Nursing Care Plan

.. dies: BUN, creatinine; blood studies: ALT, AST, bilirubin, Hct, Hgb before initiating treatment and periodically thereafter • I&O ratio, daily weights; monitor turgor, lung sounds, edema • Monitor drug levels (therapeutic level 0.5-2 ng/ml) • Cardiac status: apical pulse, character, rate, rhythm Administer: • PO with or without food; may crush tabs • K supplements if ordered for K levels *3, or foods high in K: bananas, orange juice • IV undiluted or 1 ml of drug/4 ml sterile H2O, D5, or NS; give over *5 min through Y-tube or 3-way stopcock; during digitalization close monitoring is necessary Perform/provide: • Storage protected from light Evaluate: Therapeutic response: decreased weight, edema, pulse, respiration, rales; increased urine output; serum digoxin level (0.5-2 ng/ml) Teach patient/family: • Not to stop drug abruptly; teach all aspects of drug, to take exactly as ordered • To avoid OTC medications, since many adverse drug interactions may occur; do not take antacid at same time • To notify physician of any loss of appetite, lower stomach pain, diarrhea, weakness, drowsiness, headache, blurred or yellow vision, rash, depression, toxicity • Toxic symptoms of this drug and when to notify physician • To maintain a sodium-restricted diet as ordered • To report shortness of breath, difficulty breathing, weight gain, edema, persistent cough Treatment of overdose: Discontinue drug; administer K; monitor ECG, administer an adrenergic blocking agent, digoxin immune FAB FOSINOPRIL Monopril Func. class.: Antihypertensive Chem. class.: Angiotension-converting enzyme (ACE) inhibitor Action: Selectively suppresses renin-angiotensin-aldosterone system; inhibits ACE; prevents conversion of angiotensin I to angiotensin II; results in dilation of arterial, venous vessels Uses: Hypertension, alone or in combination with thiazide diuretics Dosage and routes: • Adult: PO 10 mg qd initially, then 20-40 mg/day divided bid or qd Available forms: Tabs 10, 20 mg Side effects/adverse reactions: CV: Hypotension, chest pain, palpitations, angina, orthostatic hypotension GU: Proteinuria, Increased BUN, creatinine, decreased libido HEMA: Decreased Hct, Hgb, eosinophilia, leukopenia, neutropenia INTEG: Angioedema, rash, flushing, sweating, photosensitivity, pruritus RESP: Cough, sinusitis, dyspnea, bronchospasm META: Hyperkalemia GI: Nausea, constipation, vomiting, diarrhea CNS: Insomnia, paresthesia, headache, dizziness, fatigue, memory disturbance, tremor, mood change MS: Arthralgia, myalgia Contraindications: Hypersensitivity to ACE inhibitors, pregnancy (D), lactation, children Precautions: Impaired liver function, hypovolemia, blood dyscrasias, CHF, COPD, asthma, elderly Pharmacokinetics: PO: Peak 3 hr; serum protein binding 97%; half-life 12 hr; metabolized by liver (metabolites excreted in urine, feces) Interactions/incompatibilities: • Increased hypotension: diuretics, other antihypertensives, ganglionic blockers, adrenergic blockers • Increased toxicity: vasodilators, hydralazine, prazosin, K-sparing diuretics, sympathomimetics • Decreased absorption: antacids • Decreased antihypertensive effect: indomethacin • Increased serum levels of: digoxin, lithium • Increased hypersensitivity: allopurinol Lab test interferences: False positive: Urine acetone NURSING CONSIDERATIONS Assess: • Blood studies: neutrophils, decreased platelets • B/P, orthostatic hypotension, syncope • Renal studies: protein, BUN, creatinine; watch for increased levels that may indicate nephrotic syndrome • Baselines in renal, liver function tests before therapy begins • K levels, although hyperkalemia rarely occurs • Dipstick of urine for protein qd in first morning specimen; if protein is increased, a 24-hr urinary protein should be collected • Edema in feet, legs daily • Allergic reactions: rash, fever, pruritus, urticaria; drug should be discontinued if antihistamines fail to help • Renal symptoms: polyuria, oliguria, frequency, dysuria Administer: • IV infusion of 0.9% NaCl (as ordered) to expand fluid volume if severe hypotension occurs Perform/provide: • Storage in tight container at 86 F (30 C) or less • Supine or Trendelenburg position for severe hypotension Evaluate: • Therapeutic response: decrease in B/P Teach patient/family: • Not to discontinue drug abruptly • Not to use OTC products (cough, cold, allergy) unless directed by physician; do not use salt substitutes containing potassium without consulting physician • Importance of complying with dosage schedule, even if feeling better • To rise slowly to sitting or standing position to minimize orthostatic hypotension • To notify physician of mouth sores, sore throat, fever, swelling of hands or feet, irregular heart beat, chest pain • To report excessive perspiration, dehydration, vomiting, diarrhea; may lead to fall in B/P • That drug may cause dizziness, fainting, light-headedness during 1st few days of therapy • That drug may cause skin rash or impaired perspiration • How to take B/P; normal readings for age group Treatment of overdose: 0.9% NaCl IV INF, hemodialysis FLUOCINONIDE Flucinolone, Fluocinolone Acetonide, Fluonid, Flurosyn, Synalar, Synalar-HP, Synemol, Fluocinonide, Lidemol, Lidex, Lidex-E, Vasoderm, Vasoderm E Func. class.: Topical corticosteroid Chem. class.: Synthetic fluorinated agent, group II potency Action: Possesses antipruritic, antiinflammatory actions Uses: Psoriasis, eczema, contact dermatitis, pruritus Dosage and routes: • Adult and child: Apply to affected area tid-qid Available forms: Oint 0.05%; cream 0.05%; sol 0.05%; gel 0.05% Side effects/adverse reactions: INTEG: Burning, dryness, itching, irritation, acne, folliculitis, hypertrichosis, perioral dermatitis, hypopigmentation, atrophy, striae, miliaria, allergic contact dermatitis, secondary infection Contraindications: Hypersensitivity to corticosteroids, fungal infections Precautions: Pregnancy (C), lactation, viral infections, bacterial infections NURSING CONSIDERATIONS Assess: • Temperature: if fever develops, drug should be discontinued Administer: • Only to affected areas; do not get in eyes • Medication, then cover with occlusive dressing (only if prescribed), seal to normal skin, change q12h; use occlusive dressings with extreme caution • Only to dermatoses; do not use on weeping, denuded, or infected area Perform/provide: • Cleansing before application of drug • Treatment for a few days after area has cleared • Storage at room temperature Evaluate: • Therapeutic response: absence of severe itching, patches on skin, flaking Teach patient/family: • To avoid sunlight on affected area; burns may occur INSULIN, Beef NPH Iletin II, Humulin N, Iletin NPH, Insulatard NPH, NPH Iletin I, Pork NPH Iletin II, Novolin N, NPH Insulin, NPH Purified Pork Func.

