Digoxin Drug class: Cardiac glycoside Concept: perfusion; the passage of blood flow through the arteries and capillaries that deliver oxygen and nutrients to body cells. Uses: To treat heart failure, atrial fibrillation. Antidote: Digoxin-immune fab, Assessment: -If patient is taking digoxin and a potassium- wasting diuretic or cortisone drug, HYPERKALEMIA can result, causing digitalis toxicity -Obtain a baseline pulse rate for future comparisons. Take apical pulse for full min, if pulse is less then 60 HOLD medication -assess for signs and symptoms of digitalis toxicity: *Change in vision, nausea, vomiting, bradycardia, cardiac dysrhythmias* Analyze cues and prioritize hypothesis: Decreased gas exchange Decreased tissue perfusion Hypoxemia Ischemia Side effects: Pulse rate less then 60 beats/min Nausea Vomiting Headache Diarrhea Visual disturbances Nursing interventions: Determine signs of peripheral and pulmonary edema, which indicate that HF is present. Monitor digoxin levels. (0.8-2.0) anything higher than 2.0 is indicative of toxicity. Monitor potassium levels (3.5-5.0) watch for HYPOkalemia. Teach: Advise patient to eat foods high in potassium. Advise patients on how to take their pulse rate before administering. ACE INHIBITORS Drug Class: Antihypertensive Suffix: “pril” Concept: the passage of blood flow through the arteries and capillaries that deliver oxygen and nutrients to the body cells. Uses: Hypertension Assessment: Baseline vital signs Lab values: Albumin, BUN, creatinine, potassium, WBC. Analyze cues and prioritize hypothesis: Hypertension Anxiety Fatigue Side effects: Dizziness (orthostatic hypotension) Hypotension Angioedema (swollen tongue Nonproductive cough Hyperkalemia Nursing interventions: Monitor B/P, a sudden drop should be reported. Labs: BUN, creatinine, protein, blood glucose levels. (Caution: Hypoglycemic reactions in patients with diabetes) Teach: Do not abruptly stop taking medication Salt substitutes contain potassium Do not use during pregnancy Teach the patient to rise slowly to avoid orthostatic hypotension. Nitroglycerin Drug class: Antianginal Concept: perfusion Uses: To control angina, AMI, Hypertensive emergency, pulmonary edema, and heart failure. Assessment: Baseline vitals Obtain a health and drug history; Nitroglycerin is contraindicated for marked hypotension or acute myocardial infarction Analyze cues and prioritize hypothesis: Dyspnea Myocardial tissue injury Pain Decreased tissue perfusion Hypoxemia Anxiety Reduced functional ability Side effects: Headache is common occurrence and lasts about 30 mins Place patients in supine position with legs elevated if hypotension results from SL nitroglycerin Nursing interventions: -Monitor vitals: hypotension is associated with antianginal drugs. -Position patient sitting or lying down for the first time, after administration check patients vitals while the patient is laying down and then sitting up. Slowly rise from sitting position -Offer sip of water prior to administration. -Do not tough the nitroglycerin ointment without gloves on. Teach: No alcohol while on nitroglycerin Sublingual Nitroglycerin: absorbed under the tongue. Effects last 30-60 mins After dose, patient may experience dizziness, faintness, or headache. Repeat q5 mins (only 3 times) over 15 min period then call 911 Nitroglycerin Patch: Effects last 18-24 hours The patch should be removed nightly, allowing for a 8-12 hour period of no nitroglycerin patch. Anticoagulants Drug class: Anticoagulants Concept: clotting, a process in which blood is changed into a semisolid gel. Inhibits the hepatic synthesis of vitamin K, which decreased prothrombin and clotting factor. Uses: inhibit clot formation. Unlike thrombolytics, they do NOT dissolve clots that have already formed but rather act prophylactically to prevent new clots from forming. Used in patients with venous and arterial disorders that put them at high risk for clots. Venous: deep vein thrombosis, pulmonary embolism. Arterial: coronary thrombosis, MI, artificial heart valves, CVA (stroke). Assessment: History of abnormal clotting or health problems that affect clotting. Gather drug history Develop a flow chart that lists prothrombin time (PT) or International normalized ratio (INR) and warfarin dosages. A baseline should be obtained before warfarin is