Display 582 Signs and Symptoms of Electrolyte Imbalances

Normal laboratory values 4.5-5.3 mEq L or 9-11 mg dL* Hypocalcemia Hyperactive reflexes, carpopedal spasm, perioral paresthesias, positive Trousseau's sign, positive Chvostek's sign, muscle twitching, muscle cramps, tetany (numbness, tingling, and muscular twitching usually of the extremities), laryngospasm, cardiac arrhythmias, nausea, vomiting, anxiety, confusion, emotional lability, convulsions Hypercalcemia Anorexia, nausea, vomiting, lethargy, bone tenderness or pain, polyuria, polydipsia,...

Herbal Alert Valerian

Valerian was originally used in Europe and was brought on the Mayflower to North America. The herb is widely used for its sedative effects in conditions of mild anxiety or restlessness. It is particularly useful in individuals with insomnia. Valerian improves overall sleep quality by shortening the length of time it takes to go to sleep and decreasing the number of nighttime awakenings. It does not cause the adverse reactions common with sedative drugs, such as addiction and drug hangovers the...

Critical Thinking Exercises

Baxter, age 37 years, has been taking insulin for the past 6 years for type 1 diabetes mellitus. An assessment at the outpatient clinic reveals a blood sugar of 110 mg dL. In examining Ms. Baxter's skin, the nurse notices several areas on the thighs that appear scarred and other areas that appear as dimples or pitting in the skin. Analyze this problem. Discuss suggestions you would make to Ms. Baxter for better care. 2. Mr. Goddard, age 78 years, recently has received a diagnosis of type 2...

Thiazides and Related Diuretics

The thiazide diuretics are contraindicated in patients with known hypersensitivity to the thiazides or related diuretics, electrolyte imbalances, renal decompensation, hepatic coma, or anuria. A cross-sensitivity reaction may occur with the thiazides and sulfonamides. Some of the thiazide diuretics contain tartrazine, which may cause allergic-type reactions or bronchial asthma in individuals sensitive to tartrazine. All of the thiazide diuretics are Pregnancy Category B drugs, with the...

Contraindications Precautions And Interactions

The proton pump inhibitors are contraindicated in patients who have hypersensitivity to any of the drugs. Omeprazole (Pregnancy Category C) and lansoprazole, rabeprazole, and pantoprazole (Pregnancy Category B) are contraindicated during pregnancy and lactation. The proton pump inhibitors are used cautiously in older adults and in patients with hepatic impairment. There is a decreased absorption of lansoprazole when it is administered with sucralfate. Lansoprazole may decrease the effects of...

Loop Diuretics

Loop diuretics are contraindicated in patients with known hypersensitivity to the loop diuretics or to the sulfonamides, severe electrolyte imbalances, hepatic coma, or anuria, and in infants (ethacrynic acid). Loop diuretics are used cautiously in patients with renal dysfunction. The loop diuretics are Pregnancy Category B (ethacrynic acid and torsemide) and C drugs (furosemide and bumetanide) and must be used cautiously during pregnancy and lactation. Furosemide is used in children but should...

Selection of Preanesthetic Drugs

The preanesthetic drug is usually selected by the anesthesiologist and may consist of one or more drugs (Table 35-2). A narcotic (see Chap. 19), antianxiety drug (see Chap. 30), or barbiturate (see Chap. 26) may be given to Antianxiety Drugs With Antiemetic Properties *The term generic indicates the drug is available in generic form. *The term generic indicates the drug is available in generic form. relax or sedate the patient. Barbiturates are used only occasionally narcotics are usually...

TABLE 422 Examples of Selected Antihypertensive Combinations

Tenoretic 1GG Timolide 1G-2S Zestoretic hydrochlorothiazide (15 mg) hydrochlorothiazide (50 mg) chlorthalidone (15 mg) hydrochlorothiazide (50 mg) hydrochlorothiazide (50 mg) polythiazide (0.5 mg) hydrochlorothiazide (15 mg) hydralazine (25 mg) chlorthalidone (25 mg) hydrochlorothiazide (25 mg) hydrochlorothiazide (12.5 mg) methyldopa (2SG mg) hydralazine (SG mg) clonidine (G.1 mg) reserpine (G.12S mg) metoprolol (1GG mg) prazosin (S mg) reserpine (G.1 mg) atenolol (1GG mg) timolol maleate (1G...

Adverse Reactions

Acetaminophen causes few adverse reactions when used as directed on the label or recommended by the primary health care provider. Adverse reactions associated with the use of acetaminophen usually occur with chronic use or when the recommended dosage is exceeded. Adverse reactions to acetaminophen include skin eruptions, urticaria (hives), hemolytic anemia, pancytopenia (a reduction in all cellular components of the blood), hypoglycemia, jaundice (yellow discoloration of the skin),...

