
Monitor potassium and magnesium levels.
Initiate safety precautions.
Rise slowly from lying or sitting to standing position.
Safety precautions.
Can be administered with food (EXCEPT: Moexipril)
Do not use salt substitutes with potassium.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Angiotensin II Receptor Blockers (ARBS)
Agent(s)
Common Uses
Contraindications
Losartan (Cozaar),
Olmesartan (Benicar),
Valsartan (Diovan)
Hypertension
Heart Failure
Pregnancy
Route
PO
Onset of Action
Interactions
2 hours
MAOIs, alcohol,
diuretics may increase
hypotensive effects.
ACE inhibitors and
ASA may increase
hyperkalemia and renal
dysfunction.
Mechanism of Action
Prevent the release of aldosterone. They act on the renin-angiotensin system (RAS). ARBS block angiotensin II from the
angiotensin I receptors found in tissue. Potent vasodilator. Decreases peripheral resistance. Decrease the workload of the heart by
decreasing afterload. This will increase cardiac output and keep blood moving forward out of the heart.
Advantages/Disadvantages
Do not cause the constant, irritating dry
cough that ACE inhibitors do.
Less effective for treating hypertension in
African-American clients.
Side Effects
Adverse Effects
Headache
Dizziness
Drowsiness
GI complaints
Fatigue
Orthostatic hypotension
Hypoglycemia
Hyperkalemia
Renal dysfunction
Angioedema
Nursing Interventions
Client Education
Monitor BP and HR.
Monitor AST, ALT, BUN, Creatinine.
Rise slowly from lying and sitting position to standing position.
Safety precautions.
Can be taken on empty or full stomach.
Do not use salt substitutes.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Antianginal / Nitrates
Agent(s)
Common Uses
Contraindications
Nitroglycerin
(Nitrostat, Nitro-Bid)
Isosorbide (Isordil)
Angina
MI
Pulmonary
edema
Pre-existing
Hypertension
Head trauma
Increased ICP
Pericardial tamponade
Route
SL – 1 tab every
5 min. up to 3
doses.
Tablet
Spray
Onset of Action
Interactions
SL /IV – 1-3 min
PO – 20-30 min
Ointment – 20-60 min
Transdermal – 30-60
min
Enhance hypotensive
effects: Beta blockers,
Calcium channel blockers,
Vasodilators, Alcohol,
Erectile dysfunction meds
May antagonize effects of
Heparin: IV nitroglycerin
Mechanism of Action
Acts directly on the smooth muscle of venous and arterial blood vessels, causing relaxation and dilation. Dilates coronary arteries. Sublingual
administration rapidly absorbs into the internal jugular vein and right atrium. IV nitroglycerin vasodilates the client to decrease afterload which
increases cardiac output, so that more blood can be pumped forward.
Advantages/Disadvantages
Decreases preload, afterload, and
workload of the heart
Increases blood flow to heart muscl
Reduces myocardial oxygen demand
Side Effects
Adverse Effects
Headache
Faintness/Syncope
Nausea/vomiting
Dizziness
Flushing
Palpitations
Diaphoresis
Tolerance
Contact dermatitis with topical
Hypotension
Reflex achycardia
Paradoxical Bradycardia
Circulatory Collapse
Nursing Interventions
Client Education
Monitor Blood pressure.
Do not leave client until BP stabilizes.
Assess cardiac output.
Evaluate pain relief.
Safety precautions.
Maintain adequate hydration.
IV: Use a pump; hold for systolic BP < 100
Activate EMS if pain unrelieved after taking 1 tab SL or spray.
Do not swallow SL nitro.
Keep in dark, glass bottle.
Do not mix medications in bottle with nitroglycerin.
Do not open bottle frequently.
Keep dry and cool.
May or may not burn or fizz in mou h.
Renew every 3-5 months; 2 years of spray.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Antidysrhythmic Class III
Agent(s)
Common Uses
Contraindications
Amiodarone
(Cordarone)
Used when V-fib
and pulseless V-tach
are resistant to a
vasopressor and
defibri lation.
Fast arrhythmias.
Cardiogenic shock
2nd degree heart block
3rd degree heart block
Iodine allergy
Route
IV
Onset of Action
Interactions
Rapid
MAOIs-hyperpyretic
crisis, seizures.
PO
Mechanism of Action
Prolongs duration of action potential and refractory period to decrease heart rate. Decreases peripheral vascular resistance and
increases PR and QT intervals. First antiarrhythmic of choice.
Advantages/Disadvantages
Very little negative inotropic activity
making it advantageous for use in clients
with heart failure.
Potentially serious side effects requiring
careful monitoring.
Side Effects
Adverse Effects
Photophobia
Weakness
Skin discoloration
Tremors
Impaired thinking/reactions
Hypotension
Difficu ty breathing
Chest pain
Vision loss
Bradycardia
Wheezing
Light-headed
Jaundice
Nursing Interventions
Client Education
IV: Continuous ECG monitoring and BP monitoring
PO: Assess BP lying, standing. If systolic BP drops 20 mmHg, hold.
Monitor Hepatic studies: AST, ALT, bilirubin.
Do not skip a dose or discontinue abruptly.
Do not take with grapefruit juice.
Use sunscreen or stay out of sun to prevent burns.
Dark glasses may be needed for photophobia.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Antidysrhythmic Class Ib
Agent(s)
Common Uses
Contraindications
Lidocaine
(Xylocaine)
Frequent PVCs
Ventricular tachycardia
Alternative antiarrhythmic agent to
amiodarone in the treatment of cardiac
arrest secondary to VF or pulseless
VT resistant to CPR, cardioversion
(after 2 to 3 shocks) and a vasopressor
(epinephrine).
Adams-Stokes
syndrome
Heart block
Route
IV
Onset of Action
Interactions
45-90 seconds
Lidocaine toxicity
– cimetidine, beta
blockers.
Decrease
lidocaine effects
– barbiturates,
ciprofloxaci
Mechanism of Action
Decreases irritability of the heart muscle. Increases electrical stimulation threshold of ventricles, which stabilizes cardiac
membrane and decreases automaticity.
Advantages/Disadvantages
Severe adverse effects from lidocaine toxicity
Side Effects
Adverse Effects
Headache
Dizziness
Drowsiness
Blurred vision
Phlebitis
Heart block
Seizures
CNS depression
Respiratory depression
Malignant hyperthermia
Lidocaine toxicity
Nursing Interventions
Client Education
Administer IVP at a rate of 25-50 mg/minute. Monitor lidocaine blood levels.
Continuous ECG monitoring. Observe for prolonged PR interval and QRS
complex.
Have resuscitative equipment readily available.
Watch for malignant hyperthermia: tachypnea, tachycardia, changes in BP,
increased temperature.
Monitor for signs of toxicity (hearing impairment, muscle twitching, confusion,
seizures).
About the use of lidocaine.
Report signs of toxicity (hearing impairment,
muscle twitching, confusion)
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Anti-hypertensive / Beta-Adrenergic Blockers (Beta Blockers)
Agent(s)
Common Uses
Contraindications
Atenolol (Tenormin)
Metoprolol
(Lopressor)
Propranolol (Inderal)
Carvedilol (Coreg)
Hypertension
Angina
Dysrhythmias
MI
Unlabeled Use:
Migraines;
Tachycardia due to
stage fright.
2nd & 3rd degree Heart block
Cardiogenic shock
Hypotension
Acute Heart Failure
Sinus Bradycardia
Route
PO
IV
Onset of Action
Interactions
PO - 15 minutes
IV - Immediate
Digitalis worsens bradycardia.
Other antihypertensives and
alcohol worsen htn.
NSAIDS, Licorice, ma-haung,
ephedra decrease effect
of beta blockers causing
hypertension.
Black cohosh, Hawthorn,
Parsley, Goldenseal increase
hypotensive effect.
Mechanism of Action
Blocks beta receptor cells (catecholamines) to decrease vascular resistance, decrease BP, decrease HR, decrease myocardial
contractility, decrease workload of the heart, decrease cardiac output, decrease renin release.
Advantages/Disadvantages
Well tolerated in low doses.
African Americans do not respond well
to Beta Blockers alone for control of
HTN. Use in conjunction with diuretics
Side Effects
Blurred vision
Nasal stuffiness
Sexual dysfunction
Weakness
Lethargy
Diarrhea
Depression
Adverse Effects
Mental changes
Photosensi ivity
Fatigue
Dizziness
Nausea/ Vomiting
Headache
Insomnia
Bradycardia
Hypotension
2nd & 3rd degree Heart block
Thrombocytopenia
Bronchospasm
Wheezing
Nursing Interventions
Client Education
Monitor for increased BUN, Creatinine, AST, LDH, Glucose.
Do not discontinue abruptly: Rebound HTN, angina, dysrhythmias, MI
can result.
Monitor BP & pulse.
Hold for HR < 60 / min.
Teach how to take radial pulse and BP.
Rise slowly to prevent postural hypotension.
May cause sexual dysfunction.
Report constipation: Eat foods high in fibe .
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Calcium Antagonists / Calcium Channel Blockers
Agent(s)
Common Uses
Contraindications
Amlodipine
(Norvasc), Diltiazem
(Cardizem),
Ranolazine (Ranexa)
Angina
Hypertension
Dysrhythmias
Migraines
Raynaud’s Disease
Heart Block
Hypotension
Severe heart failure
Route
PO
IV
Onset of Action
Interactions
10-30 minutes
3 minutes
Increased levels of digitalis,
theophylline.
Decreased effects of lithium.
Increased hypotensive
effects with grapefruit juice.
Mechanism of Action
Blocks the calcium channel in the vascular smooth muscle cells. This causes vasodilation of the arterial system to decrease arterial
resistance and decrease blood pressure. This decreases afterload, which decreases the workload of the heart. These medications
dilate the coronary arteries so more oxygen reaches the heart muscle.
Advantages/Disadvantages
Decreases afterload and increases
oxygen to the heart muscle.
Decreases BP better in African
Americans than drugs in other categories
Side Effects
GI upset
Dermatitis
Headache
Need to reduce dose with known liver
disease
Adverse Effects
Ankle edema
Flushing
Dizziness
Bradycardia
Reflex achycardia
Heart Block
Hypotension
Dyspnea
Wheezing
Nursing Interventions
Client Education
Taper dose: Do not discontinue abruptly.
Monitor BP, HR – Notify PHCP for HR < 50 or Systolic BP < 90.
Monitor for increased AST, ALT, Alk phosphatase, BUN, Creatinine,
and cholesterol.
Do not stop taking abruptly. Rise slowly.
Increase fluids and fiber to counteract con ipation.
Teach how to take pulse and BP.
Avoid hazardous activities until dizziness is no longer a
problem. Avoid grapefruit products.
Report chest pain, palpitations, irregular heart rate, swelling
of extremities, tremor
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Cardiac Glycosides
Agent(s)
Common Uses
Contraindications
Digoxin (Lanoxin,
Digitek)
Heart failure
Atrial fibri lation
Ventricular
dysrhythmias.
Heart blocks
Route
Onset of Action
Interactions
PO
30 min-2 hours.
IV
5-30 min.
Loop diuretics can cause
hypokalemia and dig toxicity.
Ginseng may elevate digoxin
levels
St John’s wort decreases
absorption of digoxin.
Decrease dig absorption with
antacids.
Mechanism of Action
Promotes increased force of cardiac contraction, cardiac output, and tissue perfusion. Decreases ventricular rate. So heart
contraction is stronger, heart rate slows down. This allows more blood to be ejected out of the ventricles in a forward
direction.
Advantages/Disadvantages
Can cause digoxin toxicity. elderly are
more prone to dig toxicity
Side Effects
Adverse Effects
Headache
Dizziness
Dig toxicity: anorexia, n/v, weird arrhythmias,
vision changes.
Heart block
Nursing Interventions
Client Education
Monitor Digoxin level (Normal 0.5-2 ng/mL)
Monitor potassium (Low K+ can increase risk for dig toxicity)
Monitor apical pulse. Hold dig for HR < 60 bpm in adults.
Administer IV dose slowly over 5 minutes.
Monitor for signs of dig toxicity: anorexia, nausea/vomiting, weird
arrhythmias, vision changes.
Antidote: Digoxin immune Fab (Digibind)
Teach client how to take pulse.
Teach the signs of dig toxicity.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Catecholamine
Agent(s)
Common Uses
Contraindications
Norepinephrine
(Levophed)
Shock
Acute hypotension
Hypersensitivity
Tachy dysrhythmias
Pheochromocytoma
Hypovolemia
Route
IV
Onset of Action
Interactions
1-2 minutes
Increase pressor effect
with tricyclics, MAOIs.
Decreased
norepinephrine action
with alpha blockers.
Mechanism of Action
Potent vasoconstrictor action (alpha-adrenergic effect). It is used in shock states, often when drugs such as dopamine and
dobutamine have failed to produce adequate blood pressure. Causes increased contractility and heart rate by acting on beta
receptors of the heart.
Advantages/Disadvantages
Has potential to impair cardiac
performance and decrease organ and
tissue perfusion.
Side Effects
Headache
Dizziness
Tremor
Nausea/vomiting
Adverse Effects
Anxiety
Insomnia
Palpitations
Myocardial ischemia/Dysrhythmias
Impaired organ perfusion
Tissue necrosis with extravasation.
Cerebral hemorrhage
Anaphylaxis
Nursing Interventions
Client Education
Correct hypovolemia prior to use.
Continuous cardiac monitoring.
Precise blood pressure monitoring and HR every 2-3 min.
Taper drug slowly as abrupt discontinuation can result in severe
hypotension.
Monitor IV site for extravasation frequently. If extravasation occurs,
inject with phentolamine.
I&O
Reason for drug administration
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Direct Acting Vasodilators
Agent(s)
Common Uses
Contraindications
Hydralazine
(Apresoline)
Nitroprusside
(Nipride)
Hypertension
Hypertensive crisis
Severe heart failure
Acute MI with
hypertension and
persistent chest pain and
/or left ventricular failure
Systemic Lupus
Severe tachycardia
with heart failure
Route
Onset of Action
Interactions
PO
20-30 min
IV
Rapid
Increase antihypertensive
effects: ACE inhibitors,
vasodilators, diuretics,
alcohol, MAOIs, tricyclic
antidepressants,
hawthorn.
Mechanism of Action
Relaxes smooth muscles of the blood vessels, mainly arteries, causing vasodilation. Promotes an increase in blood flow to he
brain and kidneys.
Advantages/Disadvantages
Nitroprusside is a potent vasodilator that
rapidly decreases BP in hypertensive crisis.
Adverse effects eliminate use of these drugs
as drug of choice.
Side Effects
Adverse Effects
Headache
Dizziness
Hyperglycemia
Sodium and water retention
Peripheral edema
Reflex tachyca dia
Hypotension
Rebound hypertension
Nursing Interventions
Client Education
Monitor vital signs, I&O, glucose.
Daily weight
Nitroprusside: Monitor BP frequently with continuous cardiac
monitoring.
Purpose of medication
Safety precautions
Move slowly from lying or sitting to standing position.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Direct Vasodilators
Agent(s)
Common Uses
Contraindications
Nesiritide (Natrecor)
Acute treatment of heart
failure in clients with
dyspnea at rest
and/or minimal activity.
Valvular stenosis
Cardiomyopathy
Pericardial tamponade
Route
IV
Onset of Action
Interactions
15 minutes
Mechanism of Action
An atrial natriuretic peptide hormone that inhibits antidiuretic hormone by increasing urine sodium loss. Vasodilates veins and
arteries. Has a diuretic effect.
Advantages/Disadvantages
Useful for clients decompensating from
acute heart failure
Side Effects
Adverse Effects
Headache
Dizziness
Nausea/Vomiting
Hypotension
Irregular HR
Chest pain
Fever
Unusual weakness
For short term IV use only: up to 48 hrs.
Nephrotoxic
Nursing Interventions
Client Education
Monitor creatinine level
Monitor vital signs, hourly urine output
ECG monitoring
Daily weight
Monitor for allergic reaction (rash, pruritus, laryngeal edema, wheezing).
Purpose of medication
Report s/s of allergic reaction.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Oxygen
Agent(s)
Common Uses
Contraindications
Oxygen
Hypoxemia
Severe anemia
Carbon monoxide
poisoning
Shock
Heart failure
Use cautiously in clients
who have lost hypoxic
respiratory drive.
However, never deny
oxygen to someone who
needs it.
Route
Onset of Action
Interactions
NC
Face mask
Non-rebreather face
mask
ET
CPAP/BiPAP
Mechanism of Action
Inadequate oxygenation produces hypoxemia and significant physiologic changes to a l body systems, therefor oxygen is a
first- ine drug for all emergency situations. Oxygen also acts as a potent pulmonary vasodilator and is beneficial for c ients in
heart failure.
Advantages/Disadvantages
An FiO2 above 50% for a prolonged
period can lead to oxygen toxicity and
detrimental effects to the pulmonary
system.
Side Effects
Adverse Effects
Dry or bloody nose
Skin irritation
Morning headaches
Fatigue
Oxygen toxicity
ET: mucus plugs, tracheal injury, infection, ET
misplacement
Nursing Interventions
Client Education
Make sure that the client’s airway and breathing are adequate to
promote optimal oxygenation and ventilation.
Monitor pulse oximetry. Optimal oxygen saturation is at or above
94%.
Notify primary healthcare provider for oxygen saturation less than
90%.
Purpose of oxygen therapy.
Fire risk: Do not smoke or have open flame a ound oxygen
source.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Phosphodiesterase Inhibitors
Agent(s)
Common Uses
Contraindications
Milrinone (Primacor)
Inamrinone (Inocor)
Short term
management of heart
failure
Acute MI
Severe pulmonic
valvular disease
Route
IV (no longer
than 48-72
hours)
Onset of Action
Interactions
2-5 minutes
Increased effect with
other antihypertensives
and diuretics
Mechanism of Action
Inhibits the enzyme phosphodiesterase, promoting a positive inotropic response and vasodilation. Stroke volume and cardiac
output are increased.
Advantages/Disadvantages
Do to risk of toxicity these medications
are generally reserved for clients who
do not respond to cardiac glycosides or
ACE inhibitors.
Side Effects
Adverse Effects
Headache
NauseaVomiting
Anorexia
Ventricular arrhythmias
Hypotension
Chest pain
Thrombocytopenia
Nursing Interventions
Client Education
Continuous cardiac monitoring. BP & pulse every 5 minutes
I&O
Daily weight
Monitor electrolytes, liver function
Purpose of medication
Report angina immediately.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Sympathomimetic with Beta Adrenergic activities
Agent(s)
Common Uses
Contraindications
Dobutamine
(Dobutrex)
Shock
Hypersensitivity
Aortic stenosis
Route
IV
Onset of Action
Interactions
1-2 minutes
Increased pressor effect
and dysrhythmias with
tricyclics, MAOIs.
Mechanism of Action
The beta1 effects enhance the force of myocardial contraction (positive inotropic effect) and increasing heart rate (positive
chronotropic effect). The beta 2 effects produce mild vasodilation
Advantages/Disadvantages
Blood pressure is elevated only through
the increase in cardiac output.
Side Effects
Headache
Tremors
Dizziness
Palpitations
Adverse Effects
Nausea
Anxiety
Fatigue
Dose related:
Myocardial ischemia
Tachycardia
Hypotension
Hypokalemia
Nursing Interventions
Client Education
Correct hypovolemia prior to use.
Usual IV dose is 2-20 mcg/kg/min. Administer via electronic infusion
pump for precision. Taper gradually to avoid clinical deterioration.
Continuous cardiac and blood pressure monitoring.
I&O
Monitor vital signs
Assess for signs of myocardial ischemia.
Continuous ECG monitoring
Reason for drug administration
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Dysrhythmias
Hypertension
Class: Vasopressor/Catecholamine
Agent(s)
Common Uses
Contraindications
Route
Epinephrine HCL
(Adrenalin)
Cardiac arrest
Asystole
V-fi
Acute asthmatic
attacks
Anaphylaxis
Closed-angle glaucoma
IVP in
cardiac
arrest
Onset of Action
Interactions
Rapid
Do not use with
MAOIs or tricyclics –
hypertensive crisis may
occur.
Mechanism of Action
Vasoconstriction effects: epinephrine binds directly to alpha-1 adrenergic receptors of the blood vessels (arteries and veins)
causing direct vasoconstriction, thus, improving perfusion pressure to the brain and heart.
Cardiac Output: epinephrine also binds to beta-1-adrenergic receptors of the heart. This indirectly improves cardiac output by
increasing heart rate, heart muscle contractility, and conductivity through the AV node
Advantages/Disadvantages
Used to stimulate the heart muscle.
Side Effects
Tremors
Headache
Dizziness
Adverse Effects
Palpitations
Hypertension
Nausea/Vomiting
Cerebral hemorrhage
bronchospasms
Nursing Interventions
Client Education
WARNING: Ensure that the correct concentration, 1:10,000 is
administered IV (Not 1:1,000)
Reason for medication during a code.
Elevate extremity for 10-20 seconds to facilitate drug delivery to the
central circulation.
Auscultate lungs
Monitor pulse, BP, respirations.
Continuous cardiac monitoring
Do not administer in same IV site as Sodium Bicarbonate.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Alcohol Deterrent
Agent(s)
Common Uses
Contraindications
Route
Acamprosate
(Campral)
Alcohol abstinence
management
Hypersensitivity
Creatinine clearance < 30 mL/min
Onset of Action
Interactions
Increase glucose,
bilirubin, uric acid.
Decrease Hgb/Hct,
platelets.
PO
Mechanism of Action
Not completely understood. Thought to lower neuronal excitability, centrally mediated.
Advantages/Disadvantages
Side Effects
Anxiety
Dizziness
Insomnia
Chills
Rhinitis
Constipation
N/V
Adverse Effects
Depression
Headache
Tremors
Drowsiness
Anorexia
Diarrhea
Suicidal ideation
Dyspnea
Nursing Interventions
Client Education
Assess mental status for depression, abnormal thoughts, suicidal thoughts.
Obtain vital signs.
Evaluate therapeutic response.
Notify prescriber of depression, abnormal thoughts,
suicidal thoughts.
Do not engage in hazardous activities.
Do not drink alcohol while taking medication.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Aldehyde Dehydrogenase Inhibitor
Agent(s)
Common Uses
Contraindications
Disulfiram (Antabuse
Alcoholism
Myocardial disease
Psychoses
Pregnancy
Route
PO
Onset of Action
Interactions
2-12 hours
Severe unpleasant side effects when
taken with alcohol, or foods/ products
containing alcohol such as mouthwash,
cough medicine, cooking wine, vinegar.
Use with phenytoin can lead to phenytoin
intoxication.
Mechanism of Action
Disulfiram blocks he oxidation of alcohol. Blocks an enzyme that is involved in metabolizing alcohol intake. Disulfiram p oduces very
unpleasant side effects when combined with alcohol in the body.
Advantages/Disadvantages
Side Effects
Flushing
Increased thirst
Rapid weight gain
Severe vomiting
Blurred vision
Throbbing headache
Adverse Effects
Sweating
Swelling
Nausea
Confusion
Weakness
Allergic reaction: hives; difficu t breathing; swelling of your
face, lips, tongue, or throat.
Severe abdominal pain
Sudden vision loss
Optic neuritis/Peripheral neuritis
Hepatitis
Nursing Interventions
Client Education
Monitor liver function studies.
Assess for recent alcohol use. Do not administer for 12 hr
following alcohol ingestion.
If a severe disulfiram eaction occurs administer oxygen,
monitor ECG and serum potassium levels, and provide
supportive measures.
Monitor CBC and blood chemistry every 6 months during
therapy.
Do NOT drink alcohol while taking this medication. Severe unpleasant side
effects when taken with alcohol, or foods/ products containing alcohol such
as mouthwash, cough medicine, cooking wine, vinegar.
Wear a medical alert tag or carry an ID card.
Used with behavior modifica ion, psychotherapy, and counseling support.
Inform patient of purpose of disulfiram and he consequences of drinking
alcohol during therapy.
Avoid driving and other activities requiring alertness
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Anti-Anxiety Agents: Antihistamines
Agent(s)
Common Uses
Contraindications
Hydroxyzine (Vistaril)
Anxiety disorders
Pre and post-op
sedation
Nausea/Vomiting
1st trimester
pregnancy
Hypersensitivity
Route
PO
IM
Onset of Action
Interactions
15-60 minutes
Increased CNS effect with use of
barbiturates, opioids, analgesics,
alcohol, sedative/hypnotics.
Increased anticholinergic effects
with use of phenothiazines,
antihistamines, antidepressants,
atropine, haloperidol, MAOIs
Mechanism of Action
Depresses subcortical levels of CNS, including the limbic system.
Advantages/Disadvantages
Side Effects
Adverse Effects
Headache
Dry mouth
Dizziness
Fatigue
Increased appetite
Nausea
Diarrhea
Weight gain
Hypotension
Hives
Seizures
Nursing Interventions
Client Education
Administer IM deep in large muscle using Z-track method to
decrease pain, chance of necrosis.
Do NOT give IV or SQ.
Monitor for sedative effects.
Monitor BP
Assist with ambulation
Avoid OTC medications.
Avoid driving, activities that require alertness.
Avoid alcohol, psychotropic medications.
Do not discontinue quickly.
Rise slowly.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Anti-Anxiety Agents: Benzodiazepines
Agent(s)
Common Uses
Contraindications
Diazepam (Valium),
Lorazepam (Ativan),
Alprazolam (Xanax),
Triazolam (Halcion),
Midazolam (Versed)
Anxiety disorders
Alcohol withdrawal
Personality disorders
Panic attacks
Seizures
Pre-op sedation
Narrow angle
glaucoma
Hypersensitivity
Myasthenia gravis
Sleep apnea
Route
PO
IM
IV
Rectal
Onset of Action
Interactions
30 min
15-30 min
Immediate
Increase diazepam
effect with amiodarone,
cimetidine, verapamil,
valproic acid.
Increase toxicity with
barbiturates, SSRIs,
cimetidine, CNS
depressants, valproic acid.
Mechanism of Action
Potentiates the actions of GABA, especially in the limbic system.
Advantages/Disadvantages
Does not produce life-threatening
respiratory depression or coma if taken in
excessive amounts.
Result is less physical dependence than the
barbiturates.
Increased risk of falls with elderly
Side Effects
Drowsiness
Sedation
Headache
Blurred vision
Constipation
Anorexia
Adverse Effects
Dizziness
Depression
Tinnitus
Diarrhea
Nausea/Vomiting
Retrograde amnesia
Hypotension
Tachycardia
Neutropenia
Respiratory depression
Nursing Interventions
Client Education
BP lying, sitting, standing.
Monitor CBC, AST, ALT, bilirubin, creatinine, LDH, alkaline phosphate.
Monitor degree of anxiety, mental status.
May take with food.
Do not use for everyday stress or for > 4 months unless
directed by prescriber.
Avoid OTC medications.
Avoid driving, activities that require alertness. Rise slowly.
Avoid alcohol.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Anticonvulsant
Agent(s)
Common Uses
Contraindications
Topiramate
(Topamax)
Seizures
Unlabeled: bipolar
disorder, alcohol
dependence, mania,
bulimia
Hypersensitivity
Metabolic acidosis
Pregnancy
Route
Onset of Action
Interactions
Increased CNS depression
with alcohol, CNS
depressants. Decreased
level of oral contraceptives,
estrogen, digoxin, lithium.
PO
Mechanism of Action
May prevent seizure spread as opposed to an elevation of seizure threshold.
Advantages/Disadvantages
Side Effects
Dizziness
Insomnia
Memory loss
Diplopia
Nausea
Weight loss
Adverse Effects
Fatigue
Anxiety
Tremors
Anorexia
Dyspepsia
Suicidal ideation
Pancreatitis
Death
Nursing Interventions
Client Education
Assess mental status, mood, behavior.
Monitor seizures.
Assess renal and hepatic studies.
Assist with ambulation.
Seizure precautions.
Swallow whole. Do not break, crush, or chew.
Carry emergency ID.
Avoid driving, other activities that require alertness.
Notify prescriber of blurred vision, periorbital pain.
Maintain adequate fluid intake to p event kidney stones.
May need to increase amount of food consumed since weight
loss may occur.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Antidepressant Agents: Monamine Oxidase Inhibitors (MAOIs)
Agent(s)
Common Uses
Contraindications
Route
Onset of Action
Interactions
Phenelzine (Nardil),
Tranylcypromine
(Parnate)
Severe depression
Psychosis / PTSD
Dissociative disorders
Bulimia
Panic disorders when
other agents are
ineffective.
Concurrent use
of meperidine,
barbiturates, tricyclic
antidepressants,
antihistamines, CNS
depressants, OTC cold
medications.
PO
Up to 3 weeks
High serotonin levels result
in confusion, high BP, tremor,
hyperactivity, coma, and death
when taken with paroxetine,
fluoxe ine, amitriptyline,
nortriptyline,bupropion; pain
medications like methadone,
tramadol, and meperidine;
dextromethorphan, St. John’s Wort,
cyclobenzaprine, and mirtazapine.
Mechanism of Action
Affects chemical messengers (neurotransmitters) used to communicate between brain cells. MAOIs work by effecting changes in the brain
chemistry. An enzyme called monoamine oxidase is involved in removing the neurotransmitters norepinephrine, serotonin and dopamine
from the brain. MAOIs prevent this from happening, which makes more of these brain chemicals available to effect changes in both cells and
circuits that have been impacted by depression.
Advantages/Disadvantages
Prescribed when client does not
respond to other antidepressants.
Hypertensive crisis can be triggered by
foods rich in tyramine.
Side Effects
Dizziness
Diarrhea
Diaphoresis
Weight gain
Adverse Effects
Constipation
Tremors
Sexual dysfunction
Orthostatic hypotension
Seizures
Coma
Tachycardia
Nursing Interventions
Client Education
Monitor vital signs, reflexes, a fect, orientation, UOP.
Obtain CBC, urinalysis, thyroid function tests, ECG, EEG.
Monitor for symptoms of hypertensive crisis (elevated BP and severe
headache)
Avoid tyramine containing foods and beverages (pickled
foods, aged cheese, fermented alcohol, sour cream, figs,
shrimp, bananas, chocolate or caffeinated drinks).
Do not take any other medications without checking with
primary healthcare provider when taking a MAOI.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Antidepressant Agents: Selective Serotonin Reuptake Inhibitors (SSRIs)
Agent(s)
Common Uses
Contraindications
Fluoxetine (Prozac),
Paroxetine (Paxil),
Escitalopram (Lexapro),
Citalopram (Celexa),
Sertraline HCL (Zoloft)
Depression, Bi-polar disorder
Eating disorders, OCD
Panic attacks,
Anxiety disorder
PTSD / Phobia
Dissociative disorder
Premenstrual dysphoric
disorder
Hypersensitivity
MI
Taking MAOIs
Dehydration
Breastfeeding
Route
PO
Onset of Action
Interactions
2-4 weeks
Increase effects of
CNS and respiratory
depression, and
hypotensive effect
with alcohol and CNS
depressants.
Increase effect of
hypoglycemic.
Mechanism of Action
Serotonin is increased in nerve cells because of blockage from nerve fibers
Advantages/Disadvantages
Side Effects
Adverse Effects
Insomnia
Weight loss
Sexual dysfunction
Palpitations
Headache
Diaphoresis
GI complaints
Seizures
Hyponatremia
Dehydration
Bleeding
Suicidal ideation
Nursing Interventions
Client Education
Do NOT give with MAOIs. Wait 14 days after stopping MAOIs to administer.
Monitor liver functions.
Withdrawal should be gradual.
Therapeutic effect may take several weeks.
Do not discontinue abruptly.
Use with caution when driving.
Avoid alcohol, other CNS depressants.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Antidepressant Agents: Tricyclic Antidepressants
Agent(s)
Common Uses
Contraindications
Route
Onset of Action
Interactions
Amitryptyline (Elavil),
Nortriptyline (Pamelor),
Imipramine (Tofranil)
Depression
Anxiety
Panic disorder
OCD
Bulimia
Depression related to
alcohol and cocaine
withdrawal.
Chronic pain disorder.
Tofranil – childhood enuresis
Clients with suicidal
ideations.
History of seizures
Chronic cardiac
disease.
PO
45 minutes
Alcohol, hypnotics, sedatives,
barbiturates potentiate central
nervous system depression
when taken with tricyclic
antidepressants.
Concurrent use of MAOIs
with amitriptyline may lead to
cardiovascular instability and
toxic psychosis.
Antithyroid medications taken
with amitriptyline may increase
the risk of dysrhythmias.
Mechanism of Action
Blocks the uptake of the neurotransmitters norepinephrine and serotonin in the brain.
Advantages/Disadvantages
Effective and less expensive than SSRIs and other
drugs.
Overdose is generally lethal
Side Effects
Adverse Effects
Headache
Dry mouth
Sedation
Impotence
Urinary retention
Photosensitivity
Orthostatic hypotension
Dysrhythmias
Nursing Interventions
Client Education
Increase fluids, bu k in diet if constipation, urinary retention occur.
Administer with food, milk for GI symptoms.
Crush is client unable to swallow medication whole.
Administer at bedtime if over sedation occurs during day.
Therapeutic effects may take 2-3 weeks.
Use caution when driving, performing activities that require
alertness.
Avoid alcohol, other CNS depressants.
Wear sunscreen or large hat when outdoors.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Antipsychotic Agents: Phenothiazines
Agent(s)
Common Uses
Contraindications
Route
Chlorpromazine
(Thorazine),
Fluphenazine
Psychotic disorders
Schizophrenia
Mania
Paranoia
Tourette’s syndrome
Hypersensitivity
Subcortical brain damage
Blood dyscrasias
Renal or liver damage
Coma
PO
IM
IV
Rectal
Onset of Action
Interactions
2-3 hours
Kava kava may increase the
risk and severity of dystonic
reactions when taken with
phenothiazines.
Increase depressive effects
when taken with alcohol or
other CNS depressants.
Mechanism of Action
Blocks norepinephrine, causing sedation and hypotensive effects early in treatment. Also blocks the actions of dopamine.
Advantages/Disadvantages
Side Effects
Anorexia
Dry mouth
Polyuria
Headache
Adverse Effects
Urinary retention
Sedation
Dizziness
Nasal congestion
Orthostatic hypotension
Hypertension
Extrapyramidal reactions
Seizures
Leukopenia
Agranulocytosis
Tardive dyskinesia
Neuroleptic malignant syndrome
Nursing Interventions
Client Education
Assess baseline vital signs. Monitor serum glucose level.
Assess mental status, cardiac, eye, and respiratory disorders.
Remain with client while medication is taken and swallowed.
Avoid skin contact with liquid concentrations to prevent contact
dermatitis.
Protect liquid from light. Dilute liquid with fruit juice.
Administer with food or milk to decrease gastric irritation.
Administer IM deep into muscle.
Observe for Extra Pyramidal Symptoms.
Encourage client to take the drug exactly as prescribed.
Medication may take 6 weeks or longer to achieve full
clinical effect. Advise to wear an ID bracelet.
Do not consume alcohol or other CNS depressants, such
as narcotics.
Do not abruptly discontinue the drug.
Teach smoking cessation (Smoking increases metabolism
of some antipsychotics).
Guide client to maintain good oral hygiene by frequent
brushing and flossing of tee h.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Atypical Antipsychotics (AAP)
Agent(s)
Common Uses
Contraindications
Risperidone (Risperdal),
Quetiapine (Seroquel),
Aripiprazole (Abilify)
Psychotic disorders
Schizophrenia
Bipolar mania
Paranoia
Personality disorder
Hypersensitivity
Seizure disorders
Suicidal ideation
Route
Onset of Action
Interactions
Use with other CNS
depressants, alcohol will
increase sedation.
Use with other antipsychotics,
lithium increase risk of EPS.
PO
IM
Mechanism of Action
The exact mechanism is unknown. May be mediated through both dopamine and serotonin antagonism.
Advantages/Disadvantages
Less likely to cause extrapyramidal effects,
neuroleptic malignant syndrome and
tardive dyskinesia than the phenothiazines.
Side Effects
Sedation
Headache
Agitation
Adverse Effects
Drowsiness
Dry mouth
Anxiety
Appetite stimulation with
weight gain
Orthostatic hypotension
Seizures
Stroke
Suicidal ideation
Neuroleptic malignant syndrome
Nursing Interventions
Client Education
IM – give deeply into muscle mass.
Monitor for hoarding / not swallowing medication.
I&O
Check bilirubin, CBC, weight, lipid profile, fas ing glucose monthly.
BP lying, sitting, standing.
Rise slowly from lying or sitting position.
Avoid hot tubs, hot showers, hot tub baths as hypotension may
occur.
Avoid OTC medications unless approved by prescriber.
Avoid use with alcohol.
Heat stroke may occur in hot weather.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: CNS Stimulants: ADHD/ADD Stimulants
Agent(s)
Common Uses
Contraindications
Methylphenidate (Ritalin),
Amphetamine (Adderall),
Lisdexamfetamine (Vyvanse),
Dexmethylphenidate (Focalin)
ADD
ADHD
Heart problems
Bipolar disorder
Glaucoma
Tourette’s Syndrome
Route
PO
Onset of Action
Interactions
20-30-minutes
Taking MAO inhibitors with
this medication may cause a
serious (possibly fatal) drug
interaction.