class.: Antidiabetic Chem. class.: Exogenous unmodified insulin Action: Decreases blood sugar; indirectly increases blood pyruvate, lactate; decreases phosphate, potassium Uses: Ketoacidosis, type I (IDDM), type II (NIDDM) diabetes mellitus, hyperkalemia Dosage and routes: • Adult: SC dosage individualized by blood, urine glucose, usual dose 7-26 U; may increase by 2-10 U/day if needed Available forms: SC 100 U/ml Side effects/adverse reactions: CNS: Headache, lethargy, tremors, weakness, fatigue, delirium, sweating CV: Tachycardia, palpitations EENT: Blurred vision, dry mouth GI: Hunger, nausea META: Hypoglycemia INTEG: Flushing, rash, urticaria, warmth, lipodystrophy, lipohypertrophy SYST: Anaphylaxis Contraindications: Hypersensitivity to protamine Precautions: Pregnancy (B) Interactions/incompatibilities: • Increased hypoglycemia: salicylate, alcohol, b-blockers, anabolic steroids, fenfluramine, phenylbutazone, sulfinpyrazone, guanethidine, oral hypoglycemics, MAOIs, tetracycline • Decreased hypoglycemia: thiazides, thyroid hormones, oral contraceptives, corticosteroids, estrogens, dobutamine, epinephrine Pharmacokinetics: SC: Onset 1-2 hr, peak 4-12 hr, duration 18-24 hr Metabolized by liver, muscle, kidneys; excreted in urine Lab test interferences: Increase: VMA Decrease: K, Ca Interference: Liver function studies, thyroid function studies NURSING CONSIDERATIONS Assess: • Fasting blood glucose, 2 hr PP (80-150 mg/dl normal fasting level) (70-130 mg/dl-normal 2 hr level) • Urine ketones during illness; insulin requirements may increase during stress, illness • Hypoglycemic reaction that can occur during peak time Administer: • After warming to room temperature by rotating in palms to prevent injecting cold insulin • Increased doses if tolerance occurs • Human insulin to those allergic to beef or pork Perform/provide: • Storage at room temperature for *1 mo, keep away from heat and sunlight, refrigerate all other supply, do not use if discolored; do not freeze • Rotation of injection sites within one area: abdomen, upper back, thighs, upper arm, buttocks; keep record of sites Evaluate: • Therapeutic response: decrease in polyuria, polydipsia, polyphagia, clear sensorium, absence of dizziness, stable gait Teach patient/family: • That blurred vision occurs; not to change corrective lens until vision is stabilized 1-2 mo • To keep insulin, equipment available at all times • That drug does not cure diabetes but controls symptoms • To carry Medic Alert ID as diabetic • Hypoglycemia reaction: headache, tremors, fatigue, weakness • Dosage, route, mixing instructions, if any diet restrictions, disease process • To carry candy or lump sugar to treat hypoglycemia; have glucagon emergency kit available • Symptoms of ketoacidosis: nausea, thirst, polyuria, dry mouth, decreased B/P, dry, flushed skin, acetone breath, drowsiness, Kussmaul respirations • That a plan is necessary for diet, exercise; all food on diet should be eaten; exercise routine should not vary • To avoid OTC drugs unless directed by physician Treatment of overdose: Glucose 25g IV, via dextrose 50% solution, 50 ml or 1 mg glucagon ITRACONAZOLE Sporanox Func. class.: Antifungal Chem. class.: Triazole derivative Action: Alters cell membranes and inhibits several fungal enzymes Uses: Systemic candidiasis, chronic mucocandidiasis, oral thrush, candiduria, coccidioidomycosis, histoplasmosis, chromomycosis, paracoccidioidomycosis, blastomycosis (pulmonary and extrapulmonary) Dosage and routes: • Adult: PO 200 mg qd with food; may increase to 400 mg qd if needed; divide doses over 200 mg in two doses Available forms: Caps 100 mg Side effects/adverse reactions: GU: Gynecomastia, impotence, decreased libido INTEG: Pruritus, fever, rash, CNS: Headache, dizziness, insomnia, somnolence, depression GI: Nausea, vomiting, anorexia, diarrhea, cramps, abdominal