Exam 3 Blueprint
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Examine the side/adverse effects associated with administration of high ceiling loop diuretics.
Articulate the therapeutic uses associated with administration of high ceiling loop diuretics, thiazide diuretics, and potassium-sparing diuretics.
- Loop diuretics - edema related to HF, liver diases and nephritic syndrome.
- Thiazide diuretics -combination with ACE inhibitors to treat essentail HTN, edema to mild and moderate HF and hepatic/kidney disease
- Potassium sparing diuretics - edema related to HF and those at risk for hypokalemia because it spares K+, primary hyperaldosteronism.
Express understanding of the side/adverse effects associated with administration of potassium-sparing diuretics.
- Hyperkalemia - retaining potassium due to antagonist effect to aldosterone.
- Irregular menses
Correlate the medication effectiveness of durgs referred to as diuretics (high ceiling loop, thiazide, or potassium sparing).
- Weight loss - fluid is being excreted therby weight is lost
- B/P decreases - fluid volume is decreased thereby CO is decreased as well.
- Breath sounds are clear indicating there is no pulmonary edema.
- Peripheral edema will decrease.
Select appropriate therapeutic nursing interventions for patients receiving thiazide diuretics.
- Monitor B/P and teach to change positions slowly - orthostatic hypotension
- Obtain K+ baseline and monitor throughout therapy - hypokalemia.
- Teach patient to take in the morning - nocturia.
- Weight patient daily to evaluate effectiveness.
- Monitor cardiac status via telemetry.
- Teach to maintain adequate potassium intake.
Demonstrate understanding of the therapeutic uses associated with administration of osmotic diuretics.
- Intracranial/ocular pressure
- Cerebral edema
- Excretion of toxic substances
Specify therapeutic nursing interventions associated with administration of osmotic diuretics.
- Use a needle filter due to possible formations of crystals
- Obtainn usual diuretic baseline
- Monitor S/S of HF related to medication regimen.
Point out the contraindications/precautions associated with administration of phosphate binders.
- bowel obstruction
- Pregnancy and breast feeding
- Caution - GI disorders, GI surgery, and vitamin deficiency.
Recognize side/adverse effects of potassium supplements.
- Hyperkalemia - muscle cramps, numbness and tingling arrhythmias and decrease urine output.
- GI upsetness - diarrhea and esophageal ulceration.
Analyze appropriate therapeutic nursing interventions when administering potassium supplements.
- Monitor K+ levels and S/S of hyperkalemia.
- Monitor heart rhythm.
- Teach do not push medicaton and dilute liquid medication to prevent ulceration.
- Teach to avoid salt substitutes and excessive foods high in K+.
- Monitor IV site for redness and swelling.
- Monitor I & O.
Review side/adverse effects associated with administration of magnesium sulfate.
- Neuromuscular blockade and respiratory depression.
- Diarrhea - laxative effect.
- S/S of magnesium toxicity: RR<12/min, absent deep tendon reflex, urinary output < 20 ml/hr.
Apply understanding of therapeutic uses associated with administration of sodium bicarbonate.
- Acidosis r/t DM, cardiac arrest and vascular collapse.
- Salicylate overdose
Determine contraindication/precautions associated with administration of sodium bicarbonate.
Caution with HF, HTN, and kidney disease.
Summarize medication/food interactions associated with administration of calcium supplements.
- Glucocorticoid steroids reduce absorption of this medication
- Thiazide diuretics increase risk for hypercalcemia
- Digoxin and calcium may lead to severe bradycardia
- Tetracyclines and thyoid hormones absorption are decreased by this medication
- Do not mix calcium with phosphates, carbonates, sulfates, and tartrates.
Compare and contrast expected pharmacological actions of selective estrogen receptor modulators (SERMs) and Bisphosphonates.
- SERMS: bind to estrogen receptors to decrease bone resorption thereby slowing down bone loss, increasing lipid metabolism and blood coagulation. (note: does not affect endometrial lining of menstrual cycle)
- Biphosphonates: reduces osteoclast number and activity to to decrease bone resorption leading a decrease in Ca+.
Analyze side/adverse effects associated with administration of bisphosphonates.
- Musculoskeletal pain
- Visual disturbance
- Osteonecrosis of the jaw with IV infusion
- Hyperparathyroidism with high dose Diarrhea
Determine the expected pharmacological action associated with calcitonin-salmon
Decreases bone resorption by inhibiting osteoclast activity and increases Ca+, Na+ and phosphate by the kidneys.
ESSAY: List at least five therapeutic nursing interventions associated with the administration of bisphosphonates.
- Maintain upright 30 min after administration
- Instruct to take first thing in the morning with a full glass of water
- Instruct patient to avoid any Ca+ containing foods or antiacids
- Do not chew/suckmedication due to erosion
- Teach to perform weight bearing exercise to promote bone density
- Instruct to not take skipped dose
ESSAY: When administering Furosemide (Lasix), explain the rationale for the side/adverse effect of hypokalemia and list four nursing interventions associated with this specific side/adverse effect.
- The reason the patient is at risk for hypokalemia is because this medication works in the ascending loop of henle and therby it decreases absorption of sodium/chloride and excretion of potassium.
- i. Encourage the intake of potassium rich foods
- ii. Monitor potassium level (3.5 – 5.0 mEq/L)
- iii. Monitor EKG to detect electrolyte induced arrhythmias
- iv. Instruct S/S of hypokalemia such as weakness, thread pulse, hypotension and general muscle weakness and notify PCP if they appear.
ESSAY: Describe at least five therapeutic nursing interventions associated with IV administration of potassium supplements.
- Never give K+ bolus
- Set IV rate at 10 mEq/hr and no more than 40 mEq/L
- Discontinue IV if infiltration occurs
- Maintain precise I & O documentation to ensure adequate urine output at 30 mL/hr.
- Assess q 2 hrs IV site for phlebitis and irritation.
- Monitor telemetry for cardiac arrhythmias related to hyperkalemia.
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