Nursing implications/ client teaching

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Digoxin (Lanoxin) N.I.
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apical pulse x60 before admin. <60bpm. Notify physician if less than 60 or irregular rhythm. monitor therapeutic blood level: 0.5 – 2 ng/ ml
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Digoxin (Lanoxin) client teaching
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teach taking radial pulse at same time daily and record. Notify Dr. if irregular or if symptoms of toxicity occur. Avoid giving with meals = absorption delay
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Propranolol (Inderal) n.i.
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apical pulse x60 & no before admin. hold if <60bpm or SBP <90 mm hg.
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Propranolol (Inderal) client teaching
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teach how to take radial pulse and to notify Dr. if <60. take w/ food to facilitate absorption. Ortho hypotension: change position slowly. Do not discontinue abruptly.
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Diltiazem (Cardizem) ni
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BP before admin. withhold sbp <90 or DBP <60 mmhg do not crush. swallow whole
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Diltiazem (Cardizem) client teaching
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take w/meals and at h.s. poss. light headedness & dizziness. change position slowly. Swallow SR or Extended Release (ER) whole. Do not crush, cut or chew
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Lisinopril (Prinivil, Zestril) n.i.
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check bp b4 admin. monitor serum Na+ & K+. Monitor sore throat, fever, swelling of hands or feet, irreg pulse chest pains. Asses for dry cough. Monitor renal function. observe elderly for ortho hypotension. risk for falls
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Lisinopril (Prinivil, Zestril) client teaching
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administer one he ac & at same time each day. instruct ct to report sore throat fever, chills, chest pain or edema. taste sensation may be impaired. change positions slowly. Ortho hypo
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Furosemide (Lasix) n.i.
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monitor f.e. loss. check bp and serum K+ before admin. Monitor daily weight. safety precautions – at risk for falls. keep call light within reach. assist elderly, weak, dizzy or unsteady in walking.
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fursoemide (lasix) client teaching
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encourage potassium rich diet or oral K+ supplements if K+ low. make postiton changes slowly. Report sore throat, fever, or severe abdominal pain. take early in day to avoid nocturia.
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Hydrochlorothiazide n.i.
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monitor f.e. loss. check bp and serum k+ before admin. monitor daily weight. safety precautions- risk for falls. call light. assist elderly. for long term hf.
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Hydroclorothiazide client teaching
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schedule doses to avoid nocturia. change positions slowly. weigh daily. Diabetic patients need to monitor glucose closely.
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spirlactone n.i.
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give w/ food to enhance absorption. check BP and serum K+ before admin
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spironolactone client teaching
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weigh 2-3 times/ week. Report gains/loss of equal or greater than 5lbs. avoid excessive intake of high k foods and salt substitutes
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Acetaminophen Nursing implication
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Monitor for s/sx of hepatoxicity, esp. in ct w/ poor nutrition or who have ingested alcohol over prolonged periods.
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Acetaminophen Client teaching
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Do not take other meds containing acetaminophen without medical advice. Overdosing & chronic use can cause liver damage and other toxic effects. Do not take for longer than 10 days. Do not exceed max 4 G daily.
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Ibuprofen Nursing Implications
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Use caution in cts w/ upper gastrointestinal disorders, and renal and hepatic impairment.
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Ibuprofen Client teaching
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Take with food or milk to reduce gastrointestinal distress. Instruct the ct to use correct concentrations for age groups.
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Morphine sulfate N.i.
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Obtain baseline resp. rate depth and rhythm and pupil size; monitor for both. Asses VS at regular intervals. Monitor I&O ratio and pattern. Assist w/ ambulation. Orthostatic hypotension. Evaluate if pain relief is achieved. Monitor for constipation. Offer stool softener w/ each
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Morphine sulfate client teaching
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Encourage changes in position, deep breathing &coughing q2h, unless contraindicated. Encourage void at least q4h Avoid alcohol & other CNS depressants. May cause drowsiness, blurred vision. Use caution or avoid tasks requiring alertness until response to drug is known.
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Lorazepam N.I.
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At risk for falls — monitor depth of drowsiness or sleepiness that permits pt to respond to simple instructions whether pt appears to be asleep or awake. Supervise ambulation of older adult pt — prevent falls or injury
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Lorazepam Client Teaching
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Do not drive or engage in Hazardous activities. Do not drink lrg volumes of coffee. Do not consume alcoholic beverages. Terminate regimen gradually over period of several days. Do not abruptly; withdrawal symptoms — feelings of panic, tonic – clonic seizures, tremors, abdominal & muscle cramps, sweating, vomiting.
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Cephalexin N.I.
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Obtain specimen (blood, sputum, urine, feces, or tissue) for culture & sensitivity before administering 1st doses as ordered. Check allergy to antibiotics. Use caution in cts w/ renal impairment
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Cephalexin Client teaching
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Adminster w/ food if Gi upset occurs. Take medication for full course of therapy as directed by physician
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Atropine N.I.
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Monitor V.S. Monitor I&O, esp. in older adults & pts who’ve had surgery –> urinary retention. Monitor CNS in older adults —> drowsiness or CNS stimulation (excitement, agitation, confusion). At risk for falls.
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Atropine Client teaching
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Follow measures to relieve dry mouth: adequate hydration, frequent mouth rinses, and mouth care. May cause drowsiness, sensitivity to light & temporarily impair ability to judge distance. Careful w/ activities requiring visual acuity or mental alertness
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Heparin N.I.
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1) check dose w/ another licensed nurse. Inject into fatty layer of abdomen or just above iliac crest. Do not aspirate, do not rub or massage site post injection. 2.)Hold Skin fold between thumb and forefinger &insert whole length of needle into skin fold. Hold skin fold throughout injection. Do not rub site post injection.
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Heparin Client teaching
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Report to physician promptly signs of unexplained bleeding, such as pink red or dark brown vomitus, bleeding gums or bloody sputum, dark tarry stools. Do not take OTC drugs w/o first consulting physician.
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Aspirin N.I.
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Monitor for salicylate toxicity; sensation of fullness in ear, tinnitus and decreased or muffled hearing. Observe & report signs of bleeding (e.g. petechiae, ecchymoses, bleeding bums, bloody or black stools, cloudy or bloody urine)
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Aspirin Client teaching
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Discontinue aspirin about 1 week before surgery to reduce risk of bleeding. Discontinue with onset of ringing or buzzing in ears, impaired hearing, dizziness, GI discomfort or bleeding. Report to physician. Take with at least 8oz water, unless contraindicated. May take w/ food or milk if gastric distress.

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