NR202 oxygenation pharm test (Nurisng)
Terms
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- What are some indications for the thrombolytics Streptokinase Activase (tpa) and TNK (tenecteplase)
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1. It's for those who have had a Myocardial Infarction.
2. Activase is for those who have had a Cerebral Vascular accident.
3. It's for those who have a central venous line that has clotted off.
4. It's for those who had a massive Pulmonary embolism - Action of thrombolytics:
- Lysis of thrombi or pulmonary emboli
- Side efects of thrombolytics
- Bleeding in the GI tract or cerebral vascular area, Allergic reaction (streptokinase only)
- Nursing implications for thrombolytics
- Avoid invasive procedures, monitor ECG and VS. Monitor PTT and ACT. Monitor for bleeding and hemoccult stools. Maintain 2 IV sites. Do not give if active bleeding, BP > 180/110, recent OR, CVA, or trauma
- Expected outcomes for those receiving thrombolytics
- Relief of symptoms related to the clot
- Patient teaching for those receiving thrombolytics
- Report bleeding of gums, bruising, bright red or black tarry feces, hematuria, hematemesis
- Name 3 anticoagulants
- Heparin, Lovenox, Coumadin
- What is Heparin and Lovenox indicated for?
- They are indicated for those who have had an MI, DVT, PE, and it's for the prevention of clots in bedfast patients
- What is the action of Heparin or Lovenox
- Prevents conversion of fibrinogen to fibrin
- What are the side effects to Anticoagulants
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Bleeding, bruising,
(Coumadin)
thrombocytopenia, anemia - What are the nursing implications for Heparin and lovenox
- Monitor the lab test which is called aPTT. The normal lab values is 25-35 sec. The therapeutic value is 1.5-2.5 x control. The antidote for heparin is protamine sulfate. If converting to coumadin the pt. will need 2-3 days on both meds. SQ-do not aspirate or rub site after injection
- What are the expected outcomes for anticoagulants
- No new clot development. Lab values therapeutic
- What could you teach a patient receiving Heparin or Lovenox
- Use electric razor & soft toothbrush. MedicAlert tag. Inform dentist/MDs. Report bleeding of gums, bruising, bright red or black tarry feces, hematuria, hematemisis
- What is Coumadin indicated for?
- Prevention of clot formation in high risk patients (A-fib, prosthetic heart valve, previous clot).
- Nursing implications for Coumadin
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Monitor the lab tests: aPTT and INR
The normal lab INR values 2.0-3.0
Therapeutic 2x normal
Antidote vitamin K
Requires 3-5 days to be therapeutic. Give at 1700 every day or same time every day. - What could you teach a patient receiving coumadin
- Maintain consistent intake of Vitamin K: eat yellow and dark green vegetables. Routinely draw lab.
- Name some antiplatelet aggregation drugs
- Aspirin, Ticlid, Plavix, ReoPro, Integrillin
- What are antiplatet aggregation drugs indicatied for
- For the prevention of clot formation, for people going to have a heart cath or stent placement, and for those who have acute coronary syndrome
- What is an action for antiplatelet aggregation drugs
- They supress platelet aggregation
- What are the side effects for antiplatelet aggregation drugs
- Bruising, GI bleed (wth high dose ASA), ASA toxicity: N/V, rash, tinnitus
- Give a po antiplatelet med with what?
- food
- What is an expected outcome for someone who is taking antiplatelet aggregation
- No new clot development
- What would you teach a patient who is taking antiplatelet aggregation drugs
- PO-Give with food, Chest pain not relieved with nitro, chew one ASA and call EMS
- Name 2 Inotropic vasopressors
- Dopamine, Dobutrex
- What are the indications for inotropic vasopressors
- For those with low blood pressure, low urine output (<30 cc/hr) Heart failure
- Actions for those taking inotropic vasopressors
- 1-4 mcg/kg/min. Raise in renal perfusion. 5-10 mcg/kg/min, raises cardiac output and blood pressure
- Side effects to Inotropic vasopressors
- Infiltration causes tissue necrosis-treat with regitine
- Nursing implications for those taking inotropic vasopressors
- Infuse via IV pump through CVL. Avoid discontinuing abruptly. Monitor BP closely (frequently titrated by RN) and I and O hourly
- Expected outcome for those taking inotropic vasopressors
- output > 30 cc/hr, raise in BP
- what could a nurse teach a patient about taking inotropic vasopressors
- Notify RN of chest pain, dyspnea, numbness, tingling or pain at infusion site
- What is an Adrenergic Sympathomimetic
- Epinephrine
- What is Epinephrine for
- It is for Low BP, Low urine output (<30 cc/hr) bronchospasm
- What does epinephrine do (Actions?)
- it's a vasopressor so it raises BP and force (+ inotrope), and rate(+ chronotrope) of myocardial contraction (raises Cardiac output), it's a bronchodilator
- What are the side effects to epinephrine
- tachycardia, nervousness, restlessness, tremor, angina, arrhythmias
- What are the nursing implications for those receiving Epinephrine
- Infiltration causes tissue necrosis-watch IV site. Monitr VS, q 5-15 minutes and output q 1 hr. Dosage frequently titrated
- Expected outcomes and Pt teaching for those receiving epinephrine
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Raised Blood pressure and tissue perfusion, Output > 30cc/hr.
May cause feelings of anxiety. Report palpitations or chest pain - Name an anti-arrhythmic
- adenosine
- Wha is adenosine indicated for
- SVT conversion to Normal sinus rhythm when vagal unsuccessful
- Actions for adenosine:
- Interrupts re-entrant pathways and slows conduction in the AV node
- Possible side effects for those taking adenosine
- Brief asystole followed by conversion, transient arrhythmias, facial flushing, SOA
- Nursing implications for those taking adenosine
- ECG monitoring during admission. Give over 1-2 seconds. Proximal IV port and follow with rapid normal saline flush
- Expected outcomes for those taking adenosine
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Restores Normal sinus rhythm
Change position slowly because the med lowers BP. Report facial flushing, SOA, dizziness - Diuretics: Name 4 kinds
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Loop diuretic
Thiazide diuretic
Potassium sparing diuretic
Osmotic diuretic - What are the indications for those taking Loop, Thiazide, and Potassium sparing diuretics
- for those with heart failure, edema, hypertension
- Actions of Loop, thiazide and potassium sparing diuretics
- Promotes excretion of sodium and water. Increases urine output riding the body of excess fluid (decreasing preload).
- Nursing implications for those receiving Loop, thiazide, and potassium sparing diuretics
- Monitor daily weight, I&O, vitals, skin turgor, edema for fluid volume status. Assess for volume depletion (dehydration): dizziness, orthostatic hypotension, tachycardia, and muscle cramping, thirst, rapid pulse. Monitor serum electrolytes and replace as indicated. Avoid night doses to decrease nocturia. Loop diuretics--Potassium increased in diet: fresh orange or tomato juice, bananas, raisins, dates, figs, prunes, apricots, spinach, cauliflower, potatoes, and salt substitutes
- What are the expected outcomes for those taking loop, thiazide, and potassium sparing diuretics
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urine output < 30 cc/hr, lowered BP, Lowered edema, Lowered crackles and lowered SOA.
For potassium sparing: maintaining potassium levels w/o taking in more potassium - Pt teaching for Loop and thiazide diuretics
- Avoid sudden position changes. Foods raised in potassium. Sx of lowered potassium: N/V, anorexia, muscle cramps or weakness, arrhythmias
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Names of Loops:
Names of Thiazide diuretics
Names of Potassium sparing diuretics -
Loops: Lasix, bumex, demedex
thiazide: hydrochlorothiazide (diuril)
Potassium: sparing: Spironolactone (aldactone) triamterene - Side effects for thiazide and loop diuretics
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Loop: Lowered potassium, dehydration, hypotension, jaundice, dark urine, bleeding, bruising.
Thiazide: Dizzy, drowsy, dehydration, alkalosis, N/V, hypotension, hypochloremic, hypokalemia, hypomagnesemia, hyponatremia, hypovoleia, hypophosphatemia, hepatitis, hyperglycemia, phototoxicity, lehargy, weakness, anorexia, rashes, elevated lipids, muscle cramps, pancreatitis - Side Effects: Potassium sparing diuretics
- Monitor for raised potassium if also on ACE inhibitor or potassium. Monitor I &O, daily weights.
