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Agents used to treat shock, cardiac arrest, and anaphylaxis
- actions: varies with medication
- Indications: hypovolemic shock, cardiac arrest, anaphylaxis
- Side effects: serious rebounc effect may occur, balance betweeun underdosing and overdosing
- Nursing: monitor vitals, urine output, assess for extravastation, observe extremities for color and perfusion
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Antianxiety agents
- Action: affects neurotransimitters
- Indications: anxiety disorders, insomnia, petit mal seizure, panic attacks, acute manic episodes
- Side effects: sedation, depression, confusion, anger, hostility, headache, dry mouth, constipation, bradycardia, elevations in LDH, AST, ALT, urinary retention, hepatic dysfunction
- Nursing: monitor liver function, monitor for therapeutic blood levels, avoid alcohol, cautions when performing tasks requiring alertness, benzodiazepines are also used as muscle relaxants, sedatives, hypnotics, anticonvulsants, wean off, change smoking and caffiene (decrease affectiveness)
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Antacid medications
- action: neutralizes gastric acids, work systemically
- Indications: peptic ulcer, indigestion, reflex esophagitis, prevent stress ulcers
- Side effects: constipation, diarrhea, acid rebound between doeses
- Nursing: use medications with sodium content cautiously for clinets with cardiac and renal disease, absoprtion of tetracyclines, quinolones, phenothiazides, iron preparations, isoniazid reduced when given with antacids, effectiveness of oral contraceptives and salicylates may decrease when given with anacids, monitor bowl function, addiction, given 1 - 2 hours after eating, monitor for fluid and electorlyte imbalance
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Aminoglycosides
- Action: bacteriocidal, inhibits protein synthesis in gram-negative bacteria
- Indications: psuedomonis, E. coli
- Side effects: ototoxicity, nephrotoxicity, anorexia, nausea, vomiting, diarrhea
- Nursing: check 8th cranial nerve (hearing), check renal function (BUN, Cr), usually prescribed 7-10 days, encourage fluids, small frequent meals, peaks and troughs
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Cephalosporins
- Actions: bacteriocidal, inhibits syntesis of bacterial cell wall
- indications: tonsilitits, otitis media, periop prophylaxis, meningitis
- Side Effects: bone marrow depression, superinfections, rash
- nursing: take with food, administer liquid to children, avoid alcohol while taking and 3 days after course of medicaiton, cross allergy with penicillins, monitor renal and hepatic function, obtain c&s before first dose, may give false positive for protein or glucose in urine
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Fluoroquinolones
- action: bactericidal, interferes with DNA replication of gram negative
- Indication: treatment of infection caused by E. coli, pseudomonas, staff aureus, postexposure inhalation anthrax
- Side effect: diarrhea, elevated BUN, AST, ALT, serum cr, alkaline phosphatase, decreased WBC and hct,
- Nursing: culture and sensitivity before starting, take 1 hour before or 2 hour after meals, encourage fluids, don't take with antacids or iron, can be give probenicin to increase action
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Glycopeptides
- Action: bacteriocidal, binds to bacteral cell wall
- Indication: treatment of resistant staph infections
- Side effects: thrombophlebitis, abscess formation, nephrotoxicity, obtotoxicity
- Nursing: monitor renal function and hearing, poor abso
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Andrenergics
- Action: stimulate beta-2 receptors in lungs
- Uses: cardiac arrest, COPD
- Side effects: dysrhythmias, tremors, anticholinergic effects
- Nursing: monitor BP, peripheral pulses, check output, change mental status, safety (ambulation)
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Antidysrhythmics
- Action: interfere with the electrical excitability of heart
- Use: a fib and flutter, tachycardia, PVCs
- Side effects: lightheadedness, hypotension, urinary retention
- Nursing: monitor vitals, monitor cardiac rhythm, monitor for bradycardia and hypotentions, orthostatic hypotension (safety)
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Antibiotics
- Allergy reactions (mild to severe anaphylaxis - airway management)
- super-infection (mouth - oral candidia, GI, GU, respiratory)
- organ toxicity (liver, kidney)
- Teaching: take until gone, do culture and sensitivity first, encourage fluids, check expiration date
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Macrolide antibiotics
- Action: binds to cell membrane and changes protein function
- Uses: acute infections, acne, URI, prophylaxis before dental procedures if allergic to PCN
- Side effects: diarrhea, confusion, hepatotoxicity, superinfections
- nursing: take before or after meals, monitor liver function, increases affectiveness of coumadin, theopolin
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Penicillins
- Action: inhibits synthesis of cell wall
- Uses: moderate to severe infections, syphilis, gonococcus infections, lyme disease
- Side effects: stomatitis (breakdown of mouth and GI tract), diarrhea, biggest family with allergy, renal and hepatic changes
- Nursing: check for hypersensitivity (history of allergy), give before or after meals, cross allergy with cephalosporins, liver function tests, kidney function tests
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Sulfonamides
- Action: antagonize essential component of folic acid syntesis
- Use: ulcerative colitis, Crohns disease, otits media, UTIs
- Side effects: peripheral neuopathy, crystalluria, photosensitivity (sun exposure), GI upset, stomatits
- Nursing: take with meals, encourage fluids, good mouth care, antacids decrease uptake
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Tetracyclines
- Action: inhibits protein synthesis
- Use: infections, acne, prophylaxis for opthalmia neonatorum
- Side effects: discoloration of primary teeth if taken by mother during pregnancy or in early childhood, rash, glossitis, phototoxic reactions (sunburn)
- Nursing: Sunblock, take without food, do not take with antacid, milk or iron, monitor renal function, avoid sunlight, note expiration date (if taken beyond expiration date it is toxic)
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Anti-impotence
- Use: impotence
