ATI NOTES

FUNDIES

Pressure Ulcer risk:

Serum albumin <3 g/dL
HDL <60 mg/dL
Norton <17
Braden <18

NG tube insertion:
Pt in high fowlers (90 degrees)
Have pt take sips of water to promote insertion into esophagus
If pt gags/chokes, withdraw slightly but do not remove
Do not apply suction until position is verified by xray
After that verify position by checking pH of aspirate

24 hr urine collection:
Discard first void then save all subsequent voidings
Instruct pt to place urine in container immediately, keep container on ice or refrigerated

Phlebitis on IV site:
1st action is to apply warm compress to relieve edema

Lower extremity BP:

Pump to 30 mmHg above level where popliteal pulse could no longer be palpated

Arrhythmias:
Vtach or Vfib - defribillate
Supraventricular tachy - synchronized cardioversion
Ventricular dysrhymia - lidocaine IV bolus
Pulseless or not breathing - CPR

Going UP stairs with crutches:

1. Place weight on crutches
2. Advance unaffected leg onto stair
3. Shift weight from crutches to unaffected leg
4. Bring crutches and affected leg up the stair
Going DOWN stairs with crutches
1. Place affected leg and crutches down on step
2. Bring affected leg down along with crutches
3. Move unaffected leg down stair

Blood transfusions:
Administer blood as soon as possible after obtaining it, using 18-19 gauge, with 0.9%
sodium chloride which is isotonic to avoid RBC clotting/lysis; Stay with client for at least
30 min as most transfusion reactions manifest during first 50-100mL

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PACU:
Low BP + nausea: Side-lying position
Hypothermia: HTN - Metabolic acidosis d/t shivering

Nephrostomy tube insertion:

Decreased UO = Impaired renal function or neph tube dysfunction; notify provider
Back pain = Tube is dislodged or clogged; notify provider
Red-tinged urine = Expected finding for first 12 to 24 hrs
Febrile (37.7C / 100F) = Expected finding for first 24 hrs

Lumbar puncture:
Supine for first 1-12 hrs then dorsal recumbent position and no pillow under knees
Encourage fluid intake

Diabetic ketoacidosis:
Increased blood glucose
Administer regular (fast-acting) insulin

Pancreatitis:
Elevated – amylase, alkaline phosphatase, bilirubin
Decreased – calcium (due to fat necrosis)

Post-parathyroidectomy:
Place trach tray at bedside
Semi-Fowler’s
Offer opioids
Use sandbags to support head and neck

Total parenteral nutrition:

If new bag is not available when current infusion is nearly completed, administer 10% or
20% dextrose in water until new bag arrives. Do not use 0.9% NaCl, flush line and cap
port, nor decrease infusion rate.

IM injections:
If aspiration yields blood flash, dispose med and syringe without administering and get
new one

Isolation room:
Private – TB, shingles
Same infection – botulism, hepatitis, chlamydia

Sealed radiation implant:

Keep lead-lined container in room
Limit visitors 30min/day
Personally wear dosimeter badge
Keep all soiled linen in client’s room until radioactive source is removed

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Blood transfusion reactions:
Febrile – Antipyretic such as acetaminophen
Sepsis – IV ABX such as cephalexin
Circulatory overload – Loop diuretic such as furosemide
Allergic – Antihistamine such as diphenhydramine

Types of dressings:
Hydrocolloid – Stage3 pressure ulcer
Non-adherent gauze – Little to no drainage
Adhesive transparent film – Intact skin
Wet-to-damp dressing – Mechanical debridement

Hepatic encephalopathy:
Increased total bilirubin d/t liver being unable to excrete bilirubin
Increased aspartate aminotransferase d/t enzyme released from liver as result of
hepatic inflammation
Increased blood urea nitrogen d/t liver/renal dz
Increase blood ammonia levels d/t toxic substances absorbed by intestines not being
broken down (decrease in ammonia indicated effective treatment)

Cast Application
Expect - cold areas are where the cast is still drying, bounding dorsalis pedis pulse,
capillary refill 3-4sec
Notify provider of any increase in drainage d/t infection or improperly fitted cast

Chronic Kidney Disease:

Restrict protein: ½ cup of refried beans, 2 tbsp PB, 1 oz blanched almonds all okay
but not 3 oz salmon

Acute Kidney Failure:

Contraindicated – Naproxen, Magnesium hydroxide, Gentamicin
Safe – Calcium carbonate

Constipation-predominant IBS:
Take antacids to manage symptoms of gastric reflux and dyspepsia
Consume >30g fiber daily
Take bulk-forming (not stimulant) laxative
Drink 2-3L fluid per day

End stage kidney disease:

Expected – High phosphorus, low Hgb, high BUN
Report high potassium (hyperkalemia) as this entails risk for cardiac dysrhythmias

Total knee arthroplasty:

At time of discharge, client may have knee flexion of 90 but not in immediate post-op
period yet - if witnessed, machine needs to be adjusted

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RIGHT CVA:
Visual spatial deficits
Left hemianopsia
One-sided neglect
LEFT CVA:
Expressive aphasia
Right hemiplegia

Gastric hemorrhage shock:

1. Administer O2 via nonrebreather
2. Initiate IV therapy with large bore catheter
3. Insert NG tube
4. Administer ranitidine (stress ulcer prophylaxis)

Autonomic dysreflexia following cervical spinal cord injury:

Monitor for bradycardia

Fibrocystic breast condition:

Increase intake of vitC
Limit intake of sodium
May be prescribed diuretic to decrease breast engorgement
Should continue taking oral contraceptives to decrease estrogen overstimulation

PSYCH

Depressive disorders:
Increased risk – Females, hypothyroid, substance use disorder, single

Alcoholic cardiomyopathy:
Increased CPK

Alcohol toxicity:
Expect hypotension, cool skin (place warming blanket)
Risk for aspiration of emesis (place pt side-lying)
Ready endotracheal intubation kit in case pt becomes nonresponsive

Anorexia nervosa:
Expected findings – constipation, amenorrhea, bradycardia, orthostatic hypotension

Types of crises:
Situational – unexpected event (loved one dies, sudden accident, etc)
Adventitious – external disaster (tornado etc)
Maturational – national life event (children moving out, retirement, etc)

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ECT:
For pt that is suicidal and in need of rapid treatment
For pt who has BPD with rapid cycling
For pt who have mania and have not responded to medication therapy
NOT for pt who have just recently been diagnosed with severe depression
NOT for pt whose depression stems from situational or social problems

OB

> Fentanyl: Relief of severe/recurrent/persistent pain during labor

> Butorphanol: Relief of labor pain and severe postoperative pain after CSEC
> Meperidine: Relief of severe persistent pain
> Phototherapy (hyperbilirubinemia): Expect yellowed mucous membranes and
brown/gold urine; Monitor for irritability which indicates complication of encephalopathy
> Magnesium sulfate (preeclampsia): Expect facial flushing after initial bolus; Monitor for
UO <30mL/hr or absence of deep tendon reflexes which indicate magnesium toxicity
> Betamethasone: Corticosteroid that increases release of lung surfactant in fetus
> Nalbuphine: Contraindicated in pt with opioid dependency as this would trigger
withdrawal symptoms

APGAR: X - 0 1 2
Appearance (blue) – Allover, Extremities, None
Pulse – None, <100, >100
Grimace – No response, Grimace or feeble cry, Sneezing/coughing/pulling away
Activity – No movement, Some, Active
Respiration – None, Weak/slow/irregular, Strong

Maculopapular skin rash:

Normal in newborns

Exercising during pregnancy:

Rest on side 10 min after exercising to promote circulation and placental blood flow
Take pulse every 10-15min during exercise and if >140/min, slow down to 90/min max
Encourage non-wt bearing activities such as swimming, cycling and stretching
Avoid use of hot tubs and saunas as body temp should not exceed 38C/100F

Circumcision
via Plastibell: avoid irritants soap and water, change diaper every 4 hrs, do not wipe
away yellow exudate of healing process, and plastic rim will fall off in 1 week
Postpartum:
WBC can rise as high as 25k esp 10-12 days after delivery, without infection
Lochia alba is expected from 2-6 wks after delivery
Monitor for signs of mastitis: unilateral breast pain, chills, fever, malaise

