Course Instructor Gina Haidinyak, M.Ed., MSN, JD, RN

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1 Stephen F. Austin State University DeWitt School of Nursing PHARMACOLOGY ACROSS THE LIFESPAN SYLLABUS Course Number: NUR 308 Section Number: 001 Fall 2010 Course Instructor Gina Haidinyak, M.Ed., MSN, JD, RN ALL INFORMATION IN THIS SYLLABUS IS SUBJECT TO THE WRITTEN POLICIES AND PROCEDURES OF THE SCHOOL OF NURSING, STEPHEN F. AUSTIN STATE UNIVERSITY, NACOGDOCHES, TEXAS. IN THE CASE OF COMMISSION, OMISSION, AMBIGUITY, VAGUENESS, OR CONFLICT, THE POLICIES AND PROCEDURES OF THE SCHOOL OF NURSING SHALL CONTROL. EACH STUDENT SHALL BE RESPONSIBLE FOR ACTUAL AND/OR CONSTRUCTIVE KNOWLEDGE OF THE POLICIES AND PROCEDURES OF THE SCHOOL OF NURSING AND FOR COMPLIANCE THEREWITH. EACH STUDENT IS RESPONSIBLE FOR ALL INFORMATION IN THIS SYLLABUS. This syllabus is provided for informational purposes only. 1

2 Name: Greta Eugenia (Gina) Haidinyak, M.Ed., MSN, JD, RN Department: Nursing Phone: Office: Room 106 Office Hours: Mondays: ; Tuesdays ; Wednesdays Thursdays Class Meeting Time and Place: Tuesdays in Room 107 Textbooks and Materials: Broyles, B., Reiss B.. & Evans, M. (2007) Pharmacological Aspects of Nursing Care (7 th ed.) Clifton Park, NY: Thomson/Delmar Learning Morris, Deborah (2006) Calculating with Confidence (5 th ed.). St Louis, Missouri: Elsevier Mosby Course Description This course establishes a foundation for the pharmacological aspects of nursing and builds on concepts from core curriculum, previous, and concurrent nursing courses. The course will encompass basic principles of pharmacology, medication administration, and classification of drugs. Number of Credit Hours 3 credit hours (3 lecture) Course Prerequisites and Co-requisites Pre-requisites: NUR 304, NUR 305, Admission to Nursing Program Co-requisites: NURS 306, NURS 307 Program Learning Outcomes 1. Apply knowledge of the physical, social, and behavioral sciences in the provision of nursing care based on theory and evidence based practice. 2. Deliver nursing care within established legal and ethical parameters in collaboration with clients and members of the interdisciplinary health care team. 3. Provide holistic nursing care to clients while respecting individual and cultural diversity. 4. Demonstrate effective leadership that fosters independent thinking, use of informatics, and collaborative communication in the management of nursing care. 5.Assure responsibility and accountability for quality improvement and delivery of safe and effective nursing care. 6. Serve as an advocate for clients and for the profession of nursing. 7. Demonstrate continuing competence, growth, and development in the profession of nursing. General Education Core Curriculum /Outcomes None 2

3 Student Learning Outcomes 1. Identify concepts and principles of the arts, sciences, humanities, and nursing as foundational content for the science of pharmacological nursing. 2. Identify the nursing responsibility and accountability related to pharmacology and medication administration. 3. Identify the interdisciplinary collaboration involved with pharmacology. 4. Describe the moral, ethical, economic, political, and legal issues involved in nursing and pharmacology. 5. Explain how holistic, socio-economic, spiritual, and ethno-cultural characteristics of clients affect nursing and pharmacology. 6. Identify selected drug classifications, mechanisms of action, indications for use, and pertinent client educational needs. 7. Evaluate drug effects on physiologic and psychological processes. 8. Describe processes utilized in medication administration. 9. Demonstrate medication calculations through successful completion of calculation exam prior to administering medications in the clinical setting. Course Requirements: Homework 9% Attendance and Participation 1% Group Project 10% Test I 20% Test II 20% Test III 20% Final Exam 20% Course Calendar: TENTATIVE SCHEDULE ALL ASSIGNMENTS ARE IN BROYLES UNLESS OTHERWISE INDICATED. Aug. 31 Introduction to Course Drug Actions and their Actions (Chapters 1) Chapters 1 9 in Morris Sept. 7 Drug Administration (Chapter 2) IV Therapy and Calculations (Chapters 3 & 4) Chapters 10 14, 17, & 18 in Morris Calculation Homework #1 Due Sept. 14 Pediatric and Geriatric Therapy (Chapters 5 & 6) Diabetic and Endocrine Agents (Chapters 36 & 37) Chapters in Morris Calculation Homework #2 Due 3