Mechanism of Action
Blocking the dopamine transporter and norepinephrine transporter, leading to increased concentrations of dopamine and
norepinephrine within the synaptic cleft.
Advantages/Disadvantages
High abuse potential due to stimulant effects.
Sudden death has been reported in children
taking amphetamine with structural cardiac
abnormalities.
Side Effects
Adverse Effects
Headache
Insomnia
Dry mouth
Blurred vision
Anxiety
Nervousness
Weight loss
Nausea/Vomiting
Decreased Appetite
Hypertension
Tachycardia
Suicidal thoughts
Sudden death in children with structural Cardiac
abnormalities.
Nursing Interventions
Client Education
Monitor mental status and observe for changes in level of consciousness
and adverse effects such as persistent drowsiness, psychomotor agitation
or anxiety, dizziness, trembling or seizures.
Monitor vital signs.
Monitor gastrointestinal and nutritional status.
Monitor laboratory tests such as CBC, differential, and platelet count.
Monitor effectiveness of drug therapy. Monitor growth and development.
Monitor sleep–wake cycle
May be habit forming. Avoid drinking alcohol.
To prevent sleep problems, take this medicine in the morning.
Methylphenidate may impair thinking or reactions. Do not drive or do
anything that requires alertness.
Instruct client to report any significant inc ease in motor behavior,
changes in sensorium, or feelings of dysphoria.
Take drug with meals to reduce GI upset and counteract anorexia; eat
frequent, small nutrient-and calorie-dense snacks. Weigh weekly and
report significant losses over 1 b. Report shortness of breath, profound
fatigue, pallor, bleeding or excessive bruising (these are signs of blood
disorder).
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: CNS Stimulants: Anorexiants
Agent(s)
Common Uses
Contraindications
Phentermine
(Ionamin)
Appetite Suppressant
Obesity
Hypersensitivity
Hypertension
Glaucoma
Heart disease
Route
Onset of Action
Interactions
Taking MAO inhibitors
with this medication may
cause a serious (possibly
fatal) drug interaction.
PO
Mechanism of Action
Reduces hunger perception, a cognitive process mediated through nuclei within the hypothalamus. Outside the brain,
phentermine releases norepinephrine and epinephrine causing fat cells to break down stored fat as well.
Advantages/Disadvantages
Indicated for treatment of obesity (BMI
>30) and for those overweight (BMI
27-30) who have comorbidities such as
hypertension, high cholesterol, diabetes.
Side Effects
Anxiety
Insomnia
Dry mouth
Diarrhea
Adverse Effects
Dizziness
Headache
Nausea/Vomiting
Constipation
Hypertension
Hallucinations
Seizures
Pulmonary hypertension
Chest pain
Nursing Interventions
Client Education
Assess for tolerance to the anorectic effect of the drug. Withhold
drug and report to physician when this occurs.
Lab tests: Periodic CBC with differential and blood glucose.
Monitor periodic cardiovascular status, including BP, exercise
tolerance, peripheral edema.
Monitor weight at least 3 times/wk.
Take 1 or 2 hours after breakfast. Do not crush or chew.
Avoid drinking alcohol with Ionamin. May affect blood sugar
of client with diabetes. Do not breast feed while taking this
drug.
Report immediately any of the following: Shortness of breath,
chest pains, dizziness or fainting, swelling of the extremities.
Tolerance to the appetite suppression effects of the drug
usually develops in a few weeks. Notify physician, but do not
increase the drug dose. Weigh self at least 3 times/week at
the same time with the same amount of clothing.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: CNS Stimulants
Agent(s)
Common Uses
Contraindications
Caffeine
Migraine headache
Tension headache
Promotes alertness
Alleviates fatigue
In combination with
pain medication.
History of cardiac
disease or peptic
ulcer disease
Pregnancy
Route
PO
Rectal
IV
Onset of Action
Interactions
5-10 minutes
Taking caffeine along with ephedrine might
cause heart problems. Caffeine might block
the effects of adenosine, dipyridamole.
Ciprofloxacin, cime idine, disulfiram, est ogen
decrease how quickly the body breaks down
caffeine. Caffeine decreases how quickly the
body breaks down clozapine. Taking caffeine
along with medications that slow clotting
might increase the chances bleeding.
Rapid
Mechanism of Action
Stimulates the CNS, especially the medullary respiratory center. Has a pronounced diuretic effect and is a myocardial stimulant. It can
worsen peripheral vasoconstriction in those with hypertension and causes cerebral vasodilation, making it an effective treatment for
migraines and headaches.
Advantages/Disadvantages
Caffeine combined with alcohol
appears to improve response time
but does not reduce the errors in
judgment caused by alcohol.
Side Effects
Nervousness
Irritability
Palpitations
Adverse Effects
Insomnia
Flushing
Headache
Cardiac arrhythmias
Hypertension
Tachypnea
Confusion
Dehydration
Nursing Interventions
Client Education
For IV use: Assess respiratory status frequently.
Monitor for signs of necrotizing enterocolitis (abdominal
distension, vomiting, bloody stools, lethargy).
Monitor serum caffeine levels before and during therapy.
Monitor serum glucose levels.
Instruct on correct technique for administration. Measure oral dose accurately
with a 1-mL syringe.
Advise to consult health care professional immediately if signs of necrotizing
enterocolitis occur.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: CNS Depressants - Barbiturates
Agent(s)
Common Uses
Contraindications
Route
Onset of Action
Interactions
Phenobarbital
(Luminal), Secobarbital
(Seconal), Pentobarbital
(Nembutal)
Anesthesia induction.
Short-term anesthesia
Seizures
Short-term use of
insomnia
Pregnancy
Hypersensitivity
Depression
Suicidal tendency
Liver disease
Respiratory disease
PO
IM
IV
30 minutes
Increased CNS depression with
alcohol, narcotics, sedativehypnotics.
Decreased effectiveness of
beta-adrenergic blockers,
clozapine, corticosteroids,
digitoxin, doxycycline,
estrogens, oral contraceptives,
quinidine, theophyllines,
voriconazole, or warfarin.
5 minutes
Mechanism of Action
Acts on GABAA receptors, increasing synaptic inhibition. This has the effect of elevating seizure threshold. Phenobarbital may also
inhibit calcium channels, resulting in a decrease in excitatory transmitter release. The sedative-hypnotic effects of phenobarbital
are likely the result of its effect on the polysynaptic midbrain reticular formation, which controls CNS arousal.
Advantages/Disadvantages
Loading dose may be required. Cautious
use in elderly, associated with increased
risk of falls.
Side Effects
Adverse Effects
Drowsiness
Lethargy
Dizziness
Headache
Hangover effect
Interferes with REM sleep
Respiratory depression
Mental depression
Hepatic toxicity
Renal toxicity
Nursing Interventions
Client Education
Monitor vital signs. Ensure patient safety. Perform neuro-checks regularly.
Keep resuscitative equipment accessible.
Monitor response to and effectiveness of drug therapy.
Monitor for signs of hepatic or renal toxicity.
Monitor laboratory blood tests and urinalysis: CBC with differential,
electrolytes, BUN, PT, PTT, liver enzymes.
Do not drive or perform unsafe tasks.
Do not drink alcohol or use medicines that may cause
drowsiness
Hormonal birth control may not work as well.
To prevent pregnancy, use an extra form of birth control.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Miscellaneous Anti-Seizure
Agent(s)
Common Uses
Contraindications
Gabapentin
(Neurontin)
Seizures
Peripheral neuropathy
Migraine prophylaxis
Vasomotor symptoms in
women with breast cancer
or postmenopausal
women.
Hypersensitivity
Route
PO
Onset of Action
Interactions
1-3 hours
CNS depression with alcohol,
sedatives, antihistamines.
Increase gabapentin levels
with morphine.
Decrease gabapentin levels
with antacids, cimetidine.
Mechanism of Action
Acts on the peripheral nerves and CNS by inhibiting spontaneous neuronal firing. May inc ease seizure threshold.
Advantages/Disadvantages
Should be used cautiously with elderly.
Side Effects
Drowsiness
Fatigue
Anxiety
Constipation
Adverse Effects
Dizziness
Confusion
Rhinitis
Increased frequency of partial seizures
Leukopenia
Depression
Leukopenia
Thrombocytopenia
Nursing Interventions
Client Education
Monitor seizure activity.
Monitor mental status.
Seizure precautions
Increase fluids, bu k in diet for constipation.
Do not crush or chew caps.
Take at least 2 hours from antacids.
May take without regard to meals.
Carry ID
Avoid driving and other activities requiring alertness.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Miscellaneous Anti-Seizure
Agent(s)
Common Uses
Contraindications
Phenytoin (Dilantin)
Seizures
Status epilepticus
Unlabeled: migraines,
paroxysmal atrial
tachycardia, ventricular
tachycardia
Pregnancy
Hypersensitivity
Bradycardia
Heart block
Stokes-Adams syndrome
Route
PO
IV
Onset of Action
Interactions
2-24 hours
1-2 hours
Increase phenytoin effect with
benzodiazepines, cimetidine,
tricyclics, salicylates, alcohol.
Decrease phenytoin effects
with antacids, barbiturates,
rifampin.
Mechanism of Action
Inhibits spread of seizure activity in motor cortex by altering ion transport. Increases AV conduction.
Advantages/Disadvantages
Side Effects
Adverse Effects
Gingival hyperplasia
Dizziness
Insomnia
Paresthesias
Depression
Nystagmus
Blurred vision
Anorexia
Weight loss
Nausea/vomiting
Aplastic anemia
Agranulocytosis
Pancytopenia
Hepatitis
Suicidal tendency
Bradycardia
Ventricular fibri lation
Cardiac arrest
Stevens-Johnson Syndrome
Blue-Glove syndrome
Nursing Interventions
Client Education
IV administration should not exceed 50 mg/min in adults. Administer
slow IVP.
Monitor phenytoin level.
Monitor seizure activity.
Monitor EKG, BP, respiratory function during IV infusion.
Take with meals to decrease side effects.
Take antacids two hours before or after phenytoin.
Urine may turn pink
Oral hygiene
Avoid hazardous activities.
Carry ID
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Miscellaneous Sedative-Hypnotics
Agent(s)
Common Uses
Contraindications
Chloral Hydrate
(Noctec)
Short term
treatment of
insomnia
Sedation
Alcohol withdrawal
Hypersensitivity
Hepatic failure
Renal failure
Route
PO
Onset of Action
Interactions
10-20 minutes
Side effects of barbiturates
may be increased.
Use with loop diuretics may
cause tachycardia and blood
pressure changes.
Anticoagulants side effects
may increase.
Mechanism of Action
The mechanism of action by which the Central Nervous System (CNS) is affected is not known.
Advantages/Disadvantages
Does not interfere with REM sleep
Side Effects
Drowsiness
Nausea/Vomiting
Diarrhea
Adverse Effects
Hangover effect
Flatulence
Confusion
Cardiac arrhythmias
Sudden death
Difficu ty breathing
Chest pain
Nursing Interventions
Client Education
May dilute syrup in water or other oral liquid (eg, fruit juice or ginger
ale) to minimize gastric irritation.
Administer capsules after meals (when used as sedative).
If stomach upset occurs, take with food.
Swallow chloral hydrate whole.
Take chloral hydrate with a full glass of water or other.
Do not take 2 doses at once.
Chloral hydrate may cause drowsiness or dizziness. Do not
drive, operate machinery, or do anything else that could be
dangerous.
Avoid drinking alcohol or taking other medications that cause
drowsiness while taking chloral hydrate.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Miscellaneous Sedative-Hypnotics
Agent(s)
Common Uses
Contraindications
Eszopiclone (Lunesta),
Zolpidem (Ambien)
Insomnia
Hypersensitivity to
benzodiazepine.
Respiratory depression
Route
PO
Onset of Action
Interactions
10 minutes
Decrease CNS function with
alcohol, CNS depressants,
anticonvulsants.
Food decreases absorption.
Mechanism of Action
The precise mechanism of action of eszopiclone as a hypnotic is unknown, but its effect is believed to result from its interaction
with GABA-receptor complexes at binding domains located close to benzodiazepine receptors.
Zolpidem interacts with a GABA-BZ receptor complex and shares some of the pharmacological properties of the benzodiazepines.
Advantages/Disadvantages
Side Effects
Adverse Effects
Headache
Nervousness
Anxiety
Drowsiness
Hot flashes
Irritabi ity
Nausea / vomiting
Erectile dysfunction
Tachycardia
Depression
Hypotension
Sleep driving (Zolpidem)
Nursing Interventions
Client Education
Assess vital signs.
Check for signs of respiratory depression.
Use bed alarm for older clients.
Observe for side effects.
Teach nonpharmacologic ways to induce sleep – warm bath,
listening to music, drinking warm fluids, avoi ing caffeine.
Avoid alcohol, antidepressants, antipsychotics, and narcotic
drugs.
Take 15-30 minutes before bedtime.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Miscellaneous
Agent(s)
Common Uses
Contraindications
Carbamazepine
(Tegretol)
Acute mania associated
with bipolar disorder.
Alcohol withdrawal
Seizure disorder
Trigeminal neuralgia
Diabetic neuropathy
Hypersensitivity
Pregnancy
Route
PO
Onset of Action
Interactions
Slow
Increase CNS toxicity with
Lithium.
Fatal reaction with use of
MAOIs.
Decrease anticonvulsant
effect with use of St. John’s
wort.
Mechanism of Action
Exact mechanism unknown. Appears to decrease polysynaptic responses and block posttetanic potentiation.
Advantages/Disadvantages
Side Effects
Drowsiness
Confusion
Headache
Tinnitus
Blurred vision
Constipation
Nausea/vomiting
Adverse Effects
Dizziness
Fatigue
Hallucinations
Dry mouth
Photosensitivity
Diarrhea
A plastic anemia
Agranulocytosis
Respiratory depression
Arrhythmias
AV block
Stevens-Johnson Syndrome
Nursing Interventions
Client Education
Monitor drug effectiveness.
Assess urinalysis, BUN, creatinine q 3 months.
Provide hard candy, gum, frequent rinses for dry mouth.
Carry emergency ID regarding medication.
Avoid driving and other activities that require alertness.
Report chills, rash, light colored stools, dark urine, jaundice.
Urine may turn pink to brown.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Miscellaneous
Agent(s)
Common Uses
Contraindications
Valproic Acid
(Depakote)
Mania
Schizophrenia
Seizure disorder
Migraine prophylaxis
Unlabeled: Febrile
seizures
Hypersensitivity
Route
Onset of Action
PO
Interactions
Increase risk of toxicity with
erythromycin, salicylates,
NSAIDs.
Increase CNS depression
with alcohol, opioids,
barbiturates, MAOIs,
tricyclics.
Mechanism of Action
Increases levels of GABA in the brain, which decreases seizure activity.
Advantages/Disadvantages
Side Effects
Drowsiness
Headache
Nausea/Vomiting
Constipation
Weight loss
Adverse Effects
Dizziness
Weakness
Diarrhea
Dyspepsia
Bone marrow depression
Pancreatitis
Hepatotoxicity
Stevens-Johnson syndrome
Coma/Death with overdose
Nursing Interventions
Client Education
Monitor mental status, mood activity, sleeping/eating behavior,
suicidal thoughts.
Monitor CBC, PT/PTT, serum ammonia, platelets.
Monitor for signs of pancreatitis.
Physical dependency may result from extended use.
Avoid driving, other activities that require alertness
Drink plenty of fluids
Report visual disturbances, rash, abdominal pain, lightcolored stools, jaundice, protracted vomiting.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Mood Stabilizers
Agent(s)
Common Uses
Contraindications
Route
Onset of Action
Interactions
Lithium (Lithane,
Lithobid)
Mania
Bipolar disorder
Children < 12 years’
old
Thyroid disease
Liver disease
Renal disease
PO
Rapid
May increase lithium level with
thiazide, methyldopa, haloperidol,
NSAIDS, calcium channel blockers,
ACE inhibitors.
May increase hyperglycemia with
antidiabetics.
Caffeine may decrease lithium levels.
Mechanism of Action
Alteration of ion transport in muscle and nerve cells. Increased receptor sensitivity to serotonin.
Advantages/Disadvantages
Long-term therapy may cause
hypothyroidism
Side Effects
Adverse Effects
Headache
Memory impairment
Blurred vision
Metallic taste
Dental caries
Lethargy
Drowsiness
Tremors
Slurred speech
Dry mouth
Anorexia
Vomiting
Diarrhea
Polyuria
Dehydration
Toxic effects: tremor, confusion, seizures, death.
Hypotension
Hyperglycemia
Hyponatremia
Proteinuria
Cardiac dysrhythmias
Nursing Interventions
Client Education
Monitor serum sodium (Normal serum sodium helps to
maintain therapeutic lithium levels).
Frequently monitor Lithium level (Therapeutic range – 1-1.5
mEq/L for acute mania; Maintenance levels are 0.6-1.2
mEq/L. Levels exceeding 1.5-2.5 mEq/L begin to produce
toxicity. Normal levels and toxicity levels are very close).
Maintain adequate fluid intake of 1-2 L dail .
Importance of lab tests and follow-up visits.
Do not drive until stable lithium level.
Take with meals to decrease gastric irritation.
Wear ID indicating medication taking.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Neuromuscular Blocker
Agent(s)
Common Uses
Contraindications
Succinylcholine
Chloride (Anectine)
Facilitation of ET
intubation.
Skeletal muscle
relaxation.
Hypersensitivity
Malignant
hyperthermia
Trauma
Route
IM
IV
Onset of Action
Interactions
2-3 minutes
1 minute
Increase dysrhythmias with
theophylline. Melatonin blocks
succinylcholine. Increase
neuromuscular blockade with
aminoglycosides, beta blockers,
glycosides, procainamide, lithium,
opioids, thiazides.
Mechanism of Action
Inhibits transmission of nerve impulses by binding with cholinergic receptor sites, thus antagonizing action of acetylcholine.
Causes release of histamine.
Advantages/Disadvantages
Side Effects
Adverse Effects
Bradycardia
Tachycardia
Flushing
Weakness
Muscle pain
Increased secretions
Sinus arrest
Myoglobulinemia
Apnea
Respiratory depression
Angioedema
Nursing Interventions
Client Education
Monitor for electrolyte imbalances: May lead to increased action
of product.
Monitor vital signs until fully recovered.
I&O
Check for urinary retention, frequency, hesitancy.
Use of medication.
Care during recovery.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Dysrhythmias
Rhabdomyolysis
Bronchospasm
Anaphylaxis
Class: Non-phenothiazines
Agent(s)
Common Uses
Contraindications
Haloperidol
(Haldol)
Acute and chronic psychosis
Schizophrenia resistant to
other medications.
Tourette’s syndrome
Paranoia
Children with severe behavior
problems who are combative.
Suppress narcotic withdrawal.
Narrow angle glaucoma
Severe hepatic, renal,
cardiovascular disease.
Parkinson’s disease
Bone marrow depression
Route
PO
IM
IV
Onset of Action
Interactions
Erratic
15-30 minutes
Increase sedation with
alcohol, CNS depressants.
Increase toxicity with
anticholinergics, CNS
depressants, Lithium.
Decrease effects with
phenobarbital, caffeine.
Mechanism of Action
Alters the effects of dopamine by blocking dopamine receptors.
Advantages/Disadvantages
Side Effects
Tachycardia
Constipation
Headache
Nausea/vomiting
Photosensitivity
Adverse Effects
Urinary retention
Blurred vision
Dry mouth
Weight gain
Seizures
Respiratory depression
Laryngospasm
Dysrhythmias
Neuromalignant syndrome
Tardive dyskinesia
Orthostatic hypotension
Nursing Interventions
Client Education
Assess CBC
Obtain BP lying, sitting, standing.
Monitor for dizziness, faintness, tachycardia on rising.
Monitor for EPS.
Supervise ambulation until client stabilized on medication.
Provide sips of water, sugarless candy, gum for dry mouth.
Rise slowly from lying or sitting position.
Avoid hazardous activities until stabilized on medication.
Avoid abrupt withdrawal of medication.
Avoid OTC preparations.
About EPS.
Oral care.
Report impaired vision, jaundice, tremors, muscle twitching.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Opioid Antagonist
Agent(s)
Common Uses
Contraindications
Naltrexone
(ReVia)
Opiate addiction
Alcoholism
Nicotine withdrawal
Hypersensitivity
Opioid dependence
Route
PO
IM
Onset of Action
Interactions
15-30 minutes
Increased lethargy with phenothiazines
Increased hepatotoxicity with disulfiram
Increased bleeding risk with
anticoagulants.
Mechanism of Action
Competes with opioids at opioid-receptor sites.
Advantages/Disadvantages
Side Effects
Adverse Effects
Stimulation
Drowsiness
Dizziness
Confusion
Headache
Flushing
Nervousness
Irritability
Anxiety
Tinnitus
Blurred vision
Diarrhea
Constipation
Impotence
Nausea/vomiting
Seizures
Suicidal ideation
Pulmonary edema
DVT
Hepatotoxicity
Nursing Interventions
Client Education
Give with food, antacid to prevent N/V.
Do not give until opioid free for 7-10 days to prevent opioid
withdrawal.
Administer IM deep in gluteal. Alternate injection sites.
Aspirate before injection.
Monitor cardiac status and respiratory function.
Must be drug free to start treatment.
Using opioid while taking this medication could be fatal.
Carry emergency ID.
Use caution while driving or performing hazardous tasks.
Report suicidal thoughts.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Serotonin Agonists (SSRAs – Selective Serotonin Receptor Agonists)
Agent(s)
Common Uses
Contraindications
Ergot Alkaloids:
Ergotamine tartrate
(Ergostat), Ergotamine
with caffeine (Cafergot,
Ercaf)
Migraine headache
Pregnant
Breastfeeding
Heart disease
Hypertension
Route
Onset of Action
Interactions
SL
Intranasal
IM
IV
Variable seconds
Severe hypertension can occur
with the use of Droxidopa or
sympathomimetics. Risk of
increase ergotamine side effects
can occur with Azole antifungals,
beta-blockers, fluconazole,
fluoxe ine, fluvoxamine, HIV
protease inhibitors, sumatriptan,
macrolide antibiotics.
Mechanism of Action
Works by narrowing blood vessels in the brain, which helps to relieve migraine headaches.
Advantages/Disadvantages
Can be used to prevent or treat acute
migraine headache with or without an aura.
Side Effects
Adverse Effects
Dizziness
Nausea/vomiting
Angioedema
Arrhythmias
SOB
Toxicity may occur.
Chest pain
Muscle pain
Nursing Interventions
Client Education
Assess frequency, location, duration, and characteristics
headaches. During acute attack, assess type, location, and
intensity of pain before and 60 min after administration.
Monitor BP and peripheral pulses periodically during therapy.
Report any increases in BP.
Assess for nausea and vomiting.
Assess for toxicity manifested by severe ergotism (chest pain,
abdominal pain, persistent paresthesia in the extremities) and
gangrene. Vasodilators, dextran, or heparin may be ordered to
improve circulation.
Proper use of inhaler.
Take at the first sign of a migraine a tack.
Do not swallow, crush, or chew sublingual tablets. Do not eat,
drink, or smoke while tablet is dissolving.
If more than 1 dose needed to treat a migraine, take the second
dose at least 30 minutes after the first dose. Do not take mo e
than 2 tablets for any migraine attack. Do not take more than 3
tablets in a 24 hour period. Do not take more than 5 tablets within
a 7 day period.
Do not use ergotamine daily on a regular basis.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Serotonin Agonists (SSRAs – Selective Serotonin Receptor Agonists)
Agent(s)
Common Uses
Contraindications
Route
Triptans: Sumatriptan
(Imitrex), Almotriptan
(Axert)
Migraine headaches
Cluster headaches
History of coronary artery
disease, uncontrolled
hypertension,
cerebrovascular disease,
MI. Obesity, diabetes,
smoking, hepatic disease.
PO
SubQ
Intranasal
Onset of Action
Interactions
60 minutes
10 minutes
15 minutes
Increase vasospastic
effects with ergot
derivatives.
Increase serotonin
syndrome with SSRIs
Mechanism of Action
Causes vasoconstriction of cranial arteries to relieve migraine headaches.
Advantages/Disadvantages
Side Effects
Nausea/vomiting
Numbness
Dry mouth
Abdominal cramping
Adverse Effects
Dizziness
Tingling
Diarrhea
Hypertension
Hypotension
Cardiac arrhythmias
MI
Seizures
Stroke
Coronary artery vasospasms
Nursing Interventions
Client Education
Assess type of headache, pain, aura, alleviating and aggravating
factors.
Monitor for serotonin syndrome (delirium, coma, agitation, diaphoresis,
hypertension, fever, tremors).
Monitor BP, ECG
Monitor neurologic status
Keeping a journal: Ingestion of tyramine foods, food
additives, preservatives, coloring, artificial sweeteners,
chocolate, caffeine, may precipitate a migraine attack.
Report chest pain or tightness, sudden and severe
abdominal pain, swelling around eyes, face, lips.
Do not use for more than 3-4 headaches per month.
Nasal spray: Use 1 spray in 1 nostril. Repeat if headache
returns, but not if pain continues after 1st dose. Lie in dark,
quiet environment.
Avoid hazardous activities if dizziness, drowsiness occurs.
Avoid alcohol: may increase headache.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Skeletal Muscle Relaxants
Agent(s)
Common Uses
Contraindications
Lioresal (Baclofen),
Cyclobenzaprine (Flexeril),
Dantrolene (Dantrium),
Methocarbamol (Robaxin)
Muscle spasms.
Baclofen and
Dantrium: multiple
sclerosis,
cerebral palsy.
Hypersensitivity
Route
PO
Intrathecal
IM/IV
Onset of Action
Interactions
1-3 hours
30 minutes
CNS depression with
alcohol, tricyclics, opiates,
barbiturates, sedatives.
Increase hypotension with
antihypertensives.
Mechanism of Action
Inhibits synaptic responses in CNS by stimulating GABAb receptors. This decreases neurotransmitter function; decreases
frequency, severity of muscle spasms.
Advantages/Disadvantages
Side Effects
Dizziness
Fatigue
Dry mouth
Constipation
Anorexia
Adverse Effects
Drowsiness
Lightheadedness
Muscle weakness
Urinary retention
Nausea/vomiting
Hypotension
Angioedema
Hepatotoxicity
Seizures
Bradycardia
Anaphylaxis
CNS depression
Nursing Interventions
Client Education
Assess spasms, spasticity, ataxia for improvement with medication.
Assess BP, weight, glucose, hepatic function studies periodically.
Monitor ALT, AST with long-term Dantrium use.
I&O
Methocarbamol may turn urine green, brown, or black.
Take with meals for GI symptoms.
Do not discontinue abruptly.
Do not take with alcohol, other CNS depressants.
Avoid hazardous activities if drowsiness/dizziness occurs.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Enzymatic Debridement Agents
Agent(s)
Common Uses
Contraindications
Route
Collagenase (Santyl)
Wound debridement
Known local
or systemic
hypersensitivity to
collagenase.
OIntment
Onset of Action
Interactions
Skin products containing
heavy metals may
decrease the effect of
collagenase.
Mechanism of Action
An enzymatic debriding agent capable of specifica ly hydrolyzing peptide bonds of collagen.
Liquefies nec otic tissue without damaging granulation tissue.
Advantages/Disadvantages
Possible risk of systemic bacterial
infection
Side Effects
Adverse Effects
Slight erythema may develop in
surrounding tissue
Bacterial infection.
Nursing Interventions
Client Education
Prior to each application, cleanse wound with a gauze pad saturated
with 0.9% sodium chloride solution or a compatible cleansing agent
to remove necrotic material and follow with a normal saline solution
rinse.
Do not apply to healthy skin.
Notify primary healthcare provider of any symptoms of serious
infection (fever, chills, hyperventilation, tachycardia)
Use caution to restrict application to the lesion; avoid applying to
healthy skin.
Do not apply to internal cavities.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Topical Anti-infectives
Agent(s)
Common Uses
Contraindications
Silver sulfadiazine
(Silvadene)
Mafenide acetate
(Sulfamylon)
Silver nitrate
Povidone-Iodine (Betadine)
Prevention and
treatment
of wound sepsis in
patients with secondand third-degree
burns.
Hypersensitivity
Pregnancy
Newborns
Route
Topical
Onset of Action
Interactions
2-4- hours
Mechanism of Action
Interferes with bacterial protein synthesis.
Advantages/Disadvantages
Side Effects
Adverse Effects
Skin discoloration
Burning sensation
Rash
Transient leukopenia
Skin necrosis
Interstitial nephritis.
Nursing Interventions
Client Education
Check for allergy to sulfa antibiotics.
Check for iodine allergy with use of povidone-iodine.
Cover wound completely with ointment.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Alpha-Glucosidase Inhibitors
Agent(s)
Common Uses
Contraindications
Acarbose (Precose),
Miglitol (Glyset)
Type 2 Diabetes
DKA
Type 1 Diabetes
Cirrhosis
Intestinal obstruction
Route
Onset of Action
Interactions
Decreases levels of
digoxin, propranolol.
PO
Mechanism of Action
Delays absorption of blucose from the GI tract.
Advantages/Disadvantages
Less likely to cause hypoglycemia
Side Effects
Adverse Effects
Flatulence
Abdominal cramps
Diarrhea
Hepatotoxicity
Can be hepatotoxic
Nursing Interventions
Client Education
Monitor liver functions every 3 months for first year of herapy and
periodically thereafter.
Monitor for hypoglycemia if also taking a sulfonylurea.
FSBS
Importance of diet and exercise.
Signs/Symptoms of hypoglycemia and hyperglycemia
Take with food at the same time each day.
Self-monitoring blood glucose
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Amylin Analog
Agent(s)
Common Uses
Contraindications
Pramlintide (Symlin)
Adjunct therapy for
Type 1 & 2 Diabetes
who have failed to
achieve optimal glucose
control with insulin
alone.
Hypersensitivity
Gastroparesis
Route
SubQ
Onset of Action
Interactions
20 minutes
Increases effect of
acetaminophen.
Increases hypoglycemia
with ACE inhibitors, alcohol,
corticosteroids, insulin.
Mechanism of Action
Augments the effects of insulin. Decreases post meal glucagon and glucose. Slows stomach emptying. Decreases appetite,
leads to decreased caloric intake and weight loss.
Advantages/Disadvantages
Can assist with weight loss
Side Effects
Headache
Dizziness
Nausea/vomiting
Abdominal pain
Adverse Effects
Fatigue
Blurred vision
Anorexia
Hypoglycemia
Nursing Interventions
Client Education
Administer immediately prior to meals.
Give SubQ in abdomen or thigh. DO NOT administer in arm as
absorption is unpredictable.
Monitor for hypoglycemia/hyperglycemia
Always have oral carbohydrate available.
Medication administration.
Give SubQ in abdomen or thigh. DO NOT administer in arm as
absorption is unpredictable.
Sign/symptoms of hypoglycemia/hyperglycemia.
Always have oral carbohydrate available.
Carry a glucose source to treat hypoglycemia
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Anterior Pituitary Inhibitor Drugs
Agent(s)
Common Uses
Contraindications
Octreotide
(Sandostatin)
Acromegaly
Severe diarrhea
Flushing episodes
associated with
metastatic tumors
Variceal bleeding
Hypersensitivity
Route
SubQ
IM
IV
Onset of Action
Interactions
30 minutes
Decreased absorption of
dietary fat, Vit B12 levels.
Mechanism of Action
Inhibits growth hormone. Promotes fluid and elelct olyte reabsorption.
Advantages/Disadvantages
Side Effects
Adverse Effects
Headache
GI complaints
Fatigue
Dizziness
Flatulence
Constipation
UTI
Dysrhythmias
Heart failure
Hyperglycemia
Hypoglycemia
Cholelithiasis
Seizure
Nursing Interventions
Client Education
Assess growth hormone antibodies.
Monitor thyroid function studies.
Monitor blood glucose.
SubQ self-injection
Blood glucose monitoring
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Anterior Pituitary Stimulant Drugs
Agent(s)
Common Uses
Contraindications
Somatropin
(Genotropin,
Serostim, Nutropin)
Growth Hormone:
Growth Failure due
to growth hormone
deficienc , AIDS wasting
syndrome and short
bowel syndrome.
Growth failure
after closure of the
epiphyseal plates.
Route
SubQ
IM
Onset of Action
Interactions
15 minutes
Increase epiphyseal closure
with androgens, thyroid
hormones.
Decrease growth with
glucocorticosteroids.
Decrease insulin, antidiabetic
effect.
Mechanism of Action
Stimulates growth.
Advantages/Disadvantages
Side Effects
Adverse Effects
Headache
Fever
Nausea/Vomiting
Joint and muscle pain
Hyperglycemia
Hypothyroidism
Ketosis
Nursing Interventions
Client Education
Inject deeply into a large muscle.
Aspirate before injection.
Rotate injection sites daily.
Assess for signs/symptoms of diabetes.
Thyroid function tests.
Treatment may continue for years.
Maintain a growth record.
Report knee/hip pain or limping.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Anti-hypoglycemic
Agent(s)
Common Uses
Contraindications
Glucagon
Hypoglycemia
Hypersensitivity
Pheochromocytoma
Route
SubQ
IM
IV
Onset of Action
Interactions
10 minutes
Increased bleeding risks
with anticoagulants.
Mechanism of Action
Increases blood sugar by stimulating glycogenolysis (glycogen breakdown) in the liver. It protects the body cells, especially in the
brain and retina, by providing the nutrients and energy needed to maintain body function.
Advantages/Disadvantages
Side Effects
Adverse Effects
Dizziness
Headache
Hypotension
Nausea/vomiting
Hyperglycemia
Hypersensitivity
Nursing Interventions
Client Education
Monitor glucose levels. Use other products to control hypoglycemia if
client is conscious.
How to use product.
Glucose self-monitoring.
Sign/symptoms of hypoglycemia/hyperglycemia.
Always have oral carbohydrate available.
Carry a glucose source to treat hypoglycemia
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Anti-Thyroids
Agent(s)
Common Uses
Contraindications
Methimazole (Tapazole),
Propylthiouracil (PTU)
Hyperthyroidism
Graves Disease
Thyrotoxicosis
Pre-op to stun the
thyroid prior to
thyroidectomy.
Pregnancy
Breastfeeding
Hypersensitivity
Route
PO
Onset of Action
Interactions
Rapid
Increase response to digoxin.
Decrease effectiveness of
warfarin
Increase PT, AST, ALT, alkaline
phosphate.
Mechanism of Action
They stop the thyroid from making thyroid hormones.
Advantages/Disadvantages
Side Effects
Adverse Effects
Rash
Drowsiness
Headache
Vertigo
Nausea/vomiting
Diarrhea
Leukopenia
Agranulocytosis
Pancytopenia
Hepatitis
Nursing Interventions
Client Education
Monitor CBC with differential and PT time for bone marrow
suppression.
Monitor TSH levels.
Assess for s/s of hypothyroidism as well as hyperthyroidism.
I&O
Daily weight
Increase fluids to 3-4 L/day unless contrain icated
Report unusual bruising or bleeding.
Avoid shellfish and io ine products.
Teach client how to monitor pulse daily.
Report redness, swelling, sore throat, fever.
Do not discontinue medication abruptly because thyroid crisis
can occur.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Anti-Thyroids (Radioactive Iodine)
Agent(s)
Common Uses
Contraindications
Radioactive iodine
Hyperthyroidism
Thyroid cancer
Pregnancy
Route
Onset of Action
Interactions
PO
Mechanism of Action
Destroys thyroid cells so that the thyroid stops making thyroid hormones. Hypothyroidism is expected now.
Advantages/Disadvantages
Side Effects
Adverse Effects
Hypothyroidism
Headache
Confusion
Paresthesia
Metallic taste
Stomatitis
Nausea/Vomiting
Diarrhea
Hyperthyroidism – rebound effect post
radioactive iodine.
Nursing Interventions
Client Education
Watch for thyroid storm.
Monitor for fever, rash, metallic taste, mouth sores, sore throat, GI
distress.
Stay away from babies for 1 week
Don’t kiss anybody for 1 week.
Avoid crowds and people who are ill.
Report darkening of urine or jaundice.
Monitor for weight gain.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Biguanides
Agent(s)
Common Uses
Contraindications
Route
Onset of Action
Interactions
Metformin
(Glucophage,
Glucophage XR)
Hyperglycemia in Type 2
diabetes
Ketoacidosis
Renal impairment
Hepatic dysfunction
Cardiopulmonary insufficienc
Alcoholism
PO
Unknown
May potentiate hypoglycemia
when used with ACE inhibitors,
ARBS, calcium channel blockers,
beta-blockers, procainamide,
digoxin, furosemide, alcohol,
cimetidine
Mechanism of Action
Decreases hepatic production of glucose from stored glycogen. Lowers the glucose absorption of glucose from the small intestine.
Advantages/Disadvantages
Does not stimulate the release of
more insulin, so less likely to cause
hypoglycemia.
