Fluent Essays

Drug Drug Class Mechanism of Action Adverse Effects Nursing Implications heParin #1. ________ Inactivates clotting factors thrombin and factor Xa through the increased activity of antithrombin Critical adverse effect: #2. __________________ **Critical Allergic reaction** #3. _____________ Monitor(labs): #4. ____________ Reversal/antidote: #5. _____________ Administered Route: #6. _(2 answers)_______________ Apixaban (Eliquis) Anticoagulant inhibits platelet aggregation (factor Xa) induced by thrombin.  Critical adverse effect: #7. ________________ 1. Increased risk of hemorrhage in pregnant patients 2. Increased risk of bleeding in patients with renal impairment Warfarin (Coumadin) #8. ___________ Decreases the production of vitamin K-dependent clotting factors. (Vit K synthesis) · bruising · ____#9_______ (after long term use) Monitor(labs): INR (2-3 is normal) Reversal/antidote: #10. ____________ Nursing Implications: Avoid in pregnancy or breast feeding Frequent monitoring of PT and INR enoxaParin(Lovenox) anticoagulant #11. _____________ · Critical adverse effect is hemorrhage · Critical allergic: · #12 ________ (induced by**hint) Monitor(labs): #13 __________ Antidote: #14 _______________ fondaparinux #15 ______________ #16 ______________ 1. Can cause epidural bleeds. Labs to monitor: None Nursing Implications: · Avoid giving in patients with decrease level of consciousness, complains of back pain or is paralyzed. · Do not administer to patients for at least 6 hours after #17_______or with a #18__________ epidural Rivaroxaban (Xarelto) Apixiban (Eliquis) Edoxanban (Savaysa) Anticoagulants Inhibits factor Xa Risk for neurological impairment Lab monitoring: No routine clot studies Nursing Implications: · Avoid over the counter medications (Vit E, ginkgo biloba, fish oils, garlic, NSAIDS) · Teach patients to avoid bleeding by doing the following: (3 examples)___#19______ Drug Drug Class Mechanism of Action Adverse Effects Nursing Implications Aspirin (Acetylsalicylic Acid) Indication: Reduce risk of CVA, TIA, prevent of MI Treatment during episodes of unstable angina and MI Prevention: occlusion of stents #20. __________ Decrease platelet aggregation Side effect: · #21_________(given in high doses) · Bruising · Gastric upset Adverse reaction: · GI bleed · hemorrhagic stroke (uncontrolled HTN) Monitor(labs): platelets Antidote for ASA toxicity: #22 _______Activated Charcoal Monitor for signs of: ***toxicity – tinnitus, hyperventilation, Clopidogrel (Plavix) Antiplatelet #23 _________ Side effect: · diarrhea · gastric discomfort Adverse Reaction: · bleeding · #24 ________ Monitor (labs): #25 __________ Administered: po Abciximab Indicated: after cardiac procedures Antiplatelet (Glycoprotein (GP) receptor inhibitors) Blocks GP IIB/IIIa receptors that stop platelet aggregation Critical adverse reaction: · hemorrhage · Thrombocytopenia Monitor: hgb & Platelets ***Assess for bleeding in 1. #26 _____ 2. #27_______ 3. IV insertion sites Nursing Implications 4. ECG changes 5. No needle sticks or new IV injections Drug Drug Class Mechanism of Action Adverse Effects Nursing Implications tPA Alteplase Streptokinase Thrombolytics Break down, or lyse or existing clots 1. Bleeding Severe Effect: 1. Severe bleeding Administered: #28 _(route)_ ONLY Nursing Implications: 1. Monitor for mental status changes 2. No new IV, ABGS 3. Never give through a (route) #29 _________. 4. Do not give within 2 weeks of surgery 5. Do not give to patients with active #30 _______ 6. Can only be administered from #31______ hours from onset of symptoms 7. Monitor for cardiac changes/dysrhythmias 8. Uncontrolled hypertension or b/p (180/110) Drug Drug Class Mechanism of Action Adverse Effects Nursing Implications Erythropoietin Alfa Hematopoietic Agents #32_____________ · #33 ________ · Cardiovascular events- MI, CVA, DVT Monitor (labs): #34 _____ & _______ ***Iron levels- key ingredient with the production of RBCs Nurse Implications: 1. Monitor: #35 (hint: which main vital sign) during therapy 2. Do not administer if hemoglobin 10-11 Filgrastim Indicated for Neutropenia Hematopoietic Agents Increase production of neutrophils (in the bone marrow) · Enlarge spleen · __#36___ pain · Leukocytosis Monitor baseline (labs): CBC and