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Emergency Nursing

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  • 1. Medical and Surgical NursingEmergency NursingPrepared by: Mark Fredderick R. Abejo R.N, M.A.N 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 MEDICAL AND SURGICAL NURSING 2. The national emergency telephone number 911 is the result of an effort to improve Emergency Nursing access to EMS 3. The concept of the emergency room has Lecturer: Mark Fredderick R. Abejo R.N, M.A.N expanded to that of the emergency department, which provides various levels of careA. General information 4. Specialized electronic technology and techniques are used to monitor patient status 1. Emergency nursing deals with human continuously; these may pose safety hazards responses to any trauma or sudden illness to patients, such as possible exposure to that requires immediate intervention to electric shock prevent imminent severe damage or death 2. Care is provided in any setting to persons of D. Triage all ages with actual or perceived alterations in physical or emotional health. 1. Triage classifies emergency patients for 3. Initially, patients may not have a medical assessment and treatment priorities diagnosis. 2. Triage decisions require gathering objective 4. Care is episodic when patients return and subjective data rapidly and effectively to frequently, primary when it is the initial determine the type of priority situation option for health or preventive care, or acute present when patients need immediate and 3. Emergent situations are potentially life- additional interventions. threatening; they include such conditions as 5. Emergency nursing is a specialty area of respiratory distress or arrest, cardiac arrest, the nursing profession like no other. severe chest pain, seizures, hemorrhage, 6. Emergency nurses must be ready to treat a severe trauma resulting in open chest or wide variety of illnesses or injury situations, abdominal wounds, shock, poisonings, drug ranging from a sore throat to a heart attack. overdoses, temperatures over 105°F (40.5°C), emergency childbirth, or deliveryB. Historical Development of Emergency Nursing complications 4. Urgent situations are serious but not life- 1. Florence Nightingale was the first threatening if treatment is delayed briefly; emergency nurse, providing care to the they include such conditions as chest pain wounded in the Crimean War in 1854 without respiratory distress, major fractures, 2. The Emergency Department Nurses burns, decreased level of consciousness, Association (EDNA) was organized in 1970 back injuries, nausea or vomiting, severe 3. A competency-based examination, first abdominal pain, temperature between 102 administered in 1980, provides Certification and 105°F (38.9 and 40.5° C), bleeding from in Emergency Nursing; certification is valid any orifice, acute panic, or anxiety for 4 years 5. Nonemergency situations are not acute and 4. EDNA developed Standards of Emergency are considered minor to moderately severe; Nursing Practice, published in 1983, to be they include such conditions as chronic used as a guideline for excellence and backache or other symptoms, moderate outcome criteria against which performance headache, minor burns, fractures, sprains, is measured and evaluated. upper respiratory or urinary infections, or 5. In 1985, the Association name was changed instances in which a patient is dead on to Emergency Nurses Association (ENA), arrival recognizing the practice of emergency nursing as role-specific rather than site- E. Roles of the Emergency Nurse specific. 6. Originally ENA aimed at teaching and 1. Care provider: provides comprehensive networking, the organization has evolved direct care to the patient and family. into an authority, advocate, lobbyist, and 2. Educator: provides patient and family with voice for emergency nursing. It has 30,000+ education based on their learning needs and members and continues to grow, with the severity of the situation and allows the members representing over 32 countries patient to assume more responsibility for around the world. meeting health care needsEmergency Nursing Abejo
  • 2. Medical and Surgical NursingEmergency NursingPrepared by: Mark Fredderick R. Abejo R.N, M.A.N 3. Manager: coordinates activities of others in EMERGENCY DRUGS the multidisciplinary team to achieve the specific goal of providing emergency care 4. Advocate: ensures protection of the 1) AMINOPHYLLINE patient’s rightsF. Functions of the Emergency Nurse Brand Names: Phil Pharmawealth/Atlantic 1. Uses triage to determine priorities based on Aminophylline amp Theofil amp assessment and anticipation of the patient’s Classification: Antiasthmatic & COPD Preparations needs Dosage: Initial: 225-450 mg twice daily, increased if 2. Provides direct measures to resuscitate, if needed. IV Acute severe bronchospasm. Loading necessary dose: 5 mg/kg (ideal body wt). Maintenance: 0.5 3. Provides preliminary care before the patient is transferred to the primary care area mg/kg/hr. Rate should not exceed 25 mg/min. 4. Provides health education to the patient and Indication: PO Chronic bronchospasm as hydrate family Action: Increases the level of cAMP resulting in 5. Supervises patient care and ancillary bronchodilation personnel Adverse Reactions: Nausea, vomiting, abdominal 6. Provides support and protection for the pain, diarrhea, headache, insomnia, dizziness, patient and family anxiety, restlessness; tremor, palpitations. PotentiallyG. Legal issues affecting the provision of Fatal: Convulsions, cardiac arrhythmias, hypotensionemergency nursing and sudden death after too rapid IV injection. 1. Negligence Nursing Measures: 2. Malpractice Administer to pregnant patients only when 3. Good Samaritan Laws (these statutes may clearly needed—neonatal tachycardia, protect private citizens but usually do not apply to emergency personnel on duty or in jitteriness, and withdrawal apnea observed normal emergency situations) when mothers received xanthines up until 4. Informed consent delivery. 5. Implied consent Caution patient not to chew or crush enteric- 6. Duty to report suspected crimes to the police coated timed-release forms. 7. Duty to gather evidence in criminal Give immediate-release, liquid dosage forms investigations; be aware of hospital policy and state laws for evidence collection with food if GI effects occur. 8. Advanced directives, including durable Do not give timed-release forms with food; power of attorney and living wills these should be given on an empty stomach 1 hr before or 2 hr after meals.H. Qualifications of an Emergency Nurse Maintain adequate hydration. 1. An emergency nurse is a registered nurse Monitor results of serum theophylline levels with specialized education and experience in carefully, and arrange for reduced dosage if caring for emergency patients. serum levels exceed therapeutic range of 2. Emergency nurses continually update their 10–20 mcg/mL. education to stay informed of the latest Take serum samples to determine peak trends, issues, and procedures in medicine theophylline concentration drawn 15–30 min today. 3. Many take a special examination that proves after an IV loading dose. their level of knowledge. After successful Monitor for clinical signs of adverse effects, completion of this exam they are certified particularly if serum theophylline levels are in emergency nursing. not available. 4. Some emergency nurses also acquire Ensure that diazepam is readily available to additional certifications in the areas of treat seizures. trauma nursing, pediatric nursing, nurse practitioner, and various areas of injury Take this drug exactly as prescribed; if a prevention timed-release product is prescribed, take this 5. Many emergency nurses acquire additional drug on an empty stomach, 1 hr before or 2 certifications in the areas of trauma nursing, hr after meals. pediatric nursing, nurse practitioner, and Do not to chew or crush timed-release various areas of injury prevention 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.Emergency Nursing Abejo
  • 3. Medical and Surgical NursingEmergency NursingPrepared by: Mark Fredderick R. Abejo R.N, M.A.N Avoid excessive intake of coffee, tea, cocoa, reduced one-third to one-half when cola beverages, chocolate. amiodarone is started. Smoking cigarettes or other tobacco Give drug with meals to decrease GI products impacts the drugs effectiveness. problems. Try not to smoke. Notify the care provider if Arrange for ophthalmologic exams; smoking habits change while taking this reevaluate at any sign of optic neuropathy. drug. Arrange for periodic chest x-ray to evaluate Frequent blood tests may be necessary to pulmonary status (every 3–6 mo). monitor the effect of this drug and to ensure Arrange for regular periodic blood tests for safe and effective dosage; keep all liver enzymes, thyroid hormone levels. appointments for blood tests and other Drug dosage will be changed in relation to monitoring. response of arrhythmias; you will need to be These side effects may occur: Nausea, loss hospitalized during initiation of drug of appetite (taking this drug with food may therapy; you will be closely monitored when help if taking the immediate-release or dosage is changed. liquid dosage forms); difficulty sleeping, Have regular medical follow-up, monitoring depression, emotional lability (reversible). of cardiac rhythm, chest x-ray, eye exam, Report nausea, vomiting, severe GI pain, blood tests. restlessness, seizures, irregular heartbeat These side effects may occur: Changes in vision (halos, dry eyes, sensitivity to light; wear sunglasses, monitor light exposure);2) AMIODARONE HYDROCHLORIDE nausea, vomiting, loss of appetite (take with meals; eat small, frequent meals); sensitivityBrand Names: Anoion tab Cordarone Cordarone to the sun (use a