Clients undergoing surgery or any
radiologic procedure that involves contrast
dye should temporarily discontinue
metformin. They can resume 48 hours
after the procedure if kidney function has
returned and the creatinine is normal.
Side Effects
Dizziness
Headache
Nausea/Vomiting
Diarrhea
Weight loss
Adverse Effects
Fatigue
Anorexia
Lactic acidosis
Nursing Interventions
Client Education
Assess for hypoglycemia/hyperglycemia
Monitor CBC, renal and studies every 3 months
Administer with meals
Glucose self-monitoring.
Signs/Symptoms of hypoglycemia/hyperglycemia.
Avoid OTC medications, alcohol.
Glucophage XR tab may appear in stool.
Carry emergency ID and glucagon emergency kit.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Corticosteroids
Agent(s)
Common Uses
Contraindications
Prednisone,
Methylprednisolone
(Solu-Medrol),
Dexamethasone
(Decadron)
Used to prevent N/V
caused by chemotherapy.
Used before
chemotherapy to prevent
severe allergic reaction.
Hypersensitivity
Fungal infections
Seizure disorder
Pregnancy
Route
PO
IM
IV
Onset of Action
Interactions
1 hour
Mechanism of Action
Corticosteroids are natural hormones and hormone-like drugs that are useful in the treatment of many types of cancer, as
well as other illnesses. When these drugs are used as part of cancer treatment, they are considered chemotherapy drugs.
Corticosteroids are anti-inflammatory agents hat suppress the inflammatory p ocess that is associated with tumor growth.
Although the exact mechanism of action is unknown, these agents may block steroid-specific eceptors on the surface of cells.
This blocking action slows the growth fraction of the tumor, thus retarding its growth.
Advantages/Disadvantages
Provide the client with a sense of well-being
and varying degrees of euphoria.
Side Effects
Adverse Effects
Increased appetite
Fluid retention
Hypokalemia
Risk for infection
Hyperglycemia
Increased fat distribution
Muscle weakness
Seizures
Circulatory collapse
Infection
Nursing Interventions
Client Education
Monitor serum glucose levels, electrolytes.
Administer with food for PO medication.
Daily weight
I&O.
Take PO dose with food or milk to decrease GI symptoms.
Notify Primary healthcare provider for fever of 100.40F
(380C).
Do not take Aspirin or aspirin containing products without
approval.
Avoid sun exposure.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Fixed Combination Products
Agent(s)
Common Uses
Contraindications
Route
Onset of Action
Interactions
Glucovance
(Glyburide and
Metformin)
Type 2 Diabetes
Renal insufficienc
Type 1 Diabetes
DKA
PO
15-30 minutes
Thiazides and other diuretics, corticosteroids,
phenothiazines, estrogens, oral contraceptives,
phenytoin, calcium channel blockings, and
isoniazid may cause hyperglycemia.
The hypoglycemic action of sulfonylureas
may be potentiated by NSAIDS, salicylates,
sulfonamides, MAOIs, and beta-adrenergic
blocking agents.
Mechanism of Action
GLUCOVANCE combines glyburide and metformin hydrochloride, 2 antihyperglycemic agents with complementary mechanisms of action,
to improve glycemic control in patients with type 2 diabetes. Gluburide directly stimulates the beta cells to secrete insulin, thus decreasing
the blood glucose level. Increases the tissue response to insulin and decreases glucose production by the liver. Metformin decreases hepatic
production of glucose from stored glycogen. Lowers the glucose absorption of glucose from the small intestine.
Advantages/Disadvantages
Contraindicated for clients
with renal insufficiency due
to possible risk of developing
lactic acidosis.
Side Effects
Adverse Effects
URI
Diarrhea
Headache
Dizziness
Nausea/vomiting
Abdominal pain
Lactic acidosis
Hypoglycemia
Nursing Interventions
Client Education
Assess for hypoglycemia/hyperglycemia
Monitor CBC, renal and studies every 3 months
Administer with meals
Glucose self-monitoring.
Signs/Symptoms of hypoglycemia/hyperglycemia.
Avoid OTC medications, alcohol.
Glucophage XR tab may appear in stool.
Carry emergency ID and glucagon emergency kit.
Use sunscreen and wear protective clothing when outside for more than a
short time.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Glucocorticoids
Agent(s)
Common Uses
Contraindications
Betamethasone
(Celestone)
Dexamethasone
(Decadron), prednisone
(Deltasone),
methylprednisolone
(Solu-Medrol)
Prenisolone (Prelone)
Inflamma ion / Allergies
Cerebral edema
Septic shock
Meningitis
Asthma
Multiple sclerosis
Irritable bowel syndrome
Autoimmune diseases
Organ transplant
Hypersensitivity
Ulcerative colitis
Seizure disorders
Route
PO
IM
IV
Onset of Action
Interactions
4-8 days
1-2 hours
Increased side effects
with alcohol, salicylates,
digoxin, diuretics, NSAIDs.
Increased dexamethasone
action with salicylates,
estrogens, indomethacin,
NSAIDs.
Mechanism of Action
Blocks or reduces the inflammatory esponse.
Advantages/Disadvantages
Side Effects
Depression
Sweating
Mood changes
Hypernatremia
Hypokalemia
Adverse Effects
Flushing
Headache
Insomnia
Seizures
Circulatory collapse
Heart failure
GI bleeding
Muscle wasting
Osteoporosis
Hypertension
Cardiomyopathy
Thromboembolism
Hyperglycemia
Cushing’s syndrome
Delayed wound healing
Nursing Interventions
Client Education
Administer PO medication with food or milk to decrease GI symptoms.
IM injection deeply in large muscle mass. Avoid deltoid.
Daily weight, Monitor vital signs, I&O
Monitor for signs of infection
Monitor fluid and elect olytes and glucose.
Do not stop abruptly; taper off medication.
Take with food or milk
Avoid OTC products
Avoid exposure to chicken pox, measles, individuals with an
infection.
DO NOT discontinue abruptly.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Iodine Compounds
Agent(s)
Common Uses
Contraindications
Potassium iodide
(Lugol’s solution,
SSKI)
Hyperthyroidism
Pre-op to decrease
the chance of
bleeding.
Pregnancy
Pulmonary edema
TB
Bronchitis
Hypersensitivity
Route
PO
Onset of Action
Interactions
24-48 hours
Increase: hypothyroidism –
lithium
Increase: hyperkalemia –
ACE inhibitors, potassiumsparing diuretics.
Mechanism of Action
Decreases the size and vascularity of the thyroid gland. Inhibits secretion of thyroid hormone.
Advantages/Disadvantages
Side Effects
Adverse Effects
Headache
Confusion
Paresthesia
Metallic taste
Stomatitis
Nausea/Vomiting
Diarrhea
Angioneurotic edema
Nursing Interventions
Client Education
Dilute in milk or juice and administer through a straw to prevent teeth
discoloration.
Administer after meals to prevent GI upset.
Assess Vital signs
Monitor potassium level
Daily weight
I&O
Monitor thyroid levels
Keep of graph of weight, pulse, mood
Avoid seafood and other iodine products.
Do not discontinue abruptly as thyroid crisis may occur.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Incretin Mimetic
Agent(s)
Common Uses
Contraindications
Exenatide (Byetta)
Type 2 Diabetes
Type 1 Diabetes
DKA
Severe renal
dysfunction
Severe GI disease
Liraglutide (Victoza)
Route
SubQ
Onset of Action
Interactions
1 hour
Increase hypoglycemia
with ACE inhibitors,
sulfonylureas, alcohol.
Increase hyperglycemia with
corticosteroids.
Mechanism of Action
Suppresses glucagon secretion
Stimulates insulin release
Advantages/Disadvantages
Exenatide added to type 2 diabetic
therapy when inadequately managed by
Metformin or a Sulfonylurea.
Liraglutide not recommended for first
line therapy. Risk of thyroid C-cell tumors
including medullary thyroid cancer.
Side Effects
Adverse Effects
Headache
Dizziness
Jitteriness
Nausea/Vomiting
Diarrhea
Hypoglycemia
Pancreatitis
Angioedema
Anaphylaxis
Nursing Interventions
Client Education
Administer exenatide SQ within 1 hour of morning and evening
meals.
Monitor for hypoglycemia
Always have oral carbohydrate available.
Monitor for pancreatitis.
SubQ medication administration.
Glucose self-monitoring.
Signs/Symptoms of hypoglycemia/hyperglycemia.
Avoid OTC medications, alcohol.
Always have oral carbohydrate available.
Notify PHCP or severe abdominal pain.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Incretin Modifier
Agent(s)
Common Uses
Contraindications
Sitagliptin (Januvia),
Saxagliptin (Onglyza)
Type 2 Diabetes
Angioedema
Type 1 Diabetes
DKA
Route
Onset of Action
Interactions
Increase level of digoxin.
Increase risk of
hypoglycemia with beta
blockers, cimetidine.
Decrease antidiabetic
effect with thiazides, ACE
inhibitors.
PO
Mechanism of Action
Increases insulin secretion. Decreases Glucagon secretion.
Advantages/Disadvantages
May be taken with or without food.
Side Effects
Adverse Effects
Headache
N/V
Abdominal pain
Diarrhea
Constipation
Peripheral edema
Hypoglycemia
Pancreatitis
Acute renal failure
Anaphylaxis
Angioedema
Nursing Interventions
Client Education
Monitor for hypoglycemia.
Monitor for swelling of face, mouth, lips, dyspnea.
Monitor blood glucose, BUN, Creatinine, Hgb A1C
Do not split, crush, chew. Swallow whole.
Self-monitoring blood glucose.
Signs and symptoms of hypoglycemia/hyperglycemia.
Avoid OTC medications, alcohol, digoxin, insulins.
Notify PHCP of rash, swelling of face, dyspnea).
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Combination Insulin (Pre-mixed)
Agent(s)
Common Uses
Contraindications
Humulin 70/30,
NovoLog Mix 70/30,
Humalog Mix 75/25,
Humalog Mix 50/50
Type 1 Diabetes
Type 2 Diabetes
Hypersensitivity
Hypoglycemia
Route
SubQ
Onset of Action
Interactions
Onset and Peak
dependent on
whether combined
with a rapid acting
or short acting
insulin. All provide
24 hour duration.
Increased hypoglycemic
effect with aspirin, oral
anticoagulant, alcohol, oral
hypoglycemic, beta blockers
MAOIs.
Mechanism of Action
Decreases blood glucose by transporting glucose into cells and the conversion of glucose to glycogen. Promotes use of
glucose by body cells.
Advantages/Disadvantages
Intermediate acting insulin combined
with either rapid acting or short
acting (regular) insulin.
Side Effects
Adverse Effects
Confusion
Agitation
Tremors
Headache
Flushing
Hunger
Weakness
Lethargy
Fatigue
Redness at injection site.
Tachycardia
Palpitations
Hypoglycemia
Rebound hyperglycemia
Lipodystrophy
Shock/Anaphylaxis
Nursing Interventions
Client Education
Monitor for hypoglycemia, hypokalemia, lipodystrophy.
Always have oral carbohydrate available.
SubQ medication administration.
Glucose self-monitoring.
Signs/symptoms of hypoglycemia/hyperglycemia.
Always have oral carbohydrate available.
Carry a glucose source to treat hypoglycemia
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Intermediate Acting Insulin
Agent(s)
Common Uses
Contraindications
Route
Onset of Action
Interactions
Isophane suspension
(NPH, Humulin N,
Novolin N)
Type 1 Diabetes
Type 2 Diabetes
Hypersensitivity
Hypoglycemia
SubQ
1 – 1 ½ hour
Peak: 4-12 hours
Duration: 16-24 hrs
Increased hypoglycemic
effect with aspirin, oral
anticoagulant, alcohol,
oral hypoglycemic, beta
blockers MAOIs.
Mechanism of Action
Decreases blood glucose by transporting glucose into cells and the conversion of glucose to glycogen. Promotes use of
glucose by body cells.
Advantages/Disadvantages
Side Effects
Adverse Effects
Confusion
Agitation
Tremors
Headache
Flushing
Hunger
Weakness
Lethargy
Fatigue
Redness at injection site.
Tachycardia
Palpitations
Hypoglycemia
Rebound hyperglycemia
Lipodystrophy
Shock
Anaphylaxis
Nursing Interventions
Client Education
Cloudy suspension. Can mix with Regular or Rapid acting insulin:
Draw up clear (Regular or Rapid acting), then cloudy (NPH), “Clear
to cloudy”.
Monitor for hypoglycemia, hypokalemia, lipodystrophy.
Always have oral carbohydrate available.
SubQ medication administration.
Glucose self-monitoring.
Signs/symptoms of hypoglycemia/hyperglycemia.
Always have oral carbohydrate available.
Carry a glucose source to treat hypoglycemia
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Long Acting Insulin
Agent(s)
Common Uses
Contraindications
Glargine (Lantus)
Type 1 Diabetes
Type 2 Diabetes
Hypersensitivity
Hypoglycemia
Route
SubQ
Onset of Action
Interactions
2-4 hours
Peak: none
Duration: 24 hours
Increased hypoglycemic
effect with aspirin, oral
anticoagulant, alcohol, oral
hypoglycemic, beta blockers
MAOIs.
Mechanism of Action
Decreases blood glucose by transporting glucose into cells and the conversion of glucose to glycogen. Promotes use of
glucose by body cells.
Advantages/Disadvantages
Once daily SubQ injection provides
24-hour coverage. No peak, insulin
delivered at steady level, less risk of
hypoglycemia.
Side Effects
Adverse Effects
Confusion
Agitation
Tremors
Headache
Flushing
Hunger
Weakness
Lethargy
Fatigue
Redness at injection site.
Tachycardia
Palpitations
Hypoglycemia
Rebound hyperglycemia
Lipodystrophy
Shock
Anaphylaxis
Nursing Interventions
Client Education
Do NOT mix with any other insulin.
Monitor for hypoglycemia, hypokalemia, lipodystrophy.
Always have oral carbohydrate available.
SubQ medication administration.
Glucose self-monitoring.
Signs/symptoms of hypoglycemia/hyperglycemia.
Always have oral carbohydrate available.
Carry a glucose source to treat hypoglycemia
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Rapid Acting Insulin
Agent(s)
Common Uses
Contraindications
Aspart (NovoLog),
Lispro (Humalog),
Glulisine (Apidra)
Type 1 Diabetes
Type 2 Diabetes
Hypersensitivity
Hypoglycemia
Route
SubQ
IV
Onset of Action
Interactions
5-15 minutes
Peak: 1-3 hours
Duration: 3-5 hours
Increased hypoglycemic
effect with aspirin, oral
anticoagulant, alcohol,
oral hypoglycemic, beta
blockers MAOIs.
Mechanism of Action
Decreases blood glucose by transporting glucose into cells and the conversion of glucose to glycogen. Promotes use of glucose
by body cells.
Advantages/Disadvantages
May be given as a short-term IV therapy
with close monitoring.
Side Effects
Adverse Effects
Confusion
Agitation
Tremors
Headache
Flushing
Hunger
Weakness
Lethargy
Fatigue
Redness at injection site.
Tachycardia
Palpitations
Hypoglycemia
Rebound hyperglycemia
Lipodystrophy
Shock
Anaphylaxis
Nursing Interventions
Client Education
Administer with meals. DO NOT administer unless meal is readily
available.
Monitor for hypoglycemia, hypokalemia, lipodystrophy.
Always have oral carbohydrate available.
SubQ medication administration.
Glucose self-monitoring.
Signs/symptoms of hypoglycemia/hyperglycemia.
Always have oral carbohydrate available.
Carry a glucose source to treat hypoglycemia
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Short Acting Insulin (Regular)
Agent(s)
Common Uses
Contraindications
HUmulin R, Novolin R
Type 1 Diabetes
Type 2 Diabetes
Hypersensitivity
Hypoglycemia
Route
SubQ
IV
Onset of Action
Interactions
30 min – 1 hour
Peak: 2-4 hours
Duration: 6-8 hours
Increased hypoglycemic
effect with aspirin, oral
anticoagulant, alcohol,
oral hypoglycemic, beta
blockers MAOIs.
Mechanism of Action
Decreases blood glucose by transporting glucose into cells and the conversion of glucose to glycogen. Promotes use of
glucose by body cells.
Advantages/Disadvantages
Used for dosing clients with Sliding
Scale. Can be administered IVP or
continuous IV infusion.
Side Effects
Adverse Effects
Confusion
Agitation
Tremors
Headache
Flushing
Hunger
Weakness
Lethargy
Fatigue
Redness at injection site.
Tachycardia
Palpitations
Hypoglycemia
Rebound hyperglycemia
Lipodystrophy
Shock
Anaphylaxis
Nursing Interventions
Client Education
Administer with meals. DO NOT administer unless meal is readily
available.
Finger Stick Blood Sugars (FSBS)
Monitor for hypoglycemia, hypokalemia, lipodystrophy.
Always have oral carbohydrate available.
SubQ medication administration.
Glucose self-monitoring.
Signs/symptoms of hypoglycemia/hyperglycemia.
Always have oral carbohydrate available.
Carry a glucose source to treat hypoglycemia
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Meglitinides
Agent(s)
Common Uses
Contraindications
Nateglinide (Starlix),
Repaglinide (Prandin)
Type 2 Diabetes
Type 1 Diabetes
DKA
Route
PO
Onset of Action
Interactions
30 minutes
Antidiabetic effect
increased with use of
garlic.
Mechanism of Action
Stimulates the release of insulin from the pancreas.
Advantages/Disadvantages
May be used alone or in combination
with Metformin.
Should be avoided in clients with liver
dysfunction due to possible decreased
liver metabolism.
Side Effects
Headache
Tinnitus
Nausea/vomiting
Constipation
Angina
Adverse Effects
Weakness
Sinusitis
Diarrhea
Dyspepsia
URI
Hypoglycemia
Pancreatitis
Hemolytic anemia
Leukopenia
Nursing Interventions
Client Education
Administer 15-30 minutes before meals.
Skip dose if meal skipped.
Monitor for hypoglycemia.
Blood glucose monitoring.
Signs/Symptoms of hypoglycemia/hyperglycemia
Eat after taking medication to prevent hypoglycemia.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Mineralocorticoid
Agent(s)
Common Uses
Contraindications
Fludrocortisone
Addison’s disease
Adrenal insufficienc
Children <2 y/o
Hypersensitivity
Route
Onset of Action
Interactions
Increased BP with sodiumcontaining food or medication.
Decreased flud ocortisone action
with barbiturates, phenytoin.
Decrease potassium levels with
thiazides, loop diuretics.
PO
Mechanism of Action
Promotes increased reabsorption of sodium and loss of potassium, water, hydrogen from distal renal tubules. Aldosterone
causes the retention of sodium and water.
Advantages/Disadvantages
Can cause a negative nitrogen
balance
Side Effects
Flushing
Headache
Hypertension
Weight gain
Hypokalemia
Adverse Effects
Sweating
Dizziness
Tachycardia
Hyperglycemia
Seizures
Circulatory collapse
Embolism
Anaphylaxis
Nursing Interventions
Client Education
Daily weight
I&O
Assess for edema
Vital Signs every 4 hours
Monitor electrolytes
Administer with food or milk to decrease GI symptoms
Notify prescriber of weight gain > 5 pounds.
Notify prescriber of chest pain.
Do not discontinue medication abruptly.
Avoid exposure to disease.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Parathyroid Agent (Calcium Regulator)
Agent(s)
Common Uses
Contraindications
Calcitonin (Fortical)
Hypercalcemia
Paget’s disease
Osteoporosis
Hypersensitivity to
product, fis
Route
SubQ
IM
Onset of Action
Interactions
15 minutes
15 minutes
Decrease lithium effect.
Mechanism of Action
Calcitonin decreases serum calcium by taking the calcium out of the blood and putting it back into the bone.
Advantages/Disadvantages
Side Effects
Headache
Chills
Dizziness
Nasal congestion
Adverse Effects
Tetany
Weakness
Hypertension
Nausea/Vomiting
Anaphylaxis
Nursing Interventions
Client Education
Assess for anaphylaxis. Have emergency equipment readily available.
Monitor nutritional status.
Monitor calcium levels
Teach about method of injection if client will be selfmedicating.
Report difficu ty swallowing.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Sulfonylureas – 1st Generation
Agent(s)
Common Uses
Contraindications
Route
Onset of Action
Interactions
Tolbutamide
(Orinase),
Chlorpropamide
(Diabinese)
Type 2 Diabetes
Type 1 Diabetes
DKA
PO
20 minutes
Beta-blockers may hide signs of
hypoglycemia. ACE inhibitors, anticoagulants
MAOIs, NSAIDs, salicylates may increase risk
of hypoglycemia.
Calcium channel blockers, corticosteroids,
decongestants, diuretics, hormonal
contraceptives, albuterol, epinephrine, thyroid
supplements may result in hyperglycemia.
Mechanism of Action
Stimulating the release of the body’s natural insulin from the pancreas, which in turn helps to lower blood sugar.
Advantages/Disadvantages
Hypoglycemic reaction may occur
Side Effects
Adverse Effects
Drowsiness
Dizziness
Blurred vision
Lightheadedness
Anaphylaxis
Hypoglycemia
Jaundice
Blood dyscrasias
Nursing Interventions
Client Education
Monitor vital signs as oral antidiabetics increase cardiac
function and oxygen consumption, which can lead to
cardiac dysrhythmias.
Administer with food.
FSBS
Prepare teaching plan based on client’s knowledge of
health problems, diet, exercise, drug therapy.
Importance of diet and exercise.
Signs/Symptoms of hypoglycemia and hyperglycemia
Take with food at the same time each day.
Continue to take tolbutamide even if feeling well. Do not miss any doses.
Self-monitoring blood glucose
Use sunscreen and wear protective clothing when outside for more than a
short time.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Sulfonylureas – 2nd Generation
Agent(s)
Common Uses
Contraindications
Glipizide (Glucotrol),
Glyburide (DiaBeta),
Glimepiride (Amaryl)
Type 2 Diabetes
Type 1 Diabetes
DKA
Liver or renal
dysfunction
Route
PO
Onset of Action
Interactions
15-30 minutes
Beta-blockers may hide signs of
hypoglycemia. ACE inhibitors,
anticoagulants MAOIs, NSAIDs,
salicylates may increase risk of
hypoglycemia. Calcium channel
blockers, corticosteroids,
decongestants, diuretics, hormonal
contraceptives, albuterol, epinephrine,
thyroid supplements may result in
hyperglycemia.
Mechanism of Action
Directly stimulates the beta cells to secrete insulin, thus decreasing the blood glucose level. Increases the tissue response to
insulin and decreases glucose production by the liver.
Advantages/Disadvantages
Effective doses are lower than 1st
generation. Longer duration of
action and fewer side effects.
Side Effects
Adverse Effects
Nausea/Vomiting
Diarrhea
Abdominal pain
Hypoglycemia
Blood dyscrasias
Jaundice
Higher hypoglycemic potency than
1st generation. Hypoglycemia more
likely in the older adult.
Nursing Interventions
Client Education
Monitor vital signs as oral antidiabetics increase cardiac
function and oxygen consumption, which can lead to cardiac
dysrhythmias.
Administer with food. FSBS; Prepare teaching plan based on
client’s knowledge of health problems, diet, exercise & meds.
Importance of diet and exercise.
Signs/Symptoms of hypoglycemia and hyperglycemia
Take with food at the same time each day. Self-monitoring blood
glucose. Use sunscreen and wear protective clothing when outside for
more than a short time.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Synthetic Antidiuretic Hormone
Agent(s)
Common Uses
Contraindications
Route/Dosage
Onset of Action
Interactions
Desmopressin
Acetate (DDAVP)
Vasopressin (Pitressin)
Diabetes Insipidus
Hemophillia A
Nocturnal enuresis
Normalizes urinary
water excretion
Coronary artery disease
Hypertension
Severe renal disease
Hyponatremia
DI related to renal disease
Intranasally
IV
1 hour
1 minute
Increased
antidiuretic
effect with SSRIs,
carbamazepine
Mechanism of Action
Promotes reabsorption of water by action on renal tubular epithelium. Causes smooth muscle constriction. Increases factor VIII
levels, which increases platelet aggregation, thereby resulting in vasopressor effect (similar to vasopressin).
Advantages/Disadvantages
Clients at risk for hyponatremia or
thrombi should not receive these
medications
Side Effects
Adverse Effects
Drowsiness
Lethargy
Flushing
Nasal irritation
Congestion
Hyponatremia
Seizures
IV – Anaphylaxis
Water intoxication
Nursing Interventions
Client Education
Monitor pulse, BP
I&O
Daily weight
Observe for signs of water intoxication (lethargy, behavior changes,
disorientation)
Proper technique for nasal instillation.
Avoid OTC products with epinephrine.
Reference: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Class: Thiazolidinediones “Glitazones”
Agent(s)
Common Uses
Contraindications
Rosiglitazone
(Avandia),
Pioglitazone (Actos)
Type 2 Diabetes
Symptomatic heart
disease
Class 3 / 4 Heart failure
DKA
Type 1 diabetes
Route
Onset of Action
Interactions
Avoid concurrent use
with insulin, nitrates.
Increased antidiabetic
effect with garlic.
PO
Mechanism of Action
Improves glucose uptake in the muscles, decreases endogenous glucose production. Decrease insulin resistance and improve
blood glucose control.
Advantages/Disadvantages
Does not induce hypoglycemic reactions
if taken alone. Lowers triglyceride level.
May raise HDL cholesterol
May cause heart failure or MI
Can be hepatotoxic
May raise LDL cholesterol
Side Effects
Adverse Effects
Fatigue
Headache
Weight gain
Diarrhea
UTI
MI
CHF
Hepatotoxicity
Anaphylaxis
Nursing Interventions
Client Education
Monitor for hypoglycemia.
Monitor ALT level
Monitor glucose
Monitor blood glucose
Signs/Symptoms of hyperglycemia / hypoglycemia
Daily weight
Report edema
Report SOB, chest pain
Report symptoms of hepatic dysfunction – Nausea/
Vomiting, abdominal pain, dark urine, jaundice, anorexia.
*To use Rosiglitazone the provider and client must be enrolled in the
Avandia-Rosiglitazone Medicines Access Program.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Thyroid Hormone Replacements
Agent(s)
Common Uses
Contraindications
Route
Onset of Action
Interactions
T4 Replacement:
Levothyroxine (Synthroid),
Hypothyroidism
Myxedema
Cretinism
Adrenal insufficienc
Recent MI
Thyrotoxicosis
PO
24 hours
Increase cardiac insufficiency
risk with epinephrine products.
Decrease levothyroxine
absorption/effect with ferrous
sulfate, estrogens, antacids,
sucralfate.
T3 Replacement:
Liothyronine (Cytomel,
Triostat)
IV
Mechanism of Action
Increases metabolic rate; increases cardiac output, renal blood flo , oxygen consumption, body temperature, blood volume,
growth, development at cellular level via action on thyroid hormone receptors.
Advantages/Disadvantages
Side Effects
Adverse Effects
Insomnia
Weight loss
Anxiety
Insomnia
Headache
Nausea
Anorexia
Hypertension
Tachycardia
Chest pain
Cardiovascular collapse
Thyrotoxicosis
Nursing Interventions
Client Education
Monitor Vital Signs
Monitor for thyrotoxicosis.
Daily weight
Monitor thyroid hormone levels
Monitor cardiac status
Life-long replacement with medication is necessary.
Do not switch brands
Avoid OTC preparations with iodine.
Avoid iodine-rich foods (Iodized salt, soybeans, tofu, turnips,
seafood).
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Alternative Therapy - Cannaboids
Agent(s)
Common Uses
Contraindications
Dronabinol (Marinol)
Anti-emetic
Chemotherapy
Pregnancy
Breastfeeding
Psychiatric disorders
Route
PO
Onset of Action
Interactions
30 minutes - 1 hour
Increased CNS depression
with other CNS depression
medications.
Mechanism of Action
The mechanism of action of Marinol is not completely understood. It is thought that cannabinoid receptors in neural tissues
may mediate the effects of dronabinol and other cannabinoids. Animal studies with other cannabinoids suggest that Marinol’s
antiemetic effects may be due to inhibition of the vomiting control mechanism in the medulla oblongata.
Advantages/Disadvantages
Side Effects
Adverse Effects
Euphoria
Anxiety
Drowsiness
Visual disturbances
Orthostatic hypotension
Seizures
Paranoia
Nursing Interventions
Client Education
Monitor hydration, nutritional status.
I&O
Monitor BP and heart rate throughout therapy.
Monitor closely for side effects.
Capsules should be refrigerated.
Rise slowly from a sitting or lying position.
Do not use alcohol or drive while taking this medication.
Capsules should be refrigerated, not frozen.
Call for assistance when ambulating.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Antacids
Agent(s)
Common Uses
Contraindications
Magnesium carbonate
(Gaviscon), Magnesium
hydroxide (Milk of
Magnesia), Calcium
Carbonate (Tums),
Heartburn
Gastritis
Peptic Ulcer disease
GERD
Indigestion
Prophylaxis with burns
Hypomagnesemia
Renal failure
Route
Onset of Action
Interactions
Risk of side effects of
anticoagulants.
Blocks absorption of
other medications when
given simultaneously
PO
Mechanism of Action
Antacids work by counteracting or neutralizing the acid in the stomach. The neutralization makes the stomach contents less
corrosive.
Advantages/Disadvantages
Side Effects
Adverse Effects
Diarrhea
Loss of appetite
Hives
Itching
Dyspnea
Tightness in chest
Edema of face, mouth, tongue
Nursing Interventions
Client Education
Give either 30 minutes before or 1 hour after other medications to
prevent decreased absorption and effectiveness of medications.
Take with or without food. Follow with a full glass (240 mL)
water or other liquid.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Anti-ulcer; GI protectant
Agent(s)
Common Uses
Contraindications
Sucralfate
(Carafate)
Peptic ulcer disease
Prevention of druginduced ulcers
Hypersensitivity
Precautions:
pregnancy,
breastfeeding, renal
failure, hypoglycemia
Route
PO
Onset of Action
Interactions
30 minutes
Cimetidine, ranitidine:
decrease absorption
Mechanism of Action
Acts locally, not systemically, binding directly to the surface of an ulcer and absorbs pepsin.
Advantages/Disadvantages
Side Effects
Adverse Effects
Nausea
Constipation
Dry mouth
No systemic absorption
Nursing Interventions
Client Education
Assess for abdominal pain or blood in stools.
Don’t administer with antacids.
Watch for constipation.
Do not break, crush or chew tablets
Take on empty stomach 1 hour before meals and at bedtime
Avoid antacids 30 minutes before or 1 hour after taking this
product
Store at room temperature.
Avoid smoking.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Emollient Laxative
Agent(s)
Common Uses
Contraindications
polyethylene glycol
(GoLytely, CoLyte)
Bowel cleansing prior
to colonoscopy and
barium enema X-ray
examination.
Gastrointestinal
obstruction
Gastric retention,
Bowel perforation,
Toxic colitis,
Megacolon / ileus.
Route
PO
Onset of Action
Interactions
30-60 minutes
Oral medication administered
within one hour of the
start of administration of
GoLYTELY for Oral Solution
may be flushed f om the
gastrointestinal tract and not
absorbed.
Mechanism of Action
GoLYTELY for Oral Solution induces a diarrhea which rapidly cleanses the bowel, usually within four hours. The osmotic activity
of polyethylene glycol 3350 and the electrolyte concentration result in virtually no net absorption or excretion of ions or water.
Accordingly, large volumes may be administered without significant changes in fluid or elec olyte balance.
Advantages/Disadvantages
Cleanses the bowel thoroughly so that
diagnostic tests can be performed
efficien ly
Side Effects
Adverse Effects
Severe bloating, distention or
abdominal pain (may have to
discontinue if doesn’t resolve)
Nursing Interventions
Client Education
Observed closely with clients that have impaired swallowing or GERD
during the administration of GoLYTELY for Oral Solution.
Prepare the solution per the instructions on the bottle. It is more
palatable if chilled. For best results, no solid food should be
consumed during the 3 to 4-hour period before drinking the
solution, but in no case should solid foods be eaten within 2
hours of taking GoLYTELY for Oral Solution.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: H2 Antagonists (Histamine 2 Receptor Blockers)
Agent(s)
Common Uses
Contraindications
Route/Dosage
Onset of Action
Interactions
Cimetidine (Tagamet),
Famotidine (Pepcid),
Ranitidine (Xantac),
Nizatidine (Axid
Peptic ulcer disease
GERD
Esophagitis
GI Bleeding
Prophylaxis with
burns
Hypersensitivity
Severe renal disease
Severe liver disease
PO
15 minutes
IV
10-15 minutes
Cimetidine potentiates
the effects of warfarin,
phenytoin, theophylline,
and lidocaine. Smoking
decreases the effectiveness
of H2 Antagonists.
Mechanism of Action
Blocks the H2 receptors of the parietal cells in the stomach, thus reducing gastric acid secretion and concentration.
Advantages/Disadvantages
Overall low incidence of adverse effects
Side Effects
Headache
Dizziness
Constipation
Pruritis
Decreased libido
Adverse Effects
Confusion
Vertigo
Diarrhea
Depression
Hepatotoxicity
Cardiac dysrhythmias
Blood dyscrasias
Nursing Interventions
Client Education
Give at least 1 hour before antacids for optimal effect.
Administer IV in 20-100 mL of solution.
Take at least 1 hour before antacids for optimal effect.
Smoking decreases the effectiveness of H2 Antagonists.
Avoid foods that cause gastric irritation.
Reference: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Class: Laxative (hyperosmotic/ammonia detoxicant)
Agent(s)
Common Uses
Contraindications
lactulose
(Constulose, Enulose,
Generiac, Kristalose,
Duphalac)
Bowel prep –
diagnostic/surgical
procedures.
Clients on a lowgalactose diet.
(Galactose is a
component of
lactulose)
Hepatic
encephalopathy
Route
PO
Rectal
Onset of Action
Interactions
24 hours
Neomycin, antiinfective(oral) and antacids
decrease effects of lactulose
Mechanism of Action
Creates a hyperosmotic (acidic) environment that draws water into the colon and produces a laxative effect. It also reduces
ammonia levels by converting ammonia to ammonium. Ammonium is a water-soluble cation that is trapped in the intestines and
cannot be reabsorbed in to the systemic circulation.
Advantages/Disadvantages
Ease of use and works within 24 hours.
Side Effects
Adverse Effects
Nausea/vomiting
Diarrhea
Flatulence
Distention/bloating
Hypernatremia,
Abdominal bloating
Rectal irritation
Nursing Interventions
Client Education
Administer with a full glass of fruit juice, water or milk to increase
palatability of oral form.
Give on an empty stomach to increase effect.
Assess stool for amount, color and consistency.
Monitor glucose levels if diabetic.
Teach client causes of constipation such as lack of fiber in he
diet, fluids or exe cise.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Non-Stimulant Anorexiants
Agent(s)
Common Uses
Contraindications
Lipase Inhibitor:
Orlistat (Xenical),
OTC strength (Alli)
Obesity
Cholestasis
Malabsorption
syndromes
Route
Onset of Action
Interactions
Increases effects of
warfarin
Decreases absorption of
fat soluble vitamins.
PO
Mechanism of Action
Inhibits gastric and pancreatic lipases reducing fat absorption by 30%. The fats are excreted in feces.
Advantages/Disadvantages
Drug of choice for weight loss
Side Effects
Oily spotting
Fecal incontinence
Headache
Anxiety
Abdominal cramping
Nausea/Vomiting
Adverse Effects
Flatulence
Steatorrhea
Insomnia
Depression
Hypoglycemia
Hepatic failure
Hepatitis
Pancreatitis
Nursing Interventions
Client Education
Assess weight status before therapy.
Assess thyroid function, BMI, glucose, weight weekly.
Lessen dietary fat intake to decrease side effects.
Take multivitamin containing fat-soluble vitamins 2 hrs before
or after medication.
Psyllium taken with each dose or at bedtime may decrease GI
symptoms.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Proton Pump Inhibitors
Agent(s)
Common Uses
Contraindications
Route/Dosage
Onset of Action
Interactions
Pantoprazole (Protonix),
Omeprazole (Prilosec),
Esomeprazole (Nexium),
Lansoprazole (Prevacid)
GERD
Peptic ulcer
Esophagitis.
Prophylaxis with
burns
Hypersensitivity
Pregnancy
Lactation
Caution in liver
disease
PO
2 hours
IV
15-30 minutes
May decrease
theophylline levels.
Food decreases peak
levels. Can enhance
the action of digoxin,
oral anticoagulants,
phenytoin.
Mechanism of Action
Suppress gastric acid secretion by inhibiting the hydrogen/potassium adenosine triphosphatase (ATPase) enzyme system located in
the gastric parietal cells. They block the final step of acid p oduction.
Advantages/Disadvantages
Overall low incidence of adverse effects
Side Effects
Headache
Blurred vision
Thirst
Increased appetite
Diarrhea
Adverse Effects
Dizziness
Fatigue
Dry mouth
Anorexia
Elevated AST, ALT
Pancreatitis
Rhabdomyolysis
Nursing Interventions
Client Education
Monitor liver function studies.
Monitor glucose levels in diabetic clients.
