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MADULID, 2020UWORLD & LA CHARITY NOTES PARESTHESIA & EPIDURAL ANALGESICS
- PARESTHESIA is NOT COMMON OR A COMPLICATION to
WARFARIN a client post hip surgeries or any surgeries below the hip,
- LIVER is RICH IN VIT K & A! which indicates compromised circulation; However, it is
- INCREASED EFFECT: GET A SOCk! NORMAL to a client POST EPIDURAL ANALGESIA as this
· Gingko biloba/Ginger is a SIDE EFFECT
· E Vitamin - PARESTHESIA may also be present d/t presence of co-
· Thyroid hormone morbidities such as DM, GBS or alcohol use
· Amiodarone, ATB, Antifungal, Acetaminophen - PARESTHESIA BILATERALLY may be normal but
• ATB kills intestinal bacteria, which produces UNILATERAL is ABNORMAL
vitamin K. Thus if there is no vitamin K, there - #1 COMPLICATION OF HIP/KNEE SURGERIES is
will be more available warfarin causing HEMORRHAGE which precede abduction pillow
increased effect of warfarin · Low Hgb is normal but is only up to 8 hgb: <7 is not
· SSRI normal after a hip or knee surgery
· Omeprazole; - EPIDURAL ANALGESICS ARE NOT given together with
· Cranberry ANTICOAGULANTS because of epidural hematoma
- DECREASED EFFECT: ROCKS incidence which causes cord compression with sssx of
· Rifampin back pain and/or paralysis
· OCPs
· Carbamazepine(tegretol) FUROSEMIDE/BUMETANIDE; LOOP DIURETICS
- NEPHROTOXIC- On HIGH doses
· K Vitamin
- OTOTOXIC- On FAST administration
· St John’s Wort
- SOCK
· SSRI : St. John’s Wort More on KNEE ARTHROPLASTY
· Omeprazole : OCPs - Hospital stay: 3-5 days; Full weight bearing should be
achieved by discharge
· Cranberry : Carbamazepine
- KNEE IMMOBILIZER is used to maintain extension during
· K Vitamin : E Vitamin
ambulation and rest; Remember: Flexion and internal
- Vit K rich foods should be CONSISTENTLY TAKEN UP
rotation is avoided to post arthroplasties to prevent
WITH THE SAME AMOUNT EVERYDAY; Amount is not
dislocation. GOAL: Extension and abduction
increased nor decreased
- Client is encouraged to do ROM with extension as much
as possible thus knee immobilizer is used and not to
DIGOXIN restrict movement
- There is no reason a client taking digoxin will experience
lightheadedness because the effect of it is INCREASED
ANALGESIA
CARDIAC OUTPUT which instead should help the client
- On PCA PUMP
with the SSXX;
· Bolus dose is “extra” dose if pain mgt is not
- Lightheadedness/dizziness may be caused by HEART
adequate
BLOCKS (sign of toxicity) s/t BRADYCARDIA
· Only pt. is allowed to push, nurse only programs the
- Hold if <90bpm for infants and young children
machine
- Hold if <70bpm to an older child
- Hold if <60 for an adult · Only report for additional dose if pumps made on
pca are twice the number of usual doses being
delivered and no adequate pain mgt is achieved.
PATCHES
· Delivers medication each time patient press the
- TRANSDERMAL PATCHES such as NTG and/or Fentanyl
button
peak is at 1hr thus is NOT USED FOR ACUTE
· Continuous IV solution is REQUIRED to KVO for the
ANGINA/PAIN; Transdermal patch is more on
medication to be FLUSHED through the line
maintenance
- If an NTG patch is pulled off after inserting and client · Saline/Hep lock is not used as medication is not
reports chest pain, administer NTG PRN then apply the flushed to the line
patch · LOC is a parameter to all patient controlled pumps
- Morphine is given only if NTG does not relieve the pain such as insulin and PCA pump because they
- Scopolamine patch (for motion sickness) is applied 4 determine when to infuse the medication to
hours before starting to travel; Replace patch every 3 themselves; Thus a client with sepsis who is more
days likely to be disoriented should be assessed for LOC
- HYDROMORPHONE action is 3-4 hrs. Naloxone’s duration
is only up to 90mins. Thus, repeat doses may be
necessary and assessment should be made approx. 60
mins after administering naloxone
,MADULID, 2020
- Hydromorphone’s peak is 30 minutes, thus client with - EXTRA CAUTION to older clients d/t risk for fall, worsening
hydromorphone should be checked after 30 mins of of constipation, and increased risk for respiratory
administration; Administered over 2-3 minutes depression
- Patient may be agitated 60 minutes after naloxone - AT RISK FOR RESPIRATORY DEPRESSION: Old, Respi cases,
administration, signifying weaning off of naloxone; This Opioid-naïve (new users), and to clients with OSA
differs from a LUCID INTERVAL experienced by patients - Drug abusers are safe to be given narcotics and
with epidural hematoma which is a transition from ALOC withholding narcotics does not resolve addiction;
to alert to COMA furthermore, medical use of opioids is not addictive
- OXYCODONE is morphine-like analgesic - LARGER doses are given at night to increase interval
- FENTANYL is a synthetic opioid between doses and helps the client to rest and sleep
- HYDROMORPHONE is 2-3x stronger than morphine - Placed FARTHEST of the station to provide quiet calm
ANALGESICS DURING LABOR environment, especially those receiving continuous IV
- Pudendal nerve block- used if birth is imminent (0 station ANALGESIA to contribute to pain management
with 100% effacement and 10cm dilation); best pain - SIDE EFFECTS (NORMAL): Constipation, N/V (give with
relief with least SE with quick administration meals), Hypotension, pruritus, urinary retention (normal),
- Epidural: 1st or early 2nd stage but not in late 2nd stage together with tricyclics and anti cholinergics.
