Medical and Surgical Nursing

Emergency Nursing

Prepared by: Mark Fredderick R. Abejo R.N, M.A.N

Emergency Nursing Abejo

MEDICAL AND SURGICAL NURSING

Emergency Nursing

Lecturer: Mark Fredderick R. Abejo R.N, M.A.N

A. General information

1. Emergency nursing deals with human

responses to any trauma or sudden illness

that requires immediate intervention to

prevent imminent severe damage or death

2. Care is provided in any setting to persons of

all ages with actual or perceived alterations

in physical or emotional health.

3. Initially, patients may not have a medical

diagnosis.

4. Care is episodic when patients return

frequently, primary when it is the initial

option for health or preventive care, or acute

when patients need immediate and

additional interventions.

5. Emergency nursing is a specialty area of

the nursing profession like no other.

6. Emergency nurses must be ready to treat a

wide variety of illnesses or injury situations,

ranging from a sore throat to a heart attack.

B. Historical Development of Emergency Nursing

1. Florence Nightingale was the first

emergency nurse, providing care to the

wounded in the Crimean War in 1854

2. The Emergency Department Nurses

Association (EDNA) was organized in 1970

3. A competency-based examination, first

administered in 1980, provides Certification

in Emergency Nursing; certification is valid

for 4 years

4. EDNA developed Standards of Emergency

Nursing Practice, published in 1983, to be

used as a guideline for excellence and

outcome criteria against which performance

is measured and evaluated.

5. In 1985, the Association name was changed

to Emergency Nurses Association (ENA),

recognizing the practice of emergency

nursing as role-specific rather than site-

specific.

6. Originally ENA aimed at teaching and

networking, the organization has evolved

into an authority, advocate, lobbyist, and

voice for emergency nursing. It has 30,000+

members and continues to grow, with

members representing over 32 countries

around the world.

C. Emergency Care Environment

1. Prehospital care by emergency medical

services (EMS), emergency medical

technicians, and paramedics provides initial

stabilizations and transport of patients;

personnel communicate with the emergency

department during patient transport

2. The national emergency telephone number

911 is the result of an effort to improve

access to EMS

3. The concept of the emergency room has

expanded to that of the emergency

department, which provides various levels of

care

4. Specialized electronic technology and

techniques are used to monitor patient status

continuously; these may pose safety hazards

to patients, such as possible exposure to

electric shock

D. Triage

1. Triage classifies emergency patients for

assessment and treatment priorities

2. Triage decisions require gathering objective

and subjective data rapidly and effectively to

determine the type of priority situation

present

3. Emergent situations are potentially life-

threatening; they include such conditions as

respiratory distress or arrest, cardiac arrest,

severe chest pain, seizures, hemorrhage,

severe trauma resulting in open chest or

abdominal wounds, shock, poisonings, drug

overdoses, temperatures over 105°F

(40.5°C), emergency childbirth, or delivery

complications

4. Urgent situations are serious but not life-

threatening if treatment is delayed briefly;

they include such conditions as chest pain

without respiratory distress, major fractures,

burns, decreased level of consciousness,

back injuries, nausea or vomiting, severe

abdominal pain, temperature between 102

and 105°F (38.9 and 40.5° C), bleeding from

any orifice, acute panic, or anxiety

5. Nonemergency situations are not acute and

are considered minor to moderately severe;

they include such conditions as chronic

backache or other symptoms, moderate

headache, minor burns, fractures, sprains,

upper respiratory or urinary infections, or

instances in which a patient is dead on

arrival

E. Roles of the Emergency Nurse

1. Care provider: provides comprehensive

direct care to the patient and family.

2. Educator: provides patient and family with

education based on their learning needs and

the severity of the situation and allows the

patient to assume more responsibility for

meeting health care needs

Medical and Surgical Nursing

Emergency Nursing

Prepared by: Mark Fredderick R. Abejo R.N, M.A.N

Emergency Nursing Abejo

3. Manager: coordinates activities of others in

the multidisciplinary team to achieve the

specific goal of providing emergency care

4. Advocate: ensures protection of the

patient’s rights

F. Functions of the Emergency Nurse 1. Uses triage to determine priorities based on

assessment and anticipation of the patient’s

needs

2. Provides direct measures to resuscitate, if

necessary

3. Provides preliminary care before the patient

is transferred to the primary care area

4. Provides health education to the patient and

family

5. Supervises patient care and ancillary

personnel

6. Provides support and protection for the

patient and family

G. Legal issues affecting the provision of

emergency nursing

1. Negligence

2. Malpractice

3. Good Samaritan Laws (these statutes may

protect private citizens but usually do not

apply to emergency personnel on duty or in

normal emergency situations)

4. Informed consent

5. Implied consent

6. Duty to report suspected crimes to the police

7. Duty to gather evidence in criminal

investigations; be aware of hospital policy

and state laws for evidence collection

8. Advanced directives, including durable

power of attorney and living wills

H. Qualifications of an Emergency Nurse

1. An emergency nurse is a registered nurse

with specialized education and experience in

caring for emergency patients.

2. Emergency nurses continually update their

education to stay informed of the latest

trends, issues, and procedures in medicine

today.

3. Many take a special examination that proves

their level of knowledge. After successful

completion of this exam they are certified

in emergency nursing.

4. Some emergency nurses also acquire

additional certifications in the areas of

trauma nursing, pediatric nursing, nurse

practitioner, and various areas of injury

prevention

5. Many emergency nurses acquire additional

certifications in the areas of trauma nursing,

pediatric nursing, nurse practitioner, and

various areas of injury prevention

EMERGENCY DRUGS

1) AMINOPHYLLINE

Brand Names: Phil Pharmawealth/Atlantic

Aminophylline amp Theofil amp

Classification: Antiasthmatic & COPD Preparations

Dosage: Initial: 225-450 mg twice daily, increased if

needed. IV Acute severe bronchospasm. Loading

dose: 5 mg/kg (ideal body wt). Maintenance: 0.5

mg/kg/hr. Rate should not exceed 25 mg/min.

Indication: PO Chronic bronchospasm as hydrate

Action: Increases the level of cAMP resulting in

bronchodilation

Adverse Reactions: Nausea, vomiting, abdominal

pain, diarrhea, headache, insomnia, dizziness,

anxiety, restlessness; tremor, palpitations. Potentially

Fatal: Convulsions, cardiac arrhythmias, hypotension

and sudden death after too rapid IV injection.

Nursing Measures:

Administer to pregnant patients only when

clearly needed—neonatal tachycardia,

jitteriness, and withdrawal apnea observed

when mothers received xanthines up until

delivery.

Caution patient not to chew or crush enteric-

coated timed-release forms.

Give immediate-release, liquid dosage forms

with food if GI effects occur.

Do not give timed-release forms with food;

these should be given on an empty stomach

1 hr before or 2 hr after meals.

Maintain adequate hydration.

Monitor results of serum theophylline levels

carefully, and arrange for reduced dosage if

serum levels exceed therapeutic range of

10–20 mcg/mL.

Take serum samples to determine peak

theophylline concentration drawn 15–30 min

after an IV loading dose.

Monitor for clinical signs of adverse effects,

particularly if serum theophylline levels are

not available.

Ensure that diazepam is readily available to

treat seizures.

Take this drug exactly as prescribed; if a

timed-release product is prescribed, take this

drug on an empty stomach, 1 hr before or 2

hr after meals.

Do not to chew or crush timed-release

preparations.

Administer rectal solution or suppositories

after emptying the rectum.

It may be necessary to take this drug around

the clock for adequate control of asthma

attacks.

Medical and Surgical Nursing

Emergency Nursing

Prepared by: Mark Fredderick R. Abejo R.N, M.A.N

Emergency Nursing Abejo

Avoid excessive intake of coffee, tea, cocoa,

cola beverages, chocolate.

Smoking cigarettes or other tobacco

products impacts the drug's effectiveness.

Try not to smoke. Notify the care provider if

smoking habits change while taking this

drug.

Frequent blood tests may be necessary to

monitor the effect of this drug and to ensure

safe and effective dosage; keep all

appointments for blood tests and other

monitoring.

These side effects may occur: Nausea, loss

of appetite (taking this drug with food may

help if taking the immediate-release or

liquid dosage forms); difficulty sleeping,

depression, emotional lability (reversible).

Report nausea, vomiting, severe GI pain,

restlessness, seizures, irregular heartbeat

2) AMIODARONE HYDROCHLORIDE

Brand Names: Anoion tab Cordarone Cordarone

inj Sandoz Amiodarone HCl tab

Classification: Cardiac Drugs

Dosage: PO Initial: 200 mg 3 times/day for 1 wk,

reduce to 200 mg twice daily for a further wk.

Maintenance: 200 mg/day or lowest effective dose.

IV Initial: 5 mg/kg infusion via central venous

catheter. Max: 1.2 g/24 hr.

Indication: Ventricular and supraventricular

arrhythmias.

Action: Blocks potassium chloride leading to

prolongation of action potential duration.

Adverse Reactions: Blue-grey discoloration of skin,

photosensitivity, peripheral neuropathy, paraesthesia,

myopathy, ataxia, tremor, nausea, vomiting, metallic

taste, hypothyroidism, hyperthyroidism, alopecia,

sleep disturbances, corneal microdeposits, hot

flushes, sweating. Heart block, bradycardia, sinus

arrest, hepatotoxicity, heart failure. Potentially Fatal:

Pulmonary toxicity including pulmonary fibrosis and

interstitial pneumonitis, hepatotoxicity, thyrotoxicity.

Ventricular arrhythmias, pulmonary alveolitis,

exacerbation of arrhythmias and rare serious liver

injury. Generally in patients with high doses and

having preexisting abnormalities of diffusion

capacity.

Nursing Measures:

Monitor cardiac rhythm continuously.

Monitor for an extended period when dosage

adjustments are made.

Monitor for safe and effective serum levels

(0.5–2.5 mcg/mL).

Doses of digoxin, quinidine, procainamide,

phenytoin, and warfarin may need to be

reduced one-third to one-half when

amiodarone is started.

Give drug with meals to decrease GI

problems.

Arrange for ophthalmologic exams;

reevaluate at any sign of optic neuropathy.

