Emergency Nursing

Medical and Surgical Nursing
Emergency Nursing
Prepared 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
care
A. 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 delivery
B. 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 needs

Emergency Nursing Abejo

Emergency Nursing

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 rights

F. 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. Potentially
G. Legal issues affecting the provision of Fatal: Convulsions, cardiac arrhythmias, hypotension
emergency 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

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 drug's 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); sensitivity
Brand Names: Anoion tab Cordarone Cordarone to the sun (use a sunscreen or protective
inj Sandoz Amiodarone HCl tab clothing when outdoors); constipation (a
Classification: Cardiac Drugs laxative may be ordered); tremors,
Dosage: PO Initial: 200 mg 3 times/day for 1 wk, twitching, dizziness, loss of coordination (do
reduce to 200 mg twice daily for a further wk. not drive, operate dangerous machinery, or
Maintenance: 200 mg/day or lowest effective dose. undertake tasks that require coordination
IV Initial: 5 mg/kg infusion via central venous until drug effects stabilize and your body
catheter. 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; shortness
Action: 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 SULFATE
taste, 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 eye
arrest, hepatotoxicity, heart failure. Potentially Fatal: drops Phil Pharmawealth/Atlantic Atropine amp
Pulmonary toxicity including pulmonary fibrosis and Classification: Other Cardiovascular Drugs, Muscle
interstitial pneumonitis, hepatotoxicity, thyrotoxicity. Relaxants, Mydriatic Drugs, Antidotes, Detoxifying
Ventricular arrhythmias, pulmonary alveolitis, Agents & Drugs Used in Substance Dependence
exacerbation of arrhythmias and rare serious liver Indication/Dosage: IV Bradycardia 500 mcg every
injury. Generally in patients with high doses and 3-5 mins. Total: 3 mg. IV/IM Organophosphorus
having preexisting abnormalities of diffusion poisoning 2 mg every 10-30 mins until muscarinic
capacity. effects disappear or atropine toxicity appears. IM/SC
Premed in anesth 300-600 mcg 30-60 mins before
Nursing 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 be

Emergency Nursing

junction, enhances the conduction of AV node and 4) BUMETANIDE
increases heart rate
Adverse Reactions: Dry mouth, dysphagia, Brand Names: Burinex amp Burinex tab
constipation, flushing and dryness of skin, Classification: Sulfonamide Diuretics
tachycardia, palpitations, arrhythmias, mydriasis, Indication/Dosage: PO edema 1 mg once daily, 2nd
photophobia, 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: 5
delirium and may progress to circulatory failure and mg/day. IV Pulmonary edema 1-2 mg, repeat 20
respiratory depression. Eye drops: Systemic toxicity mins. later if needed. IV/IM Emergency edema 0.5-1
especially 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 at
Increased intraocular pressure. Inhalation: Dryness of the ascending loop of Henle
mouth, 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

needed and tolerated. HTN in diabetic nephropathy
5) CALCIUM GLUCONATE 75-100 mg/day in divided doses.
Action: inhibits ACE, reduces Sodium and water
Brand Names: Phil Pharmawealth/Harson Calcium retention, lowers blood pressure
Gluconate amp Adverse Reactions: Hypotension, tachycardia, chest
Classification: Electrolytes pain, palpitations, pruritus, hyperkalaemia.
Indication/Dosage: PO Hypocalcaemia 10-50 Proteinuria; angioedema, skin rashes; taste
mmol/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 within
administered as a continuous IV infusion. Antidote in 3 mth of starting therapy especially in patients with
severe 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 Calcium
level 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 patient's chart with
inj. Hypercalcaemia characterised by anorexia, notice that captopril is being taken; the
nausea, vomiting, constipation, abdominal pain, angiotensin II formation subsequent to
muscle weakness, mental disturbances, polydipsia, compensatory renin release during surgery
polyuria, nephrocalcinosis, renal calculi; chalky taste, will be blocked; hypotension may be
hot 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 volume
Nursing 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, loss
6) CAPTOPRIL of appetite, change in taste perception
(limited effects, will pass); mouth sores
Brand Names: Ace-Bloc tab Capomed tab (perform frequent mouth care); rash; fast
Capotec tab Capoten tab Captor tab Captril tab heart rate; dizziness, light-headedness
Cardiovaz 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 your
Prelat tab Primace tab Retensin tab Spec-Ace tab activities to those that do not require
Tensoril 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; irregular
daily. 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 3
days after MI. Initial: 6.25 mg/day, may increase
after several wk to 150 mg/day in divided doses if


