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THEORETICAL FOUNDATION OF NURSING Theory- tentatively describe, explain, or predict relationships among concepts. - concepts that propose actions that guide practice Components of a Theory 1.) Concepts- building blocks of theories - abstract descri...

THEORETICAL FOUNDATION OF NURSING Theory- tentatively describe, explain, or predict relationships among concepts. - concepts that propose actions that guide practice Components of a Theory 1.) Concepts- building blocks of theories - abstract description of phenomena 2 types: > Abstract- indirectly observable and independent of time or place > Concrete- specific to time, place and are observable 2.) Phenomenon- aspect of reality that can be consciously sensed or influenced, observable event 3.) Definitions- meaning of the concept 4.) Assumptions- statement that describes the concept - relationship or connection of factual concepts or phenomena Principle- a basic law, truth or assumption - fundamental, primary, or general law or truth from which others are derived Nursing Metaparadign- link science, philosophy and theories that is accepted to discipline of nursing. 1.) Person - recipient of nursing care 2.) Health- degree of wellness/ well-being that the client experiences 3.) Environment- situation, positive/ negative, internal or external surrounding that affects the patient 4.) Nursing- nurse’s attributes, characteristics, and actions provide care on behalf. Domain of Nursing Domain- perspective of a profession. It provides the subject, central concepts, values and beliefs, phenomena of interest. - allows nurses to recognize and treat pts’ health care needs in all health care settings - includes nursing history, theory, education, and research. Paradigm- set of beliefs that describes a discipline’s real. - connects the disciplines’s, concepts, theories, beliefs, values, and assumptions. Types of Theory 1.) Grand Theories - are abstract, broad-scoped, and complex, requiring research to be applied to nursing practice. - A general theory doesn't guide specific nursing actions. Instead, it provides a framework for global nursing ideals. - Grand theories aim to answer the question "What is nursing?" rather than focusing on a single style of nursing. Their writings reflected their own experiences 2.) Middle- Range Theories - less abstract and more constrained. Aspects of practice (administrative, clinical, or instructional) are addressed - focus on specific topic 3.) Practice Theories - also known as situation- specific theories, bring theory to the bedside. - guide the nursing care of a certain patient population at a particular period. THEORIST OF NURSING THEORY * Dorothea Orem Self Care Deficit Theory of Nursing: result when self care agency is not adequate to meet the known self- care demand. Self Care- performance or practive of actuvities that individual initiate and perform on their own behalf to maintain life, health and well being Self-Care Agency- human’s acquired ability or power to engage in self-care Therapeutic Self- Care Demand- totally of care measures necessary at specific time or over a duartion of time meeting and individual’s self care requisites by appropriate methods and related sets of operations and actions. Basic Conditioning Factors - Age - Gender - Developmental state - Health state - Sociocultural factors - Health care system factors - Diagnostic and Treatment modalities - Family system factors - Patterns of living - Activities regularly engaged in - Environmental factors - Resource adequacy and availability Self-care Requisites- reason for which self-care is undertaken; they express the intended or desired results Categories: > Universal- life processes > Developmentsl- humsn growth and developmental process > Health Deviation- result from illness, injury, or diseas or its treatment Three Classification of Nursing System 1.) Wholly Compensatory - nurses is expected to accomplish all the pt’s therapeutic self-care. 2.) Partialy Compensatory - both nurse and pt engage in meeting self-care needs 3.) Supportive- Educative - Requires assistance in decision making, behavior control and acquisition of knowledge and skills * Patricia Benner The Primacy Caring Of Model From Novice to Expret Nursing Model - states that caring practices are instilled knwoledge and skill regarding everday human needs Stages of Clinical Competence 1.) Novice - no prefessional background experience of the situation he/she involved - difficulty discerning between relevant and irrelevant asoects of the situation - beginner to profession or nurse changing area of practice - nursing students 2.) Advanced Beginner - can note recurrent meaningful situations components, but not prioritze between them - person can demonstrate marginally acceptable performance having coped with enough real situations to have pointed out by a mentor - need healpmof nurse supervisor to explain or difine situations, tomset priorities, and integrate practical knowledge - read books in order to explain situation 3.) Competent - begins to understand actions in terms of long range goals - 2 to 3years in the same area - most pivotal in clinical learning because the learner must begin to recognize patterns and determine which elements of the situation warrant attention and whoch can be ignored - devices new rules and reasoning procdures for a plan while applying learned rules for action 4.) Profecient - perceives situations as wholes rather than in terms of aspects - 3 to 5 years the nurse moves into the proficient stage - qualitative leap beyond the competent - demonstrate a new ability to see changing relevanve in a situation including the recognition snd the implementation of skilled responses to the situation as it evolves 5.) Expert - has intuitive grasp of the situation and xeros in on the accurate region of the problem - 5/years or greater in the same area - expert performer no longer relies on