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Faulkner State Community College/Division of Nursing Clinical Medication Sheet Nursing 203 Student __Kenneth Smith II_ Clients

Initials __RG____ Clinical Week __7______ Class __NUR 203__________

Drug

Classification & Mechanism of Action

Major Side Effects & Contraindications

Nursing Considerations

Drug: potassium chloride Dose: 20 mEq 1. For K+ = 3.7-3.9: 20 mEq KCI in 100 mL SWFI over 1 hr 2. For K+ = 3.6 or less: 40 mEq KCI in 100 mL SWFI, over 2 hrs and repeat K+ level 2 hours post-completion 3. For K+ = less than 3 or greater than 5.5: notify physician Route: IV Max 24rh dose: 480 mEq Frequency: PRN/ see Dose Rationale for client: Fluid and Electrolyte imbalance/ restore normal potassium levels

Functional class: Dietary supplement Chemical class: potassium chloride, Inorganic Ions Action: K+ works to maintain intracellular tonicity; it is necessary for the transmission of nerve impulses, the contraction of cardiac, skeletal and smooth muscle, and the maintenance of normal renal function. It also works as an acid/base buffer [in the case of acidosis chloride is not the appropriate salt; consider: potassium bicarbonate, potassium citrate, potassium acetate, or potassium gluconate.

Normal Range: 3.5-5 Critical Values: <2.5; >6.5

Side-Effects: CNS: Weakness CV: Bradycardia Hema: Hyperkalemia GI: Diarrhea, nausea, stomach pain, flatulence, vomiting EENT: Dyspnea Contraindications: Severe renal impairment, untreated Addison's disease, heat cramps, hyperkalemia, severe tissue trauma Overdose s/s: Nausea, Fatigue, weakness, tingling sensation, Peak T waves, small P waves, Widened QRS complex, and sinusoidal rhythm Hypokalemia s/s: muscular weakness, myalgia, muscle cramps, flaccid paralysis, hyporeflexia, flattened or inverted T waves, a U wave, ST depression and a wide PR interval.

1. Administer with plenty of fluid and/or food because of stomach irritation and discomfort 2. Labs BUN, Creatinine, Chemistry, UA 3. Antidote: 1st - Cardiac Membrane stabilization Give Ca gluconate 10 mL of a 10% calcium gluconate solution infused over 2 to 3 minutes; repeat in 1-2 mins if needed 2nd - Promotion of Potassium Influx into Cells Dextrose 50 ml over 5 min then 5-10 units of reg insulin IVP 3rd - Potassium Removal from the Body - Sodium Polystyrene Sulfonate [Kayexalate] 15g PO [preferred] in water or sorbital; or 30-50g enema deep into sigmoid colon.

Faulkner State Community College/Division of Nursing Clinical Medication Sheet Nursing 203 Student __Kenneth Smith II_ Clients Initials __RG____ Clinical Week __7______ Class __NUR 203__________ Drug: Magnesium Sulfate Dose: 1. For Mg++ = 1.8-1.9: 16 mEq (2g) Magnesium Sulfate in 50 mL D5W over 1 hr 2. For Mg++ = 1.6-1.7: 24 mEq (3g) Magnesium Sulfate in 100 mL D5W over 1.5 hrs 3. For Mg++ = 1.4-1.5: 32 mEq (4g) Magnesium Sulfate in 100 mL D5W over 2 hrs. 4. For Mg++ = 1.3 or less: 32 mEq (4g) Magnesium Sulfate in 100 mL D5W over 2 hrs and notify physician. Route: PO Max 24rh dose: 30-40 g Frequency: PRN Rationale for client: Fluid and Electrolyte imbalance/ restore normal Mag+ levels Functional Class: Electrolyte replacement Chemical Class: Mag+ Action: Stabilizes excitable membranes, Essential role in cardiac, skeletal, and smooth muscle contraction, Bloodclotting cascade cofactor, Cofactor for the synthesis of DNA and proteins
Major Side-Effects:

CNS: flaccid paralysis CV: circulatory collapse GI: n/v, cramps, diarrhea, anorexia Contraindications: hypersensitivity, abd pain, n/v, obstruction, acute surgical abd, rectal bleeding, heart block, myocardial damage Overdose s/s: Weakness, n/v, Impaired breathing, Decreased respirations, Hypotension, Hypercalcemia, Decreased/absent deep tendon reflexes, Bradycardia Hypomagnesemia s/s: weakness, cramps, tremors, spasms, nystagmus and an extensor plantar reflex, confusion, disorientation, hallucinations, depression, epileptic fits, hypertension, tachycardia and tetany

1. Assess: I&O ratio, cause of constipation 2. Assess: Cramping, rectal bleed, n/v 3.Mag Levels: Normal Range: 1.2-2.1 Critical Values: <1.3; >5.1 4. See s/s of overdose in column to the left 5. Antidote 10% Ca gluconate 5 to 10 mEq IV x1 Over Tx: 1. D/C Mag 2. Ambu bag w/ O2 if needed 3. 5 to 10 mEq of 10% Ca gluconate

Faulkner State Community College/Division of Nursing Clinical Medication Sheet Nursing 203 Student __Kenneth Smith II_ Clients Initials __RG____ Clinical Week __7______ Class __NUR 203__________
Drug: Calcium Chl Dose: Functional Class: Electrolyte replacement- calcium product Chemical Class: Ca++ Action: Cation needed for maintenance of nervous, muscular, skeletal function; enzyme reactions; normal cardiac contractility; coagulation of blood; affects secretory activity of endocrine, exocrine glands. Major Side-Effects: CV: bradycardia, short QT 1. Labs: CMP, Albumin, Ionzd Ca, Ca 2. Monitor VS and ECG carefully for bradycardia and hypotension

1. For Ionized Ca++ 1 - 1.13 : 1 gm CaCl in 50 mL 05W over 1 hr 2. For Ionized Ca++ less than 1 : 2 gms CaCl in 100 mL D5W over 1 hr
Route: IV 100ml/hr

interval, wide T wave and ST elevation, cardiac arrest,


hypotension GI: constipation, anorexia, n/v, polyuria, thirst Contraindications: hypersensitivity to drug/class/components, Hypercalcemia Overdose Tx: 1. D/C Ca++ 2. Lasix 40 80 mg IV/1-2 mins 3. Calcitonin 4 I.U./kg Q12hr by SC or IM

Overdose s/s: Hypotension, syncope, short QT interval, wide T wave and ST elevation,
drowsiness, lethargy, muscle weakness, headache, constipation, coma, anorexia, n/v, polyuria, thirst.

Max 24rh dose: 2000mg


Frequency: PRN Rationale for client:

Fluid and Electrolyte imbalance/ restore normal Ca+ + levels

Total Norm Range: 8.5-10 Total Crit Value: <1.5; >3.25 Ionzd Norm Range: 4.5-5.6 Ionzd Crit Values: <2.2; >7 1 g/dL albumin = 0.8 mg/dL serum Ca

Hypocalcemia s/s: Petechiae, Oral, perioral, acral paresthesia, tetany, Trousseau sign, Chvostek's sign, Hyperreflexia, Laryngospasm, Intermittent QT prolongation, TdP, and VFib

Faulkner State Community College/Division of Nursing Clinical Medication Sheet Nursing 203 Student __Kenneth Smith II_ Clients Initials __RG____ Clinical Week __7______ Class __NUR 203__________

Drug: Nitroprusside Dose: 50 mg/250 mL D5W and titrate to keep systolic BP less than or equal to 150; may double concentrate drip Usual maintenance rate: 0.5 to 10 mcg/ kg/ min Max Dose: 10mcg/kg/min/10min Half Life: 1-2mins Route: IV Frequency: PRN; Titrate to keep systolic BP less than or equal to 150 Rationale for client: to keep systolic BP less than or equal to 150

Functional class: Direct Vasodilator Chemical class:


Cyanides

Action: relaxes the vascular smooth muscle to dilate peripheral arteries and veins. It is active on veins than on arteries. Preload by the pooling of blood in veins. Afterload by dilating arteries thereby SVR. Dilatation of the coronary arteries also occurs. HYPOTENSION = FALL RISK teach Pt rise slowly when positions.

