Data Collection Student Name: __J. Wilder____Patient Initials: _I.W.

___ Admitting diagnosis: Fever / Cyst Draining, uncontrolled diabetes

Coexisting Medical Conditions: HTN, DM, Left knee surgery, open heart surgery

Baseline Data Treatments and Diagnostic IV Therapy Medications

Equipment Tests

VS every q 8 hrs List them here Labs: Primary: Scheduled/ Routine

Temp: 98.9° f. n/a
pulse: 98 Surgery scheduled to CBC Insulin sliding scale
resp: 22 remove cyst. Placed on Estimated Glomerular Humulin 70/30
B/P: 140/84 insulin sliding scale, Filtration Rate Diovan 160
Pulse ox: 98 Humulin 70/30. BMP Norvasc 5 mg
Blood Glucose: 165 Allopurinol 200 mg
WT TPN: Valsartan 10 mg
212 lbs n/a Zyloprim 300mg
Diltiazem 30 mg

Diet: Regular Other: Blood Products:

(questionable due to her
coexisting conditions n/a n/a
would suggest PRN:
modifications to her diet)
Other: Tylenol 650 mg
Activity: n/a Morphine 25 mg
Bedrest

I & O for past 24°

n/a

1
Reference:

Date of Admission: 11/29/2010 How many days in hospital: 2 Date of care: 11/30/2010
Patient Initials: I.W. Gender: F Age: 71
Adm. DX: Fever / Cyst Draining, uncontrolled diabetes
Any hx of Surgery: Open heart surgery, Right knee surgery, hysterectomy

Past Med. History (PMH): HTN, diabetes, open heart surgery,

Hyperlipidemia and obesity

The Disease: Diabetes Symptomatology

Pathophysiology: Per Book:
Type 1 DM is a catabolic disorder in which circulating insulin is Hyperglycemia, Polydipsia, polyuria, polyphagia, glucose in urine, weight
very low or absent, plasma glucagon is elevated, and the loss and fatigue.
pancreatic beta cells fail to respond to all insulin-secretory
stimuli. Patients need exogenous insulin to reverse this
catabolic condition, prevent ketosis, decrease
hyperglucagonemia, and normalize lipid and protein
metabolism. Type 1 DM is an autoimmune disease. The
pancreas shows lymphocytic infiltration and destruction of
insulin-secreting cells of the islets of Langerhans, causing
insulin deficiency. Approximately 85% of patients have
circulating islet cell antibodies, and the majority also have
detectable anti-insulin antibodies before receiving insulin
therapy. Most islet cell antibodies are directed against glutamic
acid decarboxylase (GAD) within pancreatic B cells.

Perry & Potter

Define the Disease: A chronic condition in which the pancreases does
not produce enough insulin thus making the patient hyperglycemic.My Patient: Blood glucose 165 at 0800 then went to 220 at 1100. Decreased healing
is a symptom on diabetes which is evidenced by the abscess on the right axilla.

Medical/ Surgical Interventions

Per Book: n/a couldn’t find

My Patient: Will be undergoing surgery to remove cyst

2
 Coexisting Medical Conditions with Definitions Symptomatology
Hypertension: Hypertension is a chronic medical Severe headache, fatigue or confusion, vision problems, chest pain, difficulty
condition in which the blood pressure is elevated breathing, irregular heartbeat, blood in urine, pounding in neck, chest or ears.

cyst: an abnormal, closed sac-like structure within a tissue that

inflammation, drainage, fever, elevated wbc, swelling and pain
contains a liquid, gaseous, or semisolid substance.

Are any of the above medical conditions contