Med-Surg HESI Study Guide

-Health Promotion For Infancy-Elderly -Normal Aging's Effects on Body Systems -Integumentary System Loss of Pigment in Hair/Skin Wrinkling of Skin Thinning of Epidermis, Easy Bruising & Tearing of Skin Decreased Skin Turgor, Elasticity, & Subcutaneous Fat Increased Nail Thickness & Decreased Nail Growth Decreased Perspiration Dry, itchy, scaly skin Seborrhic dematitis & keratosis formation (overgrowth & thickening of skin) -Neurological System Slowed reflexes Slight tremors & difficulty with fine motor movement Loss of balance Increased incidence of awakening after sleep onset Increased susceptibility to hypothermia & hyperthermia Short-term memory decline possible Long-term memory usually maintained -Musculoskeletal System Decreased muscle mass & strength Decreased mobility, range of motion, flexibility, coordination, & stability Change of gait, with shortened step and wider base Posture and stature changes causing a decrease in height Increased brittleness of the bones Deterioration of joint capsule components Kyphosis of the dorsal spine (increased convexity in the curvature) -Cardiovascular System Diminished energy and endurance, with lowered tolerance to exercise Decreased compliance of the heart muscle, with valves becoming thicker & more rigid Decreased cardiac output and decreased efficiency of blood return to the heart Decreased compensatory response, so less able to respond to increased demands on the cardiovascular system Decreased resting heart rate Weak periphreal pulses Increased blood pressure but susceptibility to postural hypotension -Respiratory System Decreased stretch and compliance of the chest wall Decreased strength and function of respiratory muscles Decreased size & number of alveoli Decreased depth of respirations and oxygen intake but not respiratory rate Decreased ability to cough and expectorate sputum -Hematological System Hemoglobin and Hematocrit average levels toward low end of normal Prone to increased blood clotting

Decreased protein available for protein-bound medications -Immune System Tendency for lymphocyte counts to be low with altered immunoglobulin production Decreased resistance to infection and disease -GI System Decreased need for calories due to lowered basal metabolic rate Decreased appetite, thirst, and oral intake Decreased lean body weight Decreased stomach emptying time Increased tendency toward constipation Increased susceptibility for dehydration Tooth loss Difficulty in swallowing food -Endocrine System Decreased secretion of hormones, with specific changes related to each hormone's function Decreased metabolic rate Decreased glucose tolerance, with resistance to insulin in periphreal tissues -Renal System Decreased kidney size, function, & ability to concentrate urine Decreased glomerular filtration rate Decreased capacity of the bladder Increased residual urine and increased incidence of infection and possibly incontinence Imparied medication excretion -Reproductive System Decreased testosterone production and decreased size of testes Changes in prostate gland, leading to urinary problems Decreased secretion of hormones with the cessation of menses Vaginal changes, including decreased muscle tone & lubrication Impotence or sexual dysfunction for both genders depending on health, medications -Normal Vitals For Infancy-Elderly Age Resting HR Respirations Temperature Blood Pressure Newborn Infant Toddler Preschooler School-Age Adolescent 100-160 bpm 90-130 bpm 80-120 bpm 70-110 bpm 60-100 bpm 55-90 bpm 30-60 breaths/min 20-40 breaths/min 20-30 breaths/min 16-22 breaths/min 18-20 breaths/min 12-20 breaths/min 96.8-99 Axillary 97-99 Axillary Avg. 73/55 Avg. 90/56

97.5-98.6 Axillary Avg. 92/55 97.5-98.6 Axillary Avg. 95/57 97.5-98.6 Oral 97.5-98.6 Oral Avg. 107/64 Avg. 121/70

Adult 60-100 bpm 12-20 breaths/min 97.5-98.6 Oral Avg. 120/80 -Nutritional Assessment of Elderly Food intake can be decreased from loss of appetite, swallowing or chewing difficulties, or GI problems Mobility issues can affect ability to shop for and prepare healthy food Neuropsychological problems can affect ability to prepare own food and eat proper diet Ensure proper fluid/fiber intake to prevent constipation & dehydration Financial hardships can also affect the ability to afford health foods

