NUR 119 Ch 59 Points

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NUR 119 Ch 59 Points
2013-09-21 13:31:50
Adult Pediatric Emergency nur119 points q1

Chapter 59: Adult and Pediatric Emergency Drugs
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  1. Oxygen is classified as a drug, because it can have both beneficial and adverse effects on the body, based on the amount and manner in which it is administered. Without oxygen, brain death begins within AAAA minutes. Oxygen is a first-line drug for all emergency situations. Ensure that the client’s airway and breathing are assessed to promote optimal oxygenation and ventilation.
    a. 6
  2. The foundation of care for cardiac emergencies is based on proper AAAA, performance of optimal cardiopulmonary resuscitation, or CPR, and application of electrical therapy according to established treatment algorithms and standards. Pharmacologic agents are used as adjuncts in synchrony with these efforts, when indicated, to enhance the likelihood of a successful outcome.
    oxygenation and ventilation
  3. Cardiac Disorders: The nurse should assist in gathering a AAAA, including all medications being taken by the client. If the client is unable to speak, a support person may provide this information.
    complete patient health history
  4. Cardiac Disorders: AAAA dilates coronary arteries and improves blood flow to an ischemic myocardium. The nurse must be aware that nitroglycerin in combination with drugs for erectile dysfunction causes profound hypotension when taken within a 24- to 48-hour period. This combination is therefore contraindicated.
  5. Cardiac Disorders: AAAA relieves pain, dilates venous vessels, and reduces the workload on the heart. The nurse must be aware that respiratory depression and hypotension are common adverse effects. This drug must be administered slowly and titrated carefully to achieve the desired therapeutic effects. The nurse will continue to closely monitor this client.
    Morphine sulfate
  6. Cardiac Disorders: AAAA acts to increase heart rate by inhibiting the action of the vagus nerve. Atropine sulfate is also used as an emergency drug to reverse the toxic effects of organophosphate pesticide and nerve agent exposure. The nurse will monitor the client continuously after administration of atropine. Significant adverse effects include cardiac dysrhythmias, tachycardia, myocardial ischemia, restlessness, anxiety, mydriasis, and urinary retention.
  7. Cardiac Disorders: Due to the potential for significant deleterious effects, AAAA is used only as a temporary measure while awaiting a transcutaneous pacemaker. It may also be used to treat bradycardia in clients with beta-blocker poisoning or after heart transplantation.
    isoproterenol infusion
  8. Cardiac Disorders: AAAA is the drug of choice to treat paroxysmal supraventricular tachycardia. The nurse will closely monitor the client after administration of adenosine. Though usually transient, ventricular ectopy, bradycardia, flushing, chest pain, and dyspnea may occur. In addition, a short period of asystole may follow injection of adenosine. Spontaneous cardiac activity typically resumes.
  9. Cardiac Disorders: AAAA is indicated for the treatment of narrow complex paroxysmal supraventricular tachycardia as an alternative to adenosine in clients with normal blood pressure and adequate left ventricular function. The nurse must carefully monitor heart rate and rhythm as well as blood pressure, because cardiac conduction disturbances and profound hypotension may occur.
  10. Cardiac Disorders: AAAA like BBBB, is administered to treat paroxysmal supraventricular tachycardia and to slow the ventricular response rate in atrial fibrillation or flutter. Diltiazem is less likely to cause cardiac depression and is very effective in controlling heart rate. The nurse must be aware that diltiazem can elevate serum digoxin levels, predisposing the client to digitalis toxicity.
    • a. Diltiazem
    • b. verapamil
  11. Cardiac Disorders: The intravenous form of AAAA is used for the treatment of life-threatening ventricular dysrhythmias and cardiac arrest. It has been found to be more effective and to have fewer proarrhythmic properties than other agents with similar actions. Significant adverse effects include hypotension and bradycardia. The nurse should slow the infusion rate to prevent or treat these effects and be prepared to administer intravenous fluids, vasopressors, and agents to increase heart rate. A temporary pacemaker may be needed.