- Side effects: headache, hypotension, priapism
- Contraindications: nitrates, alpha blockers
- Nursing: cannot take with grapefruit juice, call PCP if erection lasts longer than 4 hours
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Anticholinergics
- Action: block action of acetylcholine, dilates pupil, causes bronchodilation and decreased secretions, decreases mobility and GI secretions
- Parasympathetic nerve:
- Use: ophthalmic exam, motion sickness, pre-operative (reduce GI and bladder motility)
- Side effects: blurred vision, dry mouth, urinary retention, change in heart rate (hypotension, therefore will increase hr)
- Nursing: monitor output, contraindicated with glaucoma / paralytic illeus / BPH, give 30 min ac, hs, or 2 hour pc
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Anticonvulsants
- Action: decreases flow of calcium and sodium across neuronal membranes
- Use: seizures
- Side effects: respiratory depression, aplastic anemia, gingival hypertrophy (overgrowth of gums), ataxia (dizziness)
- Nursing: do not discontinue abruptly, monitor I&O, caustion with use of medications that lower seizure thresholds (MAOIs, antipsychotics), do not take with alcohol (both CNS depressants), drowsiness (alertness), may turn the urine pink or reddish brown
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MAOIs
- Action: causes increased concentration of neurotransmitters
- Use: depression, chronic pain
- Side effects: hypertensive crisis (present with severe headache, palipitations, stiff neck, diaphoretic) whenc taken with tyramine containing foods (aged cheese, liver, yogurt, beer, sour cream, wine, pickled products, hering, bologna, bananas, salami, raisins), photosensitivity, potentiate alcohol
- nursing: avoid tyramine containg foods, output, takes time to create desired effect, do not take with CNS stimulants or cold medications
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SSRI
- Action: inhibits CNS uptake of serotonin
- Use: depression, OCD, bulimia
- Side effects: anxiety, GI upset, change in appetite bowel function, urinary retention
- Nursing: suicide precautions (ask do you have a plan, assess 2-3 weeks into treatment), takes 4 weeks for full effect, take in the morning, monitor nutrition and fluids, turn urine pink, GI upset
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Tricyclics
- Action: inhibits reuptake of neurotransmitters
- Use: depression, sleep apnea
- Side effects: sedation, anticholinergic effects, confusion, postural hypotention, urinary retention
- Nursing: postural changes slowly, monitor for suicide (2-3 weeks into treatment), takes 2-6 weeks to work, take at night (sedative effect), monitor vitals, no alcohol, wean slowly, cannot take with sleep medications, avoid exposure to the sun
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Heterocyclics
- Action: affect of serotonin
- Use: depression and smoking cessation
- Side effects: Wellbutrin - agitation, insomnia, Desyrel - sedation
- Nursing: avoid alcohol and CNS depressants, wean slowly
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PRBCs
- - reactions les comman than with whole blood
- - companion solution: NS
- - Give over 2-4 hours
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Platelets
- - Some febrile reactions
- - keep for five days
- - companion solution: NS
- - give as quickly as possible
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Plasma
- - Circulatory overload risk
- - used with burns and coaguopathy
- - give as quickly as possible (coagulation factors become unstable
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Albumin
- - possible circulatory overload
- - 25% albumin give 1 ml/ min
- - give as quickly as possible if patient is in shock
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Prothombin
- - hepatitis risk greater than whole blood
- - allergice/febrile reactions
- - use straight line set
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Factor VIII
- -allergice and febrile reactions
- - use component drip set or syringe
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if transfusion reaction suspected
- 1. stop blood or blood product
- 2. restart normal saline
- 3. save blood container and tubing and return to blood bank
- 4. draw blood sample for plasma, hgb, culture, retyping
- 5. collect urine sample and send to lab for hgb determination
- 6. monitor voiding for hematuria
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Allergic reaction, Hypersensitivity - symptoms
- Occurs immediately or within 24 hours
- Mild -- urticaria, itching, flushing
- anaphylazid - hypoension, dyspnea, decreased Pulse Ox, flushing
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Allergic Reaction / Hypersensitivity: Nursing Considerations
- Prevention - premedicate with antihistamines
- stop the blood
- restart with NS
- Notify the physician
- Supportive care: Benadryl, oxygen, corticosteriods
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Acute Hemolytic reaction
(incompatibility)
Symptoms
- Occurs within minutes to 24 hours
- N/V, pain in lower back, hypotension, increase in pulse rate, decrease in urinary output, hematuria
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Acute Hemolytic reaction: Nursing Considerations
- Stop the blood
- Supportive: oxygen, Benadryl, airway management
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Febril reaction
most common
antibodies to donor platelets
Symptoms
- Occurs in minutes to hous
- Fever, nausea, chills, headache, flushing, tachycardia, palpitations
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Febrile Reaction: Nursing Considerations
- Stop the blood
- Aspirin
- Seen with patients after multiple transfusions
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Bacterial Infection: Symptoms
Contaminated blood products
- Occurs within minutes to less than 24 hours
- Tachycardia, hypotension, fever, chills, shock
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Bacterial Infection: Nursing Considerations
- Stop the blood
- Obtain blood culture
- Anitibiotics, IV fluids, vasopressors, steriods
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Circulatory Overload: Symptoms
Large colume over short time
- Occurs within minutes to hours
- Dyspnea, crackles, increased respiratory rate, tachycardia
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Circulatory Overload: Nursing Considerations
- Monitor clients at high-risk
- Slow or discontinue transfusion
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