Respiratory dysfunction: depression, character, rate, rhythm; notfy prescriber if respirations are <12/min; accidental overdose has occurred with high-potency orals sols
BLACK BOX WARNINGS
Abrupt discontinuation: gradually taper to prevent withdrawal symptoms; decrease by 50% q 1-2 days; avoid use of narcotic antagonists
Accidental exposure: if Duramorph or Infumorph gets on skin, remove contaminated clothing, rinse affected area with water
For morphine (Rx), Sulfate, what is involved with the NURSING PERFORM/PROVIDE?
Storage: In light-resistanct container at room temp
Assistance: With ambulation
Safety measures: side rails, night-light, call bell within easy reach
Gradual withdrawal: After long-term use
For morphine (Rx), Sulfate, what is involved with the NURSING EVALUATION?
Decrease in pain intensity
For morphine (Rx), Sulfate, what is involved with the NURSE TEACHING PATIENT/FAMILY?
To change position slowly; orthostatic hypotension may occur
To report any symptoms of CNS changes, allergic reactions
Physical dependency may result from long term use
Avoid use of alcohol, CNS depressants
Withdrawal symptoms may occur: nausea, vomiting, cramps, fecer, faintness, and anorexia
How do you treat an overdose of morphine?
Naloxone (Narcan) 0.2-0.8 mg IV
What are the following drugs used for?
1. enoxaparin (Rx), Lovenox
3. warfarin (Rx), Coumadin
1. It is used to PREVENT a clot
2. It is used when a client HAS a clot
3. It is used when a client has HAD a clot
How does enoxaparin (Rx), Lovenox, prevent a clot?
Inactivation of Factors X: Prevents the conversion of prothrombin to thrombin
Limits: Fibrin formation of stable clot
Prolonged: Clotting time
No effects: On blood clots already formed
NOTE: It increases the clotting time
By preventing a blood clot, what other illnesses do you prevent?
Myocardial Infarction (MI) - A clot in the heart
Stroke - A clot in the brain
How does warfarin sodium (Rx), Coumadin work on a client's system, when they have had a clot?
Competitive blocking of vitamin K: Prevents synthesis of Vitamin K in th liver
Subsequent prevention of the actication of dependent clotting factors, including: Factor II (prothombin), Factor VII, Factor IX, and Factor X
Which test do you run on Heparin:
PT or PTT?
PTT, which is a test to find out if the right dose of heparin is being used.
Clue: The two TT's can form an H!
NOTE: Partial thromboplastin time (PTT) and prothrombin time (PT/INR) are often done at the same time to check for bleeding problems or the chance for too much bleeding in surgery.
Define PT, INR, or PT/INR
Prothrombin time (PT) is a blood test that measures how long it takes blood to clot. A prothrombin time test can be used to check for bleeding problems. PT is also used to check whether medicine to prevent blood clots is working.
A PT test may also be called an INR test. INR (international normalized ratio) stands for a way of standardizing the results of prothrombin time tests, no matter the testing method. So your doctor can understand results in the same way even when they come from different labs and different test methods. Using the INR system, treatment with blood-thinning medicine (anticoagulant therapy) will be the same. In some labs, only the INR is reported and the PT is not reported.Blood clotting factors are needed for blood to clot (coagulation). Prothrombin, or factor II, is one of the clotting factors made by the liver. Vitamin K is needed to make prothrombin and other clotting factors. Prothrombin time is an important test because it checks to see if five different blood clotting factors (factors I, II, V, VII, and X) are present.
The prothrombin time is made longer by:
1. Blood-thinning medicine, such as heparin. [Another test, the activated partial thromboplastin time (APTT) test, is a better test to find out if the right dose of heparin is being used.]
2. Low levels of blood clotting factors.
3. A change in the activity of any of the clotting factors.
4. The absence of any of the clotting factors.
5. Other substances, called inhibitors, that affect the clotting factors.
6. An increase in the use of the clotting factors.
NOTE:An abnormal prothrombin time is often caused by liver disease or injury or by treatment with blood thinners.
For enoxaparin (Rx), Lovenox, what is the functional class?
For enoxaparin (Rx), Lovenox, what is the chemical class?
Low-molecular-weight heparin (LMWH)
For enoxaparin (Rx), Lovenox, what is the action?
Binds to antithrombin III inactivting factors Xa/IIa, thereby resulting in a higher ratio of anti-factor Xa to IIa
For enoxaparin (Rx), Lovenox, what are the uses?
