Nursing Process Focus: Quinidine (Quinidex)



Nursing Process Focus:

Patients Receiving Quinidine (Quinidex)

|Assessment |Potential Nursing Diagnoses |

|Prior to administration: |Cardiac Output, Risk for decreased, related to cardiac changes |

|Assess patient for chest pain, dysrhythmias, and vital signs |secondary to adverse effects of drug therapy |

|(initially and throughout therapy) |Nutrition, Risk for imbalance related to gastrointestinal disturbances|

|Obtain complete medical history, including allergies, especially heart|caused by medication |

|block, digitalis toxicity, heart failure, and hypotension. Include |Fluid volume, Risk for deficient, related to diarrhea secondary to |

|blood studies: cardiac enzymes, |adverse effect of medication |

|Digoxin level, electrolytes, CBC. Obtain EKG. | |

|Obtain patient’s drug history to determine possible drug interactions | |

|and allergies. | |

|Planning: Patient Goals and Expected Outcomes |

|The patient will: |

|Avoid sudden chest pain and dyspnea |

|Demonstrate a regular heart rhythm with a normal rate |

|Maintain normal bowel pattern |

|Maintain adequate nutritional status |

|Implementation |

|Interventions and (Rationales) |Patient Education/Discharge Planning |

|Assist in monitoring cardiac rate and rhythm, continuously if |Instruct patient and caregivers: |

|administering medication IV. (IV route is used when rapid therapeutic |Need for constant monitoring |

|effects are needed therefore constant monitoring is needed to detect |Potential complications of drug therapy |

|any potential serious arrhythmias. May cause cardiotoxicity including | |

|asystole because this medication can cause a reduction in conduction | |

|throughout all the regions of the heart.) | |

|Ensure that EKG is performed. (Changes precede this and show: | |

|Increase in PR and QT intervals | |

|>50% widening of QRS complex | |

|Presence of ventricular tachycardia | |

|Presence of ventricular fibrillation) | |

|Monitor EKG frequently if medication is given orally. (Medication may |Instruct patient and caregivers regarding need for frequent EKG |

|cause complete heart block.) |readings. |

|Monitor for diarrhea, which occurs in approximately 1/3 of patients. |Instruct patient to: |

|(Related to the fact that quinidine is related to quinine in structure|Take medication with food to minimize gastrointestinal upset, although|

|and action. Diarrhea may be intense.) |food may delay absorption of quinidine. |

| |Report occurrence of diarrhea to health care provider |

|Monitor for signs of arterial embolism, including sudden chest pain |Instruct patient to immediately report any sudden chest pain or |

|and dyspnea. |dyspnea to the health care provider. |

|Report immediately. (Patient is usually placed on coumadin for 3-4 | |

|weeks prior to administration of quinidine to prevent arterial | |

|embolism, a complication of atrial fibrillation.). | |

|Monitor for signs of digoxin toxicity. Report immediately. (Digoxin |Instruct patient |

|may be prescribed to prevent quinidine from increasing ventricular |Regarding signs and symptoms of digoxin toxicity and to report |

|rate; however, when used concurrently, quinidine can double digoxin |immediately |

|levels.) |To report change in heart rhythm to the health care provider. |

| |Not to miss any doses of their medication |

|Determine patient’s diet and cultural background. (A diet high in |Instruct patient to avoid adding vegetables, fruit, and milk beyond |

|vegetables, citrus fruit and milk may increase the chance of toxicity |recommended daily requirements. |

|by delaying the excretion of this medication.) | |

|Evaluation of Outcome Criteria |

|Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see “Planning”). |

Nursing Process Focus:

Patients Receiving Propranolol (Inderal)

|Assessment |Potential Nursing Diagnoses |

|Prior to administration: |Injury, Risk for, related to dizziness secondary to decreased blood |

|Assess for cardiac arrhythmias, including supraventricular |pressure |

|tachycardia, ventricular tachycardia, and tachycardia secondary to |Tissue perfusion, Risk for Ineffective, related to decreased cardiac |

|digoxin toxicity. |output related to arrhythmia |

|Assess for chest pain, palpations, vitals signs (initially and |Gas exchange, Risk for Impaired, related to side effects of medication|

|throughout therapy). |Knowledge deficient, related to drug action and side effects |

