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PN Adult Medical Surgical Online Practice 2020-2023 Remediation PHARMACOLOGICAL THERAPIES • EXPECTED FINDINGS FOR A CLIENT WHO IS TAKING DIGOXIN ▪ Heart failure results from inadequate pumping of the heart muscle with manifestations caused by the heart’s inability to meet the circulation needs of the whole body. Decreased tissue perfusion resultsin fatigue,shortness of breath, weakness, and activity intolerance. ▪ Heart failure causes a reduction in cardiac output (CO) and affect the rate,stroke volume (SV), preload, and afterload. There are two types of heart failure: left-sided (with pulmonary manifestations [dyspnea, cough, and oliguria]) and right-sided (systemic congestion with peripheral edema, jugular vein distention, weight gain). ▪ Diuretics, ACE inhibitors, angiotensin II receptor blockers(ARBs), and beta-adrenergic blockers are the medications of choice for treatment of heart failure. Cardiac glycosides are indicated if these medications are unable to control manifestations. o IDENTIFYING THE EFFECTIVENESS OF A HEMATOPOIETIC GROWTH FACTOR ▪ Depending on therapeutic intent, indications of effectivenessinclude Hgb level 10 to 11 g/dL and a maximum Hct of 33%. • Medications: Filgrastim/Pegfilgrastim o RECOGNIZING PRIORITY COMPLICATIONS OF AN EPIDURAL INFUSION ▪ Airway breathing circulation (ABC) framework • The ABC framework identifies, in order, the three basic needsfor sustaining life. o An open airway is necessary for breathing, so it isthe highest priority. o Breathing is necessary for oxygenation of the blood to occur. o Circulation is necessary for oxygenated blood to reach the body’s tissues. • The severity of manifestations should also be considered when determining priorities. A severe circulation problem can take priority over a minor breathing problem. • Some frameworks also include a ‘D’ for disability and ‘F’ for exposure. NURSING ACTIONS: • Monitor during and for at least 1 hr following insertion or injection for hypotension, anaphylaxis, muscle weakness,seizures, and dura puncture. • Monitor for respiratory depression and sedation. • Monitor the insertion site for hematoma, infection, and leakage of cerebral spinal fluid. • Check the level of sensory block. • Evaluate leg strength prior to ambulating. • Local anesthetics block the sympathetic nervous system, causing peripheral vasodilation and hypotension. This can cause reduced stroke volume, cardiac output, and peripheral resistance. Increase the rate of IV fluid infusion to compensate for the sympathetic blocking effectsto regional anesthetic. o REINFORCING TEACHING ABOUT GLUCOCORTICOIDS ▪ Client education: • Report evidence of infection related to immunosuppression. • Avoid crowds and individuals who are sick because illness can precipitate an exacerbation. • Understand the risks of pregnancy with lupus and treatment medications. • Cleanse skin with mild soap and inspect for open areas and rashes daily. • Apply lotion to dry skin. ▪ COMPLICATIONS: • Immunosuppression/neutropenia o Due to bone marrow suppression by cytotoxic medications. o The most significant adverse effect of chemotherapy. o Clients who have neutropenia might not develop a high fever or have purulent drainage, even when an infection is present.