Psychological stress can cause problems with lack of eating/anorexia Patient BMI can have a bearing on what kind of diet they need -Care of The Hospitalized Child Neonate -Anticipate needs and fulfill them in a timely manner -Provide opportunities for comfort sucking and oral stimulation with a pacifier -Provide swaddling, with the infant's hands drawn to midline and close to face; use soft voice -Provide a quiet soothing environment if very ill -Provide stimulation for each sense when appropriate -Watch for overstimulation; eye avoidance, extension of arms, splaying of fingers, zoning-out -Before painful procedures, provide comfort touching and sucking, -Follow painful procedures with tucking, holding, and cuddling -Model and share appropriate behaviors with family members regarding stimulation, touch, feeding -Provide consistent caregivers when parents are not available -Collaborate with parents on ways to provide care -Involve the parents in care as much as possible -Encourage parents to room-in if possible Infant -For younger infant, provide same care as neonate -Older infant will being to anticipate painful procedures and fight; swaddle with blankets -Expect regression and inform parents to expect it and why -Limit the number of caregivers to whom the infant must adjust -Request that parents bring the infant's security object -Encourage parents to be present during procedures Toddler -Expect regression and inform parents about behaviors -Follow home routines and rituals -Involve parents in the care of the toddler -Provide for rooming-in if possible -Allow opportunities for mobility when it can be done safely -Use all possible methods of pain control when the child must have a painful procedure -Anticipate temper tantrums when the child's frustration level is high -Maintain a safe environment for the toddler's physical acting out and temper tantrums -Encourage the child to be independent -Provide support when the toddler needs to be dependent -Approach with a positive attitude Preschooler -Provide safe ways to act out aggression (punching bags, painting, clay, etc.) -Take time for communication. Answer questions with simple concrete explanations. -Allow for choices whenever possible -Expect egocentric behavior -Provide for a safe and secure environment -Be consistent -Ask the parents how the child usually copes in new situations -Tell the child that her or she did not cause the illness -Involve parents in care and follow home routines -Place the child with other children of the same age if possible -Provide for play activites in the playroom and the room -Accept regression if it occurs and explain it to the parents

-Encourage the child to be independent School-Age Child -Inform the child of limits, and enforce them -Involve the child in planning and implementing care -Explain all procedures and allow the child time for questions and answers -Use medical and scientific terminology and diagrams, body outlines, or anatomically correct dolls -Accept regression but encourage independence -Provide privacy -Encourage the child to assist in keeping the room and belonings in order -Assist the child in contacting friends -Provide for the child's educational needs. Adolescent -Provide privacy for care and visiting -Encourage the adolescent to wear street clothes and perform normal grooming -Encourage questions about appearance and the effects of illness on the adolescent's future -Use scientific and medical terminology to prepare the adolescent for procedures -Use body outlines and diagrams and give the rationale for the procedures -When possible, provide for a special activity area that is limited to adolescent use -Encourage peers to call and visit if the adolescent's condition allows -Assist parents in communicating, supporting, and guiding adolescents -Allow favorite foods to be brought in if the adolescent does not need a special diet -Approach the adolescent with caring, understanding, and acceptance -Provide for educational needs, as for a school-age child -Teaching for Parents of The Hospitalized Child -GI Meds Antacids -Aluminum Compounds Contain significant amounts of sodium Most common side effect is constipation -Magnesium Compounds Mg Hydroxide is also a saline laxative Contraindicated in pt with bowel obstruction, appendicitis, or undiagnosed abdominal pain Magnesium can accumulate and cause toxicity in pt with renal impairment -Calcium Compounds Calcium carbonate can cause acid rebound Rapid acting, break down into CO2 in stomach, causing belching and gas Common side effect is constipation -Sodium Bicarbonate Rapid onset, liberates CO2 increasing intra-abdominal pressure and causing gas Use with caution in pt with hypertension & heart failure Can cause systemic alkalosis in pt with renal impairment Useful for treating acidosis and elevating urinary pH to promote excretion of acidic meds -React with gastric acid to produce neutral salts or salts of low acidity -Inactivate pepsin and enhance mucosal protection but do not coat ulcer crater -Should be taken on a regular schedule -Should elevate gastric pH > 5 -Tablets should be chewed thoroughly and followed with milk -Allow 1 hour between antacid administration and other meds to prevent interactions

Gastric Protectants -Misoprostol (Cytotec) Antisecretory med that enhances mucosal defenses Suppresses secretion of gastric acid and maintains submucosal blood blow by promoting vasodilation Administered with meals, causes diarrhea and abdominal pain Contraindicated with pregnancy -Sucralfate (Carafate) Creates a protective barrier against acid and pepsin Administered orally, should be taken on empty stomach May cause constipation May impede absorption of Coumadin, Dilatin, Digoxin, and some antibiotics. Administer these 2h later Muscarinic Antagonist (Pirenzepine / Gastrozepine) -Suppresses acid secretion by blocking muscarinic cholinergic receptors Histamine 2 Receptor Antagonists Suppress secretion of gastric acid Contrainicated in hypersensitive clients Use with caution in clients with impaired renal or hepatic function -Cimetidine (Tagamet) Oral, IM, or IV Food reduces rate of absorption Antacids can decrease absorption of oral, admin 1 hour apart Passes blood-brain barrier, CNS side effects can occur Dosage should be reduced in pt with renal impairment If admin with Coumadin, Dilatin, ophylline, or lidocaine doages of these should be reduced -Ranitidine (Zantac) Oral, IM, or IV Side effects are uncommon and does not penetrate blood-brain barrier Not affected by food -Famotidine (Pepcid) and nizatidine (Axid) Similar to ranitidine and cimetidine Do not need to be administered with food Proton Pump Inhibitors -Nexium, Prevacid, Prilosec, Protonix, Aciphex -Suppress gastric acid secretion -Treat ulcer disease, erosive esophagitis, pathological hypersecretory conditions -Contraindicated in hypersensitivity -Common side effects include headache, diarrhea, abdominal pain, and nausea Medication Regimens To Treat H. Pylori Infections -An antibacterial agent alone is not effective because the bacteria readily becomes resistant -Triple or quadruple therapy is used -Triple Therapy: Nexium, Amoxil, Biaxin -Quadruple Therapy: Nexium, Flagyl, tetracycline, bismuth subsalicylate Zantac, Flagyl, tetracycline, bismuth subsalicylate Prokinetic Agent -Metaclopramide (Reglan) -Stimulates motility of the upper GI tract and increases rate of gastric emptying -May cause dizziness, insomnia, and headaches

-Usually given 30 min before meals and at bedtime -Contraindicated in pt with sensitivity, mechanical obstructino, perforation, or GI hemorrhage -Can precipitate hypertensive crisis in clients with pheochromocytoma -Safety in pregnancy is not established -Can cause Parkinsonian reactions, physician will discontinue if this occurs -Anticolinergics and opoid analgesics antagonize the effects -Alcohol, sedatives, cyclosporine, and tranquilizers add additional effect Bile Acid Sequestrants -Act by absorbing and combining with intestinal salts, preventing reabsorption -Taste and palatability often cause of noncompliance in powdered form Mix with juice or flavored products -Side effects include nausea, bloating, constipation, fecal impaction, and intestinal obstruction -Stool softeners and other fiber sources can be used to abate the GI side effects -Bile acid sequestrants should be used cautiously in clients with severe constipation or bowel obstruction Lactulose (Constulose, Enulose) -Used in prevention and treatment of hepatic encephalopathy -Promotes increased peristalsis and bowel evacuation, expelling ammonia from the colon -Improves protein tolerance in clients with advanced hepatic cirrhosis -Administered orally in the form of a syrup or rectally Pancreatic Enzyme Replacements -Pancreatin, Pancrelipase -Used to supplement or replace pancreatic enzymes -Improve nutritional status and reduce fatty stools -Should be taken with all meals and snacks -Side effects include abdominal cramps or pain, nausea and diarrhea -Products that contain calcium carbonate or magnesium hydroxide interfere with its action Inflammatory Bowel Disease Drugs -Antimicrobials Ciprofloxacin (Cipro), Metronidazole (Flagyl) To prevent or treat secondary infection -5-Aminosalicylates Balsalazide (Colazal), Mesalamine, Olsalazine (Dipentum), Sulfasalazine (Azulfidine) Decrease GI inflammation -Corticosteroids Budesonide, Prednisone Act as an anti-inflammatory to decrease GI inflammation -Immunosuppressants Azathioprine (Imuran), Cyclosporine (Sandimmune, Neoral, Gengraf), Mercaptopurine Suppress the immune system, can cause pancreatitis and neutropenia Reserved for those who have not responded to traditional therapies -Immunomodulators Adalimumab (Humira), Certolizumab (Cimzia), Infliximab (Remicade), Natalizumab Monoclonal antibodies that modulate the immune response to induce and maintain remission Irritible Bowel Syndrome Drugs -IBS is a GI disorder characterized by crampy abdominal pain with diarrahea and/or constipation -Alosetron (Lotronex) Used for severe IBS Can cause severe adverse effects such as constipation, impaction, bowel obstruction, ichemic colitis

