Dilaudid (Hydromorphone)

Class: Opiod analgesic

Side effects:

Drowsiness, nausea, vomiting, anorexia, respiratory depression, constipation, orthostatic hypotention, confusion, headache, rash

Nursing Care:

moderate to severe pain

nonproductive cough

withdrawing effects: nausea, vomiting, cramps, fever, faintness, anorexia. 

Demerol (Meperidine)

Class: Opiod analgesic

Side effects:

drowsiness, sedation, euphoria, confusion, respiratory depression, headache, orthostatic hypotention.

Nursing care:

moderate to severe pain, pre-op sedation, avoid alcohol use, withdrawal symptoms, long term use can result in addiction.

Ms Contin (Morphine)

Class: Opiod Analgesic

Side effects:
Respiratory depression, sedation, euphoria, orthostatic hypotension

Nursing Care:

Given by PCA, continuous dosing may be more effective, severe pain, withdrawal symptoms and physical dependancy.

Percodan or Percocet (Oxycodone, with tylenol or aspirin)

Class: Opiod analgesics

Side effects:

Respiratory depression, sedation, drowsiness, vomiting, anorexia, cramps, constipation, confusion, rash, headaches, orthostatic hypotention

Nursing Care:

moderate to severe pain, monitor respiration with all opiod analgesics prior to administration to be more than 12, withdrawal symptoms, physical dependency. 

Tramadol (Ultram)

Class: Opiod analgesic

Side effects:

dizziness, drowsiness, sedation, headache, insomnia, nervousness, agitation, uncontrollable shaking, muscle tightness, changes in mood.

Nursing care:

management of moderate to moderately severe pain, contact provider if sores in mouth, rash, flue like symptoms, hallucinations, difficulty swallowing or breathing, withdrawal symptoms

Heparin

Class: Anti-coagulant

Side effects:

Hemorrhage from any body site, tissue irritation/pain at injection site, thrombocytopenia, anemia, fever. 

Nursing care:

Prophylaxis and treatment of thromboembolisms, low doses used to maintain patency of IVs, therapeutic PTT should be 1.5-2 times the control, antidote is protamine sulfate with in 30 min, signs of hemorrhage: bleeding gums, nose bleeds, unusual bleeding, hematuria, fall in hematocrit or blood pressure, guaic positive stools, tarry stools.Avoid ASA containing products and nsaids, wear identification bracelet. 

Warfarin

Class: Anticoagulants

Side effects:

hemorrhage, diarrhea, rash, fever.

Nursing care:

Management of pulmonary embolisms, DVT, prosthetic valve replacement, MI. Signs of hemorrhage: bleeding gums, nose bleeds, unusual bleeding, hematuria, fall in hematocrit or blood pressure, guaic positive stools, tarry stools.Avoid ASA containing products and nsaids, wear identification bracelet. Antidote is vitamin K, avoid  foods high in vitamin K such as green leafy vegetables, therapeutic PT 1.5- 2.5, INR- 2.0-3.0.

Tegretol (Carbamezipine)

Class: Anti-convulsants

Side effects:

Myelosuppression, ataxia, diplopia, rash, dizziness, drowsiness, photosensitivity.

Nursing Care:

Treatment of diabetic neuropathy, seizures, trigeminal neuralgia.

Monitor blood levels, CBC for the first two months at least

regular eye exams

tablets may be crushed or capsules opened

urine may turn reddish brown or pink

decrease effectiveness of oral contraceptives

do not use with alcohol or other CNS depressants

 take immediately after meals to lessen GI upset. 

Depakote (Dilvaproex sodium)

Class: Anti-convulsants

Side effects: 

dizziness, drowsiness, sedation, mental status and behavioral changes, nausea, vomiting, heartburn, prolonged bleeding time, constipation.