Emergency Nursing

7) 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 not
Catapres tab miss doses. Do not discontinue the drug
Classification: Other Antihypertensives unless so instructed. Do not discontinue
Indication/Dosage: PO HTN Initial: 50-100 mcg 3 abruptly; life-threatening adverse effects
times/day. Max: 2,400 mcg/day. Menopausal may occur. If you travel, take an adequate
flushing; 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, or
Epidural Severe cancer pain Initial: 30 mcg/hr as contact your health care provider with
continuous infusion in combination w/ an opioid. questions. Be sure to remove old systems
Transdermal 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 reduce
Action: 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 sensitivity
dizziness, 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 caution
weakness, sedation, pruritus, myalgia, urticaria, driving or performing other tasks that
nausea, insomnia, arrhythmias, agitation. Reduced GI require alertness or physical dexterity); dry
motility at times may cause paralytic ileus. mouth (suck on sugarless lozenges or ice
Potentially 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 position
threatening. 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

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 effects
9) 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 effects
Dosage: 5mg/2ml and fall risk. Institute measures to prevent
Indication: Cardiac failure accompanied by atrial falls.
fibrillation; management of chronic cardiac failure Assess movement disorder before and after
where systolic dysfunction or ventricular dilatation is administration.
dominant; management of certain supraventricular Caution patient not to use oral OTC
arrhythmias, particularly chronic atrial flutter & diphenhydramine products with any other
fibrillation. product containing diphenhydramine,
Action: inhibits sodium-potassium activated including products used topically.
adenosine triphosphate, promoting movement of It can cause excitation in children. Caution
calcium from extracellular to intra-cytoplasm and parents or caregivers about proper dose
strengthening myocardial contraction, also acts on calculation; overdosage, especially in infants
CNS to enhance vagal tone and children, can cause hallucinations,
Adverse Reaction: nausea, vomiting, anorexia, seizures or death Inform patient that this
headache, facial pain, fatigue, weakness, dizziness, drug may cause dry mouth. Frequent oral
drowsiness, disorientation, mental confusion, bad rinses, good oral hygiene, and sugarless gum
dreams, convulsions or candy may minimize this effect. Notify
dentist if dry mouth persists for more than 2
Nursing 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 Chloride

Emergency Nursing

Ophthalmic solution: Epifrin, Glaucon with respiratory distress) readily available in
Insect sting emergencies: EpiPen Auto-Injector case cardiac arrhythmias occur.
(delivers 0.3 mg IM adult dose), EpiPen Jr. Auto- Do not exceed recommended dosage of
Injector (delivers 0.15 mg IM for children) inhalation products; administer pressurized
OTC solutions for nebulization: AsthmaNefrin, inhalation drug forms during second half of
microNefrin, Nephron, S2 inspiration, because the airways are open
Classification: Sympathomimetic, Alpha-adrenergic wider and the aerosol distribution is more
agonist, 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 acute
Dosage: 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 after
Action: 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 may
include vasoconstriction, contraction of dilator result. Read the instructions that come with
muscles of iris. Effects on beta receptors include respiratory inhalant products, and consult
positive chronotropic and inotropic effects on the your health care provider or pharmacist if
heart (beta1 receptors); bronchodilation, vasodilation, you have any questions.
and uterine relaxation (beta2 receptors); decreased To give eye drops: Lie down or tilt head
production of aqueous humor. backward, and look up. Hold dropper above
Adverse Reaction: drowsiness, headache, eye; drop medicine inside lower lid while
nervousness, 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 least
Nursing 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, hypertension

