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What interventions should the health care professional use when caring for a patient who is taking the drug acetaminophen (Tylenol)?
- Monitor for early symptoms of overdose or poisoning (abdominal discomfort, nausea, vomiting, sweating, diarrhea); liver damage results in 48 to 72 hr following overdose.
- Prepare to administer acetylcysteine (Mucomyst, Acetadote) orally or intravenously (IV) to counteract overdose and reduce liver injury.
- Monitor blood pressure because the drug can cause hypertension particularly in women who take it regularly.
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What interventions should the health care professional use when caring for a patient who is taking the uricosuric drug allopurinol (Zyloprim)?
- Monitor for symptoms of hypersensitivity syndrome (fever, rash, eosinophilia, liver and kidney dysfunction).
- Stop drug therapy immediately for signs of hypersensitivity syndrome.
- For vomiting, ensure adequate hydration.
- Give after meals to prevent gastrointestinal upset.
- Monitor a patient when ambulating because the drug can cause drowsiness and vertigo.
- Give a mild analgesic for headache.
- Monitor complete blood count because the drug can cause agranulocytosis, aplastic anemia, and bone marrow depression.
- Monitor for unusual (metallic) taste sensations.
- Recommend regular ophthalmologic examinations because long-term use can cause cataracts.
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What interventions should the health care professional use when caring for a patient who is taking the opioid antagonist drug naloxone (Narcan)?
- Monitor vital signs for expected indications of opioid reversal: increased respiratory rate, blood pressure, and heart rate.
- Monitor heart rhythm for signs of tachycardia.
- Have oxygen and resuscitation equipment ready.
- Expect hypertension, vomiting, and cramping in an opioid-dependent patient.
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What interventions should the health care professional use when caring for a patient who is taking the centrally-acting nonopioid drug tramadol (Ultram)?
What interventions should the health care professional use when caring for a patient who is taking the centrally-acting nonopioid drug tramadol (Ultram)?
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What interventions should the health care professional use when caring for a patient who is taking the opioid agonist-antagonist drugs butorphanol (Stadol) and pentazocine (Talwin)?
- Measure baseline vital signs.
- Monitor respirations.
- For respiratory rates below 12/min, withhold the drug and stimulate breathing.
- Monitor a patient when ambulating due to the risk for sedation, dizziness, lightheadedness, drowsiness, and headache.
- Consider alternative drug if nausea does not resolve.
- Do not administer to a patient who has myocardial infarction or cardiac insufficiency due to the risk of increasing the cardiac workload.
- Ask a patient about opioid use before administration.
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What interventions should the health care professional use when caring for a patient who is taking the opioid agonist drugs morphine and meperidine (Demerol)?
- Monitor vital signs, pulse oximetry, lung sounds to watch for respiratory depression.
- For respiratory rates below 12/min, withhold the drug and stimulate breathing.
- Administer an opioid antagonist such as naloxone (Narcan) to restore respiratory rate.
- Monitor a patient when ambulating because opioids can cause sedation, dizziness, lightheadedness, and drowsiness.
- Monitor bowel function.
- Administer fiber supplement and/or stool softeners.
- For nausea and vomiting, administer an antiemetic and ensure adequate hydration.
- Monitor blood pressure because opioids can cause orthostatic hypotension.
- Monitor intake and output, watching for signs of urinary retention, such as bladder distention.
- Encourage patients to urinate every 4 hr.
- Prepare to insert a urinary catheter to drain the bladder.
- Auscultate lung sounds regularly.
- Encourage a patient (especially postoperatively) to cough frequently to prevent a build-up of respiratory secretion because opioids can suppress coughs.
- Have suction equipment available.
- Recommend the lowest possible effective dose and short-term only to prevent abuse.
- Advise a patient with physical dependence not to discontinue opioids abruptly; taper the dose over 3 days.
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What interventions should the health care professional use when caring for a patient who is taking the NSAID (COX-2 inhibitor) celecoxib (Celebrex)?
- Monitor for and report gastric upset, heartburn, nausea, diarrhea, gastrointestinal bleeding.
- Test for and treat Helicobacter pylori infection prior to long-term therapy.
- For a patient at high risk for gastric bleeding, recommend a proton pump inhibitor.
- Monitor intake and output; watch for low urine output and fluid retention.
- Monitor for rapid rises in blood urea nitrogen (BUN) and creatinine.
- Recommend the drug for short periods and in low doses only to prevent cardiovascular and cerebrovascular events.
- Recommend low-dose aspirin to prevent thromboembolic events.
- Monitor for signs of myocardial infarction and cerebrovascular accident.
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What interventions should the health care professional use when caring for a patient who is taking the NSAIDs (COX-1 and COX-2 inhibitors) aspirin/acetylsalicylic acid (Aspirin) and ibuprofen (Advil, Motrin)?
- Monitor for signs of gastrointestinal bleeding (black or dark-colored stools, abdominal pain, nausea, hematemesis).
- Test for and treat Helicobacter pylori infection prior to long-term therapy.
- For a patient at high risk for gastric bleeding, recommend a proton pump inhibitor.
- Monitor for signs of bleeding (easy bruising, petechiae, excessive bleeding from minor injuries).
- Monitor intake and output; watch for low urine output and fluid retention.
- Monitor for rapid rises in blood urea nitrogen (BUN) and creatinine.
- Monitor for sign of salicylism (tinnitus, diaphoresis, headache, dizziness, respiratory alkalosis).
- Stop aspirin therapy for patients reporting indications of salicylism.
- Recommend acetaminophen (Tylenol) and not aspirin or NSAIDs for a child or adolescent younger than 19 years old who has a viral infection, particularly chickenpox and influenza, due to the risk for Reye's syndrome.
- Recommend non-aspirin NSAIDs for short periods and in low doses only.
- Recommend low-dose aspirin to prevent thromboembolic events.
- Monitor for signs of myocardial infarction and cerebrovascular accident.
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What interventions should the health care professional use when caring for a patient who is taking the glucocorticoid drug prednisone (Deltasone)?
- Recommend larger dosage during times of illness and stress because the drug can suppress adrenal function.
- Monitor blood glucose levels for hyperglycemia, especially for a patient who has diabetes mellitus.
- Adjust dosages of insulin or hypoglycemic drugs accordingly.
- Recommend the lowest possible effective dose and alternate-day dosing to prevent myopathy and bone loss.
- Observe for gastrointestinal bleeding (bloody vomitus as well as black, tarry stools) because the drug can cause peptic ulcer disease.
- Implement gastric protective measures.
- Give with food or meals.
- Recommend an analgesic substitute if NSAID is prescribed.
- Observe for signs of infection that may not include fever or inflammation (sore throat, fatigue, tachycardia, and discharge from a wound).
- For infection, recommend initiation of appropriate antimicrobial therapy.
- Monitor intake and output; watch for edema, crackles in the lungs, and unexplained weight gain (hypernatremia).
- Monitor for generalized weakness (hypokalemia).
- Monitor for Cushing-like effects: abdominal fat, buffalo hump, and moon face.
- Determine schedule for regular ophthalmologic examinations because long-term use of the drug can cause cataracts.
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