sunscreen or protectiveinj Sandoz Amiodarone HCl tab clothing when outdoors); constipation (aClassification: Cardiac Drugs laxative may be ordered); tremors,Dosage: PO Initial: 200 mg 3 times/day for 1 wk, twitching, dizziness, loss of coordination (doreduce to 200 mg twice daily for a further wk. not drive, operate dangerous machinery, orMaintenance: 200 mg/day or lowest effective dose. undertake tasks that require coordinationIV Initial: 5 mg/kg infusion via central venous until drug effects stabilize and your bodycatheter. Max: 1.2 g/24 hr. adjusts to it).Indication: Ventricular and supraventricular Report unusual bleeding or bruising; fever,arrhythmias. chills; intolerance to heat or cold; shortnessAction: Blocks potassium chloride leading to of breath, difficulty breathing, cough;prolongation of action potential duration. swelling of ankles or fingers; palpitations;Adverse Reactions: Blue-grey discoloration of skin, difficulty with vision.photosensitivity, peripheral neuropathy, paraesthesia,myopathy, ataxia, tremor, nausea, vomiting, metallic 3) ATROPINE SULFATEtaste, hypothyroidism, hyperthyroidism, alopecia,sleep disturbances, corneal microdeposits, hot Brand Names: Anespin amp Atropol amp Euro-flushes, sweating. Heart block, bradycardia, sinus Med Atropine Sulfate amp Isopto Atropine eyearrest, hepatotoxicity, heart failure. Potentially Fatal: drops Phil Pharmawealth/Atlantic Atropine ampPulmonary toxicity including pulmonary fibrosis and Classification: Other Cardiovascular Drugs, Muscleinterstitial pneumonitis, hepatotoxicity, thyrotoxicity. Relaxants, Mydriatic Drugs, Antidotes, DetoxifyingVentricular arrhythmias, pulmonary alveolitis, Agents & Drugs Used in Substance Dependenceexacerbation of arrhythmias and rare serious liver Indication/Dosage: IV Bradycardia 500 mcg everyinjury. Generally in patients with high doses and 3-5 mins. Total: 3 mg. IV/IM Organophosphorushaving preexisting abnormalities of diffusion poisoning 2 mg every 10-30 mins until muscariniccapacity. effects disappear or atropine toxicity appears. IM/SC Premed in anesth 300-600 mcg 30-60 mins beforeNursing Measures: anesth. IV/IM/SC Overdosage w/ other compd Monitor cardiac rhythm continuously. having muscarinic actions 0.6-1 mg, repeat 2 hrly. Monitor for an extended period when dosage Ophth Inflammatory eye disorders As 0.5-1% soln: adjustments are made. 1-2 drops 4 times/day. Eye refraction As 1% soln: 1 Monitor for safe and effective serum levels drop twice daily for 1-2 days before procedure. (0.5–2.5 mcg/mL). Action: An anti-cholinergic that inhibits Doses of digoxin, quinidine, procainamide, acetylcholine at the parasympathetic neuroeffector phenytoin, and warfarin may need to beEmergency Nursing Abejo
  • 4. Medical and Surgical NursingEmergency NursingPrepared by: Mark Fredderick R. Abejo R.N, M.A.Njunction, enhances the conduction of AV node and 4) BUMETANIDEincreases heart rateAdverse Reactions: Dry mouth, dysphagia, Brand Names: Burinex amp Burinex tabconstipation, flushing and dryness of skin, Classification: Sulfonamide Diureticstachycardia, palpitations, arrhythmias, mydriasis, Indication/Dosage: PO edema 1 mg once daily, 2ndphotophobia, cycloplegia, raised intraocular pressure. dose 6-8 hr later if needed. Refractory edema Initial:Toxic doses cause tachycardia, hyperpyrexia, 5 mg/day, may increase dose depending on response.restlessness, confusion, excitement, hallucinations, Max: 10 mg/day. HTN 0.5-1 mg/day. Max: 5delirium and may progress to circulatory failure and mg/day. IV Pulmonary edema 1-2 mg, repeat 20respiratory depression. Eye drops: Systemic toxicity mins. later if needed. IV/IM Emergency edema 0.5-1especially in children, on prolonged use may lead to mg, then adjust according to response.irritation, hyperemia, edema and conjunctivitis. Action: inhibits Sodium and Chloride reabsorption atIncreased intraocular pressure. Inhalation: Dryness of the ascending loop of Henlemouth, throat. Potentially Fatal: Atrial arrhythmias, Adverse Reactions: Muscle cramps, dizziness,AV dissociation, multiple ventricular ectopics. hypotension, headache, nausea, impaired hearing, pruritus, ECG changes, musculoskeletal pain, rash,Nursing Measures: chest discomfort, renal failure, premature ejaculation, Ensure adequate hydration; provide thrombocytopenia, hypokalemia, hypomagnesaemia, environmental control (temperature) to hyponatremia, hyperuricemia, hyperglycemia, prevent hyperpyrexia. hypocalcaemia. Have patient void before taking medication if urinary retention is a problem. Nursing Measures: When used preoperatively or in other acute Give with food or milk to prevent GI upset. situations, incorporate teaching about the Mark calendars or use reminders if drug with teaching about the procedure; the intermittent therapy is best for treating ophthalmic solution is used mainly acutely edema. and will not be self-administered by the Give single dose early in day so increased patient; the following apply to oral urination will not disturb sleep. medication for outpatients: Avoid IV use if oral use is possible. Take as prescribed, 30 min before meals; Arrange to monitor serum electrolytes, avoid excessive dosage. hydration, liver function during long-term Avoid hot environments; you will be heat therapy. intolerant, and dangerous reactions may Provide diet rich in potassium or occur. supplemental potassium. These side effects may occur: Dizziness, Record alternate day or intermittent therapy confusion (use caution driving or on a calendar or dated envelopes. performing hazardous tasks); constipation Take the drug early in day so increased (ensure adequate fluid intake, proper diet); urination will not disturb sleep; take with dry mouth (suck sugarless lozenges; perform food or meals to prevent GI upset. frequent mouth care; may be transient); Weigh yourself on a regular basis, at the blurred vision, sensitivity to light same time, and in the same clothing; record (reversible; avoid tasks that require acute the weight on your calendar. vision; wear sunglasses in bright light); These side effects may occur: Increased impotence (reversible); difficulty in volume and frequency of urination; urination (empty the bladder prior to taking dizziness, feeling faint on arising, drug). drowsiness (avoid rapid position changes; Report rash; flushing; eye pain; difficulty hazardous activities, such as driving; and breathing; tremors, loss of coordination; alcohol consumption); sensitivity to sunlight irregular heartbeat, palpitations; headache; (use sunglasses, sunscreen, wear protective abdominal distention; hallucinations; severe clothing); increased thirst (suck sugarless or persistent dry mouth; difficulty lozenges; use frequent mouth care); loss of swallowing; difficulty in urination; body potassium (a potassium-rich diet, or constipation; sensitivity to light. 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.Emergency Nursing Abejo
  • 5. Medical and Surgical NursingEmergency NursingPrepared by: Mark Fredderick R. Abejo R.N, M.A.N needed and tolerated. HTN in diabetic nephropathy5) CALCIUM GLUCONATE 75-100 mg/day in divided doses. Action: inhibits ACE, reduces Sodium and waterBrand Names: Phil Pharmawealth/Harson Calcium retention, lowers blood pressureGluconate amp Adverse Reactions: Hypotension, tachycardia, chestClassification: Electrolytes pain, palpitations, pruritus, hyperkalaemia.Indication/Dosage: PO Hypocalcaemia 10-50 Proteinuria; angioedema, skin rashes; tastemmol/day. IV Hypocalcaemic tetany 2.25 mmol via disturbance, nonproductive cough, headache.slow inj , then 58-77 mL of 10% soln diluted and Potentially Fatal: Neutropenia, usually occurs withinadministered as a continuous IV infusion. Antidote in 3 mth of starting therapy especially in patients withsevere hypermagnesaemia; Severe hyperkalaemia 10 renal dysfunction or collagen diseases.mL of 10% soln, repeat every 10 mins if needed. Hyperkalaemia. Anaphylactic reactions.Action: replaces Calcium and maintains Calciumlevel Nursing Measures:Adverse Reactions: GI irritation; soft-tissue Administer 1 hr before or 2 hr after meals.calcification, skin sloughing or necrosis after IM/SC Alert surgeon and mark patients chart withinj. Hypercalcaemia characterised by anorexia, notice that captopril is being taken; thenausea, vomiting, constipation, abdominal pain, angiotensin II formation subsequent tomuscle weakness, mental disturbances, polydipsia, compensatory renin release during surgerypolyuria, nephrocalcinosis, renal calculi; chalky taste, will be blocked; hypotension may behot flushes and peripheral vasodilation. Potentially reversed with volume expansion.Fatal: Cardiac arrhythmias and coma. Monitor patient closely for fall in BP secondary to reduction in fluid volumeNursing Measures: (excessive perspiration and dehydration, Make sure prescriber specifies form of vomiting, diarrhea); excessive hypotension calcium to be given; crash carts may contain may occur. both calcium gluconate and calcium Reduce dosage in patients with impaired chloride. renal function. Tell patient to take oral calcium 1 to 11/2 Take drug 1 hr before or 2 hr after meals; do hours after meals if GI upset occurs. not take with food. Do not stop without Give I.M. injection in gluteal region in consulting your health care provider. adults and in lateral thigh in infants. Use Be careful of drop in blood pressure (occurs I.M. route only in emergencies when no I.V. most often with diarrhea, sweating, route is available bec. of irritation of tissue vomiting, dehydration); if light-headedness by calcium salts. or dizziness occurs, consult your health care Tell patient to take oral calcium with a full provider. glass of water. Avoid over-the-counter medications, Monitor calcium levels frequently. especially cough, cold, allergy medications Hypercalcemia may result after large doses that may contain ingredients that will in chronic renal failure. Report interact with ACE inhibitors. Consult your abnormalities. health care provider. These side effects may occur: GI upset, loss6) CAPTOPRIL of appetite, change in taste perception (limited effects, will pass); mouth soresBrand Names: Ace-Bloc tab Capomed tab (perform frequent mouth care); rash; fastCapotec tab Capoten tab Captor tab Captril tab heart rate; dizziness, light-headednessCardiovaz tab Conamid tab Hartylox tab Normil (usually passes after the first few days;tab Phil Pharmawealth/Panion & BF Captopril tab change position slowly, and limit yourPrelat tab Primace tab Retensin tab Spec-Ace tab activities to those that do not requireTensoril tab Unihype tab Vasostad tab alertness and precision).Classification: ACE Inhibitors Report mouth sores; sore throat, fever,Indication/Dosage: PO HTN Initial: 12.5 mg twice chills; swelling of the hands, feet; irregulardaily. Maintenance: 25-50 mg twice daily. Max: 50 heartbeat, chest pains; swelling of the face,mg 3 times/day. Heart failure Initial: 6.25-12.5 mg 2- eyes, lips, tongue, difficulty breathing.3 times/day. Max: 50 mg 3 times/day. Post MI Start 3days after MI. Initial: 6.25 mg/day, may increaseafter several wk to 150 mg/day in divided doses ifEmergency Nursing Abejo
