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Tuesday, August 14, 2007

Mike's Notes for Nclex Review Course

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Autologous Transfusion:
· Collected 4-6 weeks before surgery
· Contraindicated—infection, chronic disease, cerebrovascular or cardiovascular
disease


Hypotonic Solution
· ½ NS (0.45% Saline)

Isotonic Solution
· 0.9% NaCl (Normal Saline)
· 5% D/W (Dextrose in Water)
· Lactated Ringer’s
· 5% D/ ¼ NS (5% Dextrose in 0.225% Saline )

Hypertonic Solution
· 10% D/W (10% Dextrose in water)
· D15W
· 5% D/NS (5% Dextrose in 0.9% Saline)
· 5% D/ ½ NS (5% Dextrose in 0.45% Saline)
· 3% NaCl
· 5% Sodium Bicarbonate


Change tubing Q72 hours

Change bottle Q24 hours

Infiltration
· Assessment: cool skin, swelling, pain, decrease in flow rate
· Implementation: discontinue IV, warm compresses, elevate arm, start new site proximal to infiltrated site

IV Phlebitis, Thrmobophlebitis
· Assessment—redness, warm, tender, swelling, leukocytosis
· Implementation—discontinue IV, warm moist compresses, start IV in opposite extremity

Hematoma
· Assessment—ecchymosis, swelling, leakage of blood
· Implementation—discontinue IV, apply pressure, ice bag 24 hours, restart IV in opposite extremity

IV Clotting
· Assessment—decreased flow rate, back flow of blood into tubing
· Implementation—discontinue, do not irrigate, do not milk, do not increase rate of flow or hang solution higher, do not aspirate cannula, inject Urokinase, D/C and start on other site.

Insertion of Percutaneous Central Catheters:
· Placed supine in head-low position
· Turn head away from procedure
· Perform Valsalva maneuver
· Antibiotic ointment and transparent sterile dressing
· Verify position with x-ray
· Change tubing Q24 hours
· Nurse/patient both wear mask when dressing change 2-3x/week


Adrenergics
Actions:
· Stimulate the sympathetic nervous system: increase in peripheral resistance, increase blood flow to heart, bronchodilation, increase blood flow to skeletal muscle, increase blood flow to uterus
· Stimulate beta-2 receptors in lungs
· Use for cardiac arrest and COPD

Adrenergic Medications
· Levophed
· Dopamine
· Adrenalin
· Dobutrex

Adrenergics Side effects:
· Dysrhythmias
· Tremors
· Anticholinergic effects

Adrenergics Nursing Considerations:
· Monitor BP
· Monitor peripheral pulses
· Check output

Anti-Anxiety
Action:
· Affect neurotransmitters
Used for:
· Anxiety disorders, manic episodes, panic attacks

Anti-Anxiety
Medications:
· Librium, Xanax, Ativan, Vistaril, Equanil

Anti-Anxiety
Side effects:
· Sedation
· Confusion
· Hepatic dysfunction

Anti-Anxiety
Nursing Considerations:
· Potention for addiction/overdose
· Avoid alcohol
· Monitor Liver Function AST/ALT
· Don’t discontinue abruptly, wean off
· Smoking/caffeine decreases effectiveness


Antacids
Actions:
· Neutralize gastric acids

Used for:
· Peptic ulcer
· Indigestion, reflex esophagitis

Antacids Medications
· Amphojel
· Milk of Magnesia
· Maalox

Antacids
Side effects:
· Constipation
· Diarrhea
· Acid rebound

Antacids
Nursing Considerations:
· Interferes with absorption of antibiotics, iron preps, INH, Oral contraceptives
· Monitor bowel function
· Give 1-2 hours after other medications
· 1-3 hours after meals and at HS
· Take with fluids


Antiarrhythmics
Action:
· Interfere with electrical excitability of heart
Used for:
· Atrial fibrillation and flutter
· Tachycardia
· PVCs

Antiarrhythmics
Medications:
· Atropine sulfate
· Lidocaine
· Pronestyl
· Quinidine
· Isuprel