pain, flatulence, GI bleeding, hepatotoxicity MISC: Edema, fatigue, malaise, hypertension, hypokalemia, tinnitus Contraindications: Hypersensitivity, lactation, fungal meningitis, coadministration with terfenadine Precautions: Hepatic disease, achlorhydria or hypochlorhydine (drug-induced), children, pregnancy (C) Pharmacokinetics: PO: Peak 3-5 hr, half-life 60 hr; metabolized in liver; excreted in bile, feces; requires acid pH for absorption; distributed poorly to CSF; highly protein bound Interactions/incompatibilities: • Do not use with terfenadine: may result in rare instance of life-threatening dysrhythmias and death • Hepatotoxicity: other hepatotoxic drugs • Itraconazole increases levels of cyclosporine • Decreased action of itraconazole: antacids, H2-receptor antagonists, isoniazid, rifampin • Increased anticoagulant effect: coumarin anticoagulants • Severe hypoglycemia: oral hypoglycemics • Concomitant administration with phenytoin may result in decreased levels of itraconazole; effects of phenytoin may be increased NURSING CONSIDERATIONS Assess: • I&O ratio • Liver studies (ALT, AST, bilirubin) if on long-term therapy • For allergic reaction: rash, photosensitivity, urticaria, dermatitis • For hepatotoxicity: nausea, vomiting, jaundice, clay-colored stools, fatigue Administer: • In the presence of acid products only; do not use alkaline products or antacids within 2 hr of drug; may give coffee, tea, acidic fruit juices • With food to decrease GI symptoms • With hydrochloric acid if achlorhydria is present Perform/provide: • Storage in tight container at room temperature Evaluate: • Therapeutic response: decreased fever, malaise, rash, negative C&S for infecting organism Teach patient/family: • That long-term therapy may be needed to clear infection (1 wk-6 mo depending on infection) • To avoid hazardous activities if dizziness occurs • To take 2 hr ac administration of other drugs that increase gastric pH (antacids, H2-blockers, anticholinergics) • Importance of compliance with drug regimen • To notify physician if GI symptoms, signs of liver dysfunction (fatigue, nausea, anorexia, vomiting, dark urine, pale stools) ISOSORBIDE Ismotic Func. class.: Miscellaneous ophthalmic agent Action: Increases osmotic gradient between plasma and ocular fluids, which decreases intraocular pressure Uses: Reduces intraocular pressure from glaucoma and cataract surgery Dosage and routes: • Adult: PO 1.5 g/kg, then increase to 1-3 g/kg bid-qid Available forms: Sol 45% Side effects/adverse reactions: CNS: Headache, light-headedness, irritability, lethargy, syncope, confusion, dizziness, vertigo, disorientation GI: Nausea, vomiting, anorexia, diarrhea, cramps, thirst INTEG: Rash META: Hypernatremia, hyperosmolarity Contraindications: Hypersensitivity, anuria, severe renal disease, pulmonary edema, hemorrhagic glaucoma, dehydration Precautions: Pregnancy , patients on Na-restricted diet NURSING CONSIDERATIONS Assess: • I&O; report decrease in urinary output • Electrolytes during treatment Administer: • After pouring over ice (oral) Evaluate: • Therapeutic response: decreased intraocular pressure LEVOTHYROXINE SODIUM Func. class.: Thyroid hormone Chem.

class.: Levoisomer of thyroxine Action: Increases metabolic rates, increases cardiac output, O2 consumption, body temperature, blood volume, growth, development at cellular level Uses: Hypothyroidism, myxedema coma, thyroid hormone replacement, cretinism, thyrotoxicosis Dosage and routes: Severe hypothyroidism • Adult: PO 0.025-0.1 mg qd, increased by 0.05-0.1 mg q1-4 wk until desired response, maintenance dose 0.1-0.4 mg qd • Child: PO 0.01-0.05 qd, may increase 0.025-0.05 mg q1-4 wk until desired response Mild hypothyroidism • Initial 50 mg qd; increase by 25-50 mg at interval of 2-4 wk Cretinism • Child: IV 0.025-0.05 mg qd, may