Precautions

These drugs are used cautiously in the elderly and in patients with undiagnosed abdominal pain, liver disease, history of addiction to the opioids, hypoxia, supraventricular tachycardia, prostatic hypertrophy, and renal or hepatic impairment. The obese must be monitored closely for respiratory depression while taking the narcotic analgesics. The drug is used cautiously during lactation (wait at least 4 to 6 hours after taking the drug to breastfeed the infant). The narcotics are used cautiously...

Antiasthma Drugs

Asthma is a respiratory condition characterized by recurrent attacks of dyspnea (difficulty breathing) and wheezing caused by spasmodic constriction of the bronchi. With asthma, the body responds with a massive inflammation. During the inflammatory process, large amounts of histamine are released from the mast cells of the respiratory tract, causing symptoms such as increased mucous production and edema of the airway and resulting in bronchospasm and inflammation. With asthma the airways become...

Drug Idiosyncrasy

Drug idiosyncrasy is a term used to describe any unusual or abnormal reaction to a drug. It is any reaction that is different from the one normally expected of a specific drug and dose. For example, a patient may be given a drug to help him or her sleep (eg, a hypnotic). Instead of falling asleep, the patient remains wide awake and shows signs of nervousness or excitement. This response is an idiosyncratic response because it is different from what the nurse expects from this type of drug....

Androgens

In the male patient, androgen therapy may be given as replacement therapy for testosterone deficiency. Deficiency states in male patients, such as hypogonadism (failure of the testes to develop), selected cases of delayed puberty, and the development of testosterone deficiency after puberty may be treated with androgens. The transdermal testosterone system is used as replacement therapy when endogenous testosterone is deficient or absent. In the female patient, androgen therapy may be used as...

Promoting an Optimal Response to Therapy

Nursing care of the patient receiving a bronchodilating drug or an antiasthma drug requires careful monitoring of the patient and proper administration of the various drugs. These drugs may be given orally, parenterally, or topically by inhalation or nebulization (see Chap. 2). In general, the nurse gives the drugs around the clock to maintain therapeutic blood levels. If the drug is to be administered once a day, the nurse should give it in the morning. Dosages are individualized for each...

Artificially Acquired Active Immunity

Artificially acquired active immunity occurs when an individual is given a killed or weakened antigen, which stimulates the formation of antibodies against the antigen. The antigen does not cause the disease, but the individual will still manufacture specific antibodies against the disease. When a vaccine containing an attenuated (weakened) antigen is given, the individual may experience a few minor symptoms of the disease or even a mild form of the disease, but the symptoms are almost always...

Nonprescription Drugs

Nonprescription drugs are drugs that are designated by the FDA to be safe (if taken as directed) and obtained without a prescription. These drugs are also referred to as over-the-counter (OTC) drugs and may be purchased in a variety of settings, such as a pharmacy, drugstore, or in the local supermarket. OTC drugs include those given for symptoms of the common cold, headaches, constipation, diarrhea, and upset stomach. These drugs are not without risk and may produce adverse reactions. For...

Alteration in Cellular Environment

Some drugs act on the body by changing the cellular environment, either physically or chemically. Physical changes in the cellular environment include changes in osmotic pressures, lubrication, absorption, or the conditions on the surface of the cell membrane. An example of a drug that changes osmotic pressure is mannitol, which produces a change in the osmotic pressure in brain cells, causing a reduction in cerebral edema. A drug that acts by altering the cellular environment by lubrication is...

Gerontologic Alert

Older adults are particularly prone to constipation when tak- Iing the bile acid sequestrants. The nurse should monitor older adults closely for hard dry stools, difficulty passing stools, and any complaints of constipation. An accurate record of bowel movements must be kept. HMG-CoA reductase inhibitors and fibric acid DERIVATIVES. The antihyperlipidemic drugs, particularly the HMG-CoA reductase inhibitors, have been associated with skeletal muscle effects leading to rhab-domyolysis....

Herbal Alert Goldenseal

Goldenseal, also called Hydrastis canadensis, is an herb found growing in the certain areas of the northeastern United States, particularly the Ohio River Valley. Goldenseal has long been used alone or in combination with echinacea for colds and influenza. However, there is no scientific evidence to support the use of goldenseal for cold and influenza or as a stimulant as there is for the use of echinacea (see Chap. 54). Similarly, goldenseal is touted as an herbal antibiotic,although there is...

