Medical and Surgical Nursing
Emergency Nursing
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
MEDICAL AND SURGICAL NURSING
Emergency Nursing
Lecturer: Mark Fredderick R. Abejo R.N, M.A.N
A. General information
1. Emergency nursing deals with human
responses to any trauma or sudden illness
that requires immediate intervention to
prevent imminent severe damage or death
2. Care is provided in any setting to persons of
all ages with actual or perceived alterations
in physical or emotional health.
3. Initially, patients may not have a medical
diagnosis.
4. Care is episodic when patients return
frequently, primary when it is the initial
option for health or preventive care, or acute
when patients need immediate and
additional interventions.
5. Emergency nursing is a specialty area of
the nursing profession like no other.
6. Emergency nurses must be ready to treat a
wide variety of illnesses or injury situations,
ranging from a sore throat to a heart attack.
B. Historical Development of Emergency Nursing
1. Florence Nightingale was the first
emergency nurse, providing care to the
wounded in the Crimean War in 1854
2. The Emergency Department Nurses
Association (EDNA) was organized in 1970
3. A competency-based examination, first
administered in 1980, provides Certification
in Emergency Nursing; certification is valid
for 4 years
4. EDNA developed Standards of Emergency
Nursing Practice, published in 1983, to be
used as a guideline for excellence and
outcome criteria against which performance
is measured and evaluated.
5. In 1985, the Association name was changed
to Emergency Nurses Association (ENA),
recognizing the practice of emergency
nursing as role-specific rather than site-
specific.
6. Originally ENA aimed at teaching and
networking, the organization has evolved
into an authority, advocate, lobbyist, and
voice for emergency nursing. It has 30,000+
members and continues to grow, with
members representing over 32 countries
around the world.
Emergency Nursing
C. Emergency Care Environment
1. Prehospital care by emergency medical
services (EMS), emergency medical
technicians, and paramedics provides initial
stabilizations and transport of patients;
personnel communicate with the emergency
department during patient transport
2. The national emergency telephone number
911 is the result of an effort to improve
access to EMS
3. The concept of the emergency room has
expanded to that of the emergency
department, which provides various levels of
care
4. Specialized electronic technology and
techniques are used to monitor patient status
continuously; these may pose safety hazards
to patients, such as possible exposure to
electric shock
D. Triage
1. Triage classifies emergency patients for
assessment and treatment priorities
2. Triage decisions require gathering objective
and subjective data rapidly and effectively to
determine the type of priority situation
present
3. Emergent situations are potentially life-
threatening; they include such conditions as
respiratory distress or arrest, cardiac arrest,
severe chest pain, seizures, hemorrhage,
severe trauma resulting in open chest or
abdominal wounds, shock, poisonings, drug
overdoses, temperatures over 105°F
(40.5°C), emergency childbirth, or delivery
complications
4. Urgent situations are serious but not life-
threatening if treatment is delayed briefly;
they include such conditions as chest pain
without respiratory distress, major fractures,
burns, decreased level of consciousness,
back injuries, nausea or vomiting, severe
abdominal pain, temperature between 102
and 105°F (38.9 and 40.5° C), bleeding from
any orifice, acute panic, or anxiety
5. Nonemergency situations are not acute and
are considered minor to moderately severe;
they include such conditions as chronic
backache or other symptoms, moderate
headache, minor burns, fractures, sprains,
upper respiratory or urinary infections, or
instances in which a patient is dead on
arrival
E. Roles of the Emergency Nurse
1. Care provider: provides comprehensive
direct care to the patient and family.
2. Educator: provides patient and family with
education based on their learning needs and
the severity of the situation and allows the
patient to assume more responsibility for
meeting health care needs
Abejo
Medical and Surgical Nursing
Emergency Nursing
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
3. Manager: coordinates activities of others in
the multidisciplinary team to achieve the
specific goal of providing emergency care
4. Advocate: ensures protection of the
patient’s rights
F. Functions of the Emergency Nurse
1. Uses triage to determine priorities based on
assessment and anticipation of the patient’s
needs
2. Provides direct measures to resuscitate, if
necessary
3. Provides preliminary care before the patient
is transferred to the primary care area
4. Provides health education to the patient and
family
5. Supervises patient care and ancillary
personnel
6. Provides support and protection for the
patient and family
G. Legal issues affecting the provision of
emergency nursing
1. Negligence
2. Malpractice
3. Good Samaritan Laws (these statutes may
protect private citizens but usually do not
apply to emergency personnel on duty or in
normal emergency situations)
4. Informed consent
5. Implied consent
6. Duty to report suspected crimes to the police
7. Duty to gather evidence in criminal
investigations; be aware of hospital policy
and state laws for evidence collection
8. Advanced directives, including durable
power of attorney and living wills
H. Qualifications of an Emergency Nurse
1. An emergency nurse is a registered nurse
with specialized education and experience in
caring for emergency patients.
2. Emergency nurses continually update their
education to stay informed of the latest
trends, issues, and procedures in medicine
today.
3. Many take a special examination that proves
their level of knowledge. After successful
completion of this exam they are certified
in emergency nursing.
4. Some emergency nurses also acquire
additional certifications in the areas of
trauma nursing, pediatric nursing, nurse
practitioner, and various areas of injury
prevention
5. Many emergency nurses acquire additional
certifications in the areas of trauma nursing,
pediatric nursing, nurse practitioner, and
various areas of injury prevention
Emergency Nursing
EMERGENCY DRUGS
1) AMINOPHYLLINE
Brand Names: Phil Pharmawealth/Atlantic
Aminophylline amp Theofil amp
Classification: Antiasthmatic & COPD Preparations
Dosage: Initial: 225-450 mg twice daily, increased if
needed. IV Acute severe bronchospasm. Loading
dose: 5 mg/kg (ideal body wt). Maintenance: 0.5
mg/kg/hr. Rate should not exceed 25 mg/min.
Indication: PO Chronic bronchospasm as hydrate
Action: Increases the level of cAMP resulting in
bronchodilation
Adverse Reactions: Nausea, vomiting, abdominal
pain, diarrhea, headache, insomnia, dizziness,
anxiety, restlessness; tremor, palpitations. Potentially
Fatal: Convulsions, cardiac arrhythmias, hypotension
and sudden death after too rapid IV injection.
Nursing Measures:
Administer to pregnant patients only when
clearly needed—neonatal tachycardia,
jitteriness, and withdrawal apnea observed
when mothers received xanthines up until
delivery.
Caution patient not to chew or crush enteric-
coated timed-release forms.
Give immediate-release, liquid dosage forms
with food if GI effects occur.
Do not give timed-release forms with food;
these should be given on an empty stomach
1 hr before or 2 hr after meals.
Maintain adequate hydration.
Monitor results of serum theophylline levels
carefully, and arrange for reduced dosage if
serum levels exceed therapeutic range of
10–20 mcg/mL.
Take serum samples to determine peak
theophylline concentration drawn 15–30 min
after an IV loading dose.
Monitor for clinical signs of adverse effects,
particularly if serum theophylline levels are
not available.
Ensure that diazepam is readily available to
treat seizures.
Take this drug exactly as prescribed; if a
timed-release product is prescribed, take this
drug on an empty stomach, 1 hr before or 2
hr after meals.
Do not to chew or crush timed-release
preparations.
Administer rectal solution or suppositories
after emptying the rectum.
It may be necessary to take this drug around
the clock for adequate control of asthma
attacks.
Abejo
Medical and Surgical Nursing
Emergency Nursing
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
Avoid excessive intake of coffee, tea, cocoa,
cola beverages, chocolate.
Smoking cigarettes or other tobacco
products impacts the drug's effectiveness.
Try not to smoke. Notify the care provider if
smoking habits change while taking this
drug.
Frequent blood tests may be necessary to
monitor the effect of this drug and to ensure
safe and effective dosage; keep all
appointments for blood tests and other
monitoring.
These side effects may occur: Nausea, loss
of appetite (taking this drug with food may
help if taking the immediate-release or
liquid dosage forms); difficulty sleeping,
depression, emotional lability (reversible).
Report nausea, vomiting, severe GI pain,
restlessness, seizures, irregular heartbeat
2) AMIODARONE HYDROCHLORIDE
Brand Names: Anoion tab Cordarone Cordarone
inj Sandoz Amiodarone HCl tab
Classification: Cardiac Drugs
Dosage: PO Initial: 200 mg 3 times/day for 1 wk,
reduce to 200 mg twice daily for a further wk.
Maintenance: 200 mg/day or lowest effective dose.
IV Initial: 5 mg/kg infusion via central venous
catheter. Max: 1.2 g/24 hr.
Indication: Ventricular and supraventricular
arrhythmias.
Action: Blocks potassium chloride leading to
prolongation of action potential duration.
Adverse Reactions: Blue-grey discoloration of skin,
photosensitivity, peripheral neuropathy, paraesthesia,
myopathy, ataxia, tremor, nausea, vomiting, metallic
taste, hypothyroidism, hyperthyroidism, alopecia,
sleep disturbances, corneal microdeposits, hot
flushes, sweating. Heart block, bradycardia, sinus
arrest, hepatotoxicity, heart failure. Potentially Fatal:
Pulmonary toxicity including pulmonary fibrosis and
interstitial pneumonitis, hepatotoxicity, thyrotoxicity.
Ventricular arrhythmias, pulmonary alveolitis,
exacerbation of arrhythmias and rare serious liver
injury. Generally in patients with high doses and
having preexisting abnormalities of diffusion
capacity.
Nursing Measures:
Monitor cardiac rhythm continuously.
Monitor for an extended period when dosage
adjustments are made.
Monitor for safe and effective serum levels
(0.5–2.5 mcg/mL).
Doses of digoxin, quinidine, procainamide,
phenytoin, and warfarin may need to be
Emergency Nursing
reduced one-third to one-half when
amiodarone is started.
Give drug with meals to decrease GI
problems.