Arrange for periodic chest x-ray to evaluate

pulmonary status (every 3–6 mo).

Arrange for regular periodic blood tests for

liver enzymes, thyroid hormone levels.

Drug dosage will be changed in relation to

response of arrhythmias; you will need to be

hospitalized during initiation of drug

therapy; you will be closely monitored when

dosage is changed.

Have regular medical follow-up, monitoring

of cardiac rhythm, chest x-ray, eye exam,

blood tests.

These side effects may occur: Changes in

vision (halos, dry eyes, sensitivity to light;

wear sunglasses, monitor light exposure);

nausea, vomiting, loss of appetite (take with

meals; eat small, frequent meals); sensitivity

to the sun (use a sunscreen or protective

clothing when outdoors); constipation (a

laxative may be ordered); tremors,

twitching, dizziness, loss of coordination (do

not drive, operate dangerous machinery, or

undertake tasks that require coordination

until drug effects stabilize and your body

adjusts to it).

Report unusual bleeding or bruising; fever,

chills; intolerance to heat or cold; shortness

of breath, difficulty breathing, cough;

swelling of ankles or fingers; palpitations;

difficulty with vision.

3) ATROPINE SULFATE

Brand Names: Anespin amp Atropol amp Euro-

Med Atropine Sulfate amp Isopto Atropine eye

drops Phil Pharmawealth/Atlantic Atropine amp

Classification: Other Cardiovascular Drugs, Muscle

Relaxants, Mydriatic Drugs, Antidotes, Detoxifying

Agents & Drugs Used in Substance Dependence

Indication/Dosage: IV Bradycardia 500 mcg every

3-5 mins. Total: 3 mg. IV/IM Organophosphorus

poisoning 2 mg every 10-30 mins until muscarinic

effects disappear or atropine toxicity appears. IM/SC

Premed in anesth 300-600 mcg 30-60 mins before

anesth. IV/IM/SC Overdosage w/ other compd

having muscarinic actions 0.6-1 mg, repeat 2 hrly.

Ophth Inflammatory eye disorders As 0.5-1% soln:

1-2 drops 4 times/day. Eye refraction As 1% soln: 1

drop twice daily for 1-2 days before procedure.

Action: An anti-cholinergic that inhibits

acetylcholine at the parasympathetic neuroeffector

Medical and Surgical Nursing

Emergency Nursing

Prepared by: Mark Fredderick R. Abejo R.N, M.A.N

Emergency Nursing Abejo

junction, enhances the conduction of AV node and

increases heart rate

Adverse Reactions: Dry mouth, dysphagia,

constipation, flushing and dryness of skin,

tachycardia, palpitations, arrhythmias, mydriasis,

photophobia, cycloplegia, raised intraocular pressure.

Toxic doses cause tachycardia, hyperpyrexia,

restlessness, confusion, excitement, hallucinations,

delirium and may progress to circulatory failure and

respiratory depression. Eye drops: Systemic toxicity

especially in children, on prolonged use may lead to

irritation, hyperemia, edema and conjunctivitis.

Increased intraocular pressure. Inhalation: Dryness of

mouth, throat. Potentially Fatal: Atrial arrhythmias,

AV dissociation, multiple ventricular ectopics.

Nursing Measures:

Ensure adequate hydration; provide

environmental control (temperature) to

prevent hyperpyrexia.

Have patient void before taking medication

if urinary retention is a problem.

When used preoperatively or in other acute

situations, incorporate teaching about the

drug with teaching about the procedure; the

ophthalmic solution is used mainly acutely

and will not be self-administered by the

patient; the following apply to oral

medication for outpatients:

Take as prescribed, 30 min before meals;

avoid excessive dosage.

Avoid hot environments; you will be heat

intolerant, and dangerous reactions may

occur.

These side effects may occur: Dizziness,

confusion (use caution driving or

performing hazardous tasks); constipation

(ensure adequate fluid intake, proper diet);

dry mouth (suck sugarless lozenges; perform

frequent mouth care; may be transient);

blurred vision, sensitivity to light

(reversible; avoid tasks that require acute

vision; wear sunglasses in bright light);

impotence (reversible); difficulty in

urination (empty the bladder prior to taking

drug).

Report rash; flushing; eye pain; difficulty

breathing; tremors, loss of coordination;

irregular heartbeat, palpitations; headache;

abdominal distention; hallucinations; severe

or persistent dry mouth; difficulty

swallowing; difficulty in urination;

constipation; sensitivity to light.

4) BUMETANIDE

Brand Names: Burinex amp Burinex tab

Classification: Sulfonamide Diuretics

Indication/Dosage: PO edema 1 mg once daily, 2nd

dose 6-8 hr later if needed. Refractory edema Initial:

5 mg/day, may increase dose depending on response.

Max: 10 mg/day. HTN 0.5-1 mg/day. Max: 5

mg/day. IV Pulmonary edema 1-2 mg, repeat 20

mins. later if needed. IV/IM Emergency edema 0.5-1

mg, then adjust according to response.

Action: inhibits Sodium and Chloride reabsorption at

the ascending loop of Henle

Adverse Reactions: Muscle cramps, dizziness,

hypotension, headache, nausea, impaired hearing,

pruritus, ECG changes, musculoskeletal pain, rash,

chest discomfort, renal failure, premature ejaculation,

thrombocytopenia, hypokalemia, hypomagnesaemia,

hyponatremia, hyperuricemia, hyperglycemia,

hypocalcaemia.

Nursing Measures:

Give with food or milk to prevent GI upset.

Mark calendars or use reminders if

intermittent therapy is best for treating

edema.

Give single dose early in day so increased

urination will not disturb sleep.

Avoid IV use if oral use is possible.

Arrange to monitor serum electrolytes,

hydration, liver function during long-term

therapy.

Provide diet rich in potassium or

supplemental potassium.

Record alternate day or intermittent therapy

on a calendar or dated envelopes.

Take the drug early in day so increased

urination will not disturb sleep; take with

food or meals to prevent GI upset.

Weigh yourself on a regular basis, at the

same time, and in the same clothing; record

the weight on your calendar.

These side effects may occur: Increased

volume and frequency of urination;

dizziness, feeling faint on arising,

drowsiness (avoid rapid position changes;

hazardous activities, such as driving; and

alcohol consumption); sensitivity to sunlight

(use sunglasses, sunscreen, wear protective

clothing); increased thirst (suck sugarless

lozenges; use frequent mouth care); loss of

body potassium (a potassium-rich diet, or

supplement will be needed).

Report weight change of more than 3 lb in 1

day; swelling in ankles or fingers; unusual

bleeding or bruising; nausea, dizziness,

trembling, numbness, fatigue; muscle

weakness or cramps.

Medical and Surgical Nursing

Emergency Nursing

Prepared by: Mark Fredderick R. Abejo R.N, M.A.N

Emergency Nursing Abejo

5) CALCIUM GLUCONATE

Brand Names: Phil Pharmawealth/Harson Calcium

Gluconate amp

Classification: Electrolytes

Indication/Dosage: PO Hypocalcaemia 10-50

mmol/day. IV Hypocalcaemic tetany 2.25 mmol via

slow inj , then 58-77 mL of 10% soln diluted and

administered as a continuous IV infusion. Antidote in

severe hypermagnesaemia; Severe hyperkalaemia 10

mL of 10% soln, repeat every 10 mins if needed.

Action: replaces Calcium and maintains Calcium

level

Adverse Reactions: GI irritation; soft-tissue

calcification, skin sloughing or necrosis after IM/SC

inj. Hypercalcaemia characterised by anorexia,

nausea, vomiting, constipation, abdominal pain,

muscle weakness, mental disturbances, polydipsia,

polyuria, nephrocalcinosis, renal calculi; chalky taste,

hot flushes and peripheral vasodilation. Potentially

Fatal: Cardiac arrhythmias and coma.

Nursing Measures:

Make sure prescriber specifies form of

calcium to be given; crash carts may contain

both calcium gluconate and calcium

chloride.

Tell patient to take oral calcium 1 to 11/2

hours after meals if GI upset occurs.

Give I.M. injection in gluteal region in

adults and in lateral thigh in infants. Use

I.M. route only in emergencies when no I.V.

route is available bec. of irritation of tissue

by calcium salts.

Tell patient to take oral calcium with a full

glass of water.

Monitor calcium levels frequently.

Hypercalcemia may result after large doses

in chronic renal failure. Report

abnormalities.

6) CAPTOPRIL

Brand Names: Ace-Bloc tab Capomed tab

Capotec tab Capoten tab Captor tab Captril tab

Cardiovaz tab Conamid tab Hartylox tab Normil

tab Phil Pharmawealth/Panion & BF Captopril tab

Prelat tab Primace tab Retensin tab Spec-Ace tab

Tensoril tab Unihype tab Vasostad tab

Classification: ACE Inhibitors

Indication/Dosage: PO HTN Initial: 12.5 mg twice

daily. Maintenance: 25-50 mg twice daily. Max: 50

mg 3 times/day. Heart failure Initial: 6.25-12.5 mg 2-

3 times/day. Max: 50 mg 3 times/day. Post MI Start 3

days after MI. Initial: 6.25 mg/day, may increase

after several wk to 150 mg/day in divided doses if

needed and tolerated. HTN in diabetic nephropathy

75-100 mg/day in divided doses.

Action: inhibits ACE, reduces Sodium and water

retention, lowers blood pressure

Adverse Reactions: Hypotension, tachycardia, chest

pain, palpitations, pruritus, hyperkalaemia.

Proteinuria; angioedema, skin rashes; taste

disturbance, nonproductive cough, headache.

Potentially Fatal: Neutropenia, usually occurs within

3 mth of starting therapy especially in patients with

renal dysfunction or collagen diseases.

Hyperkalaemia. Anaphylactic reactions.

Nursing Measures:

Administer 1 hr before or 2 hr after meals.

Alert surgeon and mark patient's chart with

notice that captopril is being taken; the

angiotensin II formation subsequent to

compensatory renin release during surgery

will be blocked; hypotension may be

reversed with volume expansion.

Monitor patient closely for fall in BP

secondary to reduction in fluid volume

(excessive perspiration and dehydration,

vomiting, diarrhea); excessive hypotension

may occur.

Reduce dosage in patients with impaired

renal function.

Take drug 1 hr before or 2 hr after meals; do

not take with food. Do not stop without

consulting your health care provider.

Be careful of drop in blood pressure (occurs

most often with diarrhea, sweating,

vomiting, dehydration); if light-headedness

or dizziness occurs, consult your health care

provider.

Avoid over-the-counter medications,

especially cough, cold, allergy medications

that may contain ingredients that will

interact with ACE inhibitors. Consult your

health care provider.

These side effects may occur: GI upset, loss

of appetite, change in taste perception

(limited effects, will pass); mouth sores

(perform frequent mouth care); rash; fast

heart rate; dizziness, light-headedness

(usually passes after the first few days;

change position slowly, and limit your

activities to those that do not require

alertness and precision).

Report mouth sores; sore throat, fever,

chills; swelling of the hands, feet; irregular

heartbeat, chest pains; swelling of the face,

eyes, lips, tongue, difficulty breathing.

Medical and Surgical Nursing

Emergency Nursing

Prepared by: Mark Fredderick R. Abejo R.N, M.A.N

Emergency Nursing Abejo

7) CLONIDINE

Brand Names: Catapin amp Catapres amp

Catapres tab

Classification: Other Antihypertensives

Indication/Dosage: PO HTN Initial: 50-100 mcg 3

times/day. Max: 2,400 mcg/day. Menopausal

flushing; Migraine prophylaxis 50 mcg twice daily,

up to 75 mg twice daily. IV Hypertensive crisis 150-

300 mcg via slow inj. Max: 750 mcg over 24 hr.

Epidural Severe cancer pain Initial: 30 mcg/hr as

continuous infusion in combination w/ an opioid.

Transdermal HTN As patch releasing 100-300 mcg

clonidine base/day at constant rate: Apply once wkly.

Action: stimulates alpha 2 receptors and inhibits

central vasomotor centers, lowers peripheral vascular

resistance, blood pressure, and heart rate

Adverse Reactions: Dry mouth, drowsiness,

dizziness, headache, constipation, impotence, vivid

dreams, urinary retention; dry, itching, burning

sensation in the eye; fluid or electrolyte imbalance,

GI upset, paralytic ileus, orthostatic hypotension,

weakness, sedation, pruritus, myalgia, urticaria,

nausea, insomnia, arrhythmias, agitation. Reduced GI

motility at times may cause paralytic ileus.

Potentially Fatal: Transient hypertension or profound

hypotension, respiratory depression, convulsion.

Clonidine withdrawal syndrome could be life

threatening. Bradycardia, coma and disturbances in

conduction (in individuals with preexisting diseases

of SA/AV nodes, overdose or on digitalis).

Nursing Measures:

Take drug 1 hr before or 2 hr after meals; do

not take with food. Do not stop without

consulting your health care provider.

Be careful of drop in blood pressure (occurs

most often with diarrhea, sweating,

vomiting, dehydration); if light-headedness

or dizziness occurs, consult your health care

provider.

Avoid over-the-counter medications,

especially cough, cold, allergy medications

that may contain ingredients that will

interact with ACE inhibitors. Consult your

health care provider.

These side effects may occur: GI upset, loss

of appetite, change in taste perception

(limited effects, will pass); mouth sores

(perform frequent mouth care); rash; fast

heart rate; dizziness, light-headedness

(usually passes after the first few days;

change position slowly, and limit your

activities to those that do not require

alertness and precision).

Report mouth sores; sore throat, fever,

chills; swelling of the hands, feet; irregular

heartbeat, chest pains; swelling of the face,

eyes, lips, tongue, difficulty breathing.

Take this drug exactly as prescribed. Do not

miss doses. Do not discontinue the drug

unless so instructed. Do not discontinue

abruptly; life-threatening adverse effects

may occur. If you travel, take an adequate

supply of drug.

Use the transdermal system as prescribed;

refer to directions in package insert, or

contact your health care provider with

questions. Be sure to remove old systems

before applying new ones.

Attempt lifestyle changes that will reduce

your BP: stop smoking and using alcohol;

lose weight; restrict intake of sodium (salt);

exercise regularly.

Use caution with alcohol. Your sensitivity

may increase while using this drug.

These side effects may occur: Drowsiness,

dizziness, light-headedness, headache,

weakness (often transient; observe caution

driving or performing other tasks that

require alertness or physical dexterity); dry

mouth (suck on sugarless lozenges or ice

chips); GI upset (eat small, frequent meals);

dreams, nightmares (reversible); dizziness,

light-headedness when you change position

(get up slowly; use caution climbing stairs);

impotence, other sexual dysfunction,

decreased libido (discuss with care

providers); breast enlargement, sore breasts;

palpitations.

Report urinary retention, changes in vision,

blanching of fingers, rash.

8) DIAZEPAM

Brand name: Valium

Classification: Anxiolytics

Dosage: 10mg/2ml

Indication: relief of anxiety, agitation & tension due

to psychoneurotic states & transient situational

disturbances

Action: a benzodiazepine that probably potentiates

the effects of GABA, depresses the CNS &

suppresses the spread of seizure activity

Adverse Reaction: drowsiness,dysarthria, slurred

speech, tremor, transient amnesia, fatigue, ataxia,

headache, insomnia, paradoxical anxiety,

hallucination

Nursing Measures:

Do not administer intra-arterially; may

produce arteriospasm, gangrene.

Change from IV therapy to oral therapy as

soon as possible.

Medical and Surgical Nursing

Emergency Nursing

Prepared by: Mark Fredderick R. Abejo R.N, M.A.N

Emergency Nursing Abejo

Do not use small veins (dorsum of hand or

wrist) for IV injection.

Reduce dose of narcotic analgesics with IV

diazepam; dose should be reduced by at

least one-third or eliminated.

Carefully monitor P, BP, respiration during

IV administration.

Maintain patients receiving parenteral

benzodiazepines in bed for 3 hr; do not

permit ambulatory patients to operate a

vehicle following an injection.

Monitor EEG in patients treated for status

epilepticus; seizures may recur after initial

control, presumably because of short

duration of drug effect.

Monitor liver and kidney function, CBC

during long-term therapy.

Taper dosage gradually after long-term

therapy, especially in epileptic patients.

Arrange for epileptic patients to wear

medical alert ID indicating that they are

epileptics taking this medication.

Discuss risk of fetal abnormalities with

patients desiring to become pregnant.

9) DIGOXIN

Brand name: Digitek, Lanoxicaps, Lanoxin, Novo-

Digoxin (CAN)

Classification: Inotropics

Dosage: 5mg/2ml

Indication: Cardiac failure accompanied by atrial

fibrillation; management of chronic cardiac failure

where systolic dysfunction or ventricular dilatation is

dominant; management of certain supraventricular

arrhythmias, particularly chronic atrial flutter &

fibrillation.

Action: inhibits sodium-potassium activated

adenosine triphosphate, promoting movement of

calcium from extracellular to intra-cytoplasm and

strengthening myocardial contraction, also acts on

CNS to enhance vagal tone

Adverse Reaction: nausea, vomiting, anorexia,

headache, facial pain, fatigue, weakness, dizziness,

drowsiness, disorientation, mental confusion, bad

dreams, convulsions

Nursing Measures:

Monitor apical pulse for 1 min before

administering; hold dose if pulse < 60 in

adult or < 90 in infant; retake pulse in 1 hr.

If adult pulse remains < 60 or infant < 90,

hold drug and notify prescriber. Note any

change from baseline rhythm or rate.

Check dosage and preparation carefully.

Avoid IM injections, which may be very

painful.

Follow diluting instructions carefully, and

use diluted solution promptly.

Avoid giving with meals; this will delay

absorption.

Have emergency equipment ready; have K+

salts, lidocaine, phenytoin, atropine, cardiac

monitor on standby in case toxicity

develops.

Monitor for therapeutic drug levels: 0.5–2

ng/mL.

10) DIPENHYDRAMINE

Brand name: Benadryl

Classification: antihistamine

Dosage: 50mg/ml

Indication: Hay fever, urticaria, vasomotor rhinitis,

angioneurotic edema, drug sensitization, serum &

penicillin reaction, contact dermatitis, atopic eczema,

other allergic dermatoses, pruritus, food sensitivity,

parkinsonism, motion sickness.

Action: prevents histamine mediated responses, drug

provides local anesthesia and suppresses cough reflex

Adverse Reaction: CV and CNS effects, blood

disorders, GI disturbances, anti-muscarinic effects

and allergic reactions.

Nursing Measures:

Monitor carefully, assess for confusion,

delirium, other anticholinergic side effects

and fall risk. Institute measures to prevent

falls.

Assess movement disorder before and after

administration.

Caution patient not to use oral OTC

diphenhydramine products with any other

product containing diphenhydramine,

including products used topically.

It can cause excitation in children. Caution

parents or caregivers about proper dose

calculation; overdosage, especially in infants

and children, can cause hallucinations,

seizures or death Inform patient that this

drug may cause dry mouth. Frequent oral

rinses, good oral hygiene, and sugarless gum

or candy may minimize this effect. Notify

dentist if dry mouth persists for more than 2

weeks.

11) EPINEPHRINE

Brand name:

Epinephrine Bitartrate

Aerosols: Primatene Mist

Epinephrine Borate

Ophthalmic solution: Epinal

Epinephrine Hydrochloride

Injection, OTC nasal solution: Adrenalin Chloride

Medical and Surgical Nursing

Emergency Nursing

Prepared by: Mark Fredderick R. Abejo R.N, M.A.N

Emergency Nursing Abejo

Ophthalmic solution: Epifrin, Glaucon

Insect sting emergencies: EpiPen Auto-Injector

(delivers 0.3 mg IM adult dose), EpiPen Jr. Auto-

Injector (delivers 0.15 mg IM for children)

OTC solutions for nebulization: AsthmaNefrin,

microNefrin, Nephron, S2

Classification: Sympathomimetic, Alpha-adrenergic

agonist, Beta1and beta2-adrenergic agonist, Cardiac

stimulant, Vasopressor, Bronchodilator, Antasthmatic

drug, Nasal decongestant, Mydriatic, Antiglaucoma

drug

Dosage: 1mg/ml

Indication: Acute asthmatic attacks, Advanced

cardiac life support

Action: Naturally occurring neurotransmitter, the

effects of which are mediated by alpha or beta

receptors in target organs. Effects on alpha receptors

include vasoconstriction, contraction of dilator

muscles of iris. Effects on beta receptors include

positive chronotropic and inotropic effects on the

heart (beta1 receptors); bronchodilation, vasodilation,

and uterine relaxation (beta2 receptors); decreased

production of aqueous humor.