|Obtain complete medical history, including, allergies, cardiac, | |

|endocrine, depressive disorders. Include the following blood studies:| |

|CBC, electrolytes, glucose, cardiac enzymes. | |

|Compare EKG at baseline to throughout therapy. | |

|Obtain patient’s drug history to determine possible drug interactions | |

|and allergies. | |

|Planning: Patient Goals and Expected Outcomes |

|The patient will: |

|Demonstrate a change in heart rhythm |

|Exhibit a decrease in cardiac arrhythmias |

|Demonstrate expected outcomes of drug therapy and list reportable side effects. |

|Maintain adequate tissue perfusion |

|Implementation |

|Interventions and (Rationales) |Patient Education/Discharge Planning |

|Monitor for cognitive dysfunction and depression in the elderly, as |Advise patient regarding potential cognitive side effects and to |

|well as hallucinations and psychosis (more likely with higher doses). |report any signs of depression to the health care provider. |

|(These reactions appear to be related to the lipid solubility of this | |

|medication and its ability to cross the blood-brain barrier.) | |

|Monitor for proper medication use. (Abrupt discontinuation of |Instruct patient to: |

|medication may cause myocardial infarction, severe hypertension and |Never discontinue the medication abruptly and to take the medication |

|ventricular arrhythmias because of a potential rebound effect.) |exactly as prescribed. |

| |Take the medication even if feeling well |

| |Take pulse prior to taking the medication. If pulse is irregular, |

| |instruct patient to withhold medication and contact the health care |

| |provider immediately |

|Monitor for hypotension. (Medication may lower blood pressure as a |Instruct patient to change position slowly to avoid dizziness. |

|result of decreased cardiac output.) | |

|Monitor for hypoglycemia. (There is an increased incidence of |Instruct patients with Type I Diabetes Mellitus to: |

|hypoglycemia in patients with Type I Diabetes Mellitus because this |Check blood sugar regularly |

|medication may inhibit glycogenolysis). |Report unusually low blood sugar reading to the health care provider. |

|Monitor for diarrhea. (This side effect may be related to the |Instruct patient to take medication with food to decrease GI upset. |

|medication’s effect on the vascular smooth muscle receptors.) | |

|Evaluation of Outcome Criteria |

|Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see “Planning”). |

Nursing Process Focus: Patients Receiving Amiodarone (Cardarone)

|Assessment |Potential Nursing Diagnoses |

|Prior to administration: |Cardiac output, Risk for decreased, related to cardiac arrhythmias |

|Assess for ventricular fibrillation, recurrent unstable ventricular |Injury, Risk for, related to adverse effects of medication |

|tachycardia (initially and throughout therapy). |Gas exchange, Risk for Impaired related to pulmonary damage secondary |

|Obtain complete medical history, especially cardiac and liver disease,|to side effects of medication |

|lung disorders, and eye disorders including blood studies: liver |Nutrition, Risk for imbalanced related to gastrointestinal distress |

|function tests. Obtain baseline eye exam. |secondary to side effects of medication |

|Obtain patient’s drug history to determine possible drug interactions | |

|and allergies. | |

|Planning: Patient Goals and Expected Outcomes |

|The patient will: |

|Demonstrate ability to measure own pulse. |

|Describe the need to change positions slowly to prevent postural hypotension. |

|Remain free of physical injury |

|Maintain adequate nutrition |

|Demonstrate adequate respiratory function |

|Implementation |

|Interventions and (Rationales) |Patient Education/Discharge Planning |

|Auscultate lung sounds frequently. (Pulmonary toxicity can occur and |Advise patient to notify the health care provider at the first sign of|

|may be fatal. Occurs most frequently with oral dosing because |shortness of breath or cough. |

|absorption is highly variable. Lung tissue which receives good blood | |

|flow appears to receive a greater effect from the medication.) | |

|Monitor heart rate and rhythm. (May worsen the arrhythmia it is trying|Instruct patient to report change in heart rate and rhythm to health |

|to treat. May also cause bradycardia, heart block and cardiac arrest |care provider. |

|because it slows conduction and increases the refractory period.) | |

|Monitor liver enzymes. (Drug may cause liver disease because this |Instruct patient regarding signs and symptoms of liver disease such as|