Prevention of deep vein thrombosis (DVT), [inpatient or outpatient], PE (pulmonary embolism), [inpatient] in hip and knee replacement, abdominal surgery at risk for thrombosis; unstable angina/non-Q-wave MI
For enoxaparin (Rx), Lovenox, what are the contraindications?
Hypersensitivity to this product, benzyl alcohol, heparin, pork*; active major bleeding, hemophilia, leukemia with bleeding, peptic ulcer disease, thrombocytopenic purpur, heparin-induced thrombocytopenia
* indicates an unusual finding
For enoxaparin (Rx), Lovenox, what are the contraindication precautions?
Low weight men (<57 kg), women (<45 kg)
Severe renal/hepatic disease
Subacute bacterial endocarditis
BLACK BOX WARNING: Lumbar puncture, epidural anesthesia, and spinal anesthesia
For enoxaparin (Rx), Lovenox, when is it safe to administer the medication?
Only after screening patient for bleeding disorders (PT)
Do no mix with other products or inf fluids
**ONLY this product when ordered; not interchangeable wth heparin or other LMWHs
At same time each day to maintain steady blood levels
Avoid all IM inj that may cause bleeding
Prepare in a sterile environment using aseptic technique
Dilution may be stored for up to 4 wk in glass vial at room temp, up to 2 wk in TB syringes with rubber stoppers at room temp or refrigerated
For enoxaparin (Rx), Lovenox, how should the medication be administered?
"Love Qt Bubbles, but hate to aspirate!"
SubQ route: DO NOT give IM (begin 1 hour prior to surgery)
DO NOT aspirate
DO NOT expel the bubble from the syringe before administration
NOTE: Inject slowly (slow taps) for about 20-30 seconds, wait 10 seconds before pulling out the needle, this will keep the client from getting a bruise
For enoxaparin (Rx), Lovenox, what are the side effects on the HEMA?
Life threatening: Hemorrhage, hypochromic anemia, thrombocytopenia, and bleeding
For enoxaparin (Rx), Lovenox, what are the pharmacokinetics?
SubQ: 90% absorbed
Maximum antithrombin activity: 3-5 hour
Elimination half-life: 4 1/2 hr
Excreted: In urine
For enoxaparin (Rx), Lovenox, what is involved with the NURSING ASSESSMENT?
Blood studies: (Hct/Hgb, CBC, coagulation studies, platelets, occult blood in stools), anti-factor Xa (should be checked 4 hr after inj); thrombocytopenia may occur
Renal studies: BUN/creatinine baseline and periodically
Bleeding: Gums, petechiae, ecchymosis, black tarry stools, hematuria - Notify PrescriberBLACK BOX WARNING: Neurologic symptoms in patients who have received spinal anesthesia
For enoxaparin (Rx), Lovenox, what is involved with the NURSING PERFORM/PROVIDE?
Storage at 77 degrees F (25 degrees C)
Do not freeze
For enoxaparin (Rx), Lovenox, what is involved with the NURSING EVALUATION?
Therapeutic response: Prevention of DVT
For enoxaparin (Rx), Lovenox, what is involved with the NURSE TEACHING PATIENT/FAMILY?
To use soft-bristle toothbrush: To avoid bleeding gums
To use electric razor: To avoid bleeding from nicks/cuts
To report any signs of bleeding: gums, under skin, urine, and stools
To avoid OTC products containing aspirin (anticoagulant) unless approved by prescriber
For enoxaparin (Rx), Lovenox, how do you treat an overdose?
Protamine SO4 1% sol
Dose should equal dose of enoxaparin
For warfarin (Rx), Coumadin, what is the functional class?
For warfarin (Rx), Coumadin, what is the chemical class?
For warfarin (Rx), Coumadin, what is the action?
Interferes with blood clotting by indirect means; depresses hepatic synthesis of vit K-dependent coagulation factors (II, VII, IX, X)
For warfarin (Rx), Coumadin, what are the uses?
Antiphospholipid antibody syndrome, arterial thromboembolism prophylaxis, DVT, MI prophylaxis, after MI, stroke prophylaxis, and thrombosis prophylaxis
For warfarin (Rx), Coumadin, what are the unlabeled uses?
Angina and unstable angina
For warfarin (Rx), Coumadin, what are the contraindications?