Major Side-Effects: CNS: ICP CV: hypotension, shock, MI, cardiac arrest, reflex tachycardia GI: nausea, abd pain Hema: severe cyanide toxicity, Methemoglobinemia, thiocyanate toxicity Contraindications: hypersensitivity to drug/class/components

1. Labs: CBC w/ diff, Cyanide,


Methemoglobin, thiocyanate and ABGs

2. Overdose s/s [cyanide toxicity]: n/v, abd pain, diaphoresis, severe dizziness, headache, spasms, palpitations, restlessness, and chest or back pain 3. Onset: immediate. 4. Duration: 1 to 10 minutes

5. Tx for cyanide tox: 1. D/C Nitroprusside 2. Sodium Nitrite 4-6 mg/kg over 2-4mins: to convert hemoglobin into Methemoglobin 3. Then Sodium Thiosulfate 150-200 mg/kg: to convert the cyanide into thiocyanate. MAP SV/SVI
Coronary Perfusion Peripheral Perfusion

Nitroprusside Nitroprusside

CO/COI

CVP

PAP

SVR

Faulkner State Community College/Division of Nursing Clinical Medication Sheet Nursing 203 Student __Kenneth Smith II_ Clients Initials __RG____ Clinical Week __7______ Class __NUR 203__________

Drug: Epinephrine Dose: 2.5 mg/250 mL NS and titrate to keep systolic BP greater than or equal to 90; may double concentrate drip Usual maintenance rate: 1 to 4 mcg/min Half Life: 2mins Route: IV Frequency: PRN; Titrate to keep systolic BP greater than or equal to 90 Rationale for client: to keep systolic BP greater than or equal to 90 Epinephrine CO/COI CVP Epinephrine

Functional class: Alpha 1/Beta1 Adrenergic Receptor Agonist Chemical class:


Catecholamines

Action: Stimulation of Beta-1 adrenergic receptors which increases the strength of ventricular contraction and increases heart rate; Stimulation Alpha 1 adrenergic receptors SVR

Major Side-Effects: CNS: cerebral hemorrhage CV: Tachycardia, HTN, angina Resp: pulmonary edema Contraindications: hypersensitivity to drug/class/components

1. Assess: pulse, BP, lung snds, neuro checks 2. Overdose s/s: BP,HR 3. Overdose Tx: PRN Labetalol 0.25 mg/kg IV/2 mins

PAP

SVR

MAP

SV/SVI

Coronary Perfusion

Peripheral Perfusion

Drug: Nitroglycerin Dose: 50mg/250 mL D5W at 3 mL/hr Route: IV Frequency: Continuously infuse until am Rationale for client: Coronary Artery dilation/perfusion. Nitroglycerin Nitroglycerin

Functional Class: Vasodilator Chem class: Glycerol/Nitrate Action: relaxes the vascular smooth muscle to dilate peripheral arteries and veins. It is active on veins than on arteries. Preload by the pooling of blood in veins. Afterload by dilating arteries thereby SVR.

Side-Effects: CNS: dizziness, HA, weakness, syncope CV: hypotension, tachycardia, HR block GI: abd pain EENT: blurred vision Contraindications: pericardial tapenade

1. Monitor BP, LOC 2. O/D s/s: BP, LOC, N/V 3. O/D Tx: Raise legs, Trendelenburg, Bolus NS 4. HYPOTENSION = FALL
RISK teach Pt rise slowly when positions.
Peripheral Perfusion

CO/COI

CVP

PAP

SVR

MAP

SV/SVI

Coronary Perfusion

Faulkner State Community College/Division of Nursing Clinical Medication Sheet Nursing 203 Student __Kenneth Smith II_ Clients Initials __RG____ Clinical Week __7______ Class __NUR 203__________

Drug: Phenylephrine, Neosynephrine Dose: 20 mg/250 mL NS and Titrate to keep systolic BP greater than or equal to 90; may double concentrate drip Usual maintenance rate: 40-60 mcg/min Maximum dose: 10 mcg/kg/min Half Life: 2.5 3hrs Route: IV Frequency: Continuous Rationale for client:

Functional class: Positive Inotrope, Vasopressor Chemical class: Postsynaptic Alpha 1 Receptor Agonist, Sympathomimetic Action: Stimulates Alpha 1 receptors to systolic and diastolic pressures, slight decrease in cardiac output, and SVR; coronary blood flow

