Pharmacological and Parenteral Therapies

Right client, right drug, right dose, right route, and right time. Many programs add right documentation, right reason, right response, and the client's right to refuse; checking them at every administration catches most selection and dosing errors before the drug reaches the client.

Hold and notify the provider if the adult apical pulse is below 60/min (count a full minute). The classic therapeutic range is 0.5-2.0 ng/mL, but for heart failure many references target 0.5-0.8 (up to 0.9) ng/mL because higher levels raise mortality without extra benefit. Hypokalemia increases toxicity risk.

The PT/INR. A typical target INR is 2-3 (higher for some mechanical valves). Vitamin K (phytonadione) reverses warfarin; teach a consistent, not zero, intake of vitamin K-rich green leafy vegetables so the INR stays stable.

The aPTT (therapeutic about 1.5-2.5 times control) or an anti-factor Xa level. Protamine sulfate reverses heparin. Also monitor platelets, because a drop of 50% or more suggests heparin-induced thrombocytopenia.

Naloxone's duration (roughly 30-90 minutes) is often shorter than that of the opioid, especially long-acting or extended-release opioids, so sedation and respiratory depression can return. Monitor respirations, sedation, and SpO2 and be ready to repeat the dose.

It is angioedema, a rare ACE inhibitor reaction (bradykinin-mediated) that can obstruct the airway at any point in therapy. Stop the drug, assess the airway first, and call for help; the client should never take an ACE inhibitor again. Other ACE inhibitor effects include dry cough, hyperkalemia, and first-dose hypotension.