- Indications: Osmotic diuretic
- Edema of tissues, acute oliguric renal failure, raised ICP or intraocular pressure
- Names: osmotic diuretic
- Mannitol, Albumin
- Action: osmotic diuretic
- Mobilizes fluid from extravascular tissues back into the intrvascular space- relieves and reduces edema
- Expected outcomes:osmotic diuretic
- raise in output, lower in edema, lower ICP
- Nursing Implications:osmotic diuretic
- Monitor VS, urine output, PA pressures & edema. Often given prior to loop diuretics
- Side Effects: osmotic diuretic
- Fluid overload & transient volume expansion
- Pt. teaching: osmotic diuretic
- Report dyspnea, SOA, explain purpose
- Opioid Analgesic:Name
- Morphine Sulfate
- Indications: Opioid Analgesic
- Pulmonary edema & chest pain associated with MI or PE
- Action: Opioid Analgesic
- Alters perception & response to pain. Mild vasodilation
- Side Effects: Opioid Analgesic
- respiratory depression, confusion, sedation, decreased BP, constipation
- Nursing Implications: Opioid Analgesic
- Assess pain, narcotic check, If resp <10, decrease or hold dose. Assess VS, orthostatic decreased BP, bowel function. Antidote is Narcan Naloxone dose
- Expected outcomes:Opioid Analgesic
- Decreased or cessation of pain
- Pt. teaching: Opioid Analgesic
- Causes drowsiness or dizziness- help with activity. Prevent constipation. TCDB q2hrs
- Name cardiac glycoside:
- digoxin (lanoxin)
- Indications: cardiac glycoside
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Treatment of HF, Atrial fibrillation and atrial flutter
(slows ventricular rate) - Actions: cardiac glycoside
- Increases the force of myocardial contraction (+ inotropic effect), Slows conduction through the SA and AV nodes. Slows heart rate (negative chronotropic effect). Increase filling time, Increased cardiac output
- Side effects: cardiac glycoside
- anorexia , N/V, weak, ABD. Pain, Diplopia, yellow-green halos, dysrhythmias , palpitations
- Nursing implications: cardiac glycosides
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hold dose and notify Dr. if HR is <60 or BP <100
Assess for Hypokalemia, hypomagnesemia, or hypercalcemia may causes digitalis toxicity. Norm levels 0.5–2 ng/ml. Antidote is digoxin immune Fab (Digibind OR Ovine) - Expected outcomes: cardiac glycosides
- Decreased HR, change to NSR, increased urine output, decreased edema
- Pt teaching: cardiac glycosides
- Daily pulse monitoring-Hold if <60. Don’t take with antacids or laxatives, add potassium foods to diet
- Nitrates: name
- Isordil, nitroprusside, nitroglycerin
- Nitrates: indications
- Tx and prevent angina
- nitrates actions:
- Dilates arterial, venous, and vessels decreasing preload, afterload, cardiac workload, and o2 demand. Dilates coronary decreasing cardiac workload and increasing CO
- Side effects: nitrates
- Decreased bp, increased hr, dizziness, HA Do not use if pt is taking viagra.
- Nursing implications: nitrates
- Tx HA with cool compress & tylenol. IV nitro mixed in glass bottle & monitor BP q15min. topical applied on dry, hairless site over muscle (remove old patch) Monitor BP before giving-hold if SBP<100
- Expected Outcome: Nitrates
- Decreased chest pain, increase activity tolerance
- Pt teaching: nitrates
- Avoid ETOH, hot showers/tub
- Name: Ace inhibitors
- Captopril, Fosinopril,(pril’s)
- Indications: Ace inhibitors
- Tx Heart Failure, Hypertension
- Actions: Ace inhibitors
- Vasodilitation, decrease blood volume, Increased cardiac output & renal blood flow, decrease edema & pulmonary congestion, decrease ventricular remodeling
- Side effects: Ace inhibitors
- Persistent dry cough, WBC or Differential changes, Hypokalemia, increase in BUN or creatinine
- Nursing implications: Ace inhibitors
- Assess BP & WBC before first dose. Give PO 1 hour A.C. Report Side Effects
- Expected outcomes: Ace inhibitors
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Decreased BP, wt, SOA, & edema
Increase in urine output - Pt teaching: Ace inhibitors
- Change position slowly. Do not take potassium supplements concurrently. Report peripheral edema, signs of infection, or SOB
- Name some Beta blockers:
- Atenolol, Metoprolol ("olol") as a suffix
- Indications: beta blockers
- Antianginal, antihypertensive, acute MI, heart failure, tachyarrhythmias
- Actions: beta blockers
- Decreases cardiac workload, decreases Heart rate (-chronotrope), Decreases contractility (-inotrope), decreases myocardial O2 consumption, and decreases BP
- Side effects: beta blockers
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Decreased HR, BP,
SOA, fatigue, bronchospasm, impotence, HF, sleep disturbances, triglyceride levels raised. - Nursing implications: beta blockers
- Hold and call the doctor if BP is less than 100 or hear rate less than 50. Do not discontinue abruptly. Report slow, irregular pulse, swelling, weight gain, or difficulty breathing.
