Ox y t oc i nDos ageandAdmi ni s t r at i on Par ent er al dr ugpr oduc t ss houl dbei ns pec t edv i s ual l yf orpar t i c ul at emat t erand di s col or at i onpr i ort oadmi ni s t r at i on,whenev ers ol ut i onandc ont ai nerper mi t . Dos ageofOx y t oc i ni sde t er mi nedb yt heut er i n er es pons e.Thef ol l o wi n gd os age i nf or mat i oni sbas eduponv ar i ousr egi mensandi ndi c at i onsi ngener al us e. A.I nduc t i onorSt i mul at i onofLabor I nt r av enousi nf us i on( dr i pmet hod)i st heonl yac c ept abl emet hodofadmi ni s t r at i onf or t hei nduc t i onors t i mul at i onofl abor . Ac cur at ec ont r ol oft her at eofi nf us i onfl owi ses sent i al .Ani nf us i onpumporot hers uc h dev i c eandf r equentmoni t or i ngofs t r engt hofc ont r ac t i onsandf et al hear tr at ear e nec es sar yf ort hes af eadmi ni s t r at i onofOx yt oc i nf ort hei nduc t i onors t i mul at i onof l abor .I fut er i nec ont r ac t i onsbec omet oopower f ul ,t hei nf us i onc anbeabr upt l ys t opped, andox yt oc i cs t i mul at i onoft heut er i nemus cul at ur ewi l l s oonwane. 1.Ani nt r av enousi nf us i onofnonOx yt oc i nc ont ai ni ngs ol ut i ons houl dbes t ar t ed. Phy s i ol ogi cel ec t r ol y t es ol ut i ons houl dbeus ede x ceptunderunus ual c i r c ums t anc es . 2.T opr epar et heus ual s ol ut i onf ori nf us i on,1mLOx yt oc i nI nj ec t i on,10USPUni t s / mL i sc ombi nedas ept i c al l ywi t h1, 000mLofnonhy dr at i ngdi l uent( phy si ol ogi cel ec t r ol y t e s ol ut i on) .Thec ombi neds ol ut i on,r ot at edi nt hei nf us i onbot t l et oens ur et hor ough mi x i ng,c ont ai ni ng10mU/ mL.Addt hec ont ai nerwi t hdi l ut eox yt oc i csol ut i ont ot he s y s t em t hr oughus eofac ons t anti nf us i onpumporot hers uc hdev i c e,t oc ont r ol ac cur at el yt her at eofi nf us i on. 3 .Th ei n i t i a ld os es ho ul db en omor et h an1t o2mU/ mi n.t h ed os ema ybegr ad ual l y i nc r eas edi ni nc r ement sofnomor et han1t o2mU/ mi n.unt i l ac ont r ac t i onpat t er nhas beenes t abl i s hedwhi c hi ssi mi l art onor mal l abor . 4.Thef et al hear tr at e,r es t i ngut er i net one,andt hef r equenc y ,dur at i on,andt hef or c eof c ont r ac t i onss houl dbemo moni t or ed. 5.TheOx yt oc i ni nf us i ons houl dbedi s cont i nuedi mmedi at el yi nt heev entofut er i ne hy per ac t i v i t yorf et al di s t r es s.Ox y gens houl dbeadmi ni s t er edt ot hemot her .Themot her andt hef et usmu mus tbee v al uat edbyt her es pons i bl eph ys i c i an. B.Cont r ol ofPos t par t um Ut er i neBl eedi ng
1.I nt r av enousI nf us i on( Dr i pMet hod) : T oc o nt r o lp os t p ar t u mb l e ed i n g,1 0t o4 0u ni t sofOx y t o c i nma yb ea dd edt o1 , 00 0mLo f anonhy dr at i ngdi l uent( phy si ol ogi cel ec t r ol y t es ol ut i on)andr unar at enec es sar yt o c ont r ol ut er i neat ony . 2.I nt r amus cul arAdmi ni s t r at i on: 1mL( 10uni t s )ofOx yt oc i nc anbegi v enaf t ert hedel i v er yoft hepl ac ent a. C.T r eat mentofI nc ompl et eorI nev i t abl eAbor t i on I nt r av enousi nf us i onwi t hphy s i ol ogi csal i nes ol ut i on,500mL,or5% dex t r os ei n phy s i ol ogi cs al i nes ol ut i ont owhi c h10uni t sofOx y t oc i nha v ebeenaddeds houl dbe i nf us edatar at eof20t o40dr opspermi nut es . Generic Name: Methergine Brand name:Methylergonovine name:Methylergonovine Maleate Pharmacologic:ergot Pharmacologic: ergot alkaloids Availability Tablets:200 Tablets: 200 mcg (0.2 mg).Injection: mg). Injection: 200 200 mcg (0.2 mg)/ml in 1-ml ampules. Action Methylergonovine maleate(methergine) is an ergot alkaloid that stimulate smooth muscle tissue.Because the smooth muscle of the uterus is especially sensitive to this drug it is used postpartally to stimulate the uterus to contract in order to decrease !lood loss !y clamping off uterine !lood vessels and to promote the involution process ."n addition the drug has vasoconstrictive effect on all !lood vesselsespecially the larger arteries. Route,osage,!re"uency Methergine has a rapid onset of action and may !e given orally or intramuscularly. #sually IM dose: #$% mg follo$ing mg follo$ing e%pulsion of the placenta.&he dose may !e repeated every 2-' hours if necessary. #sual oral dose: #$% mg every mg every ' hours (si% doses) Maternal &ontraindications regnancyhepatic or renal disease cardiac disease hypertension or preeclampsia
contraindicate this drugs use.Methylergonovine maleate must !e used $ith caution during lactation. Maternal 'ide ())ects ypertensionnauseavomitingheadache!randycardiadi**inesstinnitusa!dominal crampspalpitationsdyspneachest pain and allergic reactions may !e noted. Nursing Im*lications
Monitor fundal height and consistency and the amount and character of the lochia.
+ssess the !lood pressure !efore and routinely throughout drug administration.
,!serve for adverse effects or symptoms of ergot to%icity(ergotism) such as nausea and vomitingheadachemuscle paincold or num! fingers and toeschest pain and general $eakness.
Patient +!amily Teaching
"nstruct patient to take medication as directed do not skip or dou!le up on missed doses. "f a dose is missed omit it and return to regular dose schedule.
+dvise patient that medication may cause menstrual-like cramps
aution patient to avoid smoking !ecause nicotine constricts !lood vessels.
"nstruct patient to notify health care professional if infection develops as this may cause increased sensitivity to the medication.
Nursing Implications Assessment & Drug Effects •
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Monitor vital signs (particularly BP) and uterine response during and after parenteral administration of methylergonovine until partum period is stabilized (about 1–2 h). otify physician if BP suddenly increases or if there are fre!uent periods of uterine rela"ation.
Patient & Family Education •
#eport severe cramping for increased bleeding.
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#eport any of the follo$ing% &old or numb 'ngers or toes nausea or vomiting chest or muscle pain. o not breast feed $hile ta*ing this drug.
Magnesium +ulfate rug +tudy &lassi'cation% ,herapeutic% mineral and electrolyte replacements-supplements. Pharmacologic% minerals-electrolytes ndications ,reatment-prevention of hypomagnesemia. ,reatment of hypertension. /nticonvulsant associated $ith severe eclampsia pre0eclampsia or acute nephritis. nlabeled uses% Preterm labor. ,reatment of ,orsade de pointes. /dunctive treatment for bronchodilation in moderate to severe acute asthma. Mechanism of /ction 3ssential for the activity of many enzymes. Plays an important role in neurotransmission and muscular e"citability. ,herapeutic 34ects% #eplacement in de'ciency states. #esolution of eclampsia.
&ontraindications-Precautions &ontraindicated in%5ypermagnesemia6 5ypocalcemia6 /nuria6 5eart bloc*6 /ctive labor or $ithin 2 hr of delivery (unless used for preterm labor). se &autiously in% /ny degree of renal insu7ciency6 igitalized patients. /dverse #eactions-+ide 34ects
&+% dro$siness. #esp% decreased respiratory rate. &8% arrhythmias bradycardia hypotension. 9% diarrhea.M+%muscle $ea*ness. erm% :ushing s$eating. Metab% hypothermia. #oute-osage ,reatment of e'ciency (e"pressed asmg of Magnesium) M 8 (/dults)% +evere de'ciency;<–12 g-day in divided doses6mild de'ciency;1 g ! =hr for > doses or 2?@ mg-*g over > hr. M 8 (&hildren A1 month)% 2?–?@ mg-*g-dose ! >–= hr for –> doses ma"imum single dose% 2 g. 8 (eonates)% 2?–?@ mg-*g-dose ! <–12 hr or 2– doses. +eizures-5ypertension M 8 (/dults)% 1 g ! = hr for > doses as needed. M 8 (&hildren)% 2@–1@@ mg-*g-dose ! >–=hr as needed may use up to 2@@ mg-*g-dose in severe cases. 3clampsia-Pre03clampsia 8 M (/dults)% >–? g by 8 infusion concurrently $ith up to ? g M in each buttoc*6 then >–? g M! > hr or > g by 8 infusion follo$ed by 1–2 g-hr continuous infusion (not to e"ceed >@ g-day or 2@ g->< hr in the presence of severe renal insu7ciency). ursing Management 1. 5ypomagnesemia-/nticonvulsant% Monitor pulse blood pressure respirations and 3&9 fre!uently throughout administration of parenteral magnesium sulfate. #espirations should be at least 1=-min before each dose. 2. Monitor neurologic status before and throughout therapy. nstitute seizure precautions. Patellar re:e" (*nee er*) should be tested before each parenteral dose of magnesium sulfate. f response is absent no additional doses should be administered until positive response is obtained. . Monitor inta*e and output ratios. rine out put should be maintained at a level of at least 1@@ ml-> hr. >. 3"plain purpose of medication to patient and family.
i r ons uppl ement ( Or al r out e, Par ent er al r out e) UsesFori r onsuppl ement I r oni sami ner al t hatt hebodyneedst opr oduc er edbl oodc el l s .Whent hebodydoes no tge tenoughi r on,i tc anno tpr oduc et henumberofn or ma lr edbl oodc el l sneededt o k eepy oui ngoodheal t h.Thi scondi t i oni scal l edi r ondefi ci enc y( i r ons hor t age)ori r on d efi c i e nc yan emi a . Al t houghman ype opl ei nt heU. S.ge te noughi r onf r om t hei rdi e t ,s omemus tt ak e addi t i onal amount st omeett hei rneeds .Fore xampl e,i r oni ss omet i mesl os twi t hs l owor s ma l l a mo un t sofb l e ed i n gi nt h ebo dyt ha ty o uwo ul dno tb ea wa r eo fa ndwhi c hca n onl ybedet ec t edbyy ourdoc t or .Yourdoc t orc andet er mi nei fy ouha v eani r on defi c i enc y ,whati sc aus i ngt hedefi c i enc y ,andi fani r ons uppl ementi snec es s ar y . Lac kofi r onma yl eadt ounus ual t i r ednes s ,s hor t nes sofbr eat h,adec r eas ei nph ys i c al per f or manc e,andl e ar ni ngpr obl emsi nc hi l dr enandadul t s ,a ndma yi nc r eas ey o ur c hanc eofget t i ngani nf ec t i on. Somecon di t i onsma yi nc r eas ey o urneedf ori r on.Thes ei nc l u de: •
Bl e ed i n gp r o bl e ms
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Bur ns
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He mo di a l y s i s
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I nt es t i nal di s eas es
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St omachpr obl ems
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St omachr emov al
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Us eofmedi c i nest oi nc r eas ey o urr edbl oodc el l c ount
I naddi t i on,i nf ant s ,es pec i al l yt hos er ec ei v i ngbr eas tmi l korl owi r onf or mul as ,may needaddi t i onal i r on.
I nc r eas ednee df ori r o ns uppl ement ss houl db edet er mi nedb yy o urh eal t hc ar e pr of es si onal . I nj ec t abl ei r oni sadmi ni s t er edonl ybyorundert hes uper v i s i onofy ourheal t hc ar e pr of es si onal .Ot herf or msofi r onar eav ai l abl ewi t houtapr es cr i pt i on;howev er ,y our heal t hc ar epr of es s i onal ma yha v es pec i al i ns t r uc t i onsont hepr operus eanddos ef or y ourc ondi t i on.
I mpor t a nc eofDi e t Forgoodheal t h,i ti si mpor t antt haty oueatabal anc edandv ar i eddi et .Fol l owc ar ef ul l y a nydi e tp r o gr am y o urh eal t hc a r epr of es s i on al ma yr e c omme nd .Fo ry o urs p ec i fi c di et ar yvi t ami nand/ ormi ner al needs ,as ky ourheal t hc ar epr of es si onal f oral i s tof appr opr i at ef oods .I fy out hi nkt haty ouar enotget t i ngenoughv i t ami nsand/ ormi ner al s i ny o urdi e t ,y o uma yc hoos et ot ak eadi e t ar ys uppl ement . I r oni sf oundi nt hedi e ti nt wof or ms —hemei r on,wh i c hi swel l abs or bed,andnonheme i r on,whi c hi spoor l yabs or bed.Thebes tdi et ar ys our c eofabs or babl e( heme)i r oni s l eanr edmeat .Chi c k en,t ur k ey ,andfi shar eal s os our c esofi r on,butt heycont ai nl es s t ha nr e dme at .Ce r ea l s ,b ea ns ,a nds o mev e ge t a bl esc on t a i np oo r l yab s or b ed ( nonheme)i r on.Foodsr i c hi nv i t ami nC( e. g. ,c i t r usf r ui t sandf r es hv eget abl es ) ,eat en wi t hs mal l amount sofhemei r onc ont ai ni ngf oods ,s uc hasmeat ,ma yi nc r eas et he a mo un to fn on he mei r o na bs o r b edf r o mc e r e al s ,b ea ns ,a ndo t h erv e g et a bl e s .So me f oods( e. g. ,mi l k ,eggs ,s pi nac h,fi ber c ont ai ni ng,c off ee,t ea)ma ydec r eas et heamount o fn on he mei r o na bs or b edf r o mf o od s.Add i t i o na li r o nma yb ea dde dt of o odf r om c ook i ngi ni r onpot s . Thedai l yamountofi r onneededi sdefi nedi ns ev er al d i ff er entwa y s . •
ForU. S. —
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Re c o mme nd edDi e t a r yAl l o wa nc e s( RDAs )a r et h ea mo un to fv i t a mi n sa ndmi n er a l s neededt opr o vi def oradequat enut r i t i oni nmos theal t h yper s ons .RDAsf oragi v ennut r i ent ma yv ar ydependi ngonaper s on' sage,s e x,andph y si c al c ondi t i on( e . g. ,pr egnanc y ) .
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Dai l yVal ues( DVs )ar eus edonf oodanddi e t ar ys uppl ementl abel st oi ndi c at et he per c entoft her ec ommendeddai l yamounto feac hnut r i entt hataser v i ngpr o v i des .DV r e pl a ce st h ep r e v i o usde s i g na t i o no fUn i t edSt a t e sRe co mme nd edDai l yAl l o wa nc es ( USRDAs ) .
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ForCanada—
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Re c omme nd edNu t r i e ntI n t a k es( RNI s )a r eus edt ode t e r mi n et h ea mo un t so fv i t a mi n s , mi ner al s ,andpr ot ei nneededt opr ov i deadequat enut r i t i onandl es s ent her i s kofc hr oni c d i s ea s e.
Nor mal dai l yr ec ommendedi nt ak e si nmi l l i gr ams( mg)f ori r onar egener al l ydefi nedas f ol l o ws( No t et hatt heRDAan dRNIar ee x pr es s edasanac t ua lamountofi r on,whi c hi s r ef er r edt oas“ el ement al ” ' i r on.Thepr oduc tf or m[ e. g. ,f er r ousf umar at e,f er r ous gl uc onat e,f er r ouss ul f at e]hasadi ffer ents t r engt h) : Per s ons
U. S.
Cana da
( mg)
( mg)
I nf ant sbi r t ht o3y ear sofage
6–10
0. 3–6
Chi l dr en4t o6y ear sofage
10
8
Chi l dr en7t o10y ear sofage
10
8–10
Adol es c entandadul tmal es
10
8–10
Adol es c entandadul tf emal es
10–15
8–13
Pr egnantf emal es
30
17–22
Br eas t f eedi ngf emal es
15
8–13
Bef or eUsi ngi r onsuppl ement I fy ouar et ak i ngadi et ar ysuppl ementwi t houtapr es cr i pt i on,c ar ef ul l yr eadandf ol l ow an ypr ec aut i onsont hel abel .Fort hes es uppl ement s ,t hef ol l owi ngs houl dbe c ons i der ed: Al l er gi es
T el l y ourdoc t ori fy ouhav eev erhadanyunus ual oral l er gi cr eac t i ont omedi c i nesi nt hi s gr ouporanyot hermedi c i nes .Al s ot el l y ourheal t hc ar epr of es si onal i fy ouhav eany ot hert y pesofal l er gi es ,s uc hast of oodsdy es ,pr es er v at i v es ,orani mal s .Fornonpr es cr i pt i onpr oduc t s ,r eadt hel abel orpac kagei ngr edi ent sc ar ef ul l y .
Pedi at r i c
Pr obl emsi nc hi l dr enha v eno tbeenr epor t edwi t hi nt ak eofnor mal dai l yr ec ommende d amount s .I r ons uppl ement s ,whenpr es c r i bedbyy ourheal t hc ar epr of es s i onal ,ar enot ex pec t edt oc aus edi ffer ents i deeffec t si nc hi l dr ent hant heydoi nadul t s .Howev er ,i ti s i mpor t antt of ol l owt hedi r ec t i onsc ar ef ul l y ,s i nc ei r onov er dos ei nc hi l dr eni ses pec i al l y d an ge r o us . St udi esons odi um f er r i cgl uc onat eha v es hownt hatt hi ss uppl ementi ss af et ous ei n c hi l dr enages6t o15y ear s .Thes af et yofs odi um f er r i cgl uc onat ehasnotbeen det er mi nedi npat i ent swhoar ey oungert han6y e ar sofage. Ger i at r i c
Pr obl emsi nol deradul t sha v enotbeenr epor t edwi t hi nt ak eofnor mal dai l y r e c omme nd eda mo un t s .El d er l ype op l es o me t i me sd on ota bs o r bi r o na se as i l yas y o ungeradul t sandma yneedal ar gerdos e.I fy o ut hi nky oune edt ot ak eani r on s uppl ement ,c hec kwi t hy ourheal t hc ar epr of es si onal fi r s t .Onl yy ourheal t hc ar e p r o f e s si on al c a nd ec i d ei fy o un eedani r o ns u ppl e me nta ndho w mu chy ous h ou l dt a k e. Pregnancy
I ti ses pec i al l yi mpor t antt haty ouar er ec ei v i ngenoughv i t ami nsandmi ner al swheny ou bec omepr eg nantandt haty o uc ont i n uet or ec ei v et her i ghta mountofv i t ami nsand mi ner al st hr oughouty ourpr egnanc y . Hea l t h yf e t al gr o wt ha ndde v el opmentd epe ndona s t eadys uppl yofnut r i ent sf r om mot hert of et us .Dur i ngt hefi r s t3mont hsofpr egnanc y , apr operdi etus ual l ypr ov i desenoughi r on.Howev er ,dur i ngt hel as t6mont hs ,i nor der t ome ett h ei n cr e as e dn ee dsoft h ed ev e l o pi ngba by ,a ni r o ns u pp l eme ntma ybe r e c omme nde db yy ou rhe al t hc ar ep r o f es s i o na l . Ho wev e r ,t ak i ngl ar geamount so fadi e t ar ys up pl ementi npr egnanc yma ybehar mf u lt o t hemo t herand/ orf e t usa nds houl dbeav oi ded. Br eastFeedi ng
I ti ses pec i al l yi mpor t antt haty our ec ei v et her i ghtamount sofv i t ami nsandmi ner al ss o t haty ourbabywi l l al s ogett hev i t ami nsandmi ner al sneededt ogr owpr oper l y .I r on nor mal l yi spr es enti nbr eas tmi l ki ns mal l amount s .Whenpr es c r i bedbyaheal t hc ar e
pr of es si onal ,i r onpr epar at i onsar enotk nownt oc aus epr obl emsdur i ngbr eas t f eedi ng. Howev er ,nur s i ngmot her sar eadv i s edt oc hec kwi t ht hei rheal t hc ar epr of es s i onal bef or et ak i ngi r ons uppl ement soran yot hermedi c at i on.T ak i ngl ar geamount sofa di et ar ys uppl ementwhi l ebr eas t f eedi ngma ybehar mf ul t ot hemot herand/ ori nf antand s h ou l dbeav o i de d. I nt e r a ct i onswi t hMe di c i ne s
Al t houghc er t ai nmedi c i nesshoul dnotbeus edt oget heratal l ,i not herc as est wo di ff er entmedi c i nesmaybeus edt oget herev eni fani nt er ac t i onmi ghtoc c ur .I nt hes e c a se s ,y o urd oc t o rma ywa ntt oc h an get h edo s e,o ro t he rp r e c au t i o nsma ybe nec es s ar y .Wheny ouar et ak i ngan yoft hes edi et ar ysuppl ement s ,i ti ses pec i al l y i mpor t antt haty ourheal t hc ar epr of es si onal k nowi fy ouar et ak i nganyoft hemedi c i nes l i s t edbel ow.Thef ol l owi ngi nt er ac t i onshav ebeens el ec t edont hebas i soft hei rpot ent i al s i gni fi canc eandar enotnec es sar i l yal l i nc l us i v e. Us i ngdi et ar ysuppl ement si nt hi scl as swi t hanyoft hef ol l owi ngmedi c i nesi sus ual l ynot r e c omme nde d,b utma yber e qu i r edi ns o mec a s es .I fb ot hme di c i ne sar ep r es c r i b ed t og et her ,y o urd oc t o rma yc h an get h ed os eo rh owof t e ny o uus eon eo rbo t hoft h e med i c i n es . •
Al t r et ami ne
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Amy g da l i n
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Dabr af eni b
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Da s a bu v i r
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De f e r o x a mi n e
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Di go xi n
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El t r o mb op ag
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El v i t egr av i r
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Ke t o co na zo l e
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Ledi pas v i r
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Par i t apr ev i r
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Pa z o pa ni b
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Phen y t oi n
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Ri l pi v i r i ne
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Vi s mo de gi b
I nt e r a ct i onswi t hFood/ T oba cc o/ Al c ohol
Cer t ai nmedi c i ness houl dnotbeus edatorar oundt het i meofeat i ngf oodoreat i ng c er t ai nt y pesoff oods i nc ei nt er ac t i onsmayoc cur .Us i ngal c ohol ort obac cowi t hc er t ai n medi c i nesma yal s oc aus ei nt er ac t i onst ooc c ur .Di s c us swi t hy ourheal t hc ar e pr of es si onal t heus eofy ourmedi c i newi t hf ood,al c ohol ,ort obac co. Ot herMedi calPr obl ems
Th epr e s enc eofo t h ermed i c a lpr o bl e msma ya ffe ctt h eus eo fd i e t ar ys upp l e me nt si n t hi sc l as s.Mak es ur ey out el l y ourdoc t ori fy ouhav eanyot hermedi c al pr obl ems , es pec i al l y : •
Al c ohol abus e( orhi s t or yof )or
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Bl oodt r ans f us i ons( wi t hhi ghr edbl oodc el l i r onc ont ent )or
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Ki dneyi nf ec t i onor
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Li v erdi s eas eor
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Po r p hy r i ac u t a neo ust a r d a—Hi g he rb l oo dl e v el soft h ei r o ns up pl e me ntma yo cc u r ,wh i c h ma yi n cr e as et h ec ha nc eofs i d ee ffe ct s .
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Ar t hr i t i s( r heumat oi d)o r
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As t hmaoral l er gi esor
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Hea r td i s ea se —Th ei nj e c t e df o r mo fi r o nma yma k et h es ec on di t i o nswor s e.
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Col i t i soro t heri nt es t i nal pr obl emsor
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I r onov er l oadcondi t i ons( e. g. ,hemoc hr omat os i s ,hemos i der os i s ,hemogl obi nopat hi es ) or
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St o ma c hu l c e r —I r o ns u p pl e me nt sma yma k et h es ec on di t i o nswo r s e .
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Ot h era ne mi a s —I r o ns u pp l e me nt sma yi n c r ea s ei r o nt ot o x i cl e v el si na ne mi a sn ot as s oc i at edwi t hi r ondefi c i enc y .
Pr operUseofi r onsuppl ement Af t ery ous t ar tus i ngt hi sdi et ar ysuppl ement ,c ont i nuet or et ur nt oy ourheal t hc ar e pr of es s i onal t os eei fy ouar ebenefi t i ngf r om t hei r on.Somebl oodt es t smaybe nec es sar yf ort hi s . I r oni sbes tabs or bedwhent ak enonanempt ys t omac h,wi t hwat erorf r ui tj ui c e( adul t s : f ul l gl as sor8ounc es ;c hi l dr en:½ gl as sor4ounc es ) ,about1hourbef or eor2hour s af t ermeal s .Howev er ,t ol es sent hepos si bi l i t yofs t omac hups et ,i r onmaybet ak enwi t h f oodori mmedi at el yaf t ermeal s . Fors af ea ndeff ec t i v eus eofi r ons upp l ement s : •
Fol l owy ourheal t hc ar epr of es si onal ' si ns t r uc t i onsi ft hi sdi et ar ys uppl ementwas pr es c r i bed.
•
Fol l owt hemanuf ac t ur er ' spac kagedi r ec t i onsi fy ouar et r eat i ngy our s el f .I fy out hi nky ou s t i l l needi r onaf t ert ak i ngi tf or1or2mont hs ,c hec kwi t hy ourheal t hc ar epr of es si onal .
Li qu i df or msofi r ons up pl ement t endt os t ai nt het eet h.T opr ev ent ,r educ e,orr emov e t hes es t ai ns : •
Mi xeac hdos ei nwat er ,f r ui tj ui c e,ort omat oj ui c e.Youma yus eadr i nk i ngt ubeors t r aw t ohel pk eept hei r ons uppl ementf r om ge t t i ngont het eet h.
•
Wh endo se sofl i qu i di r o ns u pp l e me nta r et obegi v e nb ydr o pp er ,t h ed os ema ybe pl ac edwel l bac ko nt het ongueandf ol l o wedwi t hwat erorj ui c e.
•
I r onst ai nsont ee t hcanus ual l yber emo v edbybr us hi ngwi t hbak i ngsoda( s odi um bi c ar bonat e)ormedi c i nal per o x i de( h y dr ogenper o xi de3%) .
Dosi ng
Thedos emedi c i nesi nt hi scl as swi l l bedi ffer entf ordi ffer entpat i ent s .Fol l owy our doc t or ' sor der sort hedi r ec t i onsont hel abel .Thef ol l owi ngi nf or mat i oni nc l udesonl yt he av er agedos esoft hes emedi c i nes .I fy ourdos ei sdi ff er ent ,donotc hangei tunl es sy our doc t ort el l sy out odos o. Theamou ntofmedi c i net haty o ut ak edependsont hes t r engt hoft hemedi c i ne.Al s o, t hen umbe ro fd os esy o ut a k ee ac hd ay ,t h et i mea l l o we db et we end os es ,a ndt h el e ngt h
o ft i mey o ut a k et h eme di c i n ed ep endo nt h eme di c a lpr ob l e mf o rwh i c hy o ua r eu s i n g t heme di c i ne. Foror al dos agef or ms( c aps ul es ,t abl et s ,or al s ol ut i on) :
•
T opr e v en td efi c i e nc y , t h ea mo un tt ak e nb ymo ut hi sba se do nn or ma ld ai l y
o
r ecommendedi nt akes:
Fo rt h eU. S.
o
Ad ul ta ndt e en ag ema l e s —1 0mi l l i g r a ms( mg )p erd a y .
o
Adul tandt eenagef emal es—10t o15mgperday .
o
Pr egnantf emal es—30mgperday .
o
Br e as t f e ed i n gf e ma l e s —1 5mgp erd a y .
o
Ch i l d r e n7t o10y e ar so fa ge —1 0mgpe rd a y .
o
Ch i l d r e n4t o6y e a r so fa ge —1 0mgpe rd a y .
o
Chi l dr e nb i r t ht o3y e ar so fa ge —6t o10mgpe rd ay .
o
ForCanada
o
Adul tandt eenagemal es—8t o10mgperday .
o
Ad ul ta ndt e en ag ef e ma l e s —8t o1 3mgp erd a y .
o
Pr egnantf emal es—17t o22mgperday .
o
Br e as t f e ed i n gf e ma l e s —8t o13mgpe rd ay .
o
Ch i l d r e n7t o10y e ar so fa ge —8t o10mgpe rd a y .
o
Ch i l d r e n4t o6y e a r so fa ge —8mgpe rd a y .
o
Chi l dr e nb i r t ht o3y e ar sofa ge —0 . 3t o6mgp erd ay .
2 T ot r eatdefi c i enc y :
Ad ul t s ,t e en ag er s ,a ndc h i l d r e n— Th ed os ewi l l b ede t e r mi n edb yy o ur
o
doc t or ,bas edonyourc ondi t i on. ri nj ec t i ondos agef or ms : 2 Fo 1 Ad ul t s ,t e en ag er s ,a ndc hi l d r e n— Th ed os ewi l l b ede t e r mi n edb yy o urd oc t o r ,b as edo n
y ourc ondi t i on.
Mi ss edDose
I fy oumi s sad os eofi r ons uppl ement ,s k i pt hemi s s eddos eandgobac kt oy ourr egul ar d os i n gs c he du l e .Dono td ou bl edos e s . St or age
Keepoutoft her eac hofc hi l dr en. St or et hemedi c i nei nac l os edc ont ai n eratr oom t emper at ur e,a wa yf r om heat , moi s t ur e,anddi r ec tl i ght .Keepf r om f r eez i ng. Don otk e e po ut d at e dme di c i n eo rme di c i n en ol o ng ern ee de d.
Pr ecaut i onsWhi l eUsi ngi r onsuppl ement Wheni r oni scombi nedwi t hc er t ai nf oodsi tmayl os emuc hofi t sv al ue.I fy ouar et ak i ng i r on,t hef ol l owi ngf oodsshoul dbeav oi ded,oronl yt ak eni nv er ysmal l amount s ,f orat l eas t1hourbef or eor2hour saf t ery out ak ei r on: •
Cheeseandyogur t
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Eggs
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Mi l k
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Sp i n ac h
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T e ao rc o ff ee
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Wh ol e g r a i nbr e ad san dc e r e al sa ndbr a n
Dono tt ak ei r ons uppl ement sanda nt ac i dsorc al c i um s upp l ement satt hes amet i me.I t i sbes tt os pac edos esoft hes e2pr oduc t s1t o2hour sapar t ,t ogett hef ul l benefi tf r om eac hme di c i neordi e t ar ys uppl ement . t houtapr es cr i pt i on: I fy ouar et ak i ngi r ons uppl ement swi •
Dono tt ak ei r ons uppl ement sbymout hi fy ouar er ec ei v i ngi r oni nj ec t i ons .T odos oma y r es ul ti ni r onpoi s oni ng.
•
Dono tr egul ar l yt ak el ar geamount sofi r onf orl ongert han6mont hswi t houtc hec k i ng wi t hy ourheal t hc ar epr of es si onal .Peopl edi fferi nt hei rneedf ori r on,andt hos ewi t hc er t ai n medi c al c ondi t i onsc angr adual l ybec omepoi s onedbyt ak i ngt oomuc hi r onov eraper i odof t i me.Al s o,unabs or bedi r oncanmas kt hepr es enc eofbl oodi nt hes t ool ,whi c hma ydel a y di s cov er yofas er i ouscondi t i on.
I fy ouhav ebeent ak i ngal ongac t i ngorc oat edi r ont abl etandy ours t ool s havenot bec omebl ac k ,c hec kwi t hy ourheal t hc ar epr of es s i onal .Thet abl et sma ynot b eb r e ak i n gdo wnp r op er l yi ny o urs t o ma c h,a ndy o uma yno tb er ec e i v i nge no ug hi r o n. I ti si mpor t antt ok eepi r onpr epar at i onsoutoft her eac hofc hi l dr en.Keepa1ounc e y r u p bot t l eofs ofi pec acav ai l abl eathomet obet ak eni nc as eofani r onov er dos e emer genc ywhenadoc t or ,poi s onc ont r ol c ent er ,o re mer genc yr oom or d er si t sus e. I fy out hi nky ouoran y oneel s ehast ak enanov er dos eofi r onmedi c i ne : •
Cal l y ourdoc t or ,apoi s onc ont r ol c ent er ,ort henear es thos pi t al emer genc yr oom at o nc e .Al wa y sk ee pt h es ep ho nenu mb er sr e adi l ya v ai l a bl e .
•
Fol l owan yi ns t r uc t i onsgi v ent oy ou.I fs y r upofi pec achasbeenor der edandgi v en,do no tdel a ygoi ngt ot heemer genc yr oom whi l ewai t i ngf ort hei pec acs y r upt oemp t yt he s t omac h,s i nc ei tma yr equi r e20t o30mi nut est os ho wr es ul t s
•
Got ot h ee me r g en c yr o om wi t h ou td el a y
•
T ak et hec ont ai nerofi r onwi t hy ou.
Ear l ys i gnsofi r ono v er dos ema ynotappearf orupt o60mi nut esormor e.Dono td el a y goi ngt ot heemer genc yr oom whi l ewai t i ngf ors i gnst oappear .
i r onsuppl ementSi deEffect s Al o ngwi t hi t sn ee de de ff ec t s ,ame di c i n ema yc au s es o meu nwa nt e de ffe c t s .Al t h ou gh notal l oft hes es i deeff ec t smayoc c ur ,i ft heydooc c urt he yma yneedmedi c al at t ent i on. Chec kwi t hy ourdoc t orassoonaspos s i bl ei fan yoft hef ol l owi ngs i deeff ec t soc c ur : Mor ec ommon-wi t hi nj ec t i ononl y •
Bac k ac he,gr oi n,s i de,ormus c l epai n
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c hes tpai n
•
c hi l l s
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di z zi nes s
•
f ai nt i ng
•
f as thear t beat
•
f ev erwi t hi nc r eas eds weat i ng
•
fl us hi ng
•
headache
•
met al l i ct as t e
•
n au se ao rv o mi t i ng
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numbnes s ,pai n,ort i ngl i ngofhandsorf ee t
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pai norr ednes sati nj ec t i ons i t e
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r ednes sofs k i n
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s ki nr as horhi v es
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s wel l i ngofmout hort hr oat
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t r oubl edbr eat hi ng
Mor ec ommon-wh ent a k e nb ymo ut ho nl y •
Ab do mi n al o rs t o ma c hpa i n
•
c r ampi ng( c ont i nui ng)o rs or enes s
L e s sc o mmo no rr a r e-wi t hi nj ec t i ononl y •
Doubl ev i s i on
•
gener al unwel l f eel i ng
•
weak nes swi t houtf eel i ngdi z z yorf ai nt
L e s sc o mmo no rr a r e-wh ent a k e nb ymo ut hon l y •
Ches tort hr oatpai n,es pec i al l ywhens wal l owi ng
•
s t ool swi t hs i gnsofbl ood( r edorbl ac kc ol or )
Ea r l ys y mp t o msofi r o no v er d os e
Sy mp t o msofi r o no v er d os ema yno to c c urf oru pt o6 0mi n ut e so rmor ea f t e rt h e o v e r d os ewa st a k en .Byt h i st i mey o us h ou l dh av eha de me r g en c yr o om t r e at me nt .Do no tde l a ygoi ngt oemer genc yr oom whi l ewai t i ngf ors i gnst oa ppear . •
Di a r r h ea( ma yc o nt a i nb l o od )
•
f e v e r
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nausea
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s t o ma c hp ai no rc r a mp i n g( s h ar p )
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v omi t i ng,s ev er e( ma yc on t ai nbl ood)
L at es y mp t o mso fi r o no v er d os e •
Bl ui s hc ol or edl i ps ,fi nger nai l s ,andpal msofhands
•
c onv ul s i ons( s ei z ur es )
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p al e ,c l a mmys k i n
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s hal l owandr api dbr eat hi ng
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u nu su al t i r e dn es so rwe ak ne ss
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we aka ndf a s th ea r t b ea t
Somesi deeff ec t sma yoc c urt hatus ual l yd ono tneedme di c al at t ent i on.Thes esi de eff ec t sma ygoa wa ydur i ngt r eat mentasy ourbodyadj us t st ot hemedi c i ne.Al s o,y our heal t hc ar epr of es s i ona lma ybeabl et ot el l y o uab outwa y st opr e v entorr educ es ome oft hes es i deeffec t s .Chec kwi t hy ourheal t hc ar epr of es si onal i fanyoft hef ol l owi ng s i d eeff ec t sc ont i nueorar ebo t her s omeori fy o uha v ean yques t i onsaboutt hem: Mor ec ommon •
Cons t i pat i on
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di ar r hea
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l e gc r a mp s
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nausea
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v omi t i ng
Le s sc ommon
St o ol sc o mmo nl yb ec omedar kg r e enorb l a ckwh eni r o np r e par at i o nsa r et a k enby mout h.Thi si sc aus edb yunabs or bedi r onandi shar ml es s .Ho we v er ,i nr ar ec as es , bl ac kst ool sofas t i c k yc ons i s t enc yma yoc c ural ongwi t hot hers i deeff ec t ss uc hasr ed s t r eak si nt hes t ool ,c r ampi ng,s or enes s ,ors har ppai nsi nt hes t omac horabdomi nal ar ea.Chec kwi t hy ourheal t hc ar epr of es s i onal i mmedi at el yi ft hes es i deeff ec t sappear . I fy ouhav ebeenr ec ei v i ngi nj ec t i onsofi r on,y oumaynot i c eabr owndi s col or at i onof y ours k i n.Thi sc ol orus ual l yf adeswi t hi ns ev er al week sormont hs . •
Dar k e ne dur i n e
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h e a r t b u r n
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s t ai nedt eet h
Ot hers i deeffec t snotl i s t edmayal s ooc curi ns omepat i ent s .I fy ounot i c eanyot her effec t s ,c hec kwi t hy ourheal t hc ar epr of es s i onal . Cal l y ourdoc t orf ormedi c al adv i c eabouts i deeff ec t s .Youma yr epor ts i deeff ec t st ot he FDAat1800FDA1088.
Administration Oral
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9ive on an empty stomach if possible because oral iron preparations are best absorbed then (i.e. bet$een meals). Minimize gastric distress if needed by giving $ith or immediately after meals $ith ade!uate li!uid.
•
o not crush tablet or empty contents of capsule $hen administering.
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o not give tablets or capsules $ithin 1 h of bedtime.