an analytic principle (rule, guideline, maxim) to connect his/her understanding of the situation to an appropriate action - operates from a deep understanding of the total situation * Florence Nightingale Environmental Theory, Modern Nursing - Lady with the lamp - Mother of Modern Nursing - First Nurse Researcher and Nurse Theories - she enhanced cleanliness and sanitary conditions by observing and collecting data. Nightingale’s Canon - Ventilation and Warmth - Light - Cleanliness - Health of Houses - Noise - Bed and Bedding - Personal Cleanliness - Variety - Chattering Hopes and Advices - Taking Food - Petty Management - Observation of the Sick * Virginia Henderson Definition of Nursing And 14 Fundamental Human Needs - focuses on the importance of increasing the patient’s independence to hasten their progress in the hospital - emphasize the basic human needs and how nurses can assist in meeting those needs 14 Basic Needs 1. Breathe normally 2. Eat and drink adequately 3. Eliminate body waste 4. Move and maintain desirable posture 5. Sleep and rest 6. Select suitable clothing, dress and undress 7. Maintain body temp 8. Keep the body clean and well groomed and protect the integument 9. Avoid dangers in the environment and avoid injuring others 10. Communicate with others in expressing emotions, needs, fears, or opinions 11. Worship according to one’s faith 12. Work in such a way that there is a sense of accomplisment 13. Play, or participate in various forms recreation 14. Learn, discover or satisfy the curiosity that leads to “normal” development and health, and use available health facilities. * Dorothy Johnson Behavioral System Model - advocate to foster efficient and effective behavioral functioning in the patient to prevent illness and stresses the importance of research- based knowledge about the effect of nursing care on patients 7 subsystem: 1. Attachment or Affiliative - forms the basis for social organization 2. Dependency- promotes helping behavior that calls for a nurtusring response 3. Ingestive- has to do with when, how, what, how much, and under what conditions we eat 4. Eliminative- addresses when, how and under what conditions we eliminate 5. Sexual- dual function of precreation and gratification 6. Achievement- attempts to manipulate the environment. Control or mastery of an aspect of self or environment to some standard of excellence. 7. Aggressive or Protective- protection and preservation * Hildegard Peplaua Theory of Interpersonal Relations - this theory emphasized the nurse-client relationship as the foundation of nursing practice Phase in Nurse Patient Interaction 1. Orientation Phase - directed by the nurse, involves engaging the client in treatment, providing explanations and information, and answering questions - starts when the client meets nurse as a stranger 2. Identification subphase (working phase) - selection of appropriate assistance - patient begins to have a feeling of belonging and capability pf dealing with the problem which decreases the feeling of helplessness and hopelessness - Nursing diagnosis 3. Exploitation subphase - use of professional assitance formproblem solving alternatives - rendering of our nursing management 4. Termination phase (resolution phase) - termination of professional relationship * Faye Glenn Abdellah Twenty One Nursing Problems - patient centered approach that involves identifying individual patient needs and addressing them in the nursing care plan Abdellah's 21 Nursing Problems 1. To maintain good hygiene and physical comfort. 2. To promote optimal activity: exercise, rest, sleep. 3. To promote safety through prevention of accident, injury, or other trauma and through the prevention of the spread of infection. 4. To maintain good body mechanics and prevent and correct deformity. 5. To facilitate the maintenance of a supply of oxygen to all body cells. 6. To facilitate the maintenance of nutrition of all body cells. 7. To facilitate the maintenance of elimination. 8. To facilitate the maintenance of fluid and electrolyte balance. 9. To recognize the physiological responses of the body to disease conditions -pathological, physiological, and compensatory. 10. To facilitate the maintenance of regulatory mechanisms and functions. 11. To facilitate the maintenance of sensory function. 12. To identify and accept positive and negative expressions, feelings and reactions. 13. To identify and accept interrelatedness of emotions and organic illness. 14. To facilitate the maintenance of effective verbal and nonverbal communication. 15. To promote the development of productive interpersonal relationships. 16. To facilitate progress toward achievement and personal spiritual goals. 17. To create or maintain a therapeutic environment. 18. To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs. 19. To accept the optimum possible goals in the light of limitations, physical and emotional. 20. To use community resources as an aid in resolving problems arising from illness. 21. To understand the role of social problems as influencing factors in the cause of illness. * Madeleine Leininger Transcultural Nursing Theory - identified a lack of cultural and care knowledge as the missing component to a nurse’s understanding of the many variations required in patient care to support compliance, healing, and wellness Sunrise enabler- comprehensively guide and to make culturally congruent care, decisions and actions. * Sister Callista Roy Adaptation Model - synthesizes different (borrowed) theories, such as systems, stress, and adaptation, into a collective view for explication of a person interacting with the environment Adaptation Level- condition of the life processes decribed on three level as integrated, compensatory and compromised Stimulus- any factor that provokes a response. Stimuli may arise from either the internal or external environment 3 Classes of Stimuli 1. Focal stimuli- internal and external stimulus which