Strict risk management procedure must be followed by bother the prescriber and the client -Lubiprostone(Amitiza) Increases intestinal motility and increases the passage of stool Side effects include nausea, headache, diarrhea, flatulence -Tegaserod (Zelnorm) Decreases visceral sensation and increases GI motility and secretions Most serious adverse effect is diarrhea and CV events such as MI and stroke Use of medication is restricted, only those with not CV disease and lack of response to other treatment Antiemetics -Serotonin Antagonists(Anzemet, Kytril, Zofran, Aloxi) -Glucosteroids (Decadron, Solu-Medrol) -Substance P/Neurokinin 1 Antagonists (Emend) -Benzodiazepines (Ativan, Valium) -Dopamine Antagonists (Thorazine, Trilafon, Compazine, Phenergan) -Butyrophenones (Haldol, Inapsine) -Cannabinoids (Marinol, Cesamet) -Antihistamines(Marezine, Dramamine, Benadryl) -Others (Reglan, Motilium, Transderm Scop) -Medications to control nausea and vomiting -Monitor for drowsiness and protect the client from injury -Monitor vitals and I&O, limit odors to clients room, limit oral intake to clear liquid Laxatives -Bulk Forming Citrucel, Metamucil, FiberCon Absorb water into feces and increase bulk to produce large soft stool Contraindicated in bowel obstruction -Stimulants Dulcolax, Fleet laxative, Senokot, Ex-Lax Stimulate motility of the large intestine -Surfactants Colace (Docusate sodium) Inhibit absorption of water so fecal mass remains large and soft Used to avoid straining -Osmotics Milk of magnesia, citrate of magnesia, fleet enema Attract water into the large intestine to produce bulk and stimulate peristalsis -Lubricants Mineral Oil Act to soften the feces, ease the strain of passing stool Interferes with the absorption of fat soluble vitamins ADE&K Medications To Control Diarrhea -Motofen, Lomotil, Immodium -Bismuth subsalicylates -Tincture of opium -Identify and treat the underlying cause, treat dehyrdation, replace fluids and electrolytes, relieve abdominal discomfot and cramping, and reduce the passage of stool -IV Calculations Drop Rate = (Volume in mL*Drops Per mL(drop factor))/Time in minutes Ex. 1500 mL NS ordered over 12 hours. Using drop factor of 15 drops/mL find drop rate:

Drop Rate = (1500*15)/720 Drop Rate = 22500/720 Drop Rate = 31.25 drops / minute BUT drops must be rounded to whole number so, Drop Rate = 31 drops/min (31 gtt/min) Drip Rate (ml/hr) = Volume to be infused / Time in hours for infusion Ex. 1500 ml NS ordered over 12 hours. What is the drip rate in mL/hr? Drip Rate = 1500 mL/12 hours Drip Rate = 125 mL/hr -IV Piggyback -GERD Backflow of gastric and duodenal contents into the esophagus Caused by and incompetent lower esophageal sphincter, pyloric stenosis, or motility disorder Symptoms include heartburn, epigastric pain, dyspepsia, regurgitation, pain and difficulty swallowing, hypersalivation Interventions: -Avoid factors that lower esophageal sphincter pressure or cause esophageal irritation such as peppermint, chocolate, coffee, fried or fatty foods, carbonated beverages, alcoholic beverage, and smoking -Eat a low fat high fiber diet, and do not eat or drink 2 hours before bedtime -Elevate head of bed on 6-8 inch blocks -Avoid the use of anticholinergics due to delayed stomach emptying -Surgical treatment involves fundoplication (wrapping a portion of the gastric fundus around the sphincter of the esophagus -Peptic Ulcer Disease Ulceration in the mucosal wall of the stomach, pylorous, duodenum, or esophagus in portions accessible to gastric secretions; erosion may extend through the muscle May be referred to as gastric, duodenal, or esophageal. Most common are gastric & duodenal. Predisposing factors include stress, smoking, corticosteriod use, NSAID use, alcohol abuse, history of gastritis, family history of gastric ulcers, or infection with H.pylori Gastric Ulcer Gnawing, sharp pain in or left of epigastric region 30-60 min after a meal Duodenal Ulcer Burning pain occurs in the epigastric area 1.5-3 hours after a meal and during night Interventions: -Administer small, bland feedings during active phase -Administer H2 receptor antagonists or proton pump inhibitors as prescribed -Administer antacids as prescribed -Administer anticholinergics as prescribed -Administer mucosal barrier protectants as prescribed 1 hours before each meal -Administer prostoglandins as prescribed for their protective and antisecretory actions -Surgical interventions include: Total Gastrectomy removal of stomach Vagotomy removal of vagus nerve Gastric resection removal of the lower half of the stomach Billroth I Pastial gastrectomy with remaining segment attached to duodenum Billroth II Partial gastrectomy, with remaining segment attached to jejunum Pyloroplasty Enlargement of the pylorus to prevent or decrease pyloric obstruction thereby enhancing gastric emptying -Gallbladder Disease (Cholecystitis) Causes Inflammation of the gallbladder that may occur as an acute or chronic process

Acute inflammation is associated with gallstones Chronic cholecystitis results when inefficient bile rmptying and gallbladder muscle wall disease cause a fibrotic and contracted gallbladder Acalculous cholecystitis occurs in the absence of gallstones and is caused by bacterial invasion via the lymphatic or vascular systems. Treatments Maintain NPO during nausea and vomiting episodes Maintain nasogastric decompression for severe vomiting Administer antiemetics as prescribed Administer analgesics as prescribed Administer antispasmodics as prescribed to relax smooth muscle Instruct the client with chronic cholecystitis to eat small, low fat meals Instruct the client to avoid gas-forming foods Cholecystectomy (removal of gallbladder) & Choledocholithotomy (surgical removal of stones via incision) -Suctioning -GI Testing Risk Factors For Certain Tests Complications of Tests -Pre-op Assessment Teaching Positioning Ways to promote infection control Quality Measurements -Intra-op Assessment Teaching Positioning Ways to promote infection control Quality Measurements -Post-op Assessment Teaching Positioning Ways to promote infection control Quality Measurements -Post-op and the elderly - anesthesia's effects on the body -Post-op Ambulation & Assistive Devices -Pre-op Diet/Nutrition -Post-op Diet/Nutrition -Wound Assessment & Dressings -Sutures, Staples, Drain Systems: Care & Removal For Discharge -Musculoskeltal Disorders -Carpal Tunnel Assessment Treatment Teaching -Hip Fractures Complications