4 Sept. 21 CALCULATION TEST Calculation Homework #3 Due Antimicrobial Agents - Antibiotics (Chapter 7) Sept. 28 Antimicrobial and Related Agents (Chapters 8 and 9) GI Agents (Chapters 24, 25 and 26) PRESENTATIONS #1 AND #2 FRIDAY, Oct. 1 Oct. 5 MAKE-UP CALCULATION TEST AT 1:00 PM TEST I Agents for Eye, Ear and Skin Disorders (Chapters 41, 42 & 43) Oct. 12 ANS Agents (Chapter 34) Respiratory Agents (Chapters 14, 15 and 16) PRESENTATIONS #3, #4, and #5 Oct. 19 WALK (no class) Oct. 26 CV Agents I (Chapters 17 & 18) CV Agents II (Chapter 19) PRESENTATIONS #6, #7, and #8 Nov. 2 CV Agents III (Chapter 20) CV Agents IV (Chapters 21, 22 & 23) PRESENTATIONS #9, #10, and #11 Nov. 9 TEST II Chemotherapy and Immune Agents (Chapters 39 & 40) Nov. 16 Agents for Pain and Inflammation (Chapters 10, 12 and 13) Neurological Agents I (Chapters 27 and 28) PRESENTATIONS #12, #13, and #14 Nov. 23 Neurological Agents II (Chapters 29, 30 and 31) Neurological Agents III (Chapters 32 and 33) PRESENTATIONS #15 and #16 Nov. 30 Dec. 7 Test III Optional Review Make-up Exams Dec. 14 COMPREHENSIVE FINAL EXAMINATION ( ) 4

5 Grading Policy: A = B = C = F = 74 and below Attendance Policy: Class attendance and participation are important. Students are expected to attend class. Attendance and participation are worth one percent (1%) of the grade. In a class which meets only once a week, more than three (3) unexcused absences is excessive and may result in a loss of one percent (1%) credit. Academic Integrity (A -9.1) Academic integrity is a responsibility of all university faculty and students. Faculty members promote academic integrity in multiple ways including instruction on the components of academic honesty, as well as abiding by university policy on penalties for cheating and plagiarism. Definition of Academic Dishonesty Academic dishonesty includes both cheating and plagiarism. Cheating includes but is not limited to (1) using or attempting to use unauthorized materials to aid in achieving a better grade on a component of a class; (2) the falsification or invention of any information, including citations, on an assigned exercise; and/or (3) helping or attempting to help another in an act of cheating or plagiarism. Plagiarism is presenting the words or ideas of another person as if they were your own. Examples of plagiarism are (1) submitting an assignment as if it were one s own work when, in fact, it is at least partly the work of another; (2) submitting a work that has been purchased or otherwise obtained from an Internet source or another source; and (3) incorporating the words or ideas of an author into one s paper without giving the author due credit. Please read the complete policy at Withheld Grades (Semester Grades Policy A 54) Ordinarily, at the discretion of the instructor of record and with the approval of the academic chair/director, a grade of WH will be assigned only if the student cannot complete the course work because of unavoidable circumstances. Students must complete the work within one calendar year from the end of the semester in which they receive a WH, or the grade automatically becomes an F. If students register for the same course in future terms the WH will automatically become an F and will be counted as a repeated course for the purpose of computing the grade point average. The circumstances precipitating the request must have occurred after the last day in which a student could withdraw from a course. Students requesting a WH must be passing the course with a minimum projected grade of C. 5