Pregnancy (X), breastfeeding, hypersensitivity, hemophilia, leukemia with bleeding, peptic ulcer disease, thrombocytopenic purpura, hepatic disease (severe), malignant hypertension, subacute bacterial endocarditis, acute nephritis, blood dyscrasias, eclampsia, preeclampsia, hemorrhagic tendencies; surgery of CNS, eye; traumatic surgery with large open surface, bleeding tendencies of GI/GU/Respiratory tract, stroke, aneurysms, pericardial effusion, spinal puncture, major regional/lumbar block anesthesia
For warfarin (Rx), Coumadin, what are the contraindication precautions?
Geriatric patients, alcoholism, CHF, debilitated patients, trauma, indwelling catheters, severe hypertension, active infections, protein C deficiency, polycythemia vera, vasculitis, severe diabetes, Asian patients (CYP2C9, VKORC1)
For warfarin (Rx), Coumadin, what are the side effects on the CNS?
Life threatening: NONE
For warfarin (Rx), Coumadin, what are the side effects on the GI?
Life threatening: Hepatitis
For warfarin (Rx), Coumadin, what are the side effects on the GU?
Life threatening: Hematuria
For warfarin (Rx), Coumadin, what are the side effects on the HEMA?
Life threatening: Hemorrhage, agranulocytosis, leukopenia, and eosinophilia
For warfarin (Rx), Coumadin, what are the side effects on the INTEG?
Life threatening: NONE
For warfarin (Rx), Coumadin, what are the side effects on the SYST?
Life threatening: Anaphylaxis, exfoliative dermatitis, and purple toe syndrome (blood pools here, can also happen in the fingers)
For warfarin (Rx), Coumadin, what are the pharmacokinetics?
Onset: 12-24 hours
Peak: 1 1/2-4 days
Duration: 3-5 days
Effective half-life: 20-60 hours
Metabolized: In the liver
Excreted: In the urine, feces (active/inactive metabolites)
Bound to plasma proteins: 99% (must have albumin test!)
For warfarin (Rx), Coumadin, what are the side effects on the pharmacotherapeutics?
1. Thrombus: Completion of therapy following heparin
2. Pulmonary embolism: Completion of therapy following heparin
3. Long-term prophylaxis: For thrombus prevention
4. Prophylaxis: For atrial fibrillation
For warfarin (Rx), Coumadin, what is involved with the NURSING ASSESSMENT?
BLACK BOX WARNING:
Blood studies: (Hct, PT, platelets, occult blood in stools) q3mo
INR: in hospital daily after 2nd or 3rd dose; when in therapeutic range for 2 consecutive days, monitor 2-3X wk for 1-2 wk then less frequently, depending on stability of INR results
Outpatient: Moitor every few days until stable dose then periodically thereafter, depending on stability of INR results
BLACK BOX WARNING: Bleeding gums, petechiae, ecchymosis, black tarry stools, hematuria; fatal hemorrhage can occur
**Fever, skin rash, and urticaria
For warfarin (Rx), Coumadin, what is involved with the NURSING PERFORM/PROVIDE?
Storage in tight container
For warfarin (Rx), Coumadin, what is involved with the NURSING EVALUATION?
Therapeutic response: decrease in deep venous thrombosis
For warfarin (Rx), Coumadin, what is involved with the NURSE TEACHING PATIENT/FAMILY?
To avoid OTC preparations that may cause serious product interations unless directed by prescriber
To carry emergency ID identifying product taken
About the importance of compliance
To report any signs of bleeding, gums, under skin, urine, stools; to use soft bristle toothbrush to avoid bleeding gums; to use electric razor
To avoid hazardous activities (football, hockey, skiing), dangerous work
About the importance of avoiding unusual changes in vitamin intake, diet, or lifestyle
To inform all health care providers of anticoagulant intake
For warfarin (Rx), Coumadin, what is the treatment for an overdose?
Administer vitamin K
What are antibiotics used for?
Treatment and prophylaxis of various bacterial infections
Action taken to prevent disease, by specified means or against a specified disease
What does a bactericidal do?
EXAMPLE: like homicidal
What does a bacteriostatic do?
Inhibits the growth of susceptible pathogenic bacteria
What does a C&S test do?
Determines which antibiotic is effective against a specific organism.
What does "symptomatic relief as microorganisms are eradicated" mean, in regard to a antibiotic?
If the antibiotic is working, then such symptoms as fever, melaise, redness, swelling, exudate production, etc. should disappear.
True or False
Antibiotics will work against a virus.
True or False
Antibiotics will work against a fungi.
What is a bacteria?
A one celled organism
List some of the groups of antibiotics (antiinfectives).
What were the first antibiotics to be developed?
What type of antiinfectives are penicillins and cephalosporins?
People who are allergic to penicillin may also be sensitive to __________?
What is a common penicillin medication that is prescribed as an antiinfective?
amoxicillin (Rx) Gen-Amoxicillin, Moxatag
What is a common Cephalosporin medication that is prescribed as an antiinfective?
cephadroxil (Rx) Keflex
For amoxicillin (Rx), Gen-Amoxicillin, Moxatag, what is the functional class?
For amoxicillin (Rx), Gen-Amoxicillin, Moxatag, what is the chemical class?
For amoxicillin (Rx), Gen-Amoxicillin, Moxatag, what is the action?
Interferes with cell wall replication of susceptible organisms: The cell wall, rendered osmotically unstable, swells and bursts from osmotic pressure
Bactericidal: Lysis mediated by bacterial cell wall autolysins
For amoxicillin (Rx), Gen-Amoxicillin, Moxatag, what are the uses?
For amoxicillin (Rx), Gen-Amoxicillin, Moxatag, what is involved in the NURSING PERFORM/PROVIDE?
Adequate intake of fluids (2L) during diarrhea episodes
Scratch test to assess allergy after securing order from prescriber; usually done when penicillin is only product of choice
Storage in tight container; after reconstituting, oral susp refrigerated for 14 days
****MAKE SURE YOU HAVE THESE - IN CASE OF ALLERGIC REACTION: Adrenaline, suction, tracheostomy set, endotracheal intubation equipment on unit
For amoxicillin (Rx), Gen-Amoxicillin, Moxatag, what is involved in the NURSING EVALUATION?
Therapeutic response: absence of infection; prevention of endocarditis (inflammation of heart chambers and/or valves), resolution of ulcer symptoms
For amoxicillin (Rx), Gen-Amoxicillin, Moxatag, what is involved in the NURSE TEACHING PATIENT/FAMILY?
That caps may be opened, contents taken with fluids; that chewable form is available; to take as prescribed, not to double dose
All aspects of product therapy: to complete entire course of medication to ensure organism death (10-14 days); that culture may be taken after completed course of medication
To use nonhormonal form of contraception (can render ineffective!)To report sore throat, fever, fatigue, diarrhea (superinfection or agranulocytopenia), blood in stool, abdominal pain (pseudomembranous colitis), decreased urinary output.
That product must be taken in equal intervals around the clock to maintain blood levels; to take without regard to food
****To wear or carry emergency ID if allergic to penicillins
For amoxicillin (Rx), Gen-Amoxicillin, Moxatag, what is treatment for an OVERDOSE?
For cefadroxil (Rx), Keflex, what is the functional class?
For cefadroxil (Rx), Keflex, what is the chemical class?
ANAPHYLAXIS: Fever, flushing, rash, urticaria, pruritus, dyspnea (Must take a temperature first!)
NOTE: For tendon pain, especially in children
For ciprofloxacin (Rx), Cipro, what is involved in the NURSING PERFORM/PROVIDE?
Limited intake of alkaline foods, products: milk, dairy products, alkaline antacids, sodium bicarbonate; caffeine intake if excessive cardiac or CNS stimulation
For ciprofloxacin (Rx), Cipro, what is involved in the NURSING EVALUATION?
Therapeutic response: decreased pain, frequency, urgency, C&S; absence of infection
For ciprofloxacin (Rx), Cipro, what is involved in the NURSE TEACHING PATIENT/FAMILY?
Not to take any products tht contain magnesium, calcium (such as antacids), iron, aluminum with this product or within 2 hr of product
To report tendon pain, chest pain, palpitations
To ambulate, perform activities with assistance if dizziness occurs
To complete full course of product therapy; not to double or miss doses
To contact prescriber if adverse reaction occurs, if inflammation or pain in tendon occurs
TO FREQUENTLY RINSE MOUTH; USE SUGARLESS CANDY, GUM FOR DRY MOUTH
NOTE:To contact prescriber if taking theophylline (used to prevent and treat wheezing, shortness of breath, and difficulty breathing caused by asthma, chronic bronchitis, emphysema, and other lung diseases. It relaxes and opens air passages in the lungs, making it easier to breathe.)
For gentamicin (Rx), what is the functional class?
For gentamicin (Rx), what is the chemical class?
For gentamicin (Rx), what is the action?
Interferes with protein synthesis in bacterial cell by binding to ribosomal subunit, thus causing misreading of genetic code; inaccurate peptide sequence forms in protein chain, thereby causing bacterial death
For gentamicin (Rx), what are the uses?
Sever systemic infections of CNS, respiratory, GI, urinary tract, bone, skin, soft tissues caused by susceptible strains of Pseudomonas aeruginosa, Proteus, Klebsiella, Serratia, Escherichia coli, Enterobacter, Citrobacter, Staphylococcus, Shigella, Salmonella, Acinetobacer, Bacillus anthracis, acute PID
For gentamicin (Rx), what are the contraindications?
Hypersensitivity to this product, other aminoglycosides; fungal/viral/mycobacterial infection
BLACK BOX WARNING:Pregnancy (D), severe renal disease
For gentamicin (Rx), what are the contraindication precautions?
Weight before treatment; calculation of dosage is usually based on ideal body weight but may be calculated on actual body weight
BLACK BOX WARNING:
RENAL DISEASE: I&O ratio, urinalysis daily for proteinuria, cells, casts; report sudden change in urine output; urine pH if product is used for UTI; urine should be kept alkaline; urine for CCr testing, BUN, serum cratinine; lower dosage should be given with renal impairment (CCr <80 ml/min); toxicity is increased in patients with decreased renal function of high doses are given
VS during inf; watch for hypotension, change in pulse
IV site for thrombophlebitis, including pain, redness, swelling q30min, change site if needed, discontinue, apply warm compresses to site
SERUM PEAK DRAWN AT 30-60 MIN AFTER IV INF OR 60 MIN AFTER IM INJECTION AND TROUGH LEVEL DRAWN JUST BEFORE NEXT DOSE: Blood level should be 2-4 times bacteriostatic level; peak (5-10 mcg/ml), trough (0.5-2 mcg/ml), depending on type of infection
BLACK BOX WARNING:
HEARING DEFICITS: Eighth cranial nerve dysfunction by audiometric testing; also ringing, roaring in ears, vertigo; assess hearing before, during, after treatment
Dehydration: high specific gravity, decrease in skin turgor, dry mucous membranes, dark urine
OVERGROWTH OF INFECTION: fever, malaise, redness, pain, swelling, perineal itching, diarrhea, stomatitis, change in cough or sputum
C&S before starting treatment to identify infecting organism
VESTIBULAR DYSFUNCTION: nausea, vomiting, dizziness, headache; product should be discontinued if severe
Inj sites for redness, swelling, abscesses; use warm compresses at site
For gentamicin (Rx), what is involved with the NURSING PREFORM/PROVIDE?
Adequate fluids of 2-3 L/day unless contraindicated to prevent irritation of tubules
Supervised ambulation, other safety measures with vestibular dysfunction
For gentamicin (Rx), what is involved with the NURSING EVALUATION?
Therapeutic response: absence of fever, draining wounds, negative C&S after treatment
For gentamicin (Rx), what is involved with the NURSE TEACHING PATIENT/FAMILY?
To report headache, dizziness, symptoms of overgrowth of infection, renal impairment
To report loss of hearing: ringing, roaring in the ears, feeling of fullness in the head
What are the NURSING CONSIDERATIONS for antibiotic agentsand increasing the therapeutic effects?
1. Assess for s/s infection prior to and throughout therapy
2. Advise patient to notify healthcare preofessional if symptoms donot improve or if they worsen
3. Obtain C&S prior to initiating therapy - first dose may be given prior to receiving results
4. Handle/store/administer drug, per manufacturer guidelines
5. Monitor lab values, as indicated
6. Most antibiotics should be administered around the clock to maintain herapeutic serum levels
7. Stress importance of completing full course of therapy
What are the NURSING CONSIDERATIONS for antibiotic agentsand decreasing the adverse effects?
Determine previous hypersensitivities
Be aware of cross-sensitivities (ex, penicillins & cephalosporins)
Advise pt to report signs of superinfection, allergy, serious side effects
Prophylactic yogurt, acidophilus
Mouth care/ice chips if stomatitis occurs
maintain adequate hydration
Compresses/gentle massage to painful injections sites