Nclex Pharm Tips[1]

8/13/2019 Nclex Pharm Tips[1]

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A sign o) im"rovement )rom deydration #ould !e a decreased urine s"eci)ic gravity and adecreased8decreasing ematocrit. So te S o) 4.549 and a Hct o) :;< #ould !e te ans#er. Itis te !est ans#er o) te t#o you ad in you =uestion.Te normal urine S is 4.55>-4.5>9 2$sually !et#een 4.545-4.5?9 #it normal ydration andvolume3 2di))erent texts give a sligtly di))erent range3.S 4.5?9-4.5>5@ 2concentrated urine3S 4.554-4.545 2dilute urine3S 4.554-4.54 in in)ants under ? years o) ageS"eci)ic gravity is a measurement o) te ,idney6s a!ility to concentrate urine. Te range o) urine6sS de"ends on te state o) ydration and varies #it urine volume and te load o) solids to !eexcreted under standardied conditionsB #en )luid inta,e is restricted or increased+ Smeasures te concentrating and diluting )unctions o) te ,idney. (oss o) tese )unctions is anindication o) renal dys)unction.S values usually vary inversely #it amounts o) urine excreated 2decrease in urine volume Cincrease in s"eci)ic gravity3. Ho#ever in some conditions tis is not te case.

%% A**R%VIATI'NS'$- !ot eyes'R- rigt eye

'S- le)t eye

&$SHINS 2Hy"ersecretion o) Adrenal &ortex Hormones3

& C &ec, VS+ "articularly *P$ C $rinary out"ut E #eigt monitoringS C Stress ManagementH C Hig &H'N dietI C In)ection "recautionN C Na@ restriction C lucose E %lectrolytes MonitoringS C S"ousal su""ort

ADDIS'N6S 2Hy"osecretion o) Adrenal &ortex Hormones3Al#ays Remem!er te ; A6s o) Addison6s disease

4.3 Avoid Stress?.3 Avoid Strenuous>.3 Avoid Individuals #it In)ection:.3 Avoid 'T& meds9.3 A li)elong lucocorticoids Tera"y;.3 Al#ays #ear medic alert !racelet

Hirscs"rungFs diagnosed #it rectal !io"sy loo,ing )or a!sence o) ganglionic cells. &ardinal sign

in in)ants is )ailure to "ass meconium+ and later te classic ri!!on-li,e and )oul smelling stools.

Intussusce"tion common in ,ids #it &/. '!struction may cause )ecal emesis+ currant 7elly-li,estools 2!lood and mucus3. A !arium enema may !e used to ydrostatically reduce tetelesco"ing. Resolution is o!vious+ #it onset o) !o#el movements.

Git om"alocele and gastroscisis 2erniation o) a!dominal contents3 dress #it loose salinedressing covered #it "lastic #ra"+ and ,ee" eye on tem". 1id can lose eat =uic,ly.

A)ter a ydrocele re"air "rovide ice !ags and scrotal su""ort.


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No "enylalanine #it a ,id "ositive )or P1$ 2no meat+ no dairy+ no as"artame3.

Second voided urine most accurate #en testing )or ,etones and glucose.

Never give "otassium i) te "atient is oliguric or anuric.

Ne"rotic syndrome is caracteried !y massive "roteinuria 2loo,s dar, and )roty3 caused !yglomerular damage. &orticosteroids are te mainstay. eneralied edema common.

A "ositive Gestern !lot in a cild 4 monts 2"resence o) HIV anti!odies3 indicates only tat temoter is in)ected. T#o or more "ositive "?: antigen tests #ill con)irm HIV in ,ids 4 monts.Te "?: can !e used at any age.

/or HIV ,ids avoid 'PV and Varicella vaccinations 2live3+ !ut give Pneumococcal and in)luena.MMR is avoided only i) te ,id is severely immunocom"romised. Parents sould #ear gloves )orcare+ not ,iss ,ids on te mout+ and not sare eating utensils.

Hy"otension and vasoconstricting meds may alter te accuracy o) o? sats.

An antacid sould !e given to a mecanically ventilated "atient #8 an ng tu!e i) te " o) teas"irate is 9.5. As"irate sould !e cec,ed at least every 4? rs.

Am!ient air 2room air3 contains ?4< oxygen.

Te )irst sign o) ARDS is increased res"irations. (ater comes dys"nea+ retractions+ air unger+cyanosis.

Normal P&GP is -4>. Readings o) 4-?5 are considered ig.

/irst sign o) P% 2"ulmonary em!olism3 is sudden cest "ain+ )ollo#ed !y dys"nea and tacy"nea.

Hig "otassium is ex"ected #it car!on dioxide narcosis 2ydrogen )loods te cell )orcing

"otassium out3. &ar!on dioxide narcosis causes increased intracranial "ressure.

Pulmonary sarcoidosis leads to rigt sided eart )ailure.

An N tu!e can !e irrigated #it cola+ and sould !e taugt to )amily #en a client is going ome#it an N tu!e.

4.AMIODARONE HCL (CORDARONE3- monitor eart rate and rytm?.ENTACAPONE (COMTAN3 anti"ar,insonian+ May cause "otosensitivity so "rotect te eyesin sunligt>.ALMOTRIPTAN MALEATE (AXERT3- serotonin rece"tor agonist+ used to treat N'T to "reventmigraine eadaces:. PANTOPRAZOLE (PROTONIX3 do not crus te medication9. IBUPROFEN (MOTRIN3 !est given #it meals+ re"ort any sign o)!leeding;.CARBAMAZEPINE (TEGRETOL3- may cause !one marro#su""ression+ cec, te &*&+ Discontinue graduallyJ.GENTAMICIN/ TOBRAMYCIN- aminoglycosides+ cec, te "ea,249 to >5 minutes a)ter administration3 and troug levels 2 #itin an our !e)ore te next dose3 Itis !est monitored a)ter te tird or te )ourt dose.. ISONIAZID- "revents s"read o) T* a)ter ? #ee,s o) treatment+Kaundice indicates e"atotoxicity


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L.ZIDOVUDINE (AZT3- may decrease !lood com"onents+ cec, &*&45. GEMFIBROZIL (LOPID)- LOWERS CHOLESTEROL+ !est ta,enal) an our !e)ore meals.44. ROSUVASTATIN (CRESTOR)lo#ers (D( and HD(+ ec, teAST EA(T4?.PRAVASTATIN( Prava!"#)-re"ort unex"lained muscle "ain4>.SIMVASTATIN (ZOCOR3- lo#ers (D( and triglyceriede+ ave anannual eye exam4:.LOVASTATIN (MEVACOR3 lo#ers colesterol+ cec, te liver)unction tests49.PROPRANOLOL (INDERAL3-old te medication i) te eart rateis less ten 95 "er minute. Te drug may cause *R'N&H'SPASM4;.BUMETANIDE (BUMEX3 diuresis may cause "otassiumde"letion+ !est ta,en in te morning4J.AMNIODIPINE BESYLATE (NORVASC3- used to treaty"ertension+ cec, te *P4.CLOPIDOGREL ( PLAVIX)-re"ort any sign o) !leeding+ !estta,en #it meals4L.TICLODIPINE(T$#$%3- used to "revent stro,eB monitor )or signs o)!leeding and colestasis 27aundice+ dar, urine+ligt colored stools3?5.GLIPIZIDE (G#&"'r"#3- do not drin, #it alcool as it may #orsen

y"oglycemia+ !est ta,en >5 minutes !e)ore meals.?4.INSULIN GLARGINE (LANTUS3 long acting insulin+ N'T indicated )or dia!etic ,etoacidosis??.ROSIGLITAZONE (AVANDIA) IN&R%AS%S INS$(IN S%NSITIVIT+ may causee"atotoxicity?>.ACARBOSE (PRECOSE3- assess !lood glucose levels?:. Mecliine 2ANTIV%RT3- antiemetic+ used to treat te nausea resulting )rom vertigo+ it does nottreat vertigo directly.?9. ALUMINUM HYDROXIDE AND MAGNESIUM TRISILICATE2Rio"an3- antacid+ re"ort any sign o) !leeding?;. ESOMEPRAZOLE ( NEXIUM) used to treat %RD+ do notce#+ may !e ta,en #it oter antacids?J. TADALAFIL (C$a#$)-used to treat erectile dys)unction+ Do N'Tadminister to clients ta,ing Nitroglycerine as te drug com!ination may

cause )atal y"otension.?.FINASTERIDE (Pr"arPr"*+$a3- decreases te "rostate gland+"regnant #omen sould avoid contact #it te crused ta!let?L.RISEDRONATE (ACTONEL3 used to treat osteo"orosis andPagets disease+can !e ta,en #it vitD+ta,e #it a )ull glass o) distilled or "lainH?'>5.ALENDRONATE (F"a,a3- can !e ta,en #it vitamin D+ sould!e ta,en se"arately #it oter drugs. *est ta,en *%/'R% M%A(S #itGAT%R. Avoid orange 7uice+ tea or co))ee. R%MAIN $PRIHT A/T%RTA1IN TH% DR$>4. FLUOXETINE ( Pr".a3- te drug may ta,e >-: #ee,s !e)ore tetera"eutic e))ects !ecomes evident. It can "otentiate te e))ects o)0digoxin+ coumadin and valium.>?. B&*r"*$" (WELLBUTRIN3- used to treat de"ression and smo,ing+ cange "osition slo#ly+

contraindicated )or clients #itS%I$R%S.>>. RISPERIDONE(R$*+r%a#3-may cause agranulocytosis+ re"ort )ever and sore troat to te"ysician>:.PIROXICAM (F+#%++3- Avoid concurrent use #it ASPIRIN AND&'$MADIN+ may #orsen !leeding>9. CYCLOBENZAPRINE(FLEXERIL3- relives muscle s"asm+ avoid activities re=uiring alertness2avoid driving3>;. CROMOLYN SODIUM (INTAL3- treatment )or astma+ may cause diiness>J. TIMOLOL- used to treat glaucoma or ocular y"ertension


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>.THEOPHYLLINE(THEODUR3- used to treat astma+ !est ta,en onan em"ty stomac+ re"ort nausea + vomiting and insomnia+ do not crus enteric coated )orm.>L.CARBIDOPA/LEVODOPA(S$+,+') - avoid )oods ig in VIT.*;2#eat+ liver+ "or,3+ may decrease te a!sor"tion o) te drug:5.DIAZEPAM (Va#$&,)-must !e administered se"arately+ maycause dro#siness

Miotic gtts C (ittle Pu"ilMydriatic gtts C (arge Pu"il

MaH&a0o &NS Stimulanto &auses addictiono Gitdra#al sym"toms0 de"ression+ )atigue+ irrita!ilityo Git e"edra li,e e))ecto $sed to treat astmao &an cause #eigt losso Not given in"atients #it DM alters te !lood sugar levelC!a,",$#+o /or diarrea+ anti!acterial+antiviral

o &I0 *roncial astma+ anticoagulant tera"yCra1+rr2o /or $TI and astmao Not )or DMo Sa)e in "regnancyo $se #it caution in DME!$a+ao Immune system stimulanto Not used )or more tan 4: dayso Store it a#ay )rom direct ligto Not given in T* and cronic conditionsG$0+ro Antiemetic+

tx )or colic and )latulenceo Re"ort !leeding and &NS de"ressionG$+0o /atigue+ aterosclerosis+ de"ression+ &ao Re"ort ginseng a!use syndrome+ Diarrea+ nervousness+ edema+ insomniaG$03" B$#"1ao Im"roves !lood circulationo $sed in Aleimers Diseaseo &I "regnancy+ lactation and clotting d8oG"'& 4"vao Im"roves memoryo /or $TI+ sna,e !ites+ reumatismo &I0 "regnancy+ lactation and use o) sedatives

4AVAo Anxiety+ menstrual "ro!lem+ le"rosyo A%0 &NS de"ression+ e"atotoxicityo Not given to "ts #it anti"sycotic inc sedative e))ects o) drugsVALERIANo Tran=uilier+ sedativeo Not given #it valiumo $ses0 insomnia+ mm. s"asm


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DRUGSIr" S&**#+,+'-F+SO5&C Mineral Su""lement AnemiaHC Relie) o) )atigue 8 Inc strengt%C *est !e)ore meals+ a)ter meals i) #it I irritation&C ta,es e))ect a)ter ?->#ee,s+ Inc a!sor"tion #it orange 7uice1C %lixi)orm use stra#In7ecta!le trac, metod 2laterally stretc te s,in+ 45 seconds3S%0 &onsti"ation and !lac, stools

