The nursing process is important as a well-established, research-supported framework for professional nursing practice. Which is the correct order for the steps of the nursing process?
a. Evaluation, Planning, Diagnoses, Assessment, Implementation
b. Planning, Assessment, Diagnoses, Implementation, Evaluation
c. Diagnoses, Assessment, Planning, Evaluation, Implementation
d. Assessment, Diagnoses, Planning, Implementation, Evaluation
-Used in bradycardia and for ophthalmic applications
-Also used as antidote for cholinesterase inhibitor poisoning
-Actions include increase pupil dilation, cycloplegia, decreased airway secretions, decreased acid secretions, decreased gut motility, decreased bladder urgency in cystitis
-Toxicity: increased body temp (due to decreased sweating), rapid pulse, dry mouth, dry and flushed skin, cycloplegia, constipation, disorientation;
-Can cause acute angle-closure glaucoma in elderly (due to mydriasis), urinary retention in men with prostatic hyperplasia, and hyperthermia in infants
-See also homatropine and tropicamide
Probenecid, Furosemide, Acetazolamide, Celecoxib, Thiazides, Sulfonamide antibiotics, Sulfasalazine, Sulfonylureas.
Patients with sulfa allergies may develop
fever, urinary tract infection, Stevens-
Johnson syndrome, hemolytic anemia, thrombocytopenia, agranulocytosis, and urticaria (hives). Symptoms range from mild to life threatening.
-Azithromycin, clarithromycin, erythromycin
-Inhibit protein synthesis by blocking translocation ("macroslides"); bind to the 23S rRNA of the 50S ribosomal subunit. Bacteriostatic.
-Atypical pneumonias (Mycoplasma, Chlamydia, Legionella), STIs (Chlamydia), gram-positive cocci (streptococcal infections in patients allergic to penicillin), and B. pertussis.
Toxicity: MACRO: Gastrointestinal Motility issues, Arrhythmia caused by prolonged QT interval, acute Cholestatic hepatitis, Rash, eOsinophilia. Increases serum concentration of theophyllines, oral anticoagulants. Clarithromycin and erythromycin inhibit cytochrome P-450.
Resistance: methylation of 23S rRNA-binding site prevents binding of drug.
-Sulfamethoxazole (SMX), sulfisoxazole, sulfadiazine
-Inhibit folate synthesis. Para-aminobenzoic acid (PABA) antimetabolites inhibit dihydropteroate synthase. Bacteriostatic (bactericidal when combined with trimethoprim). (Dapsone, used to treat lepromatous leprosy, is a closely related drug that also inhibits folate synthesis.)
-Gram-positives, gram-negatives, Nocardia, Chlamydia. Triple sulfas or SMX for simple UTI.
-Toxicity: Hypersensitivity reactions, hemolysis if G6PD deficient, nephrotoxicity (tubulointerstitial nephritis), photosensitivity, kernicterus in infants, displace other drugs from albumin (e.g., warfarin).
-Resistance: Altered enzyme (bacterial dihydropteroate synthase), decreased uptake, or increased PABA synthesis.
-Ciprofloxacin, norfloxacin, levofloxacin, ofloxacin, moxifloxacin, gemifloxacin, enoxacin.
-Inhibit prokaryotic enzymes topoisomerase
II (DNA gyrase) and topoisomerase IV. Bactericidal. Must not be taken with antacids.
-Gram-negative rods of urinary and GI tracts (including Pseudomonas), Neisseria, some gram-positive organisms.
Toxicity: GI upset, superinfections, skin rashes, headache, dizziness. Less commonly, can cause leg cramps and myalgias.
-Contraindicated in pregnant women, nursing mothers, and children < 18 years old due to possible damage to cartilage. Some may prolong QT interval. May cause tendonitis or tendon rupture in people > 60 years old and in patients taking prednisone.
-Resistance: chromosome-encoded mutation in DNA gyrase, plasmid-mediated resistance, efflux pumps.
-Iatrogenic Cushing syndrome (hypertension, weight gain, moon facies, truncal obesity, buffalo hump, thinning of skin, striae, osteoporosis, hyperglycemia, amenorrhea, immunosuppression), adrenocortical atrophy, peptic ulcers, steroid diabetes, steroid psychosis.
-Adrenal insufficiency when drug stopped abruptly after chronic use.
Bleeding, teratogenic, skin/tissue necrosis
A , drug-drug interactions. Proteins C and S
have shorter half-lives than clotting factors
II, VI, IX, and X, resulting in early transient hypercoagulability with warfarin use. Skin/tissue necrosis believed to be due to small vessel microthromboses.
-For reversal of warfarin, give vitamin K.
-For rapid reversal, give fresh frozen plasma.
-Heparin "bridging": heparin frequently used
when starting warfarin. Heparin's activation of antithrombin enables anticoagulation during initial, transient hypercoagulable state caused by warfarin. Initial heparin therapy reduces risk of recurrent venous thromboembolism and skin/tissue necrosis.
Alteplase (tPA), reteplase (rPA), streptokinase, tenecteplase (TNK-tPA)
-Mechanism: Directly or indirectly aid conversion of plasminogen to plasmin, which cleaves thrombin and fibrin clots. Increase PT, increase PTT, no change in platelet count.
-Use: Early MI, early ischemic stroke, direct thrombolysis of severe PE.
-Toxicity: Bleeding. Contraindicated in patients with active bleeding, history of intracranial bleeding, recent surgery, known bleeding diatheses, or severe hypertension. Treat toxicity with aminocaproic acid, an inhibitor of fibrinolysis. Fresh frozen plasma and cryoprecipitate can also be used to correct factor deficiencies.
-G1: alkylating agents (carmustine, cisplatin, lomustine)
-S: antimetabolites (azanthroprine, cladribine, cytarabine, 5-fluouracil, hydroxyurea, methotrexate, 6-MP, 6-thioguanine), also etoposide, teniposide
-G2: bleomycin, etoposide, teniposide
-M: microtubule inhibitors (paclitaxel), vinca alkaloids (vinblastine, vincristine)
-Mechanism: various; bind intracytoplasmic receptor; alter gene transcription.
-Use: most commonly used glucocorticoids in cancer chemotherapy. Used in CLL, non-Hodgkin lymphoma (part of combination chemotherapy regimen). Also used as immunosuppressants (e.g., in autoimmune diseases).
-Toxicity: Cushing-like symptoms; weight gain, central obesity, muscle breakdown, cataracts, acne, osteoporosis, hypertension, peptic ulcers, hyperglycemia, psychosis.
-CSA Schedule 2 drug
-Behavioral restlessness, tremulousness, hyperactivity, respiratory depression, N/V, ↑intracranial pressure, postural HoTN accentuated by hypovolemia, constipation, urinary retention, itching around nose, urticaria
-CI: concomitant use of full w/ partial agonists (or antagonists), ↓pulmonary function, head injury, pregnancy, impaired hepatic or renal function, endocrine dysfunction
-Drug Interactions: sedative hypnotics, antipsychotics, MOAIs