  • 6. Medical and Surgical NursingEmergency NursingPrepared by: Mark Fredderick R. Abejo R.N, M.A.N7) CLONIDINE heartbeat, chest pains; swelling of the face, eyes, lips, tongue, difficulty breathing.Brand Names: Catapin amp Catapres amp Take this drug exactly as prescribed. Do notCatapres tab miss doses. Do not discontinue the drugClassification: Other Antihypertensives unless so instructed. Do not discontinueIndication/Dosage: PO HTN Initial: 50-100 mcg 3 abruptly; life-threatening adverse effectstimes/day. Max: 2,400 mcg/day. Menopausal may occur. If you travel, take an adequateflushing; Migraine prophylaxis 50 mcg twice daily, supply of drug.up to 75 mg twice daily. IV Hypertensive crisis 150- Use the transdermal system as prescribed;300 mcg via slow inj. Max: 750 mcg over 24 hr. refer to directions in package insert, orEpidural Severe cancer pain Initial: 30 mcg/hr as contact your health care provider withcontinuous infusion in combination w/ an opioid. questions. Be sure to remove old systemsTransdermal HTN As patch releasing 100-300 mcg before applying new ones.clonidine base/day at constant rate: Apply once wkly. Attempt lifestyle changes that will reduceAction: stimulates alpha 2 receptors and inhibits your BP: stop smoking and using alcohol;central vasomotor centers, lowers peripheral vascular lose weight; restrict intake of sodium (salt);resistance, blood pressure, and heart rate exercise regularly.Adverse Reactions: Dry mouth, drowsiness, Use caution with alcohol. Your sensitivitydizziness, headache, constipation, impotence, vivid may increase while using this drug.dreams, urinary retention; dry, itching, burning These side effects may occur: Drowsiness,sensation in the eye; fluid or electrolyte imbalance, dizziness, light-headedness, headache,GI upset, paralytic ileus, orthostatic hypotension, weakness (often transient; observe cautionweakness, sedation, pruritus, myalgia, urticaria, driving or performing other tasks thatnausea, insomnia, arrhythmias, agitation. Reduced GI require alertness or physical dexterity); drymotility at times may cause paralytic ileus. mouth (suck on sugarless lozenges or icePotentially Fatal: Transient hypertension or profound chips); GI upset (eat small, frequent meals);hypotension, respiratory depression, convulsion. dreams, nightmares (reversible); dizziness,Clonidine withdrawal syndrome could be life light-headedness when you change positionthreatening. Bradycardia, coma and disturbances in (get up slowly; use caution climbing stairs);conduction (in individuals with preexisting diseases impotence, other sexual dysfunction,of SA/AV nodes, overdose or on digitalis). decreased libido (discuss with care providers); breast enlargement, sore breasts;Nursing Measures: palpitations. Take drug 1 hr before or 2 hr after meals; do Report urinary retention, changes in vision, not take with food. Do not stop without blanching of fingers, rash. consulting your health care provider. Be careful of drop in blood pressure (occurs 8) DIAZEPAM most often with diarrhea, sweating, vomiting, dehydration); if light-headedness Brand name: Valium or dizziness occurs, consult your health care Classification: Anxiolytics provider. Dosage: 10mg/2ml Avoid over-the-counter medications, Indication: relief of anxiety, agitation & tension due especially cough, cold, allergy medications to psychoneurotic states & transient situational that may contain ingredients that will disturbances interact with ACE inhibitors. Consult your Action: a benzodiazepine that probably potentiates health care provider. the effects of GABA, depresses the CNS & These side effects may occur: GI upset, loss suppresses the spread of seizure activity of appetite, change in taste perception Adverse Reaction: drowsiness,dysarthria, slurred (limited effects, will pass); mouth sores speech, tremor, transient amnesia, fatigue, ataxia, (perform frequent mouth care); rash; fast headache, insomnia, paradoxical anxiety, heart rate; dizziness, light-headedness hallucination (usually passes after the first few days; change position slowly, and limit your Nursing Measures: activities to those that do not require Do not administer intra-arterially; may alertness and precision). produce arteriospasm, gangrene. Report mouth sores; sore throat, fever, Change from IV therapy to oral therapy as chills; swelling of the hands, feet; irregular soon as possible.Emergency Nursing Abejo
  • 7. Medical and Surgical NursingEmergency NursingPrepared by: Mark Fredderick R. Abejo R.N, M.A.N Do not use small veins (dorsum of hand or Follow diluting instructions carefully, and wrist) for IV injection. use diluted solution promptly. Reduce dose of narcotic analgesics with IV Avoid giving with meals; this will delay diazepam; dose should be reduced by at absorption. least one-third or eliminated. Have emergency equipment ready; have K+ Carefully monitor P, BP, respiration during salts, lidocaine, phenytoin, atropine, cardiac IV administration. monitor on standby in case toxicity Maintain patients receiving parenteral develops. benzodiazepines in bed for 3 hr; do not Monitor for therapeutic drug levels: 0.5–2 permit ambulatory patients to operate a ng/mL. vehicle following an injection. Monitor EEG in patients treated for status 10) DIPENHYDRAMINE epilepticus; seizures may recur after initial control, presumably because of short Brand name: Benadryl duration of drug effect. Classification: antihistamine Monitor liver and kidney function, CBC Dosage: 50mg/ml during long-term therapy. Indication: Hay fever, urticaria, vasomotor rhinitis, Taper dosage gradually after long-term angioneurotic edema, drug sensitization, serum & therapy, especially in epileptic patients. penicillin reaction, contact dermatitis, atopic eczema, Arrange for epileptic patients to wear other allergic dermatoses, pruritus, food sensitivity, medical alert ID indicating that they are parkinsonism, motion sickness. epileptics taking this medication. Action: prevents histamine mediated responses, drug Discuss risk of fetal abnormalities with provides local anesthesia and suppresses cough reflex patients desiring to become pregnant. Adverse Reaction: CV and CNS effects, blood disorders, GI disturbances, anti-muscarinic effects9) DIGOXIN and allergic reactions.Brand name: Digitek, Lanoxicaps, Lanoxin, Novo- Nursing Measures:Digoxin (CAN) Monitor carefully, assess for confusion,Classification: Inotropics delirium, other anticholinergic side effectsDosage: 5mg/2ml and fall risk. Institute measures to preventIndication: Cardiac failure accompanied by atrial falls.fibrillation; management of chronic cardiac failure Assess movement disorder before and afterwhere systolic dysfunction or ventricular dilatation is administration.dominant; management of certain supraventricular Caution patient not to use oral OTCarrhythmias, particularly chronic atrial flutter & diphenhydramine products with any otherfibrillation. product containing diphenhydramine,Action: inhibits sodium-potassium activated including products used topically.adenosine triphosphate, promoting movement of It can cause excitation in children. Cautioncalcium from extracellular to intra-cytoplasm and parents or caregivers about proper dosestrengthening myocardial contraction, also acts on calculation; overdosage, especially in infantsCNS to enhance vagal tone and children, can cause hallucinations,Adverse Reaction: nausea, vomiting, anorexia, seizures or death Inform patient that thisheadache, facial pain, fatigue, weakness, dizziness, drug may cause dry mouth. Frequent oraldrowsiness, disorientation, mental confusion, bad rinses, good oral hygiene, and sugarless gumdreams, convulsions or candy may minimize this effect. Notify dentist if dry mouth persists for more than 2Nursing Measures: weeks. Monitor apical pulse for 1 min before administering; hold dose if pulse < 60 in 11) EPINEPHRINE adult or < 90 in infant; retake pulse in 1 hr. If adult pulse remains < 60 or infant < 90, Brand name: hold drug and notify prescriber. Note any Epinephrine Bitartrate change from baseline rhythm or rate. Aerosols: Primatene Mist Check dosage and preparation carefully. Epinephrine Borate Avoid IM injections, which may be very Ophthalmic solution: Epinal painful. Epinephrine Hydrochloride Injection, OTC nasal solution: Adrenalin ChlorideEmergency Nursing Abejo
  • 8. Medical and Surgical NursingEmergency NursingPrepared by: Mark Fredderick R. Abejo R.N, M.A.NOphthalmic solution: Epifrin, Glaucon with respiratory distress) readily available inInsect sting emergencies: EpiPen Auto-Injector case cardiac arrhythmias occur.(delivers 0.3 mg IM adult dose), EpiPen Jr. Auto- Do not exceed recommended dosage ofInjector (delivers 0.15 mg IM for children) inhalation products; administer pressurizedOTC solutions for nebulization: AsthmaNefrin, inhalation drug forms during second half ofmicroNefrin, Nephron, S2 inspiration, because the airways are openClassification: Sympathomimetic, Alpha-adrenergic wider and the aerosol distribution is moreagonist, Beta1and beta2-adrenergic agonist, Cardiac extensive. If a second inhalation is needed,stimulant, Vasopressor, Bronchodilator, Antasthmatic administer at peak effect of previous dose,drug, Nasal decongestant, Mydriatic, Antiglaucoma 3–5 min.drug Use topical nasal solutions only for acuteDosage: 1mg/ml states; do not use for longer than 3–5 days,Indication: Acute asthmatic attacks, Advanced and do not exceed recommended dosage.cardiac life support Rebound nasal congestion can occur afterAction: Naturally occurring neurotransmitter, the vasoconstriction subsides.effects of which are mediated by alpha or beta Do not exceed recommended dosage;receptors in target organs. Effects on alpha receptors adverse effects or loss of effectiveness mayinclude vasoconstriction, contraction of dilator result. Read the instructions that come withmuscles of iris. Effects on beta receptors include respiratory inhalant products, and consultpositive chronotropic and inotropic effects on the your health care provider or pharmacist ifheart (beta1 receptors); bronchodilation, vasodilation, you have any questions.and uterine relaxation (beta2 receptors); decreased To give eye drops: Lie down or tilt headproduction of aqueous humor. backward, and look up. Hold dropper aboveAdverse Reaction: drowsiness, headache, eye; drop medicine inside lower lid whilenervousness, tremors, cerebral hemorrhage, looking up. Do not touch dropper to eye,dizziness, weakness, vertigo, pain fingers, or any surface. Release lower lid; keep eye open, and do not blink for at leastNursing Measures: 30 sec. Apply gentle pressure with fingers to Monitor heart rate. inside corner of the eye for about 1 min; Use extreme caution when calculating and wait at least 5 min before using other eye preparing doses; epinephrine is a very potent drops. drug; small errors in dosage can cause These side effects may occur: Dizziness, serious adverse effects. Double-check drowsiness, fatigue, apprehension (use pediatric dosage. caution if driving or performing tasks that Use minimal doses for minimal periods of require alertness); anxiety, emotional time; "epinephrine-fastness" (a form of drug changes; nausea, vomiting, change in taste tolerance) can occur with prolonged use. (eat frequent small meals); fast heart rate. Protect drug solutions from light, extreme Nasal solution may cause burning or heat, and freezing; do not use pink or brown stinging when first used (transient). solutions. Drug solutions should be clear Ophthalmic solution may cause slight and colorless (does not apply to suspension stinging when first used (transient); for injection). headache or brow ache (only during the first Shake the suspension for injection well few days). before withdrawing the dose. Report chest pain, dizziness, insomnia, Rotate SC injection sites to prevent necrosis; weakness, tremor or irregular heart beat monitor injection sites frequently. (respiratory inhalant, nasal solution), Keep a rapidly acting alpha-adrenergic difficulty breathing, productive cough, blocker (phentolamine) or a vasodilator (a failure to respond to usual dosage nitrate) readily available in case of excessive (respiratory inhalant), decrease in visual hypertensive reaction. acuity (ophthalmic). Have an alpha-adrenergic blocker or facilities for intermittent positive pressure 12) FUROSEMIDE breathing readily available in case pulmonary edema occurs. Brand name: Apo-Furosemide (CAN), Furoside Keep a beta-adrenergic blocker (CAN), Lasix, Myrosemide (CAN) (propranolol; a cardioselective beta-blocker, Classification: loop diuretics such as atenolol, should be used in patients Dosage: 20mg/2ml Indication: edema, hypertensionEmergency Nursing Abejo
  • 9. Medical and Surgical NursingEmergency NursingPrepared by: Mark Fredderick R. Abejo R.N, M.A.NAction: inhibits Sodium and Chloride reabsorption at Monitor patient for orthostatic hypotensionthe proximal and distal tubules and the ascending which is most marked in the morning and inloop of Henle hot weather, and with alcohol or exercise.Adverse Reaction: vertigo, headache, dizziness,paresthesia, weakness, restlessness, fever, nocturia,oliguria, polyguria 14) HYDROCORTISONE SODIUM SUCCINATENursing Measures: Monitor BP after administration Brand name: A-hydroCort, Solu-Cortef Administer with food or milk to prevent GI Classification: corticosteroid hormones upset. Stock Dose:100 mg/ 2 mL, 250 mg/ 2 mL Reduce dosage if given with other Indication: endocrine, hematologic, rheumatic & antihypertensives; readjust dosage gradually collagen disorders, dermatologic, ophth, GI, resp & as BP responds. neoplastic diseases, edematous states, control of Give early in the day so that increased severe incapacitating allergic conditions, TB urination will not disturb sleep. meningitis w/ subarachnoid block or impending Avoid IV use if oral use is at all possible. block when used concurrently with appropriate anti- Do not mix parenteral solution with highly TB chemotherapy, shock secondary to adrenocortical acidic solutions with pH below 3.5. insufficiency or shock unresponsive to conventional Do not expose to light, may discolor tablets therapy when adrenocortical insufficiency may be or solution; do not use discolored drug or present solutions. Action: Decreases inflammation, mainly by stabilizing leukocyte lysosomal membranes, Discard diluted solution after 24 hr. suppresses immune response, stimulates bone Refrigerate oral solution. marrow and influences protein, fat, and carbohydrate Measure and record weight to monitor fluid metabolism changes. Adverse Reactions: fluid and electrolyte Arrange to monitor serum electrolytes, disturbances, decreased carbohydrate tolerance, hydration, liver function. impaired wound healing, thin fragile skin, muscle Arrange for potassium-rich diet or weakness, steroid myopathy, osteoporosis, aseptic supplemental potassium as needed. necrosis, peptic ulceration w/ possible perforation, cataracts, increased intraocular and intracranial13) HYDRALAZINE HYDROCHLORIDE pressure, growth retardation, Cushingoid state, protein catabolism, psychic derangements,Brand name: Supres exophthalmos, masking of infections, gaspingClassification: antihypertension syndrome, seizures, menstrual irregularities.Dosage: 20mg/mlIndication: For hypertensive patient Nursing Measures:Action: a direct acting peripheral vasodilator that Give daily before 9 AM to mimic normalrelaxes arteriolar smooth muscles peak diurnal corticosteroid levels andAdverse Reaction: tachycardia, palpitation, angina minimize HPA suppression.pectoris, severe headache, dizziness, weight gain, GI Space multiple doses evenly throughout thedisturbances, pruritus, rashes, nausea and vomiting day.Nursing Measures: Do not give IM injections if patient has Give oral drug with food to increase thrombocytopenic purpura. bioavailability(drug should be given in a Rotate sites of IM repository injections to consistent relationship ti ingestion of food avoid local atrophy. for consistent response to therapy). Use minimal doses for minimal duration to Drug may cause a syndrome resembling minimize adverse effects. systemic lupus erythematosus (SLE). Taper doses when discontinuing high-dose Arrange for CBC, LE cell preparations, and or long-term therapy. ANA titers before and periodically during prolonged therapy, even in the Arrange for increased dosage when patient asymptomatic patient. Discontinue if blood is subject to unusual stress. dyscrasias occur. Reevaluate therapy if Use alternate-day maintenance therapy with ANA or LE tests are positive. short-acting corticosteroids whenever Arrange for pyridoxine if patient develops possible. symptoms of peripheral neuritis.Emergency Nursing Abejo
  • 10. Medical and Surgical NursingEmergency NursingPrepared by: Mark Fredderick R. Abejo R.N, M.A.N Do not give live virus vaccines with 17) MAGNESIUM SULFATE immunosuppressive doses of hydrocortisone. Brand name: Elin Magnesium Sulfate Provide antacids between meals to help Classification: anticonvulsant avoid peptic ulcer. Dosage: 250 mg/10 mL Indication: treatment of hypomagnesemia accompanied by signs of tetany, control of HTN,15) ISOSORBIDE-5- MONONITRATE encephalophathy & convulsions, prevention & control of convulsions in patients w/ preeclampsia orBrand name: Imdur eclampsia, prevention of hypomagnesemia in patientsClassification: anti- anginal drug receiving TPNStock Dose: SL: 5 mg/mL ; Oral: 30 mg, 60 mg Action: may decrease acetylcholine released byIndication: prophylactic treatment of angina pectoris nerve impulses, but its anticonvulsant mechanism isAction: Thought to reduce cardiac oxygen demand unknownby decreasing preload and afterload. Drug also may Adverse Reactions: flushing, sweating, hypotension,increase blood flow through the collateral coronary muscular weakness, sedation & confusion; decreasedvessels deep tendon reflexes; resp. paralysisAdverse Reactions: headache, hypotension w/dizziness and nausea, tachycardia Nursing Measures: Monitor the following: I.V.: RapidNursing Measures: administration: ECG monitoring, vital signs, deep tendon reflexes; magnesium, calcium, Monitor BP and heart rate. and potassium levels; renal function during Assess location, duration, intensity, and administration. Obstetrics: Patient status precipitating factors of anginal pain. including vital signs, oxygen saturation, deep tendon reflexes, level of consciousness,16) ISOSORBIDE