Adverse Reaction: drowsiness, headache,

nervousness, tremors, cerebral hemorrhage,

dizziness, weakness, vertigo, pain

Nursing Measures:

Monitor heart rate.

Use extreme caution when calculating and

preparing doses; epinephrine is a very potent

drug; small errors in dosage can cause

serious adverse effects. Double-check

pediatric dosage.

Use minimal doses for minimal periods of

time; "epinephrine-fastness" (a form of drug

tolerance) can occur with prolonged use.

Protect drug solutions from light, extreme

heat, and freezing; do not use pink or brown

solutions. Drug solutions should be clear

and colorless (does not apply to suspension

for injection).

Shake the suspension for injection well

before withdrawing the dose.

Rotate SC injection sites to prevent necrosis;

monitor injection sites frequently.

Keep a rapidly acting alpha-adrenergic

blocker (phentolamine) or a vasodilator (a

nitrate) readily available in case of excessive

hypertensive reaction.

Have an alpha-adrenergic blocker or

facilities for intermittent positive pressure

breathing readily available in case

pulmonary edema occurs.

Keep a beta-adrenergic blocker

(propranolol; a cardioselective beta-blocker,

such as atenolol, should be used in patients

with respiratory distress) readily available in

case cardiac arrhythmias occur.

Do not exceed recommended dosage of

inhalation products; administer pressurized

inhalation drug forms during second half of

inspiration, because the airways are open

wider and the aerosol distribution is more

extensive. If a second inhalation is needed,

administer at peak effect of previous dose,

3–5 min.

Use topical nasal solutions only for acute

states; do not use for longer than 3–5 days,

and do not exceed recommended dosage.

Rebound nasal congestion can occur after

vasoconstriction subsides.

Do not exceed recommended dosage;

adverse effects or loss of effectiveness may

result. Read the instructions that come with

respiratory inhalant products, and consult

your health care provider or pharmacist if

you have any questions.

To give eye drops: Lie down or tilt head

backward, and look up. Hold dropper above

eye; drop medicine inside lower lid while

looking up. Do not touch dropper to eye,

fingers, or any surface. Release lower lid;

keep eye open, and do not blink for at least

30 sec. Apply gentle pressure with fingers to

inside corner of the eye for about 1 min;

wait at least 5 min before using other eye

drops.

These side effects may occur: Dizziness,

drowsiness, fatigue, apprehension (use

caution if driving or performing tasks that

require alertness); anxiety, emotional

changes; nausea, vomiting, change in taste

(eat frequent small meals); fast heart rate.

Nasal solution may cause burning or

stinging when first used (transient).

Ophthalmic solution may cause slight

stinging when first used (transient);

headache or brow ache (only during the first

few days).

Report chest pain, dizziness, insomnia,

weakness, tremor or irregular heart beat

(respiratory inhalant, nasal solution),

difficulty breathing, productive cough,

failure to respond to usual dosage

(respiratory inhalant), decrease in visual

acuity (ophthalmic).

12) FUROSEMIDE

Brand name: Apo-Furosemide (CAN), Furoside

(CAN), Lasix, Myrosemide (CAN)

Classification: loop diuretics

Dosage: 20mg/2ml

Indication: edema, hypertension

Medical and Surgical Nursing

Emergency Nursing

Prepared by: Mark Fredderick R. Abejo R.N, M.A.N

Emergency Nursing Abejo

Action: inhibits Sodium and Chloride reabsorption at

the proximal and distal tubules and the ascending

loop of Henle

Adverse Reaction: vertigo, headache, dizziness,

paresthesia, weakness, restlessness, fever, nocturia,

oliguria, polyguria

Nursing Measures:

Monitor BP after administration

Administer with food or milk to prevent GI

upset.

Reduce dosage if given with other

antihypertensives; readjust dosage gradually

as BP responds.

Give early in the day so that increased

urination will not disturb sleep.

Avoid IV use if oral use is at all possible.

Do not mix parenteral solution with highly

acidic solutions with pH below 3.5.

Do not expose to light, may discolor tablets

or solution; do not use discolored drug or

solutions.

Discard diluted solution after 24 hr.

Refrigerate oral solution.

Measure and record weight to monitor fluid

changes.

Arrange to monitor serum electrolytes,

hydration, liver function.

Arrange for potassium-rich diet or

supplemental potassium as needed.

13) HYDRALAZINE HYDROCHLORIDE

Brand name: Supres

Classification: antihypertension

Dosage: 20mg/ml

Indication: For hypertensive patient

Action: a direct acting peripheral vasodilator that

relaxes arteriolar smooth muscles

Adverse Reaction: tachycardia, palpitation, angina

pectoris, severe headache, dizziness, weight gain, GI

disturbances, pruritus, rashes, nausea and vomiting

Nursing Measures:

Give oral drug with food to increase

bioavailability(drug should be given in a

consistent relationship ti ingestion of food

for consistent response to therapy).

Drug may cause a syndrome resembling

systemic lupus erythematosus (SLE).

Arrange for CBC, LE cell preparations, and

ANA titers before and periodically during

prolonged therapy, even in the

asymptomatic patient. Discontinue if blood

dyscrasias occur. Reevaluate therapy if

ANA or LE tests are positive.

Arrange for pyridoxine if patient develops

symptoms of peripheral neuritis.

Monitor patient for orthostatic hypotension

which is most marked in the morning and in

hot weather, and with alcohol or exercise.

14) HYDROCORTISONE SODIUM

SUCCINATE

Brand name: A-hydroCort, Solu-Cortef

Classification: corticosteroid hormones

Stock Dose:100 mg/ 2 mL, 250 mg/ 2 mL

Indication: endocrine, hematologic, rheumatic &

collagen disorders, dermatologic, ophth, GI, resp &

neoplastic diseases, edematous states, control of

severe incapacitating allergic conditions, TB

meningitis w/ subarachnoid block or impending

block when used concurrently with appropriate anti-

TB chemotherapy, shock secondary to adrenocortical

insufficiency or shock unresponsive to conventional

therapy when adrenocortical insufficiency may be

present

Action: Decreases inflammation, mainly by

stabilizing leukocyte lysosomal membranes,

suppresses immune response, stimulates bone

marrow and influences protein, fat, and carbohydrate

metabolism

Adverse Reactions: fluid and electrolyte

disturbances, decreased carbohydrate tolerance,

impaired wound healing, thin fragile skin, muscle

weakness, steroid myopathy, osteoporosis, aseptic

necrosis, peptic ulceration w/ possible perforation,

cataracts, increased intraocular and intracranial

pressure, growth retardation, Cushingoid state,

protein catabolism, psychic derangements,

exophthalmos, masking of infections, gasping

syndrome, seizures, menstrual irregularities.

Nursing Measures:

Give daily before 9 AM to mimic normal

peak diurnal corticosteroid levels and

minimize HPA suppression.

Space multiple doses evenly throughout the

day.

Do not give IM injections if patient has

thrombocytopenic purpura.

Rotate sites of IM repository injections to

avoid local atrophy.

Use minimal doses for minimal duration to

minimize adverse effects.

Taper doses when discontinuing high-dose

or long-term therapy.

Arrange for increased dosage when patient

is subject to unusual stress.

Use alternate-day maintenance therapy with

short-acting corticosteroids whenever

possible.

Medical and Surgical Nursing

Emergency Nursing

Prepared by: Mark Fredderick R. Abejo R.N, M.A.N

Emergency Nursing Abejo

Do not give live virus vaccines with

immunosuppressive doses of

hydrocortisone.

Provide antacids between meals to help

avoid peptic ulcer.

15) ISOSORBIDE-5- MONONITRATE

Brand name: Imdur

Classification: anti- anginal drug

Stock Dose: SL: 5 mg/mL ; Oral: 30 mg, 60 mg

Indication: prophylactic treatment of angina pectoris

Action: Thought to reduce cardiac oxygen demand

by decreasing preload and afterload. Drug also may

increase blood flow through the collateral coronary

vessels

Adverse Reactions: headache, hypotension w/

dizziness and nausea, tachycardia

Nursing Measures:

Monitor BP and heart rate.

Assess location, duration, intensity, and

precipitating factors of anginal pain.

16) ISOSORBIDE DINITRATE

Brand name: Isoket IV

Classification: anti – anginal drug

Stock: IV amp 10 mg/ 10 mL

Dose: 10 mg/10mL

Indication: unresponsive left ventricular failure

secondary to acute MI, severe or unstable angina

pectoris

Action: Isosorbide dinitrate is a smooth muscle

relaxant. It is particularly effective on vascular and

bronchial smooth muscle. Its systemic cardiovascular

effects are mainly due to a decrease in venous return

(pooling of blood in the peripheral venous system).

Consequently, ventricular end-diastolic pressure and

volume are diminished, thus reducing cardiac work

and implicitly myocardial oxygen requirements. The

arterial vessels are dilated as well, though to a lesser

degree. This results in a slight drop in aortic and

systemic blood pressure relieving the myocardium

from a part of its afterload. These nitrate-induced

changes account for both the antianginal effects of

isosorbide dinitrate and for its beneficial effects in

the treatment of congestive heart failure.

Side effects/ adverse reactions: severe cerebral flow

deficiency and decreased coronary perfusion may

develop, nitrate headache and nausea.

Nursing Measures:

Monitor BP and heart rate.

Assess location, duration, intensity, and

precipitating factors of anginal pain.