Major Side-Effects: CNS: CNS stimulation, anxiety CV: Htn, V-Tach GU: Renal Failure, Urinary Retention EENT: Epistaxis Contraindications: hypersensitivity to drug/class/components, HTN, ventricular tachycardia

1. Assess: pulse, BP, lung snds, neuro checks 2. Overdose s/s: BP, VTach, Feeling of fullness in head 3. Overdose Tx: phentolamine (regitine) 5-20 mg IV/ 0.17-0.4 mg/min

Prevent hypotension Phenylephrine CO/COI CVP


Phenylephrine Drug: Ancef/ Cefazolin Dose: 1-2g/50-100 mL SW or NS Maximum 24hr dose: 12g Rate: 50-100 mL/ 30mins

PAP

SVR

MAP

SV/SVI

Coronary Perfusion

Peripheral Perfusion

Half-life: 1.8hrs
Route: IV Frequency: Q 8 hr x 3 doses Rationale for client: Empirical Prevention/Tx infection for perioperative Pts

Functional class: BroadSpectrum Antibiotic; Bacterial Cell Wall Synthesis Inhibitor Chemical Class: 1st Gen Cephalosporin Action: Binds to specific penicillin-binding proteins inside the bacterial cell wall, to inhibit bacterial cell wall synthesis. Bactericidal agent effective against staph and strep species of Gram positive bacteria

Side-Effects: CNS: seizures, anaphylaxsis Hema: thrombocytopenia, Neutropenia, Leukopenia, thrombocythemia Integ: rash, pruritis GI: N/V Diarrhea, pseudomembranous colitis, AST/ALT/ALP Contraindications: allergy to any penicillin or cephalosporin drug

Monitor for AST/ALT/ALP False (+) for Glucose in the urine. Check for hx of allergy to penicillin or cephalosporin

Faulkner State Community College/Division of Nursing Clinical Medication Sheet Nursing 203 Student __Kenneth Smith II_ Clients Initials __RG____ Clinical Week __7______ Class __NUR 203__________

Drug: Acetaminophen/Tylenol Dose: 650mg Route /Rate NG Tube Max 24rh dose: 4000 mg
Half Life: 2 3hrs

Frequency: Q6 hr PRN Rationale for client: for temp > 101.5 Max 24rh dose: 4000 mg
http://www.fda.gov/Drugs/DrugSafety/ ucm239821.htm#sa

Functional Class: nonopioid analgesic, antipyretic Chemical Class: nonsalicylate, paraaminophenol derivative Action: acts main in the CNS to inhibit cyclooxygenase in the synthesis of prostaglandins there by inhibiting the synthesis of prostaglandin in the CNS.

Major Side-Effects: uncommon CNS: stimulation, drowsiness Hema: hemolytic anemia (longterm use) GI: hepatic seizure (over dose) GU: renal failure (high prolonged dose) Contraindications: previous hypersensitivity

1. For long term use: AST, ALT, Acetaminophen level, Crt, BUN, CBC w/diff, CMP 2. Toxic levels: If serum level>200 mcg/mL within 4 hrs of ingestion [this suggest that the dose was great enough to cause toxicity] or 50 mcg/mL at 12 hrs after ingestion 3. Therapeutic Range: 5-20 mcg/mL

4. Antidote: N-acetylcysteine [Mucomyst] (best given with 8 hrs

Also, see CV Order Set; PRN orders Line A; Not To Exceed 4 gm/day acetaminophen
Drug: Ondansetron, Zofran Dose: 4mg Route: IV Functional class: Antiemetics Chemical class: Serotonin Receptor Antagonists Action: inhibits 5-HT3 receptors

of ingestion) IV: Loading 150mg/kg over 60 min Maintenance 50 mg/kg over 4 hr Then100 mg/kg over 16 hr
PO: Loading 140mg/kg Maintenance 70 mg/kg q 4h x 17 Major Side-Effects:

1. liver function panel CNS: Headache, fever [AST/ALT] CV: depressed-HR, Respirations, 2. monitor for arrhythmias Half-life: 4 hours and BP 3. monitor for constipation & Max 24rh dose: 0.4 mg/kg/day peripherally on vagal nerve terminals Hema: AST/ALT elevations diarrhea and centrally in the chemoreceptor Frequency: Q6hr PRN GI: Constipation, diarrhea 4. Diagnostic: EKG, BP, HR, trigger zone. This in turn inhibits the Rationale for client: Nausea Contraindications: RR [depressed-HR, Respirations, visceral afferent stimulation of the vomiting center hypersensitivity to ondansetron and BP] 5. Onset: Within 30 minutes

Faulkner State Community College/Division of Nursing Clinical Medication Sheet Nursing 203 Student __Kenneth Smith II_ Clients Initials __RG____ Clinical Week __7______ Class __NUR 203__________
Drug: Albumin Dose: Route: IV 1ml/min, 0.25mg/ min Functional class: Plasma Volume Expander Chemical Class: Protein Action: a blood volume expander that accounts for 70-80% of colloid oncotic pressure of plasma. Also acts as a transport protein that binds to exogenous and endogenous substances, including bilirubin and certain drugs. Major Side-Effects: CNS: Chills, fever, headache Cardiac: hypotension, CHF, decreased myocardial contractility Resp: pulmonary edema, Integ: pruritus Other: salt and water retention

Max 24rh dose: 150g


Frequency: PRN for Pulmonary Artery Mean Pressure: less than or equal to 22 mm Hg; May repeat x 1 Rationale for client: for Pulmonary Artery Mean Pressure: less than or equal to 22 mm Hg; May repeat x 1

Monitor: Hgb, Hct, electrolytes, serum protein. Normal serum albumin level is 3.5-5. Observe carefully for pulmonary edema.
Contraindications: traumatic brain injury

Drug: Regular Insulin Dose: Post Surgery Algorithm Route: IV Frequency: PRN; Titrate to Post Surgery Algorithm Rationale: Tx of post cardiac surgery hyperglycemia; goal is BG 70-110

Functional Class: Hypoglycemic Agents Antidiabetic Chemical Class: Recombinant, Biosynthetic, Fast-Acting Insulin Analogue Action: lower blood glucose by stimulating peripheral glucose uptake, inhibits hepatic glucose production, inhibits lipolysis and proteolysis, regulating glucose metabolism

Major Side-Effects:

Hema: Hypoglycemia, hypokalemia Local: erythema, lipodystrophy, pruritis, swelling Contraindications: hypersensitivity

1. Assess BG before administration 2. Onset 0.5-1h 3. Peak 2-4h 4. Duration 6-12h 5. Assess for symptoms of hypoglycemia and hyperglycemia during therapy 6. Antidote: Dextrose: 50mL of 50% dextrose (25 grams) IV; Glucose :15-20 g PO; Glucagon 1mg IV, SC, IM, may repeat in 15min

Faulkner State Community College/Division of Nursing Clinical Medication Sheet Nursing 203 Student __Kenneth Smith II_ Clients Initials __RG____ Clinical Week __7______ Class __NUR 203__________

Drug: Atropine Dose: 0.5-1 mg Route: IVP

Half-life: Max Dose: 3mg


Frequency: Q3-5mins Rationale for client: ACLS Protocol; Tx/Prevent hypotension

Functional class: Parasympatholytic, Muscarinic Receptor Antagonist Chemical class: Belladonna Alkaloid Action: HR by antagonizing Muscarinic Receptors to Vagus influence on heart function

Major Side-Effects: CNS: HA, Heat prostration CV: Tachycardia, HTN, angina Resp: pulmonary edema GI: Xerostomia; constipation; paralytic ileus; gastroesophageal reflux. GU: Urinary hesitancy and retention Contraindications: hypersensitivity to drug/class/components

1. Assess: pulse, BP, lung snds, neuro checks 2. Overdose s/s: BP,HR, Blurred vision, photophobia, dilated pupils 3. Overdose Tx: PRN Physostigmine 1 to 3 mg I.V.

