ATI Pharmacology Online Practice 2019 A Remediation Updated 2023/2024

ATI Pharmacology Online Practice 2019 A Remediation Psychosocial Integrity: substance use and Other Disorders and Dependencies 1. Opioid Agonists and Antagonist: Interventions for Heroin Toxicity a. Respiratory Depression: Monitor Respiratory rate prior and following admiration of opioids. Initial treatment of Respiratory depression and sedation is generally a reduction in opioid dose. If necessary, administer naloxone to reverse opioid effects b. An antidote, naloxone, available for IV use to relieve effects of toxicity c. Naloxone, and opioid antagonist, should be readily available for reversal of opioidincluded respiratory depression d. Administer naloxone and opioid antagonist that reverse respiratory depression and other manifestations of toxicity Pharmacological and Parenteral Therapies: Adverse effects/ contraindication, side effects, interactions, Expected actions/ outcomes, medication administration 1. Eye and Ear disorders: anticipating adverse Effects of anti-glaucoma medication a. Central nervous system disturbances i. Paresthesia of extremities, fatigue, sleepiness, rarely seizures 2. Emergency intervention following Cefazolin Administration a. Use current data to make informed clinical decisions to provide the best practice. Best practice is determined by current search collected from several sources that have desirable outcomes b. Use knowledge of evidence-based practice to guide prioritization of care and interventions; responding to clients experiencing wound dehiscence or crisis. For example, initiating CPR in the proper steps for a client experiencing cardiac arrest c. Methods to promote evidence-based practice i. Use a variety of sources of research ii. Keep current on new research by reading professional journals and collaborating with other nurses and professionals in other disciplines iii. Change traditional nursing practice with new research-based practices d. Provide rapid intervention including epinephrine administration for severe allergic reaction to prevent death. Notify the rapid response team if anaphylaxis is suspected e. Treat with epinephrine IM or IV to constrict blood vessels, improve cardiac contraction, and promote bronchodilation of the pulmonary system, every 5 to 15 minutes as needed 3. Adverse Effects of heparin a. Hemorrhage can occur if medication administration leads to high activated partial thromboplastin time. Other risk factors include client history of bleeding disorder or taking antiplatelet medications concurrently b. Nursing actions i. Monitor VS ii. Advise clients to observe for bleeding, increased heart rate, decreased blood pressure, bruising, petechial, hematomas, black tarry stools iii. Monitor activated partial thromboplastin time keep value at 1.5 to 2 times the baseline iv. If hemorrhage occurs, stop heparin administration. Check for toxicity and follow treatment protocols and discontinue other medications that affect coagulation as indicated 4. Antibiotics affecting protein synthesis; adverse effects of Gentamicin a. Ototoxicity i. Cochlear damage; hearing loss, vestibular damage; loss of balance b. Nursing action i. Monitor for tinnitus, headache hearing loss, nausea dizziness and vertigo ii. Do baseline audiometric studies; hearing test iii. Stop aminoglycoside if manifestation occur c. Client Education i. Notify the provider if tinnitus, hearing loss or headaches occur 5. Achilles tendon rupture a. Client education i. Observe for an report pain, swelling and redness at the Achilles tendon site ii. Stop taking ciprofloxacin and avoid exercise until the inflammation subsides 6. Adverse Effects of neostigmine a. As evidence by increased GI motility increased GI secretions, diaphoresis, increased salivation bradycardia and urinary urgency b. Nursing actions i. Advice the client of potential adverse effects, if effects become intolerable, instruct the client to notify the provider. ii. Treat severe adverse effects with atropine 7. NSAIDs; ibuprofen and celecoxib a. Concurrent use will increase renal reabsorption of lithium, leading to toxicity b. Nursing actions i. Avoid use of NSAIDs ii. Use aspirin as a mild analgesic 8. Heart failure, pulmonary edema a. Nursing Actions: if manifestations of heart failure develop; dyspnea, weakness, fatigue, distended neck vein, weight gain, stop the medication immediately and notify the provider 9. Sedation a. Client Education i. Medication has potential for sedation ii. Avoid activities that require alertness; driving 10. Documenting effectiveness of Filgrastim therapy a. Leukopoietic growth factors stimulate the bone marrow to increased production of neutrophils 11. Hepatotoxicity a. Can occur with many medications b. Because most medications are metabolized in the liver, the liver is particularly vulnerable to drug-induced injury c. Damage to liver cells can impair metabolism of many medications, causing medication accumulation in the body and producing adverse effects d. Many medications can alter normal values of liver function tests with no obvious clinical indications of liver dysfunction 12. Beta1 Blockade; Metoprolol, Propranolol a. Nursing Actions i. Monitor pulse, if below 50/min, hold medication and notify the provider ii. Use cautiously in clients who have diabetes mellitus. This medication can mask tachycardia, an early manifestation of low blood glucose. Advise clients to monitor blood glucose to detect hypoglycemia. 13. Cyclobenzaprine; physical dependence from long-term use a. Do not discontinue the medication abruptly 14. Methylprednisolone a. Grapefruit juice interferes with the metabolism of many medications, resulting in an increased blood level of the medication b. Hyperglycemia and glycosuria i. Clients who have diabetes should have their blood glucose monitored ii. Clients might need an increase in insulin dosage c. Infection i. Notify the provider if early manifestations of infection occur; sore throat, weakness, malaise ii. Avoid large crowds if possible iii. Practice proper hand hygiene 15. Heparin administration a. Administer deep subQ injections in the abdomen, ensuring a distance of 2 inches from the umbilicus. Do not aspirate i. Use a 20-22 gauge needle to withdraw medication from the vial. Them change the needle to a smaller needle (25 or 26 gauge, ½ to 5/8 inches long) ii. Apply gentle pressure for 1 to 2 min after the injection. Rotate and record injection sites b. Advise clients to use and electric razor for shaving and to brush with a soft toothbrush Physiological Adaptation: Fluid and Electrolyte Imbalances 1. Bone disorders a. Concurrent use of digoxin and parenteral calcium can lead to severe bradycardia i. IV injection of calcium must be given slowly with careful monitoring of client cardiac status 2. Vitamin and Minerals a. Sodium polystyrene sulfonate replaces sodium with potassium in the intestinal tract to promote potassium excretion b. Sorbitol induces a bowel movement to promote excretion of excess potassium c. Hyperkalemia i. Severe hyperkalemia can require treatment; calcium salt, glucose and insulin, sodium bicarbonate, sodium polystyrene sulfonate, peritoneal dialysis, or hemodialysis