Antiarrhythmics
Side effects:
· Lightheadedness
· Hypotension
· Urinary retention

Antiarrhythmics
Nursing Considerations:
· Monitor vital signs
· Monitor cardiac rhythm


Aminoglycosides (Antibiotics)
Action:
· Inhibits protein synthesis in gram-negative bacteria
Used for:
· Pseudomonas, E.Coli

Aminoglycosides (Antibiotics)
Medications:
· Gentamycin
· Neomycin
· Streptomycin
· Tobramycin

Aminoglycosides (Antibiotics)
Side effects:
· Ototoxicity and Nephrotoxicity
· Anorexia
· Nausea
· Vomiting
· Diarrhea

Aminoglycosides (Antibiotics)
Nursing Considerations:
· Harmful to liver and kidneys
· Check 8th cranial nerve (hearing)
· Check renal function
· Take for 7-10 days
· Encourage fluids
· Check peak/trough level


Cephalosporins (Antibiotics)
Action:
· Inhibits synthesis of bacterial cell wall
Used for:
· Tonsillitis, otitis media, peri-operative prophylaxis
· Meningitis

Cephalosporins (Antibiotics)
Medications:
· Ceclor
· Ancef
· Keflex
· Rocephin
· Cefoxitin

Cephalosporins (Antibiotics)
Side effects:
· Bone marrow depression: caution with anemic, and low PLT px
· Superinfections
· Rash

Nursing Considerations:
· Take with food
· Cross allergy with PCN
· Avoid alcohol
· Obtain C&S before first dose: to make sure medication is effective against disease/bacteria
· Can cause false-positive for proteinuria/glycosuria


Fluoroquinolones (Antibiotics)
Action:
· Interferes with DNA replication in gram-negative bacteria
Used for:
· E.Coli, Pseudomonas, S. Aureus

Fluoroquinolones
(Antibiotics)
Medications:
· Cipro

Fluroquinolones
(Antibiotics)
Side effects:
· Diarrhea
· Decreased WBC and Hematocrit
· Elevated liver enzymes (AST, ALT)
· Elevated alkaline phosphatase
Nursing Considerations:
· C&S before starting therapy
· Encourage fluids
· Take 1 hour ac or 2 hour pc (food slows absorption)
· Don’t give with antacids or iron preparation
· Maybe given with other medications (Probenicid: for gout)


Macrolide (Antibiotics)
Action:
· Binds to cell membrane and changes protein function
Used for:
· Acute infections
· Acne
· URI
· Prophylaxis before dental procedures if allergic to PCN

Macrolide (Antibiotics)
Medications:
· Erythromycin
· Clindamycin

Macrolide (Antibiotics)
Side effects:
· Diarrhea
· Confusion
· Hepatotoxicity
· Superinfections
Nursing Considerations:
· Take 1hr ac or 2-3 hr pc
· Monitor liver function
· Take with water (no fruit juice)
· May increase effectiveness of: Coumadin and Theophylline (bronchodilator)


Penicillin
Action:
· Inhibits synthesis of cell wall
Used for:
· Moderate to severe infections
· Syphilis
· Gonococcal infections
· Lyme disease

Penicillin
Medications:
· Amoxicillin
· Ampicillin
· Augmentin

Penicillin
Side effects:
· Stomatitis
· Diarrhea
· Allergic reactions
· Renal and Hepatic changes
Nursing Considerations:
· Check for hypersensitivity
· Give 1-2 hr ac or 2-3 hr pc
· Cross allergy with cephalosporins


Sulfonamides (Antibiotics)
Action:
· Antagonize essential component of folic acid synthesis
Used for:
· Ulcerative colitis
· Crohn’s disease
· Otitis media
· UTIs
Sulfonamides (Antibiotics)
Medications:
· Gantrisin
· Bactrim
· Septra
· Azulfidine
Sulfonamides (Antibiotics)
Side effects:
· Peripheral Neuropathy
· Crystalluria
· Photosensitivity
· GI upset
· Stomatitis
Nursing Considerations:
· Take with meals or foods
· Encourage fluids
· Good mouth care
· Antacids will interfere with absorption