Antidote0 De)eroxamine H&( 2Des)eral3

RHOGAM&C Prevents RH sensitiationHemolytic reaction%C ?J-?#ee,s A'+ ideally J? rs a)ter delivery o) !a!y #it R 2@3 and 2 3&oom!Fs&C Pain in in7ection site1C &ec, &oom!s test only in

OXYTOCIN

P$'"$ M+'!+r0$+&C Induce (a!or &ontracts uterus a)ter "lacental deliveryIncrease )orce o) $terine contractionHC )irmly contracted uterus%C As "rescri!ed&C Re"ort "rolonged duration o) contraction1C Avoid0 *lue coos&ec, *Po Pitocin initially causes Hy"otension ten re!ound y"ertensiono Metergine initially causes Hy"ertension ten re!ound Hy"otension

TOCOLYTICS&C Relaxes te uterine mm. during "reterm la!or

contractions 8 relaxed uterusRitodrine H&l 2uto"ar3%C 'nset o) "reterm la!or&C Re"ort maternal tacycardiaHR O 4>5 Arrytmia1C Pre"are antidote Pro"anolol

Ma0+$&, Sa'+&C Anticonvulsant+ NS de"ressantSeiure%C As "rescri!ed PIH&C Re"ort MgS': intoxication Hy"otension+ y"ocalcemia and H8A1C &ec, *P+ urine out"ut+ RR+ Patellar re)lex i) Dec antidote &a luconate

Tera"eutic level0o (oading dose : J Me=8(o Maintenance 4.9 > Me=8(o De"ression o) DTR i) Me=8(o Dec RR i) 45 4? Me=8(

C"a0a'$" Pr"+Vit 1 de"endent clotting /actorsTrom!o"lastin /i!rinogen /i!rin 2clot3Protrom!in Trom!in


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&oumadin He"arin2'ral3 2In7ecta!le3&C Anticoagulant&lot )ormation%C 'nset0 ? 9 days 4- ?days&C Re"ort signs o) !leeding1C Avoid green lea)y Vegeta!le 2contains Vit 13

Avoid ard !ristle toot!rusAntidote0 Vit 1 Protamine Sul)ate(a!0 PT PTT

CHEMOTHERAPYCELL CYCLE5 MitosisInter"aseResting 4 S ? &ell divisionRNA "roduction DNA syntesis RNA syntesis

Al,alating Agents Antimeta!olitesAnti!iotic Plant Al,aloid HormonesInter)eres DNA E Ini!it DNA E Inter)eres DNA Inter)eres RNA

Re"lication RNA syntesis &T'QAN M%TH'TR%QAT% ADRIAM&IN 'N&'VIN TAM'QI/%N M$STAR%N 2antidote0 (eucoverin3 (%N'QAN%Malignant Hy"ertermia C ParlodelMuscle rigidity C Dantrolene+ Dantrium

Administer Valium se"arately C incom"ati!le #it any oter drugsAvoid 1AVA E VA(%RIAN C Inc Res" de"ressionAntide"ressants-Avoid &itrus 7uices Dec a!sor"tion o) medAvoid St. Kon GortAcute Mania C ive AntiPsycotic #it antimanic&C C!+3 $0 "6 '"$$'27Mild Moderate Severe4.9 Me=8( ?.9 Me=8( O ?.9 Me=8(

Tirst NauseaAtaxia AnorexiaH8A VomitingIrrita!ility Diarrea*eginning /ine and tremors &oarse and tremors

A!dominal &ram"s &oma Deat1C Monitor (itium (evel early morning 2!e)ore !rea,)ast3'ut "atient at least once a montDrug o) coice )or toxicity Diamox+ Mannitol &I04.3 Pregnancy?.3 (actation>.3 Renal /ailureDietary Modi)ication Inc Na 2;45 gm3 and Inc /luid 2 >( or more3

Acute Dose0 .9 4.9 Me=8(Maintenance0 .9 4.? Me=8(%lderly 0 not exceed 4.5 Me=8( due to "oor renal excretion

MUSCULOS4ELETAL DRUGS&C /ocus0 old Tera"ySu""resses ArtritisIn)lammation%C IM #ee,ly(ie su"ine )or 45 mins to "revent 'H


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&C &ec,0Signs o) StomatitisDermatitis $nusual *leeding $nusual *ruising/everSore Troat1C Monitor Renal /unction Test

&C ANTIIN/(AMMAT'RI!u"ro)en As"irin2NSAIDFs3

AntiIn)lammatoryAnti"yreticAnalgesic/or RA E 'A AntiPlatelet aggregate

AntireumaticIn)lammation+ "ain+ RA )ever+ "latelet aggregation%C "c a)ter meals&C Re"ort0Visual distur!ances Ringing in te ears

Allergy Nausea E VomitingSore troat Ra"id !reating

/ever Hy"er"nea toxicity*lac, Stool1C Annual eye exam&ec, !leeding time

&C ANTI'$T A%NTSPro!enecid &olcicine Allo"urinol

Acute &ronic2-4?rs3 24>#ee,s3%xcretion o) u.a. Prevent de"osition o) u.a. Prevent )ormation o) u.a.

Antiin)lammatoryHC Decrease uric acid%C iven #it )ood

&C NAVDA *ruising H8A+ dro#sinessAllergy Agranulocytosis1C Inc )luid inta,e ? > (8day/re=uently cec, serum uric acid level

&ARDIA& DR$SNITRAT%

A. NitroglycerineSu!lingualTransmucosal C !et#een gums+ cee,s and li"s*. IsordilSustained release+ #it #ater and donFt crusPatc

Nasal S"ray&C &ardiac drug 2Nitrate3Dilate coronary arteries and arterioles Dec "reload Anginal Pain% C ive !e)ore onset o) "ain> Q at 9 mins intervalA)ter 49 mins 2 @ 3 "ain re"ort May indicate MI&C 4. 'intment C &over #it "lastic and "ut adesive ta"e?. Patc C Non Hairy"art>. 'ral s"ray C > s"rays in 49 minsS.%. /acial )lusing+ H8A+ Hy"otension1C Rise slo#ly to "revent 'H


9/39

Ta!let on dry+ dar, container+; monts Discard*urning Sensation Indication tat te drug is still "otent

&C &ARDIA& (&'SID%Digoxin DigitoxinHC Strengten Myocardial &ontractionNa1"um" is converted to Na&a"um" Tus increasing )orce o) contraction%C 'nset 9 ?5 mins 'nste >5 mins ? rs'!serve I irritation&C %xcreted !y ,idneys %xcreted !y te liverNormal level 4: ?; Antidote0 Digi!iveNormal level 9- ? ug8dl1C &ec, HR C Adult ;5'lder &ildren C J5In)ants C L5 445

DOPAMINE a% DOBUTAMINEInc )orce o) contraction&orrect Hemodynamic/or %mergency Situation

HC Ade=uate $rine 'ut"ut%C %mergency Situation&C Al#ays in diluted )orm1C &om"ute te drugs "ro"erly

&C ANTIARRYTHMICS(idocaine uinidine 2Qylocaine3 Atrial /i!rillation /or PV&Fs

Arrytmia+Slo# ventricular rate+Slo# atrial rate%C iven as "rescri!ed&C Ras *lurring o) Vision&onvulsion Tinnitus8'totoxicity1C &ec, HR%valuate %&

&C THROMBOLYTICSS'r+*'"3$+TPADissolves te clot !y "reventing te )ormation o) )i!rin2)i!rinolysis3&lot )ormation&lot Dissolved%C %))ective #itin ; ours

A)ter MI #itin ?: rs&C Re"ort *leeding Monitor VS1C &ontraindicated to clients tat are "rone to !leeding

&C ANTILIPEMIC AGENTS

LOVASTATIN 8UESTRAN2Ta!let3 2Po#der3HC Dec (D( C >5 5 2HD( sould !e O 5 and (D( 53%C *e)ore meals or at nigt time&C &aution0 He"atotoxic1C uestran 4 "ac, o) "o#der@:;o o) )luid 2#ater+ mil, or 7uice3&ec, liver )unction test+ Ras and !leeding

&C PERIPHERAL VASODILATORParacid


10/39

Smoot muscle relaxant /acilitates !lood circulationIscemia%C A)ter Meals&C Instruct "atient tat drug may cause H8A and S'*1C (ong term use is individual

&C BETABLOC4ER2Timolol+ %smolol+ Nadolol3HC Dec *P+ )or Hy"ertyroidism+ Dec sym"atetic 2Autonomic3 nervous system stimulation%C *e)ore meals&C Rise slo#ly0 (ie do#n )or >5 mins a)ter medication.Instruct "atient tat meds may cause !roncos"asm1C Do not give camomile and as"irin

&C ANTICHOLINERGICAtro"ine Sul)ate Vasolytic AgentHC Inc eart rate 2cec, com"lete eart rate3%C *e)ore meals&C Avoid ot environments1C &ec, )or rases and S'*

NEURODRUGS&C Anticonvulsants DilantinHC Decrease Seiure Tresold%C A)ter Meals&C %"ile"sy Maintenance&ronis $se ingivitisVisit dentist at least once a year So)t !ristle toot!rus+ massage te gums $rine is "in, tinged1C SAS 2 Saline /lus Administer drug Saline /lusTo Prevent "reci"itate

&C CHOLINESTERASEN+"'$0,$+ T+$#" C"0+

Myastenia ravis Aleimers(ong Acting Sort Acting MaintenanceTreatment Diagnostic TreatmentHC Inc muscle strengt Inc mental )unctioning%C *e)ore Activity At !edtime*e)ore meals $se muscles o) mastication&C &e#ing !ecomes stronger Dec diinessMedication is li)etimeRe"ort S8S o) e"atotoxicity1C &ec, liver )xn test1ee" at !edside Neostigmine Antidote0 atro"ine sul)ateDo not give eciniceaPre"are Traceostomy

&C ANTITBR$6a,*$$ INH S'r+*'",2$ E'!a,1&'"#In)ection%C *e)ore Meals&C Red orange urine Peri"eral Neuritis 'to+ne"ro+neuro He"atotoxicDonFt use contact lenses 2ive *;3 T'QI& Psycotic li,e Sx1C Ta,e te com"lete treatment as "rescri!ed !y te doctor 2 ; 4? monts 3Incom"lete T* treatment (ead to MDRT*


11/39

&C ANTIASTHMATeo"ylline &romolyn Na

Adult C 45 ?5 mg8dl Prevents antiistamine releasePeds C 9 45 mg8dlDilates !ronciolesHC %ase !reating%C In te morning !ecause it causes insomnia&C Nausea and vomiting RasesTeo"ylline toxicity1C &ec, te "ulse rate

Avoid &amomile cause !roncos"asmAvoid as"irin &ause !roncos"asmInaler AcuteSteroid &ronic

&C MUCOLYTICS 2Mucomyst3HC Antidote )or as"irin toxicityDec viscosity o) mucous(oose "legm

%C No s"eci)ic time&C Inc '/IS.%. !roncos"asm1C SuctionMedication as a )oul odor tat resem!le rotten egg

C9 EMETICSyru" o) I"ecacHC To induce vomiting noncorrosivePeds !elo# ; monts vomiting%C Dose de"ends on age; mos 4 yr C 45mlB4 4? yrs C 49mlBO 4? yrs C >5ml&C Administer #it glass o) #ater to enance e))ects o) i"ecac

&ardiotoxic C %nsure tat cild vomits te entire amount

&C ANTACIDSPe"tic $lcer DiseaseMaalox Ranitidine Sucral)aters :;B#,s #,sNeutralies H&l Dec H&l secretion &oats ITNormal H&( ? 9Maximum 45Pain+ dec H&l%C $sually on an em"ty stomac4 our !e)ore meals ? ours a)ter meals&C Sa,e li=uid

S%0 diarrea&onsti"ation1C Sort term tera"y %lectrolyte im!alance

ENDOCRINE DISEASE&C INSULIN OHATy"e 4 Dia!etes Mellitus Ty"e ?Regular Humulin 'rinaseIntermediate NPH Dia!inase(ongacting


