Take-home Quiz 5. 1 Renal and Respirator Chapter 28 Diuretic Drugs Drug FAMILY PROTOTYPE DRUG LOCATION ON NEPHRON PHYSIOLOGIC EFFECT, e. g. reabsorption of Na++ Typicallly USED FOR EFFECT ON H2O Na++ K+ Cl- Mg+ + Ca+ Drug interactions (food or drug) Loop Furosemide thick ascending loop of Henle Blocks Na Cl REABSORPTION EDEMA FROM liver, heart or kidney failure Decrease K+ Ca and Na Amino-glycosi des Vancomycin corticosteriod Digoxin Thiazide Indapamide distal convoluted tubule Inhibit reabsorption of Na, Cl, K+ Hypertension Increase K+ LOSS CORTICOSTERIODS diazoxide, digoxin, oral hypoglycemics Licorice Carbonic.
anhydrase inhibitors Acetazolamide proximal convoluted tubule Reduces available hydrogen ions CHF Seizures, glaucoma, altitude sickness High H2O NaCl Na+ loss ASA Primidone Cyclosporine Diflunisal Lithium Potassium SPARRING TRIAMTERENE DISTAL convolulted tubule Interferes with sodium/potassium exchange CHF edema, cirrhosis of liver, nephrosis May cause high K+ levels ACE inhibitors Insulin, hypoglycemic meds, Lithium, NSAIDs Osmotic Mannitol Proximal tubule and acts on entire nephron increases osmotic pressure forcing H20 into the kidneys acute renal failure, ICP, head trauma, intraocular pressure slight loss.
OF NA NONE Chapter 29 Fluids and Electrolytes Fluid/Electrolyte Condition Normal Range Signs and Symptoms Hypovolemia – an emergency condition in which severe blood and fluid loss. When this happens, the heart is unable to pump enough blood to the body. Hemoglobin – male: 14-18 g/dL female: 12-16 g/dL pregnant female: >11 g/dL Elderly: values are slightly decreased. Acute weight loss, decreased skin turgor, oliguria (decreased urine output), concentrated urine, weak, rapid heart rate, increased thirst, clammy, pale skin, anorexia, nausea, muscle Take-home Quiz 5. 1 Renal and Respirator Newborn: 14-24 g/dL.
0-2 weeks: 12-20 g/dL 2-6 months: 10-17 g/dL 6 months- 1 year: 9. 5-14 g/dL 1-6 years: 9. 5-14 g/dL 6-18 years: 10-15. 5 g/dL hematocrit – male: 42-52% female: 37-47% pregnant female: >33% elderly: values may be slightly decreased newborn: 44-64% 2-8 weeks: 39-59% 2-6 months: 35-50% 6 months-1 year: 29-43% 1-6 years: 30-40% 6-18 years: 32-44% RBC – Male: 4. 7-6. 1 Female: 4. 2-5. 4 Newborn: 4. 8-7. 1 2-8 weeks: 4. 0-6. 0 2-6 months: 3. 5-5 6 months-1 year: 3. 5-5. 2 1-6 years: 4. 0-5. 5 6-18 years: 4. 0-5. 5 BUN- Adult: 10-20 mg/dL Elderly may be slightly higher than those of adult. Child: 5-18 mg/dL.
Infant: 5-18 mg/dL Newborn: 3-12 mg/dL Cord: 21-40 mg/dL weakness, cramps. Hyperkalemia – an abnormally high potassium concentration in the blood, most often due to defective renal excretion but can also be caused by excessive dietary potassium or certain Potassium – Adult/elderly: 3. 5 – 5. 0 mEq/L Child: 3. 4-4. 7 mEq/L Infant: 4. 1-5. 3 mEq/L Newborn: 3. 9-5. 9 mEq/L Peaked narrow T waves on cardiac monitor or EKG, tachycardia but may lead to bradycardia, skeletal muscle weakness, intestinal colic, cramps, abdominal distention.
Take-home Quiz 5. 1 Renal and Respirator drugs, such as potassium-sparing diuretics or ACE inhibitors. Hypokalemia – a condition in which there is inadequate amount of Potassium – potassium, the major intracellular cation, in the bloodstream. Adult/elderly: 3. 5 – 5. 0 Fatigue, anorexia, nausea, vomiting, ileus, muscle weakness, leg cramps, mEq/L Child: 3. 4-4. 7 mEq/L Infant: 4. 1-5. 3 mEq/L Newborn: 3. 9-5. 9 mEq/L dysrhythmias. Hyponatremia – a condition in which there is an inadequate amount of sodium, the major extracellular cation, in the bloodstream, caused either by inadequate excretion of water or by excessive water intake. Sodium – Adult/elderly: 135-145 mEq/L Child: 136-145 mEq/L.