17) MAGNESIUM SULFATE

Brand name: Elin Magnesium Sulfate

Classification: anticonvulsant

Dosage: 250 mg/10 mL

Indication: treatment of hypomagnesemia

accompanied by signs of tetany, control of HTN,

encephalophathy & convulsions, prevention &

control of convulsions in patients w/ preeclampsia or

eclampsia, prevention of hypomagnesemia in patients

receiving TPN

Action: may decrease acetylcholine released by

nerve impulses, but its anticonvulsant mechanism is

unknown

Adverse Reactions: flushing, sweating, hypotension,

muscular weakness, sedation & confusion; decreased

deep tendon reflexes; resp. paralysis

Nursing Measures:

Monitor the following: I.V.: Rapid

administration: ECG monitoring, vital signs,

deep tendon reflexes; magnesium, calcium,

and potassium levels; renal function during

administration. Obstetrics: Patient status

including vital signs, oxygen saturation,

deep tendon reflexes, level of consciousness,

fetal heart rate, maternal uterine activity.

Oral: Renal function; magnesium levels;

bowel movements.

18) MEPERIDINE HYDROCHLORIDE

Brand name: Demerol

Classification: antivertigo drug

Dosage: 100 mg/ 2mL

Indication: relief of moderate to severe pain, pre-op

medication, support of anesth & obstet analgesia

Action: binds with opiate receptors in the CNS,

altering perception of and emotional response to pain

Adverse Reactions: resp. depression, circulatory

depression, resp arrest, shock, cardiac arrest, GI

disturbance, light headedness, dizziness, sedation,

nausea, vomiting, sweating, euphoria, dysphoria,

weakness, headache, tremor, agitation, uncoordinated

muscle movements, severe convulsions, transient

hallucinations & disorientation, visual disturbance,

flushing, tachycardia, bradycardia, palpitation,

hypotension, syncope, phlebitis, urinary retention,

allergic reactions, pain at injection site and local

tissue irritation.

Nursing Measures:

Make position changes slowly and in stages

particularly from recumbent to upright

posture. Lie down immediately if light-

headedness or dizziness occurs.

Lie down when feeling nauseated and to

notify physician if this symptom persists.

Nausea appears to worsen with ambulation.

Medical and Surgical Nursing

Emergency Nursing

Prepared by: Mark Fredderick R. Abejo R.N, M.A.N

Emergency Nursing Abejo

Avoid driving and other potentially

hazardous activities until reaction to drug is

known. Codeine may impair ability to

perform tasks requiring mental alertness and

therefore to.

Do not take alcohol or other CNS

depressants unless approved by physician.

Hyperactive cough may be lessened by

avoiding irritants such as smoking, dust,

fumes and other air pollutants.

Humidification of ambient air may provide

some relief.

Do not breast feed while taking this drug.

19) METOCLOPRAMIDE

Brand name: Apo-Metoclop (CAN), Maxeran

(CAN), Maxolon, Nu-Metoclopramide (CAN),

Octamide PFS, Reglan

Classification: antiemetic & anti-spasmodic

Dosage: 10 mg/ 2mL

Indication: disturbances of GI motility, nausea &

vomiting of central & peripheral origin associated w/

surgery, metabolic diseases, infectious & drug

induced diseases, facilitate small bowel intubation &

radiological procedures of GIT

Action: stimulates motility of upper GI tract,

increases lower esophageal sphincter tone, and blocks

dopamine receptors at the chemoreceptor trigger zone

Adverse Reactions: extrapyramidal reactions,

drowsiness, fatigue & lassitude, anxiety, less

frequently, insomnia, headache, dizziness, nausea,

galactorrhea, gynecomastia, bowel disturbances.

Nursing Measures:

Monitor BP carefully during IV

administration.

Monitor for extrapyramidal reactions, and

consult physician if they occur.

Monitor diabetic patients, arrange for

alteration in insulin dose or timing if

diabetic control is compromised by

alterations in timing of food absorption.

Keep diphenhydramine injection readily

available in case extrapyramidal reactions

occur (50 mg IM).

Have phentolamine readily available in case

of hypertensive crisis (most likely to occur

with undiagnosed pheochromocytoma).

20) MIDAZOLAM HYDROCHLORIDE

Brand name: Dormicum

Classification: hypnotics & sedatives

Dosage: 5mg/5mL

Indication: tab: disturbances of sleep rhythm,

insomnia esp difficulty in falling asleep either

initially or after premature awakening, tab/inj:

sedation in premed before surgical or diagnostic

procedures, induction & maintenance of anesth.

Action: may potentiate the effects of GABA, depress

the CNS, and suppress the spread of seizure activity

Adverse Reactions: rarely cardioresp adverse events,

nausea, vomiting, headache, hiccoughs,

laryngospasm, dyspnoea, hallucination, oversedation,

drowsiness, ataxia, rash, paradoxical reactions,

amnesic episodes.

Nursing Measures:

Do not administer intra-arterially, which

may produce arteriospasm or gangrene.

Do not use small veins (dorsum of hand or

wrist) for IV injection.

Administer IM injections deep into muscle.

Monitor IV injection site for extravasation.

Arrange to reduce dose of midazolam if

patient is also being given opioid analgesics;

reduce dosage by at least 50% and monitor

patient closely.

Monitor level of consciousness prior to,

during, and for at least 2–6 hr after

administration of midazolam.

Carefully monitor P, BP, and respirations

carefully during administration.

Keep resuscitative facilities readily

available; have flumazenil available as

antidote if overdose should occur.

Keep patients in bed for 3 hr; do not permit

ambulatory patients to operate a vehicle

following an injection.

Arrange to monitor liver and kidney

function and CBC at intervals during long-

term therapy.

Establish safety precautions if CNS changes

occur (use side rails, accompany ambulating

patient).

Provide comfort measures and reassurance

for patients receiving diazepam for tetanus.

Arrange to taper dosage gradually after

long-term therapy.

Provide patient with written information

regarding recovery and follow-up care.

Midazolam is a potent amnesiac and

memory may be altered.

21) MORPHINE SULFATE

Brand name: Morin

Classification: Analgesics (Opioid)

Dosage: Adult 5-20 mg IM/SC 4 hrly. Severe or

chronic pain Childn 10 mg IM/SC 4 hrly, range: 5-20

mg; 6-12 yr 5-10 mg, 1-5 yr 2.5-5 mg, 1-12 mth 200

mcg/kg, <1 mth 150 mcg/kg 4 hrly. Max: 15 mg.

Analgesic effect Ped 100-200 mcg/kg SC 4 hrly,

max: 15 mg/dose; or 50-100 mcg/kg slow IV. Pre-op

50-100 mcg/kg IM, max: 10 mg/dose.

Medical and Surgical Nursing

Emergency Nursing

Prepared by: Mark Fredderick R. Abejo R.N, M.A.N

Emergency Nursing Abejo

Indication: Relief of moderate to severe pain not

responsive to non-narcotic analgesics. Premed.

Analgesic adjunct in general anesth esp in pain

associated w/ cancer, MI & surgery. Alleviates

anxiety associated w/ severe pain. Hypnotic for pain-

related sleeplessness.

Action: alters perception and emotional response to

pain

Adverse Reactions: Lightheadedness, dizziness,

sedation, nausea, vomiting, constipation & sweating.

Nursing Measures:

Caution patient not to chew or crush

controlled-release preparations.

Dilute and administer slowly IV to minimize

likelihood of adverse effects.

Tell patient to lie down during IV

administration.

Keep opioid antagonist and facilities for

assisted or controlled respiration readily

available during IV administration.

Use caution when injecting SC or IM into

chilled areas or in patients with hypotension

or in shock; impaired perfusion may delay

absorption; with repeated doses, an

excessive amount may be absorbed when

circulation is restored.

Reassure patients that they are unlikely to

become addicted; most patients who receive

opioids for medical reasons do not develop

dependence syndromes.

22) NICARDIPINE HYDROCHLORIDE

Brand name: Cardepine

Classification: Calcium Antagonists

Dosage: IV infusion Dilute to 10-20 mg/100 mL

(conc of 1.01-0.02%). Initial infusion rate: 5 mg/hr;

titrate dose up to 15 mg/hr until desired therapeutic

response is achieved (DBP <95 mmHg, SBP <140

mmHg). Maintenance rate: Can be tapered down to

≤10 mg/hr. IV bolus inj 2-7 mg w/out dilution given

over 1-2 min.

Indication: Hypertensive emergencies or urgencies,

peri-op & post-op HTN, hypertensive states of NPO

patients.

Action: a Calcium channel blocker that inhibits

Calcium ion influx across cardiac and smooth muscle

cells, also dilates coronary arteries and arterioles

Adverse Reactions: Peripheral edema, headache,

tachycardia, palpitations, localized thrombophlebitis

& hypotension.

Nursing Measures:

Patients with hepatic impairment should

receive lower dose.

Monitor blood pressure.Allow atleast 3 days

between dosage adjustment to achieve

steady plasma levels.

Advise patient to report immediately if

experiencing chest pain

23) NTG PATCH

Brand name: Deponit, Minitran, Nitrek, Nitro-Dur,

Nitrodisc, Transderm-Nitro

Classification: Anti-Anginal Drugs

Dosage: Starting dose: 0.2-0.4 mg/hr. Dosing

schedule: Daily patch-on period of 12-14 hr & daily

patch-off period of 10-12 hr.

Indication: Prevention of angina pectoris due to

coronary artery disease

Action: a nitrate that reduces cardiac oxygen demand

by decreasing left ventricular end diastolic pressure

and to a lesser extent, systemic vascular resistance,

also increases blood flow through collateral coronary

vessels

Adverse Reactions: Headache. Transient episodes of

lightheadedness. Infrequently, hypotension. Syncope,

crescendo angina, rebound HTN, allergic &

anaphylactoid reactions. Rarely severe, application

site irritation.

Nursing Measures:

Administer transdermal systems to skin site

free of hair and not subject to much

movement. Shave areas that have a lot of

hair. Do not apply to distal extremities.

Change sites slightly to decrease the chance

of local irritation and sensitization. Remove

transdermal system before attempting

defibrillation or cardioversion.

To use transdermal systems, you may need

to shave an area for application. Apply to a

slightly different area each day. Use care if

changing brands; each system has a different

concentration.