Arrange for ophthalmologic exams;
reevaluate at any sign of optic neuropathy.
Arrange for periodic chest x-ray to evaluate
pulmonary status (every 3–6 mo).
Arrange for regular periodic blood tests for
liver enzymes, thyroid hormone levels.
Drug dosage will be changed in relation to
response of arrhythmias; you will need to be
hospitalized during initiation of drug
therapy; you will be closely monitored when
dosage is changed.
Have regular medical follow-up, monitoring
of cardiac rhythm, chest x-ray, eye exam,
blood tests.
These side effects may occur: Changes in
vision (halos, dry eyes, sensitivity to light;
wear sunglasses, monitor light exposure);
nausea, vomiting, loss of appetite (take with
meals; eat small, frequent meals); sensitivity
to the sun (use a sunscreen or protective
clothing when outdoors); constipation (a
laxative may be ordered); tremors,
twitching, dizziness, loss of coordination (do
not drive, operate dangerous machinery, or
undertake tasks that require coordination
until drug effects stabilize and your body
adjusts to it).
Report unusual bleeding or bruising; fever,
chills; intolerance to heat or cold; shortness
of breath, difficulty breathing, cough;
swelling of ankles or fingers; palpitations;
difficulty with vision.
3) ATROPINE SULFATE
Brand Names: Anespin amp Atropol amp Euro-
Med Atropine Sulfate amp Isopto Atropine eye
drops Phil Pharmawealth/Atlantic Atropine amp
Classification: Other Cardiovascular Drugs, Muscle
Relaxants, Mydriatic Drugs, Antidotes, Detoxifying
Agents & Drugs Used in Substance Dependence
Indication/Dosage: IV Bradycardia 500 mcg every
3-5 mins. Total: 3 mg. IV/IM Organophosphorus
poisoning 2 mg every 10-30 mins until muscarinic
effects disappear or atropine toxicity appears. IM/SC
Premed in anesth 300-600 mcg 30-60 mins before
anesth. IV/IM/SC Overdosage w/ other compd
having muscarinic actions 0.6-1 mg, repeat 2 hrly.
Ophth Inflammatory eye disorders As 0.5-1% soln:
1-2 drops 4 times/day. Eye refraction As 1% soln: 1
drop twice daily for 1-2 days before procedure.
Action: An anti-cholinergic that inhibits
acetylcholine at the parasympathetic neuroeffector
Abejo
Medical and Surgical Nursing
Emergency Nursing
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
junction, enhances the conduction of AV node and
increases heart rate
Adverse Reactions: Dry mouth, dysphagia,
constipation, flushing and dryness of skin,
tachycardia, palpitations, arrhythmias, mydriasis,
photophobia, cycloplegia, raised intraocular pressure.
Toxic doses cause tachycardia, hyperpyrexia,
restlessness, confusion, excitement, hallucinations,
delirium and may progress to circulatory failure and
respiratory depression. Eye drops: Systemic toxicity
especially in children, on prolonged use may lead to
irritation, hyperemia, edema and conjunctivitis.
Increased intraocular pressure. Inhalation: Dryness of
mouth, throat. Potentially Fatal: Atrial arrhythmias,
AV dissociation, multiple ventricular ectopics.
Nursing Measures:
Ensure adequate hydration; provide
environmental control (temperature) to
prevent hyperpyrexia.
Have patient void before taking medication
if urinary retention is a problem.
When used preoperatively or in other acute
situations, incorporate teaching about the
drug with teaching about the procedure; the
ophthalmic solution is used mainly acutely
and will not be self-administered by the
patient; the following apply to oral
medication for outpatients:
Take as prescribed, 30 min before meals;
avoid excessive dosage.
Avoid hot environments; you will be heat
intolerant, and dangerous reactions may
occur.
These side effects may occur: Dizziness,
confusion (use caution driving or
performing hazardous tasks); constipation
(ensure adequate fluid intake, proper diet);
dry mouth (suck sugarless lozenges; perform
frequent mouth care; may be transient);
blurred vision, sensitivity to light
(reversible; avoid tasks that require acute
vision; wear sunglasses in bright light);
impotence (reversible); difficulty in
urination (empty the bladder prior to taking
drug).
Report rash; flushing; eye pain; difficulty
breathing; tremors, loss of coordination;
irregular heartbeat, palpitations; headache;
abdominal distention; hallucinations; severe
or persistent dry mouth; difficulty
swallowing; difficulty in urination;
constipation; sensitivity to light.
Emergency Nursing
4) BUMETANIDE
Brand Names: Burinex amp Burinex tab
Classification: Sulfonamide Diuretics
Indication/Dosage: PO edema 1 mg once daily, 2nd
dose 6-8 hr later if needed. Refractory edema Initial:
5 mg/day, may increase dose depending on response.
Max: 10 mg/day. HTN 0.5-1 mg/day. Max: 5
mg/day. IV Pulmonary edema 1-2 mg, repeat 20
mins. later if needed. IV/IM Emergency edema 0.5-1
mg, then adjust according to response.
Action: inhibits Sodium and Chloride reabsorption at
the ascending loop of Henle
Adverse Reactions: Muscle cramps, dizziness,
hypotension, headache, nausea, impaired hearing,
pruritus, ECG changes, musculoskeletal pain, rash,
chest discomfort, renal failure, premature ejaculation,
thrombocytopenia, hypokalemia, hypomagnesaemia,
hyponatremia, hyperuricemia, hyperglycemia,
hypocalcaemia.
Nursing Measures:
Give with food or milk to prevent GI upset.
Mark calendars or use reminders if
intermittent therapy is best for treating
edema.
Give single dose early in day so increased
urination will not disturb sleep.
Avoid IV use if oral use is possible.
Arrange to monitor serum electrolytes,
hydration, liver function during long-term
therapy.
Provide diet rich in potassium or
supplemental potassium.
Record alternate day or intermittent therapy
on a calendar or dated envelopes.
Take the drug early in day so increased
urination will not disturb sleep; take with
food or meals to prevent GI upset.
Weigh yourself on a regular basis, at the
same time, and in the same clothing; record
the weight on your calendar.
These side effects may occur: Increased
volume and frequency of urination;
dizziness, feeling faint on arising,
drowsiness (avoid rapid position changes;
hazardous activities, such as driving; and
alcohol consumption); sensitivity to sunlight
(use sunglasses, sunscreen, wear protective
clothing); increased thirst (suck sugarless
lozenges; use frequent mouth care); loss of
body potassium (a potassium-rich diet, or
supplement will be needed).
Report weight change of more than 3 lb in 1
day; swelling in ankles or fingers; unusual
bleeding or bruising; nausea, dizziness,
trembling, numbness, fatigue; muscle
weakness or cramps.
Abejo
Medical and Surgical Nursing
Emergency Nursing
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
5) CALCIUM GLUCONATE
Brand Names: Phil Pharmawealth/Harson Calcium
Gluconate amp
Classification: Electrolytes
Indication/Dosage: PO Hypocalcaemia 10-50
mmol/day. IV Hypocalcaemic tetany 2.25 mmol via
slow inj , then 58-77 mL of 10% soln diluted and
administered as a continuous IV infusion. Antidote in
severe hypermagnesaemia; Severe hyperkalaemia 10
mL of 10% soln, repeat every 10 mins if needed.
Action: replaces Calcium and maintains Calcium
level
Adverse Reactions: GI irritation; soft-tissue
calcification, skin sloughing or necrosis after IM/SC
inj. Hypercalcaemia characterised by anorexia,
nausea, vomiting, constipation, abdominal pain,
muscle weakness, mental disturbances, polydipsia,
polyuria, nephrocalcinosis, renal calculi; chalky taste,
hot flushes and peripheral vasodilation. Potentially
Fatal: Cardiac arrhythmias and coma.
Nursing Measures:
Make sure prescriber specifies form of
calcium to be given; crash carts may contain
both calcium gluconate and calcium
chloride.
Tell patient to take oral calcium 1 to 11/2
hours after meals if GI upset occurs.
Give I.M. injection in gluteal region in
adults and in lateral thigh in infants. Use
I.M. route only in emergencies when no I.V.
route is available bec. of irritation of tissue
by calcium salts.
Tell patient to take oral calcium with a full
glass of water.
Monitor calcium levels frequently.
Hypercalcemia may result after large doses
in chronic renal failure. Report
abnormalities.
6) CAPTOPRIL
Brand Names: Ace-Bloc tab Capomed tab
Capotec tab Capoten tab Captor tab Captril tab
Cardiovaz tab Conamid tab Hartylox tab Normil
tab Phil Pharmawealth/Panion & BF Captopril tab
Prelat tab Primace tab Retensin tab Spec-Ace tab
Tensoril tab Unihype tab Vasostad tab
Classification: ACE Inhibitors
Indication/Dosage: PO HTN Initial: 12.5 mg twice
daily. Maintenance: 25-50 mg twice daily. Max: 50
mg 3 times/day. Heart failure Initial: 6.25-12.5 mg 2-
3 times/day. Max: 50 mg 3 times/day. Post MI Start 3
days after MI. Initial: 6.25 mg/day, may increase
after several wk to 150 mg/day in divided doses if
Emergency Nursing
needed and tolerated. HTN in diabetic nephropathy
75-100 mg/day in divided doses.
Action: inhibits ACE, reduces Sodium and water
retention, lowers blood pressure
Adverse Reactions: Hypotension, tachycardia, chest
pain, palpitations, pruritus, hyperkalaemia.
Proteinuria; angioedema, skin rashes; taste
disturbance, nonproductive cough, headache.
Potentially Fatal: Neutropenia, usually occurs within
3 mth of starting therapy especially in patients with
renal dysfunction or collagen diseases.
Hyperkalaemia. Anaphylactic reactions.
Nursing Measures:
Administer 1 hr before or 2 hr after meals.
Alert surgeon and mark patient's chart with
notice that captopril is being taken; the
angiotensin II formation subsequent to
compensatory renin release during surgery
will be blocked; hypotension may be
reversed with volume expansion.
