Category Archives: NCLEX Pharmacology
March 16, NCLEX Review: Pharmacology Cardiovascular, Endocrine
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NCLEX Pharmacology
A Quick Review on Pharmacology
♣ Show Notes:
NCLEX Review on Pharmacology
The fact is that pharmacology will always be a big part in your NCLEX Exam, and can be a huge catalyst in whether you pass or fail your NCLEX Exam. It is quite important for us to focus a lot on the content that pertains to medications, if we are reviewing for the NCLEX. The NCSBN (who is responsible for developing the NCLEX Exam) defines the category of Pharmacological and Parenteral Therapies as a sub-category within the Physiological Integrity area (of the exam) in which the nurse is basically providing care related to the administration of medications and parenteral therapies.
To be more specific, Pharmacological and Parenteral Therapy has contents that includes but is not limited to:
- Adverse Effects/Contraindications/Side Effects/Interactions
- Expected Actions/Outcomes
- Medication Administration
- Blood and Blood Products
- Parenteral/Intravenous Therapies
- Central Venous Access Devices
- Pharmacological Pain Management
- Dosage Calculation
First, I want to take a step back and look at Pharmacology from a technical sense and look at it more in depth.
What is Pharmacology?
♠ PHARMACOLOGY
Pharmacokinetics– The study if how drugs are being absorbed, distribuited, metabolized and excreted by the body.
Pharmacodynamics– is the study of how drugs are being used by the body.
Pharmacotherapeutics– the study of how the client responds to the particular drugs.
What’s in a drug name?
Chemical Name:
This tells you the chemical makeup of the drug.
Generic Name
This name is given by the company that developed the drug.
Trade Name
This is the name given to the drug by the company in which the medication originated.
The Seven Rights of Administering Drugs
- Right Client
- Right Route
- Right Drug
- Right Dose
- Right Amount
- Right Time
- Right Documentation
- Right to refuse treatment
Any drug can have a CHEMICAL NAME, A GENERIC NAME AND A BRAND OR TRADE NAME.
- The generic name of a drug is suggested by the manufacturer, and accepted by the international committee.
- How the drug is being affected affects the body and the patient’s response is called the effect.
- Efficacy refers to the degree to which a drug is able to induce it’s maximal effects.
- Adverse Effect is any unexpected or unintended response to a therapeutic use of a drug, it is also called side effect.
During this review, I want to focus specifically towards the drugs that is mostly in patients with hypertension.
DRUGS USED WITHIN THE CARDIAC SYSTEM
Cardiac Pharmacology
♣ Pharmacology Drugs for Hypertension:
DIURETICS
- – Helps get rid of the sodium and fluid in the body.
- – Used to lower the blood pressure.
– Promotes the excretion of sodium and water
– Diuretics interferes with the sodium absorption in the kidney.
– Increases the urine output. Decreases the preload and afterload..
If the patients blood pressure drop to low, it is important to give IV fluids to pt.
LETS GO OVER THE CATEGORIES OF DIURETICS ♠
♦ TYPES OF DIURETICS
♣ POTTASIUM SPARING DIURETICS
It promotes the excretion of soduium and water, while the retention of pottasium
Used for:
- Hypertension
- Edema
- Hyperaldosteronism
- Hypokalemia
Medication:
- SPIRONOLACTON (ALDACTONE)
- AMILORIDE (MIDAMOR)
- TRIAMTERENE
Now lets go to the side effects:
First, of course the person can have too much potassium or HYPERKALEMIA:
Signs of HYPERKALEMIA
- irregular heartbeat
- nervousness
- tingling in hands and feet
- shortness of breath
- tiredness or weakness
OTHER SIDE EFFECTS:
- Nausea and vomiting
- Cramping and diarrhea
- Dizziness & headache
◊
Loop Diuretics
- BUMETANIDE (BUMEX)
- FUROSEMIDE (LASIX)
◊
Osmotic Diuretics
MANNITOL
- Thizade Diuretics
HYDROCHLOROTHIAZIDE (HYDRODIURIL)
CHLOROTHIAZIDE (DIURIL)
CAUSES THE DEPLETION OF SODIUM AND WATER.
♣ CAN INDUCE HYPERGLYCEMIA
Very Important for the NCLEX:
◊ SIDE EFFECTS OF DIURETICS
- Frequent urination
- Electrolyte abnormalitie
- Muscle cramps or weakness
- Blurred vision
- confusion
- headache
- increased perspiration (sweating)
- restlessness
BETA (ADRENERGIC) BLOCKERS
– Helps lower blood pressure, puls rate and cardiac output.
– Can be used to treat headaches.
– Can be used to treat glacauma and prevent myocardial infarctions.
– Acts on the system, by blocking the symathetic vasomotor response.
For the NCLEX, try to remember that the syllable for beta blockers is usally (olol).
SIDE EFFECTS:
- Orthostatic hypotension
- bradycardia
- nausea and vomiting
- diarrhea
NOTE: Some of the symptoms may MASK signs of Hypoglycemia
♠ HYPOGLYCEMIC SYMPTOMS
NURSING INTERVENTIONS FOR CLIENTS TAKING BETA BLOCKERS:
Make sure that you monitor the client’s blood pressure, heart rate and rhythm, before administering the beta blocker. Monitor the client for signs of edema. The nurse should also assess the lungs sounds for signs of rales and ronchi. When patient are taking beta blockers, it is also very important to monitor the changes in lab values such as (protein, BUN and creatinine) which can indicate nephrotic syndrome. Nursing teaching for the NCLEX would include: Teaching the Client to rise slowly (ORTHOSTATIC HYPOTENSION) * (A SAFETY ISSUE), report any signs of bradycardia, dizziness, confusion depression or fever. It is also very important to taper off the medication properly.
Cardiac Pharmacology
♣ Calcium Channel Blockers
- – PREVENTS THE MOVEMENT MECHANISM OF CALCIUM WITHIN THE CARDIAC SYSTEM.
- – THEREFORE DECREASING THE CARDIAC WORKLOAD, AND CARDIAC MUSCLE CONTRACTILIY.
- – MEDICATIONS INCLUDE THE “DIPINE” : DILITAZEM (CARDIZEM), AMLOPIDINE (NORVASC), NEFEDIPINE, NICARDIPINE.
- – USED TO TREAT ANGINA.
- Remember:
– Blocks the calcium channels in the heart, causing a decrease in contractility.
Decreases the workload of the heart.
Used for:
Hypertension
Medications:
- Nifedipine (Procardia)
- Amplodipine (Norvasc)
- Do not give Norvasc with grapefruit, causees increase in drug level.
- Verapamil (Isoptin)
- Diltiazem (Cardizem)
SIDE EFFECTS:
Constipation
Nausea
Headache
Rapid heartbeat (tachycardia)
Drowsiness
↓
Remember:
- Make sure to monitor the heart rate and the blood pressure.
- Hold medication if HR is less than 60 or if BP is less than BP.
♠ ACE INHIBITOR
- – ACE INHIBITORS “BLOCKS” THE CONVERSION OF ANGIOTENSIN 1 TO ANGIOTENSIN 2.
- – ALTERS THE “BLOOD PRESSURE” MECHANISM THROUGH THE RENIN-ANGIOTENSIN SYSTEM.
- MEDICATIONS INCLUDES THE “PRIL” : CATOPRIL, ENALAPRIL, LISINOPRIL, RAMIPRIL.
SIDE EFFECTS:
- COUGH
- TACHYCARDIA
- NAUSEA AND VOMITING.
Remember:
GIVE ON AN EMPTY STOMACH OR 2-3 HRS. AFTER A MEAL.
♣
NCLEX Review Pharmacology
Drugs Used for treating Hypertension:
♣ ACE INHIBITORS
♥ BETA BLOCKERS
♦ CALCIUM CHANNEL BLOCKERS
REMEMBER FOR YOUR NCLEX EXAM:
- ACE INHIBITOR
- – ACE INHIBITORS “BLOCKS” THE CONVERSION OF ANGIOTENSIN 1 TO ANGIOTENSIN 2.
- – ALTERS THE “BLOOD PRESSURE” MECHANISM THROUGH THE RENIN-ANGIOTENSIN SYSTEM.
- MEDICATIONS INCLUDES THE “PRIL” : CATOPRIL, ENALAPRIL, LISINOPRIL, RAMIPRIL.
- SIDE EFFECTS: COUGH, TACHYCARDIA, NAUSEA AND VOMITING.
- GIVE ON AN EMPTY STOMACH OR 2-3 HRS. AFTER A MEAL.
- BETA BLOCKERS
- – REDUCES THE CARDIAC OUTPUT AND DECREASES THE SYMPATHETIC NERVOUS SYSTEM RESPONSE.
- – BLOCKS THE BETA RECEPTOR, CAUSING A DECREASE IN BLOOD PRESSURE.
- – MEDICATIONS INCLUDE THE “OLOL’S”: METROPOLOL, PROPANALOL, ACEBUTOLOL, NADOLOL.
- – USED FOR HYPERTENSION, MYOCARDIAL INFARCTION AND ANGINA.
- – ADVERSE EFFECTS CAN INCLUDE: BRADYCARDIA, HYPOTENSION AND HYPOGLYCEMIA (DISTRUPTS THE LIVER’S ABILITY TO CONVERT GLYCOGEN TO GLUCOSE).
- CALCIUM CHANNEL BLOCKERS
- – PREVENTS THE MOVEMENT MECHANISM OF CALCIUM WITHIN THE CARDIAC SYSTEM.
- – THEREFORE DECREASING THE CARDIAC WORKLOAD, AND CARDIAC MUSCLE CONTRACTILIY.
- – MEDICATIONS INCLUDE THE “DIPINE” : DILITAZEM (CARDIZEM), AMLOPIDINE (NORVASC), NEFEDIPINE, NICARDIPINE.
- – USED TO TREAT ANGINA.
CARDIAC GLYCOSIDES
Digoxin
- IS A CARDIAC GLYCOSIDE
- AN ANTIARRYTHMIC
- IT INCREASES CARDIAC OUTPUT
- SLOWS DOWN THE HEART RATE
Watch for Digoxin Toxicity:
Assessment and Signs of Digoxin Toxicity:
- VISION CHANGES (HALO EFFECT)
- NAUSEA AND VOMITING
- BRADYCARDIA AND ANOREXIA
- ANOREXIA
Anticoagulants
Avoid Herbs such as ‘G’ HERBS (GINSING, GINGER, GINKO, GARLIC) when using anticoagulant drugs.
Aspirin
- CAN ALSO BE USED AS A BLOOD THINNER
- IRRITATES THE STOMACH AND INTESTINES
- WATCH OUT FOR “BLACK TARRY” LOOKING STOOLS (COULD BE A SIGN OF INTESTINAL BLEEDING)
- NEVER GIVE YOUR CHILDREN ASPIRIN, CAN CAUS REYE’S SYNDROME.
Heparin:
- MAKE SURE TO CHECK THE PTT
- ANTIDOTE IS PROTAMINE SULFATE
- CAN BE SAFELY GIVEN DURING PREGNANCY.
Coumadin
- CHECK THE PT AND THE INR
- ANTIDOTE IS VITAMIN K
Lovenox
- LOVENOX, ALSO CALLED ENOXAPARIN, IS A FORM OF HEPARIN CALLED FRACTIONATED HEPARIN.
NCLEX Review: Pharmacology Adverse Reactions/ Side Effects
CARDIOVASCULAR DRUGS
ACE Inhibitors
- HYPOTENSION (MOST COMMON)
- COUGH ♣(COMMON NCLEX QUESTION)
- CHECK ELECTROLYTES FOR (HYPERKALEMIA)
Calcium Channel Blocker
- FATIGUE, HEADACHE
- DROWSINESS
- DYSRHYTMIAS
- DO NOT GIVE TO PT’S WITH 2ND OR 3RD DEGREE HEARTBLOCK
Vasodilators
- PALPITATIONS, CRAMPS
- NAUSEA & VOMITING
- BONE MARROW SUPPRESSION
- CONTRAINDICATED IN PT’S W/ CAD
- TAKE W/ FOOD TO DECREASE GI UPSET.
Diuretics
- THIAZIDE
- LOOP
- OSMOTIC
Watch for electrolyte imbalance and dehydration.
Pottasium Sparing Diuretics
- NAUSEA AND VOMITING
- WATCH FOR ELECTROLYTE IMBALANCE SUCH AS
- HYPERKALEMIA AND HYPONATREMIA.
ENDOCRINE SYSTEM PHARMACOLOGY
- PROPYLTHIOURACIL (PTU) : HYPERTHYROID MEDICATION
- FATIGUE, DROWSINESS
- BRADYCARDIA, HEADACHE
Cortisone, Prednisone (Cortisole Replacement)
- WEIGHT GAIN ♣
- DECREASED IMMUNITY ♥
- NAUSEA & VOMITING
Iodine Product (Loguls Solution)
- USED FOR THYROID STORM
- NAUSEA & VOMITING
- BRADYCARDIA, HEADACHE
Levothyroixine (Synthroid) : Hypothyroid Medication
- TACHYCARDIA ♦
- NAUSEA & VOMITING
Glimepride (Amaryl), Glipizide (Glucotrol)
- USED TO TREAT HYPERGLYCEMIA
- BE CAREFUL TO WATCH FOR HYPOGLYCEMIA ♣
ENDOCRINE SYSTEM DRUGS
Corticosteroids (decreases inflammation)
- INCREASED BP
- HYPERGLYCEMIA ♥
- WATCH OUT FOR CUSHING’S SYNDROME
Bronchodilators (relaxed bronchial muscle)
- HEADACHE, TACHYCARDIA
- PALPITATIONS
- NAUSEA AND VOMITING
TUBERCULOSIS DRUGS
Isoniazid (INH)
- B6 DEFICIENCY
- OBSERVE PT. FOR JAUNDICE
Some of the Best Nursing Homes in New York Senior Hug.
March 9, NCLEX Review: Autonomic Nervous System and Pharmacology
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NCLEX Review Shownotes:
Understand that the Nervous system includes the Central Nervous System (CNS), the Peripheral Nervous Sytem (PNS) and the Autonomic Nervous System or the (ANS).
When I say the CENTRAL NERVOUS SYSTEM, We can simplify at as the BRAIN and the SPINAL CORD.
The PERIPHERAL NERVOUS SYSTEM on the other hand, contains the CRANIAL NERVES and the SPINAL NERVES.
- WHEN WE TALK ABOUT THE AUTONOMIC NERVOUS SYTEM, WE ARE BASICALLY TALKING ABOUT THE “SYMPATHETIC” (FIGHT OR FLIGHT) SYSTEM OR THE “PARASYMPATHETIC” SYSTEM.
- .THE BASIC COMPONENT OF THE NERVOUS SYSTEM IS THE NERVE CELL OR NEURON
NEURON
– is the primary component of the nervous system.
– it is composed of cell body (gray matter), axon and dendrites.
BRAIN (Central Nervous System: Brain and Spinal Cord).
CEREBRUM- Outermost area (cerebral cortex) is gray matter, deeper area is composed of white matter
- TWO HEMISPHERES: LEFT AND RIGHT AND EACH HEMISPHERE IS DIVIDED INTO TWO LOBES.
FRONTAL LOBE
- PERSONALITY, BEHAVIOR
- HIGHER INTELLECTUAL FUNCTIONING
- BROCA’S AREA: (MOTOR SPEECH AREA)
PARIETAL LOBE
- POSTCENTRAL GYRUS: REGISTERS SENSATION (TOUCH, PRESSURE)
- INTEGRATES SENSORY INFORMATION
TEMPORAL LOBE
- HEARING, TASTE, SMELL (HINT: LOCATION OF EARS – CLOSE THE TEMPLES)
- WERNICKE’S AREA: SENSORY SPEECH AREA
- (UNDERSTANDING, FORMATION OF LANGUAGE)
OCCIPITAL LOBE
- VISION
Peripheral Nervous System- composed of Spinal Nerves (31)
Autonomic Nervous System- part of the Peripheral Nervous System
- REGULATES FUNCTIONS OCCURRING AUTOMATICALLY IN THE BODY.
- ANS REGULATES SMOOTH MUSCLE, CARDIAC MUSCLE AND GLANDS.
IT IS NOT NECESSARY TO KNOW EVERY PHYSIOLOGY FOR EVERY SINGLE PART OF THE BRAIN. BUT JUST IN CASE WE END UP GETTING LOW LEVEL QUESTIONS ON THE EXAM, THEN IT IS IMPORTANT THAT WE UNDERSTAND THE BASIC CONCEPT AND FUNCTION OF EACH AREA. IT WOULD ALSO BE A GREAT IDEA TO KNOW THE CRANIAL NERVES.
Quick NCLEX Overview:
EYE AND EAR DISORDERS
GLAUCOMA
Glaucoma: there is an increased of intraocular pressure in the eye.
There are two types:
- OPEN ANGLE GLAUCOMA OR “PRIMARY” GLAUCOMA
- PRIMARY ANGLE GLAUCOMA.
Open angle glaucoma is slow in onset and chronic, while the primary angle glaucoma needs immediate treatment.
Open Angle Glaucoma
Bilateral
Acute Angle-closure Glaucoma
Unilateral
TREATMENT
Beta Adrenergic Blockers
Cholinergic Agents (Pilocarpine) ♣ (Make sure to know this for the NCLEX)
AVOID ANTICHOLINERGICS (Atropine)
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March 2, NCLEX Review on Cardiac Diseases: Heart Failure
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NCLEX Review Notes:
NCLEX Review on Cardiac Diseases: Heart Failure
– It is an insufficiency and the inability of the pumping ability of the heart.
LEFT SIDED HEART
– Failure of the left side of the heart to pump enough blood to meet the metabolic demands of the body.
- THERE IS AN IMPAIRED OXYGENATION AND A DECREASE IN MYOCARDIAL WORKLOAD IN THE HEART.
ASSESSMENT FINDINGS in patients with Left Sided heart failure.
- CRACKLES
- DYSPNEA
- GALLOP RHYTHM: S3, S4
NCLEX Review on Heart Failure Cont.
What we would usually find in patient with left sided heart failure is that there is an INCREASE IN PULMONARY CONGESTION and there would be a left ventricular hypertrophy.
MANAGEMENT
- LOW SODIUM DIET
- SEMI FOWLERS POSITION ON PT.
- WEIGHT PATIENT DAILY
- ADMINISTER IV, OXYGEN AND MEDS AS ORDERED.
- MONITOR VITALS, I/O
RIGHT SIDED FAILURE
– Failure of the right side of the heart to pump enough blood to meet the metabolic demands of the body.
Causes:
- LEFT SIDED HEART FAILURE
- COPD
- ATHEROSCLEROSIS
- PULMONARY HYPERTENSION
Assessment:
- JUGULAR VEIN DISTENTION
- DEPENDENT EDEMA
- WEIGHT EDEMA
Diagnostic Procedures:
- B- Type Natriuretic Peptide (BNP) Levels= Elevated
- ABG’s indicates hyposemia and hypercapnia.
- Hemodynamic Monitor= Increase CVP
TREATMENT:
- Oxygen Therapy
- Paracentesis
- Thoracentesis
Drug Therapy:
- Cardiac Glycoside (Digoxin) Lanoxin
- Inotropic Agents (Dopamine, Dobutamine)
- Diuretics: Furosemide (Lasix)
- Human BNP: (Nesiritide (Natrecor)
Interventions:
- Keep Ct. in semi- fowlers position to increase chest expansion
- Assess cardiovascular status and vital signs
- Weigh the client daily: A weight gain of 1 to 2 lbs. indicates fluid gain.
Tags: Heart Failure, how to study NCLEX, NCLEX Cardiac Pharmacology, NCLEX Cardiac System, NCLEX Drugs, NCLEX Pharmacology, nclex review, NCLEX Review on Cardiac Diseases, NCLEX review on delegation, NCLEX review questions, nclex reviews
February 12, NCLEX Review on Neurogical System: ALS
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NCLEX Review: Neurological System
[youtube http://youtu.be/5AHvjKjCJhA w=400&h=300]♠ Show Notes:
Lou Gehrig’s Disease/ Amyothropic Lateral Sclerosis (ALS)
Degeneration of the nerves that controls the voluntary muscles.
ASSESSMENT:
-
Muscle Weakness and Twitching
-
Fatigue
-
dysphagia
-
dysarthia (difficulty swallowing)
-
cramping
– Lowe extremities are usually involved late in the disease.
Treatment:
Riluzole (Rilutek)
Side Effects:
- nausea, stomach pain, low fever, loss of appetite
- dark urine, clay-colored stools, jaundice
- fever, chills, body aches, flu symptoms
Antispasmodics
-
baclofen
-
diazepam
Interventions:
Conserve energy by spacing activities.
Small frequent feedings.
The Nervous System
NCLEX Review on the Neurological System
Time Management:
- Make sure to read and understand the overview of the Nervous System:
- Focus in understanding the causes and logic behind each disease.
- Have an understanding of the signs and symptoms of the disease.
- Know the medications and the rationale behind using those meds.
Understand that the Nervous system includes the Central Nervous System (CNS), the Peripheral Nervous Sytem (PNS) and the Autonomic Nervous System or the (ANS).
When I say the CENTRAL NERVOUS SYSTEM, We can simplify at as the BRAIN and the SPINAL CORD.
The PERIPHERAL NERVOUS SYSTEM on the other hand, contains the Cranial NERVES and the SPINAL NERVES.
- WHEN WE TALK ABOUT THE AUTONOMIC NERVOUS SYSTEM, WE ARE BASICALLY TALKING ABOUT THE “SYMPATHETIC” (FIGHT OR FLIGHT) SYSTEM OR THE “PARASYMPATHETIC” SYSTEM.
- .THE BASIC COMPONENT OF THE NERVOUS SYSTEM IS THE NERVE CELL OR NEURON
NEURON
– is the primary component of the nervous system.
– it is composed of cell body (gray matter), axon and dendrites.
BRAIN (Central Nervous System: Brain and Spinal Cord).
CEREBRUM- Outermost area (cerebral cortex) is gray matter, deeper area is composed of white matter
- TWO HEMISPHERES: LEFT AND RIGHT AND EACH HEMISPHERE IS DIVIDED INTO TWO LOBES.
FRONTAL LOBE
- PERSONALITY, BEHAVIOR
- HIGHER INTELLECTUAL FUNCTIONING
- BROCA’S AREA: (MOTOR SPEECH AREA)
PARIETAL LOBE
- POSTCENTRAL GYRUS: REGISTERS SENSATION (TOUCH, PRESSURE)
- INTEGRATES SENSORY INFORMATION
TEMPORAL LOBE
- HEARING, TASTE, SMELL (hint: location of ears – close the temples)
- WERNICKE’S AREA: SENSORY SPEECH AREA
- (UNDERSTANDING, FORMATION OF LANGUAGE)
OCCIPITAL LOBE
- VISION
Peripheral Nervous System- composed of Spinal Nerves (31)
Autonomic Nervous System- part of the Peripheral Nervous System
- REGULATES FUNCTIONS OCCURRING AUTOMATICALLY IN THE BODY.
- ANS REGULATES SMOOTH MUSCLE, CARDIAC MUSCLE AND GLANDS.
IT IS NOT NECESSARY TO KNOW EVERY PHYSIOLOGY FOR EVERY SINGLE PART OF THE BRAIN. BUT JUST IN CASE WE GO END UP GETTING LOW LEVEL QUESTIONS ON THE EXAM, THEN IT IS IMPORTANT THAT WE UNDERSTAND THE BASIC CONCEPT AND FUNCTION OF EACH AREA. IT WOULD ALSO BE A GREAT IDEA TO KNOW THE CRANIAL NERVES.
The CRANIAL NERVES
INCREASED INTRACRANIAL PRESSURE
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February 8, NCLEX Review on Urinary System: A Closer View
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NCLEX Review of the Urinary System
♠ Show Notes:
An NCLEX Review of the Urinary System: We will go over the major diseases that you most likely encounter in the NCLEX Exam.
The Urinary System
– is a vital system in the body that enables us to produce, store and eliminate urine.
MAINLY COMPOSED OF:
– the Kidneys
– the Prostate
– the Ureters
– the Bladder
– the Urethra
Although it is not necessary to have the physiology of each anatomy committed to your memory, it is very important to understand the concept and function of each.
DIAGNOSTIC TESTS WITH THE URINARY SYSTEM:
URINANALYSIS
Very important to remember these values for the NCLEX.
BUN Level 10-20 mg/dl
Creatinine Level 0.5- 1.5 mg/dl
Calcium 9- 11 mg/ dl
Urine Specific Gravity 1.003- 1.030
ELECTROLYTE IMBALANCE
Hyponatremia (decreased sodium)
Muscle weaknes, Headaches
Fatigue, confusion, vomiting, coma
Hpernatremia (increased sodium)
Tachycardia, dry mucus membrane
decreased urinary output
Hypokalemia (decreased pottasium)
Anorexia, nausea, vomiting
abdominal distention
Hyperkalemia (increased pottasium)
Irritability, nausea and vomiting
diarrhea
Hypokalcemia (decreased calcium)
osteoporosis, fractures, muscle spasms
tetany, n & v, vomiting.
Hypercalcemia (increased calcium)
Renal calculi, coma, arrythmias, decreased reflex
GLOMERULONEPHRITIS/ PYELONEPHRITIS
CHRONIC RENAL FAILURE
STAGES OF CHRONIC RENAL FAILURE
Stage 1 Diminished Renal Reserve
- – renal function is reduced, but no accumulation of metablic wastes occurs.
– the healthier kidney compensates for the diseased kidney
– The ability to concentrate urine is decreased - ♦ Results in nocturia and polyuria
– Stage 2 Renal Insufficiency
- – metabolic waste begin to accumulate in the blood, because affected nephrons can no
longer compensate.
– responsiveness to diuretics is decreased, resulting in Oliguria and edema
Stage 3 End Stage Renal Disease.
- – excessive amount of metabolic wastes such as
urea and creatinine accumulate in the blood.
– kidney is unable to maintain homeostasis
– treatment is by dialysis
Metabolic Changes
– Urea and Creatinine
– Sodium
– Pottasium
– Acid Base Balance
– Calcium and Phosporus
Cardiac Changes
– Hypertension
– Hyperlipidemia
– Heart Failure
– Uremic Pericarditis
INTERVENTIONS
– It is important to monitor renal, respiratory and cardiovascular status and the fluid balance.
REMEMBER FOR NCLEX
– Patient with Chronic Renal Failure would have
- ♣ UREMIA, ANEMIA AND ACIDOSIS
DIALYSIS:
Peritoneal Dialysis:
♣ Complication: can include Peritonitis
Hemodialysis:
♠ Pt. may use external shunt or surgically constructed internal arterivnous fistula (long-term)
Most common cause of renal failure is *poorly controlled diabetes & Hypertension.
Dopamine= can enhance renal perfusion and elevate blood pressure.
♠ Ways to control monitor kidney function:
- Monitor I and O
- Monitor Lab Values
- Specific Gravity
- BUN and Serum
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January 26, NCLEX Pharmacology: Cardiac Pharmacology
NCLEX Pharmacology
A Quick Review on Pharmacology
♣ Show Notes:
NCLEX Review on Pharmacology
The fact is that pharmacology will always be a big part in your NCLEX Exam, and can be a huge catalyst in whether you pass or fail your NCLEX Exam. It is quite important for us to focus a lot on the content that pertains to medications, if we are reviewing for the NCLEX. The NCSBN (who is responsible for developing the NCLEX Exam) defines the category of Pharmacological and Parenteral Therapies as a sub-category within the Physiological Integrity area (of the exam) in which the nurse is basically providing care related to the administration of medications and parenteral therapies.
To be more specific, Pharmacological and Parenteral Therapy has contents that includes but is not limited to:
- Adverse Effects/Contraindications/Side Effects/Interactions
- Expected Actions/Outcomes
- Medication Administration
- Blood and Blood Products
- Parenteral/Intravenous Therapies
- Central Venous Access Devices
- Pharmacological Pain Management
- Dosage Calculation
First, I want to take a step back and look at Pharmacology from a technical sense and look at it more in depth.
What is Pharmacology?
♠ PHARMACOLOGY
Pharmacokinetics– The study if how drugs are being absorbed, distribuited, metabolized and excreted by the body.
Pharmacodynamics– is the study of how drugs are being used by the body.
Pharmacotherapeutics– the study of how the client responds to the particular drugs.
What’s in a drug name?
Chemical Name:
This tells you the chemical makeup of the drug.
Generic Name
This name is given by the company that developed the drug.
Trade Name
This is the name given to the drug by the company in which the medication originated.
The Seven Rights of Administering Drugs
- Right Client
- Right Route
- Right Drug
- Right Dose
- Right Amount
- Right Time
- Right Documentation
- Right to refuse treatment
Any drug can have a CHEMICAL NAME, A GENERIC NAME AND A BRAND OR TRADE NAME.
- The generic name of a drug is suggested by the manufacturer, and accepted by the international committee.
- How the drug is being affected affects the body and the patient’s response is called the effect.
- Efficacy refers to the degree to which a drug is able to induce it’s maximal effects.
- Adverse Effect is any unexpected or unintended response to a therapeutic use of a drug, it is also called side effect.
During this review, I want to focus specifically towards the drugs that is mostly in patients with hypertension.
DRUGS USED WITHIN THE CARDIAC SYSTEM
Cardiac Pharmacology
♣ Pharmacology Drugs for Hypertension:
DIURETICS
- – Helps get rid of the sodium and fluid in the body.
- – Used to lower the blood pressure.
– Promotes the excretion of sodium and water
– Diuretics interferes with the sodium absorption in the kidney.
– Increases the urine output. Decreases the preload and afterload..
If the patients blood pressure drop to low, it is important to give IV fluids to pt.
LETS GO OVER THE CATEGORIES OF DIURETICS ♠
♦ TYPES OF DIURETICS
♣ POTTASIUM SPARING DIURETICS
It promotes the excretion of soduium and water, while the retention of pottasium
Used for:
- Hypertension
- Edema
- Hyperaldosteronism
- Hypokalemia
Medication:
- SPIRONOLACTON (ALDACTONE)
- AMILORIDE (MIDAMOR)
- TRIAMTERENE
Now lets go to the side effects:
First, of course the person can have too much potassium or HYPERKALEMIA:
Signs of HYPERKALEMIA
- irregular heartbeat
- nervousness
- tingling in hands and feet
- shortness of breath
- tiredness or weakness
OTHER SIDE EFFECTS:
- Nausea and vomiting
- Cramping and diarrhea
- Dizziness & headache
◊
Loop Diuretics
- BUMETANIDE (BUMEX)
- FUROSEMIDE (LASIX)
◊
Osmotic Diuretics
MANNITOL
- Thizade Diuretics
HYDROCHLOROTHIAZIDE (HYDRODIURIL)
CHLOROTHIAZIDE (DIURIL)
CAUSES THE DEPLETION OF SODIUM AND WATER.
♣ CAN INDUCE HYPERGLYCEMIA
Very Important for the NCLEX:
◊ SIDE EFFECTS OF DIURETICS
- Frequent urination
- Electrolyte abnormalitie
- Muscle cramps or weakness
- Blurred vision
- confusion
- headache
- increased perspiration (sweating)
- restlessness
BETA (ADRENERGIC) BLOCKERS
– Helps lower blood pressure, puls rate and cardiac output.
– Can be used to treat headaches.
– Can be used to treat glacauma and prevent myocardial infarctions.
– Acts on the system, by blocking the symathetic vasomotor response.
For the NCLEX, try to remember that the syllable for beta blockers is usally (olol).
SIDE EFFECTS:
- Orthostatic hypotension
- bradycardia
- nausea and vomiting
- diarrhea
NOTE: Some of the symptoms may MASK signs of Hypoglycemia
♠ HYPOGLYCEMIC SYMPTOMS
NURSING INTERVENTIONS FOR CLIENTS TAKING BETA BLOCKERS:
Make sure that you monitor the client’s blood pressure, heart rate and rhythm, before administering the beta blocker. Monitor the client for signs of edema. The nurse should also assess the lungs sounds for signs of rales and ronchi. When patient are taking beta blockers, it is also very important to monitor the changes in lab values such as (protein, BUN and creatinine) which can indicate nephrotic syndrome. Nursing teaching for the NCLEX would include: Teaching the Client to rise slowly (ORTHOSTATIC HYPOTENSION) * (A SAFETY ISSUE), report any signs of bradycardia, dizziness, confusion depression or fever. It is also very important to taper off the medication properly.
Cardiac Pharmacology
♣ Calcium Channel Blockers
- – PREVENTS THE MOVEMENT MECHANISM OF CALCIUM WITHIN THE CARDIAC SYSTEM.
- – THEREFORE DECREASING THE CARDIAC WORKLOAD, AND CARDIAC MUSCLE CONTRACTILIY.
- – MEDICATIONS INCLUDE THE “DIPINE” : DILITAZEM (CARDIZEM), AMLOPIDINE (NORVASC), NEFEDIPINE, NICARDIPINE.
- – USED TO TREAT ANGINA.
- Remember:
– Blocks the calcium channels in the heart, causing a decrease in contractility.
Decreases the workload of the heart.
Used for:
Hypertension
Medications:
- Nifedipine (Procardia)
- Amplodipine (Norvasc)
- Do not give Norvasc with grapefruit, causees increase in drug level.
- Verapamil (Isoptin)
- Diltiazem (Cardizem)
SIDE EFFECTS:
Constipation
Nausea
Headache
Rapid heartbeat (tachycardia)
Drowsiness
↓
Remember:
- Make sure to monitor the heart rate and the blood pressure.
- Hold medication if HR is less than 60 or if BP is less than BP.
♠ ACE INHIBITOR
- – ACE INHIBITORS “BLOCKS” THE CONVERSION OF ANGIOTENSIN 1 TO ANGIOTENSIN 2.
- – ALTERS THE “BLOOD PRESSURE” MECHANISM THROUGH THE RENIN-ANGIOTENSIN SYSTEM.
- MEDICATIONS INCLUDES THE “PRIL” : CATOPRIL, ENALAPRIL, LISINOPRIL, RAMIPRIL.
SIDE EFFECTS:
- COUGH
- TACHYCARDIA
- NAUSEA AND VOMITING.
Remember:
GIVE ON AN EMPTY STOMACH OR 2-3 HRS. AFTER A MEAL.
♣
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Tags: Cardiac Medications, Cardiac Pharmacology, NCLEX, NCLEX Pharmacology, Pharmacology
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