Infant: 134-150 mEq/L Newborn: 134-144 mEq/L Coma, seizure, extreme thirst, dry and flushed skin, dry and sticky tongue, dry mucous membranes, postural hypotension, fever, agitation, convulsions, restlessness, irritability. Hypomagnesemia – deficiency of magnesium in blood. Magnesium – Adult: 1. 3-2. 1 mEq/L Child: 1. 4-1. 7 mEq/L Newborn: 1. 4-2 mEq/L Cardiac dyrhythmia, muscle tremors, hyperactive deep tendon reflexes, confusion, disorientation, tachycardia, hypertension, positive signs for Chvostek’s and Trousseaus (facial muscle contraction).
Hypocalcemia – deficiency of calcium in blood. Calcium (Total)–
<10 days: 7. 6-10. 4 mg/dL Umbilical: 9. 0-11. 5 mg/dL 10 days-2 years: 9. 0-10. 6 mg/dL Child: 8. 8-10. 8 mg/dL Calcium (Ionized)- Newborn: 4. 2-5. 58 mg/dL 2 months-18 years: 4. 8-5. 52 mg/dL Adult: 4. 5-5. 6 mg/dL Laryngospasm, cardiac dysrhythmias, numbness and tingling of fingers and around the mouth, hyperactive reflexes, positive Trousseaus sign, positive Chvostek’s sign, facial muscle contraction, muscle cramps, pathological fractures. Hypochloremia – electrolyte disturbance in which there is an abnormally Chloride – Adult/elderly: 97 – 106 mEq/L Coma, seizure, extreme thirst, dry and flushed skin,
dry and sticky tongue, dry Take-home Quiz 5. 1 Renal and Respirator low level of chloride in the blood. Child: 90-110 mEq/L Newborn: 96-106 mEq/L Premature infant: 95-110 mEq/L mucous membranes, postural hypotension, fever, agitation, convulsions, restlessness, irritability. 3. ) How do the “traditional” antihistamines differ from the “new generation” antihistamines? List the drugs identified in the chapter under whether it is traditional or “new-generation”? Traditional antihistamines are older drugs that work both in the peripheral and central nervous system therefor causing sedating effects.
The new second generation of antihistamines are considered non-sedating as their mechanism of actions usually only works in the peripheral system. The second generation drugs usually do not cause sedating effects but it’s possible they may act on the central nervous system therefor a side effect could include sedation but it happens very rarely (Lilley, 2014). Nonsedating antihistamines: Loratadine, cetirizine, and fexofenadine. Traditional antihistamines: Diphenydramine, brompheniramine, chorpheniramine, dimenhydrinate, meclizine, and promethazine. 4. ) Write a brief but specific case study for two of th following patients. Develop a
nursing diagnosis, goals, outcome criteria, drug interactions/cautions as well as therapeutic levels of drugs for each patient. a. 82 year old who will be taking theophylline An 82 year old non-smoking female patient arrives at the emergency room with COPD exacerbation stating she has not been compliment with her COPD management treatments because they make her feel sick to her stomach. Her oxygenation is at 90% and respiratory rate 22 respirations per minute.
Nursing diagnosis: Noncompliance with the medication treatment related to adverse side effects of drug therapy as evidenced by client stating they make her feel sick to her stomach. Goals: Patient will remain compliant with the drug treatment. Patient will experience improved gas exchange.
Outcome criteria: Take-home Quiz 5. 1 Renal and Respirator Patient re-states the importance of taking the medication as prescribed within one day. Patient takes medications as prescribed to improve oxygenation and prevent exacerbation of symptoms within on day. Patient shows evidence of improved oxygenation levels with a SpO2 greater than or equal to 95% within 1 hour. Drug interactions and cautions: Allopurinol, cimetidine, macrolide antibiotics, quinolones, influenza vaccine, and oral contraceptives (Lilley, 2014, p. 595).
Contraindicated in patients with dysrhythmias, CHF, seizure disorders, hypertension and peptic ulcers (Skidmore-Roth, 2013, p. 1023). Coffee, cola nut, guarana, ma huang, black tea, and yerba mate increases toxicity. St. John’s wort: decreases theophylline level (Skidmore-Roth, 2013, p. 1024). Therapeutic range: 10-20 mcg/ml (Lilley, 2014, p. 596). 1. 15 cg/mL (Skidmore-Roth, 2013). 4 b. ) 4 year old child who will be taking albuterol by inhaler. Nursing DX : Deficient knowledge r/t unfamiliarity with the medication treatment regimen and the disease process. Goals:
•Child’s parent is compliant with the medication regimen and with non-pharmacologic therapies. •Child’s parent follows up with health care providers as instructed by the prescriber. •Child and parent properly demonstrate use of inhaler. •Child’s circulation remains intact and strong during therapy. Outcome criteria: •Child’s parent briefly describes disease process, signs and symptoms, and precipitating factors before discharge. •Child’s parent states the expected adverse effects of the drug being used such as palpitations, nervousness, mood changes, and insomnia after Take-home Quiz 5. 1 Renal and Respirator education is complete.
