Page 256 - Critical Care Nursing Demystified

Chapter 5 CARE OF THE PATIENT WITH NEUROLOGICAL NEEDS 241

TABLE 5–6 Commonly Used Medications for the Neurologically Impaired Patient
(Continued )
Medication Action Use Precautions
Pentobarbital To induce bar- Helpful in Totally dependent upon the
(Nembutal) biturate coma reducing ICP nurse for respiratory and
Thiopental and decrease because they circulatory support.
(Sodium ICP. Second-tier slow down Requires mechanical venti-
Pentothal) therapy used cerebral metab- lation for oxygenation, BP
when other olism, which in support through the use of
methods of turn decreases pressor therapy such as
sedation do not the oxygen and dopamine and Levophed
control restless- glucose usually with an arterial line;
ness or demands of the requires PA pressure moni-
increased ICP. brain. toring tapered off gradually.
Also used as an Monitor for DVT, PE, pneu-
anticonvulsant. monia, and infection. Do not
confuse with phenobarbital.
Propofol General anes- Sedation of Observe for bradycardia and
(Diprivan) thetic. Sedative mechanically hypotension. Monitor vital
for seizure con- ventilated signs for respiratory depres-
trol after use of patients sion; can cause apnea lasting
a benzodiaz- more than 60 seconds. Must
epine has been have intubation equipment Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
unsuccessful. available if not vented. Moni-
tor for metabolic acidosis,
hyperkalemia, rhabdomyolo-
sis, and liver, cardiac, and
renal failure. Change IV lines
every 12 hours in ICUs due
to support of bacterial
growth on tubings and vials.
Use larger veins of forearms
since burning and stinging
can occur at the site of
administration. Do not use if
solution separates; it should
be milky and opaque in
appearance.
Valium Sedative. Seizures. Provide respiratory support
(Diazepam) Depresses CNS by Decreases rest- if giving it IV. Monitor VS
Ativan potentiating an lessness in frequently. Use cautiously
(Lorazepam) inhibitory neu- patients with in severe renal impairment.
rotransmitter. increased ICP or Can lead to physical and
Also promotes if fighting psychological dependency
skeletal muscle mechanical if used long term. Can be
relaxation by ventilation. severe with flumazenil.
decreasing spinal
afferent pathways.