Nursing care:

Management of seizures, manic episodes of bipolar disorder, migrane prevention

Take immediately after meals reduce GI upset

Do not crush pills

Monitor blood level, bleeding time, liver function tests, 

Avoid abrupt withdrawal

wear tag

 Dilantin ( Phenytoin )

Class: Anti convulsants

Side effects:

drowsiness, ataxia, nystagmus, lethargy, hirsutism, blurred vision, GI upset, gingival hypertrphy.

Nursing care:

treatment of seizures, migraines, trigeminal neuralgia, bells palsy.

take immediately after meals to decrease adverse effects

may color urine and sweat pink/brown/red

IV administration may lead to cardiac arrest

never mix with any other drug or dextrose

do not use with antacids and antidiarrheals with in 2 hours of taking the med

folic acid supplements

Topamax (Topiramate)

Class: Anti-convulsants

Side effects: 

dizziness, drowsiness, fatigue,impaired concentration, nervousness, nausea, weight loss, vision loss, ataxia, photosensitivity

Nursing care:

seizures

without regards of meals

avoid abrupt withdrawal

increased water intake to prevent kidney stones

could lose vision, stop if eye problems

sunscreen

Gentamycin

Class: Aminoglycosides

Side effects: 

used in pregnancy can result in bilateral deafness

ototoxicity

nephrotoxicity

allergies

Nursing care:

severe infections

careful monitoring of blood levels

monitor for superinfections- diarrhea, URI coated tongue

8-10 glasses of water

report if hearing problelms

Diflucan (Flucanazole)

Class: Anti-fungals

Side effects:

nausea, headache, abdominal pain, diarrhea, pain distortion

Nursing care:

used to treat candidiasis

reduces metabolism of tolbutamide, glyburide, glypizide so blood glucose should be monitored closely- hyperglycemia

INH (ISONIAZID)

Class: Anti-tuberculars

Side effects:

Peripheral neuropathy

Liver damage

Nursing care:

TB

Contact clinician if signs of hepatitis: nausea, vomiting, anorexia, yellow skin, unusual tiredness or weakness

Contact clinician if sign of peripheral neuropathy: numbness, weakness, tingling.

ACYCLOVIR (ZOVIRAX)

Class: Antivirals

Side effects:

headache

blood dyscrasias

Nursing care:

Tx of herpes, varicella

do not break or crush capsules

Take without regard to meals and with a full glass of water

contact clinician if signs of superinfection

VALTREX (VALACYCLOVIR HCL)

Class: Anti-virals

Side effects: 

Nausea, vomiting, headache, abdominal cramps.

Nursing care:

TX of genital herpes, herpes zoster, herpes labialis

Avoid sexual contact with visible lesions

drink plenty of water during treatment

Class: anti-retrovirals

Side effects:

fever, headache, malaise, dyspepsia, insomnia, nausea, vomiting, diarrhea, anorexia, rash.

Nursing care:

Resolution of HIV infections and HIV after needle stick

GI upset and insomnia will resolve after 3-4 weeks

CLASS: 3RD GEN CEPHALOSPORINS (CIPROFLAXIN, CEFDINIR)

Side effects:

Diarrhea

Nursing care: 

avoid alcohol, promote drinking water.

ZITHROMAX (AZITHROMYCIN)

Class: Microlides

Side effects:
Nausea, vomiting, Diarrhea

Nursing care:

dont take with antacids

can take with or without food

monitor for superinfections

Extrapyramidal Symptoms (EPS)

Caused by atypical antipsychotics. Symptoms include:

Tardive dyskenisia- repetitive, involuntary ability to sit still such as lip smacking, finger moving, eye blinking, movements of the arms and legs.

Akathisia- complete inability to sit still

Dystonia- having very strong mucle contractions

parkinsonism- vocal tics

Other side effects of antipsychotics include:

neuroepileptic malingnant syndrome- fever, rigidity, delirium, autonomic instability- elevated CPK

constipation

muscle rigidity

increased appetite

Suicide

Weight gain

Autonomic Dysreflexia

Happens after spinal shock in a person who has sustained an injury above T6. Usually occurs due to a fecal impaction or full bladder. It results from an autonomic nervous system overstimulation. Symptoms include severe hypertention, nasal stuffiness, flushing of the skin above the level of the lesion, bradycardia, apprehension and anxiety.