|medication has a high lipid solubility and is distributed extensively |jaundice, right upper quadrant pain, dark urine and clay colored |

|to the liver.) |stool and to report these symptoms to health care provider immediately|

|Observe for changes in visual acuity. (May cause optic neuritis which |Instruct patient to report any vision changes to the health care |

|may lead to blindness. This is caused by corneal microdeposits.) |provider immediately. |

|Monitor blood pressure throughout drug therapy. (Hypotension is common|Instruct patient to: |

|early in therapy and is related to the dilating action of this |Change positions slowly to reduce incidence of dizziness |

|medication on peripheral blood vessels.) |Monitor blood pressure and report abnormalities to the health care |

| |provider |

|Observe for occurrence of common side effects. (Common side effects |Instruct patient to: |

|include dizziness, headache, insomnia related to the antiadrenergic |Take medication with food to minimize gastrointestinal distress. |

|properties of this medication. Gastrointestinal distress and |To cover the skin well when in direct sunlight and to wear sunglasses.|

|photosensitivity also commonly occur). Report to health care provider.|The elderly are particularly sensitive to the sun. |

|Monitor for concurrent digoxin and anticoagulant use. Amiodarone |Advise patient to: |

|increases digoxin levels in the blood and enhances the actions of |To report changes in cardiac rhythm |

|anticoagulants. |To report occurrence of abnormal bleeding or bruising. |

|Evaluation of Outcome Criteria |

|Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes are met (see “Planning”). |

Nursing Process Focus: Patients Receiving Verapamil (Calan)

|Assessment |Potential Nursing Diagnoses |

|Prior to administration: |Injury, Risk for, related to dizziness secondary to hypotension |

|Assess for dysrhythmias, heart rate, and radial pulse |Gas exchange, Impaired, related to side effects of medication |

|(initially and throughout therapy). |Cardiac output, Risk for Decreased, related to hypotension and |

|Obtain complete medical history, including allergies, |bradycardia secondary to side effects of medication |

|especially cardiac, renal, liver and respiratory diseases |Nutrition, Risk for Imbalanced, related to nausea secondary to |

|including blood studies: BUN, creatinine, liver function tests.|medication |

|Obtain patient’s drug history to determine possible drug | |

|interactions and allergies. | |

|Planning: Patient Goals and Expected Outcomes |

|The patient will: |

|Demonstrate relief of shortness of breath and dizziness |

|Exhibit expected outcome of drug therapy and list reportable side effects |

|Demonstrate blood pressure monitoring and pulse measurement prior to medication. |

|Remain free of physical injury |

|Maintain adequate nutritional status |

|Implementation |

|Interventions and (Rationales) |Patient Education/Discharge Planning |

|Observe for side effects such as hypotension and bradycardia. |Instruct patient to take own blood pressure prior to taking medication |

|(Verapamil causes a decrease in total peripheral resistance |and if blood pressure is less than 90/60, hold medication and notify |

|which can significantly lower blood pressure. Bradycardia can |the health care provider immediately. |

|result because Verapamil slows SA and AV node conduction.) | |

|Monitor for signs of pulmonary edema and shortness of breath |Advise patient to notify health care provider of any breathing |

|(related to dilation of the coronary arteries). |difficulties. |

|Monitor serum liver enzymes level (Verapamil may cause an |Instruct patient concerning the importance of having lab work done |

|elevation in liver enzymes.) |because medications may cause severe liver damage. |

|Monitor renal status |Instruct patient: |

|Monitor BUN and creatinine levels (Verapamil may cause renal |Concerning the importance of having lab work done because medications |

|damage.) |may cause severe renal and kidney damage. |

|Monitor intake and output. |To report changes in urinary output to the health care provider. |

|Monitor bowel pattern for occurrence of constipation. (Verapamil|Advise patient to: |

|often causes nausea and constipation). |Take medication with food if gastric distress is a problem. |

| |Maintain regular bowel habits. Advise patient to increase fruits and |

| |fiber in the diet. |

|Observe for signs of digoxin toxicity. (Causes increased digoxin|Instruct patient to notify health care provider of all medications |

|and quinidine levels when used with diltiazem.) |taken and to notify health care provider if there is a change in |

| |cardiac rhythm |

|Evaluation of Outcome Criteria |

| |

|Evaluate effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see “Planning”). |

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