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Newborn ranges:
> HR: 120-160
> Respirations: 30-60
> Axillary temp: 36.5-37.2C
> Length: 45-55cm
> Weight: 2.5-4kg
> Bilirubin: <8
> Glucose: 40-60
> Hct: 48-69
> WBC: 9k-30k
Tests:
Doppler blood flow – fetal blood flow
BPP – fetal breathing movement
Amniocentesis – fetal hemolytic disorders
Fetal chromosome analysis – karyotyping
Hispanic culture:
Protect head/feet from cold air
Delay baby’s bath for 14 days after delivery
Bed rest for 3 days while drinking warm beverages
Rh immune globulin:
To prevent blood incompatibilities in next pregnancy
If Rh-negative, pt will receive this within 72 hrs after giving birth to Rh-positive baby
Elevated 1hr50g glucose screening:
Obtain prescription for 3hr glucose test
Post-epidural hypotension:
Apply O2 10L/min via face mask
Increase IV infusion rate
Elevate legs
Possibly administer vasopressor such as ephedrine
Severe preeclampsia:
Expect 3+ deep tendon reflexes, proteinuria of >.3g/300mg in 24 hr urine,
oliguria >20mL, and visual disturbances such as blurred vision and photophobia
Amniocentesis:
After abnormal maternal serum alpha-fetoprotein (MSAFP), + ultrasound
Complication is preterm labor/miscarriage, instruct pt to report feeling to abd tightness
Management of DM1 during pregnancy:
Maintain FBG at 60-90
Eat 3-5 meals a day including complex carbohydrates high in fiber
Eat fewer carbs at breakfast than other meals

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Decelerations:
Early – benign; from compression of fetal head during uterine contractions
Variable – usually begin/end suddenly, v-shaped, transient and benefit from intervention
such as repositioning pt; from cord compression
Late – requires interventions such as changing position, increasing IV fluids,
discontinuing oxytocin, administrating 8-10L oxygen via face mask, and delivering
newborn if FHR does not respond to the aforementioned; from uteroplacental
insufficiency
Prolonged – requires immediate interventions or risk of fetal death; notify provider
immediately and prepare for emergency CSEC if pattern not corrected
Leopold maneuvers:
1. Palpate fundus to ID fetal part
2. Determine location of fetal back
3. Palpate inlet to ID fetal part
4. Palpate cephalic prominence to ID attitude of head
Third trimester:
Expect – 3-4 contractions per hr, increased anxiety, interrupted sleep pattern
Report – dull intermittent back pain as this indicates preterm labor
Bathing:
Every other day, with only warm (36.6-37.2C/98-99F) water and no soap, immersing
only after cord falls off on its own
Discharge teaching:
Breastfeed every 2-3 hrs, awakening every 4 hr during right until newborn is feeding
well and gaining wait adequately
After hepB vacc during stay, Will receive next vaccines in 2 months
Don’t need to wear gloves at home to change baby’s diaper
Notify provider if sins of jaundice as bilirubin rises from birth until 5 th day

PEDS
> Desmopressin (DI, enuresis, hemophilia A, von Willebrand): For hyposecretion of
antidiuretic hormones
> Luteinizing hormone-releasing hormone (precocious puberty): Slows prepubertal
growth; Also tx for advanced prostate cancer
> Recombinant growth hormone (hypopituitarism): To counteract inhibited cell growth
> Levothyroxine (hypothyroidism)
> Zinc oxide (diaper dermatitis; + karaya or cornstarch powder and wash w/ mild soap)
> ABX ointment (yeast-related dermatitis)
> Varicella vaccine: 1 in 25 people develop mild rash