Grontologie Alert

The older adult is particularly vulnerable to adverse reactions of the adrenergic drugs, particularly epinephrine. In addition, older adults are more likely to have preexisting cardiovascular disease that predisposes them to potentially serious cardiac arrhythmias. The nurse closely monitors all elderly patients taking an adrenergic drug. It is important to report any changes in the pulse rate or rhythm immediately. In addition, epinephrine may temporarily increase tremor and rigidity in older...

Calcium Channel Blockers

Calcium channel blockers are primarily used to prevent anginal pain associated with certain forms of angina, such as vasospastic (Prinzmetal's variant) angina and chronic stable angina. They are not used to abort (stop) anginal pain once it has occurred. When angina is caused by coronary artery spasm, these drugs are recommended when the patient cannot tolerate therapy with the beta (p)-adrenergic blocking drugs (see Chap. 23) or the nitrates. Calcium channel blockers used as antianginals are...

Herbal Alert Larginine

L-arginine is commonly sold in health food specialty shops as a supplement capable of improving vascular health and sexual function in men. The herb may be beneficial in improving health in individuals with congestive heart failure, peripheral artery disease, angina, hypertension, hyperlipidemia, and type 2 diabetes. The herb appears to increase nitric oxide concentrations. Abnormalities of the vascular endothelial cells may cause vasoconstriction, inflammation, and thrombolytic activity. These...

Display 422 Importance of the Systolic Blood Pressure

In most individuals, the systolic pressure increases sharply with age, whereas the diastolic pressure increases until about age 55 years and then declines. Older individuals with an elevated systolic pressure have a condition known as isolated systolic hypertension (ISH). When the systolic pressure is high, blood vessels become less flexible and stiffen, leading to cardiovascular disease and kidney damage. Research indicates that treating ISH saves lives and reduces illness. The treatment is...

Preadministration Assessment

Before therapy with an antihypertensive drug is started, the nurse obtains the blood pressure (see Fig. 42-3) and pulse rate on both arms with the patient in standing, sitting, and lying positions. The nurse correctly identifies all readings (eg, the readings on each arm and the three positions used to obtain the readings) and records these on the patient's chart. The nurse also obtains the patient's weight, especially if a diuretic is part of therapy or if the primary care provider prescribes...

Ongoing Assessment

Monitoring and recording the blood pressure is an important part of the ongoing assessment, especially Figure 42-3. The nurse takes the patient's blood pressure prior to administering an antihypertensive drug. Figure 42-3. The nurse takes the patient's blood pressure prior to administering an antihypertensive drug. early in therapy. The primary care provider may need to adjust the dose of the drug upward or downward, try a different drug, or add another drug to the therapeutic regimen if the...

Educating the Patient and Family

Nurses can do much to educate others on the importance of having their blood pressure checked at periodic intervals. This includes people of all ages because hypertension is not a disease seen only in older individuals. Once hypertension is detected, patient teaching becomes an important factor in successfully returning the blood pressure to normal or near normal levels. To ensure lifetime compliance with the prescribed therapeutic regimen, the nurse emphasizes the importance of drug therapy,...

Amphotericin B

Amphotericin B is the most effective drug available for the treatment of most systemic fungal infections. Administration often results in serious reactions, Tinea pedis, tinea cruris, tinea corporis, mild to moderate onychomycosis of fingernails and toenails Tinea pedis, tinea cruris, and other ringworm Tinea pedis, tinea cruris, tinea corporis Tinea pedis, tinea cruris, tinea corporis Abrasions, minor cuts, surface injuries, and superficial Tinea pedis, tinea cruris, tinea corporis Tinea...

Miscellaneous Antidepressants

The miscellaneous antidepressant drugs are contraindicated in patients with known hypersensitivity to the drugs. Among the miscellaneous antidepressants, bupropion and maprotiline are Pregnancy Category B drugs. Other miscellaneous antidepressants discussed in this chapter are Pregnancy Category C drugs. Safe use of the antidepressants during pregnancy has not been established. They should be used during pregnancy only when the potential benefits outweigh the potential hazards to the developing...

Summary Drug Table Cardiotonics And Miscellaneous Inotropic Drugs

Digitek, Lanoxicaps, Lanoxin, generic Heart failure (HF), atrial fibrillation, atrial flutter, paoxysmal atrial tachycardia Headache, weakness, drowsiness, visual disturbances, nausea, vomiting, anorexia, arrhythmias Loading dose G.75-1.25 mg or G.125-G.25 mg IV maintenance G.125-G.25 mg d PO Short-term management of HF in patients with no response to digitalis, diuretics, or vasodilators Arrhythmia, hypotension, nausea, vomiting, abdominal pain, anorexia, hepatotoxicity IV 0.75 mg kg bolus,...