DINITRATE fetal heart rate, maternal uterine activity.Brand name: Isoket IV Oral: Renal function; magnesium levels;Classification: anti – anginal drug bowel movements.Stock: IV amp 10 mg/ 10 mLDose: 10 mg/10mL 18) MEPERIDINE HYDROCHLORIDEIndication: unresponsive left ventricular failuresecondary to acute MI, severe or unstable angina Brand name: Demerolpectoris Classification: antivertigo drugAction: Isosorbide dinitrate is a smooth muscle Dosage: 100 mg/ 2mLrelaxant. It is particularly effective on vascular and Indication: relief of moderate to severe pain, pre-opbronchial smooth muscle. Its systemic cardiovascular medication, support of anesth & obstet analgesiaeffects are mainly due to a decrease in venous return Action: binds with opiate receptors in the CNS,(pooling of blood in the peripheral venous system). altering perception of and emotional response to painConsequently, ventricular end-diastolic pressure and Adverse Reactions: resp. depression, circulatoryvolume are diminished, thus reducing cardiac work depression, resp arrest, shock, cardiac arrest, GIand implicitly myocardial oxygen requirements. The disturbance, light headedness, dizziness, sedation,arterial vessels are dilated as well, though to a lesser nausea, vomiting, sweating, euphoria, dysphoria,degree. This results in a slight drop in aortic and weakness, headache, tremor, agitation, uncoordinatedsystemic blood pressure relieving the myocardium muscle movements, severe convulsions, transientfrom a part of its afterload. These nitrate-induced hallucinations & disorientation, visual disturbance,changes account for both the antianginal effects of flushing, tachycardia, bradycardia, palpitation,isosorbide dinitrate and for its beneficial effects in hypotension, syncope, phlebitis, urinary retention,the treatment of congestive heart failure. allergic reactions, pain at injection site and localSide effects/ adverse reactions: severe cerebral flow tissue irritation.deficiency and decreased coronary perfusion maydevelop, nitrate headache and nausea. Nursing Measures: Make position changes slowly and in stagesNursing Measures: particularly from recumbent to upright Monitor BP and heart rate. posture. Lie down immediately if light- Assess location, duration, intensity, and headedness or dizziness occurs. precipitating factors of anginal pain. Lie down when feeling nauseated and to notify physician if this symptom persists. Nausea appears to worsen with ambulation.Emergency Nursing Abejo
  • 11. Medical and Surgical NursingEmergency NursingPrepared by: Mark Fredderick R. Abejo R.N, M.A.N Avoid driving and other potentially sedation in premed before surgical or diagnostic hazardous activities until reaction to drug is procedures, induction & maintenance of anesth. known. Codeine may impair ability to Action: may potentiate the effects of GABA, depress perform tasks requiring mental alertness and the CNS, and suppress the spread of seizure activity therefore to. Adverse Reactions: rarely cardioresp adverse events, Do not take alcohol or other CNS nausea, vomiting, headache, hiccoughs, depressants unless approved by physician. laryngospasm, dyspnoea, hallucination, oversedation, Hyperactive cough may be lessened by drowsiness, ataxia, rash, paradoxical reactions, avoiding irritants such as smoking, dust, amnesic episodes. fumes and other air pollutants. Humidification of ambient air may provide Nursing Measures: some relief. Do not administer intra-arterially, which Do not breast feed while taking this drug. may produce arteriospasm or gangrene. Do not use small veins (dorsum of hand or19) METOCLOPRAMIDE wrist) for IV injection. Administer IM injections deep into muscle.Brand name: Apo-Metoclop (CAN), Maxeran Monitor IV injection site for extravasation.(CAN), Maxolon, Nu-Metoclopramide (CAN), Arrange to reduce dose of midazolam ifOctamide PFS, Reglan patient is also being given opioid analgesics;Classification: antiemetic & anti-spasmodic reduce dosage by at least 50% and monitorDosage: 10 mg/ 2mL patient closely.Indication: disturbances of GI motility, nausea & Monitor level of consciousness prior to,vomiting of central & peripheral origin associated w/ during, and for at least 2–6 hr aftersurgery, metabolic diseases, infectious & drug administration of midazolam.induced diseases, facilitate small bowel intubation & Carefully monitor P, BP, and respirationsradiological procedures of GIT carefully during administration.Action: stimulates motility of upper GI tract, Keep resuscitative facilities readilyincreases lower esophageal sphincter tone, and blocks available; have flumazenil available asdopamine receptors at the chemoreceptor trigger zone antidote if overdose should occur.Adverse Reactions: extrapyramidal reactions, Keep patients in bed for 3 hr; do not permitdrowsiness, fatigue & lassitude, anxiety, less ambulatory patients to operate a vehiclefrequently, insomnia, headache, dizziness, nausea, following an injection.galactorrhea, gynecomastia, bowel disturbances. Arrange to monitor liver and kidney function and CBC at intervals during long-Nursing Measures: term therapy. Monitor BP carefully during IV Establish safety precautions if CNS changes administration. occur (use side rails, accompany ambulating Monitor for extrapyramidal reactions, and patient). consult physician if they occur. Provide comfort measures and reassurance Monitor diabetic patients, arrange for for patients receiving diazepam for tetanus. alteration in insulin dose or timing if Arrange to taper dosage gradually after diabetic control is compromised by long-term therapy. alterations in timing of food absorption. Provide patient with written information Keep diphenhydramine injection readily regarding recovery and follow-up care. available in case extrapyramidal reactions Midazolam is a potent amnesiac and occur (50 mg IM). memory may be altered. Have phentolamine readily available in case of hypertensive crisis (most likely to occur 21) MORPHINE SULFATE with undiagnosed pheochromocytoma). Brand name: Morin20) MIDAZOLAM HYDROCHLORIDE Classification: Analgesics (Opioid) Dosage: Adult 5-20 mg IM/SC 4 hrly. Severe orBrand name: Dormicum chronic pain Childn 10 mg IM/SC 4 hrly, range: 5-20Classification: hypnotics & sedatives mg; 6-12 yr 5-10 mg, 1-5 yr 2.5-5 mg, 1-12 mth 200Dosage: 5mg/5mL mcg/kg, <1 mth 150 mcg/kg 4 hrly. Max: 15 mg.Indication: tab: disturbances of sleep rhythm, Analgesic effect Ped 100-200 mcg/kg SC 4 hrly,insomnia esp difficulty in falling asleep either max: 15 mg/dose; or 50-100 mcg/kg slow IV. Pre-opinitially or after premature awakening, tab/inj: 50-100 mcg/kg IM, max: 10 mg/dose.Emergency Nursing Abejo
  • 12. Medical and Surgical NursingEmergency NursingPrepared by: Mark Fredderick R. Abejo R.N, M.A.NIndication: Relief of moderate to severe pain not Monitor blood pressure.Allow atleast 3 daysresponsive to non-narcotic analgesics. Premed. between dosage adjustment to achieveAnalgesic adjunct in general anesth esp in pain steady plasma levels.associated w/ cancer, MI & surgery. Alleviates Advise patient to report immediately ifanxiety associated w/ severe pain. Hypnotic for pain- experiencing chest painrelated sleeplessness.Action: alters perception and emotional response to 23) NTG PATCHpainAdverse Reactions: Lightheadedness, dizziness, Brand name: Deponit, Minitran, Nitrek, Nitro-Dur,sedation, nausea, vomiting, constipation & sweating. Nitrodisc, Transderm-Nitro Classification: Anti-Anginal DrugsNursing Measures: Dosage: Starting dose: 0.2-0.4 mg/hr. Dosing Caution patient not to chew or crush schedule: Daily patch-on period of 12-14 hr & daily controlled-release preparations. patch-off period of 10-12 hr. Dilute and administer slowly IV to minimize Indication: Prevention of angina pectoris due to likelihood of adverse effects. coronary artery disease Tell patient to lie down during IV Action: a nitrate that reduces cardiac oxygen demand administration. by decreasing left ventricular end diastolic pressure Keep opioid antagonist and facilities for and to a lesser extent, systemic vascular resistance, assisted or controlled respiration readily also increases blood flow through collateral coronary available during IV administration. vessels Use caution when injecting SC or IM into Adverse Reactions: Headache. Transient episodes of chilled areas or in patients with hypotension lightheadedness. Infrequently, hypotension. Syncope, or in shock; impaired perfusion may delay crescendo angina, rebound HTN, allergic & absorption; with repeated doses, an anaphylactoid reactions. Rarely severe, application excessive amount may be absorbed when site irritation. circulation is restored. Reassure patients that they are unlikely to Nursing Measures: become addicted; most patients who receive Administer transdermal systems to skin site opioids for medical reasons do not develop free of hair and not subject to much dependence syndromes. movement. Shave areas that have a lot of hair. Do not apply to distal extremities.22) NICARDIPINE HYDROCHLORIDE Change sites slightly to decrease the chance of local irritation and sensitization. RemoveBrand name: Cardepine transdermal system before attemptingClassification: Calcium Antagonists defibrillation or cardioversion.Dosage: IV infusion Dilute to 10-20 mg/100 mL To use transdermal systems, you may need(conc of 1.01-0.02%). Initial infusion rate: 5 mg/hr; to shave an area for application. Apply to atitrate dose up to 15 mg/hr until desired therapeutic slightly different area each day. Use care ifresponse is achieved (DBP <95 mmHg, SBP <140 changing brands; each system has a differentmmHg). Maintenance rate: Can be tapered down to concentration.≤10 mg/hr. IV bolus inj 2-7 mg w/out dilution givenover 1-2 min. 24) PARACETAMOLIndication: Hypertensive emergencies or urgencies,peri-op & post-op HTN, hypertensive states of NPO Brand name: Aeknilpatients. Classification: Analgesics (Non-Opioid) &Action: a Calcium channel blocker that inhibits AntipyreticsCalcium ion influx across cardiac and smooth muscle Dosage: Adult & childn ≥10 yr 2-3 mL, ≤10 yr 1-2cells, also dilates coronary arteries and arterioles mL. Depending on severity of case, dose may beAdverse Reactions: Peripheral edema, headache, repeated 4 hrly. In severe cases, dose may betachycardia, palpitations, localized thrombophlebitis administered by IV very slowly& hypotension. Indication: Pyrexia of unknown origin. Fever & pain associated w/ common childhood disorders,Nursing Measures: tonsillitis, upper resp tract infections post- Patients with hepatic impairment should immunization reactions, after tonsillectomy & other receive lower dose. conditions. Prevention of febrile convulsion. Headache, cold, sinusitis, muscle pain, arthritis & toothacheEmergency Nursing Abejo
  • 13. Medical and Surgical NursingEmergency NursingPrepared by: Mark Fredderick R. Abejo R.N, M.A.NAction: produce analgesia by blocking pain impulses 26) TERBUTALINEby inhibiting synthesis of prostaglandin in CNS,relieves fever Brand name: BricalinAdverse Reactions: Hematological, skin & other Classification: Antiasthmatic & COPD Preparationsallergic reactions Dosage: Antiasthmatic & COPD Preparations Indication: For reversible airways obstruction, inNursing Measures: asthma, COPD. Decreases uterine contractility & Use liquid form for children and patients may be used to arrest premature labor who have difficulty swallowing. Action: relaxes bronchial smooth muscles by In children, don’t exceed five doses in 24 stimulating beta-2 receptors hours. Adverse Reaction: Fine tremor of skeletal muscle Advise patient that drug is only for short esp hands, palpitations, tachycardia, nervous tension, term use and to consult the physician if headache, peripheral vasodilation. giving to children for longer than 5 days or adults for longer than 10 days. Nursing Measures: Advise patient or caregiver that many over Use minimal periods of time; drug tolerance the counter products contain acetaminophen; can occur with prolonged use. be aware of this when calculating total Keep beta-adrenergic blocker readily dailydose. available in case cardiac arrhythmias occur. Warn patient that high doses or Do not recommended dosage. unsupervised long term use can cause liver damage. 27) VERAPAMIL HYDROCHLORIDE25) PHENYTOIN Brand name: Calan, Calan SR, Covera-HS, Isoptin, Isoptin SR, Verelan, Verelan PMBrand name: Dilantin Classification: Calcium AntagonistsClassification: Anticonvulsants Dosage: Isoptin tab Adult 40-80 mg tid-qid. Max:Dosage: Adult Initially 100 mg tid. Maintenance: 480 mg daily. Childn >6 yr 40-120 mg bid-tid, up to300-400 mg daily. Childn ≥6 yr Initially 100 mg tid, 360 mg daily, childn ≤6 yr 40 mg bid-tid. Isoptin SRsubsequent dosage should be adjusted according to 180 Coronary insufficiency 1 tab bid. Usual dailytherapeutic response, <6 yr 30 mg bid, may be dose: 240-480 mg. Hypertension 1 tab in theincreased to 30 mg tid or qid. Pedia 5 mg/kg/day morning. Isoptin SR 240 1 tab in the morning. IfInitially in 2-3 equally divided doses. Max: 300 mg required after 2 wk, increase dose to 2 tab daily.daily. Maintenance: 4-8 mg/kg/day Isoptin amp 5 mg slow IV, if required, 5 mg after 5-Indication: Tonic-clonic & complex partial 10 min. Then, if required, continuous drip infusion of(psychomotor, temporal lobe), prevention & 5-10 mg/hr up to 100 mg/day. Angina pectoris &treatment of seizures occurring during or following rapid elimination of tachyarrhythmias 1-2 amp IV, ifneurosurgery required bid-tidAction: may stabilize neuronal membranes and limit Indication: Isoptin/Isoptin SR 180 Essentialseizure activity by either by increasing efflux or hypertension, chronic coronary insufficiency, anginadecreasing influx of Na ions across cell membrane in pectoris, paroxysmal supraventricular tachycardia,the motor cortex during generation of nerve impulses tachyarrhythmias, long-term treatment after MI.Adverse Reactions: GI disturbances; ataxia, slurred Isoptin SR 240 Essential hypertensionspeech; diplopia, nystagmus & mental confusion w/ Action: decreases myocardial contractility andheadache, dizziness, gingival hyperplasia, hirsutism, oxygen demand, it also dilates coronary arteries andhyperglycemia, osteomalacia arterioles Adverse Reactions: Constipation, dizziness, nausea.Nursing Measures: Rarely, vertigo, headache, hypotension, ankle edema, Assess location, duration, frequency, and flushing, fatigue, nervousness, erythromelalgia, characteristics of seizure activity. EEG may paraesthesia, neuropathy; bradycardiac arrhythmias, be monitored periodically throughout CHF. Dyspnea therapy, Assess oral hygiene. Vigorous oral cleaning beginning within 10 days of Nursing Measures: initiation of phenytoin therapy may help Monitor patient carefully (BP, cardiac control gingival hyperplasia. rhythm, and output) while drug is being titrated to therapeutic dose. Dosage may be increased more rapidly in hospitalized patients under close supervision.Emergency Nursing Abejo
  • 14. Medical and Surgical NursingEmergency NursingPrepared by: Mark Fredderick R. Abejo R.N, M.A.N Ensure that patient swallows SR tablets 29) FENOTEROL/IPRATROPIUM BROMIDE whole: do not cut, crush, or chew them. Monitor BP very carefully with concurrent Brand name: Berodual doses of antihypertensives. Classification: Antiasthmatic & COPD Preparations Monitor cardiac rhythm regularly during Dosage: Berodual inhalation soln Adult (including stabilization of dosage and periodically elderly) & adolescent >12 yr Treatment of 1 mL for during long-term therapy. immediate symptom relief. Intermittent & long-term Administer sustained-release form in the treatment 1-2 mL for each administration, up to morning with food to decrease GI upset. qid. Moderate bronchospasm or w/ assisted Protect IV solution from light. ventilation 0.5 mL. Childn 6-12 yr Treatment of Monitor patients with renal or hepatic attacks 0.5-1 mL. Intermittent & long-term impairment carefully for possible drug treatment 0.5-1 mL for each administration, up to accumulation and adverse reactions. qid. Moderate bronchospasm or w/ assisted ventilation 0.5 mL. Childn <6 yr (<22 kg body28) IPRATROPIUM INHALATION wt) Up to 0.5 mL up to tid. Berodual F UDV Adult & childn >12 yr Acute asthma episodes 1 vial, in veryBrand name: Atrovent severe cases, 2 vials are needed. Intermittent & long-Classification: Antiasthmatic & COPD Preparations, term treatment 1 vial up to qid.anticholinergics or antimuscarinics Indication: prevention and treatment of symptoms inStock: 0.5 mg/2 mL chronic obstructive airway disorders with reversibleDosage: Adult (including elderly) & adolescent >12 bronchospasmyr Acute attacks 1 vial, may repeat doses until patient Action: for the prevention and treatment of reversibleis stable. Maintenance: 1 vial tid-qid. bronchospasm associated with bronchial asthma andIndication: Bronchodilator for treatment of especially chronic bronchitis with or withoutbronchospasm associated w/ COPD, including emphysemachronic bronchitis, emphysema and asthma Adverse Reactions: Fine tremor of skeletal muscles,Action: it works by binding to specific receptors nervousness, restlessness, palpitations; less(called muscarinic receptors) in the airway, helping frequently tachycardia, dizziness or headache. Dryto relax the smooth muscle of the airway. When used mouth, throat irritation or allergic reactions, cough,to treat a runny nose, it works by decreasing the paradoxical bronchoconstriction (rare). Urinaryproduction of fluid in the glands that line the nasal retention may occur in particular, in patients w/passages preexisting outflow tract obstruction.Adverse Reaction: Headache, nausea, dry mouth,increased heart rate & palpitations, ocular Nursing Measures:accommodation disturbances, GI motility Protect solution for inhalation from light.disturbances, urinary retention, ocular side effects, Store unused vials in foil pouch.cough, local irritation, bronchoconstriction, skin rash, Use nebulizer mouthpiece instead of faceangioedema, urticaria, laryngospasm, anaphylactic mask to avoid blurred vision or aggravationreactions. of narrow-angle glaucoma. Can mix albuterol in nebulizer for up to 1 hr.Nursing Measures: Ensure adequate hydration, control Protect solution for inhalation from light. environmental temperature to prevent Store unused vials in foil pouch. hyperpyrexia. Use nebulizer mouthpiece instead of face Have patient void before taking medication mask to avoid blurred vision or aggravation to avoid urinary retention. of narrow-angle glaucoma. Teach patient proper use of inhalator. Can mix albuterol in nebulizer for up to 1 hr. Ensure adequate hydration, control 30) BUDESONIDE environmental temperature to prevent hyperpyrexia. Brand name: Symbicort Have patient void before taking medication Classification: Corticosteroids to avoid urinary retention. Dosage: 80/4.5 mcg x 60 doses; 160/4.5 mcg x 60 Teach patient proper use of inhalator. 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 rangingEmergency Nursing Abejo
