Code Phrases

Question 1

Nephrotoxicity, RF, nephropathy

Answer 1

Monitor

• fluid and electrolyte imbalance
• daily I/O, weight gain
• acid-base imbalance
• renal panel (BUN, Creatinine, GFR)

Avoid

• in RF pt/ use with caution if necessary
• nephrotoxic drugs

Nephrotoxic Drugs

• NSAIDs
• ACE
• ARB
• diuretics
• certain abx
• IV contrast dye
• poor excretion
• proteinuria
• hematuria
• may need dialysis

Question 2

Hepatotoxicity

Answer 2

Monitor

• transaminitis (AST, ALT, bili, alkaline phosphatase, low total protein, low albumin)
• ammonia level

Avoid

• LF pt
• hepatotoxic agents (ETOH, acetaminophen)
• alcohol - worsening reaction and liver disease

Educate
- s/s and assess for jaundice, ascites, RUQ pain, N/V/D, sweating, coma, death, high risk for bleed

• obtain baseline liver and monitor trends, abdominal fullness
• low protein
• poor metabolism
• kernicterus: damage in newborns caused by hyperbilirubinemia moving to brain tissue

Question 3

ototoxicity

Answer 3

Cochlear Damage
- hearing loss, tinnitus, educate, monitor
- prevent:
- avoid loop diuretics (furosemide, bumetanide, toresemide)
- always slow push loops if given
- avoid glycopeptides (vancomycin)
avoid aminoglycosides

Vestibular damage
- vertigo, balance deficit

Question 4

CNS changes

Answer 4

AMS

• disorientation, confusion
• agitation, anxiety, insomnia
• lethargy, drowsiness

Seizure precautions
Dysphasia (communication)
dizziness, ataxia, fall
VS changes, orthostatic hypotension, dysrhythmia, shock
pesthesia

Question 5

Dysrhythmia

Answer 5

high/low HR
low CO
low BP
orthostatic hypotension

Monitor

• heart rhythm and treat
• electrolyte levels (CMP)

Question 6

Hypotension, OH

Answer 6

Monitor

• BP
• reflex tachycardia and dysrhythmia

Risk of dizziness, lightheadedness, fall
Provide ambulation assistance

Avoid
- sudden position changes

Question 7

Hypertension (HTN)

Answer 7

Monitor

• BP before administering medication
• trend
• treat the HA
• heart rate and rhythm

Reduce BP prior to administering medication for increase BP or bleeding

Question 8

Photosensitivity, phototoxicity

Answer 8

Avoid

• sunlight
• tanning bed

Monitor

• skin changes
• rashes may become steven-johnson or lead to angioedema and shock

Use sunscreen, and protective clothing