Emergency Nursing

Action: inhibits Sodium and Chloride reabsorption at Monitor patient for orthostatic hypotension
the proximal and distal tubules and the ascending which is most marked in the morning and in
loop of Henle hot weather, and with alcohol or exercise.
Adverse Reaction: vertigo, headache, dizziness,
paresthesia, weakness, restlessness, fever, nocturia,
oliguria, polyguria 14) HYDROCORTISONE SODIUM
SUCCINATE
Nursing 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 intracranial
13) HYDRALAZINE HYDROCHLORIDE
pressure, growth retardation, Cushingoid state,
protein catabolism, psychic derangements,
Brand name: Supres
exophthalmos, masking of infections, gasping
Classification: antihypertension
syndrome, seizures, menstrual irregularities.
Dosage: 20mg/ml
Indication: For hypertensive patient
Nursing Measures:
Action: a direct acting peripheral vasodilator that
Give daily before 9 AM to mimic normal
relaxes arteriolar smooth muscles
peak diurnal corticosteroid levels and
Adverse Reaction: tachycardia, palpitation, angina
minimize HPA suppression.
pectoris, severe headache, dizziness, weight gain, GI
Space multiple doses evenly throughout the
disturbances, 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

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 or
Brand name: Imdur eclampsia, prevention of hypomagnesemia in patients
Classification: antianginal drug receiving TPN
Stock Dose: SL: 5 mg/mL ; Oral: 30 mg, 60 mg Action: may decrease acetylcholine released by
Indication: prophylactic treatment of angina pectoris nerve impulses, but its anticonvulsant mechanism is
Action: Thought to reduce cardiac oxygen demand unknown
by decreasing preload and afterload. Drug also may Adverse Reactions: flushing, sweating, hypotension,
increase blood flow through the collateral coronary muscular weakness, sedation & confusion; decreased
vessels deep tendon reflexes; resp. paralysis
Adverse Reactions: headache, hypotension w/
dizziness and nausea, tachycardia Nursing Measures:
Monitor the following: I.V.: Rapid
Nursing 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 mL
Dose: 10 mg/10mL
18) MEPERIDINE HYDROCHLORIDE
Indication: unresponsive left ventricular failure
secondary to acute MI, severe or unstable angina
Brand name: Demerol
pectoris
Classification: antivertigo drug
Action: Isosorbide dinitrate is a smooth muscle
Dosage: 100 mg/ 2mL
relaxant. It is particularly effective on vascular and
Indication: relief of moderate to severe pain, pre-op
bronchial smooth muscle. Its systemic cardiovascular
medication, support of anesth & obstet analgesia
effects 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 pain
Consequently, ventricular end-diastolic pressure and
Adverse Reactions: resp. depression, circulatory
volume are diminished, thus reducing cardiac work
depression, resp arrest, shock, cardiac arrest, GI
and 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, uncoordinated
systemic blood pressure relieving the myocardium
muscle movements, severe convulsions, transient
from 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 local
Side effects/ adverse reactions: severe cerebral flow
tissue irritation.
deficiency and decreased coronary perfusion may
develop, nitrate headache and nausea.
Nursing Measures:
Make position changes slowly and in stages
Nursing 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

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 or
19) 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 if
Octamide PFS, Reglan patient is also being given opioid analgesics;
Classification: antiemetic & anti-spasmodic reduce dosage by at least 50% and monitor
Dosage: 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 after
surgery, metabolic diseases, infectious & drug administration of midazolam.
induced diseases, facilitate small bowel intubation & Carefully monitor P, BP, and respirations
radiological procedures of GIT carefully during administration.
Action: stimulates motility of upper GI tract, Keep resuscitative facilities readily
increases lower esophageal sphincter tone, and blocks available; have flumazenil available as
dopamine receptors at the chemoreceptor trigger zone antidote if overdose should occur.
Adverse Reactions: extrapyramidal reactions, Keep patients in bed for 3 hr; do not permit
drowsiness, fatigue & lassitude, anxiety, less ambulatory patients to operate a vehicle
frequently, 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: Morin
20) MIDAZOLAM HYDROCHLORIDE Classification: Analgesics (Opioid)
Dosage: Adult 5-20 mg IM/SC 4 hrly. Severe or
Brand name: Dormicum chronic pain Childn 10 mg IM/SC 4 hrly, range: 5-20
Classification: hypnotics & sedatives mg; 6-12 yr 5-10 mg, 1-5 yr 2.5-5 mg, 1-12 mth 200
Dosage: 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-op
initially or after premature awakening, tab/inj: 50-100 mcg/kg IM, max: 10 mg/dose.