confront the individual 2. Contextual stimuli- other stimuli present that contribute to the effect of the focal stimulus 3. Residual stimuli- environmental factors whose effects are unclear in a given situation Four Adaptive Modes > Physiological- physical mode (individual’s physical health and functions) > Self-concept- group identity mode (individual’s beliefs and feelings about themself) > Role function mode (individual’smrolse in society) > Interdependence mode (individual’s relationships and interactions with others) * Betty Neuman Neuman Systems Model - view the client as an open system that responds to stressors in the environment - client system consists of basic or core structure that is protected by lines of resistance Line of resistance- series of broken rings surrounding the basic core structure - represent the resource factors that help the client defend against a stressor such as the body’s immune system Normal Line of defense- model’s outer solid circle - represent a stability state for the individual or system Flexible Line of defense- model’s outer broken ring; dynamic and can be rapidly altered over a short time Stressors - Tension-producing stimuli that have the potential to disrupt system stability. Intrapersonal forces occurring within the individual, such as conditional responses Interpersonal forces occurring between one or more individuals, such as role expectations. Extrapersonal forces occurring outside the individual, such as financial circumstances. Prevention as Intervention 1. Primary prevention - Health Promotion and Disease Prevention 2. Secondary prevention - Early detection and prompt treatment 3. Tertiary prevention - Rehabilitation Entropy - A process of energy depletion and disorganization moving the system toward illness or possible death. Negentropy - A process of energy conservation that increases organization and complexity, moving the system toward stability or a higher degree of wellness Reconstitution - Occurs following treatment of stressor reactions. Represent return of system to stability, which may be at a higher or lower level of wellness than prior to stressor invasion. * Abraham Harold Maslow Maslow’s Hierarchy of needs - theory of motivation which states that five categories of human needs dictate an individual’s behavior. * Jean Watson Theory of Transpersonal Nursing - theory of human caring and nursing - CARING is the essense of nursing Transpersonal- describe an intersubjective, human to human relationship that encompasses two individuals, both the nurse and the patient in a guven moment Ten Carative Factors 1. Formation of a humanistic-altruistic system of values. 2. Installation of faith-hope. 3. Cultivation of sensitivity to self and to others. 4. Development of a helping-trust relationship. 5. Promotion and acceptance of the expression of positive and negative feelings. 6. Systematic use of the scientific problem-solving method for decision making. 7. Promotion of transpersonal teaching-learning. 8. Provision for supportive, protective, and corrective mental, physical, sociocultural, and spiritual environment. 9. Assistance with gratification of basic human needs. 10. Allowance for existential-phenomenological forces. ASSUMPTIONS - Caring can be effectively demonstrated and practiced only interpersonally. - Caring consists of carative factors that result in the satisfaction of certain human needs. - Effective caring promotes health and individual or family growth. - Caring responses accept a person not only as he or she is now but as what he or she may become. - A caring environment is one that offers the development of potential while allowing the person to choose the best action for himself or herself at a given point in time. - Caring is more "healthogenic" than is curing. The practice of caring integrates biophysical knowledge with knowledge of human behavior to generate or promote health and to provide ministrations to those who are ill. A science of caring is therefore complementary to the science of curing. - The practice of caring is central to nursing. (Watson, 1979) CLASSIFICATION OF NURSING THEORIES Classification- theories are classified depending on their >function > level of abstraction, or > goal orientation - Descriptive: identify the properties and working of a discipline - Explanatory: examine how properties relate and thus affect the disciple - Predictive: calculate relationships between properties and how they occur - Prescriptive: to identify under which conditions relationships occur  PHARMACOLOGY Pharmacology- study of drugs, their origin, nature, properties and their effects upon living organism Pharmacotheraphy- use of drugs to prevent, disgnose, or treat sogns, symptoms snd disease process Pharmacodynamics- what the drug does to the body - involves drug actions on target cells Pharmacokinetics- what the body does to the drug - involves drug movement through the body to reach sites of action, metabolism and excretion MEDICATION ADMINISTRATION 6 Rights of Medication Administration - Medication - Patient - Route - Dosage - Time - Documentation Routes of Administration 1.) Enteral or oral (most common) - ingested into gi tract - per orem - safest, most accessible - slowest absorption, most comfortable Position: upright position (90 degree) Rationale: prevent aspiration Liquid or Solid Enteric coated: don’t crash or don’t chew 2.) Parenteral - injected into blood or body tissues - invasive and fastest procedure - most dangerous and painful needles: universal precaution 1.) Hand washing 2.) Never recap needles after used 3.) Dispose to sharp container Needles and gauges ID SC IM Length 3/8 - 5/8 5/8 - 1/2 1/2 - 1 1/2 C= 24 - 25 Gauge 26 - 27 25 - 26 A= 23 - 24 Angle 15 45 90 3.) Topical (transdermal) - absorbed across skin or mucous membrane - is a medicated adhesive patch that is placed on skin to deliver a specific dose of medication through skin and into blood stream 4.) Inhalation - inhaled directly into lung to elicit local effects 5.) Rectal and vaginal suppository - inserted for local effect 6.) Otic: Ears Position: Side lying Age of pt: 3y/o and above (up and back) below 3 y/o (down and back) Rationale: to straighten the ear canal Solution: warm—>immerse the canister into warm water Rationale: to prevent discomfort Direction: Side of the ear canal Rationale: to prevent hearing loss Technique: Clean procedure 7.) Optic: Eyes Position: Neck hyperextended or look up 2 types of meds 1. Liquid: drops - direction: lower and outer of the conjunctiva 2. Solid: ointment - direction: inner to outer of cantus First Pass Effect/ first pass metabolism - occurs whenever the drug is administered orally, enters the liver, and suffers extensive biotransformation to such an extent that the bioavailability is drastically reduced Heavy first pass effect: - drug taken orally results in very little of the drug reaching systemic circulation Bioavailability - is the fraction or % of a drug that reaches systemic circulation ANTIEMETIC AND PROKINETIC DRUGS Vomiting (Emesis) is the forceful expulsion of contents of the stomach and often, the proximal small intestine Emetic- these are drugs used to evoke vomiting Indications: - poisoning - acute cases of poisoning (except in corrosive substances poisoning or if patient is not fully conscious) - alcoholic intoxication Antiemetic drugs- medicines that ease nausea or vomiting. A person might use an over-the-counter or prescription version to help with symptoms of nausea. Side Effects: - constipation or diarrhea - headache - fatigue - malaise - dizziness - light-headedness - blurred vision - dry mouth - photo sensivity Patient teaching 1. Antihistamine or Antimuscarinics - Do not exceed recommended dosage. - Be advised that drowsiness may occur. - Avoid alcohol, sedatives, and tranquilizers, which may increase drowsiness. - Avoid alcoholic drinks. - Be careful when driving a motor vehicle or operating machinery 2. Dopamine Receptor Antagonists - They should avoid alcohol and other CNS depressants. Clients may experience increased photosensitivity and extreme temperatures should be avoided. Clients should be advised that urine may turn pinkish to reddish-brown. 3. 5- HT3 Receptor Antagonists/ Seratonin Antagonists - Teach clients to immediately inform their healthcare provider if they experience a change in heart rate, lightheadedness, or feel faint or have any signs and symptoms of hypersensitivity reactions such as fever, chills, rash, or breathing problems 4. Nuerokinin 1 (NK-1) Receptor Antagonist - Teach clients taking warfarin that they will need to monitor their INR levels more closely, which may require adjustment of the warfarin dosage while taking aprepitant. Teach clients using an oral contraceptive to use backup birth control. ANTITUSSIVE WITH CODEINE Antitussive Agents - are drugs that suppress coughing, possibly by reducing the activity of the cough center in the brain - it used to relieve dry cough 2 types - Centrally acting antitussives: Narcotics (codeine, hydrocodone) : Non- narcotics Opioid derevativs (dextromethorphan) - Long acting agents : demulsent throat lozenges, steam enhalent) Codeine - is an opioid (methylmorphine) with relatively limited analgesic effect; it does not cause significant respiratory depressions but has good antitussive properties - raises stimulus threshold of the cough center and thus has a cough suppressing effect - in most humans 10% of a codeine dose is transformed to morphine through demethylation in the liver. This explains the analgesic effect that is absent in individuals with the respective genetic traits Mechanism of Action - Codeine works by binding to opioid receptors in the brain and spinal cord. This binding reduces the transmission of pain signals and suppresses the cough reflex in the brain stem. Guaifenesin is an expectorant that works by thinning and loosening mucus in the airways. Nursing Considerations - With the risk of respiratory depressions associated with this medication, baseline respiratory effort must be assessed. Nurses should monitor for signs of dependence as codeine has the potential for abuse and dependence. - No alcohol use due to CNS depression Side Effects - sedation and drowsiness. It is important to also monitor for respiratory depression, blurred vision, dry mouth, urinary retention, nausea, vomiting, and constipation. Health teaching - Clients should take care to avoid irritants that stimulate their cough, such as smoking. Additionally, antitussive medications can cause drowsiness, and clients should avoid taking them with other CNS depressants or alcohol. - Clients should not drive or operate heavy machinery while taking the medication due to the potential for sedation. DIURETICS - used to decrease blood pressure and to decrease symptoms of fluid overload such as edema - Douretics cause diuresis (increased urine flow) by inhibiting sodium and water reabsorption from the kidney tubules Types of Diuretics - loop diuretics - thiazide - potassium- sparing diuretics - osmotic diuretics Loop Diuretics (Furosemide) - Loop diuretics inhibit sodium (Na) and chloride (Cl) reabsorption through direct action primarily in the ascending loop of Henle but also in the proximal and distal tubules. Thiazide diuretics act primarily on the distal convoluted tubule, inhibiting Na and Cl reabsorption. Uses: - To treat edema that involves fluid volume excess resulting from a number of disorders of the heart, liver, or kidney - Hypertension Nursing Considerations 1. Monitor for adequate intake and output and potassium loss. 2. Monitor patient’s weight and vital signs. 3. Monitor for signs and symptoms of hearing loss, which may last from 1 to 24 hours. 4. Teach patient to take medication early in the day to decrease nocturia. 5. Teach patient to report any hearing loss or signs of gout. 6. Monitor electrolytes (potassium) 7. Assess renal function Side Effects - Dehydration, hyponatremia, hypochloremia, hypokalemia - Unusual tiredness, weakness, dizziness - Irregular heartbeat, weak pulse, orthostatic hypotension - Tinnitus, hyperglycemia, hyperuricemia, hearing loss (Lasix) Health teaching - Advise clients to change position slowly as they may experience orthostatic changes. - Clients should also report weight gain of more than three pounds in a day to their health care provider. - Clients should also be encouraged to enjoy potassium-rich foods during loop diuretic drug therapy. SPIRONOLACTONE (Aldactone) - Blocks the action of aldosterone in the distal nephron, which leads to retention of potassium and increased excretion of sodium. Effects of spironolactone are delayed, taking up to 48 hours to develop, so action is not immediate. Classification: Potassium sparing diuretics Uses: - Treats hypertension and edema - Reduces edema in patients with severe heart failure - Primary hyperaldosteronism, premenstrual syndrome, polycystic ovary syndrome, acne in young women Side Effects - Hyperkalemia - Weakness, gastrointestinal (GI) disturbances, and leg cramps - Dehydration - Endocrine effects: hirsutism, menstrual irregularities, gynecomastia, impotence, deepening of voice Nursing Considerations 1. Monitor intake and output, and watch for cardiac dysrhythmias. 2. Monitor levels of electrolytes (e.g., potassium, sodium); do not administer with potassium supplements or salt substitutes containing potassium chloride. 3. Teach patient to report leg cramps, weakness, fatigue, or nausea. 4. Teach patient to restrict intake of potassium-rich foods (e.g., nuts, dried fruits, spinach, citrus fruits, potatoes, bananas). 5. Teach patient to take medication with or after meals if GI upset occurs. 6. Have patient notify health care provider if menstrual irregularities, gynecomastia, or impotence occurs. Health teaching - Clients should be instructed to take these medications at the same time each day and notify their health care provider if they experience significant changes in weight. - Diuretics may cause orthostatic changes so individuals should change positions slowly. - Clients should be advised to avoid salt substitutes and foods that contain high levels of potassium. WARFARIN SODIUM (COUMADIN) - Warfarin is an oral anticoagulant that antagonizes vitamin K, which is necessary for the synthesis of clotting factors VII, IX, X, and prothrombin. As a result, it disrupts the coagulation cascade. Uses - Long-term prophylaxis of thrombosis; is not useful in emergency because of delayed onset of action - Prevents venous thrombosis and thromboembolism associated with atrial fibrillation and prosthetic heart valves - Decreases risk of recurrent transient ischemic attacks (TIAs) and recurrent myocardial infarction Side Effects - Spontaneous bleeding - Hypersensitivity reactions (e.g., dermatitis, fever, pruritus, urticaria) - Red-orange discoloration of urine (not to be confused with hematuria); weakening of bones with long-term use leading to risk of fractures Nursing Considerations 1. Monitor prothrombin time (PT) and international normalized ratio (INR) as ordered (2 to 3 is usually an acceptable INR for anticoagulation). 2. Interacts with a large number of medications; consequently, evaluate medications for interactions before initiating therapy. 3. Monitor for bleeding tendencies; vitamin K is an antidote. 4. Teach patient to maintain intake of vitamin K (keep constant intake of foods such as green, leafy vegetables, mayonnaise, and canola oil) and do not abruptly increase or decrease intake. 5. Patient must advise all health care providers if patient is taking warfarin, because it is very slow to be excreted from the body. 6. Teach patient to wear a medical alert bracelet. Health Teaching - Avoid alcohol, cranberries, and grapefruit as they increase the effect of warfarin and the risk for bleeding. - Strictly adhere to the prescribed dosage schedule. - Follow INR monitoring guidelines as provided by the provider. - Avoid any activity or sport that may result in traumatic injury. - Tell their provider if they experience frequent falls because warfarin can increase their risk for bleeding in the brain. - Eat a normal, balanced diet to maintain a consistent intake of vitamin K (such as green, leafy vegetables). - Tell all health care professionals and dentists that they are taking warfarin, especially before surgery or dental procedures. - Use electric razors instead of straight razors. - Carry identification stating that they are taking warfarin. DIGOXIN - Digoxin is a cardiac glycoside medication that has been used for centuries to treat heart failure. - three effects on heart muscle: positive inotropic action (increases contractility, stroke volume and, thus, cardiac output) negative chronotropic action (decreases heart rate) negative dromotropic action (decreases conduction of cardiac cells) - Digoxin works by inhibiting the sodium and potassium pump, which results in an increase in intracellular sodium and an influx of calcium into cardiac cells, causing the cardiac muscle fibers to contract more efficiently and increase cardiac output. Uses - Heart failure—to improve cardiac output - Atrial fibrillation and flutter Side Effects (cause of digoxin toxicity) - Dizziness, headache, malaise, fatigue - Nausea, vomiting, visual disturbances (blurred or yellow vision; halos around dark objects), anorexia—frequently foreshadow serious toxicity - Hypokalemia (most common reason for digoxin-related dysrhythmias is diuretic-induced - hypokalemia), dysrhythmias, bradycardia Nursing Considerations 1. Monitor digoxin serum levels; check for toxicity (2 ng/mL is considered toxic). Digoxin has a narrow therapeutic range. 2. Monitor pulse, and teach patients to take their pulse. Report a pulse rate less than 60 or greater than 100 beats/ min for adults and rates less than 100 beats/min for pediatric patients: hold the dose and notify a primary health care provider. 