- Expected Outcome: beta blockers
- Lowered HR, Lowered BP, Lowered occurance of chest pain
- Pt teaching: beta blockers
- Keep fast acting nitrates on hand for acute attacks. Do not discontinue abruptly. Check BP and HR daily
- Names of Calcium channel blockers:
- Verapamil, Nifedipine (ipine’s)
- Indications: calcium channel blockers
- Antiangina, antihypertensive, antidysrhythmic
- Actions Calcium channel blockers:
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Decreases contractility (- inotrope), HR (-chronotrope), & conduction
causes Vasodilitation -
Side effects
Calcium channel blockers: - Abnormal dreams, anxiety, confusion, dizzy/lightheaded, drowsy, HA, jittery, nervous, psych disturbance, weakness, blurred vision, Arrhythmias, CHF, bradycardia, chest pain, hypotension, cough, SOA, Abnormal liver function, nocturia, polyuria, Sex dysfunction, flushing, increased sweating, hyperglycemia, joint stiffness, muscle cramps.
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Nursing implications
Calcium channel blockers: - hold dose and notify Dr. if HR is <50 or BP <100 Antidote is calcium
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Expected outcome
Calcium channel blockers: - Decreased chest pain, HR, & BP
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Pt teaching
Calcium channel blockers: - Keep fast-acting nitrates on hand for acute attacks. Check BP & HR daily
- Anti-Arrhythmic names:
- Lidocaine, Amiodarone, Atropine
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Indications
Anti-Arrhythmics: Lidocaine and Amiodarone -
Ventricular dysrhythmias – PVCs and V-tachy
Amiodarone PO-SVT
Prolong refractory period, lowers ventricular irritability and PVCs -
Actions
Anti-Arrhythmics:Lidocaine and amiodarone - lowers BP, Lowers HR, anorexia, N/V, constipation,
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Side Effects
Anti-Arrhythmics: lidocaine and amiodarone - Photosensitivity, ataxia, seizures
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Nursing implications
Anti-Arrhythmics: Lidocaine and Amiodarone - Infuse via IV pump with an in-line filter. Correct Potassium & Magnesium levels before starting. Monitor ECG rhythms
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Expected Outcome
Anti-Arrhythmics: Lidocaine and amiodarone - Cessation of life- threatening arrhythmias
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Pt teaching
Anti-Arrhythmics: Lidocaine and Amiodarone - Monitor pulse daily, wear protective clothing and sunblock for photosensitivity.
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Indications
Atropine: - Sympatomatic sinus bradycardia
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Actions
Atropine: - Increase SA node automaticity & AV node conduction
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Side Effects
Atropine: - Tachycardia, dry mouth, blurred vision, drowsiness, urinary hesitancy
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Nursing Implications
Atropine: - Not effective in heart transplants. Assess ECG strips & VS. Monitor I&O, and bowel function. Provide oral care or lozenge for dry mouth
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Expected Outcomes
Atropine: - Increased HR with relief of symptoms of brady
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Pt teaching
Atropine: - Hard candy or gum will decrease dry mouth, prevent constipation with increased fluids and stool softeners
- Anti-infectives (Antibiotics): Name all kinds
- Penicillin: -icillin, Cephalosporin: Cef-, Aminoglycosides: -mycin, -micin, Amikacin, Fluoroquinolones: C,G,L -acin, Tetracyclines: -cycline, Macrolides: Er, AZ—mycin or –Er-ocin, Sulfonamides: Sulf-, Metronidazole (Flagyl)
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Indications
Antibiotics: - Treatment or prophylaxis of bacterial infections
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Actions
Antibiotics: - Kill or inhibit growth of susceptible bacteria. Not effective on viruses or fungi.
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S.E.