Report severe diarrhea; black, tarry stools; abdominal pain.
Hyperglycemia may occur in diabetic clients.
Continue taking even if feeling better.
Reference: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Class: Serotonin Blocker Antiemetics
Agent(s)
Common Uses
Contraindications
Ondansetron (Zofran),
Granisetron (Kytril),
Dolasetron,
Netupitan/
palonosetron (Akymzeo)
Post-op Nausea and
Vomiting
Chemotherapy
Hypersensitivity
Torsades de
pointes
Route
PO
IV
Onset of Action
Interactions
30 minutes
10 minutes
Use with apomorphine can
lead to unconsciousness,
hypotention. Do NOT use
together.
Decrease ondansetron effect
with rifampin, phenytoin.
Mechanism of Action
Suppress nausea and vomiting by blocking the serotonin receptors in the afferent vagal nerve terminals in the upper GI tract.
Advantages/Disadvantages
Do not block the dopamine receptors;
therefore, they do not cause extrapyramidal
symptoms as do the phenothiazine
antiemetics.
Side Effects
Adverse Effects
Headache
Diarrhea
Dizziness
Fatigue
Transient elevation of AST and ALT.
Bronchospasm
Nursing Interventions
Client Education
Monitor ECG for QT prolongation in clients with cardiac disease or
receiving other medications that prolong QT.
Report diarrhea, constipation, rash, changes in respirations.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Anticoagulants
Agent(s)
Common Uses
Contraindications
Route
Onset of Action
Interactions
Heparin sodium,
warfarin (Coumadin),
Enoxaparin (Lovenox),
dabigatran etexilate
(Pradaxa)
DVT
Pulmonary embolisms
Thromboembolic
complications
Prevention of clot formation
Dialysis
Open heart surgery
DIC
Atrial fibri lation with
embolization
Bleeding
Hypersensitivity
SubQ
IV
20-60 minutes
5 minutes
Increase heparin action with
oral anticoagulants, salicylates,
NSAIDS, penicillin, SSRIs.
Decrease heparin action
with digoxin, tetracyclines,
antihistamines, cardiac glycosides,
nicotine, nitroglycerin. Increase
bleeding risk with garlic, ginger,
ginkgo, green tea.
Mechanism of Action
Prevents conversion of fibrinogen to fibrin and
Advantages/Disadvantages
Does not dissolve clots already present
othrombin to thrombin by enhancing inhibitory effects of antithrombin III.
Side Effects
Adverse Effects
Injection site reactions
Fever
Chills
Headache
Rash
Hemorrhage
Hypotension
Thrombocytopenia
Anaphylaxis
Nursing Interventions
Client Education
Monitor aPTT (Activated Partial Thromboplastin Time)
Heparin dosage is adjusted to keep the aPTT between 1.5 and 2.5 times
the normal control level.
Have antidote Protamine Sulfate readily available.
Monitor for bleeding.
Do not massage SubQ injection.
Purpose of medication.
Avoid OTC preparations.
Bleeding precautions.
Carry ID identifying product.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Antiplatelets
Agent(s)
Common Uses
Contraindications
Acetylsalicylic acid (Aspirin),
Clopidogrel (Plavix),
Abciximab (ReoPro IV),
Dipyridamole (Persantine),
Eptifiba ide (Integrilin),
Ticlopidine (Ticlid),
Tirofiban (Aggrastat),
Anagrelide HCL (Agrylin)
Decrease platelet
aggregation
Arterial thrombi
Thrombotic stroke
TIA’s
Post-MI thrombi
Prevents re-occlusion
post stent
Bleeding ulcer
Active bleeding
Route
Onset of Action
Interactions
PO
1-2 hours
IV
Rapid
Increased bleeding when
taken with Dong quai,
feverfew, garlic, and
ginkgo biloba.
Mechanism of Action
Antiplatelets are used to prevent thrombosis in the arteries by suppressing platelet aggregation.
Advantages/Disadvantages
Long-term, low-dose ASA therapy has been
found to be both an effective and inexpensive
treatment for suppressing platelet aggregation.
Side Effects
Adverse Effects
GI complaints
Tinnitus
Dizziness
Serious bleeding episodes
Thrombocytopenia
Agranulocytosis
Nursing Interventions
Client Education
Monitor for bleeding
Safety precautions
Bleeding precautions
Teach bleeding precautions.
Notify health care provider if surgery is scheduled while
on antiplatelet medication. It should be discontinued at
least 7 days prior to surgery.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Hematopoietic Agent
Agent(s)
Common Uses
Contraindications
Route
ErythropoietinStimulating Agents
(ESAs):
Epoetin alfa (Procrit),
Darbepoetin alfa
(Aranesp)
Anemia associated
with: Chronic renal
failure, HIV, and
Chemotherapy
Reduce need for
blood transfusions in
surgical clients.
Uncontrolled hypertension
Hypersensitivity to human
albumin
Onset of Action
Interactions
Anticoagulants: need for
an increase in heparin
during hemodialysis
SubQ
IV
Mechanism of Action
Erythropoietin is one factor controlling the rate of red blood cell production.
Advantages/Disadvantages
Side Effects
Hypertension
Headache
Fever
Adverse Effects
Flushing
Seizures
Bone pain
Seizures
Hypertensive encephalopathy
CHF
DVT
Nursing Interventions
Client Education
Monitor hemoglobin. Target hemoglobin should never exceed 12g/dL
Monitor Blood Pressure.
Only use one dose per vial
Do not shake solution, it can cause the glycoprotein to denature.2g/dl.
Monitor for seizures
Teach patient or family how to take blood pressure.
Teach patient to avoid hazardous activity during
treatment.
Teach patients with renal disease to include high iron and
low potassium foods in their diet: meat, dark green leafy
vegetables, eggs and enriched breads.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Hematopoietic Agent
Agent(s)
Common Uses
Contraindications
Folic Acid, Vitamin B9
(Folate) Folacin
Megaloblastic anemia
Pregnancy
Hypersensitivity
Other types of
Anemias
Route
Onset of Action
Interactions
Estrogens,
glucocorticoids,
Hydantoin increase the
need for folic acid.
PO
SubQ
IM
IV
Mechanism of Action
Folic acid is needed for erythropoiesis to increase RBCs, WBCs and platelet formation needed in megablastic anemia and is
necessary for DNA and RNA synthesis.
Advantages/Disadvantages
Genera
Side Effects
Adverse Effects
Allergic bronchospasm
Pruritus
Rash
General malaise
Erythema
Confusion
Depression
Excitability, irritability
Anaphylaxis
Nursing Interventions
Client Education
Monitor Hgb, Hct and reticulocyte count; and
folate levels: 6 – 15mcg/mL baseline, throughout treatment
Teach foods high in folic acid: bran, yeast, dried beans, nuts,
fruit, fresh vegetables, asparagus.
Take as prescribed, do not double up
Advise that urine may become dark
Identify products taking that cause increase folic acid use: alcohol,
oral contraceptives, estrogens, glucocorticoids.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Hematopoietic Agent
Agent(s)
Common Uses
Contraindications
Vitamin B12
(Cyanocobalamin)
Anacobin, Nascobal,
Cobex
Vitamin B12
Deficienc , pernicious
Anemia,
Vitamin B12
malabsorption
Optic nerve atrophy
(Leber’s disease)
Pregnancy and
breastfeeding
Cobalt Allergy
Route
Onset of Action
Interactions
Cimetidine, colchicine,
chloramphenicol,
aminoglycosides,
anticonvulsants and
potassium products cause
a decreased absorption
IM
SubQ
Nasal
Sublingual
PO
Mechanism of Action
Advantages/Disadvantages
Ease of use and low cost
Side Effects
Adverse Effects
Fever
Diarrhea
Pruritus
Flushing/itching
Pain at injection site
Cardiac failure
Thrombosis
Optic nerve atrophy
Pulmonary edema
Hypokalemia
Nursing Interventions
Client Education
Monitor potassium levels.
Monitor CBC for increase in RBC, Hemoglobin.
Monitor for CHF or pulmonary edema in cardiac patients.
Life-long treatment is required for pernicious anemia.
Teach foods high in B12 such as: egg yolks, fish, o gan meats,
dairy products, clams, and oysters.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Immunotherapy
Agent(s)
Common Uses
Contraindications
Interleukin-2 (IL-2),
Interferon-alfa
Leukemia
Melanoma
Non-Hodgkin’s
lymphoma
AIDS related Kaposi
sarcoma
Hypersensitivity
Route
Onset of Action
Interactions
SubQ
IM
Mechanism of Action
Has antiviral, antiproliferative, and immune-modulatory effects, which means that these drugs inhibit intracellular replication of
DNA, interferes with tumor cell growth, and enhances natural killer cell activity.
Advantages/Disadvantages
Can improve resistance to invading
microorganisms and reduce cell
proliferation.
Side Effects
Adverse Effects
Flulike syndrome
Nausea/Vomiting
Anorexia
Taste alterations
Poor concentration
Seizures
Transient aphasia
Psychoses
Suicidal ideation
Cyanosis
Orthostatic hypotension
Thrombocytopenia
Diarrhea
Xerostomia
Nursing Interventions
Client Education
Keep prefi led syringes in the refrigerator.
Do not freeze or shake. Protect from light.
Obtain baseline CBC and liver function tests.
Keep prefi led syringes in the refrigerator.
Do not freeze or shake. Protect from light.
Notify prescriber of adverse effects.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Plasminogen Inactivators/Anti-fib olytic Agents
Agent(s)
Common Uses
Contraindications
Aminocaproic acid
(Amicar)
Excessive
bleeding from
hyperfibrinolysis
Disseminated
intravascular
coagulation (DIC)
Route
IV
PO
Onset of Action
Interactions
1 hour
Factor IX complex:
increased risk of
thrombosis
Mechanism of Action
Promotes clot formation by inhibiting plasminogen activators.
Advantages/Disadvantages
Antidote for thrombolytic therapy with
excessive bleeding.
Side Effects
Adverse Effects
Edema
Headache
Malaise
Nausea/Vomiting
Diarrhea
Abdominal pain
Uncommon and generally mild.
Rare:
Thrombophlebitis
Orthostatic hypotension.
Nursing Interventions
Client Education
Monitor bleeding episode.
Continuous cardiac monitoring – Looking for signs of re-occlusion
Monitor for signs of MI
Report signs of angina, MI
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Thrombolytics
Agent(s)
Common Uses
Contraindications
Tenecteplase
(TNKase), Reteplase
(Retavase), Alteplase
(tPA), Streptokinase,
Urokinase
Acute MI
Thrombolic stroke
Pulmonary embolism
DVT
Intracranial neoplasm
Intracranial bleed
Suspected aortic
dissection
Internal bleeding
Route
IV
Onset of Action
Interactions
5-10 minutes
Increased bleeding when
taken with oral anticoagulants,
NSAIDs, ginkgo, garlic, ginger,
green tea. Decreased effects
when taken with nitroglycerin.
Mechanism of Action
Promotes the fibrinoly ic mechanism (converting plasminogen to plasmin, which destroys the fibrin in he blood clot). The
thrombus disintegrates when a thrombolytic drug is administered within 4 hours after an acute MI. Necrosis is prevented or
minimized.
Advantages/Disadvantages
Dissolves clot within 4 hours after an acute
MI.
Risk for hemorrhage
Side Effects
Adverse Effects
Bleeding
Nausea
Vomiting
Fever
Hemorrhage
Bronchospasms
Reperfusion anemias
Stoke
Anemia
Anaphylaxis
MI
Nursing Interventions
Client Education
Check baseline vital signs and baseline CBC, PT, INR.
Obtain medical and drug history. Bleeding history.
Have Amicar readily available – Antidote.
Continuous cardiac monitoring.
Continuously monitor for hemorrhage for 24 hours.
Initiate bleeding precautions
Avoid venipuncture/arterial sticks
Explain thrombolytic treatment.
Advise to report lightheadedness, dizziness, palpitations,
nausea, pruritus, or urticaria.
Avoid use of aspirin or NSAIDS for pain or discomfort.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Antiviral Monoclonal Antibody
Agent(s)
Common Uses
Contraindications
Palivizumab (Synagis)
RSV Immune globin
(RespiGam)
Prevents RSV in
premature infants
and infants born with
certain lung disorders
or heart disease.
Bleeding or clotting
disorders
Low platelet count
Route
Onset of Action
Interactions
IM
Mechanism of Action
A man-made antibody to respiratory syncytial virus (RSV).
Advantages/Disadvantages
Side Effects
Adverse Effects
Fever
Crying or fussiness
Change in appetite or sleeping
patterns
Cyanosis
Black tarry stools
Bleeding gums
Nursing Interventions
Client Education
Dosage is based on weight of infant and must be calculated with
every dose.
Must take it monthly during the RSV season – November
through April
Local reactions may occur to injection: tenderness, hives and
swelling
May interfere with other live vaccines and may need to
revaccinated if taken with 10 months after completed
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Biologic
Agent(s)
Common Uses
Contraindications
adalimumab
Humira
Crohn’s disease,
Psoriatic arthritis
Rheumatoid arthritis
Active infections
Lymphoma/leukemia
Tuberculosis
Route
Onset of Action
Interactions
Anakinra (Kineret) also used
to treat rheumatoid arthritis,
vaccines
SubQ
Mechanism of Action
Biologics work by targeting and blocking the effects of a protein in your body called TNF – alpha. In autoimmune disorders, there
is too much of this protein which can cause the body to attack itself. In rheumatoid arthritis, too much of this protein can cause
pain, stiffness and swelling in the joints. In ulcerative colitis or Crohn’s, adalimumab can decrease the symptoms and put the client
in remission.
Advantages/Disadvantages
Provide very specific ta geting of the
involved cells.
Expensive and not always covered by
insurance. Significant adverse symptoms
Side Effects
Adverse Effects
Headache
Nausea
Sinus infections
Rash at the injection site
Cancers
Sepsis
Fungus and other opportunistic infections
Nursing Interventions
Client Education
Check for injection site reactions.
Assess for TB prior to therapy
Assess for blood dyscrasias: CBC, differential periodically
Learn proper administration of med in the thigh, abdomen
and upper arm
Rotate sites at least one inch from old site.
Advise no vaccines
Report signs of infection immediately.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Immune Globulin
Agent(s)
Common Uses
Contraindications
Route
Rho (D) immune/
globulin (RhoGAM)
Suppresses active
antibody response
and formation of Rho
(D) antibodies
Immune globulins
IgA deficienc
Hypersensitivity
IM
IV
Onset of Action
Interactions
May interfere with the
immune response to
live MMR and varicella
vaccines.
Mechanism of Action
Suppresses the active antibody response and formation of Rho (D) antibodies in Rho (D) negative women who have been
exposed to Rho (D) positive blood as the result of pregnancy or other obstetric condition. Also used to suppress Rh
isoimmunization in Rho (D) negative individuals following transfusion of Rho positive blood. Treatment of ITP in Rho (D) positive
non-splenectomized patients
Advantages/Disadvantages
Side Effects
Adverse Effects
Fever
Headache
Nausea
Dizziness
Rash
Malaise
Mild hemolysis (increased bilirubin,
decreased hemoglobin),
Injection-site reaction
Intravascular hemolysis
Nursing Interventions
Client Education
Administer within 72 hours after termination of pregnancy, delivery or
obstetric complication.
Closely monitor patients with ITP in a healthcare setting for ≥8 hours
after administration. Perform dipstick urinalysis as baseline and after
administration at 2 hours, 4 hours, and just prior to the end of monitoring
period.1 25 Monitor for signs and symptoms of intravascular hemolysis.
Assess renal function (including BUN and creatinine) before initiating
Rho(D)
Teach women the importance of informing clinicians
if they are or plan to become pregnant or plan to
breast-feed. Teach patients when using RhoGAM, the
importance of retaining the patient identifica ion card and
of presenting this card to healthcare providers. Instruct
patients receiving Rho(D) IG for the treatment of ITP to
immediately report signs or symptoms of hemolysis (e.g.,
back pain, chills, fever, discolored urine, swelling, SOB).
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Immune Serum
Agent(s)
Common Uses
Tetanus Immune
Globulin (Baytet)
Exposure to tetanus
Contraindications
Route/Dosage
Onset of Action
Interactions
IM
2 days
These vaccines may not work
as well if received shortly
after a tetanus injection:
Measles, mumps, rubella
(MMR), polio.
Mechanism of Action
Tetanus immune globulin works by giving your body the antibodies it needs to protect it against tetanus infection. This is
called passive protection. This passive protection lasts long enough to protect your body until your body can produce its own
antibodies against tetanus.
Advantages/Disadvantages
Side Effects
Adverse Effects
Itching
Redness at injection site
Anorexia
Mild fever
Pain at injection site
Facial edema
Difficu ty swallowing
Tightness of chest
Dyspnea
Nursing Interventions
Client Education
Monitor for signs of significant eaction (eg, wheezing; chest
tightness; fever; itching; bad cough; blue skin color; seizures;
or swelling of face, lips, tongue, or throat).
Reason for medication
Educate client about signs of a significant eaction (eg, wheezing;
chest tightness; fever; itching; bad cough; blue skin color; seizures;
or swelling of face, lips, tongue, or throat).
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Immune System Agents/ Immunosuppressant/ Anti-rejection
Agent(s)
Common Uses
Contraindications
tacrolimus (Prograf)
cyclosporine
(Sandimmune)
Autoimmune
diseases
Prevent organ
transplant rejection
Hypersensitivity
Use cautiously in:
Diabetes, HTN
Hyperkalemia
Hyperuricemia
Route
Onset of Action
Interactions
Aminoglycosides: increased
toxicity
Antifungals and calcium
channel blockers: increase
blood levels
Vaccines decrease effect
PO
IV
Mechanism of Action
Produces immunosuppression by inhibiting lymphocytes
Advantages/Disadvantages
Side Effects
Insomnia
Fever
Nausea/vomiting
Muscle spasms
Adverse Effects
Back pain
UTI’s
Infection
Hypertension
Hepatotoxicity
Nephrotoxicity
Pulmonary edema
Nursing Interventions
Client Education
Monitor liver functions test: AST, ALT, amylase, and bilirubin
Monitor serum creatinine and BUN and output - 75% of patients will
experience a decrease in urinary output
Watch for anaphylaxis
Monitor blood studies
Advise to report if pregnancy is planned
Report fever, rash, severe diarrhea, chills, sore throat,
because serious infections can occur.
Report clay colored tools or cramping as it may indicate
hepatotoxicity.
Avoid crowds or persons who are sick to reduce infections.
Avoid eating raw shellfish
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Vaccines - Biologic Response Modifiers (BRMs
Agent(s)
Common Uses
Contraindications
Route/Dosage
Hepatitis B
recombinant viral
antigen
HPV recombinant
viral antigen
Prevention of Hepatitis
B which can lead to liver
cancer.
Prevention of cervical, anal,
oropharyngeal cancers;
genital warts
Life threatening allergies
Pregnancy
IM
Life threatening allergies
Pregnancy
IM
Onset of Action
Interactions
Mechanism of Action
Hepatitis B vaccine recombinant is used to prevent infection by the hepatitis B virus. The vaccine works by causing your body
to produce its own protection (antibodies) against the disease. It cannot give you the hepatitis B virus (HBV) or the human
immunodeficiency virus (HIV).
HPV: When a client receives the vaccine, the immune system produces antibodies against these proteins so if the body ever
encounters them again in the form of the actual HPV virus it is well equipped to deal with and destroy the virus.
Advantages/Disadvantages
Side Effects
Adverse Effects
HPV: Available for both men and women ages
9-26 years of age.
Injection site soreness
Fever
Anaphylactic reaction
Hep B: Does not treat Hep B
HPV: Does not treat cervical cancer
HPV: fainting, dizziness, nausea, headache,
and skin reactions
Nursing Interventions
Client Education
Observe client for s/s of adverse reaction to vaccines.
Keep epinephrine readily available for immediate use in case of anaphylactic
reaction.
Provide client with record of immunizations received.
Discuss vaccine-preventable diseases
Answer questions regarding vaccine safety and efficac
Advise female clients of childbearing age to avoid
pregnancy for 1 month.
Provide Vaccine Information Statements from CDC
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Vaccines and Toxoids
Agent(s)
Common Uses
Contraindications
Route/Dosage
Onset of Action
Interactions
Tetanus Toxoid
Prevention of tetanus
Hypersensitivity
Active infection
Poliomyelitis outbreak
Immunosuppression
Febrile illness
SubQ
IM
2 weeks
Increased
immunosuppression
if given with warfarin,
corticosteroids, or
cancer chemotherapy
drugs
Mechanism of Action
Vaccines work by causing the body to produce its own protection (antibodies). Tetanus vaccine is usually first given to infants wi h 2 other
vaccines for diphtheria and whooping cough (pertussis) in a series of 3 injections. This medication is usually used as a “booster” vaccine after
this first series. Booster injec ions may be needed at the time of injury in older children and adults if it has been 5-10 years since the last
tetanus vaccine was received. Booster injections should also be given every 10 years even if no injury has occurred.
Advantages/Disadvantages
Do not use the vaccine on children younger
than 7 years if it has the preservative
thimerosal in it, as this may contain mercury
Side Effects
Adverse Effects
Mild fever
Joint pain
Muscle aches
Nausea
Tiredness
Pain/itching/redness at injection site
Tingling of hands/feet
Hearing problems
Trouble swallowing
Muscle weakness
Seizures
Swelling of face/tongue
Nursing Interventions
Client Education
Have epinephrine infection (1:1,000) readily available should an acute
anaphylactic reaction occur.
Monitor for signs of anaphylactic reaction.
Record the date, lot number and manufacturer of the vaccine on the
immunization record.
Make sure the client/parents were fully informed of benefits
and risks of immunization by the PHCP.
Provide a copy of the immunization record with the date, lot
number and manufacturer of the vaccine listed.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Erectile dysfunction
Agent(s)
Common Uses
Contraindications
Vardenafil (Levitra),
Sildenafil ( iagra),
Tadalafil (Cia is)
Erectile Dysfunction
Severe cardiac disease
Peptic ulcers
GERD
Hepatic disease
Route
PO
Onset of Action
Interactions
30 minutes
Do not use with nitrates
of any form
Mechanism of Action
Enhances erectile function by increasing blood flow into he corpus cavernosum
Advantages/Disadvantages
Side Effects
Adverse Effects
Headache
Nasal congestion
Rash
Hypotension
Exfoliative dermatitis
Priapism
Cardiac arrest
Nursing Interventions
Client Education
Monitor Vital Signs
Watch for indications of changes in cardiac output
Take before sexual activity; do not use more than once a day.
Teach to report an erection lasting > 4 hours.
Does not protect against STDs
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Hormones: Estrogen
Agent(s)
Common Uses
Contraindications
Route
Estrogen
Conjugated estrogen
(Premarin),
Primary ovarian failure
Menopause and posthysterectomy Palliative
treatment of breast cancer
Osteoporosis
Prevention of post-partum
lactation and dysmenorrhea.
Thyroid dysfunction
Family history
of breast cancer
Thrombophlebitis
PO
Transdermal
Topical
Onset of Action
Interactions
Increased risk of
cardiovascular
disease and some
forms of breast
cancer.
Mechanism of Action
Affects release of pituitary gonadotropins.
Advantages/Disadvantages
Side Effects
Adverse Effects
Hypertension
Headache
Weight changes
MI
Stroke
Thromboembolism
Seizure
Nursing Interventions
Client Education
Monitor Blood pressures, weight, serum calcium, glucose and liver
enzymes
Smoking cessation if necessary
Smoking increases risk of embolism, stroke or MI
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Hormones: Progesterone
Agent(s)
Common Uses
Contraindications
Progesterone
(Endometrin,
Prometrium)
Estrogen/Progesterone
Combination (Prempro)
Fibroids, uterine
cancer, endometriosis,
amenorrhea, uterine
bleeding, premenstrual
syndrome (PMS).
Prevention of miscarriage.
Hormone Replacement
Therapy
Pregnancy,
Reproductive
cancer
Thromboembolic
disorders
STDs
Route
Onset of Action
PO
IM
Vaginal
insert &
gel
Interactions
Barbiturates and phenytoin
decrease progesterone
effect.
CYP3A4 inhibitors
(ketoconazole, cimetidine,
clarithromycin, danazol,
diltiazem, erythromycin,
fluconazole, verapamil,
voriconazole) increase
progesterone effect
Mechanism of Action
Inhibits secretion of pituitary gonadotropins, which prevents follicular maturation, ovulation; stimulates growth of mammary tissue;
antineoplastic action against endometrial cancer.
Advantages/Disadvantages
Side Effects
Adverse Effects
Weight changes
Breast tenderness
Depression
Cholestatic jaundice
Pulmonary embolus
Thromboembolism
Spontaneous abortion
Insomnia
Dizziness
Stroke
MI
Angioedema
Nursing Interventions
Client Education
Assess for abnormal uterine bleeding, daily weights, I & O
Teach to report breast lumps, vaginal bleeding, edema,
jaundice, dark urine, clay-colored stools, dyspnea,
headache, blurred vision, abdominal pain, numbness or
stiffness in legs, or chest pain.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Hormones: Testosterone
Agent(s)
Common Uses
Testosterone
(Depo-testosterone,
AndroGel,
Testoderm)
Delayed male puberty
Male hypogonadism
Metastatic breast cancer
Contraindications
Route
Onset of Action
Interactions
PO
Topical
IM
Mechanism of Action
Hormone replacement when natural levels are low.
Advantages/Disadvantages
Side Effects
Hair growth
Spermatogenesis
Increased libido
Gynecomastia
Adverse Effects
Acne
Edema
Hypercalcemia
Priaprism
Hyperkalemia
Anaphylaxis (rare).
Nursing Interventions
Client Education
Administration may alter glucose tolerance test, thyroid tests, and serum
cholesterol. Suppresses clotting factors.
May decrease insulin requirements.
I&O, monitor for decreased urinary output and weight gain (associated
with Na and water retention)
Report symptoms of electrolyte imbalances immediately
Ensure proper administration technique
Report priaprism immediately
Teach good skin hygiene
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Selective Estrogen Receptor Modulators (SERMs)
Agent(s)
Common Uses
Contraindications
Toremefene
(Fareston),
Raloxifen (Evista)
Breast cancer postmenopausal
women
Pregnancy
Breast feeding
Hypersensitivity
Route
Onset of Action
Interactions
Decrease action of
anticoagulants
PO
Mechanism of Action
Act like anti-estrogens to slow tumor growth, but have fewer side effects than tamoxifen.
Advantages/Disadvantages
Fewer side effects than tamoxifen
Side Effects
Adverse Effects
Insomnia
Stroke
Thromboembolism
Pulmonary embolism
Nursing Interventions
Client Education
Bone density test at baseline and throughout treatment
Take calcium supplements, Vitamin D if intake is inadequate
Weight-bearing exercise
Report fever, acute migraine, emotional distress
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Uterine Stimulants
Agent(s)
Common Uses
Contraindications
Oxytocin (Pitocin)
Methylergonovine
(Methergine)
Labor induction,
Postpartum uterine
atony/hemorrhage
Serum toxemia,
Cephalopelvic disproportion
Fetal distress
Prolapsed umbilical cord
Active genital herpes
Route
IV
IM
Intranasal(after
delivery)
Onset of Action
Interactions
1 minute
3-5 minutes
Hypertension with
vasopressors, ephedra
Cautious use in clients
with history of migraines,
diabetes, and renal disease
Mechanism of Action
Acts directly on myofibrils p oducing uterine contraction; stimulates milk ejection by breast; vasoactive antidiuretic effect.
Methergine: administer after delivery of a placenta.
Advantages/Disadvantages
Side Effects
Adverse Effects
Uterine hyperstimulation
Hypertension
Tachycardia
PVC’s
Seizures
Coma
Hypotension
Abruptio placenta
Water intoxication
Fetus: Jaundice, hypoxia, intracranial
hemorrhage
Nursing Interventions
Client Education
Monitor VS, fetal HR and rhythm, intake and output.
Teach to report increased blood loss, abdominal cramps,
fever or foul-smelling lochia
Stop oxytocin for contractions lasting longer than 90 seconds,
contractions < 2 minutes apart and/or with a pattern of fetal late
decelerations.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Loop Diuretics
Agent(s)
Common Uses
Contraindications
Route/Dosage
Onset of Action
Interactions
Furosemide (Lasix)
Bumetanide (Bumex)
Torsemide (Demadex)
Heart Failure
Renal Failure
Hepatic disease
Hypertension
Hypercalcemia (increases
renal excretion of calcium)
FVE
Hypovolemia
Anuria
Severe electrolyte
imbalances
Hepatic coma
PO
60 minutes
IV
5 minutes
Increase ototoxicity
with aminoglycosides.
Increase bleeding
with anticoagulants.
Increase digoxin
toxicity with digoxin
and hypokalemia
Mechanism of Action
Causes diuresis, but also will cause vasodilation to trap blood out in the arms and legs which reduces preload and afterload.
Advantages/Disadvantages
Rapidly removes fluid to help c ients in acute
heart failure or pulmonary edema.
Potassium-wasting
Should not be used if a thiazide could
alleviate body fluid excess
Side Effects
Adverse Effects
Nausea
Diarrhea
Vertigo
Constipation
Weakness
Headache
Electrolyte imbalances
Abdominal cramping
Constipation
Severe dehydration
Marked hypotension
Hyperglycemia
Hearing loss
Renal failure
Thrombocytopenia
Gout
Nursing Interventions
Client Education
Assess vital signs, UOP, electrolytes.
Daily weight
Monitor potassium levels. Observe for signs of hypokalemia.
Monitor digoxin levels if taking digoxin.
Administer IV dose over 1-2 minutes to prevent hypotension and ototoxicity.
Advise to take in the morning and not in the evening to
prevent sleep disturbance and nocturia.
Rise slowly from lying or sitting to standing.
Take with food to avoid nausea.
Eat foods high in potassium.
Reference: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Class: Osmotic Diuretic
Agent(s)
Common Uses
Contraindications
Route/Dosage
Onset of Action
Interactions
Mannitol (Osmitrol)
Early stage acute
renal failure
Reduction of
intracranial pressure
Reduction of
intraocular pressure
seen with glaucoma
Hypersensitivity
Severe dehydration
Active intracranial
bleed
IV
1 hour
May decrease
effectiveness of
Lithium
Mechanism of Action
Inhibits reabsorption of electrolytes and water by affecting pressure of glomerular fi trate.
Advantages/Disadvantages
Used in emergency, trauma, critical
care and neurosurgical settings to treat
cerebral edema and decreased increased
ICP
Side Effects
Adverse Effects
Headache
Dry mouth
Hypotension
Fluid and electrolyte imbalance
Dehydration
Rebound increased intracranial or
intraocular pressure
May crystallize when exposed to low
temperatures.
Very irritating to veins
Nursing Interventions
Client Education
Administer through a fi ter.
Assess neuro status
Monitor lab values (electrolytes and serum osmolality)
I&O
Daily weight
Change IV every 24 hours
Monitor for orthostatic hypotension
Reason for medication
Rise slowly from lying or sitting position.
Report signs of electrolyte imbalance, confusion, pain at injection
site, hearing loss, blurred vision.
Reference: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Class: Potassium-Sparing Diuretics
Agent(s)
Common Uses
Contraindications
Route/Dosage
Onset of Action
Interactions
Spironolactone
(Aldactone)
Triamterene (Dyrenium)
Hypertension
Hyperaldosteronism
Reverse potassium
loss from diuretic
induced hypokalemia
Severe kidney or hepatic
disease
PO
Unknown
Do not take with
ACE inhibitors
or ARBS as
hyperkalemia is
more likely.
Mechanism of Action
Acts in the renal tubules and late distal tubule to promote sodium and water excretion and potassium retention. Aldosterone
antagonist.
Advantages/Disadvantages
Potassium supplements not needed. Mild
diuretic.
Can lead to hyperkalemia
Side Effects
Adverse Effects
Photosensitivity
GI upset
Headache
Dizziness
Hyperkalemia
Nursing Interventions
Client Education
Monitor UOP (at least 600 mL/day) for adequate renal perfusion.
Monitor electrolytes
Daily weight
Observe for signs of hyperkalemia (N/V, diarrhea, abdominal cramps, leg
cramps, tingling hands and feet, peaked t-wave.
Avoid sodium substitutions, K+ supplements, and foods
high in potassium.
Teach signs of hyperkalemia.
Avoid exposure to direct sunlight.
Reference: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Class: Thiazide Diuretics
Agent(s)
Common Uses
Contraindications
Route/Dosage
Onset of Action
Interactions
Hydrochlorothiazide
(HydroDiuril, HCTZ
Hypertension
Diabetes Insipidus
Edema associated with
steroid use, estrogen
therapy, heart disease
or liver disease.
HCTZ: contraindicated
with known sensitivity to
sulfonamides or thiazides.
Renal failure with anuria
PO
2 hours
Increase dig toxicity
with digoxin if
hypokalemia present.
Increase renal toxicity
with ASA. Decrease
absorption with
NSAIDS
Mechanism of Action
Action is on the renal distal tubules, promoting sodium, potassium and water excretion ad decreasing preload and cardiac output.
Also decreases edema. Acts on arterioles, causing vasodilation, thus decreasing blood pressure.
Advantages/Disadvantages
Not effective for immediate diuresis
Should only be given with adequate
renal perfusion.
Side Effects
Dizziness
Vertigo
Weakness
Diarrhea
Photosensitivity
Adverse Effects
Hyperglycemia
Constipation
Nausea/Vomiting
Abdominal pain
Severe dehydration
Hypotension
Gout
Hypokalemia
Shock
Aplastic Anemia
Nursing Interventions
Client Education
Monitor vital signs, UOP, Electrolytes, glucose, uric acid.
Daily weight
Assess peripheral extremities for edema.
Observe for s/s of hypokalemia (muscle weakness, leg cramps,
cardiac dysrhythmias).
Teach s/s of hypokalemia
Take medication in the morning to avoid sleep disturbance and
nocturia.
How to take BP
Safety precautions
Rise slowly from lying or sitting to standing position.
Use sunblock when in direct sunlight for photosensitivity.
Reference: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Class: Anti-Tuberculin
Agent(s)
Common Uses
Contraindications
Isoniazid (INH),
Rifampin (Rifadin)
Tuberculosis (TB)
Hypersensitivity
Route
PO
IV
Onset of Action
Interactions
Rapid
Acetaminophen,
chloramphenicol,
cyclosporine, digoxin,
diltiazem, antacids
Mechanism of Action
Prevents the replication of tubercle bacilli by inhibiting DNA dependent polymerase. Bactericidal against the following organisms:
staphylococcus aureus, Haemophilus influenza, Neisseria meningi is, legionella pneumophila
Advantages/Disadvantages
Side Effects
Adverse Effects
Headache
Vertigo
Dyspepsia
Hepatotoxicity
Nausea/vomiting
Red-brown discoloration to sweat,
urine and sputum.
Pseudomembranous colitis
Pancreatitis
Acute renal failure
Nursing Interventions
Client Education
Monitor liver function test every month
Monitor renal status
Observe for diarrhea, abdominal pain, fever associated with
pseudomembranous colitis.
Culture before treatment started
This medication is best taken on an empty stomach with a full
glass of water (8 ounces or 240 milliliters) 1 hour before or 2
hours after meals
Do not take antacids with rifampin since it will lessen the
effectiveness of this drug.
Keep MD appointments to prevent relapse.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Bronchodilators – Antileukotriene / Leukotriene Receptor Antagonist
Agent(s)
Common Uses
Contraindications
Montelukast
(Singulair),
Zafirlukast (Accolate
Asthma
Hypersensitivity
Route
Onset of Action
Interactions
Barbiturates decrease
montelukast levels; black
and green tea increase
stimulation
PO
Mechanism of Action
Inhibits leukotriene formation which prevents smooth muscle contraction of the bronchial airways, decreased mucus secretion and
reduced vascular permeability (which reduces edema).
Advantages/Disadvantages
Stops asthma symptoms that are caused
by the immune system at the cellular
level.
Side Effects
Headache
GI upset
Drowsiness
Adverse Effects
Dizziness
Insomnia
Thrombocytopenia
Suicide thoughts
Seizures
Nursing Interventions
Client Education
Monitor liver enzymes, can be hepatotoxic.
Not indicated for acute episodes, improvement
usually seen after one week of administration.
Monitor CBC and blood chemistry during treatment.
Assess for suicidal thoughts.
Assess respiratory rate, rhythm, depth and auscultate fields bilatera ly.
Avoid hazardous activities dizziness may occur
Teach not to be used for acute attacks
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Bronchodilators – Beta Adrenergic Agonists
Agent(s)
Common Uses
Contraindications
Albuterol (Proventil,
Ventolin), Terbutaline
Sulfate (Brethine),
Salmeterol (Serevent),
Asthma
Bronchitis
Emphysema
COPD
Hypersensitivity
Tachy-arrhythmias
Severe cardiac disease
or heart block
Route
PO
Aerosol
Nebulizer
Onset of Action
Interactions
30 minutes
5-15 minutes
Adrenergic drugs
increase action of
albuterol so don’t use
together.