where birth is imminent because the medication peaks - AE: Respiratory depression
at 30 minutes - THUS the risk for respiratory depression and sedation is
- IV Narcotic (Demerol); early labor; has a duration of 2-3 NONE to clients on long term opioids as these symptoms
hours, thus is avoided 1-4 hours of birth d/t respi develop tolerance
depression - R. DEPRESSION is common to opioid naïve patients
- CONSTIPATION does not develop tolerance, thus is
common to long term opioid use
CODEINE
- Is an opioid; Thus already has opioid SE (N/V, hypotension,
dizziness, constipation) so it should be taken with food
because GI irritation is common
- Photosensitivity is not a feature
NYSTATIN
- Swish and swallow but do not follow with drinking a glass
of water for medication to stay in tissues as long as
possible
MORE ON OPIOIDS:
- While this is swallowed, corticosteroids/anticholinergics
- WITHDRAWAL
used for asthma is only swished to reduce
· EARLY 6-12h: Diaphoresis
oral/esophageal candidiasis
· LATE 2-3d: Abdominal cramps, nausea, fever
- A client on opioid must ALWAYS be EASY to be aroused.
PAIN ASSESSMENT
DIFFICULTY to be aroused means OVERDOSE of
- UNCONSCIOUS: For patients who cannot adequately
medication or TOXICITY which warrants INTERVENTION
describe the pain, baseline behavioral indicators must be
IMMEDIATELY
obtained to the family members then nonverbal indicators
should be assessed second
- CONSCIOUS: Behavioral assessment tool is not effective
when the client is engaging in activities as the client may
mask different expressions while on activity. THE BEST
assessment tool is to use the SAME scale every day for THE
SAME CLIENT
ISSUES on LIGHTHEADEDNESS/DIZZINESS
- Digoxin; heart block
- NTG; over-dosage/profound hypotension;
- NO OPIOID to clients with head injury or those at risk for - Calcium channel blockers; orthostatic hypotension
INCREASED ICP because hypoventilation increases ICP
more and assessment will be compromised as decreased ISSUES on HEADACHE
LOC will be mistaken as worsening of condition - NORMAL in: NTG, Ca channel blockers, statins, CHF
(dilutional hyponatremia)
- ABNORMAL: Desmopressin
,MADULID, 2020
- NSD with previous CS is at risk for uterine rupture
ISSUES on HYPERTENSION/HEART PROBLEMS - 1st sign: abnormal FHR
- NOT given to Heart failure (causes water retention): ANT - OTHER signs: constant abdominal pain, loss of fetal
· ADH/Desmopressin station, sudden cessation of uterine contraction,
· NSAIDs tachycardia d/t hypovolemic shock
· THIZOLIDINEDIONES (-GLITAZONE)
- CI to uncontrolled hypertension (>180)
· SSRIs/MAOIs; these causes constriction
· Kidney transplant
· Thrombolytics
· EPO (SE is hypertension)
ISSUES on GRAPEFRUIT: Contraindicated to:
- CaChannel Blocker/Sildenafil; severe hypotension
- Statins: myopathy
NITROGLYCERIN
- PROFOUND HYPOTENSION as evidenced by
DIZZINESS/LIGHTHEADEDNESS is NOT normal and may
indicates overdose, also with CaChannel
- HA, Flushing, Nervousness are normal due to
vasodilation together with CaChannelBl
- EMS is called if no relief of symptoms after taking 1 PILL
- 6 mos. Only:
- INSULIN 3 mos if on ref; 1 mon in room temp
**HYPOTENSION may also be a complication of rapid bladder
decompression and paracentesis (treated with IV albumin) CLOMIPHENE (Clomid, Serophene)
- Infection is more on if the bladder is not decompressed - First line TX for infertility
- Estrogen modulator, inducing ovulation
DESMOPRESSIN - Taken day 3-5 of menses and ovulation occurs 5-9 days
- Di naghe-headache and De-spray after completion of medication.
