NR 293 Final Exam Study Guide With Exam 1 and 2 review at the bottom

NR 293 Final Exam Study Guide 2023/2024 *** NEED TO KNOW 1. Sildenafil Nitrates contraindicated with sildenafil (Viagra). Use of the erectile dysfunction drugs Sildenafil (Viagra). Sildenafil (Viagra)*** o First oral drug for treatment of ED o Causes relaxation of the smooth muscle in the corpora cavernosa (erectile tubes) of the penis and permits the inflow of blood. o Sildenafil contraindicated in men with major cardiovascular disorders, especially if they use nitrate medications such as nitroglycerin*** - it can cause severe hypotension. 2. EC aspirin education *** Ask students: What is Enteric-coated aspirin mean? When a medication is EC or Enteric-coated is to prevent the breakdown in the stomach. *** Patient education: avoid giving children under the age of 18 Aspirin. Reye’s Syndrome (Acute and potentially life-threatening condition involving progressive neurologic deficits that can lead to coma and may also involve liver damage). Crushing the pill destroys that protection and can cause stomachache or indigestion. Enteric coated aspirin is best taken with 6 to 8 ounces of water and with food to help decrease GI upset - to avoid irritation to the esophagus instruct the patient to remain upright and not lie down for up to 30 mins after taking the aspirin ** if it has a strong vinegar like odor then discard (page 422) - enteric coated is not to be crushed or broken - instruct patient to report any ringing in the ears, persistent GI or abdominal pain, or easy bruising and/or bleeding (page 691) 3. Bumetanide ***Bumetanide report hearing loss; ototoxicity ***Bumetanide: is a high-ceiling loop diuretic. ***High-ceiling diuretics can cause ototoxicity. Patient education about the possible hearing loss and to notify their medical provider with a tinnitus or hearing loss NOTE: Bumetanide is a strong diuretic ('water pill') and may cause dehydration and electrolyte imbalance. (LOOP DIURETIC) 4. Furosemide X 10 (questions) ***Hypokalemia is an adverse effect of Furosemide ***Best source of Potassium is Bananas; 1 cup contains ~ 806 mg of Potassium (K+) ***Patient education. If a patient is prescribed K+ 20 mEq extended-release medication. The patient needs to take the pill whole as it is an extended release. Patient needs to avoid crushing, breaking, or chewing the medication. *** Loop Diuretics; Dietary teaching- provider will include K on their diet; Instruct patient to consult health care professional regarding a diet high in potassium *** know Lasix- dietary - While you don't have to avoid any specific food when you are taking furosemide, your doctor may prescribe a low-sodium or low-salt diet. He also may recommend that you add plenty of potassium-rich foods and beverages to your diet, such as bananas, raisins and orange juice; he also may prescribe a potassium supplement. ***Compute Lasix IV’s Additional NOTES: Pt is taking furosemide, what dietary thing do they need to increase while taking this drug and what should we tell them to eat o Increase potassium and eat bananas Pt has heart failure and they have been given furosemide. What lab levels would you monitor o Potassium bc it is a loop diuretic that depletes potassium o Watch for hypokalemia Nursing/Patient Teaching Food high in potassium include bananas, oranges, dates, apricots, raisins, broccoli, green beans, potatoes, meats, fish, and legumes. Patients taking diuretics along with a digitalis preparation should be taught to monitor for digitalis toxicity (Bradycardia, HA, dizziness, confusion, nausea, and visual disturbances - Gastrointestinal: anorexia, nausea, vomiting, diarrhea). Patients with diabetes mellitus who are taking thiazide or loop diuretics should be told to monitor blood glucose and watch for elevated levels. Teach patients to change positions slowly and to rise slowly after sitting or lying to prevent dizziness and fainting related to orthostatic hypotension. Encourage patients to keep a log of their daily weight. Patients who have been ill with nausea, vomiting, or diarrhea should notify their primary care providers because fluid and electrolyte imbalances can result. Signs and symptoms of hypokalemia include muscle weakness, constipation, irregular pulse rate, and overall feeling of lethargy. Remind patients to return for follow-up visits and lab work. Instruct patients to notify their primary care providers immediately if they experience rapid heart rates or syncope (reflects hypotension or fluid loss). Excessive consumption of licorice can lead to additive hypokalemia in patients taking thiazides. Monitor for adverse effects: ● Metabolic alkalosis, drowsiness, lethargy, hypokalemia, tachycardia, hypotension, leg cramps, restlessness, decreased mental alertness Monitor for hyperkalemia with potassium-sparing diuretics. Monitor for therapeutic effects: ● Reduction of edema ● Reduction of fluid volume overload ● Improvement in manifestations of HF ● Reduction of hypertension ● Return to normal intraocular pressures 5. Medication Calculations: 3 Questions 6. Potassium Chloride Just Got this in the book. A patient has been given a new order for spironolactone (Aldactone), 50 mg daily. While reviewing the patient’s orders, the nurse notes that the patient has an existing order for potassium chloride (K-Dur), 20 mEq daily. The patient’s potassium level is 4.0 mEq/L. What is the nurse’s priority action at this time? Answer: Normal 3.5-5.5 mEq/L Spironolactone (Aldactone) is a potassium-sparing diuretic, meaning that the patient’s potassium levels may increase. At this time, the patient’s potassium level is within normal limits, but taking the potassium supplement with the spironolactone may cause a dangerous rise in potassium levels. The priority action will be for the nurse to contact the prescriber to clarify the orders and to hold the potassium dose until the orders have been clarified. In addition, the patient’s potassium level will need to be monitored regularly. A Potassium supplement. For treatment and prevention of potassium depletion commonly found in diuretic therapy. Also used for arrhythmias occurring with digoxin toxicity. Adverse reactions/side effects: Confusion, weakness, arrhythmias, ECG changes, GI disturbances. Important to infuse SLOWLY through IV infusion pump. 7. Sucralfate X 2 Questions ***Sucralfate: needs to be taken on empty stomach. 