B- adrenergic blockers
Mechanism of Action
These drugs are usually used during the acute phase of an asthma attack to quickly reduce airway constriction and restore airflow
to normal. They are agonist or stimulators of the adrenergic receptors in the sympathetic nervous system. They imitate the effects
of norepinephrine and cause bronchodilation.
Advantages/Disadvantages
Side Effects
Muscle tremor
Nervousness
Tachycardia
Adverse Effects
Anxiety
Insomnia
Hypertension
Hallucinations
Dysrhythmias
Nursing Interventions
Client Education
Assess heart rate and rhythm, assess respiratory function, ABGs, lung
sounds
Watch for evidence of allergic reactions. Notify prescriber if
bronchospasms occur.
Do not use other bronchodilators or OTC medications with
Terbutaline, as they may cause additive cardiovascular effects.
Do not break, crush or chew extended release tablets
Give inhaler instructions.
Limit caffeine products such as chocolate, coffee, tea and cola
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Mucolytic
Agent(s)
Common Uses
Contraindications
Route
Acetylcysteine
(Mucomyst)
Acetaminophen
toxicity
Bronchitis/ COPD
Cystic Fibrosis
Atelectasis
Increased ICP
Status asthmaticus
PO
IV
Nebulizer
Onset of Action
Interactions
5-10 minutes
Nitrates: increased
effects, Iron, copper,
nickel or rubber
– Interacts with
acetylcysteine
Mechanism of Action
Decreases the viscosity of secretions in respiratory tract by breaking disulfide inks of mucoproteins. Inactivates acetaminophen
toxic metabolites in acetaminophen overdose.
Advantages/Disadvantages
Side Effects
Stomatitis
Nausea/vomiting
Drowsiness
Chest tightness
Adverse Effects
Fever
Rhinorrhea
Diaphoresis
Hepatotoxicity
Anaphylaxis
Bronchospasms
Nursing Interventions
Client Education
Assess cough type, frequency, character including sputum.
Assess character, rate, rhythm of respirations.
Assess liver function test
May be given in nebulizer or instilled intratracheally
If the patient vomits within one hour of administration, repeat the
dose.
Give gum, hard candy, frequent rinsing of mouth for dryness of oral
cavity
Teach patient that unpleasant odor will decrease after
repeated use.
Tell client to avoid alcohol and other CNS depressants as they
will enhance the sedating properties of this product.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Calcium Salts
Agent(s)
Common Uses
Contraindications
Route/Dosage
Onset of Action
Interactions
Calcium gluconate
Calcium chloride
Hypocalcemia
Hypermagnesemia
Hypoparathyroidism
Cardiac toxicity
caused by
hyperkalemia
Hypercalcemia
Digoxin toxicity
Ventricular fibri lation
Renal calculi
IV
Unknown
Increase
hypercalcemia with
thiazide diuretics.
Mechanism of Action
Maintains nervous, muscular, skeletal function. Maintains normal cardiac contractility, coagulation of blood. Affects secretory activity
of endocrine, exocrine glands. Reverses the respiratory depression and potential arrhythmias caused by magnesium toxicity.
Advantages/Disadvantages
Side Effects
Adverse Effects
Hypotension
Bradycardia
Dysrhythmias
Nausea/Vomiting
Constipation
Dry mouth
Widening QRS complex
Cardiac arrest
Seizures
IV site extravasation
Nursing Interventions
Client Education
Monitor calcium and magnesium levels
Cardiac monitoring
Seizure precautions
Observe IV tubing for precipitation
Carefully monitor IV site
Add calcium rich foods to diet (dairy products, shellfish, dark
green leafy vegetables)
Decrease oxalate and zinc-rich foods: nots, legumes, chocolate,
spinach, soy.
Avoid immobilization.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Phosphorus
Agent(s)
Common Uses
Contraindications
Route/Dosage
Phosphate (Phospho
Soda, Fleets enema)
Hypercalcemia
Hypophosphatemia
Constipation
Hyperphosphatemia
Appendicitis
PO
Rectal
Onset of Action
Interactions
Mechanism of Action
Essential in bone and teeth formation and for neuromuscular activity. Assists in energy transfer in cells. Supports acid-base balance.
Phosphorus has an inverse relationship to calcium. So if calcium is high, phosphorus is low.
Advantages/Disadvantages
Side Effects
Nursing Interventions
Adverse Effects
Client Education
Monitor calcium, magnesium and phosphorus levels.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Electrolyte; Anti-Convulsant
Agent(s)
Common Uses
Contraindications
Route/Dosage
Onset of Action
Interactions
Magnesium Salts
(Magnesium sulfate)
Preeclampsia
Eclampsia
Hypersensitivity
Heart block
IM
IV
1 hour
30 minutes
Increase effect of neuromuscular
blockers, antihypertensives,
calcium channel blockers.
Decrease effect of digoxin.
Decrease absorption of
tetracyclines, fluo oquinolones,
nitrofurantoin.
Mechanism of Action
Acts as a CNS depressant. Decreases acetylcholine from motor nerves, which blocks neuromuscular transmission and decreases
incidence of seizures. Secondary effect is reduction in BP as magnesium sulfate relaxes smooth muscles. Secondarily affects
peripheral vascular system with increased uterine blood flow caused by vaso ilation. Also inhibits uterine contractions.
Advantages/Disadvantages
Decreases BP while preventing
seizures in PIH clients
Must be closely monitored for
hypermagnesemia.
Side Effects
Adverse Effects
Muscle weakness
Flushing and warmth
Sedation
Confusion
Flaccid paralysis
Circulatory collapse
Heart block
Hypotension
Respiratory depression
Nursing Interventions
Client Education
Seizure precautions.
Monitor BP.
Cardiac monitoring.
Monitor for magnesium toxicity (thirst, confusion, decreased
DTRs)
I&O
Hourly urinary outputs
Reason for medication. Expected results.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Cation Exchange Resin
Agent(s)
Common Uses
Contraindications
Route/Dosage
Sodium polystyrene
sulfonate (Kayexalate)
Hyperkalemia
GI obstruction
PO
Rectal
Onset of Action
Interactions
Increased risk of
hypokalemia when used
with loop diuretics and
cardiac glycosides.
Decrease effect of lithium
and thyroid hormones.
Mechanism of Action
Exchanges potassium for sodium in the large intestine.
Advantages/Disadvantages
Side Effects
Adverse Effects
Constipation
Anorexia
Nausea/vomiting
Fecal impaction
Hypernatremia
Hypocalcemia
Hypomagnesemia
Nursing Interventions
Client Education
Cardiac monitoring
Monitor electrolyte levels
Assess bowel function daily
Monitor for fecal impaction
I&O
Daily weight
Reason for medication and expected results.
Low potassium diet
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Electrolyte/Potassium supplements
Agent(s)
Common Uses
Contraindications
Route/Dosage
Onset of Action
Interactions
Potassium
(Kaochlor, KCL,
Micro K, K Dur)
Hypokalemia
Prevention of
Hypokalemia
Hypokalemic alkalosis
Renal insufficiency or failu e
Addison’s disease
Hyperkalemia
Severe dehydration
Potassium Sparing diuretics
PO
IV
30 minutes
Rapid
Increases serum potassium
levels: ACE inhibitors,
Potassium sparing diuretics,
NSAIDS, beta-adrenergic
blockers, heparin, salt
substitutes. Decreases
serum potassium: loop and
thiazide diuretics, licorice.
Mechanism of Action
Transmits and conducts nerve impulses. Conracts skeletal, smooth, and cardiac muscles.
Advantages/Disadvantages
Side Effects
Adverse Effects
Nausea/vomiting
Diarrhea
Abdominal cramps
Irritability
IV site phlebitis
Hyperkalemia
Life-threatening dysrhythmias
Respiratory distress.
Nursing Interventions
Client Education
Give oral potassium with at least 3-8 ounces’ fluid and wi h meals.
Always put IV potassium on a pump to infuse.
Monitor infusion at least hourly. Check IV site for infi tration.
Do not give potassium IVP. Do not give IM.
Assess urine output before and during IV potassium.
Monitor serum potassium, creatinine, BUN, glucose, electrolytes,
ABGs.
Monitor for signs/symptoms of hyperkalemia.
Drink a full glass of water or juice with potassium supplements.
Take with a meal.
Signs/symptoms of hyperkalemia and hypokalemia.
Foods containing potassium.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Alkalinizer
Agent(s)
Common Uses
Contraindications
Route/Dosage
Onset of Action
Interactions
Sodium bicarbonate
Severe acidosis
based on ABGs
Cardiac arrest
Metabolic alkalosis
Respiratory alkalosis
Hypocalcemia
Hypochloremia
IV
15 minutes
Do not infuse epinephrine,
norepinephrine or
dopamine in the same site
as sodium bicarbonate as
they will inactivate by the
sodium bicarbonate.
Mechanism of Action
Intravenous sodium bicarbonate therapy increases plasma bicarbonate, buffers excess hydrogen ion concentration, raises
blood pH and reverses the clinical manifestations of acidosis.
Advantages/Disadvantages
Not the first ine medication during a
cardiac arrest.
Can lead to alkalosis.
Side Effects
Adverse Effects
Irritability
Headache
Confusion
Irregular pulse
Edema
Flatulence
Metabolic alkalosis
Tetany
Seizures
Cardiac arrest
Nursing Interventions
Client Education
Monitor ABGs
Assess respiratory and heart rate
I&O
Daily weight
Monitor electrolytes
About medication and expected outcome
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Plasma Volume Expander
Agent(s)
Common Uses
Contraindications
Route/Dosage
Onset of Action
Albumin (Albumarc,
Albuminar,
Plasbumin)
Shock
Burns
Hypoproteinemia
ARDS
Nephrotic syndrome
Hypersensitivity
CHF
Severe anemia
Renal insufficienc
Pulmonary edema
IV
15 minutes
Interactions
Mechanism of Action
Exerts oncotic pressure, which expands volume of circulating blood and maintains cardiac output. When injected intravenously, it will
increase circulating plasma volume by approximately 3.5 times the volume infused within 15 minutes if the client is well hydrated. This
extra fluid educes hemoconcentration and blood viscosity.
Advantages/Disadvantages
Side Effects
Adverse Effects
Fever
Chills
Flushing
Headache
Nausea/Vomiting
Increases salivation
Fluid volume excess
Pulmonary edema
Anaphylactic shock
Hypertension
Nursing Interventions
Client Education
Assess blood studies: Hgb, Hct.
Assess vital signs
I&O
Daily weight
Monitor oxygen saturation
Assess lung sounds, CVP, monitoring for signs of FVE
Reason for medication.
Report signs of hypersensitivity such as rash, itching, confusion,
anxiety
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Phosphorus Binding Drugs
Agent(s)
Common Uses
Contraindications
Route/Dosage
Sevelamer (RenaGel),
Calcium acetate
(PhosLo)
Chronic kidney
disease
Hyperphosphatemia
Pregnancy
Bowel obstruction
Hypersensitivity
Hypercalcemia
PO
Onset of Action
Interactions
Take Ciprofloxacin
at least 2 hours
before or 6 hours
after sevelamer.
Mechanism of Action
Binding phosphate in the dietary tract and decreasing absorption, thus lowering the phosphate concentration in the serum.
Advantages/Disadvantages
Side Effects
Adverse Effects
Nausea/Vomiting
Stomach pain
Loss of appetite
Flatulence
Constipation
Dry mouth
Allergic Reaction
Nursing Interventions
Client Education
Monitor for reduced vitamins D, E, K and folic acid levels
Take with meals
Notify prescriber of severe abdominal pain, worsening
constipation.
Avoid use of calcium supplements including antacids.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Infection Control
All clients admitted to the hospital automatically are considered to be on standard precautions.
The diseases listed below require standard precautions plus additional precautions that are noted
in the isolation/precaution column.
Infection/
Condition
Isolation/
Precautions
Infective
Material
Duration of
Isolation
Comments
Amebiasis
(Entamoeba
histolytica)
Dysentery
Contact
Precautions
Feces
Duration of illnessuntil symptom free.
Bronchiolitis
Contact
Precautions
(for infants and
young children
only).
Respiratory
secretions
Duration of illnessuntil symptom
free. If respiratory
syncytial virus (RSV)
antigen positive,
refer to RSV.
Various etiologic agents have been associated with this syndrome,
i.e., respiratory syncytial virus (RSV), parainfluenza viruses,
adenoviruses, influenza viruses
Chickenpox
(Varicella)
Airborne
and Contact
Precautions
Airborne
droplets and
skin lesions
Until all lesions are
crusted (at least 5
days after onset of
lesions).
Susceptible persons should not enter the room. Persons immune
from previous varicella infection may enter the room without a
mask. Those immune by vaccination should wear a mask when
entering the room. A specially vented room is necessary. The door
to the client’s room should remain closed. The client must wear a
mask when leaving their room. Susceptible clients who have been
exposed should be placed on Airborne Precautions beginning
10 days after exposure and continuing through day 21 after last
exposure (up to 28 days if VZIG has been given). Clients are
considered infectious 2 days before onset of rash and up to 5 days
after onset of lesions. After exposure, use varicella zoster immune
globulin (VSIZ) as recommended by Infectious Diseases Service.
Infection Control
All clients admitted to the hospital automatically are considered to be on standard precautions.
The diseases listed below require standard precautions plus additional precautions that are noted
in the isolation/precaution column.
Infection/
Condition
Isolation/
Precautions
Infective
Material
Duration of
Isolation
Clostridium
difficile
enterocolitis
Contact
Isolation
Feces
Duration of
illness-until
symptom free
Common cold
Droplet
Precautions
(for infants
and young
children
only).
Respiratory
secretions
Duration of
illness-until
symptom free
Conjunctivitis,
viral (acute
Contact
Isolation
Eye
drainage
Duration of
illness-until
symptom free
Decubitus
ulcer, infected,
Contact
Isolation
Wound
drainage
Depends on
the extent and
condition of the
ulcer.
hemorrhagic)
major
Comments
Rhinoviruses are most frequently associated with the
common cold. Infection is usually mild in adults, but may be
severe in infants and young children. Other etiologic agents
such as respiratory syncytial virus (RSV) and parainfluenza
viruses may also cause this syndrome.
Major: No dressing or dressing does not adequately
contain drainage.
Infection Control
All clients admitted to the hospital automatically are considered to be on standard precautions.
The diseases listed below require standard precautions plus additional precautions that are noted
in the isolation/precaution column.
Infection/
Condition
Isolation/
Precautions
Infective Material
Duration of Isolation
Diphtheria
•
Cutaneous
Contact
Precautions
Wound drainage
Until cultures from infected
sites are negative for
Corynebacterium diphtheriae
on two separate days. Collect
cultures > 24 hours apart and
not sooner than 24 hours after
the last dose of antibiotics.
•
Pharyngeal
Droplet
Precautions
Respiratory secretions
Until cultures are negative for
Corynebacterium diphtheriae
on two separate days. Collect
cultures > 24 hours apart and
not sooner than 24 hours after
the last dose of antibiotics.
Contact
and Droplet
Precautions
Direct contact through
broken skin or mucous
membranes (eyes, nose
and mouth)
Blood and body fluid
Objects contaminated
with Ebola virus
(needles/syringes)
Infected animals
Duration of illness
Ebola
Comments
Client rooms should have negative
pressure and contain their own lab
facilities. Those treating clients or
entering room should wear PPE:
full-body, hazmat suits. Droplet
precautions are needed, but health
care providers would also wear a
special respirator mask that fi ters
airborne particles, such as an N95
mask. Client needs dedicated
medical equipment (preferably
disposable)
Infection Control
All clients admitted to the hospital automatically are considered to be on standard precautions.
The diseases listed below require standard precautions plus additional precautions that are noted
in the isolation/precaution column.
Infection/
Condition
Isolation/
Precautions
Infective
Material
Duration of Isolation
Comments
Epiglottitis
Droplet
Precautions
Respiratory
secretions
Until 24 hours after
start of effective
therapy.
Epiglottis is often due to Haemophilus influenzae.
Treatment for both systemic infection and carrier state
is needed. For recommendations regarding prophylaxis
after exposure, call Infectious Diseases Service (for clients
and family) and Occupational Health (for employees).
Escherichia coli
gastroenteritis
eropathogenic,
enterotoxigenic,
enteroinvasive,
entero hemorrahagic)
Contact
Precautions
Feces
Fifth’s Disease/
Erythema
Infectiosum
(Parvovirus B19)
Droplet
Precautions
Respiratory
secretions
Until onset of rash
(not considered
infectious after
appearance of rash).
German Measles
• Rubella
Droplet
Precautions (does
not require room
with negative
pressure and
external exhaust)
Respiratory
secretions
and urine
For 7 days after onset
of rash.
Susceptible persons should not enter the room. Persons
immune by vaccination or natural illness may enter the
room without a mask. Susceptible clients who have
been exposed should be placed on Droplet Precautions
beginning 7 days after exposure and continuing through
day 21 after last exposure. Clients are considered
infectious a few days before to7 days after onset of rash.
Infection Control
All clients admitted to the hospital automatically are considered to be on standard precautions.
The diseases listed below require standard precautions plus additional precautions that are noted
in the isolation/precaution column.
Infection/
Condition
Isolation/
Precautions
Infective
Material
Duration of Isolation
Comments
German
Measles
• Congenital
rubella
Contact
Precautions
(does not
require room
with negative
pressure
and external
exhaust)
Respiratory
secretions
and urine
Isolation is required during
any admission for the fi st
year after birth, unless
nasopharyngeal and urine
cultures after 3 months of
age are negative for rubella
Susceptible persons should not enter the room. Persons
immune by vaccination or natural illness may enter the
room without a mask. Susceptible clients who have
been exposed should be placed on Droplet Precautions
beginning 7 days after exposure and continuing through
day 21 after last exposure. Clients are considered
infectious a few days before to7 days after onset of rash.
Haemophilus
influenzae,
invasive
Droplet
Precautions
Respiratory
secretions
Until 24 hours after start
of effective therapy.
Treatment for both systemic infection and carrier state
is needed. For recommendations regarding prophylaxis
after exposure, call Infectious Diseases Service (for clients
and family) and Occupational Health (for employees).
•
Epiglottitis
•
Meningitis
Droplet
Precautions
Respiratory
secretions
Until 24 hours after start
of effective therapy.
Treatment for both systemic infection and carrier
state is needed. For recommendations regarding
prophylaxis after exposure, call Infectious Diseases
Service (for clients and family) and Occupational
health (for employees).
•
Pneumonia
Droplet
Precautions
(for infants
and young
children only).
Respiratory
secretions
Until 24 hours after start
of effective therapy.
Treatment for both systemic infection and carrier
state is needed. For recommendations regarding
prophylaxis after exposure, call Infectious Diseases
Service (for clients and family) and Occupational
health (for employees).
Infection Control
All clients admitted to the hospital automatically are considered to be on standard precautions.
The diseases listed below require standard precautions plus additional precautions that are noted
in the isolation/precaution column.
Infection/Condition
Isolation/
Precautions
Infective
Material
Duration of
Isolation
Hand, foot, and
mouth disease
Contact
Precautions
Respiratory
secretions
and feces
For 7 days after
onset
Hepatitis, viral
• Type A
Contact
Precautions
(for diapered
or incontinent
clients)
Feces
Duration of
illness
Lesion
secretions
Duration of
illness-until
symptom free.
Herpes simplex
•
Mucocutaneous
Disseminated
severe or primary
Contact
precautions
•
Neonatal
Contact
precautions
Until lesions dry
and crusted
Comments
Infection Control
All clients admitted to the hospital automatically are considered to be on standard precautions.
The diseases listed below require standard precautions plus additional precautions that are noted
in the isolation/precaution column.
Infection/Condition
Isolation/
Precautions
Infective
Material
Duration of
Isolation
Comments
Herpes zoster
(Shingles)
•
Disseminated
Airborne
and Contact
Precautions
Lesion and
respiratory
secretions
Duration of - until
all lesions are
crusted.
Persons susceptible to varicella should not
enter the room.
Impetigo
Contact
Precautions
Lesions
For 24 hours after
start of effective
antibiotic therapy.
Influenz
Droplet
Precautions
Respiratory
secretions
Duration of illnessuntil symptom free.
Clients who have been exposed should
be managed in consultation with Infection
Control.
In the absence of an epidemic, influenza may
be difficu t to diagnose on clinical grounds.
During epidemics, the accuracy of diagnosis
increases. Co-horting of clients may be
considered during periods of high census.
Immunization is strongly encouraged for health
care providers and clients at risk for serious
complications. Contact Infectious Diseases
Service for recommendations regarding the
use of prophylaxis for non-immunized persons.
Infection Control
All clients admitted to the hospital automatically are considered to be on standard precautions.
The diseases listed below require standard precautions plus additional precautions that are noted
in the isolation/precaution column.
Infection/
Condition
Isolation/
Precautions
Infective
Material
Duration of Isolation
Comments
Lice
(pediculosis)
Contact
Precautions
Infested
area
Until effective
treatment has been
completed and
room/ personal items
adequately disinfected.
Employees with direct contact should be examined for
infestation. Clothing and bedding may be disinfected by machine
washing and drying *use hot cycles). Dry cleaning or storing
items in a plastic bag for 10 days is also effective. Use of an
environmental insecticide is not needed.
Measles
(rubeola, red
measles)
Airborne
Precautions
(use a
monitored
room with
negative
pressure
and external
exhaust)
Respiratory
secretions
For 4 days after onset
of rash. For immunocompromised
patients, maintain
precautions for
duration of illness.
Promptly notify Infection Control. Susceptible persons should
stay out of the room. All other persons should wear a mask upon
entry. A specially vented room is necessary. The client must
wear a mask when leaving the room. The door to the client’s
room should remain closed. Susceptible clients who have been
exposed should be placed on Airborne Precautions beginning
5 days after exposure and continuing through day 21 after last
exposure. Clients are considered infectious 4 days before to 4
days after onset of rash.
Meningococcal
pneumonia
(Neisseria
meningitidis)
Droplet
Precautions
Respiratory
secretions
Until 24 hours after
start of effective
therapy.
Treatment for both system infection and carrier state is
needed. For recommendations regarding prophylaxis after
exposure, call infectious Diseases Service (for clients and
family) and Occupational Health (for employees).
Infection Control
All clients admitted to the hospital automatically are considered to be on standard precautions.
The diseases listed below require standard precautions plus additional precautions that are noted
in the isolation/precaution column.
Infection/Condition
Isolation/
Precautions
Infective
Material
Duration of
Isolation
Comments
Meningococcemia
(meningococcal
sepsis) (Neisseria
meningitidis)
Droplet
Precautions
Respiratory
secretions
Until 24 hours
after start of
effective therapy.
Treatment for both system infection and carrier state is
needed. For recommendations regarding prophylaxis after
exposure, call infectious Diseases Service (for clients and
family) and Occupational Health (for employees).
Meningitis
• Haemophilus
influenzae,
known or
suspected
Droplet
Precautions
Respiratory
secretions
Until 24 hours
after start of
effective therapy.
Treatment for both systemic infection and carrier state is
needed. For recommendations regarding prophylaxis after
exposure, call Infectious Diseases Service (for clients and
family) and Occupational Health (for employees).
•
Neisseria
meningitis
(meningococcal),
known or
suspected
Droplet
Precautions
Respiratory
secretions
Until 24 hours
after start of
effective therapy.
Treatment for both systemic infection and carrier state is
needed. For recommendations regarding prophylaxis after
exposure, call Infectious Diseases Service (for clients and
family) and Occupational Health (for employees).
•
Viral (aseptic or
nonbacterial)
Contact
Precautions
(for infants
and young
children only
Feces
Duration of illnessuntil symptoms
free.
Enteroviruses are the most common cause of aseptic
meningitis.
Infection Control
All clients admitted to the hospital automatically are considered to be on standard precautions.
The diseases listed below require standard precautions plus additional precautions that are noted
in the isolation/precaution column.
Infection/Condition
Isolation/Precautions
Infective Material
Duration of Isolation
Comments
Mumps
Droplet Precautions
(does not require a
room with negative
pressure and external
exhaust)
Respiratory
secretions
For 9 days after onset of
swelling.
Susceptible personnel who have
been exposed should be excluded
from work from the 12th day after
exposure through the 26th day
after exposure, or if symptoms
develop until 9 days after the
onset of parotitis.
Multi Drug Resistant
Organisms (MDRO)
• Methicillin-resistant
Staph. Aureus
(MRSA) infection or
colonization
• Vancomycinresistant
enterococcus (VRE)
Contact precautions
Wound drainage
and/or secretions/
excretions from
colonized/infected
sites
Until 2 cultures obtained
after completion of
antibiotic treatment
are negative on 2
separate days, from all
previously colonized/
infected sites (including
nasal colonization, if
applicable).
Previously positive clients
must be placed on Contact
Precautions when readmitted
to the hospital until repeat
cultures are negative as per
criteria under “Duration of
Isolation.”
Necrotizing Fasciitis
(Flesh-eating
bacteria)
Contact precautions
Rarely spread from
person to person.
Direct contact
through broken
skin or mucous
membranes (eyes,
nose and mouth)
Blood and body
fluid
Objects
contaminated with
bacteria(needles/
syringes)
Duration of illnessuntil symptom free and
wounds healed.
Group A strep is considered
the most common cause,
but can also be caused by
Klebsiella, Clostridium, E coli,
Staph aureaus and Aeromonas
hydrophila. Good wound care
is the best prevention. Prompt
treatment with IV antibiotics
is needed. Patients are usually
managed in a burn center or
surgical ICU setting.
Contact precautions
Infection Control
All clients admitted to the hospital automatically are considered to be on standard precautions.
The diseases listed below require standard precautions plus additional precautions that are noted
in the isolation/precaution column.
Infection/Condition
Isolation/
Precautions
Infective
Material
Duration of
Isolation
Pharyngitis
Droplet
Precautions
(for infants
and young
children only)
Respiratory
secretions
Until 24 hours
after start of
effective therapy
Plague
• Pneumonic
Droplet
Precautions
Pneumonia
• Adenovirus
Droplet and
Contact
Precautions
(for infants
and young
children only)
Respiratory
secretions
and feces
Duration of
illness-until
symptom free.
Droplet
Precautions
(for infants
and young
children only)
Respiratory
secretions
Duration of
illness-until
symptom free.
•
Bacterial
not listed
elsewhere
(including
gram-negative
bacteria
Comments
If client requires transport, must have mask on.
Infection Control
All clients admitted to the hospital automatically are considered to be on standard precautions.
The diseases listed below require standard precautions plus additional precautions that are noted
in the isolation/precaution column.
Infection/Condition
Isolation/Precautions
Infective
Material
Duration of Isolation
Pneumonia (con’t)
• Etiology
unknown
Droplet Precautions (for infants
and young children only). Use
Contact Precautions during RSV
season, during an RSV outbreak,
or if RSV is in the diagnostic
differential. Resume Droplet
Precautions if RSV is ruled out.
Respiratory
secretions
Duration of illnessuntil symptom free.
If respiratory syncytial
virus (RSV) antigen
positive, refer to RSV.
•
Haemophilus
influenza
Droplet Precautions (for infants
and young children only)
Respiratory
secretions
Until 24 hours after
start of effective
therapy.
•
Herpes simplex
Droplet Precautions
Respiratory
secretions
Duration of illnessuntil symptom free
•
Meningococcal
(Neisseria
meningitidis)
Droplet Precautions
Respiratory
secretions
Until 24 hours after
start of effective
therapy.
Comments
Infection Control
All clients admitted to the hospital automatically are considered to be on standard precautions.
The diseases listed below require standard precautions plus additional precautions that are noted
in the isolation/precaution column.
Infection/Condition
Isolation/
Precautions
Infective
Material
Duration of Isolation
Comments
Respiratory
syncytial virus
(RSV) infection or
suspected
Contact
precautions
Respiratory
secretions
Until symptom free and
nasopharyngeal antigen test
is negative for RSV (at least
1 week after positive test)
on 2 consecutive days.
To avoid the possibility of false-negative
test results, the “calgi swab” method
should be used to obtain nasopharyngeal
specimens.
Rotavirus
infection
Contact
Precautions
Feces
Duration of illness and stool
study negative for rotavirus
on 2 separate days.
Rubella
• German
Measles
Droplet
Precautions
(does not
require room
with negative
pressure
and external
exhaust)
Respiratory
secretions
For 7 days after onset of
rash
Contact
Precautions
(does not
require room
with negative
pressure
and external
exhaust)
Respiratory
secretions
Isolation is required
during any admission for
the first year after bir h,
unless nasopharyngeal
and urine cultures after
3 months of age are
negative for rubella
•
Congenital
Rubella
Susceptible persons should not enter the
room. Persons immune by vaccination or
natural illness may enter the room without
a mask. The client must wear a mask when
leaving the room. Susceptible clients who
have been exposed should be placed on
Droplet Precautions beginning 7 days after
exposure and continuing through day 21
after last exposure. Clients are considered
infectious a few days before to 7 days after
onset of rash. (applicable to both types)
Infection Control
All clients admitted to the hospital automatically are considered to be on standard precautions.
The diseases listed below require standard precautions plus additional precautions that are noted
in the isolation/precaution column.
Infection/
Condition
Isolation/
Precautions
Infective
Material
Duration of Isolation
Comments
SARS (Severe
Acute
Respiratory
Syndrome)
Airborne
and Contact
Precautions with
goggles over
eyes
Respiratory
droplets
Scabies
Contact
precautions
Infested
area
For 24 hours after
start of effective
therapy and
room/ personal
items adequately
disinfected.
Employee with direct contact should be
examined for infestation. Clothing and bedding
may be disinfected by machine washing
and drying (use hot cycles). Dry cleaning or
storing items in a plastic bag for 10 days is also
effective. Use of an environmental insecticide is
not needed.
Scarlet fever
Droplet
Precautions (for
infants and young
children only)
Respiratory
secretions
For 24 hours after
effective therapy
Shingles (Herpes
zoster)
• Disseminated
Airborne
and Contact
Precautions (use
a monitored
room with
negative
pressure and
external exhaust)
Lesion
secretions
Duration of illness
until all lesions are
crusted
Persons susceptible to varicella should not enter the
room. Persons immune from prior natural illness or
vaccination may enter without a mask. The door
to the client’s room should remain closed and the
client must wear a mask when leaving. Susceptible
clients who have been exposed should be managed
in consultation with Infection Control. Clients are
considered infectious 2 days before onset of rash
and up to 5 days after onset of lesions.
Infection Control
All clients admitted to the hospital automatically are considered to be on standard precautions.
The diseases listed below require standard precautions plus additional precautions that are noted
in the isolation/precaution column.
Infection/Condition
Isolation/
Precautions
Infective Material
Duration of
Isolation
Comments
Smallpox
Airborne and
Contact
Precautions
(strict gown/
glove)
Large and small
respiratory droplets,
skin lesions, secretions.
Onset of rash
to separation
of scabs
(approximately
3 weeks)
Private rooms preferred. In event of large
outbreak, clients with same diagnosis can
share respiratory isolation room.
Limit client transport, if necessary, client
wears mask.
Syphilis
• Skin and mucous
membrane,
including
congenital,
primary, and
secondary
Contact
Precautions
Lesion secretions,
blood, body fluid
For 24 hours
after start
of effective
therapy.
Tuberculosis
• Pulmonary,
confirmed or
suspected (sputum
smear is AFB
positive and/
or chest x-ray
appearance
strongly suggests
active TB, i.e.,
cavitary lesions; or
laryngeal.
Airborne
Precautions
(use a
monitored
room with
negative
pressure
and external
exhaust)
Airborne droplet nuclei
A specially vented room is necessary.
The door to the patient’s room should
remain closed. Persons entering the
room should wear specially fi ted NIOSH
approved respiratory protection. The
client should leave the room only for
essential purposes, particularly if the
client has multidrug-resistant TB. When
leaving the room, the client should
wear a high-fi tration surgical mask; for
mechanically-supported ventilation,
add a bacterial fi ter to fi ter the client’’
exhaled air.
Infection Control
All clients admitted to the hospital automatically are considered to be on standard precautions.
The diseases listed below require standard precautions plus additional precautions that are noted
in the isolation/precaution column.
Infection/
Condition
Isolation/Precautions
Infective
Material
Duration of Isolation
Comments
Typhoid fever
(Salmonella
typhi)
Contact Precautions
(for diapered and
incontinent children)
Feces
Duration of illness until symptom free.
Whooping
cough
(pertussis)
Droplet Precautions
Respiratory
secretions
For 7 days after start of
effective therapy.
For recommendations regarding
prophylaxis after exposure, call Infectious
Diseases Service (for clients and family)
and Occupational Health (for employees).
Zika Virus
Standard/Contact
Precautions only unless in the labor
and delivery setting.
Apply practices and
personal protective
equipment (PPE) to
prevent exposure
as indicated by
labor and delivery
procedure.
Body fluids
(blood,
urine,
saliva and
amniotic
fluid)
Pregnancy: Men should
wait for 6 months after
symptoms started (if they
get sick) before trying
to conceive with their
partner. Women should
wait at least 8 weeks after
travel (or 8 weeks after
symptoms started if they
get sick) before trying to
get pregnant. The waiting
period is longer for men
because Zika stays in
semen longer than in
other body fluids
Patients post exposure should protect
themselves for 3 weeks from mosquito bites
order to prevent further spread of virus. Zika
virus is primarily transmitted through the bite
of the mosquito, but sexual transmission has
also been documented. Zika virus RNA has
been detected in body fluids (blood, urine,
saliva and amniotic fluid). Zika can also be
spread during pregnancy from mother to fetus
causing birth defects. There are no reports
of transmission through breastfeeding. CDC
does not recommend Zika virus testing for
asymptomatic men, children, or women who
are not pregnant.
Infection Control Precautions
(CDC, Guidelines for isolation procedure, 2007)
Standard Precautions
•
Standard Precautions apply to 1) blood; 2) all body fluids, sec etions, and
excretions except sweat, regardless of whether or not they contain visible
blood; 3) nonintact skin; and 4) mucous membranes.
•
Use Standard Precautions, or the equivalent, for the care of all clients.
A. Handwashing
•
Wash hands after touching blood, body fluids, sec etions, excretions, and
contaminated items, whether or not gloves are worn.
•
Wash hands immediately after gloves are removed, between client contacts,
and when otherwise indicated to avoid transfer of microorganisms to other
clients or environments.
•
It may be necessary to wash hands between tasks and procedures on the same
client to prevent cross-contamination of different body sites.
•
Use soap and water for routine handwashing.
B. Gloves
•
Wear gloves (clean, nonsterile gloves are adequate) when touching blood,
body fluids, sec etions, excretions, and contaminated items.
•
Put on clean gloves just before touching mucous membranes and nonintact skin.
•
Change gloves between tasks and procedures on the same client after contact with material that may contain a high concentration of microorganisms.
•
Remove gloves promptly after use, before touching noncontaminated items and environmental surfaces, and before going to another client, and
wash hands immediately to avoid transfer of microorganisms to other clients
or environments.
C. Mask, Eye Protection, Face Shield
•
Wear a mask and eye protection or a face shield to protect mucous
membranes of the eyes, nose, and mouth during procedures and client-care activities that are likely to generate splashes or sprays of
blood, body fluids, sec etions, and excretions.
D. Gown
•
Wear a gown (a clean, nonsterile gown is adequate) to protect skin
and to prevent soiling of clothing during procedures and client-care
activities that are likely to generate splashes or sprays of blood, body
fluids, sec etions, or excretions.
•
Remove a soiled gown as promptly as possible, and wash hands to
avoid transfer of microorganisms to other clients or environments.
E. Client-Care Equipment
•
Handle used client-care equipment soiled with blood, body fluids,
secretions, and excretions in a manner that prevents skin and mucous
membrane exposures, contamination of clothing, and transfer of
microorganisms to other clients and environments.
•
Ensure that reusable equipment is not used for the care of another
client until it has been cleaned and reprocessed appropriately.
•
Ensure that single-use items are discarded properly.
F. Linen
•
Handle, transport, and process used linen soiled with blood, body
fluids, sec etions, and excretions in a manner that prevents skin and
mucous membrane exposures and contamination of clothing and that
avoids transfer of microorganisms to other clients and environments.
G. Needle Disposal
•
Used needles and any “sharps” are placed directly into puncture resistant containers. Do not recap or use two hand technique. Sharps
with built-in safety features are used when available.
Contact Precautions
•
Contact Precautions are designed to reduce the risk of transmission of
microorganisms by direct or indirect contact.
•
Direct-contact transmission involves skin-to-skin contact and physical
transfer of microorganisms to a susceptible host from an infected or
colonized person, such as occurs when personnel turn clients, bathe
clients, or perform other client-care activities that require physical contact.
•
Direct-contact transmission also can occur between two clients.
•
Indirect-contact transmission involves contact of a susceptible host with a
contaminated intermediate object, usually inanimate, in the client’s
environment.
In addition to Standard Precautions, use Contact Precautions, or the equivalent,
for specified clients known or suspected to be infected or colonized with
epidemiologically important microorganisms that can be transmitted by direct
contact with the client (hand or skin-to-skin contact that occurs when performing
client-care activities that require touching the client’s dry skin) or indirect contact
(touching) with environmental surfaces or client-care items in the client’s
environment.