Monitor patient closely for fall in BP
secondary to reduction in fluid volume
(excessive perspiration and dehydration,
vomiting, diarrhea); excessive hypotension
may occur.
Reduce dosage in patients with impaired
renal function.
Take drug 1 hr before or 2 hr after meals; do
not take with food. Do not stop without
consulting your health care provider.
Be careful of drop in blood pressure (occurs
most often with diarrhea, sweating,
vomiting, dehydration); if light-headedness
or dizziness occurs, consult your health care
provider.
Avoid over-the-counter medications,
especially cough, cold, allergy medications
that may contain ingredients that will
interact with ACE inhibitors. Consult your
health care provider.
These side effects may occur: GI upset, loss
of appetite, change in taste perception
(limited effects, will pass); mouth sores
(perform frequent mouth care); rash; fast
heart rate; dizziness, light-headedness
(usually passes after the first few days;
change position slowly, and limit your
activities to those that do not require
alertness and precision).
Report mouth sores; sore throat, fever,
chills; swelling of the hands, feet; irregular
heartbeat, chest pains; swelling of the face,
eyes, lips, tongue, difficulty breathing.
Abejo
Medical and Surgical Nursing
Emergency Nursing
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
7) CLONIDINE
Brand Names: Catapin amp Catapres amp
Catapres tab
Classification: Other Antihypertensives
Indication/Dosage: PO HTN Initial: 50-100 mcg 3
times/day. Max: 2,400 mcg/day. Menopausal
flushing; Migraine prophylaxis 50 mcg twice daily,
up to 75 mg twice daily. IV Hypertensive crisis 150-
300 mcg via slow inj. Max: 750 mcg over 24 hr.
Epidural Severe cancer pain Initial: 30 mcg/hr as
continuous infusion in combination w/ an opioid.
Transdermal HTN As patch releasing 100-300 mcg
clonidine base/day at constant rate: Apply once wkly.
Action: stimulates alpha 2 receptors and inhibits
central vasomotor centers, lowers peripheral vascular
resistance, blood pressure, and heart rate
Adverse Reactions: Dry mouth, drowsiness,
dizziness, headache, constipation, impotence, vivid
dreams, urinary retention; dry, itching, burning
sensation in the eye; fluid or electrolyte imbalance,
GI upset, paralytic ileus, orthostatic hypotension,
weakness, sedation, pruritus, myalgia, urticaria,
nausea, insomnia, arrhythmias, agitation. Reduced GI
motility at times may cause paralytic ileus.
Potentially Fatal: Transient hypertension or profound
hypotension, respiratory depression, convulsion.
Clonidine withdrawal syndrome could be life
threatening. Bradycardia, coma and disturbances in
conduction (in individuals with preexisting diseases
of SA/AV nodes, overdose or on digitalis).
Nursing Measures:
Take drug 1 hr before or 2 hr after meals; do
not take with food. Do not stop without
consulting your health care provider.
Be careful of drop in blood pressure (occurs
most often with diarrhea, sweating,
vomiting, dehydration); if light-headedness
or dizziness occurs, consult your health care
provider.
Avoid over-the-counter medications,
especially cough, cold, allergy medications
that may contain ingredients that will
interact with ACE inhibitors. Consult your
health care provider.
These side effects may occur: GI upset, loss
of appetite, change in taste perception
(limited effects, will pass); mouth sores
(perform frequent mouth care); rash; fast
heart rate; dizziness, light-headedness
(usually passes after the first few days;
change position slowly, and limit your
activities to those that do not require
alertness and precision).
Report mouth sores; sore throat, fever,
chills; swelling of the hands, feet; irregular
Emergency Nursing
heartbeat, chest pains; swelling of the face,
eyes, lips, tongue, difficulty breathing.
Take this drug exactly as prescribed. Do not
miss doses. Do not discontinue the drug
unless so instructed. Do not discontinue
abruptly; life-threatening adverse effects
may occur. If you travel, take an adequate
supply of drug.
Use the transdermal system as prescribed;
refer to directions in package insert, or
contact your health care provider with
questions. Be sure to remove old systems
before applying new ones.
Attempt lifestyle changes that will reduce
your BP: stop smoking and using alcohol;
lose weight; restrict intake of sodium (salt);
exercise regularly.
Use caution with alcohol. Your sensitivity
may increase while using this drug.
These side effects may occur: Drowsiness,
dizziness, light-headedness, headache,
weakness (often transient; observe caution
driving or performing other tasks that
require alertness or physical dexterity); dry
mouth (suck on sugarless lozenges or ice
chips); GI upset (eat small, frequent meals);
dreams, nightmares (reversible); dizziness,
light-headedness when you change position
(get up slowly; use caution climbing stairs);
impotence, other sexual dysfunction,
decreased libido (discuss with care
providers); breast enlargement, sore breasts;
palpitations.
Report urinary retention, changes in vision,
blanching of fingers, rash.
8) DIAZEPAM
Brand name: Valium
Classification: Anxiolytics
Dosage: 10mg/2ml
Indication: relief of anxiety, agitation & tension due
to psychoneurotic states & transient situational
disturbances
Action: a benzodiazepine that probably potentiates
the effects of GABA, depresses the CNS &
suppresses the spread of seizure activity
Adverse Reaction: drowsiness,dysarthria, slurred
speech, tremor, transient amnesia, fatigue, ataxia,
headache, insomnia, paradoxical anxiety,
hallucination
Nursing Measures:
Do not administer intra-arterially; may
produce arteriospasm, gangrene.
Change from IV therapy to oral therapy as
soon as possible.
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
wrist) for IV injection.
Reduce dose of narcotic analgesics with IV
diazepam; dose should be reduced by at
least one-third or eliminated.
Carefully monitor P, BP, respiration during
IV administration.
Maintain patients receiving parenteral
benzodiazepines in bed for 3 hr; do not
permit ambulatory patients to operate a
vehicle following an injection.
Monitor EEG in patients treated for status
epilepticus; seizures may recur after initial
control, presumably because of short
duration of drug effect.
Monitor liver and kidney function, CBC
during long-term therapy.
Taper dosage gradually after long-term
therapy, especially in epileptic patients.
Arrange for epileptic patients to wear
medical alert ID indicating that they are
epileptics taking this medication.
Discuss risk of fetal abnormalities with
patients desiring to become pregnant.
9) DIGOXIN
Brand name: Digitek, Lanoxicaps, Lanoxin, Novo-
Digoxin (CAN)
Classification: Inotropics
Dosage: 5mg/2ml
Indication: Cardiac failure accompanied by atrial
fibrillation; management of chronic cardiac failure
where systolic dysfunction or ventricular dilatation is
dominant; management of certain supraventricular
arrhythmias, particularly chronic atrial flutter &
fibrillation.
Action: inhibits sodium-potassium activated
adenosine triphosphate, promoting movement of
calcium from extracellular to intra-cytoplasm and
strengthening myocardial contraction, also acts on
CNS to enhance vagal tone
Adverse Reaction: nausea, vomiting, anorexia,
headache, facial pain, fatigue, weakness, dizziness,
drowsiness, disorientation, mental confusion, bad
dreams, convulsions
Nursing Measures:
Monitor apical pulse for 1 min before
administering; hold dose if pulse < 60 in
adult or < 90 in infant; retake pulse in 1 hr.
If adult pulse remains < 60 or infant < 90,
hold drug and notify prescriber. Note any
change from baseline rhythm or rate.
Check dosage and preparation carefully.
Avoid IM injections, which may be very
painful.
Emergency Nursing
Follow diluting instructions carefully, and
use diluted solution promptly.
Avoid giving with meals; this will delay
absorption.
Have emergency equipment ready; have K+
salts, lidocaine, phenytoin, atropine, cardiac
monitor on standby in case toxicity
develops.
Monitor for therapeutic drug levels: 0.5–2
ng/mL.
10) DIPENHYDRAMINE
Brand name: Benadryl
Classification: antihistamine
Dosage: 50mg/ml
Indication: Hay fever, urticaria, vasomotor rhinitis,
angioneurotic edema, drug sensitization, serum &
penicillin reaction, contact dermatitis, atopic eczema,
other allergic dermatoses, pruritus, food sensitivity,
parkinsonism, motion sickness.
Action: prevents histamine mediated responses, drug
provides local anesthesia and suppresses cough reflex
Adverse Reaction: CV and CNS effects, blood
disorders, GI disturbances, anti-muscarinic effects
and allergic reactions.
Nursing Measures:
Monitor carefully, assess for confusion,
delirium, other anticholinergic side effects
and fall risk. Institute measures to prevent
falls.
Assess movement disorder before and after
administration.
Caution patient not to use oral OTC
diphenhydramine products with any other
product containing diphenhydramine,
including products used topically.
It can cause excitation in children. Caution
parents or caregivers about proper dose
calculation; overdosage, especially in infants
and children, can cause hallucinations,
seizures or death Inform patient that this
drug may cause dry mouth. Frequent oral
rinses, good oral hygiene, and sugarless gum
or candy may minimize this effect. Notify
dentist if dry mouth persists for more than 2
weeks.
11) EPINEPHRINE
Brand name:
Epinephrine Bitartrate
Aerosols: Primatene Mist
Epinephrine Borate
Ophthalmic solution: Epinal
Epinephrine Hydrochloride
Injection, OTC nasal solution: Adrenalin Chloride
Abejo
Medical and Surgical Nursing
Emergency Nursing
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
Ophthalmic solution: Epifrin, Glaucon
Insect sting emergencies: EpiPen Auto-Injector
(delivers 0.3 mg IM adult dose), EpiPen Jr. Auto-
Injector (delivers 0.15 mg IM for children)
OTC solutions for nebulization: AsthmaNefrin,
microNefrin, Nephron, S2
Classification: Sympathomimetic, Alpha-adrenergic
agonist, Beta1and beta2-adrenergic agonist, Cardiac
stimulant, Vasopressor, Bronchodilator, Antasthmatic
drug, Nasal decongestant, Mydriatic, Antiglaucoma
drug
Dosage: 1mg/ml
Indication: Acute asthmatic attacks, Advanced
cardiac life support
Action: Naturally occurring neurotransmitter, the
effects of which are mediated by alpha or beta
receptors in target organs. Effects on alpha receptors
include vasoconstriction, contraction of dilator
muscles of iris. Effects on beta receptors include
positive chronotropic and inotropic effects on the
heart (beta1 receptors); bronchodilation, vasodilation,
and uterine relaxation (beta2 receptors); decreased
production of aqueous humor.
