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Emergencynursing 110208063045 Phpapp01 PDF
Emergencynursing 110208063045 Phpapp01 PDF
Emergency Nursing
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
Avoid excessive intake of coffee, tea, cocoa, reduced one-third to one-half when
cola beverages, chocolate. amiodarone is started.
Smoking cigarettes or other tobacco Give drug with meals to decrease GI
products impacts the drug's effectiveness. problems.
Try not to smoke. Notify the care provider if Arrange for ophthalmologic exams;
smoking habits change while taking this reevaluate at any sign of optic neuropathy.
drug. Arrange for periodic chest x-ray to evaluate
Frequent blood tests may be necessary to pulmonary status (every 3–6 mo).
monitor the effect of this drug and to ensure Arrange for regular periodic blood tests for
safe and effective dosage; keep all liver enzymes, thyroid hormone levels.
appointments for blood tests and other Drug dosage will be changed in relation to
monitoring. response of arrhythmias; you will need to be
These side effects may occur: Nausea, loss hospitalized during initiation of drug
of appetite (taking this drug with food may therapy; you will be closely monitored when
help if taking the immediate-release or dosage is changed.
liquid dosage forms); difficulty sleeping, Have regular medical follow-up, monitoring
depression, emotional lability (reversible). of cardiac rhythm, chest x-ray, eye exam,
Report nausea, vomiting, severe GI pain, blood tests.
restlessness, seizures, irregular heartbeat These side effects may occur: Changes in
vision (halos, dry eyes, sensitivity to light;
wear sunglasses, monitor light exposure);
2) AMIODARONE HYDROCHLORIDE nausea, vomiting, loss of appetite (take with
meals; eat small, frequent meals); sensitivity
Brand Names: Anoion tab Cordarone Cordarone to the sun (use a sunscreen or protective
inj Sandoz Amiodarone HCl tab clothing when outdoors); constipation (a
Classification: Cardiac Drugs laxative may be ordered); tremors,
Dosage: PO Initial: 200 mg 3 times/day for 1 wk, twitching, dizziness, loss of coordination (do
reduce to 200 mg twice daily for a further wk. not drive, operate dangerous machinery, or
Maintenance: 200 mg/day or lowest effective dose. undertake tasks that require coordination
IV Initial: 5 mg/kg infusion via central venous until drug effects stabilize and your body
catheter. Max: 1.2 g/24 hr. adjusts to it).
Indication: Ventricular and supraventricular Report unusual bleeding or bruising; fever,
arrhythmias. chills; intolerance to heat or cold; shortness
Action: Blocks potassium chloride leading to of breath, difficulty breathing, cough;
prolongation of action potential duration. swelling of ankles or fingers; palpitations;
Adverse Reactions: Blue-grey discoloration of skin, difficulty with vision.
photosensitivity, peripheral neuropathy, paraesthesia,
myopathy, ataxia, tremor, nausea, vomiting, metallic 3) ATROPINE SULFATE
taste, hypothyroidism, hyperthyroidism, alopecia,
sleep disturbances, corneal microdeposits, hot Brand Names: Anespin amp Atropol amp Euro-
flushes, sweating. Heart block, bradycardia, sinus Med Atropine Sulfate amp Isopto Atropine eye
arrest, hepatotoxicity, heart failure. Potentially Fatal: drops Phil Pharmawealth/Atlantic Atropine amp
Pulmonary toxicity including pulmonary fibrosis and Classification: Other Cardiovascular Drugs, Muscle
interstitial pneumonitis, hepatotoxicity, thyrotoxicity. Relaxants, Mydriatic Drugs, Antidotes, Detoxifying
Ventricular arrhythmias, pulmonary alveolitis, Agents & Drugs Used in Substance Dependence
exacerbation of arrhythmias and rare serious liver Indication/Dosage: IV Bradycardia 500 mcg every
injury. Generally in patients with high doses and 3-5 mins. Total: 3 mg. IV/IM Organophosphorus
having preexisting abnormalities of diffusion poisoning 2 mg every 10-30 mins until muscarinic
capacity. effects disappear or atropine toxicity appears. IM/SC
Premed in anesth 300-600 mcg 30-60 mins before
Nursing Measures: anesth. IV/IM/SC Overdosage w/ other compd
Monitor cardiac rhythm continuously. having muscarinic actions 0.6-1 mg, repeat 2 hrly.
Monitor for an extended period when dosage Ophth Inflammatory eye disorders As 0.5-1% soln:
adjustments are made. 1-2 drops 4 times/day. Eye refraction As 1% soln: 1
Monitor for safe and effective serum levels drop twice daily for 1-2 days before procedure.