administered. PT: lab test that measures the time it takes blood to clot in the presence of certain clotting factors, which warfarin affects. PT level should be 1.5-2 times the reference value to be therapeutic. INR: lab test most frequently used to report PT results. Normal INR 1.3-2. Patients on warfarin therapy are maintained at an INR of 2-3. Nursing considerations: Monitor vitals, increased pulse rate followed by a decreased systolic pressure can indicate a fluid volume deficit resulting from external or internal bleeding PT and INR Examine patients’ mouth, nose, urine, and skin for bleeding. Watch older patients. Check stools for occult blood. Keep anticoagulant antagonist available, protamine sulfate for heparin and Vitamin K for warfarin Side effects: Occult bleeding, bleeding gums, Teach: advise patient to avoid large amounts of green leafy veggies, anything rich in VIT K, coffee, tea (caffeine) and herbs Inform dentist your on anticoagulant Bush teeth with soft bristle brush and shave with electric razor Encourage not to smoke. Aspirin shouldn’t be taken with warfarin. Patient should use acetaminophen. Thiazide Diuretics Drug class: Diuretic Hydrochlorothiazide Concept: elimination, excretion of body waste products through the urinary system Act on the distal convoluted renal tubule, beyond the loop of Henle, to promote sodium, chloride, and water excretion. Used: treat hypertension and peripheral edema. Assessment: Vital signs; weight, urine output, and serum chem values * electrolytes, glucose, uric acid. Check peripheral extremities for the presence of edema. Note pitting edema Obtain a history of drugs and herbal supplements. Patient problems: elimination, fluid overload, disrupted fluid and electrolyte imbalance, hypokalemia, hypernatremia. Side effects: Slowly change positions from lying to standing. Orthostatic hypotension from hypotension could occur. Prediabetic patients need to frequently monitor their blood glucose. Photosensitivity in sun; use sunblock. Nursing Interventions: If patient is taking diuretic and digoxin, hypokalemia can occur. Digitalis toxicity frequently results. Signs and symptoms of hypokalemia; muscle weakness, leg cramps, cardiac dysrhythmias. A weigh gain of 2.2 lbs is equivalent to 1 L of body fluids Note urine output to determine fluid loss or retention Teach: Take early in morning to avoid nocturia disturbances. Eat foods rich in potassium. Take drugs with food to avoid GI upset. Loop diuretics Drug class: diuretics “ides” Furosemide Concept: elimination; excretion of body waste products through the urinary system. Act on the thick ascending loop of Henle to inhibit chloride transport of sodium into the circulation and inhibit passive reabsorption. Sodium and water are lost together with potassium, calcium and magnesium. Uses: used to treat heart failure, renal dysfunction, hypertension, acute pulmonary and peripheral edema. Assessment: History of drugs taken daily. (anticoagulants, corticosteroids, lithium, amphotericin B, digitalis.) Vital signs, serum electrolytes, weight, and urine output for baseline levels. Note whether patient is hypersensitive to sulfonamides. Side effects: Rise slowly from lying or sitting to standing to prevent dizziness from fluid loss. Fluid and electrolyte imbalances (hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia, hypochloremia) Nursing interventions: Monitor urinary output to determine body fluid gain or loss. Urinary output should be less then 30 mL/hour or 600 mL/24 hours. Notify if urinary output does not increase. Weigh patient same time every morning with same type of clothing to determine fluid loss or gain. (after patient voids in the morning) 2.2 lbs is equivalent to 1L fluid loss. Vital signs alerts for marked decreases in blood pressure. Administer slowly, hearing loss may occur if injected rapidly. Observe for signs and symptoms of hypokalemia (<3.5 mEq/L) Teach: Take in morning to avoid nocturia and prevent sleep disturbances. Rise slowly from lying to sitting and sitting to standing Take with food to avoid GI upset. Antihistamines Drug class: antihistamines end in “ide” Diphenhydramine Concept: gas exchange The lungs deliver oxygen to the pulmonary capillaries, carried by hemoglobin to body cells, and carbon dioxide is carried away from body cells to the lungs and exhaled from the body Uses: to treat allergic rhinitis, the common cold, cough, sneezing, pruritus, and urticaria, and to prevent motion sickness. Assessment: Determine baseline vitals Obtain a drug history. Assess for signs and symptoms of urinary dysfunction, including retention, dysuria, and altered frequency. CBC during drug therapy Assess cardiac and respiratory status. History of environmental exposures. Drugs, recent foods eaten, and stress. Side effects: In children, nightmares, nervousness, and irritability are more likely to occur. Older adults can be sensitive to the drug causing difficult or painful urination, dizziness, drowsiness, feeling faint, and dryness of the mouth, nose, or throat. Dry mouth- sugarless candy or gum, ice chips or saliva substitute. Nursing interventions: Give with food to decrease gastric distress. Administer the intramuscular form in a large muscle. Teaching: Avoid operating motor vehicle or dangerous activities. Avoid alcohol and CNS depressants. Notify doctor is hypotension or confusion occurs If taking for motion sickness take 30 mins before offending event. Breastfeeding is not recommended while on drug therapy. Decongestant Drug class: decongestants Nasal congestion results from dilation of nasal blood vessels caused by infection, inflammation, or allergy. With this dilation, a transudation of fluid into the tissue spaces occurs that results in swelling of the nasal cavity. Uses: stimulate the alpha-adrenergic receptors, producing vascular constriction of the capillaries within the nasal mucosa. The result is shrinking of the nasal mucosa membranes and a reduction in fluid secretion. Administered by nasal spray or drops or tablets, capsule, or liquid form. Systemic decongestants: available in tablet, capsule, and liquid form. Uses: allergic rhinitis, hay fever and acute coryza. Tetrahydrozoline, phenylephrine, oxymetazoline (afrin), and pseudoephedrine. Assessment: History of hypertension. Baseline vitals; elevated temp may indicate viral infection Drug history Cardiac and respiratory status Side effects: Patient can feel nercous or restless. Rebound nasal congestion- instead of constricting, vasodilation occurs. Blood pressure and blood glucose can increase. Extreme caution in patients with hypertension, cardiac disease, hyperthyroidism, and diabetes mellitus. Nursing interventions: Observe color of bronchial secretions (yellow or green is indicative of a bronchial infection) may need antibiotics Teach: drug interactions, Pseudoephedrine can decrease effect of beta blockers. Avoid large amounts of caffeine, it can increase restlessness and palpitations caused by decongestant. Don’t use more then one or two puffs four to six times a day for 5-7 days to avoid rebound. Intranasal Glucocorticoids Intranasal glucocorticoids and steroids are effective for treating allergic rhinitis, because they have an anti-inflammatory action, thus decreasing the allergic rhinitis symptoms or rhinorrhea, sneezing, and congestion. - Beclomethasone - Budesonide - Flunisolide - Fluticasone - Mometasone - Triamcinolone These are used alone or in combo with H1 antihistamine Sprays directed away from nasal septum, and the patient should sniff gently. Side effects: headache, nasal irritation, pharyngitis, fatigue, insomnia, and candidiasis. These are used for short term otherwise indicated by health care provider. Antitussives Act on the cough control center in the medulla to suppress the cough reflex. Coughing is a natural way to clear the airway of secretions or any collected material If cough is nonproductive and irritating, a antitussive may be taken. There are three types of antitussives, nonopioid, opioid, or combination prepearations. Expectorants Loosen bronchial secretions so they can be eliminated by coughing. Expectorants are found in many OTC cold remedies along with analgesics, antihistamines, decongestants, and antitussives. Most common is guaifenesin. Hydration is the best natural expectorant. While taking patient should increase fluid intake, to at least 8 glasses per day to help loosen mucus. Albuterol Drug class: Beta2-adrenergic agonist Uses: treat asthma, and prophylaxis and treatment of bronchospasm Side effects: Tremor, dizziness, drowsiness, nervousness, restlessness, agitation, anxiety, headache. Rescue inhaler!