-Compartment Syndrome -Lab Values w/ Fractures -Hip Replacements Care Do's & Don'ts -Neurovascular Assessment -6 P's -Stump Care -Cast Care Assessment & Comfort Measures -Pain Management -Respiratory Assessment -Respitatory Problems Bronchitis -Inflammation of the trachea and bronchi, usually in association with upper respiratory infection -Usually caused by virus -Symptoms include fever, dry hacking non productive cough that is worse at night and becomes productive in 2-3 days -Interventions Treat symptoms as necessary Monitor for signs of respiratory distress Provide cool, humidified air Encourage increased fluid intake Administer antipyretics as prescribed Cough supressants may be prescribed to promote rest Bronchiolitis & Respiratory Syncytial Virus (RSV) -Inflammation of bronchioles that causes production of thick mucus that occludes bronchiole tubes and small bronchi -RSV is an acute viral infection and most common cause of bronchiolitis Highly contagious but not airborne Primarily in winter/spring Rarer in children > 2, with peak incidence at 6 months -Signs include rhinorrhea, eye or ear drainage, pharyngitis, coughing, sneezing, wheezing & intermittent fever -Later signs include tachypnea, increased coughing & wheezing, periods of cyanosis, listlessness, and apneic episodes -Interventions Airway maintenance, administration of cool humidified air & oxygen Ensure adequate fluid intake and medication administration For children with RSV, isolate in own room or with another child with RSV Use contact and standard precautions, do not care for other high-risk patients Monitor airway status, maintain patent airway For most effective airway maintenance, position at 30-40 degree angle with neck extended Monitor pulse oximetry levels Periodic suctioning is nasal secretions are copious Pneumonia -Inflammation of the pulmonary parenchyma or alveoli or both caused by a virus, mycoplasmal agents, bacteria, or aspiration of foreign substances. -Primary pneumonia offurs most often in the fall and winter months & in crowded living cond. Viral Pneumonia -Acute or insidious onset -Mild fever, slight cough and malaise to high fever, severe cough and diaphoresis

-Wheezes or fine crackles -Treatment is symptomatic, administration of O2 and fluids, antipyretics and chest physiotherapy as needed Primary Atypical Pneumonia -Acute or insidious onset -Fever, chills, anorexia, headache, malaise, and myalgia (muscle pain) -Rhinitis, sore throat, and dry hacking cough -Nonproductive cough initially progressing to production of seromucoid sputum that becomes mucopurulent or blood-steaked -Treatment is symptomatic, recovery generally within 7-10 days Bacterial Pneumonia Meds -Renal/Urinary Measurements -Renal/Urinary Disorders & Care -Male Reproductive Problems -Urinary/Renal Meds Urinary Tract Antiseptics -Inhibit growth of bacteria in the urine -Do not achieve effective concentrations in blood or tissue so cannot be used for other infections Cinoxacin -Side affects are similar to nalidixic acid -Dosage should be reduced in clients with renal impairment; failure to do so could result in accumulation of the medication to toxic levels Methenamine (Mandelamine, Hiprex, Urex) -Used to treat chronic UTIs but not recommended for acute infections -Administer after meals and at bedtime to minimize gastric distress -Chronic high-dose therapy can cause bladder irritation -Should not be used in patients with renal impairment due to risk of crystalluria -Should not be used in clients with liver impariment due to decomposition into ammonia -Requires urine with pH 5.5 or lower -Increasing fluid intake reduces antibacterial effect -Do not combine with sulfonamides -Avoid alkalinizing agents such as sodium bicarbonate or sodium carbonate -Tums, Rolaids, etc Nalidixic Acid (NegGram) -GI side effects include anorexia, nausea, vomiting, and diarrhea -Integumentary side effects include rash and photosensitivity -CNS side effects include visual disturbances and insomnia -May produce intracranial hypertension in children, should not be given to those < 3 months -Can intensify the effects of oral anticoagulants -Contraindicated in clients with a history of convulsive disorders Nitrofurantoin (Furadantin, Macrodantin, Macrobid) -GI side effects include anorexia, nausea, vomiting, and diarrhea, administer w/ milk or food -Pulmonary side effects include dyspnea, chest pain, chills, fever, cough and alveolar infiltrates these should clear up within 2-4 days after cessation -Hematological side effects include agranulocytosis, leukopenia, thrombocytopenia, and megaloblastic anemia -Peripheral neuropathy side effects include muscle weakness, tingling sensations, and numbness -Neurological side effects include headache, vertigo, drowsiness, and nystagmus -May produce a harmless brown color to urine