Emergency Nursing

Indication: Relief of moderate to severe pain not Monitor blood pressure.Allow atleast 3 days
responsive to non-narcotic analgesics. Premed. between dosage adjustment to achieve
Analgesic adjunct in general anesth esp in pain steady plasma levels.
associated w/ cancer, MI & surgery. Alleviates Advise patient to report immediately if
anxiety associated w/ severe pain. Hypnotic for pain- experiencing chest pain
related sleeplessness.
Action: alters perception and emotional response to 23) NTG PATCH
pain
Adverse Reactions: Lightheadedness, dizziness, Brand name: Deponit, Minitran, Nitrek, Nitro-Dur,
sedation, nausea, vomiting, constipation & sweating. Nitrodisc, Transderm-Nitro
Classification: Anti-Anginal Drugs
Nursing 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. Remove
Brand name: Cardepine transdermal system before attempting
Classification: 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 a
titrate dose up to 15 mg/hr until desired therapeutic slightly different area each day. Use care if
response is achieved (DBP <95 mmHg, SBP <140 changing brands; each system has a different
mmHg). Maintenance rate: Can be tapered down to concentration.
≤10 mg/hr. IV bolus inj 2-7 mg w/out dilution given
over 1-2 min. 24) PARACETAMOL
Indication: Hypertensive emergencies or urgencies,
peri-op & post-op HTN, hypertensive states of NPO Brand name: Aeknil
patients. Classification: Analgesics (Non-Opioid) &
Action: a Calcium channel blocker that inhibits Antipyretics
Calcium ion influx across cardiac and smooth muscle Dosage: Adult & childn ≥10 yr 2-3 mL, ≤10 yr 1-2
cells, also dilates coronary arteries and arterioles mL. Depending on severity of case, dose may be
Adverse Reactions: Peripheral edema, headache, repeated 4 hrly. In severe cases, dose may be
tachycardia, 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 &
toothache

Emergency Nursing

Action: produce analgesia by blocking pain impulses 26) TERBUTALINE
by inhibiting synthesis of prostaglandin in CNS,
relieves fever Brand name: Bricalin
Adverse Reactions: Hematological, skin & other Classification: Antiasthmatic & COPD Preparations
allergic reactions Dosage: Antiasthmatic & COPD Preparations
Indication: For reversible airways obstruction, in
Nursing 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 HYDROCHLORIDE

25) PHENYTOIN Brand name: Calan, Calan SR, Covera-HS, Isoptin,
Isoptin SR, Verelan, Verelan PM
Brand name: Dilantin Classification: Calcium Antagonists
Classification: 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 to
300-400 mg daily. Childn ≥6 yr Initially 100 mg tid, 360 mg daily, childn ≤6 yr 40 mg bid-tid. Isoptin SR
subsequent dosage should be adjusted according to 180 Coronary insufficiency 1 tab bid. Usual daily
therapeutic response, <6 yr 30 mg bid, may be dose: 240-480 mg. Hypertension 1 tab in the
increased to 30 mg tid or qid. Pedia 5 mg/kg/day morning. Isoptin SR 240 1 tab in the morning. If
Initially 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, if
neurosurgery required bid-tid
Action: may stabilize neuronal membranes and limit Indication: Isoptin/Isoptin SR 180 Essential
seizure activity by either by increasing efflux or hypertension, chronic coronary insufficiency, angina
decreasing 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 hypertension
speech; diplopia, nystagmus & mental confusion w/ Action: decreases myocardial contractility and
headache, dizziness, gingival hyperplasia, hirsutism, oxygen demand, it also dilates coronary arteries and
hyperglycemia, 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