6 Students with Disabilities To obtain disability related accommodations, alternate formats and/or auxiliary aids, students with disabilities must contact the Office of Disability Services (ODS), Human Services Building, and Room 325, / (TDD) as early as possible in the semester. Once verified, ODS will notify the course instructor and outline the accommodation and/or auxiliary aides to be provided. Failure to request services in a timely manner may delay your accommodations. For additional information, go to Acceptable Student Behavior Classroom behavior should not interfere with the instructor s ability to conduct the class or the ability of other students to learn from the instructional program (see Student Conduct Code, policy D 34.1). Unacceptable or disruptive behavior will not be tolerated. Students who disrupt the learning environment may be asked to leave class and may be subject to judicial, academic or other penalties. The prohibition applies to all instructional forums, including electronic, classroom, labs, discussion groups, field trips, etc. The instructor shall have full discretion over what behavior is appropriate/inappropriate in the classroom. Students who do not attend class regularly or who perform poorly on class projects/exams may be referred to the Early Alert Program. This program provides students with recommendations for resources or other assistance that is available to help SFA students succeed. WEIGHTED MEAN AVERAGE A student must have a weighted mean average of at least seventy-five percent (75%) on Tests I, II, III and the Comprehensive Final Examination to pass the course. This will be calculated by taking each test score and multiplying it by the percentage it is worth. Those results will be added and the total divided by the total percentage of the tests. If the weighted mean average of the tests is less than 75%, the student will earn an F in the course. A STUDENT WHO FAILS THE COURSE WILL NOT BE ALLOWED TO PROGRESS IN THE NURSING PROGRAM. CALCULATION TEST A student must pass the Calculation Test before being allowed to administer medications in the clinical area. A student who does not pass the Calculation Test will earn an F in the course. MAKE-UP EXAMS For good cause shown, Make-up Exams will be given during dead week after the optional review. 6

7 TENTATIVE SCHEDULE INTRODUCTION TO COURSE Reading: Syllabus DRUGS AND DRUG ACTIONS Reading: Chapter 1 in Broyles 1. Describe the scope of the science of pharmacology 2. Identify drug sources and provide an example of each. 3. Compare the significance of the chemical name, generic name and brand name of a drug. 4. Discuss the significance of peak and trough concentrations. 5. Define half-life of a drug. 6. Define therapeutic index. 7. Differentiate among each of the following adverse drug reactions: side effect, toxic effect, allergic reaction, idiosyncratic reaction and teratogenic effect. 8. Describe how drugs are absorbed and distributed through the body. 9. Differentiate between enteral and parenteral administration of a drug. Reading: Chapter 1 5 in Morris MATH REVIEW 1. Recognize the symbols used to represent numbers in the Roman numeral system. 2. Convert Roman numerals to Arabic numbers. 3. Convert Arabic numbers to Roman numerals 4. Compare the sizes of fractions. 5. Add, subtract, divide and multiply fractions. 6. Reduce fractions to lowest terms. 7. Reade and write decimals. 8. Compare the sizes of decimals. 9. Convert fractions to decimals and decimals to fractions. 10. Add, subtract, multiply and divide fractions. 11. Round decimals to the nearest tenth and nearest hundredth. 12. Define ratio and proportion. 13. Calculate problems for a missing term (x) using ratio and proportion. 14. Define percent. 15. Convert percents to fractions, decimals and ratios. 16. Convert decimals and fractions to percents. 17. Convert fractions to ratios. 18. Determine the percents of numbers. 7