Adverse Reaction: drowsiness, headache,
nervousness, tremors, cerebral hemorrhage,
dizziness, weakness, vertigo, pain
Nursing Measures:
Monitor heart rate.
Use extreme caution when calculating and
preparing doses; epinephrine is a very potent
drug; small errors in dosage can cause
serious adverse effects. Double-check
pediatric dosage.
Use minimal doses for minimal periods of
time; "epinephrine-fastness" (a form of drug
tolerance) can occur with prolonged use.
Protect drug solutions from light, extreme
heat, and freezing; do not use pink or brown
solutions. Drug solutions should be clear
and colorless (does not apply to suspension
for injection).
Shake the suspension for injection well
before withdrawing the dose.
Rotate SC injection sites to prevent necrosis;
monitor injection sites frequently.
Keep a rapidly acting alpha-adrenergic
blocker (phentolamine) or a vasodilator (a
nitrate) readily available in case of excessive
hypertensive reaction.
Have an alpha-adrenergic blocker or
facilities for intermittent positive pressure
breathing readily available in case
pulmonary edema occurs.
Keep a beta-adrenergic blocker
(propranolol; a cardioselective beta-blocker,
such as atenolol, should be used in patients
Emergency Nursing
with respiratory distress) readily available in
case cardiac arrhythmias occur.
Do not exceed recommended dosage of
inhalation products; administer pressurized
inhalation drug forms during second half of
inspiration, because the airways are open
wider and the aerosol distribution is more
extensive. If a second inhalation is needed,
administer at peak effect of previous dose,
3–5 min.
Use topical nasal solutions only for acute
states; do not use for longer than 3–5 days,
and do not exceed recommended dosage.
Rebound nasal congestion can occur after
vasoconstriction subsides.
Do not exceed recommended dosage;
adverse effects or loss of effectiveness may
result. Read the instructions that come with
respiratory inhalant products, and consult
your health care provider or pharmacist if
you have any questions.
To give eye drops: Lie down or tilt head
backward, and look up. Hold dropper above
eye; drop medicine inside lower lid while
looking up. Do not touch dropper to eye,
fingers, or any surface. Release lower lid;
keep eye open, and do not blink for at least
30 sec. Apply gentle pressure with fingers to
inside corner of the eye for about 1 min;
wait at least 5 min before using other eye
drops.
These side effects may occur: Dizziness,
drowsiness, fatigue, apprehension (use
caution if driving or performing tasks that
require alertness); anxiety, emotional
changes; nausea, vomiting, change in taste
(eat frequent small meals); fast heart rate.
Nasal solution may cause burning or
stinging when first used (transient).
Ophthalmic solution may cause slight
stinging when first used (transient);
headache or brow ache (only during the first
few days).
Report chest pain, dizziness, insomnia,
weakness, tremor or irregular heart beat
(respiratory inhalant, nasal solution),
difficulty breathing, productive cough,
failure to respond to usual dosage
(respiratory inhalant), decrease in visual
acuity (ophthalmic).
12) FUROSEMIDE
Brand name: Apo-Furosemide (CAN), Furoside
(CAN), Lasix, Myrosemide (CAN)
Classification: loop diuretics
Dosage: 20mg/2ml
Indication: edema, hypertension
Abejo
Medical and Surgical Nursing
Emergency Nursing
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
Action: inhibits Sodium and Chloride reabsorption at
the proximal and distal tubules and the ascending
loop of Henle
Adverse Reaction: vertigo, headache, dizziness,
paresthesia, weakness, restlessness, fever, nocturia,
oliguria, polyguria
Nursing Measures:
Monitor BP after administration
Administer with food or milk to prevent GI
upset.
Reduce dosage if given with other
antihypertensives; readjust dosage gradually
as BP responds.
Give early in the day so that increased
urination will not disturb sleep.
Avoid IV use if oral use is at all possible.
Do not mix parenteral solution with highly
acidic solutions with pH below 3.5.
Do not expose to light, may discolor tablets
or solution; do not use discolored drug or
solutions.
Discard diluted solution after 24 hr.
Refrigerate oral solution.
Measure and record weight to monitor fluid
changes.
Arrange to monitor serum electrolytes,
hydration, liver function.
Arrange for potassium-rich diet or
supplemental potassium as needed.
13) HYDRALAZINE HYDROCHLORIDE
Brand name: Supres
Classification: antihypertension
Dosage: 20mg/ml
Indication: For hypertensive patient
Action: a direct acting peripheral vasodilator that
relaxes arteriolar smooth muscles
Adverse Reaction: tachycardia, palpitation, angina
pectoris, severe headache, dizziness, weight gain, GI
disturbances, pruritus, rashes, nausea and vomiting
Nursing Measures:
Give oral drug with food to increase
bioavailability(drug should be given in a
consistent relationship ti ingestion of food
for consistent response to therapy).
Drug may cause a syndrome resembling
systemic lupus erythematosus (SLE).
Arrange for CBC, LE cell preparations, and
ANA titers before and periodically during
prolonged therapy, even in the
asymptomatic patient. Discontinue if blood
dyscrasias occur. Reevaluate therapy if
ANA or LE tests are positive.
Arrange for pyridoxine if patient develops
symptoms of peripheral neuritis.
Emergency Nursing
Monitor patient for orthostatic hypotension
which is most marked in the morning and in
hot weather, and with alcohol or exercise.
14) HYDROCORTISONE SODIUM
SUCCINATE
Brand name: A-hydroCort, Solu-Cortef
Classification: corticosteroid hormones
Stock Dose:100 mg/ 2 mL, 250 mg/ 2 mL
Indication: endocrine, hematologic, rheumatic &
collagen disorders, dermatologic, ophth, GI, resp &
neoplastic diseases, edematous states, control of
severe incapacitating allergic conditions, TB
meningitis w/ subarachnoid block or impending
block when used concurrently with appropriate anti-
TB chemotherapy, shock secondary to adrenocortical
insufficiency or shock unresponsive to conventional
therapy when adrenocortical insufficiency may be
present
Action: Decreases inflammation, mainly by
stabilizing leukocyte lysosomal membranes,
suppresses immune response, stimulates bone
marrow and influences protein, fat, and carbohydrate
metabolism
Adverse Reactions: fluid and electrolyte
disturbances, decreased carbohydrate tolerance,
impaired wound healing, thin fragile skin, muscle
weakness, steroid myopathy, osteoporosis, aseptic
necrosis, peptic ulceration w/ possible perforation,
cataracts, increased intraocular and intracranial
pressure, growth retardation, Cushingoid state,
protein catabolism, psychic derangements,
exophthalmos, masking of infections, gasping
syndrome, seizures, menstrual irregularities.
Nursing Measures:
Give daily before 9 AM to mimic normal
peak diurnal corticosteroid levels and
minimize HPA suppression.
Space multiple doses evenly throughout the
day.
Do not give IM injections if patient has
thrombocytopenic purpura.
Rotate sites of IM repository injections to
avoid local atrophy.
Use minimal doses for minimal duration to
minimize adverse effects.
Taper doses when discontinuing high-dose
or long-term therapy.
Arrange for increased dosage when patient
is subject to unusual stress.
Use alternate-day maintenance therapy with
short-acting corticosteroids whenever
possible.
Abejo
Medical and Surgical Nursing
Emergency Nursing
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
Do not give live virus vaccines with
immunosuppressive doses of
hydrocortisone.
Provide antacids between meals to help
avoid peptic ulcer.
15) ISOSORBIDE-5- MONONITRATE
Brand name: Imdur
Classification: anti- anginal drug
Stock Dose: SL: 5 mg/mL ; Oral: 30 mg, 60 mg
Indication: prophylactic treatment of angina pectoris
Action: Thought to reduce cardiac oxygen demand
by decreasing preload and afterload. Drug also may
increase blood flow through the collateral coronary
vessels
Adverse Reactions: headache, hypotension w/
dizziness and nausea, tachycardia
Nursing Measures:
Monitor BP and heart rate.
Assess location, duration, intensity, and
precipitating factors of anginal pain.
16) ISOSORBIDE DINITRATE
Brand name: Isoket IV
Classification: anti – anginal drug
Stock: IV amp 10 mg/ 10 mL
Dose: 10 mg/10mL
Indication: unresponsive left ventricular failure
secondary to acute MI, severe or unstable angina
pectoris
Action: Isosorbide dinitrate is a smooth muscle
relaxant. It is particularly effective on vascular and
bronchial smooth muscle. Its systemic cardiovascular
effects are mainly due to a decrease in venous return
(pooling of blood in the peripheral venous system).
Consequently, ventricular end-diastolic pressure and
volume are diminished, thus reducing cardiac work
and implicitly myocardial oxygen requirements. The
arterial vessels are dilated as well, though to a lesser
degree. This results in a slight drop in aortic and
systemic blood pressure relieving the myocardium
from a part of its afterload. These nitrate-induced
changes account for both the antianginal effects of
isosorbide dinitrate and for its beneficial effects in
the treatment of congestive heart failure.
Side effects/ adverse reactions: severe cerebral flow
deficiency and decreased coronary perfusion may
develop, nitrate headache and nausea.
Nursing Measures:
Monitor BP and heart rate.
Assess location, duration, intensity, and
precipitating factors of anginal pain.
Emergency Nursing
17) MAGNESIUM SULFATE
Brand name: Elin Magnesium Sulfate
Classification: anticonvulsant
Dosage: 250 mg/10 mL
Indication: treatment of hypomagnesemia
accompanied by signs of tetany, control of HTN,
encephalophathy & convulsions, prevention &
control of convulsions in patients w/ preeclampsia or
eclampsia, prevention of hypomagnesemia in patients
receiving TPN
Action: may decrease acetylcholine released by
nerve impulses, but its anticonvulsant mechanism is
unknown
Adverse Reactions: flushing, sweating, hypotension,
muscular weakness, sedation & confusion; decreased
deep tendon reflexes; resp. paralysis
Nursing Measures:
Monitor the following: I.V.: Rapid
administration: ECG monitoring, vital signs,
deep tendon reflexes; magnesium, calcium,
and potassium levels; renal function during
administration. Obstetrics: Patient status
including vital signs, oxygen saturation,
deep tendon reflexes, level of consciousness,
fetal heart rate, maternal uterine activity.
Oral: Renal function; magnesium levels;
bowel movements.
18) MEPERIDINE HYDROCHLORIDE
Brand name: Demerol
Classification: antivertigo drug
Dosage: 100 mg/ 2mL
Indication: relief of moderate to severe pain, pre-op
medication, support of anesth & obstet analgesia
Action: binds with opiate receptors in the CNS,
altering perception of and emotional response to pain
Adverse Reactions: resp. depression, circulatory
depression, resp arrest, shock, cardiac arrest, GI
disturbance, light headedness, dizziness, sedation,
nausea, vomiting, sweating, euphoria, dysphoria,
weakness, headache, tremor, agitation, uncoordinated
muscle movements, severe convulsions, transient
hallucinations & disorientation, visual disturbance,
flushing, tachycardia, bradycardia, palpitation,
hypotension, syncope, phlebitis, urinary retention,
allergic reactions, pain at injection site and local
tissue irritation.
Nursing Measures:
Make position changes slowly and in stages
particularly from recumbent to upright
posture. Lie down immediately if light-
headedness or dizziness occurs.
Lie down when feeling nauseated and to
notify physician if this symptom persists.
Nausea appears to worsen with ambulation.
Abejo
Medical and Surgical Nursing
Emergency Nursing
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
Avoid driving and other potentially
hazardous activities until reaction to drug is
known. Codeine may impair ability to
perform tasks requiring mental alertness and
therefore to.
Do not take alcohol or other CNS
depressants unless approved by physician.
Hyperactive cough may be lessened by
avoiding irritants such as smoking, dust,
fumes and other air pollutants.
Humidification of ambient air may provide
some relief.
Do not breast feed while taking this drug.
19) METOCLOPRAMIDE
Brand name: Apo-Metoclop (CAN), Maxeran
(CAN), Maxolon, Nu-Metoclopramide (CAN),
Octamide PFS, Reglan
Classification: antiemetic & anti-spasmodic
Dosage: 10 mg/ 2mL
Indication: disturbances of GI motility, nausea &
vomiting of central & peripheral origin associated w/
surgery, metabolic diseases, infectious & drug
induced diseases, facilitate small bowel intubation &
radiological procedures of GIT
Action: stimulates motility of upper GI tract,
increases lower esophageal sphincter tone, and blocks
dopamine receptors at the chemoreceptor trigger zone
Adverse Reactions: extrapyramidal reactions,
drowsiness, fatigue & lassitude, anxiety, less
frequently, insomnia, headache, dizziness, nausea,
galactorrhea, gynecomastia, bowel disturbances.
Nursing Measures:
Monitor BP carefully during IV
administration.
Monitor for extrapyramidal reactions, and
consult physician if they occur.
Monitor diabetic patients, arrange for
alteration in insulin dose or timing if
diabetic control is compromised by
alterations in timing of food absorption.
Keep diphenhydramine injection readily
available in case extrapyramidal reactions
occur (50 mg IM).
Have phentolamine readily available in case
of hypertensive crisis (most likely to occur
with undiagnosed pheochromocytoma).
20) MIDAZOLAM HYDROCHLORIDE
Brand name: Dormicum
Classification: hypnotics & sedatives
Dosage: 5mg/5mL
Indication: tab: disturbances of sleep rhythm,
insomnia esp difficulty in falling asleep either
initially or after premature awakening, tab/inj:
Emergency Nursing
sedation in premed before surgical or diagnostic
procedures, induction & maintenance of anesth.
Action: may potentiate the effects of GABA, depress
the CNS, and suppress the spread of seizure activity
Adverse Reactions: rarely cardioresp adverse events,
nausea, vomiting, headache, hiccoughs,
laryngospasm, dyspnoea, hallucination, oversedation,
drowsiness, ataxia, rash, paradoxical reactions,
amnesic episodes.
Nursing Measures:
Do not administer intra-arterially, which
may produce arteriospasm or gangrene.
Do not use small veins (dorsum of hand or
wrist) for IV injection.
Administer IM injections deep into muscle.
Monitor IV injection site for extravasation.
Arrange to reduce dose of midazolam if
patient is also being given opioid analgesics;
reduce dosage by at least 50% and monitor
patient closely.
Monitor level of consciousness prior to,
during, and for at least 2–6 hr after
administration of midazolam.
Carefully monitor P, BP, and respirations
carefully during administration.
Keep resuscitative facilities readily
available; have flumazenil available as
antidote if overdose should occur.
Keep patients in bed for 3 hr; do not permit
ambulatory patients to operate a vehicle
following an injection.
Arrange to monitor liver and kidney
function and CBC at intervals during long-
term therapy.
Establish safety precautions if CNS changes
occur (use side rails, accompany ambulating
patient).
Provide comfort measures and reassurance
for patients receiving diazepam for tetanus.
Arrange to taper dosage gradually after
long-term therapy.
Provide patient with written information
regarding recovery and follow-up care.
Midazolam is a potent amnesiac and
memory may be altered.
21) MORPHINE SULFATE
Brand name: Morin
Classification: Analgesics (Opioid)
Dosage: Adult 5-20 mg IM/SC 4 hrly. Severe or
chronic pain Childn 10 mg IM/SC 4 hrly, range: 5-20
mg; 6-12 yr 5-10 mg, 1-5 yr 2.5-5 mg, 1-12 mth 200
mcg/kg, <1 mth 150 mcg/kg 4 hrly. Max: 15 mg.
Analgesic effect Ped 100-200 mcg/kg SC 4 hrly,
max: 15 mg/dose; or 50-100 mcg/kg slow IV. Pre-op
50-100 mcg/kg IM, max: 10 mg/dose.
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
responsive to non-narcotic analgesics. Premed.
Analgesic adjunct in general anesth esp in pain
associated w/ cancer, MI & surgery. Alleviates
anxiety associated w/ severe pain. Hypnotic for pain-
related sleeplessness.
Action: alters perception and emotional response to
pain
Adverse Reactions: Lightheadedness, dizziness,
sedation, nausea, vomiting, constipation & sweating.
Nursing Measures:
Caution patient not to chew or crush
controlled-release preparations.
Dilute and administer slowly IV to minimize
likelihood of adverse effects.
Tell patient to lie down during IV
administration.
Keep opioid antagonist and facilities for
assisted or controlled respiration readily
available during IV administration.
Use caution when injecting SC or IM into
chilled areas or in patients with hypotension
or in shock; impaired perfusion may delay
absorption; with repeated doses, an
excessive amount may be absorbed when
circulation is restored.
Reassure patients that they are unlikely to
become addicted; most patients who receive
opioids for medical reasons do not develop
dependence syndromes.
22) NICARDIPINE HYDROCHLORIDE
Brand name: Cardepine
Classification: Calcium Antagonists
Dosage: IV infusion Dilute to 10-20 mg/100 mL
(conc of 1.01-0.02%). Initial infusion rate: 5 mg/hr;
titrate dose up to 15 mg/hr until desired therapeutic
response is achieved (DBP <95 mmHg, SBP <140
mmHg). Maintenance rate: Can be tapered down to
≤10 mg/hr. IV bolus inj 2-7 mg w/out dilution given
over 1-2 min.
Indication: Hypertensive emergencies or urgencies,
peri-op & post-op HTN, hypertensive states of NPO
patients.
Action: a Calcium channel blocker that inhibits
Calcium ion influx across cardiac and smooth muscle
cells, also dilates coronary arteries and arterioles
Adverse Reactions: Peripheral edema, headache,
tachycardia, palpitations, localized thrombophlebitis
& hypotension.
Nursing Measures:
Patients with hepatic impairment should
receive lower dose.
Emergency Nursing
Monitor blood pressure.Allow atleast 3 days
between dosage adjustment to achieve
steady plasma levels.
Advise patient to report immediately if
experiencing chest pain
23) NTG PATCH
Brand name: Deponit, Minitran, Nitrek, Nitro-Dur,
Nitrodisc, Transderm-Nitro
Classification: Anti-Anginal Drugs
Dosage: Starting dose: 0.2-0.4 mg/hr. Dosing
schedule: Daily patch-on period of 12-14 hr & daily
patch-off period of 10-12 hr.
Indication: Prevention of angina pectoris due to
coronary artery disease
Action: a nitrate that reduces cardiac oxygen demand
by decreasing left ventricular end diastolic pressure
and to a lesser extent, systemic vascular resistance,
also increases blood flow through collateral coronary
vessels
Adverse Reactions: Headache. Transient episodes of
lightheadedness. Infrequently, hypotension. Syncope,
crescendo angina, rebound HTN, allergic &
anaphylactoid reactions. Rarely severe, application
site irritation.
Nursing Measures:
Administer transdermal systems to skin site
free of hair and not subject to much
movement. Shave areas that have a lot of
hair. Do not apply to distal extremities.
Change sites slightly to decrease the chance
of local irritation and sensitization. Remove
transdermal system before attempting
defibrillation or cardioversion.
