McKenna's Pharmacology for Nursing, 2e

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P A R T 8  Drugs acting on the cardiovascular system

assays, to determine drug effectiveness and identify toxic levels. Implementation with rationale ■ ■ Ensure that iron-deficiency anaemia is confirmed before administering drugs to ensure proper use of the drug. ■ ■ Consult with the doctor to arrange for the treatment of the underlying cause of anaemia if possible because iron replacement will not correct the cause of the iron loss. ■ ■ Administer the oral form with meals that do not include eggs, milk, coffee and tea to relieve GI irritation and nausea if GI upset is severe and to prevent drug–food interactions ; have the person drink oral solutions through a straw to prevent staining of teeth. ■ ■ Caution the person that stool may be dark or green to prevent undue alarm if this occurs. ■ ■ Take measures to help alleviate constipation to prevent discomfort and the adverse effects of severe constipation. ■ ■ Administer intramuscularly only by Z-track technique to ensure proper administration and to avoid staining of the tissues brown . Warn the person that the injection can be painful. ■ ■ Arrange for haematocrit and haemoglobin measurements before administration and periodically during therapy to monitor drug effectiveness. ■ ■ Provide comfort measures to help the person tolerate drug effects. These include small, frequent meals to minimise nausea and readily available access to bathroom facilities should constipation occur, and increased fibre and fluid intake and increased exercise to help alleviate constipation. ■ ■ Offer support and encouragement to help the person deal with the diagnosis and the drug regimen. ■ ■ Provide thorough teaching, including the drug name, dosage and route of administration; administration technique, such as parenteral Z-track injection or oral solution through a straw, and frequency of administration; foods and fluids to avoid and to include to ensure proper absorption; need for increased fluids and fibre in diet, and exercise to prevent constipation; notification of change in stool colour and consistency; potential for pain at site and staining of skin with parenteral administration; measures to avoid adverse effects; warning signs of problems and need to notify healthcare provider; and the need for follow-up laboratory testing, to enhance knowledge about drug therapy and to promote compliance.

Prototype summary: Ferrous sulfate Indications: Prevention and treatment of iron- deficiency anaemia; dietary supplement for iron. Actions: Elevates the serum iron concentration and is then converted into haemoglobin or stored for eventual conversion to a usable form of iron. Pharmacokinetics: Route Onset Peak Duration Oral 4 days 7–10 days 2–4 months T 1/2 : Not known; recycled for use, not excreted. Adverse effects: GI upset, anorexia, nausea, vomiting, constipation, diarrhoea, CNS toxicity progressing to coma and death with overdose.

Care considerations for people receiving iron preparations Assessment: History and examination ■ ■ Assess for contraindications or cautions: any known allergies to this drug to avoid

hypersensitivity reactions ; hyperchromatosis to avoid increasing already increased iron levels ; colitis, enteritis or peptic ulcer, which could lead to increased GI irritation from the drug and exacerbation of the disorder ; and haemolytic anaemias, which could increase serum iron levels and lead to toxicity. ■ ■ Perform a physical assessment to establish a baseline before beginning therapy and during therapy to determine drug effectiveness and to evaluate for any potential adverse effects. ■ ■ Inspect the colour and integrity of the skin and mucous membranes to identify potential signs and symptoms associated with anaemia and evaluate for possible adverse effects of the parenteral form. ■ ■ Assess the person’s neurological status, including level of orientation, affect and reflexes, to identify possible CNS effects and early signs of possible toxicity. ■ ■ Monitor pulse, blood pressure and perfusion, and respirations and adventitious sounds, to check cardiovascular function and detect early signs of toxicity. ■ ■ Inspect abdomen for distension and auscultate bowel sounds to evaluate GI motility. ■ ■ Inspect the skin integrity of the intended parenteral administration site to ensure intactness and evaluate for possible staining. ■ ■ Monitor the results of laboratory tests, including FBC haematocrit, haemoglobin and serum ferritin