  12. Cardiac Disorders: AAAA may be used to treat significant ventricular dysrhythmias as an alternative to amiodarone. Lidocaine exerts a local anesthetic effect on the heart, thus decreasing myocardial irritability. It is important for the nurse to continuously assess the client receiving lidocaine for signs and symptoms of lidocaine toxicity. Clients with hepatic impairment, heart failure, shock, and advanced age are at higher risk for toxicity. In these clients, the lidocaine dose may need to be reduced by as much as 50%.
  13. Cardiac Disorders: AAAA is used for ventricular arrhythmias. The nurse must monitor vital signs and the electrocardiogram with particular attention to heart rate and rhythm, as well as blood pressure and the width of the QRS complex. Procainamide administration can cause severe hypotension, heart block, rhythm disturbances, and cardiac arrest. The drug is eliminated via the kidneys; therefore, clients with renal failure are at higher risk of adverse effects and often require a lower dosage.
  14. Cardiac Disorders: AAAA may be used for refractory ventricular tachycardia, refractory ventricular fibrillation, cardiac arrest associated with hypomagnesemia, and life-threatening ventricular dysrhythmias from digitalis toxicity. It is also the drug of choice for the treatment of torsades de pointes.
    Magnesium sulfate
  15. Cardiac Disorders: AAAA is administered for profound bradycardia with hypotension, asystole, pulseless ventricular tachycardia, and ventricular fibrillation. Epinephrine increases the chances for successful electrical countershock in ventricular fibrillation.
  16. Cardiac Disorders: AAAA is prescribed to treat the metabolic acidosis that may accompany cardiac arrest and the hyperkalemia and acidotic states related to specific drug overdose situations.
    Sodium bicarbonate
  17. Intracranial Hypertension: AAAA is an osmotic diuretic used in emergency, trauma, critical care, and neurosurgical settings to treat cerebral edema and increased intracranial pressure. The nurse must be aware that mannitol is highly irritating to veins. The nurse should also carefully assess the client’s neurologic status; monitor laboratory studies, including serum osmolality; and keep accurate intake and output records to assess fluid volume status, because diuresis may be substantial.
  18. Poisoning: AAAA reverses the effects of all opiate drugs and is indicated for clients who have taken an overdose of opiate drugs, for clients with respiratory or cardiovascular depression from opiates given in a health care setting, and for those brought to the emergency department in a coma of unknown etiology. Because most opiate drugs have a longer duration of action than naloxone, the nurse must monitor the client closely for signs and symptoms of recurrent opiate effects such as respiratory depression and hypotension.
  19. Poisoning: AAAA is the reversal agent for benzodiazepine medication and may be used to counteract the effects of benzodiazepines given within the health care setting or intentional benzodiazepine overdose. Nursing considerations must include careful assessment of respiratory rate and effort, blood pressure, and mental status. If the benzodiazepine is reversed too rapidly, clients may have reactions in which they become agitated and confused and experience perceptual distortions. Because seizures are precipitated by benzodiazepine withdrawal, seizure precautions must be implemented for clients at risk and for those who have a known seizure disorder.
  20. Poisoning: AAAA may prevent the absorption of toxins into the body if the ingested substance is known to be affected by charcoal in the gastrointestinal tract. The nurse should use activated charcoal only in clients with an intact airway because there is high risk of vomiting and aspiration.
    Activated charcoal
  21. Shock: AAAA is used to treat hypotension in shock states not caused by hypovolemia. Dopamine may also be used to increase heart rate in bradycardic rhythms when atropine has not been effective. The nurse must be aware that significant vasoconstriction will occur at higher doses. The lowest effective dose of dopamine should be used. Also, clients must be weaned gradually from dopamine. The IV site must be assessed hourly for signs of drug infiltration; extravasation of dopamine can produce tissue necrosis that may necessitate surgical debridement and skin grafting.