Tetracyclines (Antibiotics)
Action:
· Inhibits protein sythesis
Used for:
· Infections
· Acne
· Prophylaxis for opthalmia neonatorum
TEtracyclines
(Antibiotics)
Medications:
· Vibramycin
· Panmycin
Tetracyclines (Antibiotics)
Side effects:
· Discoloration of primary teeth if taken during pregnancy or if child takes at young age
· Glossitis
· Rash
· Phototoxic reactions
Nursing considerations:
· Take 1 hr ac or 2-3 hr pc
· Do not take with antacids, milk, iron
· Note expiration date
· Monitor renal function
· Avoid sunlight


UTIs
· Medication:
o Furadantin
· Action:
o Anti-infective
· Side effects:
o Asthma attacks
o Diarrhea
· Nursing Considerations:
o Give with food or milk
o Monitor pulmonary status

UTIs
· Medication
o Mandelamine
· Action:
o Anti-infective
· Side effects:
o Elevated liver enzymes
· Nursing Considerations:
o Give with cranberry juice to acidify urine
o Limit alkaline foods: vegetables, milk, almonds, coconut

UTIs
· Medication
o Pyridium
· Side effects:
o Headache
o Vertigo
· Action
o Urinary tract analgesic
· Nursing Consideration
o Tell patient urine will be orange


Anticholinergics
Action:
· Inhibits action of acethylcholine and blocks parasympathetic nerves (affects heart, eyes, respiratory tract, GI tract and the bladder)
· Dilates pupil, causes bronchodilation and decreased secretions
· Decrease GI motility secretions
Used for:
· Opthalmic exam
· Motion sickness
· Pre-operative
Anticholinergic Medications:
· Pro-Banthine
· Atropine
· Scopolamine
Anticholinergic
Side Effects:
· Blurred vision
· Dry mouth
· Urinary retention
· Chage in heart rate
Nursing Consideration:
· Monitor output
· Contraindicated with glaucoma
· Give 30 min ac, hs, or 2hr pc
· Contraindicated: paralytic ileus, BPH



Heparin - Anticoagulants
Action:
· Blocks conversion of prothrombin to thrombin
Used for:
· Pulmonary embolism
· Venous thrombosis
· Prophylaxis after acute MI

Anticoagulants
Medications:
· Heparin

Anticoagulants (Heparin)
Side Effects:
· Hematuria
· Tissue irritation
Nursing Considerations:
· Monitor clotting time or Partial Thromboplastin Time (PTT)
· Normal 20-45 sec
· Therapeutic level 1.5-2.5 times control
· Antagonist—Protamine Sulfate
· Give SC or IV



Coumadin - Anticoagulant
Action:
· Interferes with synthesis of vitamin K-dependent clotting factors
Used for:
· Pulmonary embolism
· Venous thrombosis
· Prophylaxis after acute MI

Anticoagulant
Medication:
· Coumadin

Anticoagulant (Coumadin)
Side Effects:
· Hemorrhage, Alopecia
Nursing Considerations:
· Monitor Prothrombin Test (PT)
· Normal 9-12 sec
· Therapeutic level 1.5 times control
· Antagonist—Vitamin K (AquaMEPHYTON)
· Monitor for bleeding
· Give PO


Anticonvulsants
Action:
· Decreases flow of calcium and sodium across neuronal membranes
Used for:
· Seizures

Anticonvulsant
Medications:
· Dilantin
· Luminal
· Depakote
· Tegretol
· Klonopin

Anticonvulsant
Side effects:
· Respiratory depression
· Aplastic anemia
· Gingival hypertrophy
· Ataxia
Nursing Considerations:
· Don’t discontinue abruptly
· Monitor I&O
· Caution with use of medications that lower seizure threshold: MAO inhibitors & anti-psychotics
· Good mouth care
· Take with food
· May turn urine pinkish-red/pinkish-brown