3. Administer intravenous (IV) doses slowly over 5 minutes. 4. Teach patients to not double up with missed doses. 5. Teach patients to recognize early signs of hypokalemia (muscle weakness) and digitalis toxicity (nausea, vomiting, anorexia, diarrhea, blurred or yellow visual disturbances, halos around dark objects), and notify health care provider. Health teaching - The client should be instructed to follow the prescribed dosing regimen and take medications at the same time each day. - The client should be cautious not to double up on medication doses. - Additionally, the client should consult the health care provider if two or more doses of medication are missed for follow-up instruction. - Clients should receive health teaching regarding pulse rate monitoring and report any pulse rate less than 60. - If the client experiences signs of digoxin toxicity, this should be reported to the provider immediately. - The medication should be stored in its original container, and care should be taken not to mix the medication with other medications. METFORMIN (GLUCOPHAGE) - Lowers blood glucose and improves glucose tolerance by inhibiting glucose production in the liver, reducing (slightly) glucose absorption in the gut, and sensitizing insulin receptors at sites in fat and skeletal muscle Classification: oral Antidiabetic (high alert) Uses - Lowers blood glucose level in patients with type 2 diabetes - May be used for blood glucose level control in patients with gestational diabetes - Off-label use—polycystic ovary syndrome (PCOS) Side Effects - Decreased appetite, nausea, diarrhea - Decreases absorption of vitamin B12 and folic acid Nursing Considerations 1. Monitor serum glucose and HbA1c levels. 2. Assess effectiveness of blood glucose level control when used with other oral hypoglycemics (sulfonylureas). 3. Teach patient to: Avoid alcohol. Take medication as scheduled (do not skip or add doses; do not stop taking medication). Maintain dietary restrictions for glucose control. 4. Teach patient the signs of lactic acidosis: hyperventilation, muscle aches, extreme fatigue. 5. Encourage increase in vitamin B12 and folic acid in diet. Health teaching - Take with meals to avoid gastrointestinal problems. - Notify health care staff of lactic acidosis symptoms, including hyperventilation, fatigue and myalgia. - Must be taken daily and not discontinued abruptly - The patient must inform the prescriber if they have any long- term liver or kidney problems, heart failure, or if they are a heavy drinker or taking any other medication. CORTICOSTEROIDS - Corticosteroids can be prescribed in a variety of routes - Prednisone is an example of a commonly used oral corticosteroid PREDNISONE - prevents the release of substances in the body that cause inflammation. It also suppresses the immune system. Side Effects - Fluid retention, edema, and hypertension - Electrolytes: ↑Na, ↓K+, ↑Ca, and ↑BG - Mood swings and insomnia in high doses - Nausea, vomiting, and GI bleed - Bone resorption - Acne, paper thin, bruises, infections, and delayed healing - Increased appetite and weight gain - Adrenal suppression - Increased risk for infection, and infections can be masked - Long-term use may result in Cushing’s syndrome Nursing consideration 1. Do not use if signs of a systemic infection 2. When using more than 10 days, the dose must be slowly tapered 3. May increase blood glucose levels Health teaching - Advise clients that corticosteroids are not used to treat an acute asthma attack. - They can cause immunosuppression, suppress signs of infection, and cause an increase in blood glucose levels. - Clients may experience weight gain, swelling, increased fatigue, bruising, and behavioral changes. These occurrences should be reported to one’s health care provider PROTON PUMP INHIBITORS Examples Omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), pantoprazole (Protonix). Note the “prazole” ending in all the generic names. - Suppress the secretion of gastric acid by combining with an enzyme on the gastric parietal cells; block the final common pathway for gastric acid formation; decrease hydrogen ion transport into the gastric lumen. 1.) Omprazole - treats conditions that cause too much stomach acid like heartburn, stomach ulcers and reflux disease. It works by reducing the amount of acid in your stomach. It can take several days before your stomach pain gets better after taking this medication. 2.) Esomeprazole - treats heartburn, stomach ulcers, reflux disease, or other conditions that cause too much stomach acid. It works by reducing the amount of acid in the stomach 3.) Lansoprazole - reduces the amount of acid in your stomach. It treats heartburn, stomach ulcers, reflux disease or other conditions that cause too much stomach acid. Side Effects - Headache, diarrhea, nausea and vomiting - Long-term therapy: pneumonia, fractures, rebound acid hypersecretion, hypomagnesemia, vitamin B12 deficiency Nursing Implications 1. Instruct patient to avoid opening, chewing, or crushing capsules. 2. Instruct patient to return for follow-up if symptoms are unresolved after 4 to 8 weeks of therapy. 3. Teach patient to take medication before meals. 