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Milestones
3-4 months – strabismus disappears
5 months – primitive reflexes (moro, rooting, tonic neck) disappear
6 months – weighs double birth weight
8 months – sit unsupported
9-18 months – anterior fontanel closes
10 months – first word, stand while holding onto furniture
11 months – roll a ball to another person
18 months – vocab of at least 10 words
4 years – cuts shape using scissors
5 years – draws stick figure with 7 body parts
6 years – IDs right from left hand; uses utensil to spread butter
Tonsillectomy:
Limit activity postop for 10 days to decrease risk of hemorrhage
Avoid milk products as they can initiate cough response
Avoid red/brown foods postop so food and fresh/old blood can be distinguishable in vom
Notify provider if child is swallowing frequently as this is a sign of bleeding
Do not have child gargle with warm salt water as this is an irritant, for pain relief instead
give pain medication and/or an ice collar
Cardiac catheterization:
Can attend school next day but avoid strenuous activities
Regular diet
Keep site clean and dry for at least 3 days, no tub baths
Remove pressure dressing next day but apply new bandaid daily for at least next 2 days
Trach suctioning of Infant:
Only as often as needed to prevent hypoxia and maintain tube patency
Do not instill 0.9% NaCl prior to suctioning
Set vacuum pressure to 60-100 mmHg
Suction for <5 seconds only
Mononucleosis:
Mildly contagious, occurring sporadically or in groups
Caused by Epstein-Barr virus
No known specific treatment, only symptomatic tx
Diagnosed by Monospot paper blood test
Acute symptoms last 10 days with fatigue lasting up to 4 weeks
If also develops splenomegaly, activities must be restricted for 2-3 months
Ventricular septal defect:
Loud harsh murmur d/t left/right shunting and cardiac hypertrophy, but no dysrhythmias
Coarctation of aorta:
Weak femoral pulses but high BP

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Post-op open fracture repair:
Monitor for increased ESR/CRP (osteomyelitis), increased EBC (infection), and
decreased RBC (hemorrhage)
Hypercyanotic spell of Tetralogy of Fallot:
Place infant in knee-chest position to decrease return of desaturated blood from legs
and direct more blood into pulmonary artery by increasing SVR
Administer morphine IV to decrease infundibular spasms that cause decrease in
pulmonary blood flow and R-L shunting
Continue administration of fluids to decrease viscosity of infant’s blood and risk of CVA
Apply O2 at 100% via face mask to assist with dilation of pulmonary artery and cerebral
oxygen supply
Private rooms:
Positive pressure – allogenic hematopoietic stem cell transplant
Negative pressure – airborne such as measles, varicella, or TB
Contact – hepA, rotavirus
Droplet – Pertussis
DM1:
For finger sticks, puncture to side of finger pad
Give shot of regular insulin 30min before meals
Hypoglycemic? Snack 15g carbs (120mL/4 oz fruit juice or 66g/.5cup ice cream)
When sick, increase fluid intake
Heart failure:
Vomiting – digoxin toxicity
Should have 3-4oz formula every 3 hrs
Should gain 1.5lb per month until 5 months, doubling wt by 6 months
Tunneled central venous access device:
Avoid using scissors when performing dressing changes to prevent accidental cutting
Flush each lumen with heparin solution daily
Use semipermeable transparent dressing to reduce risk of infection
Bicycle safety:
Child should be able to stand on balls of feet when sitting on bike and with flat feet when
straddling center bar
Instruct to ride single file not side by side, wearing light-colored clothing with a
fluorescent stripe, in the direction of the flow of traffic
Cystic fibrosis:
Administer pancreatic enzymes within 30min of meals and snacks
If steathorrhea, increase intake of pancreatic enzymes
Encourage fluid intake to prevent dehydration via sodium/chloride loss thru sweating
Increase fat content in child’s diet to 40% of total calories