  22. Shock: AAAA is indicated in shock states when improvement in cardiac output and overall cardiac performance is desired. The nurse must monitor intake and output and assess for any signs or symptoms of myocardial ischemia, such as chest pain or development of dysrhythmias.
  23. Shock: AAAA is an extremely potent vasoconstrictor that is used when other drugs have failed to produce adequate blood pressure. Like high-dose dopamine, the peripheral vasoconstriction that results has the potential to impair cardiac performance and decrease organ and tissue perfusion. Extravasation of norepinephrine causes tissue necrosis, so attention to the IV site is essential.
  24. Shock: AAAA is used to reverse bronchoconstriction in anaphylactic shock, asthma, and cardiopulmonary disorder, or COPD. In emergency situations, it is typically administered via nebulizer. The nurse should assess breath sounds before and after administration. Assessment of the client’s subjective feelings of respiratory distress before and after administration is especially important.
  25. Shock: AAAA is used for anaphylactic shock. Liquid diphenhydramine must be used when there is tissue edema in the mouth or throat.
  26. Shock: AAAA is given to treat insulin-induced hypoglycemia or insulin shock when the client’s state of consciousness is impaired such that oral administration of sugar solutions is contraindicated. The nurse must monitor the client’s blood sugar carefully; hyperglycemia is common, especially after rapid injection. Urine output should be accurately recorded, because osmotic diuresis can occur when blood sugar is elevated, and a hyperosmolar state can result.
    Dextrose 50%
  27. Shock: AAAA is indicated in the treatment of severe insulin-induced hypoglycemia or insulin shock. In an emergency when dextrose 50% is unavailable or cannot be administered intravenously, glucagon is an effective agent.
  28. Shock: AAAA stores in infants and children may be quickly depleted in stress states produced by severe illness. Because adequate amounts of glucose are essential to strong myocardial function, hypoglycemia must be corrected to provide the greatest chance for successful resuscitation. After determining that hypoglycemia is present by the fingerstick or heelstick method, dextrose 25% or less may be administered per physician order.
  29. Pulmonary Edema: AAAA inhibits the effects of the sympathetic nervous system and lowers heart rate, blood pressure, myocardial contractility, and myocardial oxygen consumption. It reduces the vasoconstriction that results from sympathetic nervous system stimulation. This agent is indicated for the acute management of clinically significant hypertension in the presence of ischemic and hemorrhagic stroke, as well as for hypertensive crisis.
  30. Pulmonary Edema: AAAA reduces arterial blood pressure in hypertensive emergencies. The nurse should be aware that nitroprusside sodium is rapidly inactivated by light; the IV bottle or bag must be wrapped with aluminum foil or another opaque material to protect the solution from degradation. Although a faint brown tint is typical, blue or brown discoloration of the solution indicates degradation and necessitates that the solution be discarded. When nitroprusside sodium therapy is prolonged, clients are at risk for toxicity resulting from elevated serum thiocyanate or cyanide levels. Serum thiocyanate levels should be monitored every 24 to 72 hours for clients receiving prolonged infusion.
    Nitroprusside sodium
  31. Pulmonary Edema: AAAA promotes the renal excretion of water, sodium, chloride, magnesium, hydrogen, and calcium; it depletes potassium. Furosemide also has peripheral and renal vasodilating effects that can lower blood pressure. The client’s fluid and electrolyte status must be carefully assessed before and after furosemide administration, including auscultation of breath sounds for rales, strict surveillance of intake and output, and review of laboratory data when available. An indwelling urinary catheter might be necessary. Electrolyte and fluid replacement may be required during furosemide therapy to prevent physiologic consequences. The nurse must also exercise caution in administering the drug to clients with sulfonamide sensitivity, because furosemide is a sulfonamide derivative and can produce an allergic reaction.