•
•
&onsult physician about prescribing a li!uid formulation or a less corrosive form such as ferrous gluconate if the patient e"periences di7culty in s$allo$ing tablet or capsule. ilute li!uid preparations $ell and give through a stra$ or placed on the bac* of tongue $ith a dropper to prevent staining of teeth and to mas* taste. nstruct the patient to rinse mouth $ith clear $ater immediately after ingestion.
•
•
•
Mi" ferosol eli"ir $ith $ater6 not compatible $ith mil* or fruit uice. Cer0n0+ol (drops) may be given in $ater or in fruit or vegetable uice according to manufacturer. o not use discolored tablets. +tore in tightly closed containers and protect from moisture. +tore at 1?D–@D & (?ED–<=D C).
Adverse Efects ( 1%) GI: Nausea, heartburn, anore"ia constipation, diarrhea epigastric pain abdominal distress black stools. Special Senses: Fello$0bro$n discoloration of eyes and teeth (li!uid forms.) Large Chronic Doses in Inants #ic*ets (due to interference $ith phosphorus absorption). !assive Overdosage Gethargy dro$siness nausea vomiting abdominal pain diarrhea local corrosion of stomach and small intestines pallor or cyanosis metabolic acidosis shoc* cardiovascular collapse convulsions liver necrosis coma renal failure death.
Diagnostic "est Intererence By coloring feces black, large iron doses ma y cause false-positive tests for occult blood with orthotoluidine (Hematest, Occultist, Labstix); guaiac reagent benzidine test is reportedly not affected.
Interactions Drug: /,/&+ decrease iron absorption6 iron decreases absorption of ,3,#/&F&G3+ cipro#o$acin o#o$acin& chloramphenicol may delay ironHs e4ects6 iron may decrease absorption of penicillamine' Food: Cood decreases absorption of iron6 ascoric acid (vitamin C) may increase iron absorption.
harmaco*inetics Absorption: ?–1@I absorbed in healthy individuals6 1@–@I absorbed in iron0 de'ciency6 food decreases amount absorbed. Distribution: ,ransported by transferrin to bone marro$ $here it is incorporated into hemoglobin6 crosses placenta. Elimination: Most of iron released from hemoglobin is reused in body6 small amounts are lost in des!uamation of s*in 9 mucosa nails and hair6 12–@ mg-mo lost through menstruation.
Nursing Implications Assessment & Drug Effects
•
•
•
Gab tests% Monitor 5gb and reticulocyte values during therapy. nvestigate the absence of satisfactory response after $* of drug treatment. &ontinue iron therapy for 2– mo after the hemoglobin level has returned to normal (roughly t$ice the period re!uired to normalize hemoglobin concentration). Monitor bo$el movements as constipation is a common adverse e4ect.
Patient & Family Education •
•
•
•
•
ote% /scorbic acid increases absorption of iron. &onsuming citrus fruit or tomato uice $ith iron preparation (e"cept the eli"ir) may increase its absorption. Be a$are that mil* eggs or ca4eine beverages $hen ta*en $ith the iron preparation may inhibit absorption. Be a$are that iron preparations cause dar* green or blac* stools. #eport constipation or diarrhea to physician6 symptoms may be relieved by adustments in dosage or diet or by change to another iron preparation. o not breast feed $hile ta*ing this drug $ithout consulting physician.
Blood Trans)usion is commonly !eing ordered to patients $ho lost a great deal of !lood due to a disease condition or an accident. "t can also !e ordered !y the physician if the patient is to undergo an operation that $ould involve considera!le !lood loss. &he follo$ing is a step-!y-step checklist of things to do and other responsi!ilities to ensure proper !lood transfusion and prevent any un$anted reactions and errors. 1. erify the physicians $ritten order and make a treatment card according to hospital policy 2. ,!serve the 10 s $hen preparing and administering any !lood or !lood components . 3%plain the procedure/rationale for giving !lood transfusion to reassure patient and significant others and secure consent. 4et patient histories regarding previous transfusion. '. 3%plain the importance of the !enefits on oluntary Blood 5onation (+ 66178ational Blood 9ervice +ct of 177').
:. e;uest prescri!ed !lood/!lood components from !lood !ank to include !lood typing and cross matching and !lood result of transmissi!le 5isease. <. #sing a clean lined tray get compati!le !lood from hospital !lood !ank. 6. =rap !lood !ag $ith clean to$el and keep it at room temperature. >. ave a doctor and a nurse assess patients condition. ountercheck the compati!le !lood to !e transfused against the crossmatching sheet noting the +B, grouping and serial num!er of each !lood unit and e%piry date $ith the !lood !ag la!el and other la!oratory !lood e%ams as re;uired !efore transfusion. 7. 4et the !aseline vital signs- B and &emperature !efore transfusion. efer to M5 accordingly. 10.4ive pre-meds 0 minutes !efore transfusion as prescri!ed. 11.5o hand hygiene !efore and after the procedure 12.repare e;uipment needed for B& (" in?ection tray compati!le B& set " catheter/ needle 4 17/17 plaster torni;uet !lood !lood components to !e transfused lain 899 :00cc " set needle gauge 1> (only if needed) " hook gloves sterile 2@2 gau*e or transplant dressing etc. 1."f main "f is $ith de%trose :A initiate an " l ine $ith appropriate " catheter $ith lain 899 on another site anchor catheter properly and regulate " drops. 1'.,pen compati!le !lood set aseptically and close the roller clamp. 9pike !lood !ag carefully fill the drip cham!er at least half full prime tu!ing and remove air !u!!les (if any). #se needle g.1> or 17 for side drip (for adults) or g.22 for pedia (if !lood is given to the -in?ection port the gauge of the needle is disregarded). 1:.5isinfect the -in?ection port of " tu!ing (lain 899) and insert the needle from B& administration ser and secure $ith adhesive tape. 1<.lose the roller clamp of " fluid of lain 899 and regulate to C, $hile transfusion is going on. 16.&ransfuse the !lood via the in?ection port and regulate at 10-1:gtts/min initially for the first 1: minutes of transfusion and refer immediately to the M5 for any adverse reaction. 1>.,!serve/+ssess patient on an on-going !asis for any unto$ard signs and symptoms such as flushed skin chills elevated temperature itchiness urticaria and dyspnea. "f any of these symptoms occur stop the transfusion
open the " line $ith lain 899 and regulate accordingly and report to the doctor immediately. 17.9$irl the !ag gently from time to time to mi% the solid $ith the plasma 8.B one B.& set should !e used for 1-2 units of !lood. 20.=hen !lood is consumed close the roller clamp of B& and disconnect from " lines then regulate the "D of plain 899 as prescri!ed. 21.ontinue to o!serve and monitor patient post transfusion for delayed reaction could still occur. 22.e-check g! and ct !leeding time serial platelet count $ithin specified hours as prescri!ed and/or per institutions policy. 2.5iscard !lood !ag and B& set and sharps according to ealth are =aste Management (5,/538). 2'.Dill-out adverse reaction sheet as per institutional policy. 2:.emind the doctor a!out the administration of alcium 4luconate if patient has several units of !lood transfusion (-: more units of !lood).