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ultra lente Met)orminHC Inc trans)er o) glucose to cell mem!rane Pancreas to secrete insulin%C *e)ore !rea,)ast&C Re"ort Hy"oglycemia0DiinessDec ('&Di)). o) "ro!lem solving1C Hy"o occurs usually occurs at te "ea, o) action o) meds0*e)ore luncIn te a)ternoon or !e)ore dinnerIn midnigt or next dayRan,0 : 4?84;

&C THYROID DRUGSS2'!r"$% PTU2su""lement3 Ta"aole 2 45 times greater tan PT$3/or Hy"otyroidism /or Hy"ertyroidismHC Normal *MR Dec T> and T:+Ade=uate a""etite and slee"%C In morning to "revent insomnia Round te cloc,&C Re"ort signs o) overdose0 Re"ort0

Insomnia+"al"itation E Nervousness /ever+ sore troat+ !ody malaise1C (i)e time Monitor HR E *P

&C STEROIDC"r'$"+ F#"r$+6Re"lacement Tera"y

AddisionFs DiseaseHC &orrect /luid and electrolyte Im!alance%C In te morning&C iven intramuscularly

Avoid a!ru"t #itdra#alA%0 *ruising *one marro# de"ression1C Avoid salty )oods edema

Maintain a !alance diet o!esityAvoid cro#ded areas In)ection

&C RENAL DRUGS%P'%NInc R*& "roduction )or &ronic Renal /ailureHC Normal Hemoglo!in%C As "rescri!ed&C Re"ort Polycytemia Inc "roduction o) R*& &VA&ec, &om"lete *lood &ount

&C DIURETICL""* D$&r+'$ T!$a.$%+ D$&r+'$ 4 : S*arr$0 D$&r+'$

2(asix3 2Hydroclorotiaide3 2S"irinolactone3Duiril Aldactone(oo" o) Henle Distal Tu!ule *loc,s aldosteronePrevent Na a!sor"tion Prevents Na a!sor"tion Retains #aterHC Increase urine out"ut and decrease "tFs #eigt%C %arly morning "revent nocturia&C Hy"o,alemia Hy"o,alemiaDec 1 Dec 1 Inc 1Dec na Dec Na Dec NaDec &a Dec mg


13/39

1C Inc Sodium in diet&ec, %lectrolyte level &ec, *P

IMMUNUREN 2Aatio"rine3&C Immunosu""ressant -re7ection o) organs%C As "rescri!ed&C Re"ort0Nausea+ vomitingTrom!ocyto"enia*ruisingIn)ection1C &ec, &*&/re=uent Hand#asing

&C MIOTICS MYDRIATICS2Pilocar"ine3 2ATS':3/or laucoma &I )or laucoma/or eye examHC Normal I'P Dilatation o) "u"ils%C (i)etimein glaucoma As "rescri!ed

&C (o#er con7unctival sac Re"ort0 eye "ain E !lurring o) visionPress inner cantus 4 ? mins to Avoid alertness a)ter medication"revent systemic S%1C &ec, *P and *lood sugar

&C ANTIBIOTICSVancomycin Penicillin TetracyclineMRSA onorrea (ymesSy"illis Roc,y Mountain /ever In)ection%C *e)ore mealsGit I irritation A)ter meals&C 'totoxic+ Ne"rotoxic+ Allergy He"atotoxic Neurotoxic1C &ec, I and '

Pea, (evel C 49 >5 mins a)ter administrationTroug level C 49 >5 mins !e)ore te next dose

Antidote0 %"ine"rine Dee" IM and cec, &*&iven #it "ro!enecid

T2*+ "6 I$-Ra"id Acting 2lis"ro+ umalog3-'nsetC 9 minutes-Pea,C >5 minutes-Sort Acting 2novolog+ regular3-'nsetC >5 minutes-Pea,C ? ours-Intermediate Acting 2NPH3

-'nsetC 4 our-Pea,C ;-4? ours-(ong Acting 2Humulin3-'nsetC : ours-Pea,C 4;-4 ours

IV S"#&'$"Isotonic- Normal saline+ (actated Ringers+ 9< Dextrose in GaterHy"otonic- 5.:9< NS+ 5.??9< NSHy"ertonic- 9< Dextrose in 5.:9< NS+ 9< dextrose in 5.L< NS


14/39

M+%-Ca#Vol 2m(3 8 time 2minutes3 Q dro" )actor C )lo# rateDose order 8 dose on and Q amount availa!le C amount to give

-Tera"eutic Digoxin levelC 5.9-?-Tera"eutic Teo"ylline levelC 45-?5-Tera"eutic litium level C 4-4.9

- ;5 mgC 4 gr-Autonomic dyre)lexia- cec, /oley )irst-MI TreatmentC M'NA 2mor"ine+ oxygen+ nitro+ as"irin3-Hy"erglycemia C dry and dro#sy+ Hy"oglycemia C #et and #ild-Pulse "aradoxus- "ulse is #ea, on ins"iration and strong on ex"iration-Hy"otyroidism0 Decreased T> @T:+ !ut increased TSH-Hy"ertyroidism0 Increased T> @ T:+ !ut decreased TSH-ase C trom!olytic-ae"am C !enodiae"ine-aine C antiemeticB "enotiaide-aole C "roton "um" ini!itor+ anti)ungal

-!ar!ital C !ar!iturate-coxi! C cox ? enyme !loc,ers-ce"8-ce) C anti-in)ectives-caine C anestetics-cillin C "enicillin-cycline C anti!iotic-di"ine C calcium cannel !loc,er-)loxacin C anti!iotic-i"ramine C Tricyclic antide"ressant-ine C reverse transcri"tase ini!itors+ antiistamines-,inase C trom!olytics-lone+ "red- C corticosteroid-ma! C monoclonal anti!iotics

-micin C anti!iotic+ aminoglycoside-navir C "rotease ini!itornitr-+ -nitr- C nitrate8vasodilator-olol C !eta antagonist-oxin C cardiac glycoside-osin C Al"a !loc,er-"arin C anticoagulant-"raole C PPIFs-"ylline C !roncodilator-"ril C A&% ini!itor-statin C colesterol lo#ering agent-sartan C angiotensin II !loc,er-sone C glucocorticoid+ corticosteroid

-stigmine C colinergics-terol C *eta ? Agonist-tiaide C diuretic-tidine C antiulcer-tro"in C Pituitary Hormone-vir C anti-viral+ "rotease ini!itors-osin C Al"a 4 Antagonist-olam C !eno8sedative-ine C antiistamine


15/39

Parm /actsUDonFt give non-selective !eta-!loc,ers to "atients #8res"iratory "ro!lemsUVitamin & can cause )alse @ive occult !loodUAvoid te F er!s 2ginsing+ ginger+ gin,o+ garlic3 #en on anti-clotting drugs 2coumadin+ ASA+Plavix+ etc3UASA toxicity can cause ringing o) te earsUNo narcotics to any ead-in7ury victimsUMg?@ toxicity is treated #it &alcium luconateUDo not give &alcium-&annel *loc,ers #it ra"e)ruit KuiceU'xytocin is never administered troug te "rimary IVU(itium "atients must consume extra sodium to "revent toxicityUMA'I Patients sould avoid tyramine0oAacados+ !ananas+ !ee)8cic,en liver+ ca))eine+ red #ine+ !eer+ ceese 2exce"t cottage ceese3+raisins+ sausages+ "e""eroni+ yogurt+ sour cream.UDonFt give atro"ine )or glaucoma it increases I'PUDonFt give ant-acids #it )ood -- !8c it delays gastric em"tying.UDonFt give Stadol to Metadone8Heroin PreggoFs -- cause instant #itdra#al sym"tomsUInsulin clear !e)ore cloudyUDonFt give me"eridine 2Demerol3 to "ancreatitis "atientsUAl#ays veri)y !o#el sounds #en giving 1ayexelate

UHy"ercalcemia C y"o"os"atemia 2and vice versa3URadioactive Dye urine excretionUSigns o) toxic ammonia levels is asterixis 2ands )la""ing3UD45G can !e su!stituted )or TPN 2tem"orary use3UDo"amine and (asix are incom"ati!leUHy"oglycemic sivers can !e sto""ed !y olding te lim!+ seiures cannot 2in)ants3U&ommon sym"tom o) aluminum ydroxide consti"ationUTiaide diuretics may induce y"erglycemiaUTa,e iron #it Vit & it enances a!sor!tion Do not ta,e #it mil,U*4 - /or Alcoolic Patients 2to "revent Gernic,eFs ence"alo"aty E 1orsa,o))Fs synd3U*; - /or T* PatientsU*L - /or Pregnant PatientsU*4? - Pernicious anemia+ Vegetarians.

U&om"lications o) &oumadin - >HFs - Hemorrage+ ematuria E e"atitisU//P is administered to DI& !8c o) te clotting /xUMannitol 2osmtic diuretic WHead in7uryX3 crystallies at room tem" use a )ilter needleUAntianxiety medication is "armacologically similar to alcool used )or #eaning TxUAdministrate lucagon #en "t is y"oglycemia and unres"onsiveUPenao"yridine 2 Pyridium3--$rine #ill a""ear orangeURi)am"icin -- Red-urine+ tears+ s#eat3UHot and Dry C sugar ig 2y"erglycemia3U&old and clammy C need some candy 2y"oglycemia3UMed o) coice )or V-tac is lidocaineUMed o) coice )or SVT C adenosine or adenocardUMed o) coice )or Asystole C atro"ineUMed o) coice )or &H/ is Ace ini!itor.

UMed o) coice )or ana"ylactic soc, is %"ine"rineUMed o) coice )or Status %"ile"ticus is Valium.UMed o) coice )or !i"olar is litium.Uive A&% ini!itors #8)ood to "revent stomac u"setUAdminister diuretics in te morningUive (i"itor at 4J55 since te enymes #or, !est during te eveninU&ommon Tricyclic Meds - > sylla!es 2"amelor+ elavil3U&ommon MA'IFs - ? sylla!les 2nardil+ mar"lan3UTPN as a dedicated line E cannot !e mixed aead o) timeURHoAM -- iven at ? #ee,s E J? rs "ost"artum


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UDo not administer erytromycin to Multi"le Sclerosis "tU*enadryl and Qanax ta,en togeter #ill cause additive e))ects.U&an6t ta,e (asix i) allergic to Sul)a drugs.UAcetamino"en can !e used )or eadace #en te client is using nitroglycerin.UDilantin - can not give #it dextrose. 'nly give #it NS.UNever ive via IVP0o1&(oHe"arinoI!u"ro)enoInsulinoDo!utamineoASAoAl!uminoAcetamino"en

USu!stance Poisoning and AntidotesoMetanol -- %tanolo&'? -- 'xygenoDo"amine -- Pentolamine

o*enoFs 2Versed3 -- /lumaenilo(ead -- Succimer+ &alcium DisodiumoIron -- De)eroxamineo&oumadin -- Vitamin 1oHe"arin -- Protamine Sul)ateoToraine -- &ogentineoGild Musrooms - Atro"ineoRat Poison - Vit 1

UPar,land /ormula0 :cc 1g *SA *urned C Total Volume Necessaryo4st rs Y total volumeo?nd rs Z total volumeo>rd rs Z total volumes

Insulin, Coumadin, Heparin, antihypertensives, viagra, digitalis, ritalin, actonel, accutane, anti-ulcer medications, nitroglycern, to name a few. Try to look at the suffixes:

ace inhiitors end with !pril "eg: captopril# $note that this drug increases potassium in the lood,

angiotensinogen % inhiitors end in !sartan "eg: losartan#,

eta lockers end with !olol "eg: metoprolol# $caution with patients who are diaetic or who areasthmatic,

cholesterol reducing drugs usually end with !statin "eg: atorvastatin# $ note that if the patientexperiences muscular pain, they should stop immediately and report it to the doctor, also not to

consume grapefruit &uice,

impotence drugs end with 'defil "eg: sildenefil-hope I spelled it correctly...if not please excuse thetypo# $note that you cannot take this drug if you are taking nitrates such as nitroglycerin orisosoride and go to the doctor if an erection last longer than ( hours,

accutane is an acnedrug, where a pregnancy test must e done on females efore prescriingthem

actonel "again, this may e a typo# cannot e taken unless a person is ale to sit up for at least
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)*% hour to an hour after adminstration.