increase by 0.05-0.1 mg PO q2-3wk Myxedema coma • Adult: IV 0.2-0.5 mg, may increase by 0.1-0.3 mg after 24 hr; place on oral medication as soon as possible Available forms: Inj IV 200, 500 mg/vial; tabs 0.025, 0.05, 0.075, 0.088 mg, 0.1, 0.112 mg, 0.125, 0.15, 0.175, 0.2, 0.3 mg Side effects/adverse reactions: CNS: Anxiety, insomnia, tremors, headache, thyroid storm CV: Tachycardia, palpitations, angina, dysrhythmias, hypertension, cardiac arrest GI: Nausea, diarrhea, increased or decreased appetite, cramps MISC: Menstrual irregularities, weight loss, sweating, heat intolerance, fever Contraindications: Adrenal insufficiency, myocardial infarction, thyrotoxicosis Precautions: Elderly, angina pectoris, hypertension, ischemia, cardiac disease, pregnancy (A), lactation Pharmacokinetics: IV/PO: Peak 12-48 hr, half-life 6-7 days; distributed throughout body tissues Interactions/incompatibilities: • Decreased absorption of levothyroxine: cholestyramine • Increased effects of: anticoagulants, sympathomimetics, tricyclic antidepressants • Decreased effects of: digitalis drugs, insulin, hypoglycemics • Decreased effects of levothyroxine: estrogens • Considered to be incompatible in syringe with all other drugs Lab test interferences: Increase: CPK, LDH, AST, PBI, blood glucose Decrease: TSH, 131I uptake test, uric acid, triglycerides NURSING CONSIDERATIONS Assess: • B/P, pulse before each dose • I&O ratio • Weight qd in same clothing, using same scale, at same time of day • Height, growth rate if given to a child • T3, T4, FTIs, which are decreased; radioimmunoassay of TSH, which is increased; radio uptake, which is increased if patient is on too low a dose of medication • Pro-time may require decreased anticoagulant, check for bleeding, bruising • Increased nervousness, excitability, irritability, which may indicate too high dose of medication, usually after 1-3 wk of treatment • Cardiac status: angina, palpitation, chest pain, change in VS Administer: • IV after diluting with provided diluent 0.5 mg/5 ml; shake; give through Y-tube or 3-way stopcock; give 0.1 mg or less over 1 min; do not add to IV inf; 0.1 mg = 1 ml • In AM if possible as a single dose to decrease sleeplessness • At same time each day to maintain drug level • Only for hormone imbalances; not to be used for obesity, male infertility, menstrual conditions, lethargy • Lowest dose that relieves symptoms; lower dose to the elderly and in cardiac diseases Perform/provide: • Storage in tight, light-resistant container; sol should be discarded if not used immediately • Removal of medication 4 wk before RAIU test Evaluate: • Therapeutic response: absence of depression; increased weight loss, diuresis, pulse, appetite; absence of constipation, peripheral edema, cold intolerance, pale, cool dry skin, brittle nails, alopecia, coarse hair, menorrhagia, night blindness, paresthesias, syncope, stupor, coma, rosy cheeks Teach patient/family: • That hair loss will occur in child, is temporary • To report excitability, irritability, anxiety, which indicate overdose • Not to switch brands unless approved by physician • That drug may be discontinued after birth, thyroid panel evaluated after 1-2 mo • That hypothyroid child will show almost immediate behavior/personality change • That drug is not to be taken to reduce weight • To avoid OTC preparations with iodine; read labels • To avoid iodine food, iodized salt, soybeans, tofu, turnips, some seafood, some bread MAGNESIUM SALTS Concentrated Phillip’s Milk of Magnesia, Milk of Magnesia, Phillip’s Milk of Magnesia Func. class.: Laxative, saline Action: Increases osmotic pressure, draws fluid into colon neutralizes HCl Uses: Constipation, bowel preparation before surgery or examination Dosage and routes: • Adult: PO 30-60 ml hs (Milk of Magnesia), 300 mg • Adult and child *6 yr: PO 15 g in 8 oz H2O (magnesium sulfate); PO 10-20 ml (concentrated Milk of Magnesia); PO 5-10 oz hs (magnesium citrate) • Child 2-6 yr: 5-15 ml (Milk of Magnesia) Available forms: Oral sol, susp 77.5 mg/g; tabs 300, 600 mg Side effects/adverse reactions: CNS: Muscle weakness, flushing, sweating, confusion, sedation, depressed reflexes, flaccid, paralysis, hypothermia GI: Nausea, vomiting, anorexia, cramps CV: Hypotension, heart block, circulatory collapse META: Electrolyte, fluid imbalances Contraindications: Hypersensitivity, renal diseases, abdominal pain, nausea/vomiting, obstruction, acute surgical abdomen, rectal bleeding Precautions: Pregnancy (B) Pharmacokinetics: PO: Peak 1-2 hr; excreted in feces Interactions/incompatibilities: • Increased CNS depression: CNS depressants, barbiturates, narcotics, anesthetics NURSING CONSIDERATIONS Assess: • I&O ratio; check for decrease in urinary output • Cause of constipation; identify whether fluids, bulk, or exercise is missing from life-style • Cramping, rectal bleeding, nausea, vomiting; if these symptoms occur, drug should be discontinued • Mg toxicity: thirst, confusion, decrease in reflexes Administer: • With 8 oz H2O Evaluate: • Therapeutic response: decreased constipation Teach patient/family: • Not to use laxatives for long-term therapy; bowel tone will be lost • Chilling helps the taste of magnesium citrate • Shake suspension well • Do not give at hs as a laxative; may interfere with sleep • Give citrus fruit after administering to counteract unpleasant taste PIPERACILLIN SODIUM Pipracil Func. class.: Broad-spectrum antibiotic Chem. class.: Extended-spectrum penicillin Action: Interferes with cell wall replication of susceptible organisms; osmotically unstable cell wall swells and bursts from osmotic pressure Uses: Respiratory, skin, urinary tract, bone infections; gonorrhea; pneumonia; effective for gram-positive cocci (S. aureus, S. pyogenes, S.

viridans, S. faecalis, S. bovis, S. pneumoniae), gram-negative cocci (N. gonorrhoeae, N. meningitidis), gram-positive bacilli, C.

perfringens, C. tetani, gram-negative bacilli (Bacteroides, F. nucleatum, E. coli, Klebsiella, P. mirabilis, M.

morganii, P. vulgaris, P. rehgesii, Enterobacter, Citrobacter, P. aeruginosa, Serratia, Acinetobacter, Peptococcus, Peptostreptococcus, Eubacterium) Dosage and routes: Systemic infections • Adult and child *12 yr: IM/IV 100-300 mg/kg/day in divided doses q4-6h Prophylaxis of surgical infections • Adult: IV 2g -1 hr before procedure; may be repeated during surgery or after surgery Available forms: Inj IM, IV 2, 3, 4, 40 g; IV INF 2, 3, 4 g Side effects/adverse reactions: HEMA: Anemia, increased bleeding time, bone marrow depression GI: Nausea, vomiting, diarrhea, increased AST, ALT, abdominal pain, glossitis, colitis GU: Oliguria, proteinuria, hematuria, vaginitis, moniliasis, glomerulonephritis CNS: Lethargy, hallucinations, anxiety, depression, twitching, coma, convulsions META: Hypokalemia, hypernatremia Contraindications: Hypersensitivity to penicillins; neonates Precautions: Pregnancy (B); hypersensitivity to cephalosporins; CHF Pharmacokinetics: IM: Peak 30-50 min IV: Peak 20-30 min Half-life 0.7-1.33 hr; excreted in urine, bile, breast milk; crosses placenta Interactions/incompatibilities: • Decreased antimicrobial effect of piperacillin: tetracyclines, erythromycins, aminoglycosides IV • Increased piperacillin concentrations: aspirin, probenecid • Incompatible in sol with aminoglycosides, amphotericin B, chloramphenicol, lincomycin, polymyxin B, promethazine, tetracycline, Vit B with C Lab test interferences: False positive: Urine glucose, urine protein, Coombs’ test NURSING CONSIDERATIONS Assess: • I ratio; report hematuria, oliguria, since penicillin in high doses is nephrotoxic • Any patient with compromised renal system, since drug is excreted slowly in poor renal