•Child’s parent states the importance of giving the medication as prescribed and reasons for not increase or decreasing dosage before discharge. •Child’s parent understands what to look for that indicate poor perfusion/circulation, such as palpitations, chest pain, swelling of the feet, bluish discoloration of the nail beds and/or lips, and coolness of the extremities before discharge. Drug interactions/cautions: 1. Child should avoid caffeine with the use of albuterol to avoid additive sympathomimetic effects. 2. MAOI’s should not be taking with albuterol as well as other sympathomimetics (Increased risk for hypertension).
3. Diabetic patients need possible dosage adjustments with hypoglycemic drugs. 4. Overdose or excessive use may cause symptoms such as palpitations, tremors, increased heart rate, nausea, and anxiety and need to be observed for. Therapeutic effects: Albuterol shows proper therapeutic effects if bronchospasm symptoms decrease and breathing easily increases. Chapter 37 Respiratory Drugs: Drug Category Prototype Drug(s) Indications (primary use) How they work Outcomes Administra tion Teaching Short-Acting B2 agonists (SABA).
Albuterol, metaproter enol, Levalbutero l, pirbuterol, terbutaline ephedrine, epinephrin e, Asthma, bronchospa sm “Raise intracellular levels of cyclic adenosine monophosph ate, which produces smooth muscle relaxation and dilates the constricted bronchi and bronchioles” Dilation of the airways PO, inhalation , IM, IV Take-home Quiz 5. 1 Renal and Respirator (Lilley, p. 591). Long Acting B2 agonists (LABA) Salmeterol (Severent), formoterol (Foradil, Perforomist ), arformoter ol (Brovana) Asthma, COPD Causes bronchodilati on by B2 receptors by increasing levels of cyclic AMP, which relaxes smooth muscle. Ease of breathing Inhalation Anticholiner gic Bronchodilat ors Ipratropium (Atrovent), tiotropium (Spiriva) COPD, rhinorrhea.
“Block cholinergic receptors, thus preventing the binding of cholinergic substances that cause bronchoconst riction and increase secretions” (Lilley, p. 591). Bronchodilati on Ipratropiu m is available as a liquid aerosol for inhalation and as a multidose inhaler. Tiotropium is formulated for once-daily dosing. Xanthine Derivatives Natural xanthines: plant alkaloids caffeine, theobromin e, theophyllin e. Caffeine and theophylli ne are the only ones used clinically.
Synthetic xanthines: aminophylli ne Asthma, chronic bronchitis, or “Raise intracellular levels of cyclic adenosine monophosph ate, which produces smooth muscle relaxation and dilates the constricted bronchi and bronchioles” (Lilley, p. 591). Ability to breathe without difficulty PO Take-home Quiz 5. 1 Renal and Respirator emphysem a, bronchospa sm of COPD and dyphylline.
Corticosteroi ds Beclometh asone dipropionat e (Beclovent) , budesonide (pulmicort Turbuhaler) , dexametha sone sodium phosphate, flunisolide, fluticasone (Flovent), triamcinolo ne acetonide (Azmacort), ciclesonide (Omnaris) Prednisone Methylpred nisolone Severe inflammati on, immunosup presion, neoplasms, multiple sclerosis, collagen disorders, dermatolog ic disorders Decreases inflammation by increasing capillary permeability and lysosomal stabilization, minimal mineralocorti coid activity Decrease inflammation , decrease adrenal insufficiency Inhalation Oral IV/oral Leukotriene Antagonists (LTRAs) LTRA subclass 1 (indirect):
Zuleuton (Zyflo) LTRA subclass 2 (direct): Montelukas t (Singulair), and zafirlukast (Accolate) Asthma “Modify or inhibit the activity of leukotrienes, which decreases arachidonic acid-induced inflammation and allergen-indu ced bronchoconst riction” (Lilley, p. 591). Ability to breathe more easily PO Take-home Quiz 5. 1 Renal and Respirator Take-home Quiz 5. 1 Renal and Respirator References: Electrolytes S/S.
(n. d). Retrieved from http://quizlet. com/15509341/electrolytes-ss-flash-cards/ Kinney, K. (n. d). Hypovolemia/Hypervolemia. Retrieved from http://quizlet. com/15489064/hypovolemiahypervolemia-flash-cards/ Lilley, L. , Collins, S. , & Snyder, J. (2014). Pharmacology and the Nursing Process (7th ed. ). St. Louis, Missouri: Elsevier. Pagana, K. , & Pagana, T. J. (2013). Mosby’s Diagnostic & Laboratory Test Reference (Eleventh ed. ). St. Louis, Missouri: Elsevier. Potter, P. a. (2013). Fundamentals of Nursing. St. Louis: Elsevier MOSBY. Skidmore-Roth, L. (2013). Drug Guide for Nusing Students . St. Louis : ELSEVIER Mosby .