Question

type.. and please don't guess this is for exam :)

when should a nurse hold BP med, morphine, Digoxin, warfarin?

identify the assessment parametre for early detection of paralytic ileus and peritonitis

Answer 1

1.

BP medications:

Some of the classes of high blood pressure medications include Diuretics, Beta-blockers, ACE inhibitors, Angiotensin II receptor blockers, Calcium channel blockers, Central agonists, etc.

They are used whenever patient has high blood pressure . These medications reduces blood pressure by dilating arteries or slow the heart rate or reduce the force of contractions in myocardium or increase excretion of sodium & water from body.

Prior to dialysis anti hypertensives are hold. During early phase of stroke (24-48hours) antihypertensives should be hold , because during that stage high blood pressure is desirable to reduce the cerebral damage.

----------------------------------------------------------------------------------------------------------------

Morphine: It is a high alert medication.

• It is given for patient having severe pain which may be acute and chronic.
• For surgery patients
• Pain severe enough to require daily, around-the-clock long-term opioid treatment and for which alternative treatment options are inadequate (extended-release).
• For patient having pulmonary edema.
• Pain associated with myocardial infarction.

When a patient on morphine experiences any of following conditions it should be hold .The conditions are  loss of coordination, nausea, vomiting, or diarrhea,difficulty to breath or swallow along dry mouth, increased nervousness, seizures and respiratory distress .

------------------------------------------------------------------------------------------------------------------

Digoxin: It is also a high alert medication . Whenever a patient has Atrial fibrillation and atrial flutter , decreased heart rate , heart failure digoxin can be given.

Whenever you perceive that patient has digoxin toxicity , tablet digoxin should be hold. When patient has irregular heart beat, tachycardia , blurred vision digoxin may be hold. When anti arrhythmics are given , digoxin can be hold to reduce addictive bradycardia.

------------------------------------------------------------------------------------------------------------------------

Warfarin: It is a oral anticoagulant. Whenever a patient has a condition caused by blood clot like stroke , myocardial infarction, DVT , pulmonary embolism , warfarin is given . It is also given for patients who are at risk for blood clots like having prosthetic heart valve, atrial fibrillation, thrombophilia and some surgeries.

Warfarin amount is regulated by the prothrombin time and the international normalized ratio (INR). If the INR falls below 2.0, risk for formation of blood clot increases and when the INR rises above 4.0, serious bleeding risk increases. So when the INR is above 4.0 , and severe headache , dizziness , black bloody stools, heavy bleeding following any injury , appearance of red spots on skin , if the patient is taking warfarin it should be hold.

---------------------------------------------------------------------------------------------------------------------

2,Paralytic ileus: Paralysis of intestinal muscles leading to obstruction of intestine is called as paralytic ileus. Early detection parameters include abdominal distension, nausea , vomiting , and uncertain discomfort in abdomen. Physical examination involving checking bowel sounds and percussion

Peritonitis: It is the inflammation of the peritoneum , the serous membrane lining the abdominal cavity and covering the viscera. Peritonitis can happen for patients undergoing abdominal surgeries and peritoneal dialysis. Early assessment parameter includes severe pain in abdomen and pain aggravates with movement. Also fever , chills , abdominal distension helps in early detection of peritonitis.