system function; toxicity may occur rapidly • Liver studies: AST, ALT • Blood studies: WBC, RBC, H, bleeding time • Renal studies: urinalysis, protein, blood • C before drug therapy; drug may be taken as soon as culture is taken • Bowel pattern before and during treatment • Skin eruptions after administration of penicillin to 1 wk after discontinuing drug • Respiratory status: rate, character, wheezing, tightness in chest • Allergies before initiation of treatment, reaction of each medication; highlight allergies on chart, Kardex Administer: • IV after diluting 1 g or less/5 ml or more sterile H2O or 0.9% NaCl; shake; give dose over 3-5 min; may further dilute to 50-100 ml with D5W, 0.9% NS, and give over hr; discontinue primary IV • Drug after C has been completed Perform/provide: • Adrenalin, suction, tracheostomy set, endotracheal intubation equipment on unit • Adequate intake of fluids (2 L) during diarrhea episodes • Scratch test to assess allergy after securing order from physician; usually done when penicillin is only drug of choice • Storage at room temperature, reconstituted solution for 24 hr or 7 days refrigerated Evaluate: • Therapeutic response: absence of fever, purulent drainage, redness, inflammation Teach patient/family: • That culture may be taken after completed course of medication • To report sore throat, fever, fatigue; (may indicate superimposed infection) • To wear or carry Medic Alert ID if allergic to penicillins • To notify nurse of diarrhea Treatment of overdose: Withdraw drug, maintain airway, administer epinephrine, aminophylline, O2, IV corticosteroids for anaphylaxis SILVER SULFADIAZINE (topical) Silvadene, SSD, SSD AF Func. class.: Local antiinfective Chem. class.: Sulfonamide Action: Interferes with bacterial cell wall synthesis, broad-spectrum Uses: Burns (2nd, 3rd degree); prevention of wound sepsis Dosage and routes: • Adult and child: TOP apply 1/16 in to affected area qd-bid Available forms: Cream 10 mg/g Side effects/adverse reactions: INTEG: Rash, urticaria, stinging, burning, itching, pain, skin necrosis, erythema HEMA: Reversible leukopenia Contraindications: Hypersensitivity, child *2 mo Precautions: Impaired renal function, pregnancy (C), impaired hepatic function, lactation NURSING CONSIDERATIONS Assess: • Allergic reaction: burning, stinging, swelling, redness • Renal function studies; check for crystalluria Administer: • Using aseptic technique, use sterile gloves • Enough medication to cover burns completely; keep covered with medication at all times • After cleansing debris before each application; bathe daily • Analgesic before application if needed Perform/provide: • Storage at room temperature in dry place Evaluate: • Therapeutic response: relief of infection Teach patient/family: • That drug may be continued until graft can be done TRIAMCINOLONE Func.

class.: Corticosteroid Chem. class.: Glucocorticoid, intermediate-acting Action: Decreases inflammation by suppression of migration of polymorphonuclear leukocytes, fibroblasts, reversal to increase capillary permeability and lysosomal stabilization Uses: Severe inflammation, immunosuppression, neoplasms, asthma (steroid dependent), collagen, respiratory, dermatologic disorders Dosage and routes: • Adult: PO 4-48 mg/day in divided doses qd-qid; IM 40 mg qwk (acetonide, or diacetate), 5-48 mg into neoplasms (diacetate, acetonide), 2-40 mg into joint or soft tissue (diacetate, acetonide), 0.5 mg/sq in of affected intralesional skin (hexacetonide), 2-20 mg into joint or soft tissue (hexacetonide) Asthma • Adult: INH 2 tid-qid, not to exceed 16 INH/day • Child 6-12 yr: INH 1-2 tid-qid, not to exceed 12 INH/day Available forms: Tabs 1, 2, 4, 8, 16 mg; syr 2 mg/5 ml, 4.85 mg/5 ml; inj 25, 40 mg/ml diacetate; inj 3, 10, 40 mg/ml acetonide; inj 20, 5 mg/ml hexacetonide Side effects/adverse