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  Generic name: Furosemide Brand name: Lasix Drug Classification: Loop Diuretics Pregnancy Category: Category C Dosage, route, frequency:    PO(adults)- 20-80mg/day as a single dose initially, may repeat in 6-8 hrs. May increase dose by 20-40 mg q6-8h until desired response.    PO(children)-2mg/kg as a single dose, may be increased by 1-2 mg/kg q6-8h.    IM/IV(Adults)-edema-20-40mg, may repeat in 2hr and increase by 20mg q2h until response is obtained. Pulmonary edema-40mg, after 1h give additional 80mg (in CHF and renal failure). Hypercalcemia-80-100mg may repeat q1-2h    IM/IV(Children)- 1 mg/kg may increase by 1mg/kg q2h Indications: Edema due to: CHF, HEPATIC/RENAL DISEASE; Hypertension Mechanism of action: Inhibits the reabsorption of sodium and chloride from the loop of henle and distal renal tubule. Increases renal excretion of water, chloride, sodium, magnesium, hydrogen &calcium; May have renal & peripheral vasodilatory effects. Therapeutic effects: decreased blood pressure  A/E or S/E:    CNS: dizziness, encephalopathy,headache, insomnia,nervousness    EENT: hearing loss, tinnitus    CV: Hypotension    GI:Constipation,diarrhea, dry mouth, dyspepsia,nausea & vomiting    GU: Excessive urination    DERM:Photosensitivity,rashes    ENDO: Hyperglycemia    F&E: dehydration, hypochloremia,hypokalemia,hypomagnesemia,hyponatremia,hypovolemia,metabolic alkalosis    HEMAT: Blood dyscrasias    METAB: Hyperglycemia, hyperuricemia    MS: arthralgia,muscle cramps, myalgia CONTRAINDICATIONS:    Hypersensitivity    Cross-sensitivity with thiazides and sulfonamides may occur    Pre-existing electrolyte imbalance, hepatic coma, or anuria    Some liquid products may contain alcohol, avoid in patients with alcohol intolerance    Use cautiously in: severe liver disease, electrolyte depletion, geriatric patients, diabetes mellitus, increasing azostemia, pregnancy,lactation/children NURSING RESPONSIBILITIES:    Assess fluid status during therapy. Monitor daily weight, I &O, amount & location of edema, lung sounds, skin turgor & mucus  membranes. Notify physician or other health care provider if thirst dry mouth, lethargy, weakness or oliguria occurs.    Monitor BP and pulse before& during administration.    Assess patients receiving for digoxin for anorexia, nausea,vomiting, muscle cramps,paresthesia & confusion. Patients taking digitalis glycosides are at increased risk of digitalis toxicity because of the potassium-depleting effect of the diuretic.    Assess for allergy to sulfonamides    Assess patient for tinnitus & hearing loss. Audiometry is recommended for patients receiving prolonged high dose IV-therapy .    Patient/family teaching:    Instruct patient to take furosemide as directed. Do not double dose. Take missed dose ASAP.      Caution patient to change positions slowly to minimize orthostatic hypotension. Use of alcohol, exercise during hot weather or standing for long of periods during therapy may enhance orthostatic hypotension.      Instruct patient to consult for health care professional regarding diet high in potassium.      Caution patient to use sunscreen and preventive clothing to prevent  photosensitivity reactions.       Advise patient to contact health care provider immediately if muscle weakness, cramps, nausea, dizziness, numbness/tingling of extremities occurs.       Advise diabetic patients to monitor blood glucose closely.      Reinforce the need to continue additional therapies for HPN(wt. loss, exercise, restricted sodium intake, stress reduction, regular exercise, moderation of alcohol consumption, cessation of smoking.)    Generic name: Ferrous Sulfate Brand name: Feosol, FeroSul, Fer-In-Sol Drug classification: Iron supplements Dosage, route, frequency: PO (adults): 100-200 mg daily in 2/3 divided doses. (Children) 3-6 mg/kg/ day P.O in 3 divided doses. Indications: ã Prevention and treatment of iron deficiency anemias.   ã Dietary supplement for iron.  Mechanism of action: Elevates the serum iron concentration which then helps to form High or trapped in the reticuloendothelial cells for storage and eventual conversion to a usable form of iron. A/R or S/E: GI irritation, anorexia, nausea, vomiting, diarrhea, constipation, dark stool. Teeth staining with liquid formulation. Contraindications:   Nursing responsibilities:   Assessment    Obtain baseline assessment of iron deficiency before starting therapy    Evaluate hemoglobin, hematocrit, and reticulocyte count during therapy.    Monitor for adverse reaction: nausea, epigastric pain, constipation, diarrhea, black stools, anorexia, temporary teeth staining    Assess bowel elimination, increase water, bulk, and activity if constipation occurs    Assess diet and nutrition: amount of iron in diet (meat, dark green leafy vegetables, dried beans, dried fruits, eggs)    Identify cause of iron loss or anemia, (salicylates, sulfonamides, antimalarials, quinidine)    Assess patient’s and family’s knowledge of drug therapy.  Planning    Give between meals for best absorption; may give with juice; do not give with antacids or milk, delay at least 1 hour; if GI symptoms occur give after meals even if absorption is decreased; eggs, milk products, chocolate, caffeine interfere with absorption; ferrous gluconate is less GI irritating than ferrous sulfate    Do not crush, chew tablets    Give liquid preparations through plastic straw to avoid discoloration of tooth enamel; dilute thoroughly    Give at least 1 hour before bedtime because corrosion may occur in stomach    Give for < 6 months for anemia    Store in airtight, light-resistant container Implementation    Instruct patient not to substitute one iron salt for another because they have different elemental iron content. Swallow the whole tablet, do not crush or chew, do not double dose if missed, but take it as soon as remembered and avoid taking the drug with certain foods that may impair oral iron absorption like yogurt, cheese, eggs, milk, cereals tea and coffee.    Remind patient that poisoning may occur if increased beyond recommended level, as few as three tablets can cause poisoning in children. Be sure to keep the drugs out of reach of children.    Caution patient to avoid reclining position for 15-30 minutes after taking drug to avoid esophageal corrosion. Inform patient that iron may turn stools black; this could mask the presence of melena.  Evaluation    Decreased feeling of fatigue and weakness    Constipation is relieved or prevented by appropriate measures by the patient    Improvement in results of Hct, Hgb and reticulocytes on follow up examination    Patient and family state of understanding of drug therapy.
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