Faulkner State Community College/Division of Nursing Clinical Medication Sheet Nursing 203 Student __Kenneth Smith II_ Clients Initials __RG____ Clinical Week __7______ Class __NUR 203__________

Drug: Lidocaine Dose:

Pulse-less VF/VT, Stable VT 1st: 1 1.5 mg /kg Then: 0.5 0.75 mg/kg in 5 10 mins Max: 3 doses or 3 mg/kg total Maintenance Infusion 1 g/250 mL D5W or NS Infuse at 1 4 mg/min (30 50 mcg/kg/min) 1mg/min = 15 mL/hr 2mg/min = 30 mL/hr 3mg/min = 45mL/hr 4mg/min = 60 mL/hr
Route: IV

Functional class: Sodium Channel Blocker, Cardiac Depressant Chemical class: Steroid, Action: HR by antagonizing Muscarinic Receptors to Vagus influence on heart function

Major Side-Effects: CNS: seizures, coma, confusion CV: heart block, bradycardia Resp: respiratory arrest, status asthmaticus, anaphylaxis Hema: methemoglobinemia Contraindications: hypersensitivity to drug/class/components, AdamsStokes syndrome, WPW syndrome, heart block w/o pacemaker, intra-articular continuous infusion

Half-life: 1.5-2hrs Max 24hr Dose: 5.76g


Frequency: Q3-5mins Rationale for client: ACLS Protocol Drug: Acetylsalicylic Acid, Aspirin Dose: 325 mg Route : PO Max 24hr dose: 3,900mg

Half-life: 15 to 20min
Frequency: Daily

Functional Class: nonopioid analgesic, nonsteroidal antiinflammatory, antipyretic, antiplatelet Chemical Class: salicylate Action: inhibits cyclooxygenase there by

Side-Effects: CNS: seizures, coma Hema: leucopenia, Thrombocytopenia Integ: rash GI: n/v, GI bleeding, hepatitis EENT: angioedema, Reye

1. Assess: pulse, BP, lung snds, neuro checks 2. Overdose s/s: Seizures, Resp, Confusion, BP Lightheadedness, dizziness, Visual disturbance, Headache, Perioral tingling/ numbness or tingling of tongue, Sedation, Impaired concentration, Dysarthria, Tinnitus, Metallic taste, Muscular twitching, tremors 3. Overdose Tx: 1. D/C lidocaine 2. Seizures: Diazepam 5-10 mg IV Q10-20 minutes, up to 30 mg in an 8-hour period; may repeat in 2-4 hours if necessary. 3. Resp Failure: Face mask or intubation 4. BP: Epinephrine 0.5-1mg IV 1. Labs: PT, INR, LFP, BUN, Creatinine, Salicylate, Pltts 2. Salicylate levels > 400 will have sever toxic effects 3. Stop use 5-7 days before surgery [Per MDO] 4. Irreversible inhibits platelet

Faulkner State Community College/Division of Nursing Clinical Medication Sheet Nursing 203 Student __Kenneth Smith II_ Clients Initials __RG____ Clinical Week __7______ Class __NUR 203__________
Rationale for client:

prophylactic against thrombus

inhibiting the formation of prostaglandin and thromoxane A2, acts on the hypothalamus to reverse pyresis, dilates peripheral blood vessels

Syndrome, Tinnitus Contraindications: hypersensitivity, GI bleeding, bleeding disorders

aggregation 5. O/D S/S: tinnitus, hyperventilation, tachycardia, and metabolic acidosis 6. O/D Tx: 1. Activated charcoal if conscious w/bowel snds 2. 1 L of 5% D/W, 150-mEq of NaHCO3, and 40 mEq of KCl over 2.5hrs

Faulkner State Community College/Division of Nursing Clinical Medication Sheet Nursing 203 Student __Kenneth Smith II_ Clients Initials __RG____ Clinical Week __7______ Class __NUR 203__________

Drug: Acetylsalicylic Acid, Aspirin Dose: 300 mg Route : Rectal Max 24hr dose: 3,900mg

Half-life: 15 to 20min
Frequency: Daily Rationale for client:

prophylactic against thrombus

Functional Class: nonopioid analgesic, nonsteroidal antiinflammatory, antipyretic, antiplatelet Chemical Class: salicylate Action: inhibits cyclooxygenase there by inhibiting the formation of prostaglandin and thromoxane A2, acts on the hypothalamus to reverse pyresis, dilates peripheral blood vessels

