NURS 1566 Clinical Form 3: Clinical Medications Worksheets

(You will need to make additional copies of these forms)

Generic Name Trade Name Classification Dose Route Time/frequency

labetalol Normodyne, antianginals, 200 mg PO bid
Trandate antihypertensives,
Beta Blockers
Peak Onset Duration Normal dosage range
1-4 hrs 20 min-2 8-12 hrs 100 mg twice daily initially, may be increased by 100 mg
hrs twice daily q 2-3 days as needed (usual range 400-800
mg/day in 2-3 divided doses; doses up to 1.2-2.4 g/day
have been used)
Why is your patient getting this medication For IV meds, compatibility with IV drips and/or
HTN solutions
N/A
Mechanism of action and indications Nursing Implications (what to focus on)
(Why med ordered) Contraindications/warnings/interactions
Blocks stimulation of beta1 (myocardial)- and beta2 Uncompensated CHF, pulmonary edema, cardiogenic
(pulmonary, vascular, and uterine)-adrenergic shock, bradycardia or heart block. Use cautiously in:
receptor sites. Also has alpha1-adrenergic blocking Renal impairment, hepatic impairment, geriatric patients
activity, which may result in more orthostatic (increased sensitivity to beta blockers; initial dosage
hypotension. reduction recommended), pulmonary disease (including
asthma), Diabetes mellitus (may mask signs of
hypoglycemia), thyrotoxicosis (may mask symptoms).
Patients with a history of severe allergic reactions
(intensity of reactions may be increased), pregnancy,
lactation, or children (safety not established; may cause
fetal/neonatal bradycardia, hypotension, hypoglycemia, or
respiratory depression).
Common side effects
Fatigue, weakness, orthostatic hypotension, impotence,
ARRHYTHMIAS, BRADYCARDIA, CHF, PULMONARY EDEMA
Interactions with other patient drugs, OTC or
herbal medicines (ask patient specifically)
Additive hypotension may occur with other
antihypertensives (Avapro).
Lab value alterations caused by medicine
May cause increased BUN, serum lipoprotein, potassium,
triglyceride, and uric acid levels. May cause increased
ANA titers. May cause increase in blood glucose levels,
May cause increased serum alkaline phosphatase, LDH,
AST, and ALT levels. Discontinue if jaundice or laboratory
signs of hepatic function impairment occur.
Be sure to teach the patient the following about this
medication
Instruct patient to take medication exactly as directed, at
the same time each day, even if feeling well; do not skip or
double up on missed doses. If a dose is missed, it should be
taken as soon as possible up to 8 hr before next dose.
Abrupt withdrawal may precipitate life-threatening
arrhythmias, hypertension, or myocardial ischemia. Advise
patient to make sure enough medication is available for
weekends, holidays, and vacations. A written prescription
may be kept in wallet in case of emergency. Teach patient
and family how to check pulse and blood pressure. Instruct
them to check pulse daily and blood pressure biweekly.
Advise patient to hold dose and contact health care
professional if pulse is <50 bpm or blood pressure changes
significantly. Advise patients to make position changes
slowly to minimize orthostatic hypotension, especially
during initiation of therapy or when dose is increased.
Patients taking oral labetalol should be especially cautious
when drinking alcohol, standing for long periods, or
exercising, and during hot weather, because orthostatic
hypotension is enhanced. Caution patient that this
medication may increase sensitivity to cold. Instruct
patient to consult health care professional before taking any
OTC medications, especially cold preparations,
concurrently with this medication. Patients with diabetes
should closely monitor blood glucose, especially if
weakness, malaise, irritability, or fatigue occurs.
Medication may mask tachycardia and increased blood
pressure as signs of hypoglycemia, but dizziness and
sweating may still occur. Advise patient to notify health
care professional if slow pulse, difficulty breathing,
wheezing, cold hands and feet, dizziness, light-headedness,
confusion, depression, rash, fever, sore throat, unusual
bleeding, or bruising occurs. Instruct patient to inform
health care professional of medication regimen prior to
treatment or surgery. Advise patient to carry identification
describing disease process and medication regimen at all
times. Reinforce the need to continue additional therapies
for hypertension (weight loss, sodium restriction, stress
Nursing Process- Assessment
(Pre-administration assessment)
Monitor blood pressure and pulse
frequently during dose adjustment and
periodically during therapy. Assess for
orthostatic hypotension when assisting
patient up from supine position. Monitor
intake and output ratios and daily weight.
Assess patient routinely for evidence of
fluid overload (peripheral edema,
dyspnea, rales/crackles, fatigue, weight
gain, jugular venous distention).
Assessment Evaluation
Why would you hold or not give this Check after giving
med? Check frequency of refills to
Signs of overdose (bradycardia, severe determine compliance.
dizziness or fainting, severe Decrease in blood pressure.
drowsiness, dyspnea, bluish
fingernails or palms, seizures). Notify
physician or other health care
professional immediately if these
signs occur. Glucagon has been used
to treat bradycardia and hypotension.