Emergency drugs

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Questions and Answers

What is the primary action of sodium bicarbonate as described?

Acts as a primary respiratory stimulant

Releases bicarbonate ions to alkalinize the blood (correct)

Acts as a diuretic to increase urine output

Replenishes electrolytes without altering pH

Which of the following nursing considerations is crucial when administering magnesium for seizures?

Monitor blood pressure every 10 minutes

Perform a urinalysis prior to administration

Ensure respiratory rate is at least 16 breaths/min (correct)

Check for signs of hyperkalemia

In which scenario would the administration of magnesium as a 10% solution be appropriate?

To treat dysrhythmia in cardiac arrest suspected of torsade (correct)

To correct metabolic acidosis in severe dehydration

For increasing urine output in renal failure

For immediate treatment of hypokalemia

What is a recommended maximum rate of infusion for magnesium in hypomagnesaemia treatment?

3 ml/min Signup and view all the answers

What should be monitored periodically during sodium bicarbonate therapy?

Arterial blood pH and electrolyte balance Signup and view all the answers

What is a critical nursing consideration when administering high flow oxygen to patients with COPD?

Avoid high flow administration Signup and view all the answers

What is the primary mechanism of action of aspirin in treating Acute Coronary Syndrome?

Slows platelet aggregation Signup and view all the answers

Which dosage of nitroglycerin is appropriate for sublingual administration?

0.15 to 0.6 mg Signup and view all the answers

In which scenario should aspirin not be given to a patient?

If they have a history of gastrointestinal bleeding Signup and view all the answers

What condition must be monitored when a patient is receiving IV nitroglycerin?

ECG and blood pressure Signup and view all the answers

What symptom should be closely monitored to avoid nitroglycerin overdose?

Hypotension Signup and view all the answers

What is the recommended method for aspirin administration to speed up absorption?

Instructing the patient to chew chewable aspirin Signup and view all the answers

Which of the following is not an indication for administering nitroglycerin?

Osteoarthritis Signup and view all the answers

Which mechanism is NOT a function of noradrenaline?

Decreases blood flow to vital organs Signup and view all the answers

For which condition would calcium chloride be indicated?

Acute hypocalcaemia Signup and view all the answers

Which of the following statements regarding magnesium sulfate is incorrect?

It is used as an antidote for calcium channel overdose Signup and view all the answers

What is the initial dosage range for noradrenaline infusion?

4 to 10 mcg/min Signup and view all the answers

Which nursing consideration is essential for the administration of calcium chloride?

Flush IV line between calcium and sodium bicarbonate Signup and view all the answers

What adverse effect should a nurse be vigilant for when administering magnesium sulfate?

Bradycardia Signup and view all the answers

Which action is a characteristic of noradrenaline's pharmacological effects?

Increases heart output without increasing heart workload Signup and view all the answers

What is the maximum dosage interval for calcium chloride administration?

10 minutes Signup and view all the answers

What is the main function of atropine in emergency situations?

To increase heart rate Signup and view all the answers

What is a critical nursing consideration when administering amiodarone?

Diluting it in G5% solution Signup and view all the answers

Which of the following patients would most likely benefit from dopamine administration?

A patient in shock with hypotension Signup and view all the answers

In which condition is amiodarone considered the first-line medication?

Atrial and ventricular tachy-dysrhythmias Signup and view all the answers

What is the recommended infusion rate for amiodarone after the loading dose?

0.5 mg/min Signup and view all the answers

What is a potential side effect of using atropine?

Rebound tachycardia Signup and view all the answers

Which monitoring parameters are essential for a patient receiving dopamine?

Urine output and cardiac rhythm Signup and view all the answers

What is an important dosing consideration when starting amiodarone therapy?

Doses of anticoagulants may need to be reduced Signup and view all the answers

What is the recommended initial dosage range for intravenous infusion of Dobutamine?

2.5 to 20 mcg/kg/min Signup and view all the answers

What is a crucial nursing consideration when administering Epinephrine as a vasopressor?

Monitor ECG continuously Signup and view all the answers

Which of the following adverse effects should be monitored for during Dobutamine administration?

Tachycardia Signup and view all the answers

When should urine output be monitored during Dobutamine infusion?

Continuously Signup and view all the answers

What is the action of Epinephrine as a cardiac stimulant?

Increases myocardial contractility and relaxes bronchial smooth muscles Signup and view all the answers

Which patient condition is NOT an indication for administering Epinephrine?

Flu-like symptoms Signup and view all the answers

What concentration of D5W is used to prepare a 1mg/250ml solution of Epinephrine?

4 mcg/ml Signup and view all the answers

Before starting Dobutamine infusion, which condition should be corrected?

Hypovolemia Signup and view all the answers

What is the primary effect of administering low doses of dopamine (less than 5 mcg/kg/min)?

Vasodilation in various vascular beds Signup and view all the answers

What occurs at intermediate infusion rates of dopamine (5-10 mcg/kg/min)?

Enhanced impulse conduction in the heart Signup and view all the answers

What does the vasoconstriction effect of dopamine infusion at rates greater than 10 mcg/kg/min primarily activate?

