ISPN Review Toxicity 毒性
Introducing chemicals into the body can sometimes affect the body in a very noxious or toxic way and cause damage to an organism. These effects are not acceptable adverse effects but are potentially serious reactions to a drug. Drug toxicity usually occurs at doses that exceed the therapeutic efficacy of a drug. When a drug is known to have toxic effects, the benefit of the drug to the patient must be weighed against the possibility of toxic effects causing the patient harm. The drug toxicity can affect an entire system as in the CNS or a specific organ such as the liver.
Liver Injury 肝损伤
Oral drugs are absorbed and passed directly into the liver in the first-pass effect. This exposes the liver cells to the full impact of the drug before it is broken down for circulation throughout the body. Most drugs are metabolized in the liver, so any metabolites that are irritating or toxic will also affect liver integrity.
Symptoms of liver injury due to drug toxicity may include fever, malaise, nausea, vomiting, jaundice, change in color of urine or stools, abdominal pain or colic, elevated liver enzymes (e.g., aspartate aminotransferase [AST], alanine aminotransferase [ALT]), alterations in bilirubin levels, and changes in clotting factors (e.g., partial thromboplastin time). Interventions include discontinuing the drug; notifying the prescriber and/or primary caregiver; and offering supportive measures such as small, frequent meals, skin care, a cool environment, and rest periods.
Renal Injury 肾损伤
The glomerulus in the kidney has a very small capillary network that filters the blood into the renal tubule. Some drug molecules are just the right size to get plugged into the capillary network, causing acute inflammation and severe renal problems. Some drugs are excreted from the kidney unchanged; they have the potential to directly irritate the renal tubule and alter normal absorption and secretion processes. Gentamicin (Garamycin), a potent antibiotic, is frequently associated with renal toxicity.
Assessment findings of renal injury due to drug toxicity include elevated blood urea nitrogen (BUN), elevated creatinine concentration, decreased hematocrit, electrolyte imbalances, fatigue, malaise, edema, irritability, and skin rash may be seen. Interventions are to notify the prescriber and/or primary caregiver and discontinue the drug as needed and offer supportive measures — for example, positioning, diet and fluid restrictions, skin care, electrolyte therapy, rest periods, a controlled environment. In severe cases, be aware that dialysis may be required for survival.
Poisoning 中毒
Poisoning occurs when an overdose of a drug damages multiple body systems, leading to the potential for fatal reactions. Assessment parameters vary with the particular drug. Treatment of drug poisoning also varies, depending on the drug. Specific antidotes or treatments for poisoning should be identified, if known. Emergency and life support measures often are needed in severe cases.
Test 1. Which of the following will determine nursing interventions for a client on medication?
A. Assessment
B. Diagnoses
C. Implementation
D. Evaluation 2. When performing an assessment to determine which medications can be used, which of the following elements is most important?
A. Physical examination
B. Allergies
C. Presence of illness
D. Weight
本期ISPN Review答案： 1. B. Diagnoses. The nursing diagnosis is the conclusion derived from the assessment, and it is the component of the nursing process that drives the interventions. 2. B. Allergies. Allergies must be determined so that the nurse does not administer a drug that would be dangerous to the client.
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