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Nursing Process Focus: Patients Receiving Atenolol (Tenormin) Potential Nursing Diagnoses Assessment • Tissue perfusion, Risk for Ineffective Prior to administration: related to hypotension • Obtain complete health history including • Injury, Risk for related to adverse allergies, drug history and possible drug effects of medication interactions. • Assess EKG for bradydysrhthmias and heart block • Assess frequency of angina • Apical pulse, and lying and standing blood pressure Planning: Patient Goals and Expected Outcomes Patient will: • Demonstrate an understanding of risks and benefits of drug therapy. • Maintain adequate tissue perfusion • Remain free of injury related to adverse effects of medication Implementation Interventions and (Rationales) • • • • • Patient Education/Discharge Planning Monitor blood pressure both lying and • Instruct patient to change position slowly if standing (to monitor for orthostatic orthostatic hypotension occurs. hypotension). Monitor blood sugar frequently in patients • Advise patient to monitor blood sugar with diabetes mellitus. (Insulin needs may frequently until accustomed to medication. be decreased with this medication.) Observe for changes in heart rate. • Advise diabetic patients that this (Medication can mask tachycardia that medication can mask tachycardia that often occurs with hypoglycemia) accompanies hypoglycemia. Observe for changes in mood. (Decreasing • Advise patient to report any changes in sympathetic activity may cause decrease in sexual abilities or depression to health care sexual desire or ability and depression or provider. exacerbate pre-existing conditions.) Teach patient to: Monitor effects of exercise on heart rate. (This drug limits the amount of which the • Alternate periods of activity with rest heart rate increases with activity and the • Discuss effects of medication with patient will fatigue more quickly with healthcare provider if they are interfering activity.) with activity 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 Diltiazem (Cardizem) Potential Nursing Diagnoses Assessment • Tissue perfusion, Risk for Ineffective Prior to administration: related to adverse effects of medication • Obtain complete health history including • Injury, Risk for (dizziness, fainting) allergies, drug history and possible drug related to hypotension from medication interactions. • Knowledge deficient related to new • Assess blood pressure and pulse medication regime • Assess EKG for bradydysrhthmias and heart block • Assess frequency of angina Planning: Patient Goals and Expected Outcomes The patient will: • Demonstrate understanding of risks and benefits of medication • Maintain adequate tissue perfusion • Avoid physical injury related to side effects of medication Implementation Interventions and (Rationales) • Monitor neurological status (Headache may occur related to the arterial dilation effects of the drug.) • Monitor intake and output. (Patients with renal disease should not take some NSAID and should check with health care provider before taking OTC medications.) Take blood pressure in both arms and while lying standing and sitting (to monitor for orthostatic hypotension). • • Monitor patient for signs and symptoms of congestive heart failure: chronic cough, shortness of breath and weight gain as CCBs reduce contractility of the heart. Report immediately. (These symptoms can indicate pulmonary congestion. a sudden increase in weight indicates fluid retention which can result in congestive heart failure.) Patient Education/Discharge Planning Advise patient: • That his medication may cause headache • To check with health care provider prior to the use of any OTC medications to treat headache • To avoid use of NSAID during drug therapy • Instruct patient on how to monitor/record intake and output. • • Advise patient that this medication may cause dizziness therefore the patient should be careful operating heavy machinery until the patient has become accustomed to taking medication. Advise patient of signs and symptoms of heart failure (shortness of breath, weight gain, slow heart beat) and to notify health care provider if any of these occur. 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 Reteplase (Retevase) Potential Nursing Diagnoses Assessment • Tissue perfusion, Ineffective related to Prior to administration: adverse effects of medication • Obtain complete health history including • Injury, Risk for (bleeding) related to allergies, drug history and possible drug adverse effects of medication interactions • Knowledge, Deficient related to drug • Assess lab values; APTT, PT, Hgb, Hct, therapy, action, and side effects platelet count • Asses vital signs and neuro status • Assess for menses in women, recent surgery or trauma, bleeding disorders, or history of hemorrhagic stroke or GI bleeding Planning: Patient Goals and Expected Outcomes The patient will: • Demonstrate understanding of risks and benefits of drug therapy • Remain free of unusual and excessive bleeding • Maintain effective tissue perfusion Implementation Interventions and (Rationales) • • • • • • • Monitor vital signs, especially blood pressure and pulse. (Decreasing blood pressure, increase in pulse may indicate internal bleeding.) Protect patient from injury by maintaining limited mobility during drug therapy. Monitor all possible sites of bleeding during infusion Monitor neurological status for improvement if it is given for thrombotic stroke. (If status deteriorates it could indicate intracranial bleeding.) Ensure that cardiac rhythm is monitored during therapy. (Dysthrythmias may occur with reperfusion of myocardium.) Start IV lines and Foley catheter prior to beginning therapy. (This will decrease chance of bleeding from those sites.) Monitor CBC during and after therapy for indications of blood loss due to internal bleeding. (Patient has increased risk of Patient Education/Discharge Planning • Advise patient regarding need for frequent vital signs. • Inform patient that activity will be limited during infusion and pressure dressing may be needed to prevent any active bleeding. • Inform patient about assessments and why they are necessary. • Explain to patient that cardiac rhythm will be monitored during treatment. • Inform patient about procedures and why they are necessary. Instruct patient to: • Restrict activity restriction because of the possibility of increased bleeding bleeding for 2-4 days post therapy.) • Use a soft toothbrush and an electric razor. 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 Metoprolol tartrate (Lopressor) Potential Nursing Diagnoses Assessment • Tissue perfusion, Risk for Ineffective Prior to administration: related to adverse effects of medication • assess standing and lying blood pressure, • Injury, Risk for (dizziness/vertigo) EKG, apical pulse, blood glucose, CBC, related to adverse effects of medication liver and kidney function • Knowledge deficient related to • Obtain complete health history including medication therapy allergies, drug history and possible drug interactions. • Assess for presence/history of hypertension, angina, and cardiac dysrhythmias. • Obtain vital signs • Obtain EKG, observe for presence of sinus bradycardia, AV heart block, and heart failure Planning: Patient Goals and Expected Outcomes Patient will: • Demonstrate understanding of the risks and benefits of medication therapy • Maintain adequate tissue perfusion • Avoid physical injury during drug therapy Implementation Interventions and (Rationales) • Obtain apical pulse and blood pressure prior to each dose. Withhold medication if pulse is less than 60 bpm and systolic blood pressure is less than 100. • Encourage compliance with treatment regimen. (Ventricular dyrhythmias or thyroid storm may result if medication is abruptly discontinued.) • Observe for mood changes. (Depression may result from this medication.) Patient Education/Discharge Planning Instruct patient regarding: • Self monitoring of blood pressure and pulse. • Keeping a record of blood pressure and pulse. • Taking their blood pressure and pulse prior to taking medication and to withhold medication if pulse is less than 60 bpm or systolic blood pressure is less than 100 Instruct patient to: • Take medication as directed by the health care provider/ • Avoid abrupt discontinuation of medication. • Instruct patient to notify health care provider at the first signs and symptoms of depression (difficulty sleeping, weight loss, apathy, sadness). • Monitor intake and output, and observe for signs of heart failure. • Monitor patients with asthma for • respiratory distress. (Use cautiously with patients with asthma because bronchospasm may occur.) Advise diabetic patients: Monitor patients with diabetes mellitus for signs of hypoglycemia. (Patients with • To monitor blood sugar frequently. Usual diabetes mellitus may need to reduce insulin dosage may need to be reduced. insulin dosage. More frequent monitoring • Advise patient that medication may mask of blood sugar may be needed because tachycardia that accompanies medication may mask signs and hypoglycemia. symptoms of hypoglycemia.) Evaluation of Outcome Criteria • • Advise patient of early signs and symptoms of heart failure (shortness of breath, swelling of extremities, night cough) and to report immediately to a health care provide. Instruct patients to report immediately any wheezing or difficulty breathing. Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see “Planning).