8 Reading: Chapters 5 9 in Morris SYSTEMS OF MEASUREMENT 1. Express metric measures correctly using rules of the metric system. 2. State common equivalents in the metric system. 3. Convert measures within the metric system. 4. State common apothecary equivalents. 5. State common household equivalents. 6. State specific rules that relate to the apothecary and household systems. 7. Identify symbols and measures in the apothecary and household systems. 8. Convert a unit of measure to its equivalent within the same system. 9. Convert approximate equivalents between the metric, apothecary, and household systems of measure. 10. Convert between Celsius and Fahrenheit temperature. 11. Convert between units of length; inches, centimeters, and millimeters. 12. Convert between units of weight; pounds and kilograms, pounds and ounces to kilograms. Reading: Chapter 2 in Broyles DRUG ADMINISTRATION 1. Recognize the symbols used to represent numbers in the Roman numeral system. 2. Convert Roman numerals to Arabic numbers. 3. Convert Arabic numbers to Roman numerals. 4. Compare the size of fractions. 5. Add, subtract, multiply, divide and reduce fractions to the lowest terms. 6. Read and write decimals. 7. Compare the size of decimals. 8. Convert fractions to decimals and decimals to fractions. 9. Add, subtract, multiply and divide decimals. 10. Round decimals to the nearest tenth and to the nearest hundredth. 11. Define ratio and proportion. 12. Calculate ratio and proportion problems. 13. Define percent. 14. Convert percents to fractions, decimals and rations. 15. Convert decimals to percents. 16. Convert fractions to percents. 17. Convert fractions to ratios. 18. Determine the percent of numbers. 8

9 IV THERAPY Reading: Chapter 3 in Broyles 1. Describe the nursing considerations in caring for a client receiving an IV. 2. Discuss the complications of IV therapy. 3. Calculate the rate of flow of IV infusions. 4. Explain how to prepare a solution from a powdered medication according to directions on the vial or other resources. 5. Identify essential information to be placed on the vial of a medication after it is reconstituted. 6. Determine the best concentration strength for medications ordered when there are several directions for mixing. 7. Calculate dosages from reconstituted medications. 8. Differentiate between primary and secondary administration sets. 9. Differentiate between various devices used to administer IV solutions. 10. Identify the abbreviations used for IV fluids. 11. Calculate IV infusion times. Reading: Chapter 4 in Broyles CALCULATING MEDICATIONS 1. Interpret a medication prescription accurately. 2. Set up valid proportions to perform calculations required in administering medications. 3. Calculate safe dosages for adults, infants and children. 4. Calculate dosages for individual clients given the client s weight and/or height and the recommended dose. 5. List some steps to decrease errors in interpreting the strength of drugs from the written prescription. Reading: Chapters in Morris MEDICATION ADMINISTRATION 1. State the consequences of medication errors. 2. Identify the causes of medication errors. 3. Identify the role of the nurse in preventing medication errors. 4. State the rights of medication administration. 5. Identify factors that influence medication dosages. 9

10 6. Identify the common routes for medication administration. 7. Discuss the importance of client teaching. 8. Identify the components of a medication order. 9. Identify the meanings of standard abbreviations used in medication administration. 10. Interpret a given medication order. 11. Identify abbreviations, acronyms, and symbols recommended by the Joint Commission s Do Not Use list. 12. Read and write correct medical notations. 13. Identify necessary information that must be transcribed to a medication administration record (MAR). 14. Read an MAR. 15. Transcribe medication orders to an MAR. 16. Identify trade and generic names of medications. 17. Identify dosage strengths and forms in which a medication is supplied. 18. Identify directions for mixing or preparing a drug when necessary. Reading: Chapters 14, 17 and 18 in Morris CALCULATING MEDICATIONS 1. State a ratio and pro9portion to solve a given dosage calculation problem. 2. Solve simple calculation problems using the ratio and proportion method. 3. Identify the forms of oral medication. 4. Identify the terms on the medication label to be used in calculation of dosages. 5. Calculate dosages for oral and liquid medications using ration and proportion. 6. Apply principles learned concerning tablet and liquid preparations to obtain a rational answer. 7. Read and measure dosages on a syringe. 8. Read medication labels on parenteral medications. 9. Calculate dosages of parenteral medications already in solution. Reading: Chapters 5 and 6 in Broyles PEDIATRIC AND GERIATRIC THERAPY 1. Identify anatomical and physiological factors that may result in altered drug effects in children. 2. Describe how pediatric dosages may be calculated. 3. Apply the nursing process as related to the administration of medications to children. 4. Identify anatomical and physiological factors that may result in altered drug effects in the elderly. 10

11 5. Identify social and environmental factors related to drug problems in the elderly. 6. Apply ;the nursing process related to the administration of medications to the elderly. Reading: Chapter 36 in Broyles DIABETIC AGENTS 1. Explain insulin function. 2. Describe signs, symptoms and treatment of hyperglycemia and hypoglycemia. 3. Discuss three adverse effects associated with insulin administration. 4. Identify the insulin currently in use. 5. Describe the mechanism of action of oral hypoglycemic agents. 6. Differentiate among short, intermediate, and long-acting insulins and give an example of each. 7. Explain in a stepwise fashion the procedures used in mixing and administering insulin. 8. Discuss the sites commonly used for insulin administration and plan a rotation pattern. 9. Discuss the local tissue responses possible with repeated insulin injections. 10. Identify factors that may produce a change in a diabetic client s insulin requirement. 11. Briefly describe how a sliding scale of insulin administration works and describe the use of insulin pumps. 12. Discuss adverse effects commonly associated with the use of sulfonylurea oral hypoglycemic agents. 13. Discuss the assessment of a client with diabetic mellitus. 14. Apply the nursing process related to care of clients experiencing hypoglycemia or hyperglycemia. 15. Prepare teaching plans for clients with Type I and Type II diabetes. 16. Identify important information on insulin labels. 17. Read calibrations on U-100 syringes. 18. Measure insulin in single and combined dosages. 19. State the importance of calculating heparin dosages accurately. 20. Calculate heparin doses. Reading: Chapter 37 in Broyles ENDOCRINE AGENTS 1. Describe the mechanism by which each of the following forms of therapy relieves symptoms of hyperthyroidism: antithyroid drugs, iodides, radioactive iodine (I 131), beta-adrenergic blocking agents, and surgery. 2. Discuss the signs and symptoms of hyperthyroidism and hypothyroidism. 3. Explain how hypothyroidism is treated. 11

12 4. Discuss the normal function of the parathyroid glands. 5. Compare the causes, symptoms, and treatment of hypoparathyroidism and hyperparathyroidism. 6. Discuss the hormones secreted by the anterior and posterior pituitary. 7. Compare the causes, symptoms and therapy of hypopituitarism, hyperpituitarism, and diabetes insipidus. 8. Discuss the proper administration of human growth hormone, corticotrophin, and vasopressin. 9. Discuss appropriate nursing assessment of persons taking drugs affecting thyroid, parathyroid, or pituitary function. 10. Apply the nursing process related to caring for clients receiving therapy for diseases of the thyroid, parathyroid or pituitary gland. Reading: Chapters 19, 21 and 22 in Morris SOLUTIONS AND IV CALCULATIONS 1. Explain how to prepare a solution from a powdered medication according to directions on the vial or other resources. 2. Identify essential information to be placed on the vial of a medication after it is reconstituted. 6. Determine the best concentration strength for medications ordered when there are several directions for mixing. 3. Calculate dosages from reconstituted medications. 4. Differentiate between primary and secondary administration sets. 5. Differentiate between various devices used to administer IV solutions. 6. Identify the abbreviations used for IV fluids. 7. Calculate IV infusion times. Reading: Chapters 20 and 23 in Morris INSULIN AND HEPARIN CALCULATIONS 1. Identify important information on insulin labels. 2. Read calibrations on insulin syringes. 3. Measure insulin in single and combined dosages. 4. Calculate heparin dosages being administered IV and SC. 5. Calculate heparin dosages based on weight. 12