A. Client Placement
•
Place the client in a private room.
•
When a private room is not available, place the client in a room with a
client(s) who has active infection with the same microorganism but with
no other infection
B. Gloves and Handwashing
•
In addition to wearing gloves as outlined under Standard Precautions,
wear gloves (clean, nonsterile gloves are adequate) when entering the room.
•
During the course of providing care for a client, change gloves after having
contact with infective material that may contain high concentrations of
microorganisms (fecal material and wound drainage).
•
Remove gloves before leaving the client’s room and wash hands immediately with an antimicrobial agent or a waterless antiseptic agent. For a client with a C. difficil do not use an alcohol-based, hand rub because it is not effective on C. difficil . Instead use soap and water.
•
After glove removal and handwashing, ensure that hands do not touch
potentially contaminated environmental surfaces or items in the client’s
room to avoid transfer of microorganisms to other clients or environments.
C. Gown
•
In addition to wearing a gown as outlined under Standard Precautions,
wear a gown (a clean, nonsterile gown is adequate) when entering the
room if you anticipate that your clothing will have substantial contact
with the client, environmental surfaces, or items in the client’s room, or if
the client is incontinent or has diarrhea, an ileostomy, a colostomy, or
wound drainage not contained by a dressing.
•
Remove the gown before leaving the client’s environment.
•
After gown removal, ensure that clothing does not contact potentially
contaminated environmental surfaces to avoid transfer of microorganisms
to other clients or environments.
D. Client Transport
•
Limit the movement and transport of the client from the room to essential
purposes only.
•
If the client is transported out of the room, ensure that precautions are
maintained to minimize the risk of transmission of microorganisms to
other clients and contamination of environmental surfaces or equipment.
Airborne Precautions
•
Airborne Precautions are designed to reduce the risk of airborne transmission of
infectious agents.
•
Airborne Precautions apply to clients known or suspected to be infected with pathogens that can be transmitted by the airborne route.
In addition to Standard Precautions, use Airborne Precautions, for clients known or
suspected to be infected with microorganisms transmitted by airborne droplet nuclei or
evaporated droplets containing microorganisms that remain suspended in the air and
that can be dispersed widely by air currents within a room or over a long distance.
A. Client Placement
•
Place the client in an airborne infection isolation room (AIIR), which is a
private room that has: 1) monitored negative air pressure in relation to the
surrounding areas, 2) 6 to 12 air changes per hour, and 3) appropriate
discharge of air outdoors or monitored high-efficiency filtration of oom air
before the air is circulated to other areas in the hospital.
•
Keep the room door closed and the client in the room.
•
Client should have a private room.
•
When a private room is not available, place the client in a room with a client
who has active infection with the same microorganism but with no other infection.
B. Respiratory Protection
•
Wear respiratory protection (N95 respirator) when entering the room of a client
with known or suspected infectious pulmonary tuberculosis.
•
Susceptible persons should not enter the room of clients known or
suspected to have measles (rubeola) or varicella (chickenpox) if other immune
caregivers are available. If they must enter, they should wear a respirator mask.
C. Client Transport
•
Limit the movement and transport of the client from the room to essential
purposes only.
•
If transport or movement is necessary, place a surgical mask on the client.
Droplet Precautions
•
Droplet Precautions are designed to reduce the risk of droplet transmission
of infectious agents.
•
Droplet transmission involves contact of the conjunctivae or the mucous
membranes of the nose or mouth of a susceptible person.
•
Droplets are generated from the source person primarily during coughing,
sneezing, or talking and during the performance of certain procedures such
as suctioning and bronchoscopy.
•
Transmission via large-particle droplets requires close contact between
source and recipient persons, because droplets do not remain suspended
in the air and generally travel only short distances, usually 3 ft or less,
through the air.
•
Because droplets do not remain suspended in the air, special air handling
and ventilation are not required to prevent droplet transmission.
•
Droplet Precautions apply to any client known or suspected to be infected
with pathogens that can be transmitted by infectious droplets.
In addition to Standard Precautions, use Droplet Precautions, or the equivalent, for a client
known or suspected to be infected with microorganisms transmitted by droplets.
A. Client Placement
•
Place the client in a private room.
•
When a private room is not available, place the client in a room with a
client(s) who has active infection with the same microorganism but with no
other infection.
B. Mask
•
In addition to wearing a mask as outlined under Standard Precautions, wear
a mask when working within 3 ft of the client. (Logistically, some hospitals
may want to implement the wearing of a mask to enter the room.)
C. Client Transport
•
Limit the movement and transport of the client from the room to essential purposes
only.
•
If transport or movement is necessary, place a surgical mask on the client.
Isolation Precautions Exercise
What type of isolation precaution will the client be on with the following diseases?
1.
Human Immunodeficienc Virus (HIV)
2.
Multidrug- resistant organisms (MDROs) (e.g., MRSA, VRE, VISA/VRSA,
ESBLs, resistant s. pneumoniae)
3.
Candidiasis (Thrush)
4.
Varicella Zoster (Chicken pox)
5.
Clostridium Difficil Enterocolitis (C. Diff)
6.
Infectious Mononucleosis (Mono)
7.
Rubella (German Measles)
8.
Meningococcal Meningitis
9.
Impetigo
10.
Seasonal Influenz
11.
Rubeola (Measles)
12.
Tuberculosis (TB) with pulmonary involvement
13.
Infectious Parotitis (Mumps)
14.
Rotavirus
15.
Pertussis (Whooping Cough)
16.
Tetanus
17.
Escherichia Coli Gastroenteritis (E coli)
18.
Herpes zoster (Shingles) Localized
19.
Herpes zoster (Shingles) Disseminated disease
20.
Respiratory Syncytial Virus (RSV)
21.
Lice (head)
22.
Lyme disease
ANSWERS:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
Standard
Standard/ Contact*
Standard
Airborne and contact
Contact
Standard
Droplet
Droplet for 24 hours
Contact for 24 hours
Droplet
Airborne
Airborne
Droplet for 9 days
Contact
Droplet
Standard-not transmitted person to person
Standard-contact for diapered incontinent persons
Standard-localized
Airborne and contact
Contact
Contact-isolation up to 24 hours
Standard-not transmitted person to person
*Contact Precautions recommended in settings with evidence of ongoing
transmission, acute care settings with increased risk for transmission or wounds that
cannot be contained by dressings.
The Five Rights of Delegation
(The National Council of State Boards of Nursing, 1997)
1. Right task
• The task must be within the capabilities of the auxiliary
nursing staff. This is define by federal and state statutes (Nurse Practice Act),
organizational policies and procedures; job descriptions and accreditation guidelines.
• Assess each client before delegating. Ensure there is match between the
client’s needs and the skills, abilities and experience of the Auxiliary Nursing
Staff. Consider the client’s condition, the personnel’s capabilities, the
complexity of the task, and how much supervision will be required.
• Assistive personnel should not be assigned duties requiring ongoing
assessment, evaluation or decision making.
2. Right circumstances
• The care setting should be taken into consideration. For example, the role of
the LPN may differ in an acute care setting in comparison to their role in a long term care setting. Registered nurses are accountable to know the laws and regulations that apply to each setting.
• Client stability as well as the desired client outcomes should also be taken into
consideration.
3. Right person
• Know your facility’s competency standards!
• Know the job descriptions of co-workers!
• Has the personnel been trained on the task?
• Identify personal strengths and weaknesses of Auxiliary Nursing Staff.
4. Right direction/ communication
• The Registered Nurse is responsible for providing clear, concise,
correct, and complete communication to Auxiliary Nursing
Personnel at the time of delegation as well as providing
continued direction on an ongoing basis.
• Communicate clearly about the delegated task.
• Be specifi about how and when he/she should report back to you.
• Make sure the personnel understands what is expected, and do not
hesitate to ask them if they know how to perform the task.
5. Right supervision and evaluation
• You cannot just merely assign the task. You must guide, supervise,
and evaluate the carrying out of the delegated task.
• You must ensure the work meets your expectations. If it does not,
you must step in.
• Give credit and praise for accomplishments. Do not hesitate to offer
observations and share concerns.
• You should give the personnel feedback and ask for theirs. • Encourage input on how to resolve care issues and reach agreement
on future course of action.
• You must evaluate the client’s outcome and the results of the task to
ensure the desired outcome is achieved.
REMEMBER: You may delegate a task, but the responsibility remains with you,
the RN!!
Prioritization, Delegation, and Assignment Principles
•
Consider outcome expectations of the client and family.
•
Maintain compliance with your state’s Nurse Practice Act as well as the
healthcare facility’s guidelines and job descriptions.
•
Tailor the level of supervision to the experience and knowledge level of
staff assigned delegated duties.
•
Be cognizant that accountability for nursing judgment decisions
remains with the Registered Nurse.
•
The Registered Nurse is also accountable for maintaining the
appropriate level of supervision for delegated duties.
•
The Nursing Process and clinical judgment cannot be delegated by the
Registered Nurse to Nursing Assistive Personnel.
•
It is imperative for the Registered Nurse to be familiar with the client
and their clinical presentation in order to prioritize, delegate and assign
care.
•
Be aware that client conditions and clinical situations can change; the Registered Nurse must be able to re-evaluate and re-assign care as
the client’s needs or the nursing team’s abilities change.
(La Charity, Kumagi, and Bartz 2011)
EMERGENCY DEPARTMENT TRIAGE REVIEW
Scenario:
You work in a busy emergency department (ED) and are assigned as the triage RN
for a 12-hour shift. After your initial assessment of each of the 4 clients in each of
the 10 questions, which client would you take to a room immediately? Remember,
as a triage nurse it is your responsibility, based on your assessment skills, to classify
clients into 1 of 3 categories: Emergent, Urgent, and Non-urgent. The following
defini ions for these 3 categories will better help you answer these questions and
get more right than wrong.
Emergent – Life-threatening illness or injury at time of arrival.
Urgent – Stable on arrival, but needing medical intervention in timely
manner.
Non-urgent- Stable on arrival; are not in immediate need of emergency
treatment.
It is also imperative to realize your limitations and know when to ask for
assistance from other RN’s if more than 1 emergent client presents that
requires immediate intervention.
Place a checkmark by the category that best classifies he following clients.
Place an asterick (*) by the client requiring immediate intervention.
1.
A. Client with cough/congestion and productive sputum of yellow
color x 1 week. Chest pain upon inspiration. SaO2 98% on room air
with respiratory rate of 18.
Emergent ____
Urgent ____
Non-urgent ____
B. Client who slammed her right index finger in a car door with no
obvious deformity seen, but gross edema present. Cap refill < 2 sec.
Limited range of motion. P-120, R-18, BP-142/87.
Emergent ____
Urgent____
Non-urgent ____
C. Infant 10 months old with audible stridor, SaO2 88% on room air.
P -193, R - 52. Mother states infant reached in her purse and was
found playing with coins.
Emergent____
Urgent____ N on-urgent____
D. Client who bought his 12 y/o son a BB gun. While loading the
BB gun for the first time, a malfunction occur ed firing a BB pellet
into the father’s left calf. No active bleeding noted. All motor/sensory
intact. Cap refill < 2 sec. Father denies pa esthesias.
+ Dorsalis pedal pulse. P-72, R-20, BP-138/79.
Emergent____
Urgent____ N on-urgent____
2.
A. Client reports sore throat, runny nose, and cold x 10 days.
Emergent____
Urgent____ N on-urgent____
B. Client with history of bipolar disorder. States “I feel angry and want
to hurt someone.” Prior to your initial triage assessment, client was
yelling at other clients in the waiting room, claiming she was Jesus.
Emergent____
Urgent____
Non-urgent____
C. Client reports urinary frequency and dysuria x 1 week.
Emergent____
Urgent____ N on-urgent____
D. Client with chronic back pain. Was involved in a motor vehicle
crash 10 years ago. Has had multiple back surgeries. Denies new injury.
States ran out of pain medications.
Emergent____
Urgent____ N on-urgent____
3.
A. Client reports shortness of breath on exertion, gradually
progressive x 3 days. Denies chest pain. Ran out of Lasix 4 days ago.
P- 99, R- 26, BP- 154/92. SaO2 95% on room air.
Emergent____
Urgent____ N on-urgent____
B. Client states, “I just don’t feel good.” Denies pain or shortness
of breath. No nausea or vomiting. Decreased appetite. Alert &
oriented x 3. Color good/pink. T- 102.2, P-92, R- 22, BP 160/100,
SaO2 – 99%.
Emergent____
Urgent____ N on-urgent____
C. Client states, “I have nowhere to go.” Left personal care home
1 week ago. Denies pain. States, “I’m hungry.” T- 98.7, P- 68, R- 18,
BP-178/80.
Emergent____
Urgent____ N on-urgent____
D. Client reports shortness of breath and chest heaviness x 30 min. prior
to arrival. Denies nausea or vomiting or pain radiation. + diaphoresis.
P-181, R-42, BP-87/42, SaO2-91% on room air.
Emergent____
Urgent____ N on-urgent____
4.
A. 67 y/o client with sudden onset slurred speech, headache, and
right-sided weakness 1 hour prior to arrival. Attempts to speak,
but words are garbled. BP-199/119, P-117, R-22, SaO2 -96% on
room air.
Emergent____
Urgent____ N on-urgent____
B. 5 y/o client with 1 inch laceration to forehead. Was jumping on
trampoline and fell striking head on metal railing. Bleeding controlled.
Witnessed by mom. Alert & oriented x 3. Mother denies loss of
consciousness. T-98.5, P-118, R-24, BP-80/54, SaO2-99% on room air.
Emergent____
Urgent____ N on-urgent____
C. Client reports severe generalized abdominal pain. No bowel
movement x 1 week. History of lung cancer. Last chemo treatment
4 days ago. Decreased appetite. T-100.0, P-102, R-18, BP 162/91,
SaO2 -95% on room air.
Emergent____
Urgent____ N on-urgent____
D. Client 1-week post-op hysterectomy. Denies pain, but reports yellow exudate @ incision site. States site has “come open.” T-103, P-91,
R-16, BP-132/60.
Emergent____
Urgent____ N on-urgent____
5.
A. Car pulls up outside of triage dumping a 16 y/o male on the sidewalk.
Upon initial assessment you find a gun shot wound to abdomen.
Client unresponsive, profuse hemorrhaging noted.
Emergent____
Urgent____ N on-urgent____
B. Client with severe left-sided chest pain, shortness of breath,
diaphoresis with heavy pressure radiating to left arm, neck, and
shoulder. Client is clutching left side of chest.
Emergent____
Urgent____ N on-urgent____
C. Truck driver who drives a fuel truck reports gasoline splashed into eyes.
States “I can’t see.”
Emergent____
Urgent____ N on-urgent____
D. Client with severe headache, history of chronic tension headaches
and reports being under great deal of stress at home and work.
Emergent____
Urgent____ N on-urgent____
6.
A. Client sliced left ring finger above nail bed at work. Full range of
motion. Denies paresthesias. Cap. Refill < 2 seconds. Bleeding
controlled.
Emergent____
Urgent____ N on-urgent____
B. 3 month old infant with inconsolable crying. Mother states infant has been pulling on right ear x 1 day. T-101.9 rectal, P-158, R-30, SaO2-98%
on room air.
Emergent____
Urgent____ N on-urgent____
C. Client states glucose has been too high. Alert and oriented x 3. No
diaphoresis. Ate lunch 1-hour prior to arrival. States, “ran out of
insulin”. Capillary glucose finger stick in triage esulted a glucose of 267 mg/dl. T-98, P-99, R-18, BP 152/71. SaO2 97% on room air.
Emergent____
Urgent____ N on-urgent____
D. Client, 37 weeks gestation states, “My water broke.” Also with
moderate bleeding. Onset 45 minutes prior to arrival and abdominal pain with contractions < 10 minutes apart. T-99, P-139, R-24,
BP-180/110.
Emergent____
Urgent____
Non-urgent____
7.
A. Client reports suprapubic abdominal pain. Last menstrual period 2 months ago. Denies vaginal bleeding, or passage of clots. Admits
to unprotected sexual intercourse approximately 1 month ago.
Last bowel movement today was normal. T-98, P-74, R-16, BP-110/82,
SaO2-98% on room air.
Emergent____
Urgent____ N on-urgent____
B. Client presents with shortness of breath and chest pain, 1 hr. post
hemodialysis. States, “I get chest pain sometimes, but this time it
seems different.” Diaphoretic. P-147, R-40, BP 92/71, SaO2-90% on room air.
Emergent____
Urgent____ N on-urgent____
C. Client with pain/edema to left great toe. Denies recent injury.
Limited range of motion. Difficulty ambulating. -98.9, P-79, R-22,
BP-147/62, SaO2-99% on room air.
Emergent____
Urgent____ N on-urgent____
D. Client with sudden onset of nausea & vomiting 6 hrs. prior to arrival. No history of diabetes. Denies pain or hematemesis. Had lunch
outside of home with family today where she ate baked chicken.
T-99.7, P-121, R-22, B- 159/86, SaO2-98% on room air.
Emergent____
Urgent____ N on-urgent____
8.
A. Client is ambulatory to triage after being involved in a 1 car motor
vehicle crash. Car vs. light-pole. Refused ambulance care at the scene.
Occurred approximately 2 hours prior to arrival. Speed of impact
40 MPH. Unrestrained driver, struck head on windshield. Reports
severe neck pain and “tingling to toes.” P-109, R-18, BP-172/104,
SaO2-99% on room air.
Emergent____
Urgent____ N on-urgent____
B. Client 1-week post TURP. Reports urinary retention x 30 minutes.
Passed clots earlier today. States is in moderate pain. Pain # 4 on
1-10 scale P-104, R-20, BP-159/93. SaO2-96% on room air.
Emergent____
Urgent____ N on-urgent____
C. 3 y/o toddler with rash x 1 week. Afebrile with temp of 98.9 rectal.
R-28, SaO2-100% on room air.
Emergent____
Urgent____ N on-urgent____
D. Client with vertigo and blurred vision x 3 days. Denies headache or
any other pain. Denies injury. Has had family problems at home.
T-98.5, P-101, R-18, BP-145/94, SaO2-99% on room air.
Emergent____
Urgent____ N on-urgent____
9.
A. Client reports left shoulder pain. Onset 1 day ago after moving heavy
furniture. Constant in nature. T-98.4, P-77, R-20, BP-148/62,
SaO2-100% on room air.
Emergent____
Urgent____ N on-urgent____
B. Client with rectal bleeding x 4 hours. Color pale. + shortness of
breath on exertion. Skin cool/clammy. States bowel movement
was dark and tarry. T-96, P-141, R-26, BP 97/49, SaO2-95% room air.
Emergent____
Urgent____ N on-urgent____
C. Client reports left knee pain. + Dorsalis pedal pulse. Full range of
motion. Negative for paresthesias. Was wrapped with ace
bandage prior to arrival. T-98.4, P-99, R-20, BP-131/87, SaO2-99%.
Emergent____
Urgent____ N on-urgent____
D. Client reports severe lower abdominal cramping and irregular
menses with heavy blood flow x 4 months. -97.4, P-96, R-22,
BP-115/70, SaO2-100% on room air.
Emergent____
Urgent____ N on-urgent____
10.
A. Client fell approximately 5 feet off ladder while painting at home.
Landed on lawn with left ankle trapped under buttocks. + edema, no gross deformity. + dorsalis pedal pulse. Moderate pain. T-98.8, P-122,
R-26, BP- 141/89, SaO2-98% on room air.
Emergent____
Urgent____ N on-urgent____
B. Client, restrained driver struck 18-wheeler from behind. + airbag
deployment. Approximate speed of impact 45 MPH. Head struck
windshield of van. Fully spinal immobilized with c-collar in place.
Alert to person only. T-99, P-133, R-28, BP-168/81, SaO2-93% on 40%
O2 facemask.
Emergent____
Urgent____ N on-urgent____
C. Client in per EMS after “bumping into neighbor’s house” with car.
Approximate speed of impact 10 MPH. Denies loss of consciousness.
Alert and oriented x 3. Denies headache, chest pain, or shortness
of breath. Restrained driver. T-97.8, P-72, R-22, BP 128/69, SaO2-99%
on room air.
Emergent____
Urgent____ N on-urgent____
D. Client ambulatory reports right wrist pain. Tripped in flower bed
2 days ago. + right radial pulse. Cap refill < 2 seconds. No obvious
deformity.T-97.3, P-101, R-18, BP-175/101, SaO2-96% on room air.
Emergent____
Urgent____ N on-urgent____
EMERGENCY DEPARTMENT TRIAGE REVIEW
ANSWER KEY
(Letters with * signifies answer
1.
A. Non-urgent
B. Urgent
C. Emergent *
D. Urgent.
2.
A. Non-urgent
B. Emergent *
N
C. on-urgent
N
D. on-urgent
3.
A. Urgent
B. Urgent
N
C. on-urgent
D. Emergent *
4.
A. Emergent *
B. Urgent
C. Urgent
D. Urgent
5.
A. Emergent *
B. Emergent *
C. Emergent *
D. Urgent *
6.
A. Urgent
B. Urgent
C. Urgent
D. Emergent *
( All 3 answers for A-C are emergently classifie and
require immediate attention from all RN’s. This
question was written to assist you in critical thinking
skills so you may realize as the triage RN you must
ask for help.)
7.
A. Non-urgent
B. Emergent *
C. Urgent
D. Urgent
8.
A. Emergent *
B. Urgent
N
C. on-urgent
D. Urgent
9.
A. Urgent
B. Emergent *
C. Urgent
D. Urgent
10.
A. Urgent
B. Emergent *
C. Urgent
D. Urgent
DISASTER TRIAGE REVIEW
Disaster versus Emergency Triage: What is the difference?
Triage occurs in two different circumstances. The original intent of triage was
to sort and allocate treatment to patients to maximize the number of survivors.
It began as a method of treating victims of war and of disasters. During war
and disaster, priorities must be made because there is a lack of emergency
personnel and resources to care for all the victims. In mass casualty situations,
triage is used to decide who is most urgently in need of transportation to a
hospital for care (generally, those who have a chance of survival but who
would die without immediate treatment) and whose injuries are less severe
and must wait for medical care.
In contrast, the purpose of triage in the emergency department (ED) is to
prioritize incoming patients and to identify those who cannot wait to be seen. The triage nurse performs a brief, focused assessment and assigns the patient
a triage acuity level, which is a proxy measure of how long an individual
patient can safely wait for a medical screening examination and treatment.
So here is the deal.
In order to optimize overall patient outcomes in a catastrophic situation,
there is a shift from doing what is best for the individual patient to doing the
greatest good for the largest number of people. A system of triage must be
utilized to determine who will receive treatment and who will not.
Color Coding Triage System for Disasters
Advanced triage implemented by nurses or other skilled personnel involves a color-coding scheme using red, yellow, green, and black tags:
Red Tag (Immediate of Priority)
Labels those individuals who cannot survive without immediate treatment but who have a chance of survival. The victim has life-threatening injuries (airway,
bleeding, or shock) that demand immediate attention to save his or her life;
rapid, lifesaving treatment is urgent, and they should be the firs ones sent
to the hospital when firs responders arrive.
Who will you tag Red?
Breathing when airway opened.
Respirations over 30/min.
If capillary refil takes over 2 seconds and pulses weak or absent.
If circulation poor and bleeding heavily, instruct someone else to apply pressure
(or tourniquet if trained).
If coma, decreased responsiveness, or unable to answer simple questions.
Yellow tags (Delayed/Observation or Priority 2)
Labels those individuals who require observation (and possible later re-triage).
Their condition is stable for the moment and, they are not in immediate danger
of death. Injuries do not jeopardize the victim’s life. The victim may require
professional care, but treatment can be delayed. They have severe bleeding
that can be stopped and maintained, and severe limb injuries that will require
hospitalization or possibly surgery. These victims will still need hospital care
and would be treated immediately under normal circumstances.
Who will you tag Yellow?
If confused but able to respond to questions.
Broken legs
Severe pain
Confusion
Large burns
Breathing symptoms (not bad enough for red tagging)
Green tags - (Minimal/Wait or Priority 3)
Labels those individuals who are considered to be “walking wounded”. They
have minor injuries and will need medical care at some point, after more critical
injuries have been treated. They may have cuts, scrapes, injured extremities or
other minor injuries.
Who will you tag Green?
Ambulatory patients never need urgent care.
Cuts with bleeding controlled
Small burns,
Broken arms (firs aid is adequate initial treatment).
Black tags - (Expectant or No Priority)
Labels used for the deceased and for those whose injuries are so extensive that
they will not be able to survive given the care that is available. There are limited
resources available. No respirations after 2 attempts to open the airway.
Because CPR is a one-on-one care and is labor intensive, CPR is not performed
when there are many more victims than rescuers. There are going to be those
who are obviously deceased because of their injuries, and those who are critically
injured requiring lots of resources to possibly save them.
This category can be the most challenging from an ethical and emotional
perspective. While it is logical to help the greatest number of victims in a
disaster, it is difficul to walk away from a person who is on the verge of dying
due to severe injuries. The World Medical Association reminds us, “It is unethical
for a physician to persist, at all costs, at maintaining the life of a patient beyond
hope, thereby wasting to no avail scarce resources needed elsewhere”.
Who will you tag Black?
Obviously dead person
Not breathing after opening airway
Disaster Tagging Examples
Example 1
Victim pulled from smoking building reports shortness of breath. Respirations 28/
minute. Radial pulse palpable at 102/minute. Follows verbal commands.
Tag: Yellow
Treatment: None required at this time.
Why? This victim has a patent airway, respirations are less than 30/minute, a
palpable pulse, and follows commands appropriately. This victim is not in
immediate danger of death. Injuries do not jeopardize the victim’s life. The
victim may require professional care, but treatment can be delayed.
Example 2
Unresponsive victim found with abdominal wound that is bleeding profusely. Respirations 32/min. Radial pulse palpable at 116/minute.
Tag: Red
Treatment: Apply pressure to stop bleeding.
Why? This client is unresponsive with a respiratory rate greater than 30/minute
and is bleeding profusely from an abdominal wound. These assessment finding
place this victim in the Red category. The victim has life-threatening injuries
(airway, bleeding, or shock) that demand immediate attention to save his or her
life; rapid, lifesaving treatment is urgent, and they should be the firs ones sent to
the hospital when firs responders arrive.
Example 3
Unresponsive victim found with agonal respirations and weak, palpable radial
pulse. Two attempts made to open airway with 15 seconds of ventilation without
response.
Tag: Black
Treatment: None
Why? This victim’s injuries are so extensive that the victim will not be able to
survive given the care that is available. Remember, there are limited resources
available during a disaster. No respirations after 2 attempts to open the airway.
Because CPR is a one-on-one care and is labor intensive, CPR is not performed
when there are many more victims than rescuers.
Example 4
Ambulating victim who is alert and oriented with numerous cuts and abrasions
Responds to verbal commands Capillary refil 1 second. Respirations 20/minute.
Radial pulse 88/minute.
Tag: Green
Treatment: None
Why? This victim has minor injuries and will need medical care at some point, after more critical injuries have been treated. Ambulatory victims never need urgent
care.
Exercise 1: Matching
Match the client injury with the disaster tag that should be assigned to the client.
Tag Assignment
Client Assessment
Triage Tags
Client ambulates to
A. Red
nurse. Alert and crying
with obvious broken arm.
Respirations are 20,
Radial pulse 122. He is
awake, alert, and crying.
B. Black
Awake and alert client
states “can’t move or feel
legs” Respirations - 28
Radial pulse 112.
Unconscious client with
C. Yellow
open head wound. Bleeding controlled. Respirations - 18, Radial pulse 88
Unresponsive client
gurgles but can’t maintain open airway and
is not breathing. Weak
Carotid Pulse
D. Green
Exercise 2: Disaster Triage
There has been an explosion at a local plant. You have been sent to the scene to
triage victims. Tag each client as Red, Black, Yellow, or Green.
_______________
1. Confused victim with no obvious injury. Responds to
questions with mumbling, unintelligible speech. Skin
pale and sweaty, with visible tremors. Respirations –
32/min. Apical pulse 138/min. A Med Alert tag indicates
client is a diabetic.
_______________
2. Unconscious victim with large areas of red blistered
burns on arms, chest, and face. Singed hair on face
and head. Respirations – 5/min, shallow/irregular. No change after attempt to open airway.
_______________
3. Conscious, alert, but agitated victim who is 8 months
pregnant. Reports shortness of breath. Respirations
36/shallow/strained. Skin pale, cool and dry, capillary
refil 4 seconds. Difficult answering questions.
_______________
4. Victim wandering around without purpose, mumbling.
Some scratches and abrasions, but no obvious injury.
No breathing difficulties Able to provide name and
address, but speech is bizarre. Believes terrorists are
nearby and will shoot anyone leaving.
_______________
5. Unresponsive, limp victim lying prone, has a large bloody
wound to the occipital head. Blood has saturated
through clothing in many spots. Left pupil is fixe and
dilated. Respirations 10/irregular. Radial pulse 60/irregular.
_______________
6. Victim trapped under a heavy piece of equipment.
A hematoma noted on the forehead. RR 24, pulse 120.
Dazed and confused, unable to extricate self or answer questions, speech garbled.
_______________
7. Alert victim with blistered skin covering both legs
anteriorly and posteriorly. Reports severe pain 10/10.
Respirations - 20. Radial pulse 110. Good capillary refill
_______________
_______________
_______________
8. Alert victim lying on ground with severe leg pain 9/10
and light-headedness. Answers questions appropriately.
No respiratory distress. Respirations 28. Radial pulse
120/minute. Leg deformity with bone sticking out
through wound. Minimal bleeding noted.
9. Alert, pale and diaphoretic victim reporting severe chest
pain, radiating to jaw, with nausea and light-headedness.
Respirations - 28. Radial pulse weak at 128. No
signs of injury.
10. Victim walking around the triage area. Pale, shaking,
and crying. No obvious injuries. Follows commands.
Exercise 3: Disaster Triage
A disaster has been issued in a small town where a major traffi accident with
numerous casualties has occurred. You have been sent to the scene to triage victims. Tag each client as Red, Black, Yellow, or Green.
_______________
1. Unconscious victim. Chest not rising. Respirations 0/min. Radial pulse 0/min. Blood oozing from head wound.
Finger tips gray.
_______________
2. Alert and responsive victim with large piece of metal
imbedded into right thigh. Respirations 34/minute.
Radial pulse 132/minute. Capillary refil 3 seconds.
_______________
3. Alert and oriented victim with amputated right arm.
Bleeding controlled with a tourniquet. Respirations
18/min. Radial pulse 110/minute. Capillary refil 4 seconds.
_______________
4. Alert and oriented victim with facial injuries. Able to
ambulate to safety. Respirations 16/minute. Radial pulse
76/minute. Capillary refil 2 seconds.
_______________
5. Unresponsive victim with no visible injury. Has blank
stare. No chest or air movement after attempt to open
airway twice. Color does not return to finge tips.
_______________
6. Alert, victim who walked up to triage area holding right
arm. Deformity noted. Respirations 20/minute. Radial
pulse 92/minute. Capillary refil 1 second.
_______________
7. Alert and oriented victim lying supine with deformities
noted to both legs. Reporting pain 8/10. Respirations
28/min. Radial pulse 106/minute. Capillary refil 2 seconds.
_______________
8. Alert and oriented victim reporting chest pain. Pain on
palpation to right side of chest wall. Respirations
38/minute. Radial pulse 122/minute. Capillary refil 2
seconds.
_______________
9. Alert and oriented victim with deformity and swelling
to the left ankle. Respirations 22/minute. Radial pulse
90/minute. Capillary refil 1 second. _______________
10. Alert victim who becomes dizzy when sitting. Severe
cut on right thigh, heavy bleeding. Respirations
26/minute. Radial pulse weak at 152/minute Capillary
refil 4 seconds.
Exercise Answers
Exercise 1: Matching
Answers
Tag Assignment
Client Assessment
Triage Tags
D. Green
A. Red
Client ambulates to
nurse. Alert and crying
with obvious broken arm.
Respirations are 20,
Radial pulse 122. He is
awake, alert, and crying.
C. Yellow
Awake and alert client
B. Black
states “can’t move or feel
legs” Respirations - 28
Radial pulse 112.
A. Red
Unconscious client with
C. Yellow
open head wound. Bleeding controlled. Respirations - 18, Radial pulse 88
B. Black
Unresponsive client
gurgles but can’t maintain open airway and
is not breathing. Weak
Carotid Pulse
Exercise 2: Disaster Triage
D. Green
Answers
1. Red. This victim might have a low blood sugar instead of injury. If paramedics
give glucose, the client could improve to yellow.
2. Black. This breathing pattern is a near-death sign. Treat like someone who is
not breathing at all. The lungs probably look like the skin – even with a ventilator,
prognosis is dismal.
3. Red. Respiration over 30 and trouble answering. Injury unclear. Could have
lung or inhalation injury. Could have unrelated illness. Monitor for pregnancy
complication or premature delivery.
4. Green. This victim is walking. There is no physical injury, but there may be a
psychiatric illness either from stress or from underlying mental health problems.
5. Black. This victim is not expected to survive with this level of coma. The assessment suggests severe open head injury. The pupils indicate increasing intracranial
pressure.
6. Red. Unable to answer simple questions due to probable closed head injury.
7. Yellow. This victim’s breathing, circulation, and mental status are normal. Partial
thickness burns to legs can wait several hours for treatment if closely monitored
to make sure victim remains stable.
8. Yellow. An open leg fracture needs medical attention today, but the care can
be delayed a few hours. The bleeding isn’t enough to affect circulation, so treatment can be delayed.
9. Red. This victim is exhibiting signs of a probable myocardial infarction. Heart
attacks need urgent care, so even though the victim passed circulation (pulses
OK), this client would still be tagged red. On the other hand, if the client’s heart
stopped, do not do CPR in this setting.
10. Green. Remember if the victim is walking, urgent care is not needed.
Exercise 3: Disaster Triage
Answers
1. Black. This victim is already dead, so should be tagged black.
2. Red. This victim’s respirations are over 30/min. with tachycardia and a capillary
refil over 2 seconds. The victim has an impaled object in the thigh likely to be
causing internal bleeding/shock.
3. Red. This victim has an amputated arm that is bleeding enough to require the
use of a tourniquet and capillary refil is over 2 seconds.
4. Green. Remember if the victim is walking, urgent care is not needed. This client
has minor injuries that can be treated after other much later.
5. Black. This victim is already dead, so should be tagged black.
6. Green. Remember if the victim is walking, urgent care is not needed. This client
has a broken arm that firs aid can manage.
7. Yellow. This victim is stable for the moment and, is not in immediate danger of
death. The victim will require professional care for the two broken legs, but
treatment can be delayed. There is severe limb injuries that will require
hospitalization or possibly surgery. This victim will still need hospital care and
would be treated immediately under normal circumstances.
8. Red. This victim’s respirations are over 30/min. with tachycardia and possible
rib fractures which could puncture a lung. This victim needs immediate care in
order to survive.
9. Yellow. This victim is stable for the moment and, is not in immediate danger.
The victim will require professional care for the broken leg, but treatment can be
delayed.
10. Red. This victim is exhibiting signs of shock with hemorrhage, dizziness,
tachycardia and prolonged capillary refill Immediate care is needed for survival.
I.
Asthma
A.
Pathophysiology:
Asthma Handout
Chronic inflammatory disorder of the airway
What is happening in the person’s airway?
-
Edema
Inflammation
Tenacious secretions,
Smooth muscle spasms (wheezing and bronchospasm)
Decreased expiratory airflow
Causes/Triggers:
-
Allergy
-
Environmental allergens (dust mites and roaches)/Dust
-
Smoke (any form)
-
Medication
-
Pets
-
Exercise
-
Change in the weather (cold air)
-
Strong emotions
-
Change in environment (moving to new home or new school)
-
Food
B.
Signs and Symptoms:
-
Recurrent episodes of wheezing
-
Can’t catch their breath, dyspnea
-
Cough
-
Fatigue
-
Chest tightness/pain
-
Retraction in infants
-
Hyperresonance of chest with percussion
-
Course and loud breath sounds
-
Repeated episodes = barrel chest
-
Symptoms usually worse at night.
Symptoms of acute asthma attack: Child may start to report itching
in the front of their neck or their upper back; will start out feeling restless and report a headache; will be tired, irritable, with a
hacking non – productive cough; their chest begins to tighten as secretions increase and their cough becomes rattling and productive
(clear frothy sputum).
As the attack becomes more severe: The child will try to breathe more deeply; the expiratory phase will be prolonged with
audible wheezing; appearance will be pale and may become
cyanotic; restlessness increases; anxious expression; sweating; younger children may assume the tripod sitting position, whereas the older child will sit up with shoulders hunched over with hands on
legs or bed to facilitate use of accessory muscles.
C.
Diagnosis:
Difficult to diagnose asthma in infants (many conditions can cause
wheezing and retractions).
Chronic cough with no signs of infection and/or diffuse wheezing during expiration is sufficient to diagnose asthma.
Pulmonary function test: Helps to determine the presence and
degree of lung disease and response to respiratory therapy.
D.
Spirometry function test reliable for children older than 5 or 6 years.
Peak expiratory flow rate (PEFR): Max airflow that can be forcefully
exhaled in one second.
