PCC Nursing Exam 3 N50 – Flashcards

no

15%

language disorder

motor speech disorder

impairment in recognizing objects

stage 7

stage 3

acetylcholinesterase inhibitors: Used to treat mild and moderate dementia Block cholinesterase, enzyme responsible for breaking down acetylcholine Improve or stabilize cognitive decline but do not cure or reverse Nursing Considerations Monitor patient for evidence of active or occult GI bleeding. Monitor patient for bradycardia because of potential for vagotonic effects. Look alike-sound alike: Don't confuse Aricept with Ascriptin. Patient Teaching Stress that drug doesn't alter underlying degenerative disease but can temporarily stabilize or relieve symptoms. Effectiveness depends on taking drug at regular intervals. Tell caregiver to give drug just before patient's bedtime. Tell patient and caregiver not to break or crush tablets. ODTs may be taken with or without food. Have patient allow tablet to dissolve on his tongue, then swallow with a sip of water. Advise patient and caregiver to report immediately significant adverse effects or changes in overall health status and to inform health care team that patient is taking drug before he receives anesthesia. Tell patient to avoid OTC cold or sleep remedies because of risk of increased anticholinergic effects.

Nmda receptor antagonist Protects nerve cells against excess amounts of glutamate To improve cognitive function in moderate to severe AD Nursing Considerations In elderly patients, even those with a normal creatinine level, use of this drug may impair renal function. Estimate CrCl; reduce dosage in patients with moderate renal impairment. Don't give drug to patients with severe renal impairment. Monitor patient carefully for adverse reactions as he may not be able to recognize changes or communicate effectively. Patient Teaching Explain that drug doesn't cure Alzheimer disease but may aid patient to maintain function for a longer period of time. Tell patient or caregiver to report adverse effects. Urge patient to avoid alcohol during treatment. To avoid possible interactions, advise patient not to take herbal or OTC products without consulting prescriber.

MAO-B inhibitors Block breakdown of dopamine

COMT inhibitors breakdown of dopamine making more available to the brain

Anticholinergics Help control tremors & rigidity. Unknown. May block central cholinergic receptors, helping to balance cholinergic activity in the basal ganglia. Nursing Considerations Monitor vital signs carefully. Watch closely for adverse reactions, especially in elderly or debilitated patients. Call prescriber promptly if adverse reactions occur. At certain doses, drug produces atropine-like toxicity, which may aggravate tardive dyskinesia. Watch for intermittent constipation and abdominal distention and pain, which may indicate onset of paralytic ileus. Monitor elderly patients closely as they are more prone to severe adverse effects. Alert: Never stop drug abruptly. Reduce dosage gradually. Look alike-sound alike: Don't confuse benztropine with bromocriptine. Patient Teaching Warn patient to avoid activities that require alertness until CNS effects of drug are known. If patient takes a single daily dose, tell him to do so at bedtime. Advise patient to report signs and symptoms of urinary hesitancy or urine retention. Tell patient to relieve dry mouth with cool drinks, ice chips, sugarless gum, or hard candy. Advise patient to limit hot weather activities because drug-induced lack of sweating may cause overheating.

Dopamine agonists Activate release of dopamine

Dopaminergic Transmission of levodopa to brain cells to conversion to dopamine in the basal ganglia Carbidopa inhibits an enzyme that breaks down levodopa before it reaches the brain Nursing Considerations Determine optimum daily dose by careful titration in each patient. Therapy should be individualized and adjusted according to the desired therapeutic response. Observe patient and monitor vital signs, especially changes in BP, when changing positions and while adjusting dosage. Report significant changes. Alert: Because of risk of precipitating a symptom complex resembling neuroleptic malignant syndrome, observe patient closely if levodopa dosage is reduced abruptly or stopped. Hallucinations may require reduction or withdrawal of drug. Test patients receiving long-term therapy regularly for diabetes and acromegaly, and periodically for hepatic, renal, and hematopoietic function. Patient Teaching Tell patient to take drug with food to minimize GI upset; however, high-protein meals can impair absorption and reduce effectiveness. Tell patient not to chew or crush extended-release form. Advise patient to have skin checks. Warn patient and caregivers not to increase dosage without prescriber's orders. Caution patient about possible dizziness when standing up quickly, especially at start of therapy. Tell him to change positions slowly and dangle his legs before getting out of bed. Instruct patient to report adverse reactions (such as somnolence, loss of impulse control) and therapeutic effects. Advise patient receiving enteral therapy to immediately report abdominal pain, prolonged constipation, nausea, vomiting, fever, or melanotic stool. Inform patient that pyridoxine (vitamin B6) doesn't reverse beneficial effects of levodopa-carbidopa. Multivitamins can be taken without reversing levodopa's effects. Teach patient to take ODT immediately after taking from bottle and to place on top of tongue. Tablet will dissolve in seconds and will be swallowed with saliva. No additional fluid is needed.

Assess for symptoms of orthostatic hypotension, i.e. weakness, dizziness, syncope Teaching: on-off phenomenon (better "on" as a new dose of dopamine starts to take effect, and worse "off" before due for another dose) report any uncontrolled movement, mental changes, severe nausea/vomiting, difficulty urinating

-Stress incontinence - Urge incontinence - Overflow incontinence - Functional incontinence - Mixed incontinence - Total incontinence

Serotonin 3-receptor antagonists anti-nausea

-Dopamine antagonists -Antihistamines - Dronabinol, nabilone (cannabinoids)

Related to medication use in elderly • NSAIDs, po antibx, antacid use are common culprits • Ask re: recent foreign travel

Proton-pump inhibitors (PPIs) Nursing Considerations Antacids can be used while taking drug, unless otherwise directed by prescriber. Monitor patient for rash or signs and symptoms of hypersensitivity. Monitor GI symptoms for improvement or worsening. Monitor LFTs, especially in patients with preexisting hepatic disease. Alert: Prolonged use may cause low magnesium levels that require magnesium supplementation and possibly discontinuation of drug. Monitor magnesium level before treatment and periodically during treatment. Monitor patient for signs and symptoms of low magnesium level, such as abnormal heart rate or rhythm, palpitations, muscle spasms, tremor, and seizures. In children, abnormal heart rate may present as fatigue, upset stomach, dizziness, and light-headedness. Alert: May increase risk of CDAD. Evaluate for CDAD in patients who develop diarrhea that doesn't improve. Long-term therapy may cause atrophic gastritis. Look alike-sound alike: Don't confuse Nexium with Nexavar. Patient Teaching Instruct patient to take drug exactly as prescribed. Tell patient to take drug at least 1 hour before a meal. Advise patient that antacids can be used while taking drug unless otherwise directed by prescriber. Warn patient not to chew or crush drug pellets because this inactivates the drug. If patient has difficulty swallowing capsule, tell him to mix contents of capsule with 1 tablespoon of soft applesauce and swallow immediately. Advise patient to store capsules at room temperature in a tight container. Tell patient to inform prescriber of worsening signs and symptoms, pain, or diarrhea that doesn't improve. Instruct patient to alert prescriber if rash or other signs and symptoms of allergy occur. Warn patient to immediately report symptoms of low magnesium level.

H2-receptor blockers Competitively inhibits action of histamine at H2-receptor sites of parietal cells, decreasing gastric acid secretion. Nursing Considerations Assess patient for abdominal pain. Note presence of blood in emesis, stool, or gastric aspirate. Drug may be added to total parenteral nutrition solutions. High doses (100 mg or more) or prolonged I.V. therapy (5 days or longer) may increase ALT level. Monitor ALT level daily for remainder of treatment. Look alike-sound alike: Don't confuse ranitidine with rimantadine. Don't confuse Zantac with Xanax or Zyrtec. Patient Teaching Instruct patient on proper use of OTC preparation, as indicated. Remind patient to take once-daily prescription drug at bedtime for best results. Instruct patient to take without regard to meals because absorption isn't affected by food. Urge patient to avoid cigarette smoking because this may increase gastric acid secretion and worsen disease. Advise patient to report abdominal pain, blood in stool or emesis, black, tarry stools, or coffee-ground emesis.

Promotility agent Nursing Considerations Monitor bowel sounds. Safety and effectiveness of drug haven't been established for therapy lasting longer than 12 weeks. Metozolv ODT contains acesulfame K and mannitol. Monitor patient for involuntary movements of face, tongue, and extremities, which may indicate tardive dyskinesia. Monitor patient for fever, CNS symptoms, irregular pulse, cardiac arrhythmias, or abnormal BP, which may indicate neuroleptic malignant syndrome. Monitor patient for dizziness, headache, or nervousness after metoclopramide is stopped; these may indicate withdrawal. Diphenhydramine or benztropine may be used to counteract extrapyramidal adverse effects from high doses. Patient Teaching Instruct patient to take ODTs 30 minutes before food and at bedtime and not to repeat dose if inadvertently taken with food. Tell patient taking ODTs to open blister pack with dry hands and immediately place tablet on tongue, let it melt completely, and then swallow. (Taking it with water isn't necessary.) If tablet breaks or crumbles, advise patient to throw it away and take a new tablet out of the blister pack. Tell patient to avoid activities that require alertness for 2 hours after doses. Urge patient to report persistent or serious adverse reactions promptly. Advise patient not to drink alcohol during therapy. Teach patient signs and symptoms of tardive dyskinesia and neuroleptic malignant syndrome and to report any signs and symptoms that develop.

Anti-ulcer agents Probably adheres to and protects surface of ulcer by forming a barrier. Nursing Considerations Drug is minimally absorbed and causes few adverse reactions. Monitor patient for severe, persistent constipation. Drug is as effective as cimetidine in healing duodenal ulcer. Drug contains aluminum but isn't classified as an antacid. Monitor patient with renal insufficiency for aluminum toxicity. Patient Teaching Tell patient to take sucralfate on an empty stomach, 1 hour before each meal and at bedtime. Instruct patient to continue prescribed regimen to ensure complete healing. Pain and other ulcer signs and symptoms may subside within first few weeks of therapy. Urge patient to avoid cigarette smoking, which may increase gastric acid secretion and worsen disease. Antacids may be used while taking drug, but separate doses by 30 minutes.

Prostaglandin analogs

can't reach toilet in time continent person

overdistension of bladder

sudden leakage with activities that increase intra-abdominal pressure

predictable intervals when certain bladder volume is reached

strong urgency to void followed by involuntary passage of urine

May exert its antiparkinsonian effect by causing the release of dopamine in the substantia nigra. As an antiviral, may prevent release of viral nucleic acid into the host cell, reducing duration of fever and other systemic symptoms. Nursing Considerations Patients with Parkinson disease who don't respond to anticholinergics may respond to this drug. Alert: Elderly patients are more susceptible to adverse neurologic effects. Monitor patient for mental status changes. Alert: Suicidal ideation and attempts may occur in any patient, regardless of psychiatric history. Alert: Sporadic cases of neuroleptic malignant syndrome have been reported with dosage reduction or drug withdrawal. Observe patient carefully when dosage is abruptly reduced or drug is discontinued. Drug can worsen mental problems in patients with a history of psychiatric disorders or substance abuse. Monitor renal function tests and LFTs. Look alike-sound alike: Don't confuse amantadine with amiodarone, rimantadine, or ranitidine. Patient Teaching Alert: Tell patient to take drug exactly as prescribed because not doing so may result in serious adverse reactions or death. If insomnia occurs, tell patient to take drug several hours before bedtime. If patient gets dizzy when he stands up, instruct him not to stand or change positions too quickly. Instruct patient to notify prescriber of adverse reactions, especially dizziness, depression, anxiety, nausea, and urine retention. Caution patient to avoid activities that require mental alertness until effects of drug are known. Encourage patient with Parkinson disease to gradually increase his physical activity as his symptoms improve. Advise patient to avoid alcohol while taking drug.