+now the acting times of insulin, which is fast acting, long acting or the lente. They may ask whenwill a person ecome hypoglycemic, and that would e during peak hours.

penicillin: if a person has an allergy to penicillin, they may e at risk for an allergyto acephalosporin, in that case suggest a macrolide such as clarithromycin. acrolides are known tocause severe stomachpainfor some people. lso, if a nurse administers penicillin orcephalosporin, that the patient should remain with the nurse for )*% hour afterwards to intervenewith allergic reactions.

ost drugs that end with !mycin may cause nephrotoxicity or ototoxicity

arameters for digitalis administration, and also that if potassium is low and calcium andmagnesium is high, there is a higher chance for digitalis toxicity.

corticosteriods usually end with !sone "eg: predinsone#, may cause medication related diaetes,increase chances of infection, cause Cushoid symptoms "uffalo hump in ack, thin skin, easy toruise, etc...#

spirin should not e consumed with alcohol, increases leeding, causes ulcers, should e takenwith food to diminish gastric distress

ntidote for tylenolis ucomyst.dont )orget yourdiuretics... es". tose are im". also I avesome )or no# ...

,+% '!a' +% $ -ar'aCdecrease !lood "ressure+ increase cardiac load 2$sed )or tose #oside e))ect is coug #it A&%3

ANI'T%NSIN II R%&%PT'R *('&1%RSside e))ects ?nd degree AV !loc,+ angina+ muscle cram"s monitor *$N+*P and "ulse

-va'a'$(L"va'a'$)9decrease colesterol+ lo#er tricycerides 2N'T%(i"itor at nigt only do notta,e #it gra"e)ruit 7uice3

ANTIHP%R(IPID%MI&Sside e))ects muscle #ea,ness+ alo"ecia monitor liver8renal "ro)ile

"Costeoartritis+ reumatoid artritis2relieve "ain !y reducing in)lammation3NSAID8&'? %NM% *('&1%Rside e))ects tinnitus+ diiness monitor !o#el a!its 2could cause I !leed+ "latlet count3 Increaseris, o) stro,es+ eart attac,s

'$%$+C%RDHISTAMIN% ? ANTA'NIST2ini!it gastric acids3side e))ects agranulocytosis+ !rady8tacycardia monitor gastric PH8*$N I) ta,ing antacids ta,eone our a)ter or !e)ore ta,ing tese drugs

-*ra."#+Culcers+ indigestion+ %RD 2Ta,e !e)ore meals !etter a!sor"tion3PR'T'N P$MP INHI*IT'RSside e))ects gas+ diarrea+ y"erglycemia monitor (/Ts

-*ar$Ctin !lood+ DVT+ M.I.+"ost surgeries 2Antidote Protamine sul)ate--cec, PTT sould !e4.9-?.5x3 anticoag. decread vit. 1 levelsside e))ects ematuria+ !leeding+ )ever monitor PTT+ ematocrit and occult testing = >mts

-*a,-*a'+
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-a.+/a."C*enos8Antianxiety8anticonvulsantsside e))ects incontinence+ res"iratory de"ression8 monitor )or (/T+ res"irations

-caine 2anestetic3-ma! 2monoclonal anti!odies3-ce" or ce) 2ce"alos"orins3-cycline 2tetracyclines3-cal 2calciums3-done 2o"ioids3

ganciclovir sodium causes neutro"enia and trom!ocyto"enia and nurse sould monitor )or s8s o)!leeding 7ust as e=uiv. to a "t. on anticoag. tera"y.

SSRIs and MA'Is used togeter "otentially )atalDrugTera"eutic and Toxic (evels

Acetamino"en 2Tylenol3Tera"eutic0 4->5 mcg8mlToxic0 O?55 mcg8ml&ontraindicated in0

(iver diseaseSide %))ects o) Toxicity0He"atic Necrosis

Alcool 2%tanol3Tera"eutic (evel0 455 mcg8mlToxic0 O:55 mcg8ml

Amitri"tyline 2%lavil3Tera"eutic0 4?5-?95 mcg8mlToxic0 O955 mcg8ml

&ontraindicated in0 Narro#-angle glaucoma and "otential )atal reactions #en used #it MA'ini!itorsSide %))ects o) Toxicity0Dro#siness+ sedation+ letary+ )atigue+ dry mout and eyes+ !lurred vision+ y"otension+ andtacycardia.&aution "atients to use a sun screen.Tera"eutic e))ects #itin ? to ; #ee,s o) initiating tera"y.

&ar!amae"ine 2Tegretol3Tera"eutic0 -4? mcg8mlToxic0 O49 mcg8ml&ontraindicated in0

*one marro# de"ressionSide %))ects o) Toxicity0Dro#siness+ diiness+ and ataxia.&aution "atients to use a sun screen and to carry a medical alert card.

&lordiae"oxide 2(i!rium3Tera"eutic0 J55-4555 mcg8mlToxic0 O9555 mcg8ml


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&ontraindicated in0&omatose "atients #it &NS de"ression+ narro#-angle glaucomaSide %))ects o) Toxicity0Dro#siness and diiness.

Alcool Gitdra#al Treatment0 Assess "atients )or signs and sym"toms o) delirium tremors2DTs3.

Deso"yramide 2Nor"ace3Tera"eutic0 Varia!leToxic0 OJ mcg8ml&ontraindicated in0&ardiogenic soc,+ ?nd and >rd degree eart !loc,s+ sic, sinus syndromeSide %))ects o) Toxicity0Signs and sym"toms o) congestive eart )ailure.

Diae"am 2Valium3Tera"eutic0 455-4555 mcg8mlToxic0 O9555 mcg8ml

&ontraindicated in0&omatose "atients #it &NS de"ression+ narro#-angle glaucomaSide %))ects o) Toxicity0Sedation #it ataxia+ diiness+ and slurred s"eec.Tera"eutic e))ects #itin 4 to ? #ee,s o) initiating tera"y.

DigitoxinTera"eutic0 ?5->9 ng8mlToxic0 O:9 ng8ml&ontraindicated in0$ncontrolled ventricular arrytmias+ AV !loc,Side %))ects o) Toxicity0

A!dominal "ain+ anorexia+ nausea+ vomiting+ visual distur!ances+ !radycardia+ and oterarrytmias.

DigoxinTera"eutic0 5.-4.9 mcg8mlToxic0 O? mcg8ml&ontraindicated in0$ncontrolled ventricular arrytmias+ AV !loc,Side %))ects o) Toxicity0

A!dominal "ain+ anorexia+ nausea+ vomiting+ visual distur!ances+ !radycardia+ and oterarrytmias.

Doxe"inTera"eutic0 >5-495 mcg8mlToxic0 O955 mcg8ml&ontraindicated in0Narro#-angle glaucomaSide %))ects o) Toxicity0Sedation+ )atigue+ !lurred vision+ y"otension+ dry mout+ and consti"ation.&aution "atients to use a sun screen.May cause y"otension+ tacycardia+ and "otentially )atal reactions #en used #it MA'


20/39

ini!itorsTera"eutic e))ects #itin ? to ; #ee,s o) initiating tera"y.

lucocorticoids&ontraindicated in0

Serious in)ectionsSigns o) adrenal insu))iciency0 Hy"otension+ #eigt loss+ #ea,ness+ nausea+ vomiting+ anorexia+letargy+ con)usion+ restlessness.Side %))ects0De"ression or eu"oria+ "ersonality canges+ y"ertension+ decreased #ound ealing+"eteciae+ eccymoses+ y"erglycemia+ y"o,alemia+ y"ernatremia+ )luid retention+ ase"ticnecrosis o) 7oints+ osteo"orosis+ cusingoid a""earance 2moon )ace+ and !u))alo um"3Monitor !lood sugars+ *$N+ creatinine.

Advise "atients tat medication sould N'T !e a!ru"tly discontinued !y ta"ered o)) over ? to :#ee,s.

Imi"ramine 2To)ranil3Tera"eutic0 4?9-?95 mcg8ml

Toxic0 O955 mcg8ml&ontraindicated in0Narro#-angle glaucomaSide %))ects o) Toxicity0Distur!ed concentration+ con)usion+ restlessness+ agitation+ convulsions+ dro#siness+ mydriasis+arrytmias+ )ever+ allucinations+ vomiting+ and dys"nea.&aution "atients to use a sun screen.Tera"eutic e))ects #itin ? to ; #ee,s o) initiating tera"y.

(itiumTera"eutic0 5.;-4.? mcg8mlToxic0 O? mcg8ml

Serum levels sould !e monitored t#ice #ee,ly during initiation o) tera"y and every ? to >monts durgin cronic tera"y.&ontraindicated in0Severe cardiovascular or renal disease+ deydrated or de!ilitated "atientsSide %))ects o) Toxicity0Vomiting+ diarrea+ slurred s"eec+ decreased coordination+ dro#siness+ muscle #ea,ness+ andt#itcing.Tera"eutic e))ects #itin 4 to > #ee,s o) initiating tera"y.

(idocaine 2Qylocaine3Tera"eutic0 4.9-; mcg8mlToxic0 O;- mcg8ml

&ontraindicated in0Advanced AV !loc,Side %))ects o) Toxicity0&on)usion+ excitation+ !lurred or dou!le vision+ nausea+ vomiting+ ringing in ears+ tremors+t#itcing+ convulsion+ di))iculty !reating+ severe diiness or )ainting+ and slo# eart rate.Magnesium sul)ate&ontraindicated in0Hy"ermagnesemia+ y"ocalcemia+ anuria+ and eart !loc,Side %))ects o) Toxicity0Decreased res"iratory rate+ !radycardia+ arrytmias+ y"otension+ dro#siness+ )lusing+


21/39

s#eating+ and y"otermia.Monitor neurologic status !e)ore and trougout tera"y.Institute seiure "recautions.

Metotrexate

Tera"eutic0 Varia!leToxic0 O:9: mcg8ml 2: ours a)ter ig dose3&ontraindicated in0Pregnancy and lactation 2teratogenic e))ects3Side %))ects o) Toxicity0Hy"eruricemia+ a!dominal "ain+ diarrea+ stomatitis+ e"atotoxicity+ "ulcomary toxicity+ne"rotoxicity+ anemia+ leu,o"enia+ trom!ocyto"enia+ and )olic acid de)iciency&aution "atients to use a sun screen.Rescue Drug to Prevent /atal Toxicity0

(eucovorin 2)olinic acid3Peno!ar!italTera"eutic0 49-:5 mcg8ml

Toxic0 Varies >9-5 mcg8ml&ontraindicated in0&omatose "atients #it &NS de"ressionSide %))ects o) Toxicity0&on)usion+ dro#siness+ dys"nea+ slurred s"eec+ and staggering.

Penytoin 2Dilantin3Tera"eutic0 45-?5 mcg8mlToxic0 Varies #it sym"toms&ontraindicated in0Sinus !radycardia and eart !loc,Side %))ects o) Toxicity0

Nystagmus+ ataxia+ con)usion+ nausea+ slurred s"eec+ and diiness.&aution "atients to carry a medical alert card.

Procainamide 2Promestyl3Tera"eutic0 9-4? mcg8mlToxic0 O49 mcg8ml&ontraindicated in0

AV !loc, and myastenia gravisSide %))ects o) Toxicity0&on)usion+ diiness+ dro#nsiness+ decreased urination+ nausea+ vomiting+ and tacyarrytmias.

Primidone 2Mysoline3Tera"eutic0 9-45 mcg8mlToxic0 O49 mcg8ml&ontraindicated in0Por"yriaSide %))ects o) Toxicity0

Ataxia+ letargy+ canges in vision+ con)usion+ and dys"nea.&aution "atients to carry a medical alert card.


22/39

Pro"ranolol 2Inderal3Tera"eutic0 VariesToxic0 Vaires&ontraindicated in0$ncom"ensated congestive eart )ailure+ "ulmonary edema+ cardiogenic soc,+ !radycardia+ andeart !loc,Side %))ects o) Toxicity0*radycardia+ severe diiness or )ainting+ severe dro#siness+ dys"nea+ !luis )ingernails or"alms+ and seiures.&aution dia!etic "atients to monitor !lood sugar.

uinidineTera"eutic0 ?-; mcg8mlToxic0 O mcg8ml&ontraindicated in0&onduction de)ects and digitalis glycoside toxicitySide %))ects o) Toxicity0Tinnitus+ earing loss+ visual distur!ances+ eadace+ nausea+ and diiness.&ardiotoxicity signs include RS #idening+ cardiac asystole+ ventricular ecto"ic !eats+

idioventricular rytms+ "aradoxical tacycardia+ and arterial em!olism.