13 ANTIBIOTICS AND OTHER ANTIMICROBIAL AGENTS Reading: Chapters 7, 8 and 9 in Broyles 1. Identify factors determining the selection of an antimicrobial agent for the treatment of an infection. 2. Differentiate between bactericidal and bacteriostatic. 3. Describe the therapeutic actions of antibiotics. 4. Differentiate between broad and narrow spectrum agents. 5. Identify the major classes of antimicrobial agents and the drugs found in each class. 6. Discuss the major adverse effects associated with the use of each class of antimicrobial agents. 7. Discuss the appropriate nursing interventions in the administration of each class of antimicrobial agents. 8. Discuss the information clients should be told about their antimicrobial medication. 9. Describe the ways in which humans contact parasites. 10. Identify ways in which drugs may exert antiparasitic effects. 11. Apply nursing care process in the administration of antiparasitic medications. 12. Describe nursing interventions to prevent reinfestation with parasites. Reading: Chapters 24, 25 and 26 in Broyles GI AGENTS 1. Discuss the ways antiacids may interact with other drugs. 2. Explain the difference between systemic and nonsystemic antiacids and give an example of each. 3. Apply the nursing process related to caring for clients receiving agents used to treat hyperacidity and GERD. 4. Discuss the actions and effects of the various classes of drugs used in the treatment of nausea and vomiting. 5. Compare and contrast emetics and antiemetics. 6. Apply the nursing process for clients receiving emetic and antiemetic agents. 7. Describe the characteristics of an ideal laxative. 8. Discuss the differences among the major categories of laxative agents. 9. Explain the mechanism of action, common adverse effects, and appropriate nursing measures related to the use of major laxatives and drugs used for diarrhea. AGENTS FOR EYE, EAR AND SKIN DISORDERS Reading: Chapters 41, 42 and 43 in Broyles 1. Discuss the purposes for using mydriatic agents. 2. Describe two major classes of mydriatic agents, giving an example of each. 13

14 3. List the three classes of ophthalmic anti-infective agents, giving an example of each. 4. Discuss the purposes for using corticosteroid ophthalmic preparations. 5. Explain the classes of agents that decrease the formation of aqueous humor. 6. Explain the classes of agents that increase the outflow of aqueous humor. 7. Apply the nursing process related to the administration of ophthalmic agents. 8. Discuss the primary ear disorders for which otic agents are used. 9. Discuss otitis media and its treatment. 10. Discuss the classification of otic agents, providing an example of each. 11. List the classes of otic anti-infective agents, giving an example of each. 12. Apply the nursing process related to the administration of otic agents. 13. Discuss the properties of and specific uses for ointments, creams, pastes, lotions, gets, aerosol sprays, aerosol foams, powders, and oils when used in the treatment of dermatological disorders. 14. Discuss the causes of dry skin and the role of emoillients. 15. Describe the therapeutic use and appropriate method of application of keratolytic agents. 16. Discuss adverse effects and contraindications related to the use of local anesthetic agents on the skin. 17. Discuss factors to be assessed in clients receiving treatment for skin disorders. 18. Apply the nursing process related to the administration of agents used in the treatment of dermatological disorders. 19. Apply the nursing process for clients being treated for burns. Reading: Chapter 34 in Broyles ANS AGENTS 1. Explain the major functions of the sympathetic and parasympathetic branches of the autonomic nervous system (ANS). 2. Discuss the functions of the alpha and beta adrenergic receptors. 3. Differentiate among and compare the actions of four categories of drugs that affect the ANS. 4. Discuss the mechanism of action of anticholinergic and direct-acting ANS agents. 5. Identify the conditions in which the use of ANS agents would be indicated or contraindicated. 6. State five adverse effects of ANS agents. 7. Apply the nursing process relative to caring for clients receiving ANS drugs. Reading: Chapters 14, 15 and 16 in Broyles RESPIRATORY AGENTS 1. State the pathophysiological changes that occur in clients with the common cold and with allergic rhinitis. 2. State the mechanisms by which antihistamines exert their pharmacological effect. 3. Discuss the adverse effects commonly caused by antihistamines. 14