Each child’s PEFR based on age, race, height and gender.
Treatment:
-
Chest Physiotherapy
Percussion, vibration, squeezing the chest and breathing exercises
(blowing bubbles)
-
Do not administer this therapy during an acute episode
-
Monitor O2 sat
Allergy shots (Allergy proof the house) **Only administer allergy shots if emergency equipment is available in case of anaphylactic shock
Small frequent meals – to prevent abdominal distention and help prevent the diaphragm from expanding
Encourage fluids to thin secretions, but no extremely cold fluids be
cause cold can induce a bronchospasm
-
Evaluate participation in exercise activities on an individual basis
-
Humidified O2
-
Refer to Respiratory System Medications in Pharmacology under
the Resource Documents
Immunizations Birth - 6 years
1. Hepatitis B (Hep B)
8. Measles, Mumps, Rubella (MMR)
#1 @ birth
#1 @ 12 -15 months
#2 @ 1 – 2 months
#2 @ 4 – 6 years
#3 @ 6 – 18 months
2. Rotavirus vaccine (RV)
9. Varicella
#1 @ 2 months
#1 @ 12 – 15 months
#2 @ 4 months
#2 @ 4 – 6 years
#3 @ 6 months
3. Diphtheria, Tetanus, Pertussis (DTaP)
10. Hepatitis A
#1 @ 2 months
#1 @ 12-23 months
#2 @ 4 months
#3 @ 6 months
#4 @ 15 – 18 months
#5 @ 4 – 6 years
4. Haemophilus influenzae type B (Hib)
#1 @ 2 months
#2 @ 4 months
#3 @ 6 months
#4 @ 12 – 15 months
5. Pneumococcal conjugate Vaccine (PCV)
#1 @ 2 months
#2 @ 4 months
#3 @ 6 months
#4 @ 12 – 15 months
6. Inactivated Poliovirus Vaccine (IPV)
#1 @ 2 months
#2 @ 4 months
#3 @ 6 – 18 months
#4 @ 4 – 6 years
7. Influenza: @ 6 months and yearly
Immunizations 7 -18 years
1. Diphtheria, Tetanus, Pertussis (Tdap)
#1 @ 11 – 12 years and every 10 years
2. Human Papillomavirus Vaccine (HPV)
#1 @ 11 -12 years (3 doses series)
3. Influenza: Yearly
•
A severe febrile illness and a known allergic response to a previously
administered vaccine are both contraindication for immunization. A
contraindication to live virus vaccines (MMR and Varicella) is recently
acquired passive immunity.
** Varicella, MMR vaccines are contraindicated if there is a known hypersensitivity to
neomycin or gelatin.
** Influenza vaccine is contraindicated if there is a known egg or chicken protein
allergy
** DTaP is contraindicated with a known gelatin allergy
Administering Vaccines
**All immunizations are given IM, with the exception of the MMR and Varicella which
are given SQ
**Influenza may be given via intranasal spray
**Rotovirus is given orally
**When administering SQ injections use a 23-25 gauge needle, needle length for
infants (1-12 months) is 5/8”, children 12 months and older 5/8”
If giving IM injection use 22-25 gauge needle, needle length first 28 days 5/8”, infants
(2-12months) 1” for anterior thigh, toddlers and children, use a 1-1 ¼” for
anterolateral thigh and a 5/8” needle for the deltoid.
The Recommended Immunization Schedule for Persons Aged 0 through 18 years are approved by
the Advisory Committee on Immunization Practices (www.cdc.gov/vaccines/recs/acip), the American Academy of Pediatrics (http://www.aap.org), and the American Academy of Family Physicians
(http://www/aafp.org). DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR
DISEASE CONTROL AND PREVENTION
Specific Pediatric Heart Defects
A.
Acyanotic Defects
1.
Ventricular Septal Defect (VSD):
This is when there is an opening between the left and right ventricle (in
the septum)
This increases the volume on the right side of the heart. The right side
is having to pump harder so this can lead to right sided heart failure.
Many close spontaneously during the first year of life, but if not will have
surgical repair.
Signs and Symptoms:
-
-
2.
Signs of heart failure
Murmur
Coarctation of Aorta:
The aorta has a narrowing (pretend there is a tourniquet tied around the aorta). This makes it harder for the LV to pump so the client may wind up
with left sided heart failure.
Signs and Symptoms:
Hallmark Sign: There is a BIG difference in the pulses and BP of the
upper and lower extremities. For example, you may have a pediatric
client with an Upper extremity BP = 100/60 and Lower extremity
BP = 70/40
-
The upper pressures are much greater than the lower pressures.
Treatment:
-
Surgery
Angioplasty in some
-
3.
Patent Ductus Arteriosus (PDA):
Normal fetal circulation: Blood goes Right Atrium….Right Ventricle….
Pulmonary Artery…doesn’t go to lungs….instead when blood leaves PA
it goes straight over to the aorta via the ductus arteriosis. Why does the
blood do this? Because in utero the baby’s lungs are collapsed, and the
baby gets oxygen through the placenta.
This ductus arteriosis is supposed to close when the baby is born and
takes their first breath. When it closes then blood flows from the
Pulmonary Artery to the lungs etc….just like in the adult. But when it doesn’t……
This leads to increased workload on the left side of the heart and therefore left sided heart failure.
Some blood is going like it’s supposed to, but some is going over to the right
side because the left side is pushing it to the right.
Signs and Symptoms:
-
May be asymptomatic
-
May be in heart failure
-
They have a machinery - like murmur
Treatment:
-
Indomethacin (Indocin®) (prostaglandin inhibitor) will close PDA
-
May need surgery to close the ductus
B.
Cyanotic Defects
1.
Transposition of the Great Vessels:
Think about the normal blood flow in the heart (remember the square heart
in your cardiac lecture?)
In transposition of the great vessels, the pulmonary artery and the aorta
have swapped places. The aorta is still going to the right side of the heart
and the pulmonary artery is going to the left but they never connect or
cross.
So you wind up with 2 separate sets of circulation going in and out of the
heart. Yes, some blood is getting out to the systemic circulation, or the
client would be dead at birth. Instead, the baby is cyanotic at birth, but
alive. What’s keeping the baby alive?
Usually there is some other defect that is allowing that baby to get
just enough oxygen to stay alive. (often it is a PDA)
Signs and Symptoms:
-
Usually cyanotic at birth
-
If not picked up on until older……decreased growth, poor feeding
Treatment:
-
2.
Surgery
Tetralogy of Fallot:
Consists of 4 defects:
a.
Ventricular Septal Defect (VSD)
b.
Pulmonary Artery Stenosis
c.
d.
Overriding Aorta
Right Ventricular Hypertrophy
Signs and Symptoms:
-
Infants may be cyanotic at birth: others may have mild cyanosis that
progressively worsens during first year
-
Murmur
-
Acute cyanotic or hypoxic spells (blue spells/Tet spells)
*usually seen during crying, after feeding, during bowel movements
*at risk for sudden death, seizures
Older children: Squatting, nail clubbing, poor growth, exercise
intolerance
Treatment:
-
Surgery
Understanding Growth and Development
Infants
Infancy is birth to 12 months of age: Trust vs Mistrust (Erikson)
Basic Principles:
•
This is a time when the primary source of activity is through
the mouth; examples are rooting and sucking reflex, feeding,
and pacifier.
•
Repeated use of reflexes develops experiences
•
Young infants are totally self-centered; they have little tolerance
for delayed gratification
•
At 4-8 months they can perform a desired activity that will produce
a result. Example: secures object by pulling on a string
•
Late infancy: develops the concept of object permanenceunderstands parents are present even if not in line of vision,
works to get toy that is out of reach
•
Comprehends simple commands and meaning of words
•
Can say bye-bye and blow kisses
•
Begins to explore their surroundings
•
Infants trust that their needs will be meet (feedings, diaper
changes, comfort, stimulation)
•
•
The trust developed during infancy is the foundation for all
relationships and for the progression of further development
The single most important element in developing trust is consistency
in caregivers. Infants love routines! So do things like having a
regular feeding schedule, bathe every night then give a bottle and
go to bed.
Assessment Guidelines
•
Important things to focus on when assessing an infant
–
Head control: should have no head lag by 4 months
–
Pincer grasp: should have established pincer grasp by
11 months of age. Remember up until 1 month of age
hands are closed, grasping at 2-3 months is a reflex.
By 5 months, infants can voluntarily grasp an object.
–
Rolling over: should be able to roll over from abdomen
to back at 5 months of age. No your baby isn’t advanced
if they rolled over at 2 months…..it was an ACCIDENT!!
•
Weight: gain 5-7oz weekly for first 6 months; at 2 weeks, the
infant should have gained back to their birth weight, then
weight should double around 5 months of age and triple by age 1
•
Posterior fontanel closes by 2 months of age anterior fontanel
closes by 18 months of age
•
Verbal skills: should be able to imitate sound around 6 months,
by 8 months combines syllables like dada but doesn’t know the
meaning, 9 months responds to simple commands, comprehends
no-no, 10 months says dada and mama with meaning attached,
12 months says 3-5 words
Developmental Milestones
•
Some important developmental milestones to remember:
–
By 2 months can try to pull up with some head control
–
By 7 months should bear weight on feet, can sit with support,
transfers object from one hand to the other
–
By 8 months can move from sitting to kneeling, sits
without support
–
By 9 months can stand holding onto furniture, creeps on hands
and knees
–
9-10 months takes deliberate steps
–
By 12 months walks with 1 hand held, can sit down from standing
position without help
Pain Assessment
•
What are some signs an infant may be in pain?
–
–
–
–
Facial grimaces
Postural changes, thrashing
Crying loud and excessively
Inconsolable
Pain Scales
CRIES
•
Used for neonates and infants; 2 points are scored for each area for
a total possible score of 10. 0= no pain, 10=worst pain
–
–
–
–
–
Crying
Requires increased oxygen
Increasing vital signs
Expression
Sleepless
Understanding Growth and Development
Toddlers
Toddlers are age 12 months to 36 months: Autonomy vs. Shame and Doubt (Erikson)
Basic Principles:
•
The primary source of activity is continued until about 18 months of age
and then the toddler transitions into a focus on elimination needs.
•
The child learns to control his bowels, but if this process doesn’t happen
an “anal” fixation may develop and can lead to obsessive/perfection or
disorganized behaviors.
•
Cognitive development is characterized by EGOCENTRISM
–
Curious about their environment
–
Leaves parents for extended period of time
–
Searches for objects through hiding places
–
Imitates words and sounds and adult behavior
–
Engages in parallel play
–
LOVES ROUTINE!!!
–
Uses 2-3 words together
–
Possessive of their toys; uses the word MINE
–
Follows direction
Egocentrism is observed in the behaviors and play
–
•
The toddler has entered the world of NO NO NO NO NO!
–
Toddlers are aware of their will and control over others but they
are conflicted with exerting autonomy and relinquishing the
much enjoyed independence on others
–
Holding on and letting go are evident in how the toddler uses his
hands, mouth, eyes: “No don’t touch”, spitting out food, etc.
NEGATIVEISM and RITUALISM are typical
–
–
Toddlers learn to behave based on the restrictions that are placed on their actions
–
If the child’s behavior is punished they learn it is bad; if it is
rewarded, it is positive
–
By 36 months you may see developmental aspects of a
conscience
Assessment Guidelines
•
Important things to focus on when assessing the toddler
–
Steady growth in weight and height
–
Development of body image; they learn to associate body parts
with meanings
–
–
Gender identity is developed by age 3
Developing self-image, avoid using negative terms like skinny legs or chubby legs.
•
Play is important so provide enough space for play; encourage
pretend play
•
Permit child to help with adult tasks - they want to feel productive
•
Provide toys or activities that help with expression of feelings: language
skills aren’t developed enough to express all feelings
•
When assessing the child let them hold and touch equipment-this will
greatly reduce their fear.
Developmental Milestones
•
Some important developmental milestones to remember:
–
Gross motor: walks without help, creeps up stairs, kneels without
support
–
Fine motor: builds tower of 2 cubes, holds 2 cubes in one hand,
scribbles, uses cup well but struggles with a spoon
–
Language: says 4-5 words, including name, points and ask for
objects, understands simple commands, says 10 or more words,
uses 2-3 phrases, TALKS ALL THE TIME
–
Tolerates separation from parents
–
TEMPER TANTRUMS are normal
–
May develop a dependency on security item – like a special
blanket or stuffed animal
Pain Assessment
•
What are signs a toddler maybe in pain?
•
Toddlers don’t understand why or what is causing them to have pain so
they express:
–
–
–
–
–
–
FLACC
Extreme emotional upset
Physical resistance
Excessive activity
Restlessness
Loud crying
Attempts to push stimulus away
Pain Scales
•
FLACC- used for ages 2 months to 7 years (if unable to communicate pain level)
•
2 points are scored for each area for a total possible score of 10.
0= no pain, 10=worst pain
–
–
–
–
–
Face
Legs
Activity
Cry
Consolability
Understanding Growth and Development
Preschoolers
Preschool is ages 3-5 years: Initiative vs Guilt (Erikson)
Basic Principles:
•
This is a time when the primary source of activity is related to their
sexual identity and relationship with parents.
•
Becomes rival with same sex parent, develops sexual desires for
opposite sex parent. This is sometimes referred to as the Oedipus
Complex for boys and Electra Complex for girls
•
Develops a fear they will be punished for these feelings by same
sex parent and this fear eventually leads the child to learn to identify with the same sex parent
•
The preschooler’s thinking transitions from egocentric thought to social
awareness is often referred to as “magical thinking.” They believe their
thoughts are all powerful; for instance, if they wish their sister would die
and something happens and she dies, they think it is their fault
•
Literal thinkers- if you tell them they were bad for hitting a child, they
literally think they are bad, they can’t understand it’s the behavior that
was bad not THEM!
•
Poor body boundaries, they think when they have a cut all their blood is
going to come out. That’s why they always want a million Band-Aids.
Assessment Guidelines
•
Important things to focus on when assessing the preschooler
–
Usual weight gain is 4-6 pounds per year; good rule of thumb:
4 years, 40 pounds, 40 inches. Average weight of 5 year old is 42.1 pounds.
•
The preschooler begins to move from parallel play to associative play.
This is group play that is similar but without rigid organization rules. For example: everyone is sitting around playing with their blocks.
•
Imaginative and imitative play are also very important as a way for children to express their feelings when they don’t have the vocabulary
yet to describe what they are feeling.
•
Use drawing and pictures to help child express how they are feeling with procedures and interventions; allow them to help when safe for
the child, such as with dressing changes or bandages.
Developmental Milestones
Some important developmental milestones to remember:
–
Gross motor: Rides tricycle, jumps off bottom step, Skip and hop on one foot, catch a ball, jumps rope
–
Fine motor: Builds a tower of 9 blocks, when drawing can copy
circles, Use scissors usefully to cut out pictures, ties shoelaces
–
Vocabulary of 900 - 2100 words as they grow
–
Uses complete sentences starting with 3-4 words up to 6-8 words
–
Continues to talk all the time- even if no one is listening!!
Tells exaggerated stories and asks WHY, WHY, WHY?
Pain Assessment
•
•
•
What are signs a preschooler may be in pain?
Preschoolers do not understand pain is related to illness, but may relate it to an injury-remember they are magical thinkers
Responds well to distractions
–
Can verbally communicate about their pain
–
Cling to parents or caregiver
–
Fearful about what may happen, may request procedure to stop
Pain Scales
Faces
•
Faces Scale is used for age 3 and up
Have the child choose the facial expression that best fits their
–
pain level
–
It’s very important that they are able to understand the
difference between pain and feeling sad. We aren’t try to
determine how sad they are!!
Oucher
•
Oucher is used for children age 3-12 years
•
Consist of 6 photographs of faces representing no hurt to biggest hurt
•
Benefit over Faces scale: it has faces from different ethnicities
Understanding Growth and Development
School - Age
School Age is 6-12 years: Industry vs Inferiority (Erikson)
Basic Principles:
•
The child starts to place importance on privacy. Plays mostly with same
sex peers. When caring for this age be sure to provide gowns and
covers when performing procedures. Always knock on the door before
entering.
•
Has an increased need to understand the body and functions of the body.
•
One of the major tasks is mastering conservation. They learn that
physical matter doesn’t change when its form is altered. They are no longer magical thinkers. An example of this being achieved: They
understand that if a girl cuts her hair short she doesn’t become a boy,
their gender doesn’t change by having a haircut.
–
Does not reason logically, may use symbols or objects, either words or images. Understands relationship between things and
ideas, allow the child to handle equipment-this will help increase
their understanding.
•
.
•
Children become more flexible. They are now able to see and
understand things from anothers point of view, no longer rigid
thinkers. They are no longer so egocentric. This is the beginning of
logical thought formation which leads to the development of morality
They use cooperative play. They work hard in school, sports, and in their family to fill a sense of accomplishment.
–
They want to be productive and successful!!
–
The goal of this stage of development is to develop a sense
industry. This will help in building self-confidence. They continue
to improve their social skills.
–
Eager to build skills and participate in meaningful and
socially useful work. They must balance this with the knowledge
that although they are improving and successful there is always
more to learn.
–
If the child DOESN’T develop a sense of accomplishment this may result is a sense of inferiority.
•
As children move from egocentrism to more logical thinking they are also developing a conscience and moral standards. These standards are
based on the teachings and beliefs of others such as teachers and
parents.
Assessment Guidelines
•
Important things to focus on when assessing the school age child:
–
Height and weight gain slows, appears in bursts, can grow at least 2 inches in height per year
Developmental Milestones
•
–
Some important developmental milestones to remember:
Repeats activities in order to master them
–
Develops concept of numbers, knows when its morning or night,
by age 8 gives similarities and differences between two things from memory, can repeat days of the week
–
Age 6 able to use knife to spread butter, by age 8 helps with routine housework, looks after own meals
–
Socially at age 6 can share and cooperate, likes to compete in games, enjoy spending time with others of the same age
on projects and discussing the activities of the day, develops modesty: these are import ant consideration when they are
in an acute care setting.
Pain Assessment
•
What are signs a school age child may be in pain?
•
They can understand disease or injury causes pain
–
–
–
–
–
Muscle rigidity
Clenched fist
Wrinkled forehead
Able to verbalize pain by telling you location and intensity
Stalling behaviors
Pain Scales
Faces
•
Faces Scale is used for age 3 and up
Have the child choose the facial expression that best fits their
–
pain level
Oucher
•
Oucher is used for children age 3-12 years
•
Consist of 6 photographs of faces representing no hurt to biggest hurt
•
Benefit over Faces scale: it has faces from different ethnicities
Numeric Scale
•
Use for children ages 5 and up
–
Uses straight line with end points identified as no pain and
worst pain
–
Be sure the child is able to count!! Some 5 year olds haven’t
mastered this skill yet.
Understanding Growth and Development
Adolescents
Adolescents are age 12-18 years: Identity vs. Confusion (Erikson)
Basic Principles:
•
Adolescents primary focus is on peers and developing relationships out
side of the family.
–
Have the ability for mature abstract thoughts and ideas, can think
in hypothetical terms
–
As the adolescent physically matures and thought and ideas
become more complex, a new sense of identity is developed.
This identity consists of a picture of oneself that includes past, present, and future.
–
Peer groups play a large role in developing a sense a self and self-esteem, with the key to identity achievement being based
on interaction with others.
–
Barriers to developing identity would be lack of role models,
inability to identify a meaningful sense of self, and lack of
opportunities to explore alternative roles.
•
Establishes personal ethics on which to base decisions. Increase in
reasoning and social cognition
•
Understands abstract thoughts and understands opinions of others. Takes into account the opinions of others when making decisions
Assessment Guidelines
•
•
Physical changes related to sex and growth hormone effects; is varied in
rate and timing based on gender and family genetics/influences
Be clear, concise and honest when communicating with the adolescent,
particularly with body and sexuality issues.
–
Nursing considerations: give both written and verbal instructions,
give clear and complete information about disease process,
interventions, and hospitalization.
Developmental Milestones
•
Some important developmental milestones to remember:
–
GIRLS develop more quickly than BOYS. Adolescents grow stronger and more muscular.
–
Increased communication and time with peer group; enjoys activities like movies, dances, driving, sporting events
–
Preoccupied with body image, very self-centered;
relationship with peers is the most important relationship
–
Feelings of “being in love” and dating forms stable
relationships and attachments to others
–
Emotional and physical separation from parents; becomes more independent
Pain Assessment
•
What are signs an adolescent may be in pain?
•
Able to describe pain but may be fearful of telling
–
Less vocal protest
–
Less motor activity
–
Move verbal expressions like “it hurts” or “stop you’re hurting
me”
–
Muscle tension
Pain Scales
Numeric Scale
•
Use for children ages 5 and up
–
Uses straight line with end points identified as no pain and worst
pain, usually defined by describing the pain on a scale of 1-10
ABG Interpretation Practice Problems
PROBLEM
NORMAL
pH: 7.32 ________________
pH: acidosis  7.35 – 7.45  alkalosis
PCO2: 41 ________________
PCO2: basic  35 – 45  acidic
HCO3: 20 ________________
HCO3: acidic  22 - 26  basic
Interpretation: _____________________________________________________
PROBLEM
NORMAL
pH: 7.56 ________________
pH: acidosis  7.35 – 7.45  alkalosis
PCO2: 31 ________________
PCO2: basic  35 – 45  acidic
HCO3: 25 ________________
HCO3: acidic  22 - 26  basic
Interpretation: _____________________________________________________
PROBLEM
NORMAL
pH: 7.26 ________________
pH: acidosis  7.35 – 7.45  alkalosis
PCO2: 51 ________________
PCO2: basic  35 – 45  acidic
HCO3: 29 ________________
HCO3: acidic  22 - 26  basic
Interpretation: _____________________________________________________
PROBLEM
NORMAL
pH: 7.45 ________________
pH: acidosis  7.35 – 7.45  alkalosis
PCO2: 52 ________________
PCO2: basic  35 – 45  acidic
HCO3: 35 ________________
HCO3: acidic  22 - 26  basic
Interpretation: _____________________________________________________
ABG Interpretation Practice Problems
PROBLEM
NORMAL
pH: 7.32 acidosis
pH: acidosis  7.35 – 7.45  alkalosis
PCO2: 41 normal
PCO2: basic  35 – 45  acidic
HCO3: 20 acidosis (acidic)
HCO3: acidic  22 - 26  basic
Interpretation: Metabolic Acidosis
PROBLEM
NORMAL
pH: 7.56 alkalosis
pH: acidosis  7.35 – 7.45  alkalosis
PCO2: 31 alkalosis (basic)
PCO2: basic  35 – 45  acidic
HCO3: 25 normal
HCO3: acidic  22 - 26  basic
Interpretation: Respiratory Alkalosis
PROBLEM
NORMAL
pH: 7.26 acidosis
pH: acidosis  7.35 – 7.45  alkalosis
PCO2: 51 acidosis (acidic)
PCO2: basic  35 – 45  acidic
HCO3: 29 alkalosis (basic)
HCO3: acidic  22 - 26  basic
Interpretation: Respiratory acidosis with partial compensation
PROBLEM
NORMAL
pH: 7.45 normal (~alkalosis)
pH: acidosis  7.35 – 7.45  alkalosis
PCO2: 52 acidosis (acidic)
PCO2: basic  35 – 45  acidic
HCO3: 35 alkalosis (basic)
HCO3: acidic  22 - 26  basic
Interpretation: Fully compensated Metabolic alkalosis
A GREAT WAY TO REMEMBER THE...
12 CRANIAL NERVES
“On Old Olympus Towering Top A Finn And German Viewed Some Hops”
Cranial Nerve
I Olfactory
Major Function(s)
Smell
II Optic
Vision
III Oculomotor
Eyelid and eyeball movement
IV Trochlear
Innervates superior oblique
Turns eye downward and laterally
V Trigeminal
Chewing
Face & mouth - touch & pain
VI Abducens
Turns eye laterally
VII Facial
Controls most facial expressions
Secretion of tears & saliva; Taste
VIII Vestibulochochlear
(auditory)
Hearing
Equilibrium sensation
IX Glossopharyngeal
Taste
Senses carotid blood pressure
X Vagus
Senses aortic blood pressure; Slows
heart rate; Stimulates digestive organs;
Taste
XI Spinal Accessory
Controls trapezius &
sternocleidomastoid; Controls
swallowing movements
XII Hypoglossal
Controls tongue movements
CRITICAL THINKING EXERCISES
Making Room Assignments
RULE: “LIKE ILLNESSES” CAN BE PUT IN THE SAME ROOM TOGETHER.
IN THE STEM OF THE QUESTION, THE NCLEX® LADY WILL TELL YOU THAT THE TWO
CLIENTS HAVE THE EXACT SAME CONDITION.
NCLEX® CRITICAL THINKING EXERCISE FOR MAKING ROOM
ASSIGNMENTS:
The nurse is caring for a client with AIDS that is in a semi-private room. Which
client is best to assign in the room with the client who has AIDS?
1.
2.
3.
4.
The client with asthma.
The client that is 8 hours post-appendectomy.
The client with bronchitis.
The client with partial thickness burns.
Answer:
1. Correct: Asthma because that’s the only one that’s not infectious.
2. Incorrect: You would never put a fresh incision in a room with somebody that’s
HIV positive. Cross contamination could occur.
3. Incorrect: Bronchitis can be bacterial or viral, right?
4. Incorrect: This is similar to the post-appendectomy situation; someone with a
partial thickness burns would be at risk for cross contamination also.
NCLEX® CRITICAL THINKING EXERCISE:
An 18 month old is admitted to the ED with a diagnosis of rotavirus and severe
dehydration. The client has no tears and has not wet a diaper in 5 hours. The
primary healthcare provider has prescribed D5 ¼ NS with 20mEq of KCL at
20 mLs per hour per pump. What would be the best action by the nurse?
Answer:
Based on the information, it’s clear that fluids a e needed. So what are you
worried about? Potassium. Why are you worried about potassium? Because they
have not wet a diaper in five hours. Does the baby still need the fluid? es, but if
the kidneys are not working and you go ahead and give the potassium, you will
make the client go into renal failure!
So, what you do is you go ahead and start your IV, right? Yes. You get the
D5¼ NS going and call the primary healthcare provider and say, “Look, I am not
giving this baby any potassium until they start wetting their diaper, okay?”
We will not start giving the baby potassium in their fluid until the baby has star ed to void----wetting diapers. Is that what they want you to do? Yes.
Primary healthcare providers want you to look at the prescriptions or orders.
The NCLEX lady likes the word “prescription” so that is why we are using it. We
want you to feel comfortable with that word! They write prescriptions all day
long and we have to be able to look at those prescriptions and find those that
we question. They want us to question the orders if there is something to worry
about like in this scenario. There’s never anything wrong with seeking clarification.
That is the best action by the nurse in this situation to call the primary healthcare
provider before starting the potassium to clarify the order based on what is safest
for the baby.
NCLEX® CRITICAL THINKING EXERCISE:
PART I:
The charge nurse is making assignments for the shift. The staff includes an RN
pulled from the neonatal intensive care unit (NICU) who has not worked on an
adult floor in six years. What is he appropriate action by the charge nurse?
1. Send the RN back to NICU and give the nurses who are already working on
the floor an extra c ient.
2. Call the nursing supervisor and demand an RN with medical surgical
experience.
3. Attend the shift report.
4. Assign the NICU to do unlicensed assistive personnel duties.
PART II:
Which client is best to be assigned to the NICU nurse pulled to the adult medicalsurgical floor
1. 4 hour post cholecystectomy client experiencing pain every 3 - 4 hours.
2. Elderly client with unexplained syncope.
3. Teenage client 8 hours post hypophysectomy.
4. New admit diagnosed with adrenal insufficienc .
Answers: Part I
1. Incorrect : Send the RN back to NICU and give the nurses working on the floor al eady an extra client….. Doing this is a waste of a valuable RN
resource and a waste of money. Also, it does not solve the problem. Also, this would be unsafe…..for the clients and the nurse to have an
extra client.
2. Incorrect : Call the nursing supervisor and demand a RN with med-surg
experience. If the supervisor had a RN with med-surg experience, would
a NICU nurse have been sent to you?
3. Correct: Attend the shift report. This will allow the charge nurse to
assess the situation and to make assignments based on client and
unit needs. Assessment always comes first even with delegation
and assignments!
4. Incorrect: Assign the nurse to do nursing assistant duties. Doing this
is a waste of a valuable RN resource and a waste of money.
PART II: (repeated just for ease of reference)
Which client is best to be assigned to the NICU nurse pulled to the
adult medical- surgical floor
1. 4 hour post cholecystectomy client experiencing pain every 3 - 4 hours.
2. Elderly client with unexplained syncope.
3. Teenage client 8 hours post hypophysectomy.
4. New admit diagnosed with adrenal insufficienc .
Answers: Part II
1. Correct: 4 hours post cholecystectomy client experiencing pain
every 3 – 4 hours. Non-complicated client.
2. Incorrect: Elderly client with unexplained syncope? This client is at risk
for MI or severe electrolyte imbalance. Needs close monitoring.
3. Incorrect: Teenager client 8 hours post hypophysectomy? This client is at
risk for developing diabetes insipidus. Sinus surgery is a little close to
my pituitary gland. Needs close monitoring.
4. Incorrect: New admit diagnosed with adrenal insufficiency? This client is
deficient in all ste oids: glucocorticoids, mineralcorticoids, and
sex hormones. At risk for fluid volume deficit, and shock. This clien
is considered unstable, and is not a candidate for a pulled nurse.
NCLEX® CRITICAL THINKING EXERCISE:
The nurse is scheduled to administer the morning dose of Levothyroxine. The client
reports “fullness” in her chest that started after eating two hours ago. What is the
best action by the nurse?
1.
2.
3.
4.
Administer aluminum/magnesium suspension 30 mL.
Administer the Levothyroxine
Obtain a 12- lead ECG
Call the primary healthcare provider
Answers:
1. Incorrect: Administer aluminum/magnesium suspension 30 mL. Is
this going to help the client? No…..aluminum/magnesium
suspension will not stop a client from having an MI will it? That is what
you are telling the NCLEX lady…. the drug of choice for an MI would be aluminum/magnesium. We need to start with Oxygen….right….
but that was not an option so we have to go with what they give us.
2. Incorrect: Administer the levothyroxine. I don’t think so… this will make the problem worse!
3. Incorrect: Obtain a 12- lead ECG…this is delaying care! Will this fix the
problem? NO we have to select an answer that is going to fix the
problem…. if you selected that for your answer… you are looking at the ECG over and over …. You know you have no idea what it says!
4. Correct: Call the primary healthcare provider….because you know
that levothyroxine increases the heart rate and puts an increased
workload on a heart that has CAD. So could this client be having an
MI….Yes…and the only option here that will fix the p oblem…
the fact the client is having an MI….is to call the primary healthcare
provider.
ECG Handout
Sinus Rhythm
Atrial Fibrillation
Atrial Flutter
Ventricular Tachycardia
Ventricular Fibrillation
Hurst Lab Values
Please note that normal ranges will depend on the lab performing the test.
The normal values listed are to be used as references only for adults >13 years of age
LAB
NORMAL VALUES
URINALYSIS
Alb
0-8 mg/dL
pH
4.6-8.0
WBC
0-4
Glucose
negative
Specific Gravity
1.005-1.030
TOTAL CHOLESTEROL
<200 mg/dL (< 5.2 mmol/L)
HDL
Men: 45-49 mean (1.17-1.29 mmol/L)
Women: 50-59 mean (1.3-1.55 mmol/L)
LDL
60-180 mg/dL (1.6-4.7mmol/L)
ELECTROLYTES
Potassium
3.5-5.0 mEq/L (3.5-5.0 mmol/L
Sodium
135.145 mEq/L (135-145 mmol/L)
Phosphorous/Phosphate
3.0-4.5 (0.97-1.45 mmol/L)
Magnesium
1.3-2.1 mEq/L (0.65-1.05 mmol/L)
Calcium
9.0-10.5 mg/dL 2.25-2.62 mmol/L)
GLUCOSE (serum)
70-110 mg/dL (3.9-6.1 mmol/L)
HEMOGLOBIN A1C
Good Control: 2.5-5.9%
Fair Control: 6-8%
Poor Control: >8%
BILIRUBIN
Total: 0.3-1.0 mg/dL
Indirect: 0.2-0.8 mg/dL
Direct: 0.1-0.3 mg/dL
AMMONIA
10-80 mg/dL
TOTAL PROTEIN
6.4-8.3 g/dL
BUN
10-20 mg/dL
CREATININE
Men: 0.6-1.3 mg/dL
Women: 0.5-1.0mg/dL
Hurst Lab Values (continued)
LAB
NORMAL VALUES
RBC (red blood cells)
Men: 4.7-6.1 million/mm3
Women: 4.2-5.4 million/mm3
HEMOGLOBIN
Men: 13.5-17.5 g/dL
Women: 12.0-15.5 g/dL
HEMATOCRIT
Men: 42-52%
Women: 37-47%
aPTT (patients receiving anticoagulant
therapy: 1.5-2.5 times the control value
in seconds)
30-40 seconds
BLEEDING TIME
1-9 minutes
ESR (erythrocyte sedimentation rate)
Men: 0-10 mm/hr
Women: 0-20 mm/hr
INR (international normalized ratio)
1.3-2.0 (an INR of 3.0-4.5 may be considered therapeutic
depending on the client)
WBC (white blood cells)
5,000-10,000 mm3
PLATELETS
150,000-400,000 mm3 or 150-400 SI units
ALBUMIN
3.5-5 g/dL
DIGOXIN
0.5-2 ng/mL
TROPONIN T
< 0.10 ng/mL
TROPONIN I
< 0.03 ng/mL
Reference: Pagana and Pagana, Manual of Diagnostic and Laboratory Test, Mosby, St. Louis, MO, 2014
Maslow’s Hierarchy of Needs
© alan chapman 2001-4, based on Maslow’s Hierarchy of Needs
NCLEX® Strategy Questions
1. The nurse is caring for a client that has metabolic acidosis secondary to
acute renal failure. What is the initial client response to this problem?
 1. Respiratory rate increases to blow off acid.
 2. Respiratory rate decreases to conserve acid and buffer
the kidneys’ response.
 3. Kidneys will excrete hydrogen and retain bicarb.
 4. Sodium will shift to cells and buffer the hydrogens.
Rationale:
1. Correct: Yes, acute renal failure causes metabolic acidosis and the body is
trying to breathe faster to blow off some acid. The respiratory response is fast.
2. Incorrect: No, the client’s respiratory rate is fast, not slow.
3. Incorrect: This will happen, later. Did not we say about 48 hours? Not initial response.
4. Incorrect: Sodium is extracellular electrolyte, not an intracellular electrolyte
2. The daytime charge nurse identifie that a client was treated for what
condition during the night after reading the following chart entries?
Exhibit:
PROGRESS NOTES:
LAB REPORTS:
1/22/17 – 0125 Restless, picking at sheets. Disoriented to place
and time. Dyspnea on exertion. Dr. Timmons notified. Stat
ABGs ordered.
–
pH - 7.30
1/22/17 – 0145 Oxygen started at 2 liters per nasal cannula.
Incentive Spirometry and deep breathing exercises initiated.
paO2 - 91mmHg
paCO2 - 50 mmHg
HCO3 - 24 mEq/L
(24 mmol/L)
Head of bed elevated to 30º. –
 1. Respiratory Alkalosis
 2. Respiratory Acidosis
 3. Metabolic Alkalosis
 4. Metabolic Acidosis
Rationale:
2. Correct: From the chart we see restless, so we think??? Hypoxic, Now
look at pH, its? Acid and which other lab says acid…CO2 . Is CO2 a
respiratory or metabolic chemical? Respiratory. So Respiratory Acidosis.
3.A client is hospitalized hundreds of miles from home for a bone marrow
transplant. The client is in a protective environment while undergoing
intense chemotherapy. The client’s sibling comes to visit and has obvious
manifestations of an upper respiratory infection. Which nursing action would be
most appropriate at this time?
 1. Do not allow the sibling to visit, and do not upset the client by mentioning the sibling’s visit.
 2.Allow the sibling to wave at the client through the window or door, then
offer the use of the unit phone so they can talk.
 3.Allow the sibling to visit after donning a sterile gown, mask,
and gloves, but prohibit physical contact.
 4.Allow the sibling to visit after donning a sterile gown, mask,
and gloves, and have the client wear a mask.
Rationale:
2. Correct: This is the only safe answer for the client.
1. Incorrect: No, allow client to see from distance and talk with client.
3. Incorrect: Sibling does not need to be allowed in the room regardless of
protective clothing.
4. Incorrect: Sibling does not need to be allowed in the room regardless of
protective clothing.
4.The client has returned to the unit after an escharotomy of the forearm.
What is the priority nursing assessment?
 1. Infection
 2. Incision
 3. Pain
 4. Tissue perfusion
Rationale:
4. Correct: Yes! They do the escharotomy for circulation problems, check
circulation!