SalicylateTera"eutic0 VariesToxic0 Varies&ontraindicated in0Hy"ersensitivity to as"irin or oter salicylates+ !leeding disorders or trom!ocyto"eniaSide %))ects o) Toxicity0Tinnitus+ eadace+ y"erventilation+ agitation+ mental con)usion+ letargy+ diarrea+ ands#eating.May ta,e ? to > #ee,s )or maximum e))ectiveness.

Teo"yllineTera"eutic0 45-?5 mcg8mlToxic0 O?5 mcg8ml&ontraindicated in0$ncontrolled arrytmias and y"ertyroidismSide %))ects o) Toxicity0

Anorexia+ nausea+ vomiting+ stomac cram"s+ diarrea+ con)usion+ eadace+ restlessness+)lusing+ increased urination+ insomnia+ tacycardia+ arrytmias+ and seiures. Tacycardia+ventricular arrytmias+ or seiures may !e te )irst sign o) toxicity.

Val"roic Acid 2De"a,ene3

Tera"eutic0 95-455 mcg8mlToxic0 O455 mcg8ml&ontraindicated in0He"atic im"airmentSide %))ects o) Toxicity0

Anorexia+ severe nausea an dvomiting+ yello# s,in or eyes+ )ever+ sore troat+ malaise+#ea,ness+ )acial edema+ letargy+ unusual !leeding or !ruising+ or seiures.


23/39

A'$1$"'$ '!a' R+;&$r+ Fr+;&+' M"$'"r$0(A,$"0#2"$%+)

DrugsTrougsPea,s

Ami,acin9 mcg8ml>9 mcg8ml

entamicin? mcg8ml45 mcg8ml

1anamycin9 mcg8ml>9 mcg8ml

Neomycin? mcg8ml4; mcg8ml

Stre"tomycinVaries?9 mcg8ml

To!ramycin? mcg8ml?5 mcg8ml

Vancomycin9-45 mcg8ml?9 mcg8ml

A,$"0#2"$%+ must !e monitored care)ully )or side e))ects including "'"'"$$'22vesti!ularand coclear3+ +*!r"'"$$'2+ +&r"'"$$'2+ and y"ersensitivity reactions. Monitor "atients )ortinnitus+ vertigo+ earing loss+ ras+ diiness+ or di))iculty urinating.

R+a# #a1 '+'tat must !e monitored include urinalysis+ s"eci)ic gravity+ *$N+ creatinine+ andcreatinine clearance.L$v+r #a1 '+'tat must !e monitored include + AST 2S'T3+ A(T 2SPT3+ serum al,aline"os"atase+ !iliru!in+ creatinien+ and (DH concentrations.Tr"&0!te administrationo) a single dose o) medication. Pea, levels sould !e dra#n 4 our a)ter IM in7ections and >5minutes a)ter a >5-minute IV in)usion is com"leted.


24/39

Dr&0 '!a' R+;&$r+ a A'$%"'+

DrugAntidote

Acetamino"enAcetylcysteine

Anticolinesterases 2&olinergics3Atro"ine+ Pralidoxime

Antide"ressants2MA' ini!itors and tryamine-containing )oods may lead to y"ertensive crisis includingsym"toms o) cest "ain+ severe eadace+ nucal rigidity+ nausea and vomiting+ "otosensitivity+and enlarged "u"ils3Pentolamine

*enodiae"ines/lumaenil

&yanideAmyl nitrite+ sodium nitrite+ sodium tiosul)ate

Digoxin+ digitoxinDigoxin immune /as! 2Digi!ind3

/luorouracil 29/$3(eucovorin calcium

He"arinPortamine sul)ateI)os)amide

2Adverse e))ects cause emorragic cystitis3MesnaIron

De)eroxamine(ead

%detate calcium disodium+ dimera"rol+ succimerMetotrexate2Adverse e))ects cause )olic acid de)iciency3


25/39

(eucovorin calcium

'"ioid analgesics+ eroinNalme)ene+ Naloxone

Trom!olytic agentsAminoca"roic acid 2Amicar3

Tricyclic antide"ressantsPysostigmine

Gar)arin 2&oumadin3Pytonadione 2Vitamin 13

I$

Insulin'nsetPea,Duration

Regular IV45->5 min49->5 min>5-;5 min

Regular S&>5 min-4r

?-: r9-J r

NPH4-: r;-4? r4-? r

(ente4-> r-4? r4-? r

$ltralente:-; r4-?: r>; r

Monitor "atients )or onset o) HYPOGLYCEMIAreaction tat ty"ically occurs during te Pea,Pase )ollo#ing administration o) insulin. Signs and sym"toms o) HYPOGLYCEMIAincludemental con)usion+ allucinations+ convulsions+ "ale+ cool+ clammy s,in+ tacycardia+ and anxiety.Tr+a',+'includes te administration o) oral glucose. Severe y"oglycemia is li)e-treatening


26/39

and re=uires treatment #it IV glucose+ glucagon+ or e"ine"rine.Signs and sym"toms o) HYPERGLYCEMIA include "olyuria+ "olydi"sia+ and "oly"agia+ ot+ red+and dry s,in. Tr+a',+'includes insulin administration. Severe y"erglycemia is usually caused!y missing+ miscalculating or mistiming doses o) insulin or oral medication or !y overeating ordrin,ing. Severe y"erglycemia is li)e-treatening and re=uires treatment #it IV re"lacement andIV insulin.

MORE NCLEX STUDY INFORMATION

). /h negative mom gets /hogam if ay /h positive. om also gets /hogam afteraminocentesis, ectopic preganancy, or miscarriages.Hodgkins- Reed Sternberg CellsMultiple Myeloma- Benz Jones Protein (24 our urine!"#C- ele$ated " dimer% &o' ibrogen&eukemia- )rombo*ytopenia (lo' platlets belo' +,%!

.plasti* .nemia- Pan*ytopenia (&o' RBC% &/0 0BC% &/0 Platlets!Si*kle Cell- Hgb 1SSystemic (u"us - Anti nuclear anti!odiesHIV - Gestern *lot test

4. Side e))ect o) &loaril is extreme salivation?. Gen ta,ing &imetidine 2Tagamet3+ %lderly are at ris, )or develo"ing con)usion+ so cec, )ormental status.>. Side e))ects o) (idocane are !radycardia+ eart !loc,+ cardiovascular colla"se+ and cardiacarrest. Tis drug sould never !e admisnistered #itout continous %1 monitoring.

8?0!"> $ "0+$'a# !2*"'!2r"$%$, %$a0"+%@A?7+>1"r r++$0 r+v+a#$0 #"> T5 a% !$0! TSH87>!a' ar+ '!+ 2,*'", "6 "0+$'a# !2*"'!2r"$%$, $ +ar#2 $6a2@A0#ar0+ *r"'r&%$0 '"0&+"ar+ !a$r#+'!ar02#++*$+ a% "'$*a'$"87>!a' ar+ '!+ ,+'a1"#$ +66+' "6 P4U@A7CNS %a,a0+,+'a# r+'ar%a'$" a% %+r+a+% ,+#a$857$6 U >av+ $ ,"' *r",$+'>!a' "%$'$" ,$0!' '!+N &*+'@

A57!2*"3a#+,$a87>!a' $ '!+ $$'$a# $0 "6 GERD@A76"r+6 v",$'$0H$0! r$3 6"r CHOLELITIASIS7 FF+,a#+ F+r'$#+F"r'2Fa'Fa$rH$0! r$3 6"r PANCREATITIS7 MMa#+M$%%#+ a0+M+*!+"#M+a# !+av2M$%$0!' "r+ar#2 M"r$ a''a3A*$r$-6"r TIAP&r*"+7'" $!$1$' *#a'+#+' a00r+0a'$"Ar$+*'-D"+*+.$#+>+r %r&0 6"r ALZHEIMERSD+a%r"(%+a,+'!a"+)-/+ "' 1#""% $ '!+ '""#"'+76"r TB *a'$+' 'a3$0 a'$ TB %r&0;&+'$" '!+ "r%+r DECADRON-r+a'$va'+ "#% TB #+$" a% *r+$*$'a'+ !+,"*'2$/n 0/3"S# its 05)% ten "R6 it (apply "ry "ressing!

# its "R6% ten 05) it (apply 05) dressing!"rugs or Brady*ardia and "e*rease BP#soproterenol"opamine5pineprine

.tropineProstate Problems are no 737re8uen*yrgen*y3o*turia


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0o needs dialysis9 .5#/ te $o'els do.*id Base problems5le*rolyte problems#nto:i*ations/$erload o luidsremi* symptomsH2*+r","#ar H2*+r0#2+,$ "3+'"'$ 2%r",+ (HHNS)0

Severe [ lucose+ almost exclusively in Type % diaetics Similar to D1A !ut usually ave muc iger glucose 2O;553 and 01 acidosis orketonuria*ketonemia

Treat #it 6#&$%and #"> %"+ I$in)usion An im"ortant distinction is tat D1A usually occurs in Ty"e 4 Dia!etics+ #ile HHNS most o)tenoccurs in Ty"e ? Dia!etics. Remem!er tis as it is a common =uestion in te N&(%Q #orld.

R+a" 6"r HIGH a#ar,-. $r+a+% +r+'$" $ a$r>a2 '!$3 SUCTION

+%"'ra!+a# '&1+ (ETT) $ %$*#a+%/%$#"%0+%

v+'$#a'"r '&1+ "1'r&'+% 1+a&+ "6 a 3$3 "r >a'+r ("%+a'$")

#$+' "&0! 0a0 "r 1$'+ ETT

#$+' $ a$"& "r 6$0!' '!+ v+'$#a'"r

R+a" 6"r LOW a#ar,-

%$"+'$" "r #+a3 $ v+'$#a'"r

#$+' '"* *"'a+"& 1r+a'!$0

B"''#+6+% +"a'+ FIRST 6++% $ >$'! '+r$#+ >a'+r '!a 6"r,aM'$*#+ M2+#",a- "%$'$" $ >!$! +"*#a'$ *#a,a +## $6$#'ra'+ '!+ 1"+ ,arr">r+'$0 $ "'+"*"r"$ !$0! r$3 6"r 6ra'&r+ " >+ ++% '" $'a## *r+a&'$" >$'!*"$'$" !a0+

W$'! ar%$a 'a,*"a%+ v+"& *r+&r+ r$+ a% +3 v+$ 1+",+ %$'+%+%F"r !+' *!2$"'!+ra*2 *+r&$" !"% "#2 1+ %"+ $ '!+ ar+a "6 '!+ r$1 a0+Eva#&a'$" "6 HTN $ a 3+2 a+,+' $ '!+ "&r+ a&'+ 0#",+r"+*!r$'$R+",,+%+% a0+ 6"r >$'$!$0 6r", 6"r,a '" >!"#+ ,$#3 $ ? ,"'! '" *r+v+'a##+r0$+ a% #a'"+ $'"#+ra+C!r"$ &%+r 'r+a'+% a'!,a a #+a% '" #&0 r+,"%+#$0 a% *+r,a+' !a0+ $#&0 6&'$"PRIORITY CARE/TRIAGEE,+r0+' Pr$"r$'2 (?')7re2uires immediate attention and continuous evaluation yet have a highsurvival rate-trauma-cest "ain-severe res"iratory de)icits-cemical s"lases to te eyes

Ur0+' Pr$"r$'2 (%)7in&uries non life threatening..treated within )-% hours and are evaluatedevery 34 to 54 minutes thereafter.-sim"le )racture-astma #itout res"iratory distress-)ever-y"ertension-a!dominal "ain-renal stoneN"&r0+' Pr$"r$'2 (r%)7clients can wait several hours efore eing seen and re2uire )-%


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hours of evaluated thereafter.-minor laceration-s"rain-cold sym"toms6o if someone came in with a chest pain ecause they ate something wrong and another personthat came in with a high lood pressure, do pick the chest pain first.D+#+0a'$"CNA-s,in care+ )eeding+ toileting+ vital signs 2not initials3+ eigt+ #eigt+ I's+ R'M exercises+am!ulation+ trans"orting+ grooming+ and ygiene meaures o) sta!le clients.LPN/LVN-"ysiologically sta!le clients #it "redicta!le outcomes-dressings+ suctionings+urinary cateteriation+med admin2only oral+ su!cutaneous+andintramuscular3+no rectal or IV medsRN a"$a'+%7-care )or individual in a structured ealt care environmentRN BSN7-care )or individuals+ )amilies+ grou"s+ and communities in !ot structured and unstructured ealtsettings.RN (a##)7