Alpha-adrenoceptors in skeletal muscle Signup and view all the answers

Which of the following is a critical nursing consideration when administering dopamine?

Assess and correct acidosis before administration Signup and view all the answers

Which of these is NOT an indicator for the use of dobutamine?

Shock without fluid replacement Signup and view all the answers

What effect does dobutamine have on myocardial oxygen demand?

Has no effect on oxygen demand Signup and view all the answers

When should the infusion of dopamine be weaned off?

Gradually to prevent sudden hypotension Signup and view all the answers

Which physiological effect is primarily associated with higher rates of dopamine infusion (above 20 mcg/kg/min)?

Alpha receptor predominance and potential limb compromise Signup and view all the answers

Study Notes

Emergency Nursing Procedures - Oxygen

Indications: Cardiopulmonary arrest, chest pain, hypoxemia
Action: Maximizes O2 delivery to cells
Dosage: 2 to 15 L/minute via appropriate device
Nursing Considerations:
- Monitor O2 saturation regularly using pulse oximeter
- Avoid high flow administration in patients with concurrent COPD
- Use appropriate delivery device for appropriate amount of O2 ordered
- Humidification, warming, and filtering the delivered oxygen
- Monitor for signs of oxygen toxicity

Emergency Nursing Procedures - Aspirin

Classification: Antipyretic and a non-opioid analgesic
Indications: Treat Acute Coronary Syndrome (ACS)
Action: Slows platelet aggregation, reducing the risk of further occlusion or re-occlusion of the coronary artery or a recurrent ischemic event
Dosage: 160 to 325 mg (standard recommended dosage for treating ACS)
Nursing Considerations:
- Instruct patient to chew "baby" aspirin to speed absorption
- Not given on empty stomach
- Monitor platelet count

Emergency Nursing Procedures - Nitroglycerin

Classification: Anti angina - vasodilator - anti hypertension
Indications: Treat ACS, angina, hypertension, heart failure
Action:
- Anti-angina helps resolve chest pain from ACS
- A potent vasodilator, relaxes vascular smooth-muscle beds, improving blood flow to ischemic areas
- Decreases myocardial oxygen consumption, allowing the heart to work with a lower oxygen demand
- Vasodilation in peripheral vascular beds reduces preload and afterload, decreasing cardiac workload
Dosage:
- Sublingual 0.15 to 0.6 mg
- Transdermal patch 5mg or 10mg
- IV 10-300mcg/min
Nursing Considerations:
- Dilute in compatible solution (preferred over undiluted)
- Assess location, duration, intensity and precipitating factors of patient's anginal pain.
- Continuous ECG and blood pressure monitoring for patients on IV nitroglycerin
- Be alert for overdose symptoms (hypotension, tachycardia, warm flushed skin, cyanosis, headache, palpitations, confusion, nausea, vomiting, moderate fever, 48 paralysis, hypoxia leading to coma, convulsions)

Emergency Nursing Procedures - Morphine

Classification: Opiate analgesia
Indications: Analgesic of choice for pain in myocardial infarction
Action:
- Narcotic analgesic, providing immediate pain relief lasting for 2 hours.
- Inhibits transmission of pain impulses
- Relieves pulmonary congestion, lowers myocardial oxygen requirements, and reduces anxiety.
Dosage:
- Bolus IV 2-10mg, repeated every 2-4 hours if necessary
- Infusion 2-5mg/hr in NS or D5W%
Nursing Considerations:
- Obtain baseline respiratory rate, depth, rhythm, and pupil size before administering
- Monitor I&O ratio and pattern; report oliguria or urinary retention
- Frequently assess blood pressure (hypotension) and vital signs
- Oxygen and controlled respiratory equipment should be available
- Assess for pain relief

Emergency Nursing Procedures - Amiodarone (cordarone)

Classification: Anti dysrhythmia
Indications: Atrial and ventricular tachy-dysrhythmias
Action: Multichannel blocker (sodium, potassium, calcium channel, and non-competitive α & β blocker), Class III antiarrhythmic
Dosage: (Specific dosage details omitted from the provided text)

Emergency Nursing Procedures - Atropine

Classification: Anti cholinergic
Indications: Symptomatic bradycardia (first choice)
Action: Antidote for organ phosphorus insecticide poisoning; increases heart rate through anticholinergic effects
Dosage: 0.5mg IV push, may repeat up to a total dose of 2mg
Nursing Considerations:
- Take frequent vital signs (particularly noting heart rate)
- Monitor blood pressure for improvement
- Follow administration with normal saline flush
- Monitor intake and output in elderly patients (risk for urine retention)
- Assess the patient routinely for abdominal distention and auscultate for bowel sounds