15 4. Identify antihistamines that are effective in preventing or countering motion sickness, nausea and vomiting. 5. State the mechanism by which nasal decongestants exert their pharmacological effects. 6. Describe the cause of rebound congestion. 7. Discuss adverse effects of nasal decongestants. 8. Apply the nursing process related to the administration of antihistamines and nasal decongestants. 9. Discuss factors to be assessed in persons with allergic rhinitis and the common cold. 10. Identify agents currently in clinical use as antitussives or expectorants. 11. State the mechanisms by which expectorant and antitussive agents produce their therapeutic effects. 12. Discuss factors to be assessed in clients taking expectorants or antitussives. 13. Discuss when the use of expectorants or antitussive agents, or both, is clinically desirable. 14. Apply the nursing process related to the administration of expectorant and antitussive agents. 15. Explain the mechanism by which adrenergic stimulants and xanthine derivatives produce bronchodilation. 16. discuss the adverse effects commonly seen in the use of bronchodilator agents. 17. Discuss factors to be assessed in persons with chronic obstru ctive pulmonary disease (COPD). 18. Discuss the mechanism by which corticosteroids work to prevent asthmatic attacks. CARDIOVASCULAR AGENTS PARTS I, II, III, AND IV Reading: Chapters 17, 18, 19, 20, 21, 22, and 23 in Broyles 1. Distinguish between positive and negative inotropic, chronotropic, and dromotropic effects of agents on the heart. 2. Discuss the mechanisms by which cardiac glycosides provide effective treatment for heart failure. 3. Discuss factors which affect the selection for an appropriate cardiac glycoside for a particular client. 4. Define a digitalizing dose. 5. Discuss the most common gastrointestinal, neurological, and cardiac symptoms indicative of cardiac glycoside intoxication. 6. Discuss factors that may predispose a client to the development of cardiac glycoside toxicity. 7. Describe the mechanism of action and adverse effects related to the use of inamrinone and milirinone. 8. Describe the mechanism of action and adverse effects related to the use of calcium channel blockers. 9. Apply the nursing process for clients receiving cardiac drugs. 10. Discuss ways in which antiarrhythmic drugs act to diminish or obliterate rhnythm disturbances of the heart. 11. Discuss the most common adverse effects associated with antiarrhythmic agents. 15

16 12. Apply the nursing process for clients taking antiarrhythmic agents. 13. Discuss the mechanism of action and common adverse effects and apply nursing measures related to the use of the cardiac stimulants most commonly employed in the treatment of shock. 14. Discuss now nitrates reduce angina pain. 15. Identify the common routes of nitroglycerin administration and the advantages associated with each. 16. Explain the storage requirements necessary for nitroglycerin tablets to retain their potency. 17. Discuss the major adverse effects associated with the use of nitrates. 18. Discuss the therapeutic effects and adverse effects of the major peripheral vasodilating agents. 19. Apply the nursing process related to caring for clients receiving coronary and peripheral vasodilators. 20. Discuss commonly used drugs that may induce bleeding or delay coagulation time. 21. Describe the mechanisms of action of heparin, oral anticoagulatns, thrombolytic enzymes, alteplase and anistreplase. 22. Discuss the usual methods of administering heparin. 23. Describe, in a stepwise manner, the technique for subcutaneous (SC) administration of heparin. 24. Discuss safety measures used by nurses in providing care to clients receiving heparin or oral anticoagulants. 25. Apply the nursing process used in providing care for clients receiving heparin or oral anticoagulants. 26. Discuss the educational needs of clients receiving heparin, oral anticoagulants, or both. 27. Apply the nursing process for a client following intracoronary thrombolysis, employing urokinase, streptokinase, alteplase, or anistreplase. 28. Discuss the major classes of diuretics, their mechanism of action, and their side effects. 29. Explain the mechanism of action and major adverse effects for each of the commonly used antihypertensive drugs. 30. List major nursing diagnoses and goals in caring for hypertensive clients. 31. Discuss the long-term management of hypertensive clients. 32. Apply the nursing process when caring for clients experiencing a hypertensive emergency. 33. Discuss the major risk factors associated with the development of atherosclerosis. 34. Explain the mechanism of action of each class of agents used in the treatment of hyperlipidemia. 35. Discuss the role of diet and drug therapies in the control of hyperlipidemia. 36. Discuss the common adverse effects of agents used to treat hyperlipidemia. 37. Apply the nursing process related to the administration of agents used to treat hyperlipidemia. 38. Discuss common factors to be included in a comprehensive nursing assessment of the client with hyperlipidemia. 39. Explain the symptoms of anemia. 40. Identify persons at high risk for the development of iron deficiency anemia. 41. Discuss the advantages and disadvantages or oral and parenteral iron therapy. 42. Discuss the causes and effects of Vitamin B 12 deficiency. 43. Discuss drugs that can cause blood loss. 44. Identify several common causes of hypokalemia. 16

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