-assessment8"lanning care+ initiating teacing+ IV medsRN a "' %+#+0a'+ '!++ 'a37-initial assessments o) clients-evaluation o) client data-nursing 7udgement-client8)amily educatoin8evaluation-nsg diagnosisADDISONS (!2*"+r+'$" "6 a%r+a# "r'+ !"r,"+) A "6 a%%$"? av"$% 'r+ av"$% 'r+"& a'$v$'2av"$% $%$v$%&a# >$'! $6+'$"5av"$% "' ,+%

a #$6+#"0 0#&""r'$"$% '!+ra*2a#>a2 >+ar ,+%$ a#+r' 1ra+#+'C&!$0 (HYPERSECRETION OF ADRENAL CORTEX)Cec, vital signs es" *P$rinary out"ut and #eigt monitoringStress managementHig con dietIn)ection "recautionNa restrictionlucose And electrolytes monitoringS"ousal su""ort%r&0/6""% $'+ra'$"-syntroid 2ta,e on em"ty stomac--ta,e in te morning3

-digoxin 2ta,e on em"ty stomac3-yvox 2limit tyramine )ood to less tan 455mg a day3-MA'Is 2no tyramine3-tetracycine 2no dairy "roducts3-coumadin 2no vit 13-litium 2no alcool consum"tion3-!enodiae"ines-Ativan 2no gra"e)ruit 7uice3-colesterol meds 2no gra"e)ruit 7uice3-neostigmine 2give to Myestenia ravis clients :9 minutes !e)ore meal to el" #it ce#ing3%r&0/%r&0 $'+ra'$"


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2do not ta,e togeter meds3-MA'Is and SSRIs-vaso"ressin 2do not med #it demeclocycline+ e"ine"rine+ litium3-atro"ine 2monitor #it digoxin !ecause o) dig. toxicity3-atro"ine 2do not give #it "otassium salts !c it may delay solid "otassium "assage in te I tract#ic could increase ris, )or ulcers3SPECIAL DIETS >$'! '!++ 2,*'",/%$+a+/"%$'$"7-out 2no "urine in diet3-eat more cerries-Anemia 2too muc mil, can reduce inta,e o) iron3-&eliac Disease0 avoid *R'G 2!arley+ rye+ oat+ #eat3-Dia!etes ty"e 40 eat > meals a day-Dia!etes ty"e ?0 decrease in te calories and )at-diarrea0 increase "rotein+ increase calories+ decrease )i!er-cusing0 increase "rotein+ increase calories+ increase calcium and vit D-&ron6s0 increase "rotein+ increase calories+ decrease )at+ lo# residue diet-ulcer colitis0 lo# )i!er diet-neutro"enic conditions0 no mil,+ ra# )ruit or veggies-,idney stones0 avoid calcium-calcium oxalate 2renal stones30 avoid s"inac+ !lac, tea+ ru!ar!-dum"ing syndrome0 increase )at and "rotien inta,e+ lo# rougage diet+ lo# car!+ no mil,+ no

s#eets+ no li=uid !et#een mealsI,,&$.a'$"I6#&+.aa##+r02 '" +00H+*a'$'$ Ba##+r02 '" 2+a'M+a#+/,&,*a##+r02 '" +*,2$OPV/IPVa##+r02 '" 'r+*'",2$Var$+##aA##+r02 '" 0+#a'$/+",2$

Ag"sia - I don6t 3">#at it is 2#en an o!7ect is "laced in and3A*raia - My *raticed s,ills are lost 2can6t carry out a "ur"ose)ul activity3Proa$amide - /or dysrytmias unres"onsive to (idoa$eRida&ra- old+ )or artritis 2tin, siny+ aura3T+alon - Anti-'&ive 2sounds li,e tuss3C"0nex - )or Aleimer6s 2sounds li,e "0nition3

Calcium Car!onate as te most calcium o) oral ty"esN+&"o0+- sounds li,e \generates neutro"illE*o0+- sounds li,e \erytro"oetein generator\F#"max - Im"roves urinary )lo# #it *PH 2urine )lo#s3D$,+tane - An antiistimine 2D$,+ta""3Gic a'$-"a0a' $ a6+in "regnancy H+*ar$is It does not cross te "lacenta+ so #enit is ordered+ give it+ and #en you do it is su!-=.

i guy eres someting to remem!erDigitalis Toxicity includes..N - nausea

A - anorexiaV - vomitingD - diarrea

A - a!dominal "ain

Drugs #ic can cause $RIN% DIS&'('RATI'NAdriamycyn------ ReddisRi)a!utin--------- Red orangeRi)am"icin------- Red orange*actrim---------- Red orangeRo!axin--------- *ro#n+ *lac, or reenis

Aul)idine------ 'range yello#


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/lagyl------------ *ro#nisDilantin---------- Pin, tinged

Anti Psycotic-- Pin,is to Red !ro#n%arly signs o) y"oxia0R-restlessness

A-anxietyT-Tacycardia(ate signs o) y"oxia0*-!radycardia%-extreme restlessnessD-dys"neaIn "edia-/-)eeding di))icultyI-ins"iratory stridorN-nares )lare%-ex"iratory gruntingS-sternal retractionsRes"iratory Patterns1ussmaul- )ruity acetone !reat odor&eyne-sto,es- near deat !reating "attern

Seasonal A))ective Disorder 2SAD3 may a))ect over 45 million Americans.Te ty"ical sym"toms o) SAD include de"ression+ lac, o) energy+ increased need )or slee"+ acraving )or s#eets and #eigt gain. Sym"toms !egin in te )all+ "ea, in te #inter and usuallyresolve in te s"ring. Some individuals ex"erience great !ursts o) energy and creativity in tes"ring or early summer.Susce"ti!le individuals #o #or, in !uildings #itout #indo#s may ex"erience SAD-ty"esym"toms at any time o) year. Some "eo"le #it SAD ave mild or occasionally severe "eriodso) mania during te s"ring or summer. I) te sym"toms are mild+ no treatment may !e necessary.I) tey are "ro!lematic+ ten a mood sta!ilier suc as (itium migt !e considered. Tere is a

smaller grou" o) individuals #o su))er )rom summer de"ression.SAD is recognied in te DSM-IV 2Te American Psyciatric Association6s diagnostic manual3 asa su!ty"e o) ma7or de"ressive e"isode.Some individuals #o #or, long ours inside o))ice !uildings #it )e# #indo#s may ex"eriencesym"toms all year round. Some very sensitive individuals may note canges in mood during longstretces o) cloudy #eater.

A sign o) im"rovement )rom deydration #ould !e a decreased urine s"eci)ic gravity and adecreased8decreasing ematocrit. So te S o) 4.549 and a Hct o) :;< #ould !e te ans#er. Itis te !est ans#er o) te t#o you ad in you =uestion.Te normal urine S is 4.55>-4.5>9 2$sually !et#een 4.545-4.5?9 #it normal ydration andvolume3 2di))erent texts give a sligtly di))erent range3.S 4.5?9-4.5>5@ 2concentrated urine3

S 4.554-4.545 2dilute urine3S 4.554-4.54 in in)ants under ? years o) ageS"eci)ic gravity is a measurement o) te ,idney6s a!ility to concentrate urine. Te range o) urine6sS de"ends on te state o) ydration and varies #it urine volume and te load o) solids to !eexcreted under standardied conditionsB #en )luid inta,e is restricted or increased+ Smeasures te concentrating and diluting )unctions o) te ,idney. (oss o) tese )unctions is anindication o) renal dys)unction.S values usually vary inversely #it amounts o) urine excreated 2decrease in urine volume Cincrease in s"eci)ic gravity3. Ho#ever in some conditions tis is not te case.


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%% A**R%VIATI'NS'$- !ot eyes'R- rigt eye'S- le)t eye

&$SHINS 2Hy"ersecretion o) Adrenal &ortex Hormones3

& C &ec, VS+ "articularly *P$ C $rinary out"ut E #eigt monitoringS C Stress ManagementH C Hig &H'N dietI C In)ection "recautionN C Na@ restriction C lucose E %lectrolytes MonitoringS C S"ousal su""ort

ADDIS'N6S 2Hy"osecretion o) Adrenal &ortex Hormones3Al#ays Remem!er te ; A6s o) Addison6s disease

4.3 Avoid Stress?.3 Avoid Strenuous>.3 Avoid Individuals #it In)ection:.3 Avoid 'T& meds9.3 A li)elong lucocorticoids Tera"y;.3 Al#ays #ear medic alert !racelet

Hirscs"rungFs diagnosed #it rectal !io"sy loo,ing )or a!sence o) ganglionic cells. &ardinal signin in)ants is )ailure to "ass meconium+ and later te classic ri!!on-li,e and )oul smelling stools.

Intussusce"tion common in ,ids #it &/. '!struction may cause )ecal emesis+ currant 7elly-li,estools 2!lood and mucus3. A !arium enema may !e used to ydrostatically reduce te

telesco"ing. Resolution is o!vious+ #it onset o) !o#el movements.

Git om"alocele and gastroscisis 2erniation o) a!dominal contents3 dress #it loose salinedressing covered #it "lastic #ra"+ and ,ee" eye on tem". 1id can lose eat =uic,ly.

A)ter a ydrocele re"air "rovide ice !ags and scrotal su""ort.

No "enylalanine #it a ,id "ositive )or P1$ 2no meat+ no dairy+ no as"artame3.

Second voided urine most accurate #en testing )or ,etones and glucose.

Never give "otassium i) te "atient is oliguric or anuric.

Ne"rotic syndrome is caracteried !y massive "roteinuria 2loo,s dar, and )roty3 caused !yglomerular damage. &orticosteroids are te mainstay. eneralied edema common.

A "ositive Gestern !lot in a cild 4 monts 2"resence o) HIV anti!odies3 indicates only tat temoter is in)ected. T#o or more "ositive "?: antigen tests #ill con)irm HIV in ,ids 4 monts.Te "?: can !e used at any age.

/or HIV ,ids avoid 'PV and Varicella vaccinations 2live3+ !ut give Pneumococcal and in)luena.MMR is avoided only i) te ,id is severely immunocom"romised. Parents sould #ear gloves )orcare+ not ,iss ,ids on te mout+ and not sare eating utensils.


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Hy"otension and vasoconstricting meds may alter te accuracy o) o? sats.

An antacid sould !e given to a mecanically ventilated "atient #8 an ng tu!e i) te " o) teas"irate is 9.5. As"irate sould !e cec,ed at least every 4? rs.

Am!ient air 2room air3 contains ?4< oxygen.

Te )irst sign o) ARDS is increased res"irations. (ater comes dys"nea+ retractions+ air unger+cyanosis.

Normal P&GP is -4>. Readings o) 4-?5 are considered ig.

/irst sign o) P% 2"ulmonary em!olism3 is sudden cest "ain+ )ollo#ed !y dys"nea and tacy"nea.

Hig "otassium is ex"ected #it car!on dioxide narcosis 2ydrogen )loods te cell )orcing"otassium out3. &ar!on dioxide narcosis causes increased intracranial "ressure.

Pulmonary sarcoidosis leads to rigt sided eart )ailure.

An N tu!e can !e irrigated #it cola+ and sould !e taugt to )amily #en a client is going ome#it an N tu!e.

