Nursing care

The nurse carefully reviews die dose regimen with the... 

When performing the ongoing assessment, the nurse observes the patient daily for the appearance of adverse reactions. These observations are especially important when a drug is known to be nephrotoxic or ototoxic. It is important to report any adverse reactions to the primary health care provider. In addition, the nurse carefully monitors vital signs daily or as frequently as every 4 hours when the patient is hospitalized. 

Nursing care includes close monitoring of the patient immediately after insertion of the epidural catheter and throughout therapy for respiratory depression. Vital signs are taken every 30 minutes, apnea monitors are used, and a narcotic antagonist, such as naloxone, is readily available... 

Administration of penicillamine has been associated with many adverse reactions, some of which are potentially serious and even fatal. The nurse carefully evaluates any complaint or comment made by the patient and reports it to the primary health care provider. Increased skin friability may occur, which may result in easy breakdown of the skin at pressure sites, such as the hips, elbows, and shoulders. If the patient is unable to ambulate the nurse changes the patient s position and inspects pressure sites for skin breakdown every 2 hours. 

MONITORING AND MANAGING RESPIRATORY DEPRESSION These drugs depress the CNS and can cause respiratory depression. The nurse carefully assesses respiratory function (rate, depth, and quality) before administering a sedative, Vs, to 1 hour after administering the drug, and frequently thereafter. Toxic reaction of the barbiturates can cause severe respiratory depression, hypoventilation, and circulatory collapse. 

ANALEPTICS. After administration of an analeptic, the nurse carefully monitors the patient s respiratory rate and pattern until the respirations return to normal. The nurse monitors the level of consciousness, the blood pressure and pulse rate at 5- to 15-minute intervals or as ordered by the primary health care provider. The nurse may draw blood for arterial blood gas analysis at intervals to determine the effectiveness of the analeptic, as well as the need for additional drug therapy. It is... 

BARBITURATES The barbiturates can produce a hypersensitivity rash. Should a skin rash occur, the nurse must notify the primary health care provider immediately because the primary health care provider may discontinue the drug. The nurse carefully examines all affected areas and provides an accurate description. If pruritus is present, the nurse keeps the patient s nails short, applies an antiseptic cream (if prescribed), and tells the patient to avoid the use of soap until the rash subsides. 

Promoting an Optima/ Response to Therapy Effecfive management of the paHent with parkinsonism requires that the nurse carefully monitor the drug therapy, provide psychological support, and place a strong emphasis on patient and family teaching. 

Visual difficulties (eg, adverse reactions of blurred vision and diplopia) may be evidenced by the patient s sudden refusal to read or watch television or by the patient bumping into objects when ambulating. The nurse carefully evaluates any sudden changes in the patient s behavior or activity and reports them to the primary health care provider. The patient with visual difficulties may need assistance with ambulation. The room should be kept well lighted, the use of scatter or throw rugp should be avoided, and any small pieces of furniture or objects that might increase the risk of falling should be removed. The nurse carefully assesses the environment and makes the necessary adjustments to ensure the patient s safety. 

Do not abruptly discontinue use of the antiparkinsonism drugs Neuroleptic malignant-like syndrome may occur when the antiparkinsonism drugs are discontinued or the dosage of levodopa is reduced abruptly. The nurse carefully observes the patient and reports the following symptoms muscular rigidity, elevated body temperature, and mental changes... 

When die patient is hospitalized, the nurse develops a nursing care plan to meet the patient s individual needs. Vital signs are monitored at frequent intervals, usually 3 to 4 times daily. In some instances, such as when hypotensive episodes occur, the vital signs are taken more often. The nurse reports any significant change in the vital signs to the primary healdi care provider. 

If vomiting is severe the nurse observes the patient for signs and symptoms of electrolyte imbalance. The nurse monitors the blood pressure, pulse, and respiratory rate every 2 to 4 hours or as ordered by the primary health care provider. The nurse carefully measures the intake and output (urine, emesis) until vomiting ceases and the patient is able to take oral fluids in sufficient quantity. The nurse documents in the patient s chart each time the patient has an emesis. The nurse notifies the primary health care provider if there is blood in the emesis or if vomiting suddenly becomes more severe... 