Educating the Client on the Use of Herbs and Nutritional Supplements

The use of herbs and nutritional supplements to treat various disorders is common. Herbs are used for various effects, such as to boost the immune system, treat depression, and for relaxation. Individuals are becoming more aware of the benefits of herbal therapies and nutritional supplements. Advertisements, books, magazines, and Internet sites abound concerning these topics. People, eager to cure or control various disorders, take herbs, teas, megadoses of vitamins, and various other natural...

Nursing Alert

Prolonged high-dose therapy of the adrenergic drugs can produce cyanosis and tissue necrosis of distal extremities. It is important to remember to use the lowest possible dose that produces an adequate response for the shortest period of time. The nurse monitors the patient's extremities closely for any signs of cyanosis. MANAGING ANOREXIA. Administration of an adrenergic drug may cause anorexia in the patient. Management of this adverse reaction requires diligence on the part of the nurse. The...

Health Supplement Alert Melatonin

Melatonin is a hormone produced by the pineal gland in the brain. The use of melatonin obtained from animal pineal tissue is not recommended because of the risk of contamination. The synthetic form of melatonin does not carry this risk. However, melatonin is an over-the-counter dietary supplement and has not been evaluated for safety, effectiveness, and purity by the FDA. All of the potential risks and benefits may not be known. Supplements should be purchased from a reliable source to minimize...

Health Supplement Alert Cranberry

Cranberries and cranberry juice are a commonly used remedy for the prevention of urinary tract infections (UTIs) and for the relief of symptoms from UTIs. The use of cranberry juice in combination with antibiotics has been recommended by physicians for the long-term suppression of UTIs. Cranberries are thought to act by preventing the bacteria from attaching to the walls of the urinary tract. The suggested amount is 6 ounces of the juice two times daily. Extremely large doses can produce...

Miscellaneous Antineoplastic Drugs

When asparaginase is administered to a patient with diabetes, the risk for hyperglycemia is increased a dosage adjustment of the oral antidiabetic drug may be necessary. Glucocorticoids decrease the effectiveness of aldesleukin. When aldesleukin is administered with antihypertensive drugs, there is an additive hypotensive effect. Etoposide may decrease the immune response to live viral vaccines. There is an increased risk for bone marrow suppression when levamisole or hydroxyurea are...

The Patient Receiving a Cholinesterase Inhibitor for Mildto Moderate Dementia of Alzheimers Disease

A patient receiving a cholinesterase inhibitor may be treated in the hospital, nursing home, or in an outpatient setting. The patient's cognitive ability and functional ability are assessed before and during therapy. The baseline or initial assessment depends on the stage of AD. The nurse assesses the patient for confusion, agitation, and impulsive behavior. Speech, ability to perform activities of daily living, and self-care ability also are assessed. These assessments will be used by the...

Allergic Drug Reactions

An allergic reaction also is called a hypersensitivity reaction. Allergy to a drug usually begins to occur after more than one dose of the drug is given. On occasion, the nurse may observe an allergic reaction the first time a drug is given because the patient has received or taken the drug in the past. A drug allergy occurs because the individual's immune system views the drug as a foreign substance or antigen. The presence of an antigen stimulates the antigen-antibody response that in turn...

Antihypertensive Drugs

Enzyme blood pressure endogenous essential hypertension hypertension hypokalemia hyponatremia isolated systolic hypertension lumen malignant hypotension postural hypotension secondary On completion of this chapter, the student will Discuss the various types of hypertension and risk factors involved. Identify normal and abnormal blood pressure levels for adults. List the various types of drugs used to treat hypertension. Discuss the general drug actions, uses, adverse reactions,...

Display 544 Example of Passive Immunity

An example of passive immunity is the administration of immune globulins (see Summary Drug Table Agents for Passive Immunity), such as hepatitis B immune globulin. Administration of this vaccine is an attempt to prevent hepatitis B after the individual has been exposed to the virus. cient strength to cause disease. Although rare, vaccination with any vaccine may not result in a protective antibody response in all individuals given the vaccine. A toxin is a poisonous substance produced by some...

Immune Globulins and Antivenins

Antibodies in the immune globulin preparations may interfere with the immune response to live virus vaccines, particularly measles, but also others, such as mumps and rubella. It is recommended that the live virus vaccines be administered 14 to 30 days before or 6 to 12 weeks after administration of immune globulins. No known interactions have been reported with antivenins. The Patient Receiving an Immunologic Agent Before the administration of any vaccine, the nurse obtains an allergy history....

