Drug therapy outputs

RISK FOR INEFFECTIVE TISSUE PERFUSION RENAL When the patient is taking a drag tiiat is potentially toxic to die kidneys, die nurse must carefully monitor fluid intake and output. In some instances, die nurse may need to perform hourly measurements of die urinary output. Periodic laboratory tests are usually ordered to monitor the patient s response to therapy and to detect toxic drag reactions. Seram creatinine levels and BUN levels are checked frequentiy during the course of therapy to monitor kidney function. If the BUN exceeds 40 mg dL or if the serum creatinine level exceeds 3 mg cIL, the primary health care provider may discontinue the drug therapy or reduce the dosage until renal function improves. 

If the patient is to receive an osmotic diuretic, the focus of the assessment is on the patient s disease or disorder and the symptoms being treated. For example, if the patient has a low urinary output and the osmotic diuretic is given to increase urinary output, the nurse reviews the intake and output ratio and symptoms the patient is experiencing. In addition, the nurse weighs the patient and takes the vital signs as part of the physical assessment before starting drug therapy. 

The goals of therapy are to relieve congestive symptoms, optimize volume status, treat symptoms of low cardiac output, and minimize the risks of drug therapy so the patient can be discharged in a compensated state on oral drag therapy. 

In instituting single-drug therapy (monotherapy), the following considerations apply 3-blockers (p. 92) are of value in the treatment of juvenile hypertension with tachycardia and high cardiac output however, in patients disposed to bronchospasm, even 3i-se-lective blockers are contraindicated. 

Also of interest is the report by Anderson and colleagues (154) that found a reduction in the urinary output of norepinephrine and its metabolites in nine female SAD patients treated with light therapy. They concluded that the results were compatible with changes seen after antidepressant drug therapy and recommended controlled trials to confirm this preliminary finding. 

Increasing urine output 155 Increasing renal blood flow 157 Increasing glomerular filtration rate 158 Effectiveness of drug therapy in acute renal failure 158... 

Cost is defined as the value of the resources consumed by a program or drug therapy of interest. Consequence is defined as the effects, outputs, or outcomes of the program of drug therapy of interest. Consideration of both costs and consequences differentiates most pharmacoeconomic evaluation methods from traditional cost-containment strategies and drug-use evaluations. 

Another marker of sufficient tissue perfusion can be clinical assessment of end-organ function. As mentioned previously, prevention of MODS is an important factor in reducing ARDS-associated mortality. ChnicaUy, assessments of urine output and serum electrolytes are important aspects of renal function monitoring, whereas liver function tests (aminotransferases AST and ALT) are important laboratory parameters for monitoring hepatic function. Central nervous system assessment can be difficult in the ARDS patient and is confounded by concurrent drug therapies (e.g., sedatives, narcotics, etc.) that alter neurologic status. 

Measurement of renal plasma and blood flow is usually reserved for research settings to evaluate hemodynamic changes related to disease or drug therapy. The kidneys receive approximately 20% of cardiac output and representative values of renal blood flow in men and women of about 1200 250 and 1000 180 mL/min per 1.73 w have been reported, respectively. Renal plasma flow (RPF) can be estimated to be 60% of renal blood flow if it is assumed that the average hematocrit is 40%. 

A 65-year-old man had been taking mefenamic acid for 2 years when he was admitted to hospital because of diarrhoea with severe steatorrhoea, some 50 g of fat being lost daily. When all drug therapy, including mefenamic acid, was stopped, the diarrhoea ceased within 2 days. The faecal output was normal 2 weeks later (89 ). 

The nurse must carefully monitor fluid intake and output because this drug may be nephrotoxic (harmful to the kidneys). In some instances, the nurse may need to perform hourly measurements of the urinary output. Periodic laboratory tests are usually ordered to monitor the patient s response to therapy and detect toxic drug reactions. 

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