Blood administration •
•
Patient preparation
•
Pretransfusion check
•
Blood Transfusion Record
•
Transfusion Tag
•
Care and monitoring of transfused patients
•
BLOOD PRODUCT ADMII!TRATIO "PD#$ poster
•
PLAT%L%T ADMII!TRATIO "PD#$ Posters
ursing Competence It is recommended that all nurses at RC& pro'iding care to children recei'ing (lood transfusions ha'e completed the (lood transfusion competenc) package* +ou can access the package through )our ursing Competence ,ork(ook*
Patient Preparation The patient should (e read) for transfusion prior to picking up (lood from the (lood (ank* eg appropriate I- access. ,ritten order for transfusion* #or an) non/emergenc) transfusion the patient0parents should ha'e had the (enefits0risks of transfusion discussed and an opportunit) to ha'e an) 1uestions ans,ered* Consent for transfusion should then (e documeted in the medical record* #or further information and for parent and patient information packs see2 Consent and Consumer Information 3uideline
Pretransfusion check +ae transusion re,uires a -nal patient identit. chec* at the patient edside eore lood administration' "his is vital to ensure the right lood is given to the right patient'
The pretransfusion check must (e completed (efore commencing transfusion () t,o clinical staff. one of ,hom must then spike and connect the product* The staff mem(ers signing the (lood transfusion record are indicating that the check has (een completed prior to transfusion. and that no discrepanc) ,as identified* The follo,ing checks are carried out at the (edside to ensure the right patient recei'es the right (lood product2 4*
Check (lood product for an) signs of leakage. clumps or a(normal colour*
5*
Patient identification* Check name. DOB and UR on the Blood Transfusion Record and pack tag0la(el* Check name. DOB 6 UR on the patient7s ,rist(and* Are the) identical8
9*
Blood product identification* Check the pack num(er on the Blood Transfusion Record. pack tag0la(el and the product* Are the) identical8
:*
Blood 3roup* Check the (lood group "ABO and RhD$ of the product on the Blood Transfusion Record "this form reports compati(ilit)$. pack tag0la(el and the product* Do the) match8
;*
Check e
=*
Check medical orders re product t)pe. special re1uirements "eg irradiation. leucoc)te depletion$ and administration re1uirements "eg 'olume. rate$*
>*
Complete documentation2 sign. date. time the Blood Transfusion Record and file in the patient7s medical record*
IMP!"A#" If there is an) discrepanc) (et,een the (lood product. patient details 6 pack tag0la(el or if )ou are concerned a(out the appearance of the product D #" "!A#SF$SE* Report to Blood Bank immediatel)2 RC& ?n ;@5. R& ?n 5;;*
Blood "ransfusion !ecord A Blood Transfusion Record "MR054$ accompanies the release of fresh (lood products*
"he /lood "ransusion 0ecord is a legal document and must e -led in the patient medical record at the completion o transusion' "he record must e availale or at least 2 .ears'
"ransfusion "ag A tag is attached to each (lood product*
%are and monitoring of transfused patients Patients receiving transfusion should be monitored for symptoms/signs of potential complications of transfusion.
"he !o&al 'omen(s )ospital #re1uenc) of 'ital signs2 Adults / temperature. pulse. respirator) rate and (lood pressure should (e measured and recorded2
•
(efore the start of each pack of (lood or ( lood product
•
at 4; minutes after commencement
•
hourl) during transfusion
•
at the completion of each pack
#eonates / temperature. heart rate and respirator) rate should (e measured and recorded2 •
(efore the start of each pack of (lood or ( lood product
•
hourl) during transfusion
•
at the completion of each pack
ote that more fre1uent 'ital signs should (e taken if the patient has an unsta(le underl)ing condition or it the patient (ecomes un,ell or sho,s signs of a transfusion reaction* Patients should (e o(ser'ed during the first 4; minutes of transfusion as some life/threatening reactions ma) occur after the infusion of onl) a small amount of (lood* here possi(le. patients should (e informed of possi(le s)mptoms of a transfusion reaction and should inform staff immediatel) if the) feel un,ell during transfusion*
!o&al %hildren(s )ospital -ital signs "temperature. pulse. respirations. (lood pressure. o<)gen saturations and site o(ser'ations$ should (e measured and recorded •
(efore the start of each pack of fresh (lood product
•
at 4; minutes after commencement of each pack
•
hourl) until conclusion
•
at the completion of transfusion
This is a minimum re1uirement* !ome clinical areas ma) re1uire more fre1uent o(ser'ations particularl) in unsta(le or unconscious patients* Patients should (e o(ser'ed during the first 4; minutes of transfusion as some life/threatening reactions ma) occur after the infusion of onl) a small amount of (lood* here possi(le. patients should (e informed of possi(le s)mptoms of a transfusion reaction and should inform staff immediatel) if the) feel un,ell during transfusion*
Preterm la(or is defined as uterine contractions occurring after 5 ,eeks of gestation and (efore 9> completed ,eeks of gestation* Risk factors include multiple gestation, history of previous preterm labor of
delivery, abdominal surgery during current pregnancy, uterine anomaly, history of cone biopsy, maternal age younger than 20 or older than age 35. CLIICAL MAI#%!TATIO!
1.
Go$ bac* pain
2.
+uprapubic pressure
.
8aginal presure
>.
#hythmic uterine contrations
?.
&ervical dilation and e4acement
=.
Possible rupture of membranes
J.
3"pulsion of the cervical mucus plug
<.
Bloody sho$
UR!I3 MAA3%M%T
1.
/ssess the motherKs condition and evaluate0signs of labor.
Lbtain a thorough obstetric history
Lbtain specimens for complete blood count and urinalysis
etermine fre!uency duration and intensity of uterine contractions
etermine cervical dilation and e4acement
/ssess status of membranes and bloody sho$
2 3valuate the fetus for distress size and maturity (sonography and lecithin0sphingomyelin ratio) Perform measures to manage or stop preterm labor
Place the client on bed rest in the side0lying position
Prepare for possible ultrasonography amniocentesis tocolytic drug therapy and steroid theraphy
/dminister tocolytic (contraction0inhibiting) medications as prescribed.
/ssess for side e4ects of tocolytic therapy (eg decreased maternal blood pressure dyspnea chest pain and C5# e"ceeding 1<@ beats-min)
> Provide physical and emotional support. Provide ade!uate hydration ? Provide client and family education