24) PARACETAMOL

Brand name: Aeknil

Classification: Analgesics (Non-Opioid) &

Antipyretics

Dosage: Adult & childn ≥10 yr 2-3 mL, ≤10 yr 1-2

mL. Depending on severity of case, dose may be

repeated 4 hrly. In severe cases, dose may be

administered by IV very slowly

Indication: Pyrexia of unknown origin. Fever & pain

associated w/ common childhood disorders,

tonsillitis, upper resp tract infections post-

immunization reactions, after tonsillectomy & other

conditions. Prevention of febrile convulsion.

Headache, cold, sinusitis, muscle pain, arthritis &

toothache

Medical and Surgical Nursing

Emergency Nursing

Prepared by: Mark Fredderick R. Abejo R.N, M.A.N

Emergency Nursing Abejo

Action: produce analgesia by blocking pain impulses

by inhibiting synthesis of prostaglandin in CNS,

relieves fever

Adverse Reactions: Hematological, skin & other

allergic reactions

Nursing Measures:

Use liquid form for children and patients

who have difficulty swallowing.

In children, don’t exceed five doses in 24

hours.

Advise patient that drug is only for short

term use and to consult the physician if

giving to children for longer than 5 days or

adults for longer than 10 days.

Advise patient or caregiver that many over

the counter products contain acetaminophen;

be aware of this when calculating total

dailydose.

Warn patient that high doses or

unsupervised long term use can cause liver

damage.

25) PHENYTOIN

Brand name: Dilantin

Classification: Anticonvulsants

Dosage: Adult Initially 100 mg tid. Maintenance:

300-400 mg daily. Childn ≥6 yr Initially 100 mg tid,

subsequent dosage should be adjusted according to

therapeutic response, <6 yr 30 mg bid, may be

increased to 30 mg tid or qid. Pedia 5 mg/kg/day

Initially in 2-3 equally divided doses. Max: 300 mg

daily. Maintenance: 4-8 mg/kg/day

Indication: Tonic-clonic & complex partial

(psychomotor, temporal lobe), prevention &

treatment of seizures occurring during or following

neurosurgery

Action: may stabilize neuronal membranes and limit

seizure activity by either by increasing efflux or

decreasing influx of Na ions across cell membrane in

the motor cortex during generation of nerve impulses

Adverse Reactions: GI disturbances; ataxia, slurred

speech; diplopia, nystagmus & mental confusion w/

headache, dizziness, gingival hyperplasia, hirsutism,

hyperglycemia, osteomalacia

Nursing Measures:

Assess location, duration, frequency, and

characteristics of seizure activity. EEG may

be monitored periodically throughout

therapy, Assess oral hygiene. Vigorous oral

cleaning beginning within 10 days of

initiation of phenytoin therapy may help

control gingival hyperplasia.

26) TERBUTALINE

Brand name: Bricalin

Classification: Antiasthmatic & COPD Preparations

Dosage: Antiasthmatic & COPD Preparations

Indication: For reversible airways obstruction, in

asthma, COPD. Decreases uterine contractility &

may be used to arrest premature labor

Action: relaxes bronchial smooth muscles by

stimulating beta-2 receptors

Adverse Reaction: Fine tremor of skeletal muscle

esp hands, palpitations, tachycardia, nervous tension,

headache, peripheral vasodilation.

Nursing Measures:

Use minimal periods of time; drug tolerance

can occur with prolonged use.

Keep beta-adrenergic blocker readily

available in case cardiac arrhythmias occur.

Do not recommended dosage.

27) VERAPAMIL HYDROCHLORIDE

Brand name: Calan, Calan SR, Covera-HS, Isoptin,

Isoptin SR, Verelan, Verelan PM

Classification: Calcium Antagonists

Dosage: Isoptin tab Adult 40-80 mg tid-qid. Max:

480 mg daily. Childn >6 yr 40-120 mg bid-tid, up to

360 mg daily, childn ≤6 yr 40 mg bid-tid. Isoptin SR

180 Coronary insufficiency 1 tab bid. Usual daily

dose: 240-480 mg. Hypertension 1 tab in the

morning. Isoptin SR 240 1 tab in the morning. If

required after 2 wk, increase dose to 2 tab daily.

Isoptin amp 5 mg slow IV, if required, 5 mg after 5-

10 min. Then, if required, continuous drip infusion of

5-10 mg/hr up to 100 mg/day. Angina pectoris &

rapid elimination of tachyarrhythmias 1-2 amp IV, if

required bid-tid

Indication: Isoptin/Isoptin SR 180 Essential

hypertension, chronic coronary insufficiency, angina

pectoris, paroxysmal supraventricular tachycardia,

tachyarrhythmias, long-term treatment after MI.

Isoptin SR 240 Essential hypertension

Action: decreases myocardial contractility and

oxygen demand, it also dilates coronary arteries and

arterioles

Adverse Reactions: Constipation, dizziness, nausea.

Rarely, vertigo, headache, hypotension, ankle edema,

flushing, fatigue, nervousness, erythromelalgia,

paraesthesia, neuropathy; bradycardiac arrhythmias,

CHF. Dyspnea

Nursing Measures:

Monitor patient carefully (BP, cardiac

rhythm, and output) while drug is being

titrated to therapeutic dose. Dosage may be

increased more rapidly in hospitalized

patients under close supervision.

Medical and Surgical Nursing

Emergency Nursing

Prepared by: Mark Fredderick R. Abejo R.N, M.A.N

Emergency Nursing Abejo

Ensure that patient swallows SR tablets

whole: do not cut, crush, or chew them.

Monitor BP very carefully with concurrent

doses of antihypertensives.

Monitor cardiac rhythm regularly during

stabilization of dosage and periodically

during long-term therapy.

Administer sustained-release form in the

morning with food to decrease GI upset.

Protect IV solution from light.

Monitor patients with renal or hepatic

impairment carefully for possible drug

accumulation and adverse reactions.

28) IPRATROPIUM INHALATION

Brand name: Atrovent

Classification: Antiasthmatic & COPD Preparations,

anticholinergics or antimuscarinics

Stock: 0.5 mg/2 mL

Dosage: Adult (including elderly) & adolescent >12

yr Acute attacks 1 vial, may repeat doses until patient

is stable. Maintenance: 1 vial tid-qid.

Indication: Bronchodilator for treatment of

bronchospasm associated w/ COPD, including

chronic bronchitis, emphysema and asthma

Action: it works by binding to specific receptors

(called muscarinic receptors) in the airway, helping

to relax the smooth muscle of the airway. When used

to treat a runny nose, it works by decreasing the

production of fluid in the glands that line the nasal

passages

Adverse Reaction: Headache, nausea, dry mouth,

increased heart rate & palpitations, ocular

accommodation disturbances, GI motility

disturbances, urinary retention, ocular side effects,

cough, local irritation, bronchoconstriction, skin rash,

angioedema, urticaria, laryngospasm, anaphylactic

reactions.

Nursing Measures:

Protect solution for inhalation from light.

Store unused vials in foil pouch.

Use nebulizer mouthpiece instead of face

mask to avoid blurred vision or aggravation

of narrow-angle glaucoma.

Can mix albuterol in nebulizer for up to 1 hr.

Ensure adequate hydration, control

environmental temperature to prevent

hyperpyrexia.

Have patient void before taking medication

to avoid urinary retention.

Teach patient proper use of inhalator.

29) FENOTEROL/IPRATROPIUM BROMIDE

Brand name: Berodual

Classification: Antiasthmatic & COPD Preparations

Dosage: Berodual inhalation soln Adult (including

elderly) & adolescent >12 yr Treatment of 1 mL for

immediate symptom relief. Intermittent & long-term

treatment 1-2 mL for each administration, up to

qid. Moderate bronchospasm or w/ assisted

ventilation 0.5 mL. Childn 6-12 yr Treatment of

attacks 0.5-1 mL. Intermittent & long-term

treatment 0.5-1 mL for each administration, up to

qid. Moderate bronchospasm or w/ assisted

ventilation 0.5 mL. Childn <6 yr (<22 kg body

wt) Up to 0.5 mL up to tid. Berodual F UDV Adult &

childn >12 yr Acute asthma episodes 1 vial, in very

severe cases, 2 vials are needed. Intermittent & long-

term treatment 1 vial up to qid.

Indication: prevention and treatment of symptoms in

chronic obstructive airway disorders with reversible

bronchospasm

Action: for the prevention and treatment of reversible

bronchospasm associated with bronchial asthma and

especially chronic bronchitis with or without

emphysema

Adverse Reactions: Fine tremor of skeletal muscles,

nervousness, restlessness, palpitations; less

frequently tachycardia, dizziness or headache. Dry

mouth, throat irritation or allergic reactions, cough,

paradoxical bronchoconstriction (rare). Urinary

retention may occur in particular, in patients w/

preexisting outflow tract obstruction.

Nursing Measures:

Protect solution for inhalation from light.

Store unused vials in foil pouch.

Use nebulizer mouthpiece instead of face

mask to avoid blurred vision or aggravation

of narrow-angle glaucoma.

Can mix albuterol in nebulizer for up to 1 hr.

Ensure adequate hydration, control

environmental temperature to prevent

hyperpyrexia.

Have patient void before taking medication

to avoid urinary retention.

Teach patient proper use of inhalator.

30) BUDESONIDE

Brand name: Symbicort

Classification: Corticosteroids

Dosage: 80/4.5 mcg x 60 doses; 160/4.5 mcg x 60

doses; 320/9 mcg x 60 doses

Indication: regular treatment of asthma where use of

a combination (inhaled corticosteroid and long acting

beta 2 agonist) is appropriate

Action: work by reducing inflammation, which helps

with several conditions ranging

Medical and Surgical Nursing

Emergency Nursing

Prepared by: Mark Fredderick R. Abejo R.N, M.A.N

Emergency Nursing Abejo

from asthma to allergies toCrohn’s disease

Adverse Reactions: Abdominal pain, conjunctivitis

(pinkeye), cough, diarrhea, ear infection or

inflammation, fever, fungal infection in mouth,

headache, nasal or sinus inflammation, nosebleed,

pain, rash, respiratory infection, stomach or intestinal

inflammation, throat inflammation, viral infection,

vomiting, wheezing

Nursing Measures:

Taper systemic steroids carefully during

transfer to inhalational steroids; deaths from

adrenal insufficiency have occurred.