- Concept: Effects are that of SIADH: Water is restricted - Frequent sex is encouraged 5 days after completing the
d/t water intox with sssx of low Na-Dilutional medication not on the day of taking the medication for
hyponatremia (altered mental status, weakness, successful contraception
headache) which may cause seizure - Increased risk for twin
- Postmenopausal signs, N/V, weight gain d/t fluid
ISONIAZID retention are common SE
- Peripheral neuropathy is already an ADVERSE EFFECT
METOCLOPROMIDE (Reglan)
REFLUX ESOPHAGITIS; Taken in the morning, without - An antiemetic and to increase gastric emptying time to
meals/antacids/milk and with full glass of water to prevent clients with GERD thus may cause diarrhea
reflux esophagitis: No foodà nothing regurgitates - Can cause EPS and TD, just as antipsychotics
- CONCEPT: Antipsychotics can act also as antiemetic in
- TETRACYCLINE such a way that antipsychotics decreases the
- BIPHOSPHONATES/Calcium transmission of Norepi, Epi, Dopamine which is high in
· Also w/o food; For bone pain associated with bone psychotic patients; While antiemetics such as Reglan
Ca decreases nerve impulses so that the vomiting center in
- EXCEPTION: KCL the brain will be blocked. So they both decreases the
· With food d/t SE s/c as N/V nerve impulses or brain reactivity in the brain
- Common SE: Sedation, fatigue, HA, sleeplessness, dry
MISOPROSTOL/CYTOTEC mouth, constipation, diarrhea (these are all
- No to CS d/t uterine rupture s/t tearing at the incision anticholinergic properties of the medication)
site
- Oxytocin is only given after 4hrs misoprostol is
administered
- Available in oral, vaginal, rectal (only for PPH)
, MADULID, 2020
RASHES FROM MEDICATIONS
- ALWAYS consider abnormal even if mild unless otherwise
not normal
- Allopurinol and Dilantin rashes are normal; Rashes with
flu-like symptoms are not normal, which indicates SJS to
Dilantin
SJS; Flulike symptoms with painful purple or red rash that
resembles a 3rd degree burn;
EPOGEN: only given to Hgb of <10 and if anemia is
symptomatic
- HTN is a major adverse effect; Do not give if hypertensive
PHENYTOIN or check BP first
- SE: body hair, rash, folic acid depletion and osteoporosis
- TOXICITY: DEANS SNS; ANTICHOLI; Urinary retention to treat incontinence
· Dysarthria (overactive bladder); MAJOR CI is BPH and GLAUCOMA
· Encephalopathy - AIM is to treat incontinence and not to retain urine;
· Ataxia - Urinary elimination that is normal is the aim of therapy
· Nystagmus - Urinary retention is already an adverse effect
· SJS - Decreased sweat to treat hyperhidrosis thus can cause
- Food and calcium decreases its absorption leading to hyperthermia d/t no heat loss mechanism; INC OFI!
decreased serum levels resulting to seizures - Sedating effect; no mentally alert activities
- Decreases effect of OCP and WARFARIN; OCP is not PNS; CHOLI; Urinary elimination to treat retention (BPH)
recommended as birth control
- PPIs decreases calcium absorption resulting to decreased OTHER ANTICHOLINERGICS
calcium levels; Causes c. difficele - Tolterodine; Overactive bladder
- Only MagSulfate is the acceptable anticonvulsant in - Glycopyrolate; Perioperative, Hyperhidrosis
pregnancy; NO VALPROATE/PHENYTOIN/CARBAMAZEP - Dicyclomine (BentyL); IBS to decrease ulceration by
decreasing GI Acid
SOME NOTES: - Scopolamine; Motion sickness and Perioperative
- METHOTREXATE is CI in pregnancy; Only heard in - Oxybutynin; Overactive bladder (incontinence) and
ECTOPIC / H. MOLE in maternity nursing Hyperhydrosis
§ A DMARD; - Atropine, Ipatropium, Tiotropium
§ AE: Bone marrow suppression, GI irritation, - Solifenacin (Vesicare)
hepatotoxic
§ Petechiae/purpura is a red flag as it signifies CHOLINERGICS
thrombocytopenia - ZOSINs to treat urinary retention caused by BPH
§ N/V are common side effects;
§ Caffeine and folic acid decreases its effectiveness as NO vasodilators should be administered simultaneously; NTG,
methotrexate is a folic acid antagonist Zosins, Sildenafil Viagra
- PHENTOLAMINE REGITINE is the DOC for HTN CRISIS in a
client with PHEOCHROMOCYTOMA; Thus this drug is also LIVE vaccines are only administered at the age of >2y/o;
an antidote for norepinephrine extravasation MMR, VARICELLA, ROTAVIRUS
- ANTIDOTE for ALCOHOL is benzodiazepine
- ANTIDOTE for BENZO/CNS DEPRESSANTS is FLUMAZENIL HERBAL SUPPLEMENTS
ROMAZICON, NALOXONE NARCAN NALTREXONE - Saw Palmetto for Prostate: BPH
PAIN · GI discomfort
- From lower back to abdomen; true labor · Increased bleeding/antiacoag effect
- Abdomen to lower back: Acute pancreatitis or ruptured - St DepreJOHN’s wort
AAA · HTN Crisis
· Decreased anticoag effect
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