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 body
28) IPRATROPIUM INHALATION wt) Up to 0.5 mL up to tid. Berodual F UDV Adult &
childn >12 yr Acute asthma episodes 1 vial, in very
Brand 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 in
Stock: 0.5 mg/2 mL chronic obstructive airway disorders with reversible
Dosage: Adult (including elderly) & adolescent >12 bronchospasm
yr Acute attacks 1 vial, may repeat doses until patient Action: for the prevention and treatment of reversible
is stable. Maintenance: 1 vial tid-qid. bronchospasm associated with bronchial asthma and
Indication: Bronchodilator for treatment of especially chronic bronchitis with or without
bronchospasm associated w/ COPD, including emphysema
chronic 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. Dry
to 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). Urinary
production 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 face
angioedema, urticaria, laryngospasm, anaphylactic mask to avoid blurred vision or aggravation
reactions. 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 ranging

Emergency Nursing

from asthma to allergies toCrohn’s disease 32) SALBUTAMOL
Adverse Reactions: Abdominal pain, conjunctivitis
(pinkeye), cough, diarrhea, ear infection or Brand name: Aero-Vent
inflammation, fever, fungal infection in mouth, Classification: bronchodilator
headache, nasal or sinus inflammation, nosebleed, Stock: 1 mg/1 mL
pain, rash, respiratory infection, stomach or intestinal Dose: Adult & childn 2.5-5 mg. May repeat qid by
inflammation, throat inflammation, viral infection, hlebitis. Delivery of aerosol may be by face mask
vomiting, 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 blood
31) ALBUTEROL AND IPRATROPIUM pressure before administration and during
INHALATION peak of medication. Note amount, color, and
character of sputum produced.
Brand name: Combivent Monitor pulmonary function tests before
Classification: Bronchodilators initiating therapy and periodically
Stock: 2.5 mL throughout course to determine effectiveness
Dose: MDI Adult 2 puffs tid-qid. Max 12 of medication.
puffs/day. Unit dose vial Adult & childn >12 yr 1 vial Observe for paradoxical bronchospasm
every 6-8 hr. Childn 2-12 yr 3 drops/kg/dose (max: (wheezing). If condition occurs, withhold
2500 mcg of salbutamol) every 6-8 hr. medication and notify physician or other
Indication: management of reversible bronchospasm health care professional immediately.
associated with obstructive airway diseases in Instruct mother to take missed dose as soon
patients who require more than a single as remembered, spacing remaining doses at
bronchodilator regular intervals. Do not double doses or
Action: 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 the
Adverse Reactions: Fine tremor of skeletal muscle; child and to avoid respiratory irritants.
palpitations; headache, dizziness, nervousness; Advise the mother to rinse the child’s mouth
dryness 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 lungs

Emergency Nursing

Adverse Reactions: Headache, nausea, vomiting, Indication: supraventricular tachycardia; post-
palpitations, tachycardia, sweating & drowsiness operative tachycardia or hypertension; non-
compensatory sinus tachycardias; intra-operative
Nursing 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, peripheral
34) 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: Profound
Dosage: 5000 iu/1 mL; 25000 iu/1 mL bradycardia, AV block, cardiogenic shock, asystole,
Indication: treatment and prophylaxis of bronchospasm.
thromboembolic disorders
Action: Accelerates formation of antithrombin III- Nursing Measures:
thrombin complex and deactivates thrombin, Monitor patient carefully (BP, cardiac
preventing conversion of fibrinogen to fibrin rhythm, and output) while drug is being
Adverse Reactions: Slight fever, headache, chills, titrated to therapeutic dose. Dosage may be
nausea, vomiting, constipation, epistaxis, bruising, increased more rapidly in hospitalized
slight haematuria, skin necrosis (SC inj), patients under close supervision.
osteoporosis, alopecia. Hypersensitivity reactions Monitor cardiac rhythm regularly during
include urticaria, conjunctivitis, rhinitis, asthma, stabilization of dosage and periodically
angioedema and anaphylactic shock. Priapism. during long-term therapy.
Potentially Fatal: Heparin-induced thrombocytopenia
with or without thrombosis; bleeding 36) D 50-50

Nursing 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, fine
35) ESMOLOL HYDROCHLORIDE auscultatory crackles, dyspnea, and
peripheral edema)
Brand name: Brevibloc Watch out for signs of infiltration (swelling
Classification: Beta blockers and pain around IV site).
Dosage: 100mg/10ml

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