1. Incorrect: Not right away!
2. Incorrect: No, that incision is going to be bad and ugly.
3. Incorrect: Well this is the second best answer – the escharotomy for the
lack of circulation and pain is one indicator of adequate circulation, so go
with the real thing first
5.A client is admitted to the medical unit with a diagnosis of Addison’s disease.
What nursing interventions should the nurse implement for this client? Select
all that apply.
 1. Monitor for decreased potassium levels.
 2. Assist the client to select food low in sodium.
 3. Administer flud ocortisone as prescribed.
 4. Monitor intake and output.
 5. Record daily weight.
Rationale:
3., 4. & 5. Correct: The client with Addison’s disease needs sodium due to
low levels of aldosterone. If my sodium is low, then what happened to my
potassium? Fludrocortisone is a mineralocorticoid that the client will need
to take lifelong. I&O and daily weights are needed to monitor flui status.
1. Incorrect: If I do not have enough aldosterone I am losing sodium and
water and retaining potassium. So this client should be monitored for
hyperkalemia.
2. Incorrect: If I do not have enough aldosterone I am losing sodium and water. So, this is one client that needs foods high in sodium.
6. Which statements, made by a client after receiving education regarding
bleeding precautions, would indicate to the nurse that teaching was
successful? Select all that apply.
 1. “I cannot shave while I am at risk for bleeding.”
 2. “It is important to gargle with a commercial mouthwash three times a day.”
 3. “Stool softeners will help prevent rectal bleeding.”
 4. “Prior to sexual intercourse, I will use a water-based lubricant.”
 5. “I will use a soft toothbrush.”
Rationale:
3., 4., & 5. Correct: Stool softeners prevent constipation and straining that
may injure rectal tissue. Water-based lubricant will prevent friction and
tissue trauma. Soft toothbrush will prevent trauma to gum tissue.
1. Incorrect: The client can shave with an electric razor. An electric razor will prevent trauma.
2. Incorrect: Commercial mouthwash should be avoided as they contain high alcohol content that will dry oral tissues and lead to bleeding.
7.A client is reporting shortness of breath and neck pressure following a
thyroidectomy. What is the priority nursing intervention?
 1. Elevate the head of bed, remove the dressing, and stay with the client.
 2. Call a code, open the trach set, and position the client supine.
 3. Have the client say “EEE” to check for laryngeal integrity and assess Chvostek’s sign.
 4. Call the primary healthcare provider, and assess vital signs.
Rationale:
1. Correct: Yes! Sounds like respiratory distress, looks like respiratory
distress, get that dressing off the neck and see if they can breathe any
better.
2. Incorrect: Not yet! Do something firs to see if it gets better.
3. Incorrect: Well just look and check and look and check – do something.
4. Incorrect: Don’t leave the client.
8.The nurse observes a client in the manic phase of bipolar disorder in group
therapy. The client has interrupted the counselor’s group session multiple times
and states “I already know this information dealing with others when you are
down.” Which nursing action is appropriate?
 1. Engage the client to walk with the nurse to make a pot of coffee.
 2. Ask the group to reflec on the client’s behavior to determine if it
is appropriate.
 3. Ask the group to tell the client how they feel about the disruptions.
 4. Instruct the client to perform jumping jacks to get rid of some energy.
Rationale:
1. Correct: Yes! Get them away and doing something purposeful.
2. Incorrect: That is embarrassing and humiliating to the client.
3. Incorrect: Sometimes this will be helpful during times of therapy – but the client is manic at this time, will she even believe them?
4. Incorrect: No, this is getting the client active, but can the group
continue with this attention seeking jumping, person? No. Get the client
away from the activity.
9.After examining the eyes of the following client, the nurse would expect which
correlating lab work?
 1. Elevated cortisol level
 2. Elevated thyroxine level
 3. Decreased parathormone level
 4. Increased calcitonin level
Rationale:
2. Correct: Exophthalmos is a classic findin in Graves’ disease. It is a
protrusion of the eyeballs from the orbits due to impaired venous drainage
from the orbit, which causes increased fat deposits and edema in the
retro-orbital tissues. To diagnose hyperthyroid or Graves’ Disease you do a
thyroxine level which when elevated indicates a hyperthyroid state.
1. Incorrect: This would indicate hyperfunctioning of the adrenal gland as in
Cushing’s syndrome.
3. Incorrect: This lab would indicate hypoparathyroidism.
4. Incorrect: Again, this level would tell you about the parathyroid.
10. Which client should the nurse identify as being at highest risk for suicide?
 1. Seventy six year old widower with chronic renal failure
 2. Nineteen year old taking antidepressants
 3. Twenty eight year old, post-partum, crying weekly
 4. Fifty year old with obsessive-compulsive disorder (OCD)
Rationale:
1. Correct: Yes- elderly with chronic disease, especially men, are very high
risk.
2. Incorrect: There is an increased incidence and risk in this population-but
look for the highest risk.
3. Incorrect: Many post-partum clients cry weekly, this is not the red fla
client.
4. Incorrect: Chronic disease, but the widower wins out as the higher risk.
11. The client is transferred to the rehabilitation facility following an ischemic
stroke affecting the right side and aphasia. Which nursing action would
promote communication with the client?
 1. Encourage client to shake head in response to questions.
 2. Speak in a loud voice during interactions.
 3. Speak using phrases and short sentences.
 4. Encourage the use of a radio to stimulate the client.
Rationale:
3. Correct: Client is having trouble communicating. Get simple. Promote communication.
1. Incorrect: Never pick an answer that doesn’t allow the client to speak. They haven’t told us what kind of aphasia. They could have expressive aphasia.
2. Incorrect: Don’t yell at the client.
4. Incorrect: Use of radio will not promote communication with the
client. Radio should be turned off when communicating with client to decrease distraction.
12.The nurse is caring for a client with pneumonia. Which nursing observation
would indicate a therapeutic response to the treatment for the infection?
 1. Oral temperature of 101º F. (38.3º C); increased chest pain with
non-productive cough
 2. Productive cough with thick green sputum; states feels tired
 3. Respirations 20, with no reports of dyspnea; moderate amount of thick,
white sputum
 4. White cell count of 10,000 mm3, urine output at 40 mL/hr,
and no sputum
Rationale:
3. Correct: You will have sputum a while after pneumonia, but if it is white there is no infection.
1. Incorrect: Temperature is still too high and they are having chest pains.
2. Incorrect: Green sputum means infection is still there.
4. Incorrect: If pneumonia is the problem, you do not check kidneys. With pneumonia you will have sputum for a while.
13.An elderly client is prescribed to begin ambulation with a walker following hip
replacement surgery. Which intervention by the nurse will best help this client?
 1
Sit in a low chair for ease in getting up with a walker.
 2. Make sure rubber caps are present on all 4 legs of the walker.
 3. Begin weight-bearing on the affected hip immediately.
 4. Practice tying your shoes before using the walker.
Rationale:
2. Correct: Rubber caps on all 4 legs of walker will prevent falls.
1. Incorrect: If the client sits in a low chair, their hip may dislocate. You prevent
hip flexio greater than 90 degrees and leg adduction. Both can cause
dislocation.
3. Incorrect: We do not begin weight bearing immediately but as soon as the
physician says.
4. Incorrect: If you bend over to tie your shoes, what is your hip going to dodislocate. You prevent hip flexio greater than 90 degrees and leg adduction.
Both can cause dislocation.
14.A client has been admitted to the medical unit with elevated ALT, AST and
bilirubin levels.
Identify the location the nurse would anticipate discomfort. Place an “x” in the
correct location.
Rationale:
Correct: The liver is located under the right lower rib cage. The liver may be
palpable in the right upper quadrant.
15. A client had surgery for cancer of the colon and a colostomy was
performed. Prior to discharge, the client asks, “Will I still be able to swim?” The nurse’s response would be based on which understanding?
 1. Swimming is not recommended. The client should begin looking for other areas of interest.
 2. Swimming is not restricted if the client wears a dressing over the stoma at all times.
 3. The client cannot go into water that is over the stoma area, but can go into water up to the stoma area.
 4. There are no restrictions on the activity of a client with a colostomy; all previous activities may be resumed.
Rationale:
4. Correct: With the colostomy bag providing an airtight seal they can take a
shower, bath, and go swimming.
1. Incorrect: Swimming is allowed with the airtight seal that the colostomy bag
provides.
2. Incorrect: Client will wear colostomy bag with airtight seal not a dressing
over the stoma.
3. Incorrect: No, the client can swim with the airtight seal colostomy bag.
16.The nurse is evaluating whether a client understands the procedure for
collecting a 24 hour urine sample. The nurse recognizes that teaching was
successful when the client makes which statements?
Select all that apply.
 1. “I should start the 24 hour urine collection at the time of my firs
saved urine specimen.”
 2. “If I forget to collect any urine, I will need to start over.”
 3. “It is important to ensure that no feces or toilet tissue mixes
with the urine.”
 4. “When the 24 hours is up, I need to void and collect that specimen.”
 5. “The urine specimen should be stored in my refrigerator during collection.”
Rationale:
2., 3., & 4. Correct: Missed specimens make the collection inaccurate. The test
should be started over. Contamination can alter the test. The last specimen should be obtained at the end of the 24 hour period.
1. Incorrect: The time begins with the firs voiding, however, that voiding is
discarded.
5. Incorrect: Urine should be placed on ice or left at room temperature if an additive has been used. You do not want the client to store the specimen in
their refrigerator.
17.A six year old client has been receiving chemotherapy for two weeks. The
laboratory results show a platelet count of 20,000/mcL. What is the priority
nursing action?
 1. Encourage quiet play.
 2. Avoid persons with infections.
 3. Administer oxygen PRN.
 4. Provide foods high in iron.
Rationale:
1. Correct: With a low platelet count you are at risk for bleeding, and quiet play
will decrease the risk of injury.
2. Incorrect: The priority is risk for bleeding with the low platelet count, not infection.
3. Incorrect: There is no indication that client has low RBC’s or anemia.
4. Incorrect: There is no indication that client has low iron.
18. The nurse is caring for a client that has two IV access sites. Where is the best site
for the nurse to administer 20 mEq of potassium chloride (KCL) in 100 mL of normal
saline (NS) over 4 hours
Exhibit:
INTRAVENOUS FLOW SHEET
IV Site/Needle
Size
Continuous/
Saline port
Date/Time
Initiated
IV Fluid/
Blood
Products
Date/Time
Administered
IV
rate
Left antecubital
Continuous
01/01/2017
@1020
Normal
Saline
01/01/2017
@1020
KVO
Double lumen
central lineProximal line
Continuous
01/01/2017
@1300
Total
Parenteral
Nutrition
01/01/2017
@1300
50
mL/
hr
Double lumen
central lineDistal line
Saline port
01/01/2017
@1300
Saline Flush
01/01/2017
@1300
Double lumen
central lineDistal line
Saline port
01/01/2017
@1500
Blood draw
for lab.
Saline Flush
01/01/2017
@1500
Signature
 1. Central line port that is being used for lab draws
 2. Same line with the Total Parenteral Nutrition
 3. Large bore antecubital
 4. Start another peripheral IV
Rationale:
1. Correct: Yes- K is very hard on the veins, give it through the central line.
2. Incorrect: No, never put anything through a line with Total Parental Nutrition.
3. Incorrect: Second best choice- but it will burn.
4. Incorrect: No, a central line is needed.
19. The nurse is admitting a client with new onset diabetes mellitus. Which fin ings
does the nurse expect while completing the medical history and physical
examination of this client? Select all that apply.
 1. Recurrent yeast infections
 2. Reports intolerance to cold
 3. Slow, slurred speech
 4. Prescription glasses changed twice in past year
 5. Reports wanting to eat all the time
 6. Absence of menses
Rationale:
1., 4. & 5. Correct: Polyuria, polyphagia, and polydipsia are classic symptoms
of diabetes. With Type II diabetes the manifestations are often nonspecific
Common manifestations include fatigue, recurrent infections, recurrent vaginal
yeast or monilial infections, prolonged wound healing, and visual changes.
Unfortunately, the clinical manifestations appear so gradually that an individual
may blame the symptoms on another cause such as lack of sleep or increasing
age, and before the person knows it, he or she may have complications.
2. Incorrect: This is a manifestation of hypothyroidism.
3. Incorrect: This is a manifestation of hypothyroidism.
6. Incorrect: This is a manifestation of hypothyroidism.
20.A client is admitted for evaluation of cardiac arrhythmias. What would be the
most important information for the nurse to obtain when assessing this client?
 1. Ability to perform isometric exercises.
 2. Changes in level of consciousness or behavior.
 3. Recent blood glucose changes.
 4. Compliance with dietary fat restrictions.
Rationale:
2. Correct: The only answer that deals with cardiac output is #2. When the
cardiac output drops, then the LOC will decrease.
1. Incorrect: What do isometrics have to do with cardiac output?
3. Incorrect: What does blood glucose have to do with cardiac output?
4. Incorrect: Arrhythmias have nothing to do with fat.
21.A nurse is caring for a client diagnosed with heart failure (HF). The client currently
takes furosemide 40mg every morning, potassium 20mEq daily, and digoxin
0.25mg every day. Which client comment should the nurse assess firs in caring
for this client?
 1. “My finger and feet are swollen.”
 2. “My weight is up 1 pound (0.45 kg).”
 3. “There is blood in my urine.”
 4. “I am having trouble with my vision.”
Rationale:
4. Correct: Did you see the sign of Dig toxicity? Good Job!
1. Incorrect: History of heart failure, edema is common- may need bed rest or
additional diuretic therapy- not usually life threatening.
2. Incorrect: No, weight should not vary more than 3-5 pounds.
3. Incorrect: Needs investigation, but digoxin toxicity comes first more lethal.
22.A client with a T4 lesion is being cared for on the neuro rehabilitation unit. The client
suddenly reports a severe, pounding headache. Profuse diaphoresis is noted on the
forehead. The blood pressure is 180/112 and the heart rate is 56. What interventions
should the nurse initiate?
Select all that apply.
 1. Place the client supine with legs elevated.
 2. Assess bladder and bowel for distention.
 3. Examine skin for pressure areas.
 4. Eliminate drafts.
 5. Administer nifedipine if BP does not return to normal.
Rationale:
2., 3., 4., & 5. Correct: All appropriate interventions for autonomic dysreflexia This
condition occurs in clients with a T6 or higher injury. The autonomic nervous system
sends out a massive sympathetic response (epi and norepi) to stimuli. The stimuli is
one that would not bother a healthy person but very dangerous to a spinal injury
client, i.e. bladder or bowel distention, pressure areas in the bed, drafts, and other
simple triggers.
1. Incorrect: The client should be placed immediately in a sitting position to lower blood pressure.
23. The nurse is caring for a client in the 8th week of pregnancy. The client is spotting, has
a rigid abdomen, and is on bed rest. What is the most important assessment at this
time?
 1. Protein in the urine
 2. Fetal heart tones
 3. Cervical dilation
 4. Hematocrit level
Rationale:
4. Correct: The client may be bleeding! And that is an emergency!
1. Incorrect: We are not worried about pre-ecclampsia right now with this situation .
2. Incorrect: We can’t hear them yet.
3. Incorrect: No vaginal exams! We don’t want any stimulation to the cervix now.
24. Which tasks would be appropriate for the nurse to delegate to an LPN/VN?
Select all that apply
 1. Prepare a client’s room from surgery.
 2. Observe for pain relief in a client after receiving acetaminophen
with codeine.
 3. Assist a client with perineal care after having diarrhea.
 4. Clean nares around a client’s NG tube.
 5. Pour a can of tube feeding into a client’s percutaneous
endoscopic gastrostomy
Rationale
2. & 5. Correct. Both of these actions are within the scope of practice for the
LPN/LVN.
1. Incorrect. This is not cost effective. The UAP can do this.
3. Incorrect. The UAP can be assigned this task. Think cost effectiveness.
4. Incorrect. Again, the UAP can do this.
25. A nurse in an urgent care clinic is assisting with triage when five clients present to
the clinic at the same time. Prioritize the order in which the nurse should attend to
the clients.
________ 1. The client who is limping after “spraining” the right ankle.
________ 2. The client who is experiencing heaviness in the chest after eating a big meal.
________ 3. The client who is running a fever and reports muscle aches
and malaise.
________ 4. The client who is applying pressure to the hand after sustaining a minor cut.
________ 5. The client who is having difficulty breathing after eating
shellfish.
Rationale:
(5) This client should be the nurse’s highest priority and should receive
immediate attention. Anaphylaxis is a life-threatening medical emergency.
(2) Although the client may be experiencing gastroesophageal reflu following
the ingestion of a large meal, the client should be assessed immediately to rule out myocardial infraction or other cardiac problem.
(4) After attending to the client with heaviness in the chest, the nurse should
assist the client who has been cut and is bleeding.
(3) The nurse should then attend to the client who is running a low-grade fever
with muscle aches and malaise. This client should be isolated from the other
clients until the source of the fever can be determined.
(1) Finally, the nurse should attend to the client with a sprained ankle as this is
the client with the least emergent condition.
Test-taking tip: Use the ABC’s (airway, breathing, circulation) to help you
decide which client to help first Life-threatening or serious conditions should
take priority over less emergent conditions.
ANSWER: 5, 2, 4, 3, 1.
Orthopedic Tips: Crutches, Canes and Walkers
Crutches
•
The top of the crutches should reach to 1-1 1/2 inches below the armpit while the
client is standing up straight. The handgrips of the crutches should be even with the
top of your client’s hips. The elbows should bend a bit when using the handgrips.
Don’t let the tops of the crutches press into the client’s armpits.
•
When the client is going up stairs, the client should lead up with the good foot,
keeping the injured foot raised behind them. When the client is going down stairs,
hold the injured foot up in front, and hop down each stair on the good foot.
•
Three Point crutch walking: Client has to bear weight on the uninjured foot and
both crutches. The affected leg does not touch the ground.
•
Four point crutch walking: Client has to bear weight on both legs and both
crutches. Each leg is moved in sequence with the opposite crutch… the right leg
with the left crutch or the left leg and the right crutch.
Canes
•
The top of the cane should reach to the crease in the client’s wrist when the client
is standing up straight. The elbow should bend a bit when the client holds the cane.
Hold the cane in the hand opposite the side that needs support. (See “COAL”
below)
•
When the client walks, the cane and the injured leg swing and strike the ground at
the same time.
•
To climb stairs, the client should grasp the handrail (if one is available) and step up
on the good leg firs , with the cane in the hand opposite the injured leg. Then
step up on the injured leg.
•
To come DOWN stairs, put the cane on the step first, hen the injured leg, and
fina ly the good leg, which carries the client’s body weight.
Cane
Opposite
Affected
Leg
Walkers
• The client should use their arms to support some of the weight. The top
of the walker should match the crease in the client’s wrist when the client
is standing up straight.
•
First, the client should put the walker about one step ahead of themselves, making sure the legs of the walker are level to the ground. With
both hands, grip the top of the walker for support and walk into it,
stepping off on your injured leg. Touch the heel of this foot to the
ground first, then flatten the foot and finally lift the toes f the ground as
the client makes a complete step with the good leg.
• To sit, the client should back up until his/her legs touch the chair. The
client should then reach back to feel the seat before he/she sits down.
• To get up from a chair, the client should push himself/herself up and
grasp the walker’s grips. Never try to climb stairs or use an escalator with
a walker.
Walk
With
Affected
Leg
Specific Types of Cancer: An Overview
1.
Cervical Cancer:
a.
Risk factors:
•
The number one risk factor is Human Papilloma Virus.
•
Repeated STDs
•
Multiple sexual partners
•
Smoking and exposure to second hand smoke
•
Dietary factors such as certain nutritional deficiencies: folate,
beta-carotene and vitamin C.
•
Prolonged hormonal therapy
•
Family history.
•
Immunosuppression
•
Sex at a young age and multiple pregnancies
b.
Signs/Symptoms:
•
Often asymptomatic in pre-invasive cancer
•
Invasive cancer classic symptoms: painless vaginal bleeding
•
Other general S/S: watery, blood-tinged vaginal discharge, pelvic pain
(and it may occur with intercourse), leg pain along sciatic nerve, and
flank/back pain
•
Excellent cure rate if detected early
c.
Diagnosis:
•
What is the test that helps diagnose this? a Pap Smear
d.
What if the Pap Smear is abnormal? Repeat test
Treatment:
•
Electrosurgical excision
•
Laser
•
Cryosurgery
•
Radiation and chemo for late stages
•
Conization- remove part of the cervix
•
Hysterectomy
2.
Uterine Cancer: (Endometrial Cancer)
a.
Risk Factors:
•
Greater than 50 years of age
•
Taking estrogen therapy without progesterone
•
Positive family history
•
Late menopause
•
No pregnancy (null parity)
b.
Signs/Symptoms:
•
Major symptoms: post-menopausal bleeding
•
Other S/S: watery/bloody vaginal discharge, low back/abdominal
pain, pelvic pain
Diagnosis:
•
CA-125 (blood test) to R/O ovarian involvement
•
The most definitiv diagnostic test is a D&C (dilatation & curettage)
and endometrial biopsy.
d.
Treatment:
1)
Surgery: Hysterectomy
c.
•
TAH (total abdominal hysterectomy) = uterus and cervix only!
Bilateral oophorectomy (ovaries)
Bilateral salpingectomy (tubes)
•
Radical Hysterectomy:
•
•
•
May remove all of the pelvic organs
Client may have a colostomy or ileal conduit
The greatest time for hemorrhage following this surgery is during
the first 24 hours
•
Why? Pelvic congestion of blood
•
The major complication with an abdominal hysterectomy is
hemorrhage
•
Major complication with vaginal hysterectomy? Think Infection!!
•
Will probably have an indwelling catheter; if she doesn’t you better
make sure she does what in the next 8 hours? Void!
•
Why is it so important to prevent abdominal distention after this surgery?
We do not want tension on the suture line.
It can lead to dehiscence and evisceration.
•
Why do we avoid high-fowler’s position in this client?
Because high fowlers will make more blood go to the pelvis.
•
•
May have an abdominal and perineal dressing to check.
As this client is at risk for pneumonia, thrombophlebitis, and
constipation, what is one thing you can do to prevent all these
complications? Early ambulation
•
•
•
•
•
•
Avoid sex and driving.
Also avoid girdles and douches.
Any exercise, including lifting heavy objects that will increase pelvic
congestion and should be avoided.
Is it possible that the client could hemorrhage 10-14 days after this
surgery? Yes!
Is a whitish vaginal discharge okay? Yes, this is normal
Showers OR baths? Showers, baths promote ascending infections.
2)
3)
4)
Radiation: intra-cavitary radiation to prevent vaginal recurrence
Chemotherapy
Estrogen inhibitors
2.
Breast Cancer:
a.
Risk Factors:
•
•
•
•
•
•
b.
•
•
One has a 3 fold risk increase of developing breast cancer if a firs
degree relative (mother, sister, and daughter) had pre-menopausal
breast cancer.
High dose radiation to thorax prior to age 20
Period onset prior to age 12
Menopause after age 50
No pregnancy (null parity)
First birth after 30 years of age
Signs/Symptoms:
Change in the appearance of the breast (orange peel appearance,
dimpling, retraction, discharge from breast) or lump
Tail of Spence is where 48% of breast tumors occur: located in upper
outer quadrant
c.
Treatment:
1)
Surgery
2)
Chemotherapy drugs
3)
Hormonal Therapy
•
Estrogen receptor blocking agents
•
Estrogen synthesis inhibitors
4)
4.
Radiation
Lung Cancer:
a.
Risk Factors:
•
Leading cause of cancer death worldwide
•
Major risk factor: Smoking
*When you have stopped smoking for 15 years, the incidence of lung cancer is almost like that of a non-smoker.
Signs/Symptoms:
•
Hemoptysis, dyspnea (may be confused with TB, but TB has
night sweats), hoarseness, cough, change in endurance, chest
pain, pleuritic pain on inspiration, displaced trachea
•
May metastasize to bone
b.
c.
Diagnosis:
1)
Bronchoscopy
2)
Chest x-ray
3)
CT
4)
MRI
d.
Treatment:
•
•
•
•
•
•
•
Surgery: The main treatment for stage I and II lung cancer
Lobectomy: only take out part of the lung
Chest tubes and surgical side up
Pneumonectomy: the entire lung is removed
Position on affected side (surgical side down, good lung up).
No chest tubes, Why? There is not lung!
Avoid severe lateral positioning mediastinal shift
5.
Laryngeal Cancer
a.
Risk Factors:
•
Smoking, (any form of tobacco use), alcohol, voice abuse,
chronic laryngitis, industrial chemicals
b.
c.
d.
Signs/Symptoms:
•
Hoarseness, lump in neck, sore throat, cough, problems
breathing, earache, weight loss, no early signs
Diagnosis:
•
Laryngeal exam, MRI
Treatment:
1)
Surgery:
•
Total laryngectomy
•
Humidifie environment
* Remember, with a total laryngectomy ALL breathing is
done through the stoma.
2)
Radiation
3)
Chemotherapy
4)
Speech Rehabilitation
•
When should client teaching begin? Preoperatively at
admission
•
Be a good client advocate:
Refer to International Association of Laryngectomees.
*See if there are local groups such as the
Lost Cord Group.
6.
Colorectal Cancer (CRC):
a.
Risk Factors:
•
May start as a polyp
•
2/3s of colorectal cancer occurs in the rectosigmoid region
•
Most frequent site of metastasis: the Liver
*Take bleeding precautions
•
Other problems to watch for: bowel obstruction, perforation,
fistul to bladder/vagina
•
Additional risk factors: inflammator bowel diseases,
genetic, dietary factors (refine carbs, low fibe , high fat, red
meat, fried and broiled foods) if you have a firs degree
relative with CRC your risk just increased 3X the norm
•
95% of those who get CRC are greater than 50 years old.
b.
Diagnosis:
Screening
•
Fecal occult blood testing should begin at age: 50
•
The definitiv test for colorectal cancer is a colonoscopy.
c.
Signs/Symptoms:
•
Change in bowel habits, constipation, diarrhea, or narrowing
of stool
•
Other S/S: blood in the stool, cramping abdominal pain,
weakness, fatigue, anemia, abdominal fullness, unexplained
weight loss
•
May become obstructed (visible peristaltic waves with high
pitched tinkling bowel sounds)
d.
1)
2)
Treatment:
Surgery, radiation, and chemo
May have a colostomy post op or may require an abdominoperineal
resection
•
Abdominoperineal resection-removal of the colon, anus,
rectum
*Can you take a rectal temp on this client? No, there is no rectum!
*Don’t take rectal temp if thrombocytopenic, abdominoperineal resection, or
immunosuppressed*
7.
Bladder Cancer:
a.
Risk Factors:
•
Greatest risk factor is smoking
b.
Signs/Symptoms:
•
Major symptom: Painless, intermittent gross/microscopic
hematuria
c.
d.
Diagnosis:
•
Cystoscopy
Treatment:
•
Surgery (remove all or part of bladder)  urinary diversion (urostomy)
•
Ileal conduit (a piece of the ileum is turned into the bladder;
ureters are placed in one end; the other end is brought to the
abdominal surface as a stoma)
•
May be impotent
•
Hourly outputs
•
•
•
•
Increase fluid (2,000-3,000 ml of flui per day).
* Fluids help flus out conduit
Is mucus in the urine normal? Yes
The intestines always make mucus (the bladder is made from
a part of intestine).
Change appliance in the morning (This is when output will be
at its lowest).
It is OK to place a little piece of 4X4 inside the stoma during skin care to
absorb urine.......
Just don’t forget to remove it!
8.
Prostate Cancer:
a.
Signs/Symptoms:
•
•
•
b.
Diagnosis:
1)
Lab work:
•
•
•
2)
This client comes to the physician with S/S of benign prostatic
hyperplasia (BPH): hesitancy, frequency, frequent infections
(because the bladder is not completely emptied), nocturia,
urgency, dribbling. Many clients are asymptomatic.
Most common sign is painless hematuria
Digital rectal exam is done and if the prostate is hard/nodular;
usually means prostate cancer.
PSA will be increased.
Prostate-specifi antigen (PSA)
PSA is a protein that is only produced by the prostate.
Normal is less than 4 ng/ml.
If you have two or more 1st degree relatives with prostate
cancer, start PSA screenings by at least age 45
Alkaline phosphatase (if  means bone metastasis)
*Prostate cancer likes to go to the spine, sacrum, and pelvis.
Increased acid phosphatase (if  means bone metastasis)
Biopsy:
•
When prostate cancer is suspected, a biopsy must be done
for confirmatio prior to surgery.
c.
Treatment:
1)
Watchful waiting: in early stages (for asymptomatic, older
adults with another illness)
2)
Surgery:
Radical Prostatectomy (done when the cancer is localized to
the prostate)
•
Take out the prostate and the client is cancer free (if there is
no metastasis).
•
May have erectile dysfunction due to pudendal nerve dam
age.
•
May have incontinence (Kegel exercises)
•
Client is sterile.
•
If there is no lymph node involvement, no  in acid
phosphatase, and no metastasis, the surgeon will try to
preserve the pudendal nerve.
Prostatectomy (TURP- transurethral resection of the prostate)
•
Usually reserved for BPH to help urine flo , NOT a cure for
prostate CA
•
No incision (go through the urethra)
•
Most common complication? Bleeding
•
With other procedures you have to explain the risk of
impotency/infertility, because with other procedures they
have an incision.
•
Is it normal to see bleeding after this surgery? Yes
•
Continuous bladder irrigation – maintains patency, flushes out
clots.
3-way catheter
N o kinks
Subtract irrigant from output.
•
•
•
•
•
Keep up with amount of irrigant instilled
What drug do you give for bladder spasms?
belladonna and opium suppository (B&O suppository®),
oxybutynin (Ditropan®)
When the catheter is removed what do you watch for?
Urinary retention
Temporary incontinence is expected
(perineal exercises-Kegel)
Avoid sitting, driving, strenuous exercise; do not lift too
much…Why? Can cause them to bleed
•
•
•
Docusate (Colace®); avoid straining. Why? Straining will cause
them to bleed.
Increase fluids to flus out the kidneys.
The TURP is used for symptomatic relief of symptoms… to allow the urine to flo out… This is not a cure for prostate
cancer.
3)
Radiation
4)
Chemotherapy
5)
Hormone therapy
•
May decrease testosterone levels through bilateral
orchiectomy
9.
Stomach Cancer:
a.
Risk factors:
•
H-Pylori-associated with stomach cancer
•
Pernicious anemia
•
Achlorhydria
•
•
•
There is an increased instance of
stomach cancer with people who
have pernicious anemia and
achlorhydria.
Related to: pickled foods, salted meats/fish nitrates,
increased salt
Billroth II (partial gastrectomy with an anastomosis)
Tobacco and Alcohol
b.
Signs/Symptoms:
•
Most common: Heartburn and abdominal discomfort
•
Other S/S: loss of appetite, weight loss, bloody stools,
coffee-ground vomitus, jaundice (liver metastasis), epigastric
and back pain, feeling of fullness, anemia, stool (+) for occult
blood, achlorhydria (no HCL in the stomach), obstruction
Signs/Symptoms of an obstruction: abdominal distention,
nausea/vomiting, pain.) Treatment for obstruction: NPO, NG
tube to suction for abdominal decompression
c.
Diagnosis:
•
Upper GI, CT, EGD (esophagogastroduodenoscopy)
d.
Tx:
1)
Surgery (preferred): Gastrectomy
•
Fowlers position, decreases stress on the suture line
•
Will have NG tube (for decompression)
•
Two major complications:
Dumping syndrome
Vitamin B-12 deficien anemia- Pernicious anemia
*Schilling’s test: Measures the urinary excretion of
Vitamin B-12 for diagnosis of pernicious anemia
No stomach  no intrinsic factor  can’t absorb oral B-12  can’t make good
RBCs  client is anemic
2)
3)
Chemotherapy
Radiation
*TESTING STRATEGY*
Never manually irrigate a catheter with a
fresh surgery client, without a physician’s
order.
*TESTING STRATEGY*
Always assess prior to selecting an
implementation answer. Always assess the
client first
A.
Signs and Symptoms of Abuse
Signs and Symptoms of Sexual Abuse
•
Shows a sexual knowledge beyond that of expected for the age of the client
Shows bizarre sexual behavior or is pregnant
•
•
Overly affectionate and seems seductive with peers and other adults
•
Recurring genital infections or pain in the genital area
•
Pain or itching in genital area
•
Difficult walking or sitting
•
Torn, stained, or bloody underclothing
•
Bleeding/ bruising in external genitalia area, vaginal or anal area
)
•
Evidence of sexually transmitted diseases (especially in pre-teens
•
Actual report of sexual abuse
•
Threatened by physical contact
•
Regression of behavior (ex. Thumb sucking)
•
Most children will not tell because they:
1.
2.
3.
4.
Think no one will believe them
Do not have the vocabulary to explain what happened to them
Have been taught to “obey their elders”
Have been threatened not to reveal the abuse
B. Signs and Symptoms of Child Abuse or Neglect
I.
II.
III.
Signs and Symptoms of Neglect
•
•
•
•
•
•
•
•
Poor Hygiene
Inappropriate dress for weather condition
Dirty, tattered or torn clothes
Unexplained hunger
Lavish attention on everyone
Withdrawal
Poor dental health
Incomplete immunization records
Signs and Symptoms of Abuse
•
•
•
•
•
•
•
•
Aggressive, disruptive, or destructive behavior
Questionable cuts, bruises, burns, abrasions
Questionable broken bones
Black eyes
Human bites
Appear to be afraid of caretaker or parent
Reports injury by caretaker or parent
Regression of behavior (ex. Thumb sucking)
Indicators that a caregiver or parent may be abusive
•
•
•
•
•
•
Gives different and conflictin reasons for child’s injury
Gives unbelievable causes for child’s injury
Gives NO reason for child’s injury
Talks about child in degrading manner
Appears to be indifferent
Uses harsh physical discipline measures
C. Signs and Symptoms of Domestic Abuse
I.
II..
Signs and Symptoms of Domestic Abuse noted in the victim
•
•
•
•
•
•
•
•
•
•
Anxiety
Anxious to please
Confused
Hostile
Increasing depression
Longing for death
Physically injured
Unresponsive
Withdrawn or timid
Vague health complaints
Signs and Symptoms of Domestic Abuse noted in the abuser
•
Aggressive/defensive behavior
•
Conflictin stories for cause of injury
•
Excusing behavior
•
Resentful
•
New affluenc
• N ew self-neglect
•
Preoccupation or depression
•
Shifting blame
•
Substance abuse
D. Signs and Symptoms of Elderly Abuse
I.
II.
Signs and Symptoms of Elderly Abuse seen in the older person
•
Anxiety
•
Anxious to please
•
Confused
•
Hostile
•
Increasing depression
•
Longing for death
• N ew poverty
•
Physically injured
•
Shopping for physicians
•
Unresponsive
•
Withdrawn or timid
•
Vague health complaints
Signs and Symptoms of Elderly Abuse seen in the caregiver
•
Aggressive/defensive behavior
•
Conflictin stories for cause of injury
•
Excusing behavior
•
Resentful
•
New affluenc
• N ew self-neglect
•
Preoccupation or depression
•
Shifting blame
•
Substance abuse
•
Unusual fatigue
•
Withholding food/ medication
Type of Shock
TYPES OF SHOCK
Description
Cause
Treatment
Anaphylactic shock Massive vasodilation
caused by release
of histamines in
response to allergic
reaction
IV contrast, drugs
(ASA, insect bites
or stings,
anesthetic agents,
vaccines, foods,
materials (latex)
Medication: histamine H2
blockers (Tagamet®),
Epinephrine (drug of
choice), Benedryl®,
Volume expanders,
Solumedrol®,
brochodilators. Ensure
patent airway, oxygen.
Hypovolemic shock Loss of intravascular
volume, decrease
stroke volume, and
decrease cardiac
output
3rd spacing,
diuresis,
Hemorrhage (#1
cause), burns, GI
fluid loss (vomiting,
diarrhea, drainage
from NG tube), DI,
DKA, Addison’s
disease.
Medication: Levophed®
Neo-Synephrine®,
Intropin®, Pitressin®
Rapid volume replacement
(blood, isotonic solutions),
control bleeding, oxygen,
hemodynamic monitoring.
Cardiogenic shock
Inability of heart
to pump blood out
effectively (pump
failure), resulting in
decrease cardiac
output
Myocardial
infarction, lethal
ventricular
arrhythmias, Endstage heart failure.
Medication: Dobutamine®
Dopamine®, Epinephrine®,
Primacor®, Nitroglycerin®,
Nipride®, Morphine®,
intra-aortic balloon pump
(IABP), correct arrythmias,
oxygen, Intubation &
mechanical ventilation may
be necessary.
Septic shock
Massive vasodilation
caused by infla matory response of
body due to overwhelming infection
Sepsis caused by
any pathogenic
organism that
invades the body
Antimicrobial therapy,
volume replacement,
cultures, vasopressors,
hemodynamic monitoring.
Neurogenic shock
Pooling of blood
-decrease venous
return, decrease
cardiac output,
hypotension, bradycardia
Massive
vasodilation,
suppression of the
sympathetic
nervous system,
injury/disease to
the spinal cord at
T6, spinal
anesthesia.
Treat the cause,
vasopressors, airway and
ventilation support.