Normal &VP2central venous "ressure3 >-J mm Hg%ac unit o) "ac,ed red !lood cells contains ?95 mlNormal !lood sugar )or ne#!orn 95-L5 mg8dlNormal !lood sugar )or adult J5-445 mg8dlPPD 2 Mantoux Test 3 resd :-J? r+ 45 mm or iger 2 ard area under te s,in3- signi)icant @reaction. In "t #it HIV iger tan 9 mm @ readMulti"le "uncture test read in : -J? r vesicle )ormation @ reactionST'MA&H PH - 4->.9N'RMA( THR'ID /$N&TI'N T%ST0T: 9-4? mg8dl

T> ;9- 4L9 mg8dlTSH- 5.> 9.: mI$8dlHASHIM'T'FS THR'IDITIS T> ET: levels lo# E TSH ig.PRIMAR HP%RTHR'IDIDSM T> E T: levels ig E TSH lo#HP'THR'IDISM T: lo#+ T> E TSH igHASHIM'T'FS THR'IDITIS- is te most common cause o) y"otyroidismDRIP /A&T'R - ] o) dro"s in 4 mlDRIP RAT% - ] o) dro"s in)used8min/('G RAT% - ] o) ml8r4 grain2gr3C ;5 mgTRANSMISSI'N '/ H%P04. He" A)ecal8oral?. He" * "arenteral8sexual

>.He"& !lood8!ody )luids:. Delta He" - co-in)ects #it He" *$RIN%R A(*$MIN O >5 ml 8?: rIN TRA'&$(AR PR%SS$R% 2I'P345- ?4 mm Hg- i) iger "osition "t >5 + no more

A(*$MIN >.9 9.9 !est indicator )or nutritionA* PH J.>9 J.:9 R'MA - res"iratory o""osite+P&'?2car!on dioxide3 >9-:9 meta!olic ali,eH&'> ??-?J m%=8(P'? 5-455 mmHg'? L;< - 455


33/39

*NP itFs a diagnostic test )or a eart. I) itFs ig "t is ^ ris, )or eart )ailure.PT &oumadinPTT He"arinINR 5. 4.? ? - >

ANI'N AP T%STto s"eci)y cause o) meta!olic acidosis.NA2&l @ H&'>3(AS'G &'MA S&A(%- scoring 4-49. (ess tan -indicates coma.No suctioning !e)ore dra#ing A*$R%A *R%ATH T%ST-to determine "e"tic ulcer.

Anti!iotics or *ismut Su!salicylate2Pe"to-*ismol3 disc. )or 4 mont !e)ore te testSucral)ate2&ara)ate3E'me"raole2Prilosec3disc.)or 4 #ee, !e). test&imetidine2Tagamet3+/amotidine2Pe"cid3+Ranitidine2 antac3+Niatidine 2Axid3 disc. )or ?: r!e)ore te test.Gater seal cam!erexcessive !u!!lingair lea, in te cest tu!e sytem

An A4c is a !lood test tat re)lects average !lood glucose levels over a "eriod o) ?-> montsB2normal ;-J-


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indicate a condition suc as !acterial meningitis.INT$SS$S&%PTI'N treatm. *ARI$M %N%MASIN$S *RAD&ARDIA ATR'PIN% S$(/AT%HIP /RA&T$R% te a))ected leg is sorter + adducted+ E externally rotated.('G%R *RAIN ST%M INK$R HP'QIA/or extravasation during D'PAMIN2INTR'PIN3 elevate te a))ected lim!+ a""ly #armcom"ress+ E admin.Pentolamine2Regitine3Ter!utaline adverse reaction HP'1A(%MIA

ATR'PIN% S$(/AT% dosage 5.9 4 mg IV . drug isnFt admin.IM )or te treatm. o) !radycardiaR$SS%(( TRA&TI'N-s,intraction a""lied to a lo#er extremity + #it te extremity sus"endeda!ove te !ed.D$N('P S&%(%TA( TRA&TI'N is a traction o) te u""er extremity to #ere te arm elevated#it te el!o# !eing ^ L5 . N sould o!serve )or correct !ody "ositioning #it em"asis onalignment o) soulders+ i"s+ Elegs.1AGASA1I DIS%AS%2mucocuteneous lym" node syndrome3- lead to &'R'NAR ART%R

AN%$RSMS.SI&(% &%(( &RISIS0'?+ydration+!ed rest+electrolyte re"lacement+ analgesics+!loodre"lacement+anti!iotics to treat any existing in)ectionsTe average d#ell time 2"eritoneal dialysis3 a"rox. ?5 min. Te )luid in)uses #itin 45 min+ d#ells)or ?5 min+ E ten drains in a!out ?5

Alvimo"an2%ntereg3- "eri"erally acting o"ioid antagonist )or "revention o) "osto" ileus a)ter"artial !o#el resection surgery*endamustine2Treanda3- al,ylating agent )or treatment o) cronic lym"ocytic leu,emia Ecertainty"es o) non-Hod,ins lym"oma&ertliuma!2&imia3-a tumor necrosis )actor 2TN/ !loc,er3 )or resistant &ronFs disease&inrye- "revention o) angioedema attac, in "tFs #it ereditary angioedema&levidi"ine2&levi"rex3-an in7ecti!le &a cannel !loc,er )or y"ertentionDesvenla)axine2Pristi=3 an SNRI2serotonin nore"ine"rine reu"ta,e ini!itor3)or treatment o)de"ression%ltrom!o"ag2Promacta3- a trom!o"oetinrece"tor agonist )or treatment o) idio"atictrom!ocyto"enia "ur"ura%travirine2Intelence3- a non-nucleoside reverese transcri"tase ini!itor )or treatment o) advancedHIV-4 in)ection

/eno)i!ric acid 2Trili"ix3- treatment o) mixed dysli"idemia in com!ination #it a statin/esoterodine2Tovia3 an antimuscarinic )or treatment o) overactive !ladder/os"o"o)ol2(usedra3 a sedative to induce anestesia(acosamide2Vim"at3- an anticonvulsant )or treatment o) "artial onset seiures in adultsMetylnaltrexone2Rlistor3- a "eri"erally acting o"ioid antagonist )or severe o"ioid inducedconsti"ationPlerixa)ar2Moo!il3stem cell mo!ilie used !e)ore stem trans"lantationRilonace"t2Arcalyst3- an interleu,in-4 !loc,er to reducein)lammation in "tFs #it cryo"yrin-associated "eriodic syndromeRomi"lostim2N"late3 a trom!o"oeiet in rece"tor agonist to increase "latelet "roduction in "tFs#it idio"atic trom!ocyto"enic "ur"ura 2ITP3.Ru)inamide 2*anel3- an anticonvulsant )or treatment o) seiures associated #it (ennox-astaut syndrome

Silodosin2Ra"a)lo3- an al"a-!loc,er )or treatment o) !eningn "rostastasic y"ertro"y.Ta"endtadol2!rand name "ending3-treatment o) "ainTetra!enaine2Qenaine3-a monoaminede"letor )or involuntary movement o) HuntigtonFs disease(actulose2&e"ulac3- is adm to "romote ammonia excretion in te stool E tus im"rove cere!ral)unction. *ecause ('& is an accurate indicator o) cere!ral )unction + te N evaluate tee))ectiveness o) lactulose !y monitoring te ct ('&*'N% MARR'G su""ression !ecomes noticea!le J -4: days a)ter )loxuridine admin.In7ury )rom&4 -& $ADRIP(%IA- "aralysis involving all : extremIn7ury )rom T4-(: -PARAP(%IA-"aralysis involving only lo#er extremeIn7ury &?- &> usually )atal


35/39

Involvment a!ove &:- res"iratory di))icult.E "aralysis o) all : extrem. &t may ave movement inte soulder i) te in7ury is at &9 or !elo#.

Acute ne"ritis- give MPa" test- class 4 normalB ?-in)lammation + re"eat in > montsB>-mild to moderate dys"lasia+re"eat in ; #ee,s to > montsB :- "ossi!le cervical cancerB 9- #arrants a !io"sy A.S.A.P.&ARDIA& DIS'RD%R- n o T rectal routDilantin-scedule )ollo#-u" visits #it "ysician )or !lood testPrinmetalFs angina results )rom or artery s"asm1ayexalate removes "otassium)rom te !ody troug te I systemHy"ovolemic soc, )rom )luid si)ts is a ma7or )actor in A&$T% PAN&R%ATITISDantrolene2Dantrium3-decrease muscle s"astisity.Most common adverse e))ect muscle#ealness.

Amyotro"ic lateral sclerosis-elecromyogra"y 2%M3'ligoydramnios renal mal)ormations in te neonateNeostigmine2Prostigmine3-give !e)ore meals #it a small amount o) )oodPancreatic cancer-more common in A)rican Americans+ males+ E smo,ers. 'ter associated)actors incl. alcool use+ dia!etes+ o!esity+ istory o) "ancreatitis+ ex"osure to organic cemicals+consum"tion o) a ig-)at diet + E "revious a!dominal irradiation

Air em!olism-turn ct (e)t sideEin Trendelen!urgs "osition./at em!olism- '?

lucagone interacts adversely only #it oral anticoagulants+ increasing teir anticoagulant e))ect%cto"ic "regnancy- istory o) "elvic in)lammatory diseaseB intrauterine device )or ? years or moreMetronidaole2/lagyl3- cause metallic taste.'ter adverse reac. Nausea+ anorexia+ eadace + Edry mout.Moda)inil2Provigil3- "romotes #a,e)ulness )or narcole"sy'xytocin2Pitocin3-causes H?' intoxication

Amniotic )luid nitraine "a"er turns *($%Normal vaginal discarge or urine-PIN1Perior!ital edema-classic sign o) acute glomerulone"ritisNurse client relationsi" E Tera"eutic regimen ? ma7or clinical caracteristics a))ect ctcom"lientsViral meningitis-s8s )ever+ nucial rigidity+ irrita!ility+ E "oto"o!ia*ulging anterior )ontanel is a sign o) HDR'&%PHA($S

Petecial + "ur"uric ras may !e seen #it *A&T%RRIA( MM%NINITIS&'PD- ig "rotein dietSrevens-Konson Syndrome 2SKS3triggered !y a reaction to meds. s8s con7ctival !urning + )ever+coug+ sore troat+ eadace+ aces E "ains+ E rytema E mucous mem!r. As te disease"rogresses+ large "ortions o) te e"idermis are sed + ex"osing te dermis Ecausing tender s,inE a #ee"ing sur)ace. 1ee"ing te tissue intact is te main "riority )or tis ct. N8D Im"aired tissueintegrity- PriorityKimson#eed- anticolinergic agent- ot + dry s,in

Admin. ') ,etamine ydrocloride 21etalar3E te o"ioids-monitor )or allucinationDro"eridol-extra"yramidal reactionsTio"ental+ etomidate+E "ro"o)ol can "roduce air#ay re)lex y"eractivity #it iccu"s + couging+Emuscle t#itcingE 7er,ingli"iide2lucotrol3- may cause adverse s,in reactions+ suc as ras+ "urities+ E "otosensitivity

%"idural ematoma is contraindicated. *y an initial loss o) consciousness )ollo#ed !y transientconsciousness leading tounconsciousnessSu!dural ematoma results in ra"id deterioration in level o) consciousnessSu!aracnoid emorrage causes irrita!ility&oncussion may result in a !rie) loss o) consciousnessTo reverse arrytmias + !radycardia + or sinus arrest + te usual adult dosage o) atro"ine 5.9-4mg IV >-9 min PRN/lumaenil2Romaicon3reverses te e))ects o) !enodiae"ins suc as MidaolamNaloxone 2Narcan3-used to reverse te e))ects o) o"ioids suc as mor"ine


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Pentolamine2Regitine3- is in7ected into te tissue to minimie te damaging e))ects o)Do"amine2Inotro"ine3 in)iltration

Anergy testing determines te level o) immune res"onse an individual as to common micro!es&NS stimulants "roduce mood s#ings+ anorexia E#eigt loss+E tacycardia&NS de"ressants y"er"yrexia+slo# "ulse+ #eigt gain+ y"otension+ listlessness+ increaseda""etite+ slo#ing o) sensorium+ E arrytmiasTo determine &PP0 su!tract te I&P )rom te mean arterial "ressure 2MAP3.MAPC2 2 diastolic !lood "ressure ?3@systolic P 3 0 >

Am"etamines &NS - stimulants cause sym"atetic stimulation incl.y"ertension+tacycardia+ vasoconstriction E y"ertermia. Pu"ils dilatedIM in7ection o) Digoxin isnFt recommended !ecause it causes severe "ain^ te in7ection site Eincreased serum creatinine ,inase 2&13 + #ic com"licates inter"retation o) enyme levels.*lood trans)usions- 4 or 4L needleHy"oactive !o#el soundsdiarrea+ unger+or early intestinal o!struction(e)t sided eart )alure- increased "ulmonary artery diastolic "ressure&entral venous "ressure increases in eart )ailure rater tan decreasesHeart index decreases in eart )ailure. Te mean "ulmonary artery "ressure increases eart)ailure.S8S multi"le Myeloma 2!one cancer3

& - alcium 2elevation3R enal )ailure

A nemia* one lesionsSnellenFs test diagnose am!lyo"ia2_lay eye`3Resuscitation o) te neonatal #it as"yxia- ead in te _sni))`+ "osition2extending te nec,sligtly3

A!solute neutro"il count2AN&3CTotal G*& count 2< neutro"ils@-no increased ris,)or in)ection is iger #it an AN& or less tan9558mm> E te ris, o) in)ection is almost certain i) te AN& is less tan 4558mm8>

An early sig o) Digoxin toxicity- !radycardia. 'ter s8s o) dig. Tox.- arrytmias+ vomiting+y"otension+ )atigue+ dro#siness+ Evisual alos around o!7ect.2Higer tan L5 !eats8min- noti)y

te "ysician3+ do not ta,e #it meals2 slo#s te a!sor"tion rate3Aortic insu))iciency- diastolic+ murmur is ig-"itced E !lo#ing E is eard te >rd or : tintercostals s"ace ^ te le)t sterna !order.