  • 15. Medical and Surgical NursingEmergency NursingPrepared by: Mark Fredderick R. Abejo R.N, M.A.Nfrom asthma to allergies toCrohn’s disease 32) SALBUTAMOLAdverse Reactions: Abdominal pain, conjunctivitis(pinkeye), cough, diarrhea, ear infection or Brand name: Aero-Ventinflammation, fever, fungal infection in mouth, Classification: bronchodilatorheadache, nasal or sinus inflammation, nosebleed, Stock: 1 mg/1 mLpain, rash, respiratory infection, stomach or intestinal Dose: Adult & childn 2.5-5 mg. May repeat qid byinflammation, throat inflammation, viral infection, hlebitis. Delivery of aerosol may be by face maskvomiting, wheezing of ―T‖ piece. Use undiluted. For prolonged delivery time, dilute w/ sterile water or normal saline for inj.Nursing Measures: Indication: treatment of acute, severe asthma and in Taper systemic steroids carefully during routine management of chronic bronchospasm transfer to inhalational steroids; deaths from unresponsive to conventional therapy adrenal insufficiency have occurred. Action: used with anti-inflammatory medication to Arrange for use of decongestant nose drops prevent asthma attacks, Some of these medicines are to facilitate penetration if edema, excessive used to treat the symptoms of asthma, chronic secretions are present. bronchitis, emphysema, and other lung diseases, Prime unit before use for Pulmicort while others are used to prevent the symptoms Turbuhaler; have patient rinse mouth after Adverse Reactions: Dizziness, severe; feeling of each use. choking, irritation, or swelling in throat; flushing or Use aerosol within 6 mo of opening. Shake redness of skin; hives; increased shortness of breath; well before each use. skin rash; swelling of face, lips, or eyelids; tightness Store Respules upright and protected from in chest or wheezing, troubled breathing light; gently shake before use; open envelopes should be discarded after 2 wk. Nursing Measures: Assess lung sounds, pulse, and blood31) ALBUTEROL AND IPRATROPIUM pressure before administration and duringINHALATION peak of medication. Note amount, color, and character of sputum produced.Brand name: Combivent Monitor pulmonary function tests beforeClassification: Bronchodilators initiating therapy and periodicallyStock: 2.5 mL throughout course to determine effectivenessDose: MDI Adult 2 puffs tid-qid. Max 12 of medication.puffs/day. Unit dose vial Adult & childn >12 yr 1 vial Observe for paradoxical bronchospasmevery 6-8 hr. Childn 2-12 yr 3 drops/kg/dose (max: (wheezing). If condition occurs, withhold2500 mcg of salbutamol) every 6-8 hr. medication and notify physician or otherIndication: management of reversible bronchospasm health care professional immediately.associated with obstructive airway diseases in Instruct mother to take missed dose as soonpatients who require more than a single as remembered, spacing remaining doses atbronchodilator regular intervals. Do not double doses orAction: muscles in the airways and increase air flow increase the dose or frequency of doses.to the lungs Inform the mother not to smoke near theAdverse Reactions: Fine tremor of skeletal muscle; child and to avoid respiratory irritants.palpitations; headache, dizziness, nervousness; Advise the mother to rinse the child’s mouthdryness of mouth, throat irritation; urinary retention with water after each inhalation dose to minimize dry mouth.Nursing Measures: Use nebulizer mouthpiece instead of face 33) TERBUTALINE SULFATE mask to avoid blurred vision or aggravation of narrow-angle glaucoma. Brand name: Pulmonyl Can mix albuterol in nebulizer for up to 1 hr. Classification: Antiasthmatic/ Brochodilator Ensure adequate hydration, control Stock: 2.5 mg/ml environmental temperature to prevent Dose: Adult 5-10 mg, Children 2-5mg hyperpyrexia. Indication: relief of bronchospasm in obstructive Have patient void before taking medication airway diseases to avoid urinary retention. Action: It works by dilating (opening) the Teach patient proper use of inhalator. bronchioles of the lungs by relaxing the muscles around them. This allows for easier airflow into and out of the lungsEmergency Nursing Abejo
  • 16. Medical and Surgical NursingEmergency NursingPrepared by: Mark Fredderick R. Abejo R.N, M.A.NAdverse Reactions: Headache, nausea, vomiting, Indication: supraventricular tachycardia; post-palpitations, tachycardia, sweating & drowsiness operative tachycardia or hypertension; non- compensatory sinus tachycardias; intra-operativeNursing Measures: tachycardia or hypertension; unstable angina, non ST Use minimal periods of time; drug tolerance segment elevation MI can occur with prolonged use. Action: A Class II antiarrythmic and ultra-short- Keep beta-adrenergic blocker readily acting selective beta blocker that decreases heart rate, available in case cardiac arrhythmias occur. contractility and blood pressure Do not recommended dosage. Adverse Reactions: Hypotension, bradycardia, heart failure, local irritation, diaphoresis, peripheral34) HEPARIN SODIUM ischaemia, dizziness, somnolence, confusion, fatigue, paraesthesia, peripheral neuropathy, headache,Brand name: Britton Heparin Na weakness, irritability, dyspnoea, nausea, vomiting,Classification: Anticoagulants, Antiplatelets & blurred vision, urinary retention, fever, rigor,Fibrinolytics (Thrombolytics) muscular pain. Potentially Fatal: ProfoundDosage: 5000 iu/1 mL; 25000 iu/1 mL bradycardia, AV block, cardiogenic shock, asystole,Indication: treatment and prophylaxis of bronchospasm.thromboembolic disordersAction: Accelerates formation of antithrombin III- Nursing Measures:thrombin complex and deactivates thrombin, Monitor patient carefully (BP, cardiacpreventing conversion of fibrinogen to fibrin rhythm, and output) while drug is beingAdverse Reactions: Slight fever, headache, chills, titrated to therapeutic dose. Dosage may benausea, vomiting, constipation, epistaxis, bruising, increased more rapidly in hospitalizedslight haematuria, skin necrosis (SC inj), patients under close supervision.osteoporosis, alopecia. Hypersensitivity reactions Monitor cardiac rhythm regularly duringinclude urticaria, conjunctivitis, rhinitis, asthma, stabilization of dosage and periodicallyangioedema and anaphylactic shock. Priapism. during long-term therapy.Potentially Fatal: Heparin-induced thrombocytopeniawith or without thrombosis; bleeding 36) D 50-50Nursing Measures: Brand name: Phil Pharmawealth/Atlantic 50% Baseline blood coagulation tests, Hct, Hgb, Dextrose RBC and platelet counts prior to initiation or Classification: Intravenous & Other Sterile Solutions therapy and at regular intervals throughout Dosage: 50ml/vial therapy Indication: for hypoglycemia Monitor APTT levels closely Action: A simple water soluble sugar that minimizes Draw blood for coagulation tests 30 min glyconeogenesis and promotes anabolism in patients before each scheduled SC or intermittent IV whose oral caloric intake is limited dose and approximately q4h for pts Adverse Reactions: Local pain, vein irritation, receiving continuous IV heparin during thrombophlebitis & tissue necrosis in the event of dosage adjustments period. After dosage is extravasation. Fluid & electrolyte imbalance eg established, tests may be done once daily hypokalemia, hypomagnesemia & Pts vary widely in their reaction to heparin; hypophosphatemia; edema or water intoxication risk of hemorrhage appears greatest in women, all patients > 60 y, and patients with Nursing Measures: liver disease or renal insufficiency. Monitor infusion rate frequently; if signs of Monitor vitals, report fever, drop in BP, fluid overload, turn off IV drip. Infusion rapid pulse and other S&S of hemorrhage may result in fluid overload. Observe all needle sites daily for hematoma Check IV site frequently and if infiltration is and signs of inflammation noted, turn off IV drip. Have on hand protamine sulfate, specific Watch out for signs of fluid overload heparin antagonist (distended neck veins (JVD), rapid respirations, shallow tidal volume, fine35) ESMOLOL HYDROCHLORIDE auscultatory crackles, dyspnea, and peripheral edema)Brand name: Brevibloc Watch out for signs of infiltration (swellingClassification: Beta blockers and pain around IV site).Dosage: 100mg/10mlEmergency Nursing Abejo
  • 17. Medical and Surgical NursingEmergency NursingPrepared by: Mark Fredderick R. Abejo R.N, M.A.N37) POTASSIUM CHLORIDE Indication: local or regional anesthesia Action: A class IB antiarrythmic that decreases theBrand name: Phil Pharmawealth/Atlantic Potassium depolarization, automaticity, and excitability in theChloride ventricles during the diastolic phase by direct actionClassification: Electrolytes on the tissues especially the Purkinje networkDosage: 40 meqs/20 ml Adverse Reactions: Restlessness, nervousness,Indication: for hypokalemia, acute MI dizziness, tinnitus, blurred vision; GI upsets; muscleAction: Replaces potassium and maintains potassium twitching, convulsions; numbness of the tongue;level hypotension, bradycardia; methemoglobinaemia;Adverse Reactions: GI ulceration (sometimes with fetal intoxication.haemorrhage and perforation or with late formationof strictures) following the use of enteric-coated K Nursing Measures:chloride preparation; hyperkalaemia. Oral: Nausea, Check drug concentration carefully; manyvomiting, phlebiti and abdominal cramps. IV: Pain or concentrations are available.phlebitis; cardiac toxicity. Reduce dosage with hepatic or renal failure.Nursing Measures: Continuously monitor response when used Monitor serum potassium levels, renal as antiarrhythmic or injected as local function, and serum bicarbonate. anesthetic. Explain to patient purpose of the medication Keep life-support equipment and and the need to take as directed,especially vasopressors readily available in case severe when concurrent digoxin or diuretics are adverse reaction (CNS, CV, or respiratory) taken. A missed dose should be taken as occurs when lidocaine is injected. soon as remembered within 2 hr; if not, Establish safety precautions if CNS changes return to regular doseschedule. Do not occur; have IV diazepam or short-acting double dose. barbiturate (thiopental, thiamylal) readily Emphasize correct method of available in case of seizures. administration. GI irritation or ulceration Monitor for malignant hyperthermia (jaw may result from chewing enteric-coated muscle spasm, rigidity); have life-support tablets or insufficient dilution of liquid or equipment and IV dantrolene on standby. powder forms. Some extended-release Titrate dose to minimum needed for cardiac