Emergency Nursing Procedures - Dopamine

Classification: Sympathomimetic, vasopressin, inotropic
Indications: Treat shock, correct hemodynamic imbalances, improve perfusion of vital organs, correct hypotension
Action: Stimulates dopaminergic and α and β receptors of the sympathetic nervous system. Dose-dependent action (higher doses mainly α stimulation)
Dosage: Dose-dependent:
- Low rates (<5 mcg/kg/min): Vasodilation in renal, mesenteric, coronary, and intracerebral beds; increased glomerular filtration rate, renal blood flow, sodium excretion, and urine flow; no effect on blood pressure.
- Intermediate rates (5-10 mcg/kg/min): Improved myocardial contractility, increased SA rate, enhanced impulse conduction; little beta-2 stimulation (less increase in myocardial oxygen consumption)
- High rates (>10 mcg/kg/min): Vasoconstriction, increased blood pressure, effects first seen in skeletal muscle

Emergency Nursing Procedures - Dobutamine (dobutrex)

Classification: Inotropic, β1-agonist
Indications: Heart failure, cardiac decompensation (avoid in shock without adequate fluid replacement)
Action: Increases myocardial contractility and cardiac output without significantly changing blood pressure; increases coronary blood flow and myocardial oxygen consumption, mild vasodilation
Nursing Considerations: • Monitor blood pressure, pulse, respiration, ECG, and hemodynamic parameters every 5-15 minutes during and after administration. • Monitor urine output frequently. • Palpate peripheral pulses, and assess the appearance of extremities routinely; note color and temperature. • Correct acidosis and hypovolemia before dopamine infusion. • Use large veins; check frequently for blanching or pallor (indicates extravasation) • Gradually wean infusion to prevent sudden hypotension

Emergency Nursing Procedures - Epinephrine (adrenaline)

Classification: Cardiac stimulant, vasopressor, bronchodilator, beta-2 adrenergic agonist
Indications: Cardiac arrest, hypersensitivity reaction, anaphylaxis, acute asthma attacks, symptomatic bradycardia, severe hypotension
Action: Increases myocardial contractility, heart rate, SBP, and cardiac output; relaxes bronchial smooth muscle.
Dosage: For cardiac arrest: 1 mg IV, every 3-5 minutes, followed by 5 forceful inhalations. As vasopressor: 2-10 mcg/min IV, titrated to desired response (1mg/250ml D5Wyeilds 4 mcg/ml)

Emergency Nursing Procedures - Noradrenaline (nor-epinephrine, levophed)

Classification: Sympathomimetic, vasopressor
Indications: Hypotension (trauma, shock, severe cardiogenic shock)
Action: Produces vasoconstriction, increases myocardial contractility, and increases blood flow to vital organs without increasing workload or output of the heart
Dosage: 4-10 mcg/min initially, adjusted to maintain desired blood pressure (2-4mcg/min diluted in 250 to 1000ml of D5% as IV infusion)

Emergency Nursing Procedures - Calcium Chloride

Classification: Electrolyte
Indications: Acute hyperkalemia, acute hypocalcemia, calcium channel overdose, antidote for magnesium sulfate
Action: Increases cardiac contractility; calcium chloride replacement and maintenance of calcium in body fluids
Dosage: 2-4 mg/kg of a 10% solution; equivalent to 13.6 meq of calcium; may be repeated every 10 minutes
Nursing Considerations:
- Flush IV line between calcium chloride and sodium bicarbonate administrations.
- Administer calcium slowly via central line
- Monitor blood pressure (peripheral vasodilation occurs)
- Continuous ECG monitoring for dysrhythmias
- Observe for adverse effects (bradycardia, cardiac arrest, constipation, fatigue, venous irritation, depression, tingling)

Emergency Nursing Procedures - Magnesium Sulfate

Classification: Electrolyte, anti-dysrhythmia, anti-convulsant
Indications: Seizure associated with eclampsia, hypomagnesemia, torsade de pointes, life-threatening ventricular dysrhythmias secondary to digitalis toxicity.
Action: Replaces and maintains magnesium levels in body fluids; depresses the central nervous system, producing anticonvulsant effects, decreasing dysrhythmias incidence
Dosage: Cardiac arrest: 1-2 g diluted in 10 ml D5W IV push. Seizures: 1-4 g as a 10% solution IV over 1-5 minutes. Hypomagnesemia: 5 g/1000 ml D5W over 3 hours (maximum 3 ml/min).
Nursing Considerations:
- Monitor ECG, heart rate, and blood pressure every 2-5 minutes during titration
- Monitor respiration (at least 16 breaths/minute before dose)
- Monitor urine output (at least 25 ml/hour)
- Calcium (5-10 meq) may reverse respiratory depression/heart block

Emergency Nursing Procedures - Sodium Bicarbonate

Classification: Electrolyte replenisher and systemic alkalizer
Indications: Correction of severe metabolic acidosis (renal disease, uncontrolled diabetes, circulatory insufficiency due to shock, cardiac arrest, severe primary lactic acidosis).
Action: Alkalinizing agent by releasing bicarbonate ions
Dosage: In emergency, can be administered undiluted via direct IV injection or diluted in 0.9% sodium chloride, 5% glucose
Nursing Considerations:
- Fluid balance throughout therapy
- Central line administration preferred
- Obtain arterial blood pH, PO2, PaCO2, serum calcium, sodium, potassium, and renal function before and during therapy.
- Flush line before and after administration
- Observe for adverse effects (e.g., restlessness, tetany, hypokalemia, alkalosis, hypernatremia, fluid overload).

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