Aortic stenosis- systolic+ ars+loud E roug+ crescendo-decresendo murmur+ eard over teaortic area.Mitral stenosis-diastolic+ lo#-"itced rum!ling murmur eard te a"exMitral insu))iciency- "ansystolic +ig-"itced+ !lo#ing murmur te a"exMI can !e0 4.anterior ?."osterior >.lateral :.in)erior

An anterior MI causes le)t ventricular dys)unction E can lead to mani)estations o) eart )ailure +#ic include "ulmonary crac,les E dys"nea. Posterior+ lateral+E in)erior MI arenFt usuallyassociated #it eart )ailure./etal tacycardia E excessive )etal activity -4st signs o) )etal y"oxia$remia+ anemia E acidosis- consistent clinical mani)estations o) cronic renal )ailure

Adverse reaction to 'QT'&IN2PIT'&IN3- in te moter incl. y"ertension+ )luid overload+Euterine tetaning. Te antidiuretic e))ect o) oxytocyn increases renal rea!sor!tion o) H?'+ leadingto )luid overload- not deydration. Kundice E !radycardia are adverse reactions tat may occur inte neonate. Tacycardia is re"orted as a maternal adverse reaction.(itium toxicity- muscle t#itcing+ mental con)usion+ incoordination+ Ecoarse and tremors.Severe (itium toxicity- ataxia2luc, o) muscle movement3+ giddiness2diiness3+ !lurred vision+Esevere lo# *P.Monitoring Pa'? levels2"artial "ressure3E reducing te '? concentration to ,ee"P'? #itinnormal limits decrease ris, o) R%TIN'PATH '/ PR%MAT$RIT in a "remature neonatereceiving '?.


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MA'Is ave an onset o) action a"rox >-9 days./ull clinical res"onse may !e delayed )or >-:#ee,s. Te tera"eutic e))ects may continue )or 4-? #ee,s a)ter discontinuation.&onversion disorder is caracteried !y alteration or loss o) "ysical )unction #it no"ysiological !asis.It ta,es u" to ? rs )or (idocaine-"rilocaine cream2%M(A cream3 to anestetie an insertion site.Paralytic ileus-y"oactive or a!sent !o#el sounds

A!out J9< o) AN%$RSMS occur in te a!dominal aorta+ 7ust !elo# te renal arteries.&ongenital i" dislocation 2in)ant3-assessment- 'rtolanis sign- asymmetrical tig Egluteal )olds+limited i" a!duction+ )emoral sortening+ E Trendelen!urgFs signTension "neumotorax-decreased cardiac out"ut+ decr. tension+traceal deviation to te o""ositesite.(icteimFs sign ina!ility to s"ea, associated #it su!cortical a"asia1ernigFs sign @+ *rudins,iFs sign @ C meningitis*a!ins,iFs re)lex -indicator o) corticos"inal damage

Acetamino"en overdose-gastriclavage Eactivated carcoalPril2A&% ini!itors3-diiness+eadace+ Ey"otension common adverse e))ectsB may causediarres/rontal lo!e damage-a))ects "ersonality+ memory+reasoning+ concentration+Emotor control o)s"eec*rain steam damage- earing E s"eec "ro!lems

Tem"oral lo!e damage- earingEs"eec "ro!lems'cci"ital lo!e damage-vision distur!ancesMI- T-#ave inversionB ST segment elevation+E "atologic -#ave-signs o) tissue y"oxiaTe Hemovac must !e com"ressed to esta!lis suctionRetinal Detacment- ligt )lases E )loaters in )ront o) te eyelaucoma-gradual loss o) "eri"eral vision

Acute 2angle-closure3glaucoma-eadace+nausea + Eredness o) te eyes&ataracts-dou!le vision is commonIntraosseous in)usion2in)usion in te !one marro#3in an emergency+ intraosseous drug admin. Isty"ically used #en a cild is critically ill E younger tan age >(''P DI$R%TI&S adverse reaction0 #ea,ness+ irregular "ulse+ y"eractive !o#el sounds+decreased muscle tone + y"o,alemia+ventricular arrytmiasT'Q'P(ASM'SIS 'TH%R R$*%((A VIR$S &T'MAA('VIR$S H%RP%S SIMP(%Q

VIR%S 2T'RSH3 may a))ect )etus or neonate.Rear )acing car seat 2in)ants3-until ?5l!s or 4 y.o.(a!or- : stages+ > "ases04st stage onset o) la!or to )ull dilation24st "ase-early25-> cm3+?nd "ase active2>-J cm3+>rd"ase transition2J-45cm3 3?nd stage )ull dilation to !irt o) te !a!y>rd stage !irt o) te "lacenta:t stage 4 r "ost"artum*ence Kones "rotein in te urine almost al#ays con)irms multi"le myeloma

Arterial 2"eri"eral3insu))iciency o) te lo#er extremities- lo#er te legs to de"endent "ositionPulmonary em!olism sudden tacy"nea + dys"nea+ E cest "ain

AddisonFs disease- s8s y"onatremia+y"er,alemia+ deydration+ lo# *P+ meta!olic acidosisToddler- se"aration anxiety

%tnocentrism-universal unconscious tendency o) uman !eings to tin, tat teir #ays o)tin,ing+ acting+ E!elieving are te only rigt+ "ro"er E natural #aysAs"irin "t #o ta,es daily- monitor )or serum al!umin to "revent as"irin toxicitySIDH-s8s over"roduction o) antidiuretic ormone + )luid retention.Severe cases- vascular )luidoverload + signated !y 7ugular vein distentionDiscarge "lanning !egins u"on admission&illenFs sign !lue !lac, !ruising o) te area around te um!ilicus.te sign ta,es ?:-: r toa""earE "redicts a severe attac, o) A&$T% PAN&R%ATITIS.it may !e accom". *y rey TurnerFssign2 !ruising o) te )lan,3+ #ic may ten !e indicative o) "ancreatic necrosis #itretro"eritoneal or intraa!dominal !leeding


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Measels- ,o"li, s"ots1aolin E"ectin mixture21ao"ectate3-antydirreal medsSudori)erous glands secrets SG%ATPlug te o"ening o) te trac tu!e in "t #o doesnFt re=uire continuous mecanical ventilationsould !e 9-?5 minKoint a!normalities most o!vious mani)estations o) reumatoid artritisVesicular lesions im"etigoI) Ascites "resentin ct #it cirrosis o) te liver+ "otassium-s"aring diuretics suc as Aldactone+sould !e admin.+ !ecause it ini!its te action o) aldosterone in ,idneysDilantin-cild sould !rus E )loss te teet + !ecause it causes lym"oid y"er"lasia2gums32gingival y"er"lasia3NSAIDs ta,en )or long "eriod o) times-!leeding in IIM in7ectons )or in)antsEtoddlers sould not exceed volume o) 4.5 ml&rede metod-done !y gently "ressing do#n on !ladder%ndosco"y-oarseness is normalB #atc )or laryngos"asm or !roncos"asm*arium contrast2test3-lo# residue diet or clear li=uid diet )or ? days%%2electroence"alogram3- do not sto" anticoagulants !e)ore testDextrocardia-eart in te rigt sideDresslerFs syndrome- "ostmyocardial in)arction syndrome-"leuratic cest "ain+"ericarditis+)ever+Eleu,osytosis

Synco"e-transient loss o) consciousness resulting )rom an inade=uate !lood )lo# to te !rainRIHT SID% H%ART /AI($R%04. N'&T$RIA?. *$(IN N%&1 V%INS>. AN1(% E/''T %D%MA:.H%PAT'M%A((%/T SID% H%ART /AI($R%04. R%ST(%SSN%SS+ IRRITA*I(IT+ H'STI(IT+AITATI'N?. ANQI%T>. SH'RTN%SS '/ *R%ATH+ AIR H$N%R:. &'$H+ '/TH%N DR INITIA((9. TA&HPN%A;. &RA&1(%S

J. P$(M'NAR %D%MA. _/R'TH`+ SP$T$M-MA *% *(''D TIN%DL. DIAPH'R%SIS45. &AN'SIS44. G%IHT AIN&ardiac tam"onade is a medical emergency&lassic s8s 04.Hy"otension?. mu)lled eart sounds #it ig 7ugular venous "ressure2increased &VP3.SH'&1-D' N'T %levate or lo#er te ead o) te !ed.maintain com"lete !ed rest in /(ATP'SITI'N or legs sligtly raised to increase venous return.D' N'T Move ctB no commode.1ee" ct #arm.'"en "neumotorax0ole in te cest #all+ communication #it lungs&losed "neumotorax0ole in te lungB cest #all intact.air )orced into te "leural s"ace #it acontinued "ressure !uild u".si)ts mediastinum a#ay )rom a))ected siden#it results o) a

com"ressed eart .Treated #it cest tu!e insertion.&ardiac Eres"iratory arrest i) not treated.Tension "neumotorax0A N$RSIN EM%DI&A( %M%R%N&All o) tese musculos,eletal disorders+ exe"t uillian-*arre )eature te letter m04. Myasteniagravis ?.Poliomyelitis >. Amyotro"ic (ateral Sclerosis :.Muscular Dystro"iesuillian-*arre syndrome-)ollo#s a viral in)ection. Ascending "aralysis tat may a))ect muscles o)res"iration as "aralysis ascends.&or Pulmonale- rigt ventricular y"ertro"y E su!se=uent cronic eart )ailure

Astma-avoid as"irin E oter NSAIDs&t #it anemia may !e severely y"oxemic E never turn !lue+ !ut rater _asen`(o# "ressure alarm sounds- te ventilator tu!e disconnects.


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Hig "ressure alarm sounds-cec, )or o!struction or occlusion o) te air#ay 0mucous"lugs+!ittingo) te tu!e !y ct+ tu!e sli"s into rigt main stem!roncus+ or increased secretions.&ommunications di))iculties o) a ct #it &VA usually indicate involvement o) te dominantemis"ere+ usually te le)t !rain.Multi"le sclerosis-early canges0visionE motor sensationB late cange0cognitionE !o#el control%"ine"rine eye dro"s N'to ct #it eart condition

Acute closed angle glaucoma2sallo#+ narro#-angle+or congested glaucoma3-M%DI&A(%M%R%N&*lindness may occur in ?-9 days i) le)t untreated.s8s0Sudden onset o) !lurredvision+ alos or colored rings around #ite ligtsB sudden )rontal eadaceB sudden severe eye"ain + reddening o) te eye + nauseaE vomiting.

Al,aline su!stances2lye+ammonia+some "o#dered detergents+drain cleaner+E!attery )luid3in teeye Priority to treat )or.Acids in te eye- reversi!le damage.Retinal detacment-sense o) a _curtain !eing "ulled over te eye&ystocele-ernia 2!ladder into vagina3&ronic renal )ailure-lo# "rotein diet+lo# "otassium+lo# car!onated drin,s.

Acute renal )ailure- regular "rotein inta,e+ig car!+ restrict )luid ig in "otassium+ "os"orus Esodium.*romocri"tine2Parlodel3-gro#t ormone su""ressantPysical canges o) Acromegaly are irreversi!leVDR( !ecomes reactive ?-; #ee,s a)ter te "rimary in)ectionBsy"ilis is treated #it "enicillin

IM or erytromycin )or 45-49 day i) allergic to P&N.&lamidia E onorrea may !e asym"tomaticin )emales + "elvic in)lammatory disease can develo" i) le)t untreated

Nclex Pharm Tips[1]

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