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Epiglottitis:
Vaccine during infancy – Haemophilus influenzae type B
Avoid airway such as by obtaining throat culture or using tongue depressor
Prepare for nasotracheal intubation or trach
Kawasaki disease:
Fever lasting 4+ days unresponsive to antipyretics or abx
Strawberry tongue, cracked lips, edema of oral mucosa and pharynx
Cervical lymphadenopathy unilateral nontender >1.5cm
Xerophthalmia – reddening of conjunctiva and dryness of eyes
Tachycardic with gallop rhythm
Long term effects – development of coronary artery aneurysms or MI
Phenytoin therapy:
Gingival hyperplasia
Measles (rubeola):
Koplik spots
Diphertheria:
Hoarseness
Erythema infectiosum (fifth disease):
“Slapped face” rash lasting 1-4 days
Spinal deformities:
Lordosis – anterior convexity of lumbar spine; expected in toddlers but in older children
can indicate flexion contractures, congenital dislocation of hip, or obesity
Kyphosis – increased curvature of thoracic spine; rickets or posture-related
Torticollis – lateral flexion of neck; contracture of sternocleidomastoid muscle;
congenital as due to intrauterine fetal posturing or abnormality in cervical spine, or
acquired as due to traumatic lesion of sternocleidomastoid muscle
Scoliosis – unilateral rib hump with hip flexion resulting from lateral S or C shaped
curvature in thoracic spine resulting asymmetry; from neuromuscular or connective
tissue disorder, or congenital
Diaper dermatitis:
Do not use talcum powder as this has been linked to respiratory disorders in infants
Pavlik harness for developmental dysplasia of hip:
Must be worn continuously until hip is stable (6-12 wks)
Parents should not address harness in any way nor apply lotion or powders
Place diaper under the straps
Bacterial meningitis:
Increased CSF pressure, WBC count, and protein concentration
Decreased glucose level

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Rheumatic fever:
Immune response involving heart, joints, skin, and CNS
No need to restrict sodium intake nor visitors (not contagious)
Maintain bedrest to prevent cardiac damage and administer salicylates (aspirin) to
decrease fever, discomfort, and inflammation

PHARM
Equations
> To find GTT/MIN: ((volume in mL)/(time in min))*((drop factor in gtt)/1mL)) = X gtt/min

Ranges
> Hgb: Men (13.5-17.5) / Women (12-15.5)
> Hct: Men (38.8-50) / Women (34.9-44.5)
> RBC: Men (4.7-6.1) / Women (4.2-5.4)
> WBC: 4.5k - 11k
> Plt: 150k-450k
> Neutrophils: 1.5k-8k
> aPTT: 30-40 / PTT: 60-70
> INR: <1.1 OR if taking warfarin, 2-3 OR if recurrent systemic embolism 3-4.5
> ESR: Men (<15) / Women (<20)
> CPK: 22-198
> CRP: <3
> Sodium: 135-145
> Potassium: 3.5-5
> Phosphorus: 2.5-4.5
> Calcium: 8.5-10.2
> UO: 30 mL/hr
> Creatinine: Men (0.6-1.2) / Women (0.5-1.1)
> Albumin: 3.4-5.4
> BUN: 7-20
> BMI: 18.5-24.9
> HDL: Men (50-59) / Women (40-50)
> T4: 4.6-12

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Interactions
> Albuterol (respiratory issues) + caffeine = CNS overstimulation ie. tremors
> Felodipine (HTN) + grapefruit = inhibited metabolism and increased serum levels of
the medication
> Warfarin (deep vein thrombosis) + vitK such as in green leafy veggies = inhibited
anticoagulation
> Lithium (manic phase of bipolar disorder) + NSAIDS such as ibuprofen = increased
lithium levels
> Ciprofloxacin (UTI) + tendonitis = Risk for tendon rupture
> Ciprofloxacin (UTI) + caffeine = CNS overstimulation
> Ciprofloxacin (UTI) + milk = absorption interference (avoid calcium for 6 hr before and
2 hr after taking med)
> Ciprofloxacin (UTI) + crushing = inhibited effectiveness as this med is an XR tablet
> Prednisone (acute bronchitis) + vaccines = Risk for infection as glucocorticoids are
immunosuppressants
> Celebrex aka celecoxib (arthritic pain): NSAID; Pts who are allergic to this may also
be cross-allergic to thiazide diuretics such as Diuril {and
trimethoprim/sulfamethoxazole?}
> Penicillin (bacterial infection): Pts who are allergic to this may also be cross-allergic to
cephalosporins such as Cephalexin
> Timolol (glaucoma): Beta blocker that should not be taken if pt has history of
bradycardia which would be worsened; Can be taken concurrently with loratidine
(allergies) but may cause dry eyes which is managed by saline eye drops
> Spironolactone (HF) potassium sparing diuretic + Enalapril (HF) ACE inhibitor =
hyperkalemia
> Sildenafil (ED) + Nitroglycerin (angina) = vasodilation and thus significant hypotension