Anti-Depressants Monoamine Oxidase Inhibitors (MAO)
Action:
· Causes increases concentration of neurotransmitters
Used for:
· Depression
· Chronic pain

Anti-Depressants
(Monoamine Oxidase Inhibitors)
Medications:
· Marplan
· Nardil
· Parnate

Anti-Depressants
(Monoamine Oxidase Inhibitors)
Side effects:
· Hypertensive Crisis (Sudden headache, diaphoretic, palpitations, stiff neck, intracranial hemorrhage) with food that contain Tyramine
Nursing Considerations:
· Avoid foods containing Tyramine: Aged cheese, liver, yogurt, herring, beer and wine, sour cream, bologna, pepperoni, salami, bananas, raisins, and pickled products
· Monitor output
· Takes 4 weeks to work
· Don’t combine with sympathomometics vasoconstrictors, and cold medications


Anti-Depressants
Selective Serontonin Reuptake Inhibitors (SSRI)

Action:
· Inhibits CNS uptake of serotonin
Used for:
· Depression
· Obsessive-Compulsive Disorder
· Bulimia
Anti-Depressants
Selective Serontonin Reuptake Inhibitors (SSRI)
Medications:
· Paxil
· Prozac
· Zoloft
Anti-Depressants
Selective Serontonin Reuptake Inhibitors (SSRI)
Side effects:
· Anxiety
· GI upset
· Change in appetite and bowel function
· Urinary retention
Nursing Considerations:
· Suicide precautions
· Takes 4 weeks for full effect
· Take in a.m.
· May urine to pinkish-red or Pinkish-brown
· Can be taken with meals


Anti-Depressants (Tricyclics)
Action:
· Inhibits reuptake of neurotransmitters
Used for:
· Depression
· Sleep apnea

Anti-Depressants (Tricyclics)
Medications:
· Norpramin
· Elavil
· Tofranil

Anti-Depressants (Tricyclics)
Side Effects:
· Sedation/Confusion
· Anticholinergics affects
· Postural Hypotension
· Urinary retention
Nursing Considerations:
· Suicide precautions/2-6 weeks to work
· Take at hs/Don’t abruptly halt
· Avoid alcohol/OTC /Photosensitivity


Insulin
(Regular, Humulin R)
Type: Fast acting
Onset: ½ -1 hr
Peak: 2-4 hr
Duration: 6-8 hr

Insulin
(NPH, Humulin N)

Type: Intermediate acting
Onset: 2hr
Peak: 6-12hr
Duration 18-26hr

Insulin
(Ultralente, Humulin U)

Type: Slow acting
Onset: 4hr
Peak: 8-20hr
Duration: 24-36hr

Insulin
(Humulin 70/30)
Type: Combination
Onset: ½ hr
Peak: 2-12hr
Duration: 24hr



Antidiabetic Agents
Action:
· Stimulates insulin release from beta cells in pancreas
Used for:
· Type 2 diabetes (NIDDM)

Antidiabetic Agents
Medications:
· Diabinese
· Orinase
· Dymelor
· Micronase

Antidiabetic Agents
Side Effects:
· Hypoglycemia
· Allergic skin reactions
· GI upset
Nursing Considerations:
· Take before breakfast
· Monitor glucose levels
· Avoid alcohol, sulfonamides, Oral Contraceptives, (MAO), aspirin because they help to make drug work better


Hypoglycemic Agent
Action:
Stimulates liver to change glycogen to glucose
Used for:
Hypoglycemia
Hypoglycemic Agent
Medication:
Glucagon
Hypoglycemic Agent
Side Effects:
Hypotension
Bronchospasm
Nursing Considerations:
May repeat in 15min
Give carbohydrates orally to prevent secondary hypoglycemic reactions


Antidiarrheals
Action:
Slows peristalsis
Increases tone of sphincters
Used for:
Diarrhea