platelet counts Administered: IV & subQ Oprelvekin Hematopoietic Agents Simulate platelet production · #37_______ (sign of fluid overload) · anemia · Cardiac dysrhythmias Severe Reaction: · Anaphylaxis Administered: #38 _____ Monitor (labs): platelet counts, electrolyte status Nursing Implications: · Fluid retention: Teach patient to contact provider if symptoms worsen. · Use with caution in patients with cardiac history- a-fib, a-flutter Iron Sulfate Iron deficiency anemia, dietary supplement (prevention) Hematinic Agents Replacement of iron which is critical for hemoglobin function Adverse Reaction · #39_______** · Nausea · Dark Tarry stools Serious Side effect with IV route: #40_______ Patient Teaching 1. Take with vitamin #41_______ source. 2. Infusion: Give a test dose when administering #42 (which route). Keep epinephrine on h and for anaphylaxis. 3. Teach patient to increase fiber and drink plenty of fluids to reduce constipation Folic Acid Indicated: Folic acid anemia, dietary supplement Hematinic Agents Replacement for folic acid 1. Nausea 2. Flatulence 3. Rash 1. Teach patient dietary/lifestyle changes: - Increase consumption of foods high in #43_______ (e.g., green vegetables, liver). 2. If alcoholism underlies dietary deficiency, offer counseling for alcoholism, as well as dietary advice. “ Vitamin B12 Hematinic Agents Replacement Vitamin B12 anemia, Dietary supplement, absence of intrinsic factor 1. Headache 2. Nausea Serious Adverse Reaction 1. #44________** (low lab value) 2. Pulmonary edema 3. Anaphylaxis 1. Labs to Monitor: ***Serum ___#45___ Teach patient s/s of hypokalemia and instruct them to contact provider immediate. 2. Treatment duration- is #46 (how long) Answer Sheet There is only one answer per blank. If the question indications there is more than one answer, then you must have all correct to receive credit. DRUGS THAT AFFECT THE BLOOD 1. 2. 3. 4. 5. 6. (2 answers) 7. 8. 9. 10 11 12. 13. 14. 15. 16. 17. 18. 19. (3) answers 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. ________________________________________________________________________________________________________________ 31. 32. 33. 34. (2 answers) 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. FLUID AND ELECTROLYTES CASE STUDIES 1) Mr. Johnson, 68-year-old, has been vomiting and has had diarrhea for 2 days. He complains of being dizzy. The nurse assesses his physiologic status and notes that his muscles are weak, his abdomen is distended, and bowel sounds are absent. a. What Electrolyte imbalance do you suspect? b. What is the normal range for this electrolyte? c. What other symptoms can this patient have exhibited with this type of electrolyte imbalance? d. What treatment would be most appropriate for this patient? 2) Mrs. Unger has a high temperature and diaphoresis. She has been nauseated and has taken only ginger ale for the last several days. Her lab tests revealed a Sodium level of 129 mEq/L and Potassium level of 3.7 mEq/L. a. What type of electrolyte imbalance do you suspect? b. What is the normal range for this electrolyte? c. What are some other clinical signs and symptoms might you observe with this type of imbalance? d. When testing Mrs. Unger’s urine, what would you suspect her specific gravity to be? e. What treatment would be most appropriate for this patient? 3) A patient has just received an administration of an intravenous potassium too rapidly. a. What signs and symptoms would you assess for? b. What lab values would you check for this patient? c. What treatment would be prescribed for this patient? 4) An elderly patient has just been admitted to the Emergency Department with symptoms of confusion and muscle tremors. When taking his history, it is revealed he had been discharged from the hospital 2 days ago. He has been on IV therapy for a stomach virus, but could not keep down fluids after he was discharged. a. What electrolyte imbalance do you suspect for this patient? b. What other signs and symptoms might you need to assess for? c. What type of treatment would be appropriate for this patient? 5) Develop one care plan for each case study from above. It should contain a NANDA nursing diagnosis, one goal, and at least four nursing interventions. Nursing interventions are not doctor’s orders.