-Contraindicated in patients with renal impairment -Do not take with antacids Fluroquinolones -Ciprofloxacin, Enoxacin, Moxifloxacin, Norfloxacin, Ofloxacin, Gemifloxacin, Levofloxacin, Maxaquin, Sparfloxacin, Trovafloxacin (basically anything -oxacin) -Supress bacterial growth by inhibiting an enzyme necessary for DNA synthesis. -Side effects include drowsiness, dizziness, gastric distress, diarrhea, vaginitis, nausea, and vomiting -Adverse effects include psychoses, hallucinations, confusion, tremors, hypersensitivity and interstitial nephritis -Use with caution in patients with hepatic, renal, or CNS disorders -Monitor for side effects or signs of adverse reactions -Enoxacin and norfloxacin should be taken on empty stomach -Ciprofloxacin, lomefloxacin, and ofloxacin may be taken with or without food -IV infusions should be done over 60 min for ciprofloxacin and ofloxacin -Administer with a full glass of water and ensure the client maintains a urine output of at least 12001500mL daily to prevent crystalluria Sulfonamides -Sulfadiazine, sulfamethoxazole, sulfisoxazole, trimethoprim, trimethoprim-sulfamethoxazole -Suppress bacterial growth by inhibiting the synthesis of folic acid; used primarily for acute UTI -Side effects and nursing considerations include: Hypersensitivity reactions Stevens-Johnson syndrome Hemolytic anemia, agranulocytosis, leukopenia, & thrombocytosis Administer with caution w/ patients w/ renal impairment Contraindicated for hypersensitivity to sulfonamides, sulfonulureas, or thiazide Contraindicated in infants < 2 months and pregnant or breastfeeding mothers Can potentiate the effects of Coumadin, Dilantin, and Orinase Take on empty stomach with a full glass of water Avoid prolonged sun exposure Maintain daily urine output of 1200-1500 mL Use cautiously in patients with impaired kidney function, folate deficiency, severe allerfy, or bronchial asthma IV dose administered over 60-90 min Should be withheld if a rash is noted (Hypersensitivity or Stevens-Johnson) Urinary Tract Analgesic -Phenazopyridine (Pyriduium, Azo-Standard, Pyridiate, Urogesic) -Used to treat pain from UTI -Side effects include nausea, headache, and vertigo -Contraindicated in patient with renal or hepatic disease -Interferes with accurate urine testing for glucose or ketones Anticholinergics-Antispasmodics -Darifenacin, Oxybutynin, Solifenacin, Tolterodine, Trospium -Used for overactive bladder -Side effects include anorexia, nausea, vomiting, dry mouth, blurred vision, confusion, constipation, decreased sweating, dizziness, drowsiness, dry eyes, gastric distress, headache, tachycardia, urinary retention -Nursing considerations Extended release capsules should not be split, chewed, or crushedf Tolterodine should be used cautiously in clients with narrow-angle glaucoma

Do not administer oxybutynin to clients with hypersensitivity, GI obstruction, glaucoma, severe colitis, or myasthenia gravis Instruct the client to avoid hazardous activities due to dizziness/drowsiness Monitor I&O Monitor for signs of toxicity (hypotension, hypertension, confusion, tachycardia, flushed face, respiratory distress, nervousness, restlessness, irritability) Cholinergic (Bethanechol chloride / urecholine) -Used to increase bladder tone and function and to treat nonobstructive urinary retention -Side effects include headache, hypotension, flushing and sweating, increased salivation, abdominal cramps, nausea and vomiting, diarrhea, urinary urgency, bronchoconstriction, & transient complete heart block -Nursing Considerations: Administer on an empty stomach, 1 hour before or 2 hours after meals Never administer IM or IV Monitor I&O Monitor for increased bladder tone & function Monitor for cholinergic overdose(excessive salivation, sweating, involuntary urination) Have atropine sulfate readily available for IV or sub Q admin Should not be given to a client with an urinary stricture or obstruction Medications for Preventing Organ Rejection -Immunosuppressants Cyclosporine Sirolimus Tacrolimus -Glucocorticoid Prednisone -Cytotoxic Medications Azathioprine Mycophenolate mofetil -Antibodies Antithymocyte globulin, equine Basiliximab Daclizumab Muromonab-CD3