To use transdermal systems, you may need
to shave an area for application. Apply to a
slightly different area each day. Use care if
changing brands; each system has a different
concentration.
24) PARACETAMOL
Brand name: Aeknil
Classification: Analgesics (Non-Opioid) &
Antipyretics
Dosage: Adult & childn ≥10 yr 2-3 mL, ≤10 yr 1-2
mL. Depending on severity of case, dose may be
repeated 4 hrly. In severe cases, dose may be
administered by IV very slowly
Indication: Pyrexia of unknown origin. Fever & pain
associated w/ common childhood disorders,
tonsillitis, upper resp tract infections post-
immunization reactions, after tonsillectomy & other
conditions. Prevention of febrile convulsion.
Headache, cold, sinusitis, muscle pain, arthritis &
toothache
Abejo
Medical and Surgical Nursing
Emergency Nursing
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
Action: produce analgesia by blocking pain impulses
by inhibiting synthesis of prostaglandin in CNS,
relieves fever
Adverse Reactions: Hematological, skin & other
allergic reactions
Nursing Measures:
Use liquid form for children and patients
who have difficulty swallowing.
In children, don’t exceed five doses in 24
hours.
Advise patient that drug is only for short
term use and to consult the physician if
giving to children for longer than 5 days or
adults for longer than 10 days.
Advise patient or caregiver that many over
the counter products contain acetaminophen;
be aware of this when calculating total
dailydose.
Warn patient that high doses or
unsupervised long term use can cause liver
damage.
25) PHENYTOIN
Brand name: Dilantin
Classification: Anticonvulsants
Dosage: Adult Initially 100 mg tid. Maintenance:
300-400 mg daily. Childn ≥6 yr Initially 100 mg tid,
subsequent dosage should be adjusted according to
therapeutic response, <6 yr 30 mg bid, may be
increased to 30 mg tid or qid. Pedia 5 mg/kg/day
Initially in 2-3 equally divided doses. Max: 300 mg
daily. Maintenance: 4-8 mg/kg/day
Indication: Tonic-clonic & complex partial
(psychomotor, temporal lobe), prevention &
treatment of seizures occurring during or following
neurosurgery
Action: may stabilize neuronal membranes and limit
seizure activity by either by increasing efflux or
decreasing influx of Na ions across cell membrane in
the motor cortex during generation of nerve impulses
Adverse Reactions: GI disturbances; ataxia, slurred
speech; diplopia, nystagmus & mental confusion w/
headache, dizziness, gingival hyperplasia, hirsutism,
hyperglycemia, osteomalacia
Nursing Measures:
Assess location, duration, frequency, and
characteristics of seizure activity. EEG may
be monitored periodically throughout
therapy, Assess oral hygiene. Vigorous oral
cleaning beginning within 10 days of
initiation of phenytoin therapy may help
control gingival hyperplasia.
Emergency Nursing
26) TERBUTALINE
Brand name: Bricalin
Classification: Antiasthmatic & COPD Preparations
Dosage: Antiasthmatic & COPD Preparations
Indication: For reversible airways obstruction, in
asthma, COPD. Decreases uterine contractility &
may be used to arrest premature labor
Action: relaxes bronchial smooth muscles by
stimulating beta-2 receptors
Adverse Reaction: Fine tremor of skeletal muscle
esp hands, palpitations, tachycardia, nervous tension,
headache, peripheral vasodilation.
Nursing Measures:
Use minimal periods of time; drug tolerance
can occur with prolonged use.
Keep beta-adrenergic blocker readily
available in case cardiac arrhythmias occur.
Do not recommended dosage.
27) VERAPAMIL HYDROCHLORIDE
Brand name: Calan, Calan SR, Covera-HS, Isoptin,
Isoptin SR, Verelan, Verelan PM
Classification: Calcium Antagonists
Dosage: Isoptin tab Adult 40-80 mg tid-qid. Max:
480 mg daily. Childn >6 yr 40-120 mg bid-tid, up to
360 mg daily, childn ≤6 yr 40 mg bid-tid. Isoptin SR
180 Coronary insufficiency 1 tab bid. Usual daily
dose: 240-480 mg. Hypertension 1 tab in the
morning. Isoptin SR 240 1 tab in the morning. If
required after 2 wk, increase dose to 2 tab daily.
Isoptin amp 5 mg slow IV, if required, 5 mg after 5-
10 min. Then, if required, continuous drip infusion of
5-10 mg/hr up to 100 mg/day. Angina pectoris &
rapid elimination of tachyarrhythmias 1-2 amp IV, if
required bid-tid
Indication: Isoptin/Isoptin SR 180 Essential
hypertension, chronic coronary insufficiency, angina
pectoris, paroxysmal supraventricular tachycardia,
tachyarrhythmias, long-term treatment after MI.
Isoptin SR 240 Essential hypertension
Action: decreases myocardial contractility and
oxygen demand, it also dilates coronary arteries and
arterioles
Adverse Reactions: Constipation, dizziness, nausea.
Rarely, vertigo, headache, hypotension, ankle edema,
flushing, fatigue, nervousness, erythromelalgia,
paraesthesia, neuropathy; bradycardiac arrhythmias,
CHF. Dyspnea
Nursing Measures:
Monitor patient carefully (BP, cardiac
rhythm, and output) while drug is being
titrated to therapeutic dose. Dosage may be
increased more rapidly in hospitalized
patients under close supervision.
Abejo
Medical and Surgical Nursing
Emergency Nursing
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
Ensure that patient swallows SR tablets
whole: do not cut, crush, or chew them.
Monitor BP very carefully with concurrent
doses of antihypertensives.
Monitor cardiac rhythm regularly during
stabilization of dosage and periodically
during long-term therapy.
Administer sustained-release form in the
morning with food to decrease GI upset.
Protect IV solution from light.
Monitor patients with renal or hepatic
impairment carefully for possible drug
accumulation and adverse reactions.
28) IPRATROPIUM INHALATION
Brand name: Atrovent
Classification: Antiasthmatic & COPD Preparations,
anticholinergics or antimuscarinics
Stock: 0.5 mg/2 mL
Dosage: Adult (including elderly) & adolescent >12
yr Acute attacks 1 vial, may repeat doses until patient
is stable. Maintenance: 1 vial tid-qid.
Indication: Bronchodilator for treatment of
bronchospasm associated w/ COPD, including
chronic bronchitis, emphysema and asthma
Action: it works by binding to specific receptors
(called muscarinic receptors) in the airway, helping
to relax the smooth muscle of the airway. When used
to treat a runny nose, it works by decreasing the
production of fluid in the glands that line the nasal
passages
Adverse Reaction: Headache, nausea, dry mouth,
increased heart rate & palpitations, ocular
accommodation disturbances, GI motility
disturbances, urinary retention, ocular side effects,
cough, local irritation, bronchoconstriction, skin rash,
angioedema, urticaria, laryngospasm, anaphylactic
reactions.
Nursing Measures:
Protect solution for inhalation from light.
Store unused vials in foil pouch.
Use nebulizer mouthpiece instead of face
mask to avoid blurred vision or aggravation
of narrow-angle glaucoma.
Can mix albuterol in nebulizer for up to 1 hr.
Ensure adequate hydration, control
environmental temperature to prevent
hyperpyrexia.
Have patient void before taking medication
to avoid urinary retention.
Teach patient proper use of inhalator.
Emergency Nursing
29) FENOTEROL/IPRATROPIUM BROMIDE
Brand name: Berodual
Classification: Antiasthmatic & COPD Preparations
Dosage: Berodual inhalation soln Adult (including
elderly) & adolescent >12 yr Treatment of 1 mL for
immediate symptom relief. Intermittent & long-term
treatment 1-2 mL for each administration, up to
qid. Moderate bronchospasm or w/ assisted
ventilation 0.5 mL. Childn 6-12 yr Treatment of
attacks 0.5-1 mL. Intermittent & long-term
treatment 0.5-1 mL for each administration, up to
qid. Moderate bronchospasm or w/ assisted
ventilation 0.5 mL. Childn <6 yr (<22 kg body
wt) Up to 0.5 mL up to tid. Berodual F UDV Adult &
childn >12 yr Acute asthma episodes 1 vial, in very
severe cases, 2 vials are needed. Intermittent & long-
term treatment 1 vial up to qid.
Indication: prevention and treatment of symptoms in
chronic obstructive airway disorders with reversible
bronchospasm
Action: for the prevention and treatment of reversible
bronchospasm associated with bronchial asthma and
especially chronic bronchitis with or without
emphysema
Adverse Reactions: Fine tremor of skeletal muscles,
nervousness, restlessness, palpitations; less
frequently tachycardia, dizziness or headache. Dry
mouth, throat irritation or allergic reactions, cough,
paradoxical bronchoconstriction (rare). Urinary
retention may occur in particular, in patients w/
preexisting outflow tract obstruction.
Nursing Measures:
Protect solution for inhalation from light.
Store unused vials in foil pouch.
Use nebulizer mouthpiece instead of face
mask to avoid blurred vision or aggravation
of narrow-angle glaucoma.
Can mix albuterol in nebulizer for up to 1 hr.
Ensure adequate hydration, control
environmental temperature to prevent
hyperpyrexia.
Have patient void before taking medication
to avoid urinary retention.
Teach patient proper use of inhalator.
30) BUDESONIDE
Brand name: Symbicort
Classification: Corticosteroids
Dosage: 80/4.5 mcg x 60 doses; 160/4.5 mcg x 60
doses; 320/9 mcg x 60 doses
Indication: regular treatment of asthma where use of
a combination (inhaled corticosteroid and long acting
beta 2 agonist) is appropriate
Action: work by reducing inflammation, which helps
with several conditions ranging
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Medical and Surgical Nursing
Emergency Nursing
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
from asthma to allergies toCrohn’s disease
Adverse Reactions: Abdominal pain, conjunctivitis
(pinkeye), cough, diarrhea, ear infection or
inflammation, fever, fungal infection in mouth,
headache, nasal or sinus inflammation, nosebleed,
pain, rash, respiratory infection, stomach or intestinal
inflammation, throat inflammation, viral infection,
vomiting, wheezing
Nursing Measures:
Taper systemic steroids carefully during
transfer to inhalational steroids; deaths from
adrenal insufficiency have occurred.