Antibiotics: - Monitor BUN,& creatinine (renal). N/V, diarrhea, Allergic reactions: Itching red rash, SOA, wheezing, decreased BP
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Nursing implications
Antibiotics: - Assess for allergies. Culture & sensitivity prior to starting med. Monitor VS & WBC. Encourage diet increase Vit. C, protein, & fluids
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Expected Outcome
Antibiotics: - Resolution of symptoms of infections
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Pt teaching
Antibiotics: - Take all medication to prevent reoccurrence. Report Sx of infection or allergic reactions.
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Adrenergic Stimulants
names - Epinephrine, Isoproterenol (Isuprel) Metaproterenol (Alupent, Metaprel), Terbutaline, Albuterol, Salmeterol
- Anticholinergic names
- Ipratropium (Atrovent)
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Adrenergic Stimulants
Actions -
Inhaler: quick relief of acute bronchospasm
PO- long term -
Adrenergic Stimulants
indications - Smooth muscle relaxation and bronchodilation
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S.E
Adrenergic Stimulants: - Tachycardia, nervousness, restlessness, tremor
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Nursing Implications
Adrenergic Stimulants - Rescue inhaler for acute bronchospasm. Onset of action slightly quicker than anticholinergic inhalers. Assess respiratory status. Give PO with food
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Expected Outcomes
Adrenergic Stimulants and Anticholinergics - Decreased SOA, breathing easier, clearing of lung sounds
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Pt teaching
Adrenergic Stimulants and Anticholinergics - Use of inhalers⬝ shake well , use spacers, wait 1-2 mins between puffs, take adrenergic inhaler first then anticholinergic and steroid last. Hard candy or gum may decrease mouth dryness.
- Indications, Actions, and S.E. for Anticholinergics
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Indication: management of bronchospasm
Actions: Bronchodilation
Side Effects: Uncommon - Nursing Implications Anticholinergics:
- Assess Respiratory status, rate, breath sounds, degree of dyspnea, pulse. Onset of action too slow for patients in acute distress
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Mast Cell Stabilizers
Name:
Indications -
Cromolyn (intal)
Prevention of exercise induced asthma -
Side Effects
Mast Cell Stabilizers: - Irritation of nose or thrat, unpleasant taste
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Actions
Mast Cell Stabilizers: - Prevents release of histamine from mast cells
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Nursing Implications/
Pt teaching
Mast Cell Stabilizers: -
Use prophylactically. Will not help in asthma attack
Gargling decreases throat irritation. Not tx for acute asthma attack. Several weeks may be required before beneficial effect. -
Expected Outcome
Mast Cell Stabilizers: - Less frequent symptoms of asthma
- Names of Methylxanthines:
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Theophylline
Aminophylline -
Indications
Methylxanthines: - Prevent nocturnal asthma in adult clients or control airway obstruction in COPD
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Actions
Methylxanthines: - Bronchodilation, slight vasodilation, Increase CO & urinary output
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Side Effects
Methylxanthines: - Tachycardia, N/V, anxiety
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Nursing implications
Methylxanthines -
IV therapeutic level: 8 to 12 µg/mL
Narrow margin of safety & high risk of toxicity- SX:anorexia, N/V, restlessness, insomania, seizures, dysrhythmias -
Expected Outcome
Methylxanthines: - Less frequent nocturnal asthma
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Pt teaching
Methylxanthines - Avoid caffeine & smoke. Avoid OTC cough or cold meds, Minimun of 2000cc/day fluid intake
- Names of Gluco-Corticoids:
- Solu-Medrol, Prednisone, Beclamethasone
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Indications
Gluco-Corticoids: - Inflammatory conditions of the airway. Reversible airway disease (asthma, COPD)
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Actions
Gluco-Corticoids: - Supresses inflammation & normal immune response
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Side Effects
Gluco-Corticoids: - Inhaled: thrush Systemic: increased BS, mood swings, anorexia, drecased wound healing, fluid retention, increased BP, osteoporosis
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Nursing Implications
Gluco-Corticoids: - Monitor BS & WBC, I&O, daily WT. Give with food, Monitor closely for SX of infection.
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Expected Outcomes
Gluco-Corticoids: - Decrease in presenting SX (SOA,wheexzing)
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Pt teaching
Gluco-Corticoids: - Do not sotp taking med suddenly, it must be tapered off. Avoid contagious people. Rinse mouth after using inhaler to prevent thrush