Side-Effects: CNS: seizures, coma Hema: leucopenia, Thrombocytopenia Integ: rash GI: n/v, GI bleeding, hepatitis EENT: angioedema, Reye Syndrome, Tinnitus Contraindications: hypersensitivity, GI bleeding, bleeding disorders

1. Labs: PT, INR, LFP, BUN, Creatinine, Salicylate, Pltts 2. Salicylate levels > 400 will have sever toxic effects 3. Stop use 5-7 days before surgery [Per MDO] 4. Irreversible inhibits platelet aggregation 5. O/D S/S: tinnitus, hyperventilation, tachycardia, and metabolic acidosis 6. O/D Tx: 1. Activated charcoal if conscious w/bowel snds 2. 1 L of 5% D/W, 150-mEq of NaHCO3, and 40 mEq of KCl over 2.5hrs

Faulkner State Community College/Division of Nursing Clinical Medication Sheet Nursing 203 Student __Kenneth Smith II_ Clients Initials __RG____ Clinical Week __7______ Class __NUR 203__________

Drug: Reglan, Metoclopramide Dose: 10 mg/D5W or NS


Max 24hr dose: 0.5 mg/kg

Rate: 2mL/2mins Route: IV Frequency: AC & at bedtime x 3 doses Rationale for client: Prevention of GERD

Functional Class: Cholinergic, antiemetic Chemical Class: dopamine D2 antagonist Contraindications: Hypersensitivity, Seizure disorder, pheochromocytoma, breast cancer

Side-Effects: CNS: sedation, fatigue, restlessness, headache, sleeplessness, dystonia, seizures, suicide ideation, neuroleptic malignant syndrome, tardive diskinesia Hema: neutropenia, leukopenia, agranulocytosis, thrombocytopenia

1. Assess mental status: depression, anxiety, irritability 2. Monitor for tardive diskinesia, EPS, NMS 3. Labs: CBC for neutropenia, leukopenia, thrombocytopenia and agranulocytosis 4. Hold and call MD if Pltts are < 150

Action: response to dopamine gastric smooth muscle, which causes contraction of gastric muscle, relaxes pyloric, duodenal segments; increases lower esophageal sphincter pressure and improves acid clearance from the esophagus by increasing amplitude of esophageal peristaltic contractions.
Drug: Nitroglycerin/ nitro-dur Dose: 1/0.4mg Route: Topical Frequency: Q6hr/ hold if on drip Rationale for client: Chest pain Chem class: Nitrate Functional class: Vasodilator Action: Increase blood flow to the coronary arteries, improving collateral flow to ischemic regions. Decrease L Ven preload, and reduces myocardial O2 need Side-Effects: CNS: dizziness, HA, weakness CV: hypotension, tachycardia Integ: dermatitis(patch) GI: abd pain EENT: blurred vision Contraindications: pericardial tapenade

1. Assess angina pain, monitor BP 2. May increase cholersterol level falsely, and increase urine catacholamines concentration
3. HYPOTENSION = FALL RISK teach Pt rise slowly when positions.

Faulkner State Community College/Division of Nursing Clinical Medication Sheet Nursing 203 Student __Kenneth Smith II_ Clients Initials __RG____ Clinical Week __7______ Class __NUR 203__________ Drug: Famotidine (Pepcid) Dose: 20mg
Max 24hr dose:

0.667/mg/kg/day Route: IV Frequency: Q 12 hr x 2; then PO Q 12hr Rationale for client: Prophylaxis against stress ulcers Drug: Mupirocin, Bactroban Dose: 1g Route: each nare/ topical Frequency: BID for 5 days Rationale for client: preventing infection

Functional Class: H2 histamine receptor antagonist Chemical Class: Action: Allows pepsin to remain at a stable level and decreasing gastric secretion by completely inhibiting histamine at H2 receptor site Functional Class: antiinfective Chemical Class: Grampositive bacteriostat isolated from Pseudomonas Fluorescens Action: inhibits the synthesis of bacterial cell wall

Side-Effects: CNS: head ache, dizziness CV: AV block, palpitation Hema: thrombocytopenia GI: cholestatic jaundice, liver enzyme abnormalities, vomiting, nausea, abd pain, anorexia, dry mouth Side-Effects: Integ: rash, uticaria, erythema, scaling Contraindications: hysensitivity

