786
P A R T 8
Drugs acting on the cardiovascular system
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
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.