reactions: INTEG: Acne, poor wound healing, ecchymosis, petechiae CNS: Depression, flushing, sweating, headache, mood changes CV: Hypertension, circulatory collapse, thrombophlebitis, embolism, tachycardia, edema HEMA: Thrombocytopenia MS: Fractures, osteoporosis, weakness GI: Diarrhea, nausea, abdominal distention, GI hemorrhage, increased appetite, pancreatitis EENT: Fungal infections, increased intraocular pressure, blurred vision Contraindications: Psychosis, hypersensitivity, idiopathic thrombocytopenia, acute glomerulonephritis, amebiasis, fungal infections, nonasthmatic bronchial disease, child *2 yr, AIDS, TB Precautions: Pregnancy , diabetes mellitus, glaucoma, osteoporosis, seizure disorders, ulcerative colitis, CHF, myasthenia gravis, renal disease, esophagitis, peptic ulcer Pharmacokinetics: PO/IM: Peak 1-2 hr, 2 days, 1-6 wk (IM), half-life 2-5 hr Interactions/incompatibilities: • Decreased action of triamcinolone: cholestyramine, colestipol, barbiturates, rifampin, ephedrine, phenytoin, theophylline • Decreased effects of: anticoagulants, anticonvulsants, antidiabetics, ambenonium, neostigmine, isoniazid, toxoids, vaccines, anticholinesterases, salicylates, somatrem • Increased side effects: alcohol, salicylates, indomethacin, amphotericin B, digitalis, cyclosporine, diuretics • Increased action of triamcinolone: salicylates, estrogens, indomethacin, oral contraceptives, ketoconazole, macrolide antibiotics Lab test interferences: Increase: Cholesterol, Na, blood glucose, uric acid, Ca, urine glucose Decrease: Ca, K, T4, T3, thyroid 131I uptake test, urine 17-OHCS, 17-KS, PBI False negative: Skin allergy tests NURSING CONSIDERATIONS Assess: • K, blood sugar, urine glucose while on long-term therapy; hypokalemia and hyperglycemia • Weight daily; notify physician if weekly gain *5 lb • B/P q4h, pulse; notify physician if chest pain occurs • I ratio; be alert for decreasing urinary output and increasing edema • Plasma cortisol levels during long-term therapy (normal level: 138-635 nmol/L SI units when drawn at 8 AM) • Infection: increased temperature, WBC, even after withdrawal of medication; drug masks infection symptoms • K depletion: paresthesias, fatigue, nausea, vomiting, depression, polyuria, dysrhythmias, weakness • Edema, hypertension, cardiac symptoms • Mental status: affect, mood, behavioral changes, aggression Administer: • After shaking suspension (parenteral) • Titrated dose; use lowest effective dose • IM injection deeply in large mass; rotate sites; avoid deltoid; use 21G needle • In one dose in AM to prevent adrenal suppression; avoid SC administration; may damage tissue • With food or milk to decrease GI symptoms Perform/provide: • Assistance with ambulation in patient with bone tissue disease to prevent fractures Evaluate: • Therapeutic response: ease of respirations, decreased inflammation Teach patient/family: • That ID as steroid user should be carried • To notify physician if therapeutic response decreases; dosage adjustment may be needed • Not to discontinue this medication abruptly; adrenal crisis can result • To avoid OTC products: salicylates, alcohol in cough products, cold preparations unless directed by physician • About cushingoid symptoms Symptoms of adrenal insufficiency: nausea, anorexia, fatigue, dizziness, dyspnea, weakness, joint pain HOLISTIC HUMAN RESPONSES/ Functional Developmental Physiological Psychological Dimensions Cognitive Emotional Self-Conceptual Wellness & Well-being Relative decline in physical development, changes in appetite, food intake, sleep & elimination patterns. B p.316 H/O CA, Anemia, NIDDM, COPD ,A.Fib, Current necrotizing pneumonia, cathexia, empyemia Client aware of health problems and the need for interventions Discouraged with his present state of health, but accepting of necessary rehab. Activities. Frustrated with self.