Notes
> Hydroxyurea (sickle cell anemia): Toxicity = Low Hgb, Low Plt, Low neutrophils
> Dopamine (cardiogenic shock): Catecholamine to increase BP, increase UO, does not
affect respiratory

12
> Atropine (myasthenia gravis): To reverse cholinergic crisis
> Naloxone aka Buprenorphine (opioid toxicity)
> Methadone (opioid toxicity)
> Flumazenil (benzodiazepine toxicity): Treats overdose of diazepam
> Protamine sulfate (heparin toxicity)
> Ephinephrine [pre-filled injector] (anaphylaxis): Administer IM then massage site for
10 sec, instruct to expect usually 1 but sometimes 2 injections and to store at room
temperature in a dark place
> Desmopressin (diabetes insipidus): Risk for water intoxication; Monitor urine specific
gravity, creatinine clearance, serum osmolality
> Chemotherapy (cancer): High risk of fetal malformations so pts should not be trying to
get pregnant
> Rosuvastin (hypercholesterolemia): Adverse effect is myopathy which can progress to
fatal rhabdomyolysis so instruct to notify provider if muscle pain/weakness
> Fentanyl [patch] (end of life care): Opioid; May cause urinary retention and
constipation so pt needs concurrent stool softener daily; Antidote Naloxone to reverse
severe respiratory depression only for use in acute care setting not at home; Even if
patch is removed, adverse effects will persist for several hours
> Pegfilgrastim (cancer): Increases WBC
> Mannitol [IV] (acute angle closure glaucoma) (ICP): Decreases intraocular pressure
and increases diuresis; Monitor UO, BP, and lung fields; Instruct pt to report headache
to provider which indicates rebound increase in ICP; Other adverse effect include
muscle rigidity
> Rifampicin (tuberculosis)
> Isoniazid (tuberculosis)
> Mirtazapine (depression)
> Temazepam (insomnia)
> Infliximab (severe Crohn's disease) (arthritis)
> Acetaminophen (chronic pain): Risk for overdose when dosage exceeds 4000mg/day
> Percocet aka Acetaminophen/Oxycodone mix (breakthrough pain): Opioid that
contains either 325-650mg acetaminophen

13
> Parnate aka tranylcypromine (depression): Orthostatic hypotension is common so
instruct pt to move slowly when standing up; Must avoid foods that contain tyramine
such as figs and overripe banana; Adverse effects include weight gain and GI problems
such as diarrhea or constipation
> Methylphenidate (ADHD): May cause HTN due to stimulant effect, weight loss due to
appetite suppression
> Spironolactone (cirrhosis) (CHF): Potassium sparing diuretic that treats high BP and
fluid retention but may cause hyponatremia and hyperkalemia and thus lethargy and
diarrhea
> Sumatriptan (headaches): May cause drowsiness, and coronary vasospasms
resulting in angina which must be reported to provider
> Nitroglycerin [self-administered patch] (angina): Instruct pt to apply to hair-free area
and rotate location, contact provider if headache, and check BP 1 hr prior to application
> Warfarin (DVT): Instruct pt that coagulation time will be determined daily during the
1st week of therapy, to elevate legs when sitting to reduce risk of venous stasis, and
notify provider of black/tarry stools
> Isotretinoin (severe nodulocystic acne vulgaris): Before starting or refilling, a
pregnancy test is required and clients must not get pregnant as this drug is teratogenic
> Lomotil aka diphenoxylate/atropine mix (diarrhea): Decreases intestinal motility and
peristalsis so monitor for abdominal distension, and dry mouth
> Prednisone (rheumatoid arthritis): Glucocorticoid that can cause sodium/fluid retention
and edema, hyperglycemia, appetite stimulation and weight gain, and insomnia and
anxiety
> Methotrexate (rheumatoid arthritis): Taken weekly, anti-inflammatory effects begin at
3-6 weeks; May cause drowsiness, and stomatitis mouth sores which should be
reported to provider
> Ondansetron (nausea/vomiting): Anti-emetic
> Magnesium sulfate (anti-convulsant): Electrolyte replacement
> Metoprolol (myocardial infarction): Monitor for hypoglycemia, thrombocytopenia, and
bilateral lung crackled which may indicate adverse effects of reduced cardiac output and
heart failure