Antidiarrheals
Medications:
Kaopectate
Lomotil
Imodium
Paregoric

Antidiarrheals
Side Effects:
Constipation
Anticholinergic effects (urinary retention, dry mouth)
Nursing Considerations:
Do not use with abdominal pain
Monitor for urinary retention
Give 2hr before or 3 hr after other meds



Antiemetics
Action:
Increases GI motility
Blocks effect of dopamine in chemoreceptor trigger zone
Used for:
Vomiting
Antiemetics
Medications:
Tigan
Compazine
Torecan
Reglan
Antivert
Dramamine
Antiemetics
Side Effects:
Sedation
Anticholinergic effects
Nursing Considerations:
Used before chemotherapy
When used with viral infections may cause Reye’s syndrome (Toxic Encephalopathy)


Antifungals
Action:
Impairs cell membrane
Used for:
Candidiasis
Oral thrush
Histoplasmosis
Antifungals
Medications:
Amphotericin B
Nystatin

Antifungals
Side Effects:
Hepatotoxicity
Thrombocytopenia
Leukopenia
Pruritis
Nursing Considerations:
Give with food
Monitor liver function
Good oral hygiene



Antigout Agents
Action:
Decreases production and resorption of uric acid
Used for:
Gout
Antigout Agents
Medications:
Colchicine
Probenecid
Zyloprim
Antigout Agents
Side Effects:
Agranulocytosis
GI upset
Renal calculi
Nursing Considerations:
Monitor for renal calculi
Give with food, milk, antacids


Antihistamines
Action:
Block effects of histamine
Used for:
Allergic rhinitis
Allergic reactions to blood
Antihistamines
Medications:
Chlor-Trimeton
Benadryl
Phenergan
Antihistamines
Side Effects:
Drowsiness
Dry mouth
Photosensitivity
Nursing Considerations:
Give with food
Use sunscreen
Avoid alcohol


Antihyperlipidemic Agents
Action:
Inhibits cholesterol and triglyceride synthesis
Used For:
Elevated cholesterol
Reduce incidence of cardiovascular disease
Antihyperlipidemic Agents
Medications:
Questran
Lipid

Antihyperlipidemic Agents
Side Effects:
Constipation
Fat-soluble vitamin deficiency
Nursing Considerations:
Take at hs or 30 min ac
Administer 1hr before or 4-6 hr after other meds


Antihypertensives
Types: ACE Inhibitors
Action:
Blocks ACE in lungs
Used for:
Hypertension
CHF
Antihypertensives
(ACE Inhibitors)
Medications:
Capoten
Vasotec

Antihypertensives
(ACE Inhibitors)
Side Effects:
GI upset
Orthostatic hypotension
Dizziness
Nursing Considerations:
Give 1hr ac or 3hr pc
Change position slowly


Antihypertensives
Type: Beta-Adrenergic Blockers
Action:
Blocks Beta-Adrenergic Receptors
Decrease excitability/workload of heart, oxygen consumption
Decrease
Used for:
Hypertension
Angina
SVT
Antihypertensives
Type: Beta-Adrenergic
Medications;
Nadolol
Propranolol
Tenormin
Timoptic
Antihypertensives
Type: Beta-Adrenergic
Side Effects:
Changes in heart rate
Hypotension
Bronchospasm
Nursing Considerations:
Masks signs of shock and hypoglycemia
Take with meals
Do not discontinue abruptly



Antihypertensives
Type: Calcium Channel Blockers
Action:
Inhibits movement of calcium across cell membranes
Slow impulse conduction and depresses myocardial contractility
Causes dilation of coronary arteries and decreases cardiac workload and energy consumption
Used for:
Angina
Hypertension
Interstitial cystitis
Antihypertensives
Type: Calcium Channel Blockers
Medications:
Procardia
Calan
Cardizem
Antihypertensives
Type: Calcium Channel Blockers
Side Effects:
Hypotension
Dizziness
GI distress
Nursing Consideration:
Monitor vital signs
Do not chew or divide sustained-release tablets


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