Arrange for use of decongestant nose drops
to facilitate penetration if edema, excessive
secretions are present.
Prime unit before use for Pulmicort
Turbuhaler; have patient rinse mouth after
each use.
Use aerosol within 6 mo of opening. Shake
well before each use.
Store Respules upright and protected from
light; gently shake before use; open
envelopes should be discarded after 2 wk.
31) ALBUTEROL AND IPRATROPIUM
INHALATION
Brand name: Combivent
Classification: Bronchodilators
Stock: 2.5 mL
Dose: MDI Adult 2 puffs tid-qid. Max 12
puffs/day. Unit dose vial Adult & childn >12 yr 1 vial
every 6-8 hr. Childn 2-12 yr 3 drops/kg/dose (max:
2500 mcg of salbutamol) every 6-8 hr.
Indication: management of reversible bronchospasm
associated with obstructive airway diseases in
patients who require more than a single
bronchodilator
Action: muscles in the airways and increase air flow
to the lungs
Adverse Reactions: Fine tremor of skeletal muscle;
palpitations; headache, dizziness, nervousness;
dryness of mouth, throat irritation; urinary retention
Nursing Measures:
Use nebulizer mouthpiece instead of face
mask to avoid blurred vision or aggravation
of narrow-angle glaucoma.
Can mix albuterol in nebulizer for up to 1 hr.
Ensure adequate hydration, control
environmental temperature to prevent
hyperpyrexia.
Have patient void before taking medication
to avoid urinary retention.
Teach patient proper use of inhalator.
Emergency Nursing
32) SALBUTAMOL
Brand name: Aero-Vent
Classification: bronchodilator
Stock: 1 mg/1 mL
Dose: Adult & childn 2.5-5 mg. May repeat qid by
hlebitis. Delivery of aerosol may be by face mask
of ―T‖ piece. Use undiluted. For prolonged delivery
time, dilute w/ sterile water or normal saline for inj.
Indication: treatment of acute, severe asthma and in
routine management of chronic bronchospasm
unresponsive to conventional therapy
Action: used with anti-inflammatory medication to
prevent asthma attacks, Some of these medicines are
used to treat the symptoms of asthma, chronic
bronchitis, emphysema, and other lung diseases,
while others are used to prevent the symptoms
Adverse Reactions: Dizziness, severe; feeling of
choking, irritation, or swelling in throat; flushing or
redness of skin; hives; increased shortness of breath;
skin rash; swelling of face, lips, or eyelids; tightness
in chest or wheezing, troubled breathing
Nursing Measures:
Assess lung sounds, pulse, and blood
pressure before administration and during
peak of medication. Note amount, color, and
character of sputum produced.
Monitor pulmonary function tests before
initiating therapy and periodically
throughout course to determine effectiveness
of medication.
Observe for paradoxical bronchospasm
(wheezing). If condition occurs, withhold
medication and notify physician or other
health care professional immediately.
Instruct mother to take missed dose as soon
as remembered, spacing remaining doses at
regular intervals. Do not double doses or
increase the dose or frequency of doses.
Inform the mother not to smoke near the
child and to avoid respiratory irritants.
Advise the mother to rinse the child’s mouth
with water after each inhalation dose to
minimize dry mouth.
33) TERBUTALINE SULFATE
Brand name: Pulmonyl
Classification: Antiasthmatic/ Brochodilator
Stock: 2.5 mg/ml
Dose: Adult 5-10 mg, Children 2-5mg
Indication: relief of bronchospasm in obstructive
airway diseases
Action: It works by dilating (opening) the
bronchioles of the lungs by relaxing the muscles
around them. This allows for easier airflow into and
out of the lungs
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Medical and Surgical Nursing
Emergency Nursing
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
Adverse Reactions: Headache, nausea, vomiting,
palpitations, tachycardia, sweating & drowsiness
Nursing Measures:
Use minimal periods of time; drug tolerance
can occur with prolonged use.
Keep beta-adrenergic blocker readily
available in case cardiac arrhythmias occur.
Do not recommended dosage.
34) HEPARIN SODIUM
Brand name: Britton Heparin Na
Classification: Anticoagulants, Antiplatelets &
Fibrinolytics (Thrombolytics)
Dosage: 5000 iu/1 mL; 25000 iu/1 mL
Indication: treatment and prophylaxis of
thromboembolic disorders
Action: Accelerates formation of antithrombin III-
thrombin complex and deactivates thrombin,
preventing conversion of fibrinogen to fibrin
Adverse Reactions: Slight fever, headache, chills,
nausea, vomiting, constipation, epistaxis, bruising,
slight haematuria, skin necrosis (SC inj),
osteoporosis, alopecia. Hypersensitivity reactions
include urticaria, conjunctivitis, rhinitis, asthma,
angioedema and anaphylactic shock. Priapism.
Potentially Fatal: Heparin-induced thrombocytopenia
with or without thrombosis; bleeding
Nursing Measures:
Baseline blood coagulation tests, Hct, Hgb,
RBC and platelet counts prior to initiation or
therapy and at regular intervals throughout
therapy
Monitor APTT levels closely
Draw blood for coagulation tests 30 min
before each scheduled SC or intermittent IV
dose and approximately q4h for pts
receiving continuous IV heparin during
dosage adjustments period. After dosage is
established, tests may be done once daily
Pts vary widely in their reaction to heparin;
risk of hemorrhage appears greatest in
women, all patients > 60 y, and patients with
liver disease or renal insufficiency.
Monitor vitals, report fever, drop in BP,
rapid pulse and other S&S of hemorrhage
Observe all needle sites daily for hematoma
and signs of inflammation
Have on hand protamine sulfate, specific
heparin antagonist
35) ESMOLOL HYDROCHLORIDE
Brand name: Brevibloc
Classification: Beta blockers
Dosage: 100mg/10ml
Emergency Nursing
Indication: supraventricular tachycardia; post-
operative tachycardia or hypertension; non-
compensatory sinus tachycardias; intra-operative
tachycardia or hypertension; unstable angina, non ST
segment elevation MI
Action: A Class II antiarrythmic and ultra-short-
acting selective beta blocker that decreases heart rate,
contractility and blood pressure
Adverse Reactions: Hypotension, bradycardia, heart
failure, local irritation, diaphoresis, peripheral
ischaemia, dizziness, somnolence, confusion, fatigue,
paraesthesia, peripheral neuropathy, headache,
weakness, irritability, dyspnoea, nausea, vomiting,
blurred vision, urinary retention, fever, rigor,
muscular pain. Potentially Fatal: Profound
bradycardia, AV block, cardiogenic shock, asystole,
bronchospasm.
Nursing Measures:
Monitor patient carefully (BP, cardiac
rhythm, and output) while drug is being
titrated to therapeutic dose. Dosage may be
increased more rapidly in hospitalized
patients under close supervision.
Monitor cardiac rhythm regularly during
stabilization of dosage and periodically
during long-term therapy.
36) D 50-50
Brand name: Phil Pharmawealth/Atlantic 50%
Dextrose
Classification: Intravenous & Other Sterile Solutions
Dosage: 50ml/vial
Indication: for hypoglycemia
Action: A simple water soluble sugar that minimizes
glyconeogenesis and promotes anabolism in patients
whose oral caloric intake is limited
Adverse Reactions: Local pain, vein irritation,
thrombophlebitis & tissue necrosis in the event of
extravasation. Fluid & electrolyte imbalance eg
hypokalemia, hypomagnesemia &
hypophosphatemia; edema or water intoxication
Nursing Measures:
Monitor infusion rate frequently; if signs of
fluid overload, turn off IV drip. Infusion
may result in fluid overload.
Check IV site frequently and if infiltration is
noted, turn off IV drip.
Watch out for signs of fluid overload
(distended neck veins (JVD), rapid
respirations, shallow tidal volume, fine
auscultatory crackles, dyspnea, and
peripheral edema)
Watch out for signs of infiltration (swelling
and pain around IV site).
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Medical and Surgical Nursing
Emergency Nursing
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
37) POTASSIUM CHLORIDE
Brand name: Phil Pharmawealth/Atlantic Potassium
Chloride
Classification: Electrolytes
Dosage: 40 meqs/20 ml
Indication: for hypokalemia, acute MI
Action: Replaces potassium and maintains potassium
level
Adverse Reactions: GI ulceration (sometimes with
haemorrhage and perforation or with late formation
of strictures) following the use of enteric-coated K
chloride preparation; hyperkalaemia. Oral: Nausea,
vomiting, phlebiti and abdominal cramps. IV: Pain or
phlebitis; cardiac toxicity.
Nursing Measures:
Monitor serum potassium levels, renal
function, and serum bicarbonate.
Explain to patient purpose of the medication
and the need to take as directed,especially
when concurrent digoxin or diuretics are
taken. A missed dose should be taken as
soon as remembered within 2 hr; if not,
return to regular doseschedule. Do not
double dose.
Emphasize correct method of
administration. GI irritation or ulceration
may result from chewing enteric-coated
tablets or insufficient dilution of liquid or
powder forms. Some extended-release
tablets are contained in a wax matrix that
may be expelled in the stool. This
occurrence is not significant.
Instruct patient to avoid salt substitutes or
low-salt milk or food unless approved by
health care professional.
Patient should be advised to read all labels
to prevent excess potassium intake.
Advise patient regarding sources of dietary
potassium.
Encourage compliance with recommended
diet.
Instruct patient to report dark, tarry, or
bloody stools; weakness; unusual fatigue; or
tingling of extremities.