Seizure Management

pillow under head, loose clothing, airway at bedside, clear space, padded railing.

Fetal Development

8 weeks- heart beat present, legs and arms just starting to form

12 weeks- lungs have acquired shape

16 weeks- stomach begins to collect meconium, lanugo present on body, transperent skin with blood vessels. You can tell whether its a boy or girl and whether the heart has formed.

20 weeks- The fetus sucks thumb and weighs appx 7 ounces

38 weeks- Baby can hear and breathe.

Colostomy Care

You can put a breathmint in the pouch

Drink cranberry juice, parsley, yoghurt,crackers, toast, buttermilk- helps prevent odor/ gas

Do no eat onion, beans, cucumbers, drink beer, smoke, skip meals or chew gum- all contribute to bad odor/flatus

Contraindication for Thrombolytic Therapy

trauma in the last two months

active bleeding

hemmorhagic stroke

intracranial or intraspinal surgery

intracranial neoplasm

arteriovenous malformation

aneurysm

sever uncontrolled HTN

Magnesium Sulfate

Given to prevent preeclampsia. Toxicity can cause CNS depression and calcium gluconate would be the antidote.

Proparacaine Hydrochloride (Proparacaine)

Eye anesthetic. Avoid from rubbing or touching because it may cause corneal damage.

Physical Assesment of a New Born.

Head circumference - 33- 35 cm

Chest- usually 1 inch less than the head, 30.5-33 cm

Acrocyanosis

Edema of the scalp

Heart range- 120 (sleeping)- 180 (crying)

Respirations- 30-60 breaths/min

Straight Catheter

After draining 300-500 cc of urine, clamp the bag because rapid decompression of bladder can result in bladder damage.

Complications of Thoracentisis

pulmonary edema

hypoxia

hemothorax

pneumothorax

subcutaneous emphysema

spleen and liver puncture

Symptoms of Right sided heart failure

Anorexia

Ascites

Arrythmias

Dependant edma

Fatigue

Gallop rhythm S3 and S4

Hepatomegaly

Jugular vein distention

Nausea

Tachycardia

Weight gain

Symptoms of Left sided heart failure

Dry, non productive cough

Third heart sound

Crakles- due to pulmonary congestion

Dyspnea- increased venous pressure

Paroxysmal nocturnal dyspneas

Tachycardia

Tachypnea

Disemminated Intravascular Coagulation (DIC)

Occurs as a complication of diseases that accelerate clotting. Accelerated clotting process causes small blood vessel occlusion, organ necrosis and depeltion of circulating clotting factors and platelets and activation of the fibrinolytic system- which can cause sever hemmorhage.

Cause:

Infection- Septic shock

Burns, trauma, brain tissue destruction, transplant rejection, hepatic necrosis

acute leukemia

Obstetric complication such as abruptio placentae, amniotic fluid embolism, retained dead fetus

Assesment findings/ symptoms:

Abnormal bleeding without accompanying history of serious hemorrhagic disorder- petechiae, hematomas, ecchymosis, cutaneous oozing.

Oliguria

Shock

PT greater than 15 seconds, prologed PTT greater than 60-80 seconds, platelets less than 100,000

seizures

sever muscle contractins

coma

dyspnea

nausea

vomiting

Dopamine

used for correction of hemodynamic instabilityas as a result of shock

monitor vital signs

monitor heart rhythm for side effects.