Arrange for use of decongestant nose drops

to facilitate penetration if edema, excessive

secretions are present.

Prime unit before use for Pulmicort

Turbuhaler; have patient rinse mouth after

each use.

Use aerosol within 6 mo of opening. Shake

well before each use.

Store Respules upright and protected from

light; gently shake before use; open

envelopes should be discarded after 2 wk.

31) ALBUTEROL AND IPRATROPIUM

INHALATION

Brand name: Combivent

Classification: Bronchodilators

Stock: 2.5 mL

Dose: MDI Adult 2 puffs tid-qid. Max 12

puffs/day. Unit dose vial Adult & childn >12 yr 1 vial

every 6-8 hr. Childn 2-12 yr 3 drops/kg/dose (max:

2500 mcg of salbutamol) every 6-8 hr.

Indication: management of reversible bronchospasm

associated with obstructive airway diseases in

patients who require more than a single

bronchodilator

Action: muscles in the airways and increase air flow

to the lungs

Adverse Reactions: Fine tremor of skeletal muscle;

palpitations; headache, dizziness, nervousness;

dryness of mouth, throat irritation; urinary retention

Nursing Measures:

Use nebulizer mouthpiece instead of face

mask to avoid blurred vision or aggravation

of narrow-angle glaucoma.

Can mix albuterol in nebulizer for up to 1 hr.

Ensure adequate hydration, control

environmental temperature to prevent

hyperpyrexia.

Have patient void before taking medication

to avoid urinary retention.

Teach patient proper use of inhalator.

32) SALBUTAMOL

Brand name: Aero-Vent

Classification: bronchodilator

Stock: 1 mg/1 mL

Dose: Adult & childn 2.5-5 mg. May repeat qid by

hlebitis. Delivery of aerosol may be by face mask

of ―T‖ piece. Use undiluted. For prolonged delivery

time, dilute w/ sterile water or normal saline for inj.

Indication: treatment of acute, severe asthma and in

routine management of chronic bronchospasm

unresponsive to conventional therapy

Action: used with anti-inflammatory medication to

prevent asthma attacks, Some of these medicines are

used to treat the symptoms of asthma, chronic

bronchitis, emphysema, and other lung diseases,

while others are used to prevent the symptoms

Adverse Reactions: Dizziness, severe; feeling of

choking, irritation, or swelling in throat; flushing or

redness of skin; hives; increased shortness of breath;

skin rash; swelling of face, lips, or eyelids; tightness

in chest or wheezing, troubled breathing

Nursing Measures:

Assess lung sounds, pulse, and blood

pressure before administration and during

peak of medication. Note amount, color, and

character of sputum produced.

Monitor pulmonary function tests before

initiating therapy and periodically

throughout course to determine effectiveness

of medication.

Observe for paradoxical bronchospasm

(wheezing). If condition occurs, withhold

medication and notify physician or other

health care professional immediately.

Instruct mother to take missed dose as soon

as remembered, spacing remaining doses at

regular intervals. Do not double doses or

increase the dose or frequency of doses.

Inform the mother not to smoke near the

child and to avoid respiratory irritants.

Advise the mother to rinse the child’s mouth

with water after each inhalation dose to

minimize dry mouth.

33) TERBUTALINE SULFATE

Brand name: Pulmonyl

Classification: Antiasthmatic/ Brochodilator

Stock: 2.5 mg/ml

Dose: Adult 5-10 mg, Children 2-5mg

Indication: relief of bronchospasm in obstructive

airway diseases

Action: It works by dilating (opening) the

bronchioles of the lungs by relaxing the muscles

around them. This allows for easier airflow into and

out of the lungs

Medical and Surgical Nursing

Emergency Nursing

Prepared by: Mark Fredderick R. Abejo R.N, M.A.N

Emergency Nursing Abejo

Adverse Reactions: Headache, nausea, vomiting,

palpitations, tachycardia, sweating & drowsiness

Nursing Measures:

Use minimal periods of time; drug tolerance

can occur with prolonged use.

Keep beta-adrenergic blocker readily

available in case cardiac arrhythmias occur.

Do not recommended dosage.

34) HEPARIN SODIUM

Brand name: Britton Heparin Na

Classification: Anticoagulants, Antiplatelets &

Fibrinolytics (Thrombolytics)

Dosage: 5000 iu/1 mL; 25000 iu/1 mL

Indication: treatment and prophylaxis of

thromboembolic disorders

Action: Accelerates formation of antithrombin III-

thrombin complex and deactivates thrombin,

preventing conversion of fibrinogen to fibrin

Adverse Reactions: Slight fever, headache, chills,

nausea, vomiting, constipation, epistaxis, bruising,

slight haematuria, skin necrosis (SC inj),

osteoporosis, alopecia. Hypersensitivity reactions

include urticaria, conjunctivitis, rhinitis, asthma,

angioedema and anaphylactic shock. Priapism.

Potentially Fatal: Heparin-induced thrombocytopenia

with or without thrombosis; bleeding

Nursing Measures:

Baseline blood coagulation tests, Hct, Hgb,

RBC and platelet counts prior to initiation or

therapy and at regular intervals throughout

therapy

Monitor APTT levels closely

Draw blood for coagulation tests 30 min

before each scheduled SC or intermittent IV

dose and approximately q4h for pts

receiving continuous IV heparin during

dosage adjustments period. After dosage is

established, tests may be done once daily

Pts vary widely in their reaction to heparin;

risk of hemorrhage appears greatest in

women, all patients > 60 y, and patients with

liver disease or renal insufficiency.

Monitor vitals, report fever, drop in BP,

rapid pulse and other S&S of hemorrhage

Observe all needle sites daily for hematoma

and signs of inflammation

Have on hand protamine sulfate, specific

heparin antagonist

35) ESMOLOL HYDROCHLORIDE

Brand name: Brevibloc

Classification: Beta blockers

Dosage: 100mg/10ml

Indication: supraventricular tachycardia; post-

operative tachycardia or hypertension; non-

compensatory sinus tachycardias; intra-operative

tachycardia or hypertension; unstable angina, non ST

segment elevation MI

Action: A Class II antiarrythmic and ultra-short-

acting selective beta blocker that decreases heart rate,

contractility and blood pressure

Adverse Reactions: Hypotension, bradycardia, heart

failure, local irritation, diaphoresis, peripheral

ischaemia, dizziness, somnolence, confusion, fatigue,

paraesthesia, peripheral neuropathy, headache,

weakness, irritability, dyspnoea, nausea, vomiting,

blurred vision, urinary retention, fever, rigor,

muscular pain. Potentially Fatal: Profound

bradycardia, AV block, cardiogenic shock, asystole,

bronchospasm.

Nursing Measures:

Monitor patient carefully (BP, cardiac

rhythm, and output) while drug is being

titrated to therapeutic dose. Dosage may be

increased more rapidly in hospitalized

patients under close supervision.

Monitor cardiac rhythm regularly during

stabilization of dosage and periodically

during long-term therapy.

36) D 50-50

Brand name: Phil Pharmawealth/Atlantic 50%

Dextrose

Classification: Intravenous & Other Sterile Solutions

Dosage: 50ml/vial

Indication: for hypoglycemia

Action: A simple water soluble sugar that minimizes

glyconeogenesis and promotes anabolism in patients

whose oral caloric intake is limited

Adverse Reactions: Local pain, vein irritation,

thrombophlebitis & tissue necrosis in the event of

extravasation. Fluid & electrolyte imbalance eg

hypokalemia, hypomagnesemia &

hypophosphatemia; edema or water intoxication

Nursing Measures:

Monitor infusion rate frequently; if signs of

fluid overload, turn off IV drip. Infusion

may result in fluid overload.

Check IV site frequently and if infiltration is

noted, turn off IV drip.

Watch out for signs of fluid overload

(distended neck veins (JVD), rapid

respirations, shallow tidal volume, fine

auscultatory crackles, dyspnea, and

peripheral edema)

Watch out for signs of infiltration (swelling

and pain around IV site).

Medical and Surgical Nursing

Emergency Nursing

Prepared by: Mark Fredderick R. Abejo R.N, M.A.N

Emergency Nursing Abejo

37) POTASSIUM CHLORIDE

Brand name: Phil Pharmawealth/Atlantic Potassium

Chloride

Classification: Electrolytes

Dosage: 40 meqs/20 ml

Indication: for hypokalemia, acute MI

Action: Replaces potassium and maintains potassium

level

Adverse Reactions: GI ulceration (sometimes with

haemorrhage and perforation or with late formation

of strictures) following the use of enteric-coated K

chloride preparation; hyperkalaemia. Oral: Nausea,

vomiting, phlebiti and abdominal cramps. IV: Pain or

phlebitis; cardiac toxicity.

Nursing Measures:

Monitor serum potassium levels, renal

function, and serum bicarbonate.

Explain to patient purpose of the medication

and the need to take as directed,especially

when concurrent digoxin or diuretics are

taken. A missed dose should be taken as

soon as remembered within 2 hr; if not,

return to regular doseschedule. Do not

double dose.

Emphasize correct method of

administration. GI irritation or ulceration

may result from chewing enteric-coated

tablets or insufficient dilution of liquid or

powder forms. Some extended-release

tablets are contained in a wax matrix that

may be expelled in the stool. This

occurrence is not significant.

Instruct patient to avoid salt substitutes or

low-salt milk or food unless approved by

health care professional.

Patient should be advised to read all labels

to prevent excess potassium intake.

Advise patient regarding sources of dietary

potassium.

Encourage compliance with recommended

diet.

Instruct patient to report dark, tarry, or

bloody stools; weakness; unusual fatigue; or

tingling of extremities.

Notify health care professional if nausea,

vomiting, diarrhea, or stomach discomfort

persists.

Dosage may require adjustment. Emphasize

the importance of regular follow-up exams

to monitor serum levels and progress.

38) LIDOCAINE HYDROCHLORIDE

Brand name: Abbott Lidocaine

Classification: Anaesthetics - Local & General

Dosage: 50 ml/vial

Indication: local or regional anesthesia

Action: A class IB antiarrythmic that decreases the

depolarization, automaticity, and excitability in the

ventricles during the diastolic phase by direct action

on the tissues especially the Purkinje network

Adverse Reactions: Restlessness, nervousness,

dizziness, tinnitus, blurred vision; GI upsets; muscle

twitching, convulsions; numbness of the tongue;

hypotension, bradycardia; methemoglobinaemia;

fetal intoxication.