1. Monitor for: GI bleed, blood in emesis, thrombocytopenia, C/O cardiac s/s 2. Labs: ALT, AST, T Billi, Pltts, CMP 3. Hold and call MD if Pltts are < 150 Contraindications: hypersensitivity Assess for allergic reaction such as edema, dermatitis and
pruritus

Faulkner State Community College/Division of Nursing Clinical Medication Sheet Nursing 203 Student __Kenneth Smith II_ Clients Initials __RG____ Clinical Week __7______ Class __NUR 203__________

Drug: Hydrocodone, Lortab [contains 500 mg of Acetaminophen] Dose: 5 mg Route: PO Frequency: Q4hr Rationale for client: mildmoderate pain

Functional Class: antitussive, opioid analgesic Chemical Class: semisynthetic opioid Action: antagonizes opioid receptors in CNS to reduce pain, inhibits the release of nociceptive neurotransmitters such as substance P, GABA, dopamine, acetylcholine, and norepinephrine

Side-Effects: CNS: drowsiness, seizures CV: circulatory depression, cardiac arrest (in children), depressed-HR, Respirations, and BP GI: n/v, anorexia, constipation EENT: respiratory depression, pulmonary edema Contraindications: acne rosacea/vulgaris, Cushings, measles, perioral dermatitis, varicella, abrupt discontinuation, hypersensitivity to this product or benzyl hysensitivity
Side-Effects: CNS: drowsiness, dizziness, confusion, headache, sedation, euphoria CV: , shock, cardiac arrest Hema: thrombocytopenia GI: n/v, anorexia, constipation, cramps EENT: respiratory depression Contraindications: hypersensitivity, addiction, hemorrhage, bronchial asthma, increased intracranial pressure

1. Assess: CNS changes, allergic reactions 2. Antidote: naloxone 0.4-2mg Q2-3min; max of 10mg 3. Assess type, location, and intensity of pain 4. Assess therapeutic response: decreased level of pain 5. Assess bowel function routinely 6. HYPOTENSION = FALL RISK teach Pt rise slowly when positions.

Drug: Morphine Dose: 2-6 mg/mL Route: IV Frequency: PRN Q1hr Max Dose: up to 80mg/hr Rationale for client: breakthrough pain

Functional Class: opioid analgesic Chemical Class: alkaloid Action: antagonizes opioid receptors in CNS to reduce pain, inhibits the release of nociceptive neurotransmitters such as substance P, GABA, dopamine, acetylcholine, and norepinephrine

1. Assess: CNS changes 2. Allergic reactions 3. Monitor I&O: check decreased output, constipation 4. Antidote: naloxone or Narcan 0.4-2mg Q2-3min; max
of 10mg

5. Toxic levels: 200-5000 ng/mL 6. HYPOTENSION = FALL


RISK teach Pt rise slowly when positions.

Faulkner State Community College/Division of Nursing Clinical Medication Sheet Nursing 203 Student __Kenneth Smith II_ Clients Initials __RG____ Clinical Week __7______ Class __NUR 203__________
Drug: IMDUR/ Isosorbide Mononitrate Dose: 30mg Route: PO Frequency: Daily Rationale for client: Coronary Artery dilation/perfusion. Functional Class: Vasodilator Chem class: Glycerol/Nitrate Action: relaxes the vascular smooth muscle to dilate peripheral arteries and veins. It is active on veins than on arteries. Preload by the pooling of blood in veins. Afterload by dilating arteries thereby SVR. Side-Effects: CNS: dizziness, HA CV: Hypotension, syncope, bradycardia GI: N/V Contraindications: Volume depleted pt, R ventricular infarction, Hypertrophic cardiomyopathy

1. Assess: location of angina pain, and precipitating factors. 2. Monitor: BP, P, HR 3. Onset: Oral: 30-60 min 4. Half-life: 4 hours 8. use with sildenafil (Viagra) may precipitate acute hypotension, myocardial infarction, or death
5. HYPOTENSION = FALL RISK teach Pt rise slowly when positions.

Isosorbide Mononitrate Isosorbide Mononitrate

CO/COI

CVP

PAP

SVR

MAP

SV/SVI

Coronary Perfusion

Peripheral Perfusion

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