1 hour before each meal and at bedtime to form a protective layer over the gastric ulcer. What is sucralfate? o Antiulcer medication so it coats the stomach and protects the ulcers for healing What is the therapeutic effect of sucralfate? o Pt reports relief of abdominal pain Sucralfate: may delay the absorption of PPIs Cytoprotective drug Used for stress ulcers, peptic ulcer disease Attracted to and binds to the base of ulcers and erosions, forming a protective barrier over these areas Protects these areas from pepsin, which normally breaks down proteins (making ulcers worse) 8. Docusate stool softening emollient laxatives- used to treat constipation, soften fecal impactions, and prevent opioid induced constipation page 802-803 Docusate does not cause patients to defecate; it simply softens the stool to ease its passage. In addition to the docusate salt formulations, combination products are also available. Docusate use is contraindicated in patients with intestinal obstruction, fecal impaction, or nausea and vomiting. Onset: 1-3 days 9. Omeprazole ***The PPIs: the overall therapeutic effect is decreased Dyspepsia (Heartburn, indigestions, or acid stomach) Additional NOTES: Why would we give omeprazole to pt. What does it do? o Reduces gastric secretion and helps heal duodenal/gastric ulcers Pt has GERD and they are on omeprazole. What symptoms would we want to monitor? o Diarrhea (C. diff) 10. Cimetidine X 2 Questions • ***Drug-to-drug interaction: Cimetidine inhibits drug-metabolizing enzyme in the liver and may lead to increased blood levels and cause toxicity; for example, Theophylline (may need to decrease the dose), beta-blockers, calcium channel blockers. • ***Cimetidine can be taken with or without foods. Foods can slow the rate of absorption of the cimetidine and prolong the effects. • ***Eating 5 to 6 small meals per day can enhance the therapeutic effects of Cimetidine. Additional Notes: Pt has duodenal ulcer and is taking cimetidine and theophylline. What instruction should be included o Reduce theophylline dosage 11. Esomeprazole ***The PPIs: the overall therapeutic effect is decreased Dyspepsia (Heartburn, indigestions, or acid stomach) ***Esomeprazole and any PPIs are at risk for Pneumonia due to the elevation of the gastric pH, and especially during the first few days of treatment. Patient teaching: S&S of respiratory infections and need to notify the medical provider. 12. Bisacodyl ***•Senna is contraindicated in bowel obstruction, fecal impaction, or ABD (abdominal) surgery to prevent perforation. The bowel doesn’t allow for any passage of stool passage, therefore, giving any laxative stimulants will on cause worsening ABD cramps and discomfort. ***•How to administer Bisacodyl suppository: after applying non-sterile gloves, lubricate the index finger, using a sterile water-soluble lubricating jelly, position patient on the lef t lateral side, and insert suppository just beyond internal sphincter, the apply gentle pressure to hold the buttocks together momentarily if needed to keep medication in place. ****•Stool softeners need to be taken with a full glass of water to decrease the risk of constipation. (LAXATIVES) Give bisacodyl with water because of interactions with milk, antacids, and juices. Patients should take all laxative tablets with 6 to 8 oz of water. A healthy, high-fiber diet and increased fluid intake should be encouraged as an alternative to laxative use. Long-term use of laxatives often results in decreased bowel tone and may lead to dependency. All laxative tablets should be swallowed whole, not crushed, or chewed, especially if enteric coated. Inform patients to contact their prescribers if they experience severe abdominal pain, muscle weakness, cramps, or dizziness, which may indicate possible fluid or electrolyte loss. Monitor for therapeutic effect. Bowel obstruction… laxatives… they would not pass it Fecal impaction they should not take laxative GI obstruction: antacids may stimulate GI motility when they are undesirable because of the presence of an obstructive process requiring surgical intervention. 13. Prostate Cancer (will review in class) Assess PSA level and perform digital rectal examination before beginning any drugs for treatment of prostate disease. • PSA: Prostate-Specific Antigen test. Level by age. 14. Cisplatin and bladder cancer *** Cisplatin: • Side effects: anemia as a result of myelosuppression (bone marrow suppression). Patient may need blood transfusion. • Lab monitoring: CBC Cisplatin (Platinol) - Treat solid tumors 15. Ciprofloxacin *** Patient education with when taking a Quinolone antibiotic; they need to report any tendon discomfort to the provider. This could be tendinitis and is at risk for tendon rupture.  Gram-negative bacteria such as Pseudomonas spp.  Anthrax (ciprofloxacin)  Interactions Oral quinolones: antacids, calcium, magnesium, iron, zinc preparations, or sucralfate  Patients need to take the interacting drugs at least 1 hour before or after taking quinolones. 16. Allopurinol *** Allopurinol: • PO or IV • Patient teaching: increase PO fluids up to 2 to 3 liters per day to prevent toxicity of the medication and decrease uric acid level. Furthermore, to prevent kidney stones • Monitor serum and urine uric acid levels; begin to decrease 2-3 days after therapy • Allopurinol is associated with the development of potentially life-threatening skin adverse effects of exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis