Question

Classification Mechanism of action Why is your client taking this drug? Nursing Implications Adverse Effects NPH Novolin insulin 2 Regular Novolin Insulin 3 Nitroglycerin 4Heparin S Thiamine Furosemide Losartan Potassium Hydrochlorathiazide Lanoxin Metropolol 8 Tramadol a Cipro (0 Toradol SDocusate Sodium

hi thank you again for helping me out. i also beed the dosage and route for all please & thank you ?

Answer 1

1. NPH Novolin insulin :

# Therapeutic Classification:

Antidiabetics, hormones.

# Pharmacological Classification:

Pancreatics.

# Mechanism of Action:

Lowers blood glucose by: stimulating glucose uptake in skeletal muscle and fat, inhibiting hepatic glucose production.

Other actions of insulin: inhibition of lipolysis and proteolysis, enhanced protein synthesis.

# Therapeutic Effects:

Control of hyperglycemia in diabetic patients.

# Dosage and Route:

Subcut; Dose depends on blood glucose, response, and many other factors.

# Side effects - hypoglycemia

# Critical Nursing Responsibilities:

High Alert: Medication errors involving insulins have resulted in serious patient harm and death. Clarify all ambiguous orders and do not accept orders using the abbreviation "u" for units, which can be misread as a zero or the numeral 4 and has resulted in tenfold overdoses. Insulins are available in different types and strengths. Check type, dose, and expiration date with another licensed nurse. Do not interchange insulins without consulting physician or other health care professional.

Do not confuse Humulin with Humalog. Do not confuse Novolin with Novolog.

Use only insulin syringes to draw up dose. The unit markings on the insulin syringe must match the insulin's units/mL. Special syringes for doses <50 units are available. Prior to withdrawing dose, rotate vial between palms to ensure uniform solution; do not shake.

When mixing insulins, draw regular insulin or insulin lispro into syringe first to avoid contamination of regular insulin vial.

Insulin should be stored in a cool place but does not need to be refrigerated.

When transferring from once-daily NPH human insulin to insulin glargine, the dose usually remains unchanged. When transferring from twice-daily NPH human insulin to insulin glargine, the initial dose of insulin glargine is usually reduced by 20%.

NPH insulin should not be used in the management of ketoacidosis.

SC: Administer NPH insulin within 30-60 min before a meal.

2. Regular Novolin insulin :

# Classification

Antidiabetic, short acting

# Indications for Use

Control hyperglycemia with diabetes patients

# Action

Stimulate glucose uptake in skeletal muscle and fat

# Side effects

hypoglycemia

# Nursing interventions :-

Assess for hypo/hyperglycemia, can give Insulin (R) in IV in severe cases, use insulin syringe.

Demonstrate proper administration technique, give 15-30 minutes before meals, remind nutritional guidelines.

Monitor blood glucose, hemoglobin (AIC-shows management), use SSI fro high blood sugar coverage

3. Nitroglycerin :

# Classification -Nitrate vasodilator.

# Action: Relaxes vascular smooth muscle. Helps with chest pain! Promotes peripheral pooling of blood, reduction of peripheral resistance, and decreased venous return to the heart.

# Dose/times/route

Sublingual (beneath tongue, not very good), PO, IV, transdermal, topical.

# Usual Side Effects

Dizziness, lightheadedness, or fainting when sitting up or standing (Orthostatic hypotension). Flushing of the face and neck; headache; irritation at the injection site; nausea; vomiting.

# Side effects that must be reported

Severe allergic reactions: blurred vision, dry mouth, heavy sweating, irregular heartbeat, worsening chest pain, pale skin, pounding in the chest, rapid heartbeat, severe dizziness or headache, severe nausea, shortness of breath, slow heartbeat.

# Reason patient is taking medication :

Management of angina pectoris. Control BP. To produce controlled hypotension during surgical procedures.

# Nursing interventions :

Administer IV nitroglycerin with extreme caution to patients with hypotension. Monitor patient closely for change in levels of consciousness and for dysrythmias.

4. Heparin :

# Classification - anticoagulant

# Action

• Potentiates the inhibitory effect of antithrombin on factor Xa and thrombin.

• In low doses, prevents the conversion of prothrombin to thrombin .

# Side effects :-

- hepatitis ,alopecia , urticaria , rashes ,bleeding , thrombocytopenia , pain at injection site , fever , hypersensitivity , osteoporosis

# Nursing interventions :-

Assess for signs of bleeding and hemorrhage (bleeding gums; nosebleed; unusual bruising; black, tarry stools; hematuria; fall in hematocrit or BP; guaiac-positive stools). Notify health care professional if these occur.

» Assess patient for evidence of additional or increased thrombosis. Symptoms will depend on area of involvement.

» Monitor patient for hypersensitivity reactions (chills, fever, urticaria).

SC

• Observe injection sites for hematomas, ecchymosis, or inflammation.

Lab Test Considerations

• Monitor activated partial thromboplastin time (aPTT) and hematocrit prior to and periodically during therapy. When intermittent IV therapy is used, draw aPTT levels 30 min before each dose during initial therapy and then periodically. During continuous administration, monitor aPTT levels every 4 hr during early therapy. For Subcut therapy, draw blood 4-6 hr after injection.

» Monitor platelet count every 2-3 days throughout therapy. May cause mild thrombocytopenia, which appears on 4th day and resolves despite continued heparin therapy. Heparin-induced thrombocytopenia (HIT), a more severe form which necessitates discontinuing medication, may develop on 8th day of therapy; may reduce platelet count to as low as 5000/mm3 and lead to increased resistance to heparin therapy. HIT may progress to development of venous and arterial thrombosis (HITT) and may occur up to several wk after discontinuation. Patients who have received a previous course of heparin may be at higher risk for severe thrombocytopenia for several months after the initial course.

» May cause hyperkalemia and ↑ AST and ALT levels.

Toxicity and Overdose

• Protamine sulfate is the antidote. Due to short half-life, overdose can often be treated by withdrawing the drug.