ARDS And Asthma

Symptoms of ARDS:

Anxiety

restlessness

crackles

rhonchi

decreased breath sounds

dyspnea

tachypnea

Symptoms of Asthma:

Dyspnea

Wheezing on expiration

Non productive cough

Tachypnea

Tachycardia

Chlorothiazide (diuril) or Hydrochlorothiazide (Lisinopril)

Class: Thiazides

Side effects:

headache, dizziness, hypotension, tachycardia, nausea, vommiting, diarrhea, fatigue

Nursing care:

Avoid isometric exercises because it can lead to rise in BP due to vasovagal response, avoid changing positions rapidly, avoid taking at night to avoid nocturia, avoid high Na (Canned soups, lunch meats, cheese)  and K foods (orange juice, citrus fruits, raisins)

Carbidopa/ Levidopa

Class: replacement dopinergic agent

Side effects:

twitching, headache, dizziness, dark urine/sweat, cardiac arrhythmias, mental changes: confusion, agitation, mood alteration

Nursing care:

change positions slowly

full therapeutic effect may take months

decreased effects with liver, pork, wheat germ and Vitamin B6

look for reduction in tremors- for example a person can ambulate better

Lithium

controls manic episodes, mood stabilizer

Side efffects:

dizziness, impaired vision, reversible leukocytosis, fine hand tremors

Signs of intoxication-

vomiting

diarrhea

drowsiness

muscle weakness

ataxia

Nursing care:

Draw blood in AM prior to dosing. Target levels for treatment is 0.5-1.5 mEq/L and for treatment its .6-1.2 mEq/L

check serum levels 2 times durign weekly treatments and q 2-3 months during maintenance

Gi symptoms reduced if taken with meals

closely monitor blood/urin glucose

dose reduced in depressive stage

Drink 10-12 glasses of water a day

take adequte sodium as if there is a decrease in sodium the Li will replace sodium in the cells and cause toxicity. 6-10 grams.

Avoid caffeine, increased saunas, exercise.

Hypothyroidism (Myxedema)

Signs and sympoms:

Weight gain

intolerance to heat

lethargy

masked face

dry hair

thickened skin

enlarged tongue

drooling

Glucophage (Metformin)

Side effects:

headache

weakness

dizziness

dowsiness

agitation

nausea

vomiting

diarrhe

lactic acidosis

Nursing care:

twice a day with meals to decrease GI upset and provide best absorption

signs of acidosis:

hyperventilation

fatigue

malaise

chills

myalgia

sleepiness

have quick source of sugar or glucagon emergency kit available

Multiple Sclerosis

Neurodegenerative disease caused bydegeneration of myelin sheath in neurons of the brain and spinal cord

Assement findings:

Nystagmus, diplopia, blurred vision, optic neuritis, weakness, paresthesia, impaired sensation, paralysis, decreased short term memory like performing calculations, urinary retention, numbness or tingling, constipation.

Teaching:

Assist with physical therapy such as active, resistive, stretchin exercises to maintain muscle tone, reduce spasticity, explain bath water shouldnt be too hot as it may exaggerate symptoms

encourage family and client to establish daily routine to maintain optimal functioning. Activity should be regulated by client's tolerance. The client should be encouraged to have regular rest periods to prevent fatigue

Folate deficiency

Anticonvulsants may cause folate and vitamin D deficiency

Folate deficiency can cause anemia

sources:

geen leafy vegetables

legume

tomatoes

various fruits such as oranges and cantaloupe

Vitamin D source- milk

Appendicitis

Assesment:

Anorexia

Generalized abdominal pain that becomes localized in the lower abdomen (McBurney point)

Nausea and vomiting

sudden cessation of pain indicates rupture

pain before nausea and vomitting- appendicitis

Nause and vommiting before pain- gastroenteritis

NPO until bowel sounds return postoperatively- then advance diet to promote healing and postoperative needs

Steps to Self breast exam

Stand infront of mirror with hands at sides

While standing press hands firmly into hip and bow slightly

While standing raise one arm and palpate breast firmly. Repeat on other hand.

Lay down, raise one hand and palpate breast firmly. Repeat on other hand.