(0.5–2.5 mcg/mL). Action: An anti-cholinergic that inhibits
Doses of digoxin, quinidine, procainamide, acetylcholine at the parasympathetic neuroeffector
phenytoin, and warfarin may need to be
Emergency Nursing Abejo
Medical and Surgical Nursing
Emergency Nursing
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
Do not use small veins (dorsum of hand or Follow diluting instructions carefully, and
wrist) for IV injection. use diluted solution promptly.
Reduce dose of narcotic analgesics with IV Avoid giving with meals; this will delay
diazepam; dose should be reduced by at absorption.
least one-third or eliminated. Have emergency equipment ready; have K+
Carefully monitor P, BP, respiration during salts, lidocaine, phenytoin, atropine, cardiac
IV administration. monitor on standby in case toxicity
Maintain patients receiving parenteral develops.
benzodiazepines in bed for 3 hr; do not Monitor for therapeutic drug levels: 0.5–2
permit ambulatory patients to operate a ng/mL.
vehicle following an injection.
Monitor EEG in patients treated for status 10) DIPENHYDRAMINE
epilepticus; seizures may recur after initial
control, presumably because of short Brand name: Benadryl
duration of drug effect. Classification: antihistamine
Monitor liver and kidney function, CBC Dosage: 50mg/ml
during long-term therapy. Indication: Hay fever, urticaria, vasomotor rhinitis,
Taper dosage gradually after long-term angioneurotic edema, drug sensitization, serum &
therapy, especially in epileptic patients. penicillin reaction, contact dermatitis, atopic eczema,
Arrange for epileptic patients to wear other allergic dermatoses, pruritus, food sensitivity,
medical alert ID indicating that they are parkinsonism, motion sickness.
epileptics taking this medication. Action: prevents histamine mediated responses, drug
Discuss risk of fetal abnormalities with provides local anesthesia and suppresses cough reflex
patients desiring to become pregnant. Adverse Reaction: CV and CNS effects, blood
disorders, GI disturbances, anti-muscarinic effects
9) DIGOXIN and allergic reactions.
Action: inhibits Sodium and Chloride reabsorption at Monitor patient for orthostatic hypotension
the proximal and distal tubules and the ascending which is most marked in the morning and in
loop of Henle hot weather, and with alcohol or exercise.
Adverse Reaction: vertigo, headache, dizziness,
paresthesia, weakness, restlessness, fever, nocturia,
oliguria, polyguria 14) HYDROCORTISONE SODIUM
SUCCINATE
Nursing Measures:
Monitor BP after administration Brand name: A-hydroCort, Solu-Cortef
Administer with food or milk to prevent GI Classification: corticosteroid hormones
upset. Stock Dose:100 mg/ 2 mL, 250 mg/ 2 mL
Reduce dosage if given with other Indication: endocrine, hematologic, rheumatic &
antihypertensives; readjust dosage gradually collagen disorders, dermatologic, ophth, GI, resp &
as BP responds. neoplastic diseases, edematous states, control of
Give early in the day so that increased severe incapacitating allergic conditions, TB
urination will not disturb sleep. meningitis w/ subarachnoid block or impending
Avoid IV use if oral use is at all possible. block when used concurrently with appropriate anti-
Do not mix parenteral solution with highly TB chemotherapy, shock secondary to adrenocortical
acidic solutions with pH below 3.5. insufficiency or shock unresponsive to conventional
Do not expose to light, may discolor tablets therapy when adrenocortical insufficiency may be
or solution; do not use discolored drug or present
solutions. Action: Decreases inflammation, mainly by
stabilizing leukocyte lysosomal membranes,
Discard diluted solution after 24 hr.
suppresses immune response, stimulates bone
Refrigerate oral solution.
marrow and influences protein, fat, and carbohydrate
Measure and record weight to monitor fluid
metabolism
changes.
Adverse Reactions: fluid and electrolyte
Arrange to monitor serum electrolytes,
disturbances, decreased carbohydrate tolerance,
hydration, liver function.
impaired wound healing, thin fragile skin, muscle
Arrange for potassium-rich diet or
weakness, steroid myopathy, osteoporosis, aseptic
supplemental potassium as needed.
necrosis, peptic ulceration w/ possible perforation,
cataracts, increased intraocular and intracranial
13) HYDRALAZINE HYDROCHLORIDE
pressure, growth retardation, Cushingoid state,
protein catabolism, psychic derangements,
Brand name: Supres
exophthalmos, masking of infections, gasping
Classification: antihypertension
syndrome, seizures, menstrual irregularities.