Because each brand is slightly different, die nurse carefully reviews any instruction sheets with the patient and provides information about how the unit is assembled, used, and cleaned. 

TH E PATIEN T WITH ED EM A. Fhtients with edema caused by heart failure or other causes are weighed daily or as ordered by the primary health care provider. A daily weight is taken to monitor fluid loss. Weight loss of about 2 lb/d is desirable to prevent dehydration and electrolyte imbalances. The nurse carefully measures and records the fluid intake and output every 8 hours. The critically ill patient or the patient with renal disease may require more frequent measurements of urinary output. The nurse obtains the blood pressure, pulse, and respiratory rate every 4 hours or as ordered by the primary health care provider. An acutely ill patient may require more frequent monitoring of the vital signs. 

Ms. Howard, age 86 years, has Alzheimer s disease and is a resident in a nursing home. She has a UTI and is prescribed cinoxadn (Cinobac). Discuss specific nursing tasks to include in a nursing care plan for this patient. What potential problems could be anticipated because of the Alzheimer s disease What drugs might the primary care provider prescribe for the Alzheimer s disease ... 

GASTROINTESTINAL STIM ULANTS. The nurse carefully times the administration of oral metoclopramide for 30 minutes before each meal. Dexpanthenol is administered intramuscularly or IV. The nurse tells the patient that intestinal colic may occur within 30 minutes of administration and that this is not abnormal and will pass within a short time... 

Nursing management of a patient with diabetes requires diligent, skillful, and comprehensive nursing care... 

Care must be taken when giving insulin to use the correct insulin. Names and packaging are similar and can easily be confused. The nurse carefully reads all drug labels before preparing any insulin preparation. For example, Humalog (insulin lispro) and Humulin R (regular human insulin) are easily confused because of die similar names. 

The nurse carefully checks the health care provider s order for the type and dosage of insulin immediately before withdrawing the insulin from the vial. All air bubbles must be eliminated from the syringe barrel and hub of the needle before withdrawing the syringe from the insulin vial. 

The nurse carefully observes patients with cardiovascular disease taking the thyroid hormones. The development of chest pain or worsening of cardiovascular disease should be reported to the primary health care provider immediately because the patient may require a reduction in the dosage of the thyroid hormone. 

If Hie patient experiences a rash while taking methimazole or propylthiouracil, tlie nurse carefully documents Hie affected areas, noting size, texture, and extent of tlie rash, and reports tlie occurrence of Hie rash to tlie primary health care provider. Soothing creams or lubricants may be applied, and soap is used sparingly, if at all, until Hie rash subsides. 

Develop a nursing care plan for Ms. Morris, a 28-year-old, woman who is admitted to the obstetric unit with premature labor during her third trimester. This is her second child, and die has had two miscarriages. She is prescribed ritodrine for preterm labor. Analyze what nursing diagnoses would have the highest priority. Discuss how you would explore and plan to meet her emotional needs. 

Continually update nursing assessments, nursing diagnoses, and nursing care plans to meet the changing needs of the patient. 

During the first 30 minutes of infusion of a fat solution, the nurse carefully observesthe patient for difficulty in breathing, headache, flushing, nausea, vomiting, or signs of a hypersensitivity reaction. If any of these reactions occur, the nurse dis-continuesthe inf us on and immediately notifies the primary health care provider. 

Educating the Patient and Family To ensure accurate compliance with tiie prescribed drug regimen, tiie nurse carefully explains tiie dose and time intervals to tiie patient or a family member. Because... 

Social detoxification, which involves the nonpharmacological treatment of alcohol withdrawal, has been shown to be effective (see Naranjo et al. 1983). It consists of frequent reassurance, reality orientation, monitoring of vital signs, personal attention, and general nursing care (Naranjo and Sellers 1986). Social detoxification is most appropriate for patients in mild-to-mod-erate withdrawal. The medical problems commonly associated with alcoholism (Sullivan and O Connor 2004) may substantially complicate therapy, so that care must be taken to refer patients whose condition requires medical management. 

Understanding the human genome should lead to improved therapies that may have a favorable impact on health care expenditure. In many cases, pharmacogenomics-based therapies will be therapeutic (and economic) substitutes for other more invasive procedures such as surgery or will reduce the need for expensive support care such as long-term assisted living or skilled nursing care. 

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