Exam 3 Blueprint

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Exam 3 Blueprint
2011-08-03 01:50:50

Meds affecting the Renal System
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  1. Examine the side/adverse effects associated with administration of high ceiling loop diuretics.
    • hypotension
    • ototoxicity
    • hypokalemia
  2. 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.
  3. Express understanding of the side/adverse effects associated with administration of potassium-sparing diuretics.
    • Hyperkalemia - retaining potassium due to antagonist effect to aldosterone.
    • Gynecomastia
    • Hirsutism
    • Irregular menses
  4. 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.
  5. 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.
  6. Demonstrate understanding of the therapeutic uses associated with administration of osmotic diuretics.
    • Glaucoma
    • Intracranial/ocular pressure
    • Cerebral edema
    • Excretion of toxic substances
  7. 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.
  8. Point out the contraindications/precautions associated with administration of phosphate binders.
    • bowel obstruction
    • hypophospatemia
    • Pregnancy and breast feeding
    • Caution - GI disorders, GI surgery, and vitamin deficiency.
  9. Recognize side/adverse effects of potassium supplements.
    • Hyperkalemia - muscle cramps, numbness and tingling arrhythmias and decrease urine output.
    • GI upsetness - diarrhea and esophageal ulceration.
  10. 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.
  11. 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.
  12. Apply understanding of therapeutic uses associated with administration of sodium bicarbonate.
    • Acidosis r/t DM, cardiac arrest and vascular collapse.
    • GERD
    • Salicylate overdose
  13. Determine contraindication/precautions associated with administration of sodium bicarbonate.
    Caution with HF, HTN, and kidney disease.
  14. 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.
  15. 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+.
  16. Analyze side/adverse effects associated with administration of bisphosphonates.
    • Esophagitis
    • Musculoskeletal pain
    • Visual disturbance
    • Osteonecrosis of the jaw with IV infusion
    • Hyperparathyroidism with high dose Diarrhea
  17. 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.
  18. 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
  19. 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.
  20. 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.