14
> Bactrim aka trimethoprim/sulfamethoxazole (bacterial infection): Instruct pt to increase
water intake to 8-10 cups aka 64-80 oz per day to decrease risk of renal damage from
crystalluria aka kidney stones
> Lisinopril (HTN) (CHF): ACE inhibitor; Adverse effects to report include severe
headache, facial edema, and dry cough from bradykinin buildup in which case the pt
must stop taking the med immediately
> Oxytocin (labor induction): Discontinue if resting uterine pressure is above 15-
20mmHg, uterine contracting occur more often than every 2-3 min, contractions have
pressure of 50+mmHg, and/or if contractions persist for 60+seconds
> Pilocarpine [eyedrops] (glaucoma): Instruct pt that it can interfere with vision so driving
must be postponed until vision clears, cause transient brow pain which usually
disappears 10-14 days after initiation, cause adverse reactions in other parts of the
body, and must be taken for the rest of the the pt's life
> Risedronate (osteoporosis): Instruct pt to take in morning before ingesting anything
besides water, not to drink milk with med, to take antacid containing calcium or
aluminum or magnesium either 2 hr before or 2 hr after, and to sit upright for 30-60 min
to reduce adverse GI effects such as esophagitis and dyspepsia
> Captopril (HTN/HF): ACE inhibitor that can cause hypotension so instruct pt to change
positions slowly, take 1 hr before meals
> Cyclosporine (post liver transplant): Monitor for signs of nephrotoxicity such as high
creatinine
> Zidovudine (HIV): Monitor for signs of anemia such as low Hgb
> Digoxin (HF/arrhythmias): Increases cardiac contractility; Withhold if HR <60/min
> Isosorbide mononitrate (angina pectoris): Withhold if SBP is below certain range
> Epoetin alfa (anemia): Stimulates bone marrow production of RBC so Hgb would
show efficacy
> Gentamicin (infection): Potentially ototoxic so instruct pt to report any hearing loss or
changes to provider asap
> Lactobacillus acidophilus (diarrhea): Recolonizes intestinal flora if normal flora is
lacking
> Lovastatin (hypocholesteremia)

15
> Furosemide (HTN): Reduces circulating blood volume; Watch for hyponatremia
> Nitroglycerine (HTN): Dilates coronary arteries and lowers BP
> Omeprazole (GERD): Proton pump inhibitor that suppresses gastric acid production
> Antacids (heartburn): neutralize gastric acid
> Ranitidine (peptic ulcer disease)
> Hydromorphone (biliary colic pain)
> Phenytoin (seizures)
> Enalapril (HTN): Assess and instruct on orthostatic hypotension
> Acetylcystine (COPD): Thins pulmonary secretions so pt is better able to cough up
secretions
> Psyllium (constipation): Stir med briskly and take immediately after mixing to prevent
clumping; Take after meals to prevent appetite suppression; Follow each dose with
additional 240mL/8oz of liquid; Expect results in 12-24hrs and regularly in 2-3 days
> Heparin (DVT, PE, thromboembolism): Do not use suppositories; Avoid flossing; Use
electric razor; Feel free to eat green leafy veggies
> Lidocaine (premature ventricular contractions): Anti-dysrhythmic
> Norepinephrine (low BP) (HF): Vasoconstrictor
> Amityriptyline (depression): Monitor for urinary retention d/t anticholinergic effect
> Atomoxetine (ADHD): Monitor for dark urine which indicates liver failure, for weight
loss d/t reduced appetite, for fatigue, and for sweating
> Dextroamphetamine (ADHD): Expect wt loss and constipation; Administer after
breakfast and 6 hrs before bedtime
> Fluoxetine (depressive disorder): SSRI; Expect dry mouth, wt loss, and possibly
sexual dysfunction such as anorgasmia and impotence (contact provider if these occur);
Improvements takes 1-3+ wks;
> Lithium (manic phase of BPD): Monitor for and report hyponatremia as decreased
sodium indicates reduced renal excretion of lithium and thus risk of lithium toxicity
> Succinylcholine (ECT): Muscle-paralyzing agent that decreases muscle movement
during procedure to minimize risk of injury

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