Lente Insulin Is A Nursing Alert

Insulin requirements may change when the patient experiences any form of stress and with any illness, particularly illnesses resulting in nausea and vomiting. Insulin is ordered by the generic name (insulin zinc suspension, extended) or the trade (brand) name (Humulin U) (see the Summary Drug Table Insulin Preparations). The nurse must never substitute one brand of insulin for another unless the substitution is approved by the health care provider because some patients may be sensitive to...

Bile Acid Sequestrants

The bile acid sequestrants are contraindicated in patients with known hypersensitivity to the drugs. Bile acid sequestrants are also contraindicated in those with complete biliary obstruction. These drugs are used cautiously in patients with a history of liver or kidney disease. Bile acid sequestrants are used cautiously during pregnancy (Pregnancy Category C) and lactation (decreased absorption of vitamins may affect the infant). The bile acids sequestrants, particularly cholestyra-mine, can...

Summary Drug Table Antipsychotic Drugs Continued

Dyskinesia, dry eyes, blurred vision, constipation, dry mouth, photosensitivity 10-20 mg IM nausea, vomiting 15 40 mg d PO in divided doses anxiety 5 mg TID, PO effects, dystonia, akathisia, hypotension dizziness, vertigo, nausea, constipation, dry mouth, diarrhea, headache, restlessness, blurred vision nervousness, akathisia, constipation, fever, weight gain pseudoparkinsonism, dystonia, akathisia, tardive dyskinesia, photophobia, blurred vision, dry mouth, salivation, nasal congestion,...

Chapter Objectives

Lipoproteins (HDL) HMG-CoA reductase inhibitors lipoproteins (LDL) rhabdomyolysis triglycerides On completion of this chapter, the student will Discuss cholesterol, HDL, LDL, and triglyceride levels and how they contribute to the development of heart disease. Discuss therapeutic life changes and how they affect cholesterol levels. Discuss the general actions, uses, adverse reactions, contraindications, precautions, and interactions of antihyperlipidemic drugs. Discuss important...

Bronchodilators Sympathomimetic

A bronchodilator is a drug used to relieve bron-chospasm associated with respiratory disorders, such as bronchial asthma, chronic bronchitis, and emphysema. These conditions are progressive disorders characterized by a decrease in the inspiratory and expiratory capacity of the lung. Collectively, they are often referred to as COPD. The patient with COPD experiences dyspnea (difficulty breathing) with physical exertion, has difficulty inhaling and exhaling, and may exhibit a chronic cough. The...

Evaluation

To determine the effectiveness of patient teaching, the nurse evaluates the patient's knowledge of the material presented. Evaluation can be done in several ways, depending on the nature of the information. For example, if the patient is being taught to administer insulin, several demonstrations can be scheduled, followed by a return demonstration by the patient with the nurse observing to evaluate the patient's technique. Questions such as Do you understand or Is there anything you don't...

Sulfonylureas

Adverse reactions seen with the sulfonylureas include hypoglycemia, anorexia, nausea, vomiting, epigastric discomfort, weight gain, heartburn, and various vague neurologic symptoms, such as weakness and numbness of the extremities. Often, these can be eliminated by reducing the dosage or giving the drug in divided doses. If these reactions become severe, the health care provider may try another oral antidiabetic drug or discontinue the use of these drugs. If the drug therapy is discontinued, it...

Review Questions

The nurse monitors the patient taking an anabolic steroid for the more severe adverse reactions, which include_. 2. The nurse must be aware that older men taking the androgens are . B. at greater risk for hypertension C. at increased risk for confusion D. at increased risk for prostate cancer 3. When monitoring a patient taking an oral contraceptive, the nurse would observe the patient for signs of excess progestin. Which of the following reactions would indicate to the nurse that a patient...

Antihyperlipidemic Drugs

Lipoproteins HDL HMG-CoA reductase inhibitors lipoproteins LDL rhabdomyolysis triglycerides On completion of this chapter, the student will Discuss cholesterol, HDL, LDL, and triglyceride levels and how they contribute to the development of heart disease. Discuss therapeutic life changes and how they affect cholesterol levels. Discuss the general actions, uses, adverse reactions, contraindications, precautions, and interactions of antihyperlipidemic drugs. Discuss important preadministration...

Herbal Alert Diuretics

Numerous herbal diuretics are available as over-the-counter OTC products. Most plants and herbal extracts available as OTC diuretics are nontoxic. However, most are either ineffective or no more effective than caffeine. The following are selected herbals reported to possess diuretic activity celery, chicory, sassafras, juniper berries, St. John's wort, foxglove, horsetail, licorice, dandelion, digitalis purpurea, ephedra, hibiscus, parsley, and elderberry. There is very little and in many...