Notify health care professional if nausea,
vomiting, diarrhea, or stomach discomfort
persists.
Dosage may require adjustment. Emphasize
the importance of regular follow-up exams
to monitor serum levels and progress.
38) LIDOCAINE HYDROCHLORIDE
Brand name: Abbott Lidocaine
Classification: Anaesthetics - Local & General
Dosage: 50 ml/vial
Emergency Nursing
Indication: local or regional anesthesia
Action: A class IB antiarrythmic that decreases the
depolarization, automaticity, and excitability in the
ventricles during the diastolic phase by direct action
on the tissues especially the Purkinje network
Adverse Reactions: Restlessness, nervousness,
dizziness, tinnitus, blurred vision; GI upsets; muscle
twitching, convulsions; numbness of the tongue;
hypotension, bradycardia; methemoglobinaemia;
fetal intoxication.
Nursing Measures:
Check drug concentration carefully; many
concentrations are available.
Reduce dosage with hepatic or renal failure.
Continuously monitor response when used
as antiarrhythmic or injected as local
anesthetic.
Keep life-support equipment and
vasopressors readily available in case severe
adverse reaction (CNS, CV, or respiratory)
occurs when lidocaine is injected.
Establish safety precautions if CNS changes
occur; have IV diazepam or short-acting
barbiturate (thiopental, thiamylal) readily
available in case of seizures.
Monitor for malignant hyperthermia (jaw
muscle spasm, rigidity); have life-support
equipment and IV dantrolene on standby.
Titrate dose to minimum needed for cardiac
stability, when using lidocaine as
antiarrhythmic.
Reduce dosage when treating arrhythmias in
CHF, digitalis toxicity with AV block, and
geriatric patients.
Monitor fluid load carefully; more
concentrated solutions can be used to treat
arrhythmias in patients on fluid restrictions.
Have patients who have received lidocaine
as a spinal anesthetic remain lying flat for 6–
12 hr afterward, and ensure that they are
adequately hydrated to minimize risk of
headache.
Check lidocaine preparation carefully;
epinephrine is added to solutions of
lidocaine to retard the absorption of the local
anesthetic from the injection site. Be sure
that such solutions are used
only to produce local anesthesia. These
solutions should be injected cautiously in
body areas supplied by end arteries and used
cautiously in patients with peripheral
vascular disease, hypertension,
thyrotoxicosis, or diabetes.
Use caution to prevent choking. Patient may
have difficulty swallowing following use of
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Medical and Surgical Nursing
Emergency Nursing
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
oral topical anesthetic. Do not give food or
drink for 1 hr after use of oral anesthetic.
Treat methemoglobinemia with
methylene blue, 0.1 mg/kg, IV over 10 min.
Apply lidocaine ointments or creams to a
gauze or bandage before applying to the
skin.
Monitor for safe and effective serum drug
concentrations (antiarrhythmic use: 1–5
mcg/mL). Doses > 6–10 mcg/mL are usually
toxic
39) SODIUM BICARBONATE
Brand name: Hospira Sodium Bicarbonate
Classification: Alkalinizers
Dosage: 10mEq/10ml; 50mEq/50ml
Indication: metabolic acidosis, systemic or urinary
alkalinization, antacid, cardiac arrest
Action: Restores buffering capacity of the body and
neutralizes excess acid
Adverse Reaction: Tetany, edema, gastric distention,
belching, flatulence, hypokalemia, metabolic
alkalosis, hypernatremia, chemical cellulitis because
of alkalinity, pain, irritation, tissue necrosis,
ulceration or sloughing at the site of infiltration
Nursing Measures:
do not take drug with milk to avoid
hypercalcemia, abnormally high alkalinity in
tissues and fluids, or kidney stones.
do not give to patients with metabolic or
respiratory alkalosis, and in those with
hypocalcemia in which alkalosis may
produce tetany, hypertension, seizures, or
heart failure.
monitor for alkalosis by obtaining blood pH,
PaO2, PCO2, and electrolyte levels
40) DOPAMINE
Brand name: Intropin
Classification: Adrenergics (Sympathomimetics)
Dosage: 40 mg/Ml; 80  mg/mL; 160 mg/mL
Indication : shock and hemodynamic imbalances,
hypotension
Action: Stimulates dopaminergic and alpha beta
receptors for the sympathetic nervous system
resulting in a positive inotropic effect and increased
cardiac output. Action is dose-related; large doses
cause mainly alpha stimulation
Adverse Reaction: ectopic beats, tachycardia,
anginal pain, palpitation, hypotension,
vasoconstriction, ventricular arrhythmias,
hypertension, headache, anxiety, dilated pupils,
nausea, vomiting, decreased urine output, dyspnea
Emergency Nursing
Nursing Measures:
Monitor vital signs and ECG closely
1% throughout therapy.
Monitor I&O regularly; note decreases in
urine output.
Monitor central venous pressure or
pulmonary wedge pressure if possible
during infusion.
Note significant changes in vital signs, ECG
changes, deterioration of peripheral
pulses, and/or cold, mottled extremities
41) DOBUTAMINE
Brand name: Dobatrey
Classification: Adrenergics
Dosage: 12.5 mg/mL
Indication: increased cardiac output in short term
treatment of cardiac decompensation caused by
depressed contractility
Action: Stimulates heart’s beta1 receptors to increase
myocardial contractility and stroke volume. Increases
cardiac output by decreasing peripheral vascular
resistance, reducing ventricular filling pressure, and
facilitating AV node conduction
Adverse Reaction: increased systolic BP, increased
heart rate, chest pain, increased number of premature
ventricular beats, headache, tingling sensations,
paresthesia. nausea, vomiting, dyspnea, phlebitis,
local inflammation after infiltration, leg cramps
Nursing Measures:
Monitor vital signs, ECG, cardiac output,
pulmonary capillary wedge pressure, central
venous pressure and urinary output carefully
throughout infusion.
Monitor patency and placement of IV
catheter to reduce risk of extravasation and
phlebitis.
Watch out for symptoms of overdosage such
as excessive hypertension, tachycardia,
nausea, vomiting, tremor, headache, chest
pain
42) LIDOCAINE PREMIXED
Brand name: Xylocaine
Classification: Antiarrhythmic agent, Local
anesthetic
Dosage: 0.2% (2mg/ml); 0.4% (4g/ml); 0.8% (8g/ml)
Indication: ventricular arrhythmias caused by MI,
cardiac manipulation or cardiac glycosides
Action: Acts as an anesthetic by stabilizing the
neuronal membrane by inhibiting the ionic fluxes
required for the initiation and conduction of
impulses, thereby effecting local anesthetic action.
Also acts as an antiarrhythmic by decreasing the
depolarization, automaticity, and excitability in the
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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
on the tissues, especially the Purkinje network,
without involvement of the autonomic system.
Neither contractility, systolic arterial blood pressure,
atrioventricular (AV) conduction velocity, nor
absolute refractory period is altered by usual
therapeutic doses
Adverse Reaction: bradycardia, cardiac arrest, CV
collapse, hypotension, apprehension, confusion,
dizziness, drowsiness, hallucinations, headache,
light-headedness, mood changes, nervousness,
tremors, conjunctival hyperemia, corneal epithelial
changes, diplopia, tinnitus, visual disturbances,
nausea, vomiting, erythema, petechiae, edema,
injection-site reactions, including bruising, burning,
contusion, hemorrhage, local reactions, including
soreness at IM injection site, venous thrombosis or
phlebitis, extravasation, burning, stinging, sloughing,
respiratory depression or arrest, hypersensitivity
reactions
Nursing Measures:
Explain that adverse reactions related to the
CNS (eg, drowsiness, confusion,
paresthesias, convulsions, respiratory arrest)
can occur and are a result of CNS toxicity.
Advise patient that drug may cause dizziness
or drowsiness and to avoid getting out of
bed or walking without assistance.
Advise patients that skin reactions, including
erythema, petechiae, and edema, may occur
with intradermal injection.
Systemic effects can occur following topical
use; use lowest possible dose to avoid
serious toxicity, shock, or heart block.
Do not use in patients with congenital or
idiopathic methemoglobinemia or in infants
younger than 12  mo of age who are
receiving methemoglobin-inducing drugs.
Use with caution and in lower doses in
patients with CHF, reduced cardiac output,
digitalis toxicity, and in elderly patients
43) MANNITOL
Brand name: Osmitrol
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
blurred vision, chest pain, chills or fever, confusion,
decreased alertness, difficulty urinating, extreme
dizziness, extreme thirst or dry mouth, fast or
irregular heartbeat, headache, muscle cramps, pain,
redness, or swelling at the injection site, weakness
Nursing Measures:
Monitor vital signs, including CVP, and
fluid intake and output.
Monitor weight, renal function, and serum
sodium and potassium levels daily
Watch out for symptoms of overdosage such
as excessive hypertension, tachycardia,
nausea, vomiting, tremor, headache, chest
pain
To relieve thirst, give frequent mouth care
and fluids
44) DEXTROSE 5% IN WATER (D5W)
SOLUTION
Brand name: None
Classification: Isotonic/Hypotonic Solution
Dosage: 250ml bottles (5g dextrose/100ml water)
Indication: fluid replacement and caloric
supplementation in patients who can’t maintain
adequate oral intake or are restricted from doing so
Action: Provides some sugar for cellular metabolism
and supplies body water
Adverse Reaction: Increases free water and may
cause intracellular edema, fluid overload, infiltration
(swelling and pain at infusion site)
Nursing Measures:
Monitor infusion rate frequently; if signs of
fluid overload, turn off IV drip. Infusion
may result in fluid overload.
Check IV site frequently and if infiltration is
noted, turn off IV drip.
Watch out for signs of fluid overload
(distended neck veins (JVD), rapid
respirations, shallow tidal volume, fine
auscultatory crackles, dyspnea, and
peripheral edema)
Watch out for signs of infiltration (swelling
and pain around IV site).
Abejo