tablets are contained in a wax matrix that stability, when using lidocaine as may be expelled in the stool. This antiarrhythmic. occurrence is not significant. Reduce dosage when treating arrhythmias in Instruct patient to avoid salt substitutes or CHF, digitalis toxicity with AV block, and low-salt milk or food unless approved by geriatric patients. health care professional. Monitor fluid load carefully; more Patient should be advised to read all labels concentrated solutions can be used to treat to prevent excess potassium intake. arrhythmias in patients on fluid restrictions. Advise patient regarding sources of dietary Have patients who have received lidocaine potassium. as a spinal anesthetic remain lying flat for 6– Encourage compliance with recommended 12 hr afterward, and ensure that they are diet. adequately hydrated to minimize risk of Instruct patient to report dark, tarry, or headache. bloody stools; weakness; unusual fatigue; or Check lidocaine preparation carefully; tingling of extremities. epinephrine is added to solutions of Notify health care professional if nausea, lidocaine to retard the absorption of the local vomiting, diarrhea, or stomach discomfort anesthetic from the injection site. Be sure persists. that such solutions are used Dosage may require adjustment. Emphasize only to produce local anesthesia. These the importance of regular follow-up exams solutions should be injected cautiously in to monitor serum levels and progress. body areas supplied by end arteries and used cautiously in patients with peripheral38) LIDOCAINE HYDROCHLORIDE vascular disease, hypertension, thyrotoxicosis, or diabetes.Brand name: Abbott Lidocaine Use caution to prevent choking. Patient mayClassification: Anaesthetics - Local & General have difficulty swallowing following use ofDosage: 50 ml/vialEmergency Nursing Abejo
  • 18. Medical and Surgical NursingEmergency NursingPrepared by: Mark Fredderick R. Abejo R.N, M.A.N oral topical anesthetic. Do not give food or Nursing Measures: drink for 1 hr after use of oral anesthetic. Monitor vital signs and ECG closely Treat methemoglobinemia with 1% throughout therapy. methylene blue, 0.1 mg/kg, IV over 10 min. Monitor I&O regularly; note decreases in Apply lidocaine ointments or creams to a urine output. gauze or bandage before applying to the Monitor central venous pressure or skin. pulmonary wedge pressure if possible Monitor for safe and effective serum drug during infusion. concentrations (antiarrhythmic use: 1–5 Note significant changes in vital signs, ECG mcg/mL). Doses > 6–10 mcg/mL are usually changes, deterioration of peripheral toxic pulses, and/or cold, mottled extremities39) SODIUM BICARBONATE 41) DOBUTAMINEBrand name: Hospira Sodium Bicarbonate Brand name: DobatreyClassification: Alkalinizers Classification: AdrenergicsDosage: 10mEq/10ml; 50mEq/50ml Dosage: 12.5 mg/mLIndication: metabolic acidosis, systemic or urinary Indication: increased cardiac output in short termalkalinization, antacid, cardiac arrest treatment of cardiac decompensation caused byAction: Restores buffering capacity of the body and depressed contractilityneutralizes excess acid Action: Stimulates heart’s beta1 receptors to increaseAdverse Reaction: Tetany, edema, gastric distention, myocardial contractility and stroke volume. Increasesbelching, flatulence, hypokalemia, metabolic cardiac output by decreasing peripheral vascularalkalosis, hypernatremia, chemical cellulitis because resistance, reducing ventricular filling pressure, andof alkalinity, pain, irritation, tissue necrosis, facilitating AV node conductionulceration or sloughing at the site of infiltration Adverse Reaction: increased systolic BP, increased heart rate, chest pain, increased number of prematureNursing Measures: ventricular beats, headache, tingling sensations, do not take drug with milk to avoid paresthesia. nausea, vomiting, dyspnea, phlebitis, hypercalcemia, abnormally high alkalinity in local inflammation after infiltration, leg cramps tissues and fluids, or kidney stones. do not give to patients with metabolic or Nursing Measures: respiratory alkalosis, and in those with Monitor vital signs, ECG, cardiac output, hypocalcemia in which alkalosis may pulmonary capillary wedge pressure, central produce tetany, hypertension, seizures, or venous pressure and urinary output carefully heart failure. throughout infusion. monitor for alkalosis by obtaining blood pH, Monitor patency and placement of IV PaO2, PCO2, and electrolyte levels catheter to reduce risk of extravasation and phlebitis.40) DOPAMINE Watch out for symptoms of overdosage such as excessive hypertension, tachycardia,Brand name: Intropin nausea, vomiting, tremor, headache, chestClassification: Adrenergics (Sympathomimetics) painDosage: 40 mg/Ml; 80  mg/mL; 160 mg/mLIndication : shock and hemodynamic imbalances, 42) LIDOCAINE PREMIXEDhypotensionAction: Stimulates dopaminergic and alpha beta Brand name: Xylocainereceptors for the sympathetic nervous system Classification: Antiarrhythmic agent, Localresulting in a positive inotropic effect and increased anestheticcardiac output. Action is dose-related; large doses Dosage: 0.2% (2mg/ml); 0.4% (4g/ml); 0.8% (8g/ml)cause mainly alpha stimulation Indication: ventricular arrhythmias caused by MI,Adverse Reaction: ectopic beats, tachycardia, cardiac manipulation or cardiac glycosidesanginal pain, palpitation, hypotension, Action: Acts as an anesthetic by stabilizing thevasoconstriction, ventricular arrhythmias, neuronal membrane by inhibiting the ionic fluxeshypertension, headache, anxiety, dilated pupils, required for the initiation and conduction ofnausea, vomiting, decreased urine output, dyspnea impulses, thereby effecting local anesthetic action. Also acts as an antiarrhythmic by decreasing the depolarization, automaticity, and excitability in theEmergency Nursing Abejo
  • 19. Medical and Surgical NursingEmergency NursingPrepared by: Mark Fredderick R. Abejo R.N, M.A.Nventricles during the diastolic phase by a direct action blurred vision, chest pain, chills or fever, confusion,on the tissues, especially the Purkinje network, decreased alertness, difficulty urinating, extremewithout involvement of the autonomic system. dizziness, extreme thirst or dry mouth, fast orNeither contractility, systolic arterial blood pressure, irregular heartbeat, headache, muscle cramps, pain,atrioventricular (AV) conduction velocity, nor redness, or swelling at the injection site, weaknessabsolute refractory period is altered by usualtherapeutic dosesAdverse Reaction: bradycardia, cardiac arrest, CV Nursing Measures:collapse, hypotension, apprehension, confusion, Monitor vital signs, including CVP, anddizziness, drowsiness, hallucinations, headache, fluid intake and output.light-headedness, mood changes, nervousness, Monitor weight, renal function, and serumtremors, conjunctival hyperemia, corneal epithelial sodium and potassium levels dailychanges, diplopia, tinnitus, visual disturbances, Watch out for symptoms of overdosage suchnausea, vomiting, erythema, petechiae, edema, as excessive hypertension, tachycardia,injection-site reactions, including bruising, burning, nausea, vomiting, tremor, headache, chestcontusion, hemorrhage, local reactions, including painsoreness at IM injection site, venous thrombosis or To relieve thirst, give frequent mouth carephlebitis, extravasation, burning, stinging, sloughing, and fluidsrespiratory depression or arrest, hypersensitivityreactions 44) DEXTROSE 5% IN WATER (D5W) SOLUTIONNursing Measures: Explain that adverse reactions related to the Brand name: None CNS (eg, drowsiness, confusion, Classification: Isotonic/Hypotonic Solution paresthesias, convulsions, respiratory arrest) Dosage: 250ml bottles (5g dextrose/100ml water) can occur and are a result of CNS toxicity. Indication: fluid replacement and caloric Advise patient that drug may cause dizziness supplementation in patients who can’t maintain or drowsiness and to avoid getting out of adequate oral intake or are restricted from doing so bed or walking without assistance. Action: Provides some sugar for cellular metabolism Advise patients that skin reactions, including and supplies body water erythema, petechiae, and edema, may occur Adverse Reaction: Increases free water and may with intradermal injection. cause intracellular edema, fluid overload, infiltration Systemic effects can occur following topical (swelling and pain at infusion site) use; use lowest possible dose to avoid Nursing Measures: serious toxicity, shock, or heart block. Monitor infusion rate frequently; if signs of Do not use in patients with congenital or fluid overload, turn off IV drip. Infusion idiopathic methemoglobinemia or in infants may result in fluid overload. younger than 12  mo of age who are Check IV site frequently and if infiltration is receiving methemoglobin-inducing drugs. noted, turn off IV drip. Use with caution and in lower doses in Watch out for signs of fluid overload patients with CHF, reduced cardiac output, (distended neck veins (JVD), rapid digitalis toxicity, and in elderly patients respirations, shallow tidal volume, fine auscultatory crackles, dyspnea, and43) MANNITOL peripheral edema) Watch out for signs of infiltration (swellingBrand name: Osmitrol and pain around IV site).Classification: osmotic diureticDosage: 5% , 10%, 15%, 20%, 25% in 500cc/1,000ccIndication: test dose for marked oliguria orsuspected inadequate renal function, oliguria, toreduce intraocular or intracranial pressure, diuresis indrug intoxicationAction: Increases osmotic pressure of glomerularfiltrate; drug elevates plasma osmolalityAdverse Reaction: Increased urination, nausea,runny nose, vomiting, severe allergic reactions (rash,hives, itching, difficulty breathing, tightness in thechest, swelling of the mouth, face, lips, or tongue),Emergency Nursing Abejo