Nursing Measures:

Check drug concentration carefully; many

concentrations are available.

Reduce dosage with hepatic or renal failure.

Continuously monitor response when used

as antiarrhythmic or injected as local

anesthetic.

Keep life-support equipment and

vasopressors readily available in case severe

adverse reaction (CNS, CV, or respiratory)

occurs when lidocaine is injected.

Establish safety precautions if CNS changes

occur; have IV diazepam or short-acting

barbiturate (thiopental, thiamylal) readily

available in case of seizures.

Monitor for malignant hyperthermia (jaw

muscle spasm, rigidity); have life-support

equipment and IV dantrolene on standby.

Titrate dose to minimum needed for cardiac

stability, when using lidocaine as

antiarrhythmic.

Reduce dosage when treating arrhythmias in

CHF, digitalis toxicity with AV block, and

geriatric patients.

Monitor fluid load carefully; more

concentrated solutions can be used to treat

arrhythmias in patients on fluid restrictions.

Have patients who have received lidocaine

as a spinal anesthetic remain lying flat for 6–

12 hr afterward, and ensure that they are

adequately hydrated to minimize risk of

headache.

Check lidocaine preparation carefully;

epinephrine is added to solutions of

lidocaine to retard the absorption of the local

anesthetic from the injection site. Be sure

that such solutions are used

only to produce local anesthesia. These

solutions should be injected cautiously in

body areas supplied by end arteries and used

cautiously in patients with peripheral

vascular disease, hypertension,

thyrotoxicosis, or diabetes.

Use caution to prevent choking. Patient may

have difficulty swallowing following use of

Medical and Surgical Nursing

Emergency Nursing

Prepared by: Mark Fredderick R. Abejo R.N, M.A.N

Emergency Nursing Abejo

oral topical anesthetic. Do not give food or

drink for 1 hr after use of oral anesthetic.

Treat methemoglobinemia with 1%

methylene blue, 0.1 mg/kg, IV over 10 min.

Apply lidocaine ointments or creams to a

gauze or bandage before applying to the

skin.

Monitor for safe and effective serum drug

concentrations (antiarrhythmic use: 1–5

mcg/mL). Doses > 6–10 mcg/mL are usually

toxic

39) SODIUM BICARBONATE

Brand name: Hospira Sodium Bicarbonate

Classification: Alkalinizers

Dosage: 10mEq/10ml; 50mEq/50ml

Indication: metabolic acidosis, systemic or urinary

alkalinization, antacid, cardiac arrest

Action: Restores buffering capacity of the body and

neutralizes excess acid

Adverse Reaction: Tetany, edema, gastric distention,

belching, flatulence, hypokalemia, metabolic

alkalosis, hypernatremia, chemical cellulitis because

of alkalinity, pain, irritation, tissue necrosis,

ulceration or sloughing at the site of infiltration

Nursing Measures:

do not take drug with milk to avoid

hypercalcemia, abnormally high alkalinity in

tissues and fluids, or kidney stones.

do not give to patients with metabolic or

respiratory alkalosis, and in those with

hypocalcemia in which alkalosis may

produce tetany, hypertension, seizures, or

heart failure.

monitor for alkalosis by obtaining blood pH,

PaO2, PCO2, and electrolyte levels

40) DOPAMINE

Brand name: Intropin

Classification: Adrenergics (Sympathomimetics)

Dosage: 40 mg/Ml; 80  mg/mL; 160 mg/mL

Indication : shock and hemodynamic imbalances,

hypotension

Action: Stimulates dopaminergic and alpha beta

receptors for the sympathetic nervous system

resulting in a positive inotropic effect and increased

cardiac output. Action is dose-related; large doses

cause mainly alpha stimulation

Adverse Reaction: ectopic beats, tachycardia,

anginal pain, palpitation, hypotension,

vasoconstriction, ventricular arrhythmias,

hypertension, headache, anxiety, dilated pupils,

nausea, vomiting, decreased urine output, dyspnea

Nursing Measures:

Monitor vital signs and ECG closely

throughout therapy.

Monitor I&O regularly; note decreases in

urine output.

Monitor central venous pressure or

pulmonary wedge pressure if possible

during infusion.

Note significant changes in vital signs, ECG

changes, deterioration of peripheral

pulses, and/or cold, mottled extremities

41) DOBUTAMINE

Brand name: Dobatrey

Classification: Adrenergics

Dosage: 12.5 mg/mL

Indication: increased cardiac output in short term

treatment of cardiac decompensation caused by

depressed contractility

Action: Stimulates heart’s beta1 receptors to increase

myocardial contractility and stroke volume. Increases

cardiac output by decreasing peripheral vascular

resistance, reducing ventricular filling pressure, and

facilitating AV node conduction

Adverse Reaction: increased systolic BP, increased

heart rate, chest pain, increased number of premature

ventricular beats, headache, tingling sensations,

paresthesia. nausea, vomiting, dyspnea, phlebitis,

local inflammation after infiltration, leg cramps

Nursing Measures:

Monitor vital signs, ECG, cardiac output,

pulmonary capillary wedge pressure, central

venous pressure and urinary output carefully

throughout infusion.

Monitor patency and placement of IV

catheter to reduce risk of extravasation and

phlebitis.

Watch out for symptoms of overdosage such

as excessive hypertension, tachycardia,

nausea, vomiting, tremor, headache, chest

pain

42) LIDOCAINE PREMIXED

Brand name: Xylocaine

Classification: Antiarrhythmic agent, Local

anesthetic

Dosage: 0.2% (2mg/ml); 0.4% (4g/ml); 0.8% (8g/ml)

Indication: ventricular arrhythmias caused by MI,

cardiac manipulation or cardiac glycosides

Action: Acts as an anesthetic by stabilizing the

neuronal membrane by inhibiting the ionic fluxes

required for the initiation and conduction of

impulses, thereby effecting local anesthetic action.

Also acts as an antiarrhythmic by decreasing the

depolarization, automaticity, and excitability in the

Medical and Surgical Nursing

Emergency Nursing

Prepared by: Mark Fredderick R. Abejo R.N, M.A.N

Emergency Nursing Abejo

ventricles during the diastolic phase by a direct action

on the tissues, especially the Purkinje network,

without involvement of the autonomic system.

Neither contractility, systolic arterial blood pressure,

atrioventricular (AV) conduction velocity, nor

absolute refractory period is altered by usual

therapeutic doses

Adverse Reaction: bradycardia, cardiac arrest, CV

collapse, hypotension, apprehension, confusion,

dizziness, drowsiness, hallucinations, headache,

light-headedness, mood changes, nervousness,

tremors, conjunctival hyperemia, corneal epithelial

changes, diplopia, tinnitus, visual disturbances,

nausea, vomiting, erythema, petechiae, edema,

injection-site reactions, including bruising, burning,

contusion, hemorrhage, local reactions, including

soreness at IM injection site, venous thrombosis or

phlebitis, extravasation, burning, stinging, sloughing,

respiratory depression or arrest, hypersensitivity

reactions

Nursing Measures:

Explain that adverse reactions related to the

CNS (eg, drowsiness, confusion,

paresthesias, convulsions, respiratory arrest)

can occur and are a result of CNS toxicity.

Advise patient that drug may cause dizziness

or drowsiness and to avoid getting out of

bed or walking without assistance.

Advise patients that skin reactions, including

erythema, petechiae, and edema, may occur

with intradermal injection.

Systemic effects can occur following topical

use; use lowest possible dose to avoid

serious toxicity, shock, or heart block.

Do not use in patients with congenital or

idiopathic methemoglobinemia or in infants

younger than 12  mo of age who are

receiving methemoglobin-inducing drugs.

Use with caution and in lower doses in

patients with CHF, reduced cardiac output,

digitalis toxicity, and in elderly patients

43) MANNITOL

Brand name: Osmitrol

Classification: osmotic diuretic

Dosage: 5% , 10%, 15%, 20%, 25% in 500cc/1,000cc

Indication: test dose for marked oliguria or

suspected inadequate renal function, oliguria, to

reduce intraocular or intracranial pressure, diuresis in

drug intoxication

Action: Increases osmotic pressure of glomerular

filtrate; drug elevates plasma osmolality

Adverse Reaction: Increased urination, nausea,

runny nose, vomiting, severe allergic reactions (rash,

hives, itching, difficulty breathing, tightness in the

chest, swelling of the mouth, face, lips, or tongue),

blurred vision, chest pain, chills or fever, confusion,

decreased alertness, difficulty urinating, extreme

dizziness, extreme thirst or dry mouth, fast or

irregular heartbeat, headache, muscle cramps, pain,

redness, or swelling at the injection site, weakness

Nursing Measures:

Monitor vital signs, including CVP, and

fluid intake and output.

Monitor weight, renal function, and serum

sodium and potassium levels daily

Watch out for symptoms of overdosage such

as excessive hypertension, tachycardia,

nausea, vomiting, tremor, headache, chest

pain

To relieve thirst, give frequent mouth care

and fluids

44) DEXTROSE 5% IN WATER (D5W)

SOLUTION

Brand name: None

Classification: Isotonic/Hypotonic Solution

Dosage: 250ml bottles (5g dextrose/100ml water)

Indication: fluid replacement and caloric

supplementation in patients who can’t maintain

adequate oral intake or are restricted from doing so

Action: Provides some sugar for cellular metabolism

and supplies body water

Adverse Reaction: Increases free water and may

cause intracellular edema, fluid overload, infiltration

(swelling and pain at infusion site)

Nursing Measures:

Monitor infusion rate frequently; if signs of

fluid overload, turn off IV drip. Infusion

may result in fluid overload.

Check IV site frequently and if infiltration is

noted, turn off IV drip.

Watch out for signs of fluid overload

(distended neck veins (JVD), rapid

respirations, shallow tidal volume, fine

auscultatory crackles, dyspnea, and

peripheral edema)

Watch out for signs of infiltration (swelling

and pain around IV site).