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DOSAGE: Edema: Adult: PO 20-80 mg/day in AM, may give another dose in 6 hr, up to 600 mg/day; IM/IV 20-40 mg, increased by 20 mg q2hr until desired responsePT EDUCATION: Teach patient to take the medication early in the day to prevent nocturia, Instruct the patient to take with food or milk if GI symptoms of nausea and anorexia occur, Teach patient to maintain a record of weight on a weekly basis and notify physician of weight loss of >5 lb, Caution the patient that this product causes a loss of potassium, that food rich in potassium should be added to the diet; refer to a dietitian for assistance in planning, Caution the patient to rise slowly from sitting or reclining positions, not to exercise in hot weather or stand for prolonged periods because orthostatic hypotension will be enhanced; lie down if dizziness occurs,Advise patient to wear protective clothing and sunscreen to prevent photosensitivity, Caution patient not to use alcohol or any OTC medications without physician’s approval; serious product reactions may occur, Advise patient to continue taking medication even if feeling better; this product controls symptoms but does not cure the condition, Advise the patient with hypertension to continue other medical treatment (exercise, weight loss, relaxation techniques, cessation of smoking),Teach patient to contact prescriber if rash, cramps, nausea, dizziness, numbness, weakness occurFC: Loop diuretic CC: Sulfonamide derivative TU: Decreased edema in lung tissue, peripherally; decreased B/P USE: Pulmonary edema, edema in HF, nephrotic syndrome, ascites, hepatic disease, hypertensionNAME: furosemide (Rx) / LasixFC: Osmotic laxative TU: STOOL softener USE: Constipation DOSAGE: Adult: PO 17 g (a heaping tablespoon) in 8 oz of waterPT EDUCATION: {nursing consideration}NAME: Polyethylene glycol / ClearLax / MiraLax / GlycolaxACTION: In solution as an osmotic action drawing H20 into GI lumen, increases the number of bowel movementsSIDE EFFECTS: abdominal bloating, cramping,flatulence, nausea, high doses may produce diarrhea and excessive stool frequency, particularly in elderly nursing home pt. Pt taking other med containing PEG have occasionally developed urticaria suggestive ofan allergic reactionANTIDOTE: NURSING CONSIDERATIONS: Mix powder until fully dissolved in 8ox liquid, provide another drink to help wash taste outCONTRAINDICATION: Hypersensitivity, GI obstruction, megacolon, GI perforationNURSING CONSIDERATIONS: [1] HF: Assess fluid volume status: I&O ratios and record, count or weigh diapers as appropriate, weight, distended red veins, crackles in lung, color, quality, and specificgravity of urine, skin turgor, adequacy of pulses, moist mucous membranes, bilateral lung sounds, peripheral pitting edema; dehydration symptoms of decreasing output, thirst, hypotension, dry mouth and mucous membranes should be reported [2] Monitor electrolytes: potassium, sodium, chloride, magnesium; also include BUN, blood pH, ABGs, uric acid, CBC, blood glucose [3]Hypertension: Assess B/P before and during therapy, lying, standing, and sitting as appropriate; orthostatic hypotension can occur rapidly [4] Ototoxicity: Assess patient for tinnitus, hearing loss, earpain; periodic testing of hearing is needed when high doses of this product are given by IV route [5] Hypokalemia: acidic urine, reduced urine osmolality, nocturia, polyuria and polydipsia; hypotension, broad T-wave, U-wave, ectopy, tachycardia, weak pulse; muscle weakness, altered LOC, drowsiness, apathy, lethargy, confusion, depression; anorexia, nausea, cramps, constipation, distention, paralytic ileus; hypoventilation, respiratory muscle weakness [6] Monitor for CV, GI, neurologic manifestationsof hyponatremia: increased B/P, cold, clammy skin, hypovolemia or hypervolemia; anorexia, nausea, vomiting, diarrhea, abdominal cramps; lethargy, increased ICP, confusion, headache, seizures, coma, fatigue, tremors, hyperreflexia [7] Monitor for neurologic, respiratory manifestations of hyperchloremia: weakness, lethargy, coma; deep rapid breathing [8] Beers: Use with caution in older adults, may exacerbate or cause syndrome of inappropriate antidiuretic hormone secretion or hyponatremia, monitor sodium level closely when changing dose[9] Serious rash: Monitor for skin rash often, Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme may occur and is life-threateningACTION: Acts on the ascending loop of Henle in the kidney, inhibiting reabsorption of electrolytes sodium and chloride, causing excretion of sodium, calcium, magnesium, chloride, water, and some potassium; decreases reabsorption of sodium and chloride and increases excretion of potassium in the distal tubule of the kidney; responsible for slight antihypertensive effect and peripheral vasodilatationSIDE EFFECTS: Headache, fatigue, weakness, vertigo, paresthesiasOrthostatic hypotension, chest pain, ECG changes, circulatory collapse,Loss of hearing, ear pain, tinnitus, blurred vision, Hypokalemia, hypochloremic alkalosis, hypomagnesemia, hyperuricemia, hypocalcemia, hyponatremia, metabolic alkalosis, Hyperglycemia,Nausea, diarrhea, dry mouth, vomiting, anorexia, cramps, oral or gastric irritations, pancreatitis, Polyuria, renal failure, glycosuria, bladder spasms, Thrombocytopenia, agranulocytosis, leukopenia, neutropenia, anemia, Rash, pruritus, purpura, sweating, photosensitivity, urticaria, Cramps, stiffness, Toxic epidermal necrolysis, erythema muliforme, Stevens-Johnson syndromeNAME: fluticasone (Rx) / Flonase / Flovent HFA / Flovent Diskus NAME: tamsulosin (Rx) / FlomaxNURSING CONSIDERATIONS: [1] Assess for BPH: change in urinary patterns, baseline, throughout treatment; monitor I&O ratios, weight daily, edema, report weight gain or edema [2] Monitor CBC with differential and liver function tests; B/P and heart rate [3] Monitor urodynamic studies/urinary flow rates, residual volume [4] Orthostatic hypotension: monitor B/P standing, sitting [4] Pregnancy/breastfeeding: Not to be usedfor womenCONTRAINDICATION: HypersensitivityFC: Selective α-adrenergic blocker, BPH agent CC: Sulfamoyl phenethylamine derivative TU: Decreased symptoms of benign prostatic hyperplasia (BPH) USE: Symptoms of BPH FC: Corticosteroids, inhalation; antiasthmatic. TU: Decreased severity of asthma USE: Prevention of chronic asthma during maintenance treatment in those requiring oral corticosteroids; nasal symptoms of seasonal/perennial and allergic/nonallergic

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MCC NUR 214 - Polyethylene glycol

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