4. Encourage patient to maintain adequate intake of calcium and vitamin D. 5. Teach patient to report any symptoms of hypomagnesemia (tremor, muscle cramps, seizures, dysrhythmias). Health teaching - Do not chew, cut, or crush. - Antacids may be taken with esomeprazole if needed. - Esomeprazole should not be used for immediate relief of heartburn. It may take 1 to 4 days for the medicine to fully work. - If you are having difficulty swallowing the esomeprazole capsule, you may open them and sprinkle the contents on 1 tablespoon of applesauce. Swallow the applesauce right away. Don’t mix the contents with any other food. HISTAMINE 2 RECEPTOR ANTAGONIST (H2RA) - H2-receptor antagonists (H2RA) inhibit histamine action on H2-receptors, which are found on the gastric parietal cells. This action reduces the secretion of gastric acid, as well as hydrogen ion concentration. - Types Cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), nizatidine (Axid). Note the “tidine” ending in all the generic names. Uses - Prevention and treatment of gastric and duodenal ulcers - Heartburn, acid indigestion, and gastroesophageal reflux disease Side Effects - Diarrhea, constipation - Older adults: confusion, agitation - Decrease in stomach acid may increase growth of Candida and bacteria in stomach, resulting in increased risk for pneumonia - Cimetidine: May bind with androgens to cause gynecomastia and impotence; effects reverse after medication is withdrawn; when given IV bolus may cause hypotension and dysrhythmias Nursing Implications 1. Oral medications may be taken without regard to meals. 2. At least 1 hour should separate the administration of antacids and cimetidine. 3. Teach patient to avoid alcohol. 4. Smoking may decrease effectiveness. 5. Teach patient the signs of gastric bleeding (black tarry stools, “coffee-grounds” vomitus) and to notify health care provider if any occur. 6. Teach patient to notify health care provider for any indication of respiratory problems. 7. Teach patient that 5 to 6 small meals a day may be preferable to 3 large meals a day. CEFTRIAXONE - treats infections caused by bacteria. It belongs to a group of medications called cephalosporin antibiotics. It will not treat colds, the flu, or infections caused by viruses. - Each generation has increasing bactericidal activity to break down gram-negative bacteria and anaerobes, as well as to reach the cerebrospinal fluid. Cephalosporins interfere with bacterial cell wall synthesis and are considered broad-spectrum. The cell weakens, swells, bursts, and dies as a result of increased osmotic pressure inside the cell. Increased cephalosporin resistance is caused by production of beta-lactamases Uses - Gram-negative and gram-positive bacterial infections; is not active against viral or fungal infections Side Effects - Hypersensitivity reactions: rash, pruritus, fever. - Anorexia, nausea, flatulence, vomiting, diarrhea. - Can promote a Clostridium difficile infection. - Severe immediate anaphylactic reactions are rare. - Ceftriaxone and cefotetan may cause bleeding tendencies. - Taking cefotetan or cefazolin and drinking alcohol may cause a serious disulfiram-like reation Nursing Considerations 1. Evaluate intramuscular (IM) and intravenous (IV) sites for reaction, such as abscess and thrombophlebitis. 2. Minimize complication of thrombophlebitis by rotating injection sites and slowly injecting in a dilute solution. 3. IM injections are frequently painful; forewarn patient. 4. Do not reconstitute ceftriaxone with any calcium diluents (Ringer solution). 5. Notify health care provider (HCP) if diarrhea occurs—can promote development of Clostridium difficile infection. 6. Monitor renal and hepatic studies throughout therapy. 7. With medications that cause bleeding tendencies, monitor for bleeding. 8. If GI upset occurs, patient can take medication with food. 9. Teach patient to refrigerate oral suspensions. 10. Instruct patient to report any signs of allergy (e.g., skin rash, itching, hives). Health teaching - This medication is injected into a vein or into a muscle. It is usually given by a health care provider in a hospital or clinic setting. It may also be given at home. - Talk to your care team about the use of this medication in children. While it may be prescribed for children as young as newborns for selected conditions, precautions do apply. - Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once. - If you have diabetes, you may get a false-positive result for sugar in your urine. INSULIN - used to control glucose in patients with diabetes mellitus. It is the only parenteral antidiabetic agent available for exogenous replacement of low levels of insulin. Uses: - Treatment of type 1 diabetes - Treatment of type 2 diabetes when other agents have failed - Short-term treatment of type 2 diabetes during periods of stress - Management of diabetic ketoacidosis, hyperkalemia, and marked insulin resistance Adverse Effect - hypoglycemia and ketoacidosis - local reactions at the injection site (lipodystrophy Nursing Considerations 1. U100 insulin is the most common concentration. 2. NPH is the only cloudy insulin; roll vial gently between palms to mix. 3. Draw up clear (regular, lispro, aspart, and glulisine—short acting) before the cloudy (intermediate, NPH) insulin to prevent contaminating a short-acting insulin with a long- acting insulin. 4. Inject subcutaneously; aspiration is not necessary. 5. Avoid massaging the site after injection. 6. Rotate sites within anatomic area; the abdomen is preferred for more rapid, even absorption. 7. Only NPH (Humulin) can be mixed with short-acting insulins. 8. Only the short-acting insulins may be administered intravenously (IV). 9. Hypoglycemia is the primary drawback in maintaining tight control of glucose level. 10. Store unopened vials of insulin in the refrigerator; vial currently in use should be stored at room temperature for 1 month. 11. Prefilled syringes should be stored vertically with the needle pointing up to avoid clogging the needle; gently agitate the syringe to resuspend the insulin before use. May be stored in refrigerator for at least 1 week, perhaps 2 weeks. Health teaching - Ensure that patient has dietary and exercise regimen and using good hygiene practices to improve the effectiveness of the insulin and decrease adverse effects of the disease. - Monitor nutritional status to provide nutritional consultation as needed. - Gently rotate the vial containing the agent and avoid vigorous shaking to ensure uniform suspension of insulin. - Rotate injection sites to avoid damage to muscles and to prevent subcutaneous atrophy. - Store insulin in a cool place away from direct sunlight to ensure effectiveness. Predrawn syringes are stable for 1 week if refrigerated. - Provide good skin care and foot care, to prevent the development of serious infections and changes in therapeutic insulin doses. CALCIUM CHANNEL BLOCKERS (Class IV antiarrhythmics) - verapamil, diltiazem - Block calcium access to the cells, causing decreased heart contractility and conductivity and leading to a decreased demand for oxygen; promote vasodilation. Class IV antiarrythmics - depress action potential generation and slows down phases 1 and 2 of action potential. This action slows down both conduction and automaticity. Uses - Angina, hypertension, and dysrhythmias (verapamil and diltiazem) Side Effects - Decreased blood pressure, edema of the extremities, headache - Constipation (verapamil), nausea, skin flushing, dysrhythmias Nursing Implications 1. Administer before meals; may be taken with food if needed; do not crush or allow patient to chew sustained-release medication preparations. 2. Monitor vital signs and watch for low blood pressure. 3. Teach about postural hypotension and to notify health care provider of signs of edema (swelling in ankles or feet). 4. Check liver and renal function studies. 5. Weigh patient; report any peripheral edema or weight gain. 6. Teach patient to avoid grapefruit juice. 7. Teach patient that constipation can be minimized by increasing dietary fiber and fluid. 8. Teach patients to notify health care provider of symptoms of slow heartbeat, shortness of breath, or weight gain. CALCIUM GLUCONATE - used to prevent or treat low blood calcium levels in people who do not get enough calcium from their diets. - It may be used to treat conditions caused by low calcium levels such as bone loss (osteoporosis), weak bones (osteomalacia/rickets), decreased activity of the parathyroid gland (hypoparathyroidism), and a certain muscle disease (latent tetany). Side Effect - warmth, tingling, or a heavy feeling; - a chalky taste in your mouth; - upset stomach, gas; or - constipation. (Call a doctor) - signs of an allergic reaction to calcium gluconate: hives - difficulty breathing; swelling of your face, lips, tongue, or throat. - little or no urinating; - swelling, rapid weight gain; - a light-headed feeling, like you might pass out; - slow or irregular heartbeats; or - high levels of calcium in your blood--nausea, vomiting, constipation, increased thirst or urination, muscle weakness, bone pain, confusion, lack of energy, or feeling tired. Nursing Consideration 1. Use all the calcium product with extreme caution in digitalised patient and patient with sacroidosis and renal or cardiac diseases. 2. Double checked that you are giving the correct form of calcium resuscitation are ay contain both calcium gluconate and calcium chloride. 3. Monitor calcium level frequently. Maintain calcium level of 9 - 10.4 mg/dl. 4. Sign, confusio elt sevee hy ercalcemia may enclude 5. Dont confuse calcium with calcitriole, calcium gluconate with calcium glubionate, calcium chloride with calcium gluconate. Health teaching - Tell the patient to take oral calcium 1-11/2 hour after meal if GI upset occur. - Tell the patient to take oral calcium with a full glass of water. - Tell the patient to report anorexia nausea vomiting, constipation, abdominal pain, dry mouth, thirst or polyurea. - Warn the patient that in the meal before she takes calcium. She should not have spinch hole grains cereals or dry product these food may interfere with calcium absorption. CEPHALOSPORIN - Each generation has increasing bactericidal activity to break down gram-negative bacteria and anaerobes, as well as to reach the cerebrospinal fluid. Cephalosporins interfere with bacterial cell wall synthesis and are considered broad-spectrum. The cell weakens, swells, bursts, and dies as a result of increased osmotic pressure inside the cell. Increased cephalosporin resistance is caused by production of beta-lactamases. Uses - Gram-negative and gram-positive bacterial infections; is not active against viral or fungal infections Side Effects (Very Similar to Penicillin) - Hypersensitivity reactions: rash, pruritus, fever. - Anorexia, nausea, flatulence, vomiting, diarrhea. - Can promote a Clostridium difficile infection. - Severe immediate anaphylactic reactions are rare. - Ceftriaxone and cefotetan may cause bleeding tendencies. - Taking cefotetan or cefazolin and drinking alcohol may cause a serious disulfiram-like reaction. Nursing Implications 1. Evaluate intramuscular (IM) and intravenous (IV) sites for reaction, such as abscess and thrombophlebitis. Minimize complication of thrombophlebitis by rotating injection sites and slowly injecting in a dilute solution. 2. IM injections are frequently painful; forewarn patient. 3. Do not reconstitute ceftriaxone with any calcium diluents (Ringer solution). 4. Notify health care provider (HCP) if diarrhea occurs—can promote development of Clostridium difficile infection. 5. Monitor renal and hepatic studies throughout therapy. 6. With medications that cause bleeding tendencies, monitor for bleeding. 7. If GI upset occurs, patient can take medication with food. 8. Teach patient to refrigerate oral suspensions. 9. Instruct patient to report any signs of allergy (e.g., skin rash, itching, hives). Health teaching - Clients who are prescribed cephalosporins should be specifically cautioned about a disulfiram reaction, which can occur when alcohol is ingested while taking the medication. - Additionally, individuals should be instructed to monitor for rash and signs of superinfection (such as black, furry overgrowth on tongue; vaginal itching or discharge; loose or foul-smelling stool) and report to the prescribing provider. - It is also important to note that cephalosporin can enter breastmilk and may alter bowel flora of the infant. Thus, use during breastfeeding is often discouraged. IV FLUID COMPUTATION Good luck guys! Kaya naten to! PAPASA TAYO IN GOD’S WILL