Dosage: 20mg/ml
Indication: For hypertensive patient
Nursing Measures:
Action: a direct acting peripheral vasodilator that
Give daily before 9 AM to mimic normal
relaxes arteriolar smooth muscles
peak diurnal corticosteroid levels and
Adverse Reaction: tachycardia, palpitation, angina
minimize HPA suppression.
pectoris, severe headache, dizziness, weight gain, GI
Space multiple doses evenly throughout the
disturbances, pruritus, rashes, nausea and vomiting
day.
Nursing Measures:
Do not give IM injections if patient has
Give oral drug with food to increase
thrombocytopenic purpura.
bioavailability(drug should be given in a
Rotate sites of IM repository injections to
consistent relationship ti ingestion of food
avoid local atrophy.
for consistent response to therapy).
Use minimal doses for minimal duration to
Drug may cause a syndrome resembling
minimize adverse effects.
systemic lupus erythematosus (SLE).
Taper doses when discontinuing high-dose
Arrange for CBC, LE cell preparations, and
or long-term therapy.
ANA titers before and periodically during
prolonged therapy, even in the Arrange for increased dosage when patient
asymptomatic patient. Discontinue if blood is subject to unusual stress.
dyscrasias occur. Reevaluate therapy if Use alternate-day maintenance therapy with
ANA or LE tests are positive. short-acting corticosteroids whenever
Arrange for pyridoxine if patient develops possible.
symptoms of peripheral neuritis.
Avoid driving and other potentially sedation in premed before surgical or diagnostic
hazardous activities until reaction to drug is procedures, induction & maintenance of anesth.
known. Codeine may impair ability to Action: may potentiate the effects of GABA, depress
perform tasks requiring mental alertness and the CNS, and suppress the spread of seizure activity
therefore to. Adverse Reactions: rarely cardioresp adverse events,
Do not take alcohol or other CNS nausea, vomiting, headache, hiccoughs,
depressants unless approved by physician. laryngospasm, dyspnoea, hallucination, oversedation,
Hyperactive cough may be lessened by drowsiness, ataxia, rash, paradoxical reactions,
avoiding irritants such as smoking, dust, amnesic episodes.
fumes and other air pollutants.
Humidification of ambient air may provide Nursing Measures:
some relief. Do not administer intra-arterially, which
Do not breast feed while taking this drug. may produce arteriospasm or gangrene.
Do not use small veins (dorsum of hand or
19) METOCLOPRAMIDE wrist) for IV injection.
Administer IM injections deep into muscle.
Brand name: Apo-Metoclop (CAN), Maxeran Monitor IV injection site for extravasation.
(CAN), Maxolon, Nu-Metoclopramide (CAN), Arrange to reduce dose of midazolam if
Octamide PFS, Reglan patient is also being given opioid analgesics;
Classification: antiemetic & anti-spasmodic reduce dosage by at least 50% and monitor
Dosage: 10 mg/ 2mL patient closely.
Indication: disturbances of GI motility, nausea & Monitor level of consciousness prior to,
vomiting of central & peripheral origin associated w/ during, and for at least 2–6 hr after
surgery, metabolic diseases, infectious & drug administration of midazolam.
induced diseases, facilitate small bowel intubation & Carefully monitor P, BP, and respirations
radiological procedures of GIT carefully during administration.
Action: stimulates motility of upper GI tract, Keep resuscitative facilities readily
increases lower esophageal sphincter tone, and blocks available; have flumazenil available as
dopamine receptors at the chemoreceptor trigger zone antidote if overdose should occur.
Adverse Reactions: extrapyramidal reactions, Keep patients in bed for 3 hr; do not permit
drowsiness, fatigue & lassitude, anxiety, less ambulatory patients to operate a vehicle
frequently, insomnia, headache, dizziness, nausea, following an injection.
galactorrhea, gynecomastia, bowel disturbances. Arrange to monitor liver and kidney
function and CBC at intervals during long-
Nursing Measures: term therapy.
Monitor BP carefully during IV Establish safety precautions if CNS changes
administration. occur (use side rails, accompany ambulating
Monitor for extrapyramidal reactions, and patient).
consult physician if they occur. Provide comfort measures and reassurance
Monitor diabetic patients, arrange for for patients receiving diazepam for tetanus.
alteration in insulin dose or timing if Arrange to taper dosage gradually after
diabetic control is compromised by long-term therapy.
alterations in timing of food absorption.
Provide patient with written information
Keep diphenhydramine injection readily regarding recovery and follow-up care.
available in case extrapyramidal reactions Midazolam is a potent amnesiac and
occur (50 mg IM). memory may be altered.
Have phentolamine readily available in case
of hypertensive crisis (most likely to occur 21) MORPHINE SULFATE
with undiagnosed pheochromocytoma).
Brand name: Morin
20) MIDAZOLAM HYDROCHLORIDE Classification: Analgesics (Opioid)
Dosage: Adult 5-20 mg IM/SC 4 hrly. Severe or
Brand name: Dormicum chronic pain Childn 10 mg IM/SC 4 hrly, range: 5-20
Classification: hypnotics & sedatives mg; 6-12 yr 5-10 mg, 1-5 yr 2.5-5 mg, 1-12 mth 200
Dosage: 5mg/5mL mcg/kg, <1 mth 150 mcg/kg 4 hrly. Max: 15 mg.
Indication: tab: disturbances of sleep rhythm, Analgesic effect Ped 100-200 mcg/kg SC 4 hrly,
insomnia esp difficulty in falling asleep either max: 15 mg/dose; or 50-100 mcg/kg slow IV. Pre-op
initially or after premature awakening, tab/inj: 50-100 mcg/kg IM, max: 10 mg/dose.
Emergency Nursing Abejo
Medical and Surgical Nursing
Emergency Nursing
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
Indication: Relief of moderate to severe pain not Monitor blood pressure.Allow atleast 3 days
responsive to non-narcotic analgesics. Premed. between dosage adjustment to achieve
Analgesic adjunct in general anesth esp in pain steady plasma levels.
associated w/ cancer, MI & surgery. Alleviates Advise patient to report immediately if
anxiety associated w/ severe pain. Hypnotic for pain- experiencing chest pain
related sleeplessness.
Action: alters perception and emotional response to 23) NTG PATCH
pain
Adverse Reactions: Lightheadedness, dizziness, Brand name: Deponit, Minitran, Nitrek, Nitro-Dur,
sedation, nausea, vomiting, constipation & sweating. Nitrodisc, Transderm-Nitro
Classification: Anti-Anginal Drugs
Nursing Measures: Dosage: Starting dose: 0.2-0.4 mg/hr. Dosing
Caution patient not to chew or crush schedule: Daily patch-on period of 12-14 hr & daily
controlled-release preparations. patch-off period of 10-12 hr.
Dilute and administer slowly IV to minimize Indication: Prevention of angina pectoris due to
likelihood of adverse effects. coronary artery disease
Tell patient to lie down during IV Action: a nitrate that reduces cardiac oxygen demand
administration. by decreasing left ventricular end diastolic pressure
Keep opioid antagonist and facilities for and to a lesser extent, systemic vascular resistance,
assisted or controlled respiration readily also increases blood flow through collateral coronary
available during IV administration. vessels
Use caution when injecting SC or IM into Adverse Reactions: Headache. Transient episodes of
chilled areas or in patients with hypotension lightheadedness. Infrequently, hypotension. Syncope,
or in shock; impaired perfusion may delay crescendo angina, rebound HTN, allergic &
absorption; with repeated doses, an anaphylactoid reactions. Rarely severe, application
excessive amount may be absorbed when site irritation.
circulation is restored.
Reassure patients that they are unlikely to Nursing Measures:
become addicted; most patients who receive Administer transdermal systems to skin site
opioids for medical reasons do not develop free of hair and not subject to much
dependence syndromes. movement. Shave areas that have a lot of
hair. Do not apply to distal extremities.
22) NICARDIPINE HYDROCHLORIDE Change sites slightly to decrease the chance
of local irritation and sensitization. Remove
Brand name: Cardepine transdermal system before attempting
Classification: Calcium Antagonists defibrillation or cardioversion.
Dosage: IV infusion Dilute to 10-20 mg/100 mL To use transdermal systems, you may need
(conc of 1.01-0.02%). Initial infusion rate: 5 mg/hr; to shave an area for application. Apply to a
titrate dose up to 15 mg/hr until desired therapeutic slightly different area each day. Use care if
response is achieved (DBP <95 mmHg, SBP <140 changing brands; each system has a different
mmHg). Maintenance rate: Can be tapered down to concentration.
≤10 mg/hr. IV bolus inj 2-7 mg w/out dilution given
over 1-2 min. 24) PARACETAMOL
Indication: Hypertensive emergencies or urgencies,
peri-op & post-op HTN, hypertensive states of NPO Brand name: Aeknil
patients. Classification: Analgesics (Non-Opioid) &
Action: a Calcium channel blocker that inhibits Antipyretics
Calcium ion influx across cardiac and smooth muscle Dosage: Adult & childn ≥10 yr 2-3 mL, ≤10 yr 1-2
cells, also dilates coronary arteries and arterioles mL. Depending on severity of case, dose may be
Adverse Reactions: Peripheral edema, headache, repeated 4 hrly. In severe cases, dose may be
tachycardia, palpitations, localized thrombophlebitis administered by IV very slowly
& hypotension. Indication: Pyrexia of unknown origin. Fever & pain
associated w/ common childhood disorders,
Nursing Measures: tonsillitis, upper resp tract infections post-
Patients with hepatic impairment should immunization reactions, after tonsillectomy & other
receive lower dose. conditions. Prevention of febrile convulsion.
Headache, cold, sinusitis, muscle pain, arthritis &
toothache
Emergency Nursing Abejo
Medical and Surgical Nursing
Emergency Nursing
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
ventricles during the diastolic phase by a direct action blurred vision, chest pain, chills or fever, confusion,
on the tissues, especially the Purkinje network, decreased alertness, difficulty urinating, extreme
without involvement of the autonomic system. dizziness, extreme thirst or dry mouth, fast or
Neither contractility, systolic arterial blood pressure, irregular heartbeat, headache, muscle cramps, pain,
atrioventricular (AV) conduction velocity, nor redness, or swelling at the injection site, weakness
absolute refractory period is altered by usual
therapeutic doses
Adverse Reaction: bradycardia, cardiac arrest, CV Nursing Measures:
collapse, hypotension, apprehension, confusion, Monitor vital signs, including CVP, and
dizziness, drowsiness, hallucinations, headache, fluid intake and output.
light-headedness, mood changes, nervousness, Monitor weight, renal function, and serum
tremors, conjunctival hyperemia, corneal epithelial sodium and potassium levels daily
changes, diplopia, tinnitus, visual disturbances, Watch out for symptoms of overdosage such
nausea, vomiting, erythema, petechiae, edema, as excessive hypertension, tachycardia,
injection-site reactions, including bruising, burning, nausea, vomiting, tremor, headache, chest
contusion, hemorrhage, local reactions, including pain
soreness at IM injection site, venous thrombosis or To relieve thirst, give frequent mouth care
phlebitis, extravasation, burning, stinging, sloughing, and fluids
respiratory depression or arrest, hypersensitivity
reactions 44) DEXTROSE 5% IN WATER (D5W)
SOLUTION
Nursing Measures:
Explain that adverse reactions related to the Brand name: None
CNS (eg, drowsiness, confusion, Classification: Isotonic/Hypotonic Solution
paresthesias, convulsions, respiratory arrest) Dosage: 250ml bottles (5g dextrose/100ml water)
can occur and are a result of CNS toxicity. Indication: fluid replacement and caloric
Advise patient that drug may cause dizziness supplementation in patients who can’t maintain
or drowsiness and to avoid getting out of adequate oral intake or are restricted from doing so
bed or walking without assistance. Action: Provides some sugar for cellular metabolism
Advise patients that skin reactions, including and supplies body water
erythema, petechiae, and edema, may occur Adverse Reaction: Increases free water and may
with intradermal injection. cause intracellular edema, fluid overload, infiltration
Systemic effects can occur following topical (swelling and pain at infusion site)
use; use lowest possible dose to avoid Nursing Measures:
serious toxicity, shock, or heart block. Monitor infusion rate frequently; if signs of
Do not use in patients with congenital or fluid overload, turn off IV drip. Infusion
idiopathic methemoglobinemia or in infants may result in fluid overload.
younger than 12 mo of age who are Check IV site frequently and if infiltration is
receiving methemoglobin-inducing drugs. noted, turn off IV drip.
Use with caution and in lower doses in Watch out for signs of fluid overload
patients with CHF, reduced cardiac output, (distended neck veins (JVD), rapid
digitalis toxicity, and in elderly patients respirations, shallow tidal volume, fine
auscultatory crackles, dyspnea, and
43) MANNITOL peripheral edema)
Watch out for signs of infiltration (swelling
Brand name: Osmitrol and pain around IV site).
Classification: osmotic diuretic
Dosage: 5% , 10%, 15%, 20%, 25% in 500cc/1,000cc
Indication: test dose for marked oliguria or
suspected inadequate renal function, oliguria, to
reduce intraocular or intracranial pressure, diuresis in
drug intoxication
Action: Increases osmotic pressure of glomerular
filtrate; drug elevates plasma osmolality
Adverse Reaction: Increased urination, nausea,
runny nose, vomiting, severe allergic reactions (rash,
hives, itching, difficulty breathing, tightness in the
chest, swelling of the mouth, face, lips, or tongue),
Emergency Nursing Abejo