-
What do diuretics do for HTN?
lower blood volume through urinary excretion of water and electrolytes
-
what electrolytes are affected by diuretics to treat HTN?
-
what is the action of Microzide (hydrochlorothiazide)?
- Diuresis via ↓ kidney absorption
- ↓BP and workload
-
what is the action of Lasix (furosemide)?
- Most diuresis via ↓kidney LOOP absorption
- ↓BP and workload
-
what is the action of Vasotec (enalapril)?
- reduces levels of angiotensin II (vasoconstrictor) and aldosterone
- ↓BP and workload lowering peripheral resistance & blood volume
-
what happens to electrolytes with ACE inhibitors (enalapril)?
increased excretion of Na+ and H2O
-
what are the adverse effects of Vasotec (enalapril)?
- cough
- postural hypotension
- hyperkalemia
- angioedema (↑ risk with AfroAmerican)
- renal failure
- agranulocytosis
-
what are the nursing considerations of Vasotec (enalapril)?
- monitor BP/HR
- falls risk (dizziness)
- monitor labs
- daily weights
-
what is the action of Procardia (nifedipine)?
- causes vasodilation, decreasing BP
- works on ARTERIOLES
-
what class of drug is Procardia (nifedipine)?
Ca+ channel blocker
-
what are the side effects of Procardia (nifedipine)?
- ↓peristalsis of bowels=constipation
- dizziness
- HA
- arrhythmias
- peripheral edema
- brady or tachy
- flushing
- Nausea (GI upset)
- possible male infertility
- sexual difficulties
-
what are the nursing considerations of Procardia (nifedipine)?
- monitor BP/HR (REPORT <90/60
- falls risk due to dizziness
- monitor labs
- daily weights
- safe and well tolerated by elderly and afro-american
-
what is the mechanism of action of digoxin?
- to cause more forceful heartbeat
- slower heart rate
-
what are the side effects of digoxin?
- N/V
- bradycardia
- neutropenia
- dysrhythmias
- dig toxicity
- hold if HR <60
-
what are the s/s of digoxin toxicity (>2.0 ng/ml)?
- N/V/D
- flu-like symptoms
- visual disterbances
- dysrhythmias
- brady/tachy
- hypotension
- heart block
-
what drug increases contractility?
positive intrope (DIGOXIN)
-
what class of drugs decrease contractility?
negative intrope (BETA-BLOCKERS)
-
What is the mechanism of action of metoprolol (Lopressor)?
- to slow heart rate and B/P
- reducing workload of the heart
-
What are the side effects of metoprolol (Lopressor)?
- hypotension
- bradycardia
- sexual dysfunction
- drowsiness
- fatigue
- insomnia
-
Nursing considerations of beta-blockers (metoprolol)?
- assess BP and HR prior to admin
- hold if HR <60
- never stop abruptly
- monitor labs
-
ACE inhibitors can cause what adverse effects relating to blood cell counts?
- agranulocytosis
- neutropenia (captopril only)
-
What is the therapeutic INR range of Warfarin (coumadin)?
2.0 - 3.0
-
What is the mechanism of action of warfarin (Coumadin)
- inhibit specific clotting factors to prevent formation or enlargement of clots
- Interferes with Vitamin K synthesis in liver affecting clotting factors
-
What are the side effects of warfarin (Coumadin)?
abnormal bleeding
-
What labs are monitored for heparin?
- aPTT
- ↑ values indicate risk for bleeding - need to ↓ dose
-
what is the 15-15-15 rule for hypoglycemia treatment?
- give 15 gm sugar
- wait 15 min
- monitor BS
- give 15 gm additional sugar
-
what are the s/s of hypoglycemia?
- BS <70
- fatigue
- weakness
- HA
- tremors
- sweating
- confusion, dizziness, shakiness
- tachycardia, palpitations
- pale, cool skin
-
name the drug classes for the pneumonic "Some Mothers Buy Toy Animals"
- sulfonylureas
- meglitinides
- biguanides
- thiazolindinediones
- alpha-glucose inhibitors
-
what are the labs to monitor DM?
- FBG
- A1C
- random capillary glucose
-
Humalog KwikPen and U-100 insulin device pt teaching
- inject 1-60 units at a time (may dial backward to correct)
- must prime with 2 units to a stream of insulin
- this ensures the correct amount of insulin each time
- needle replaced after each injection
-
why is the TDD (total daily dose) of basal-bolus insulin protocols adjusted?
- adjust TDD up or down based on:
- past response to insulin
- presence of hyperglycemia inducing agents/stress
-
lispro (Humalog) is what action of insulin?
RAPID
-
what is the onset, peak, and duration of lispro (Humalog)
- onset 5-15 min
- peak 0.5-1 hr
- duration 3-4 hrs
-
what is the action of regular insulin (Humulin R, Novolin R)?
Short
-
what are the onset, peak, and duration of regular insulin (Humulin R, Novolin R)
- onset 30-60 min
- peak 2-4 hrs
- duration 5-7 hrs
-
what is the action of NPH insulin?
Intermediate
-
what is the onset, peak, and duration of NPH insulin?
- onset 1-2 hrs
- peak 4-12 hrs
- duration 18-24 hrs
-
what is the action of detemir (Levemir) insulin?
Long
-
what is the onset, peak, and duration of detemir (Levemir) insulin?
- onset gradual: over 24 hrs
- peak 6-8 hrs
- duration to 24 hours
-
what is the action of Lantus insulin?
Long
-
what is the onset, peak and duration of Lantus insulin?
- onset gradual: begins at 1.1 hrs
- peak - no peak
- duration to 24 hrs
-
What does the pathogenicity of an organism mean?
- ability of organism to cause infection, overcome host
- pseudomonas
- shigella
-
What does the virulence of an organism mean?
- a microbe's ability to cause disease when present in minute amounts
- measure of disease-producing potential
-
What causes a superinfection?
- too many host flora are killed by ABX (broad spectrum)
- pathogenic microorganisms have chance to multiply
-
What are the S/S of a superinfection?
- diarrhea
- bladder pain
- painful urination
- abnormal vaginal discharge
- thrush
- candidiasis
- cough
-
Broad-spectrum ABX are used for?
- effective for wide variety of bacteria
- Gram -
- Gram +
-
Narrow spectrum ABX are used for?
- effective for narrow group of bacteria
- examples:
- gram-
- gram+
- aerobic
- anaerobic
-
What is the mechanism of action of PCN
kill bacteria by disrupting cell walls with PCN's beta-lactam ring
-
What are the adverse effects of PCN?
- N/V/D
- super-infections
- anaphylaxis
- nullify BCP's
- rash
-
What is the mechanism of action of cefotaxime (cephalosporins)?
act with broad-spectrum activity against gram- organisms
-
What is an important nursing consideration of cephalosporins?
Ask pt about allergy to PCN - cross sensitivity
-
What are the adverse effects of cefotaxime (cephalosporins)?
- hypersensitivity
- anaphylaxis
- D/N/V
- pain at injection site
- ↓ PT levels
- renal and hepatic fx
- NO ETOH!
-
What is the mechanism of action of tetracycline (Sumycin)?
effective against broad range of gram+ AND gram- organisms
-
What are the adverse effects of tetracycline (Sumycin)?
- super-infections
- N/V/D
- epigastric burning
- discoloration of teeth
- photosensitivity
-
What groups are tetracyclines not used for?
- children <8 yo
- Pregnancy Cat D
-
What is the mechanism of action of azithromycin (macrolides)?
effective broad spectrum for most gram+ bacteria
-
What are the adverse effects of azithromycin (macrolides)?
- N&V
- abdominal cramping
- hepatotoxicity
-
What is the mechanism of action of gentamicin (aminoglycosides)?
- broad-spectrum
- reserved for serious systemic infections
- aerobic gram- bacteria
- some gram+
-
What are the adverse effects of gentamicin (aminoglycosides)?
- ototoxicity
- nephrotoxicity
-
What is the mechanism of action of levaquin (fluoroquinolones)?
inhibit bacterial DNA
-
What are the adverse effects of levaquin (fluoroquinolones)?
- N/V/D
- phototoxicity
- HA
- dizziness
- Stevens-Johnson Syndrome
- Black Box: tendonitis & tendon rupture
-
Which ABX cause photosensitivity?
- sulfa
- levaquin
- tetracycline
-
What is the mechanism of action of sulfamethoxazole (Sulfonamides)?
- inhibits bacterial metabolism of folic acid
- UTI's
- pneumonia, bronchitis (chronic)
- bowel infections
-
What are the adverse effects of sulfamethoxazole (Sulfonamides)?
- skin rashes
- N/V
- agranulocytosis, thrombocytopenia
- photosensitivity
- anemia or other hematological disorders
-
What are the nursing considerations of sulfonamides?
- assess renal function
- ↑ risk for crystalluria
- Stevens-Johnson syndrome
-
What is vancomycin effective for?
-
What are the adverse effects of vancomycin?
- ototoxicity
- nephrotoxicity
- red man syndrome
-
What are the S/S of red man syndrome?
- hypotension
- red rash
- chills
- fever
- itching
-
What culture is performed for suspected sepsis?
blood cultures
-
what culture is performed for suspected UTI?
Urine culture
-
what culture is performed for suspected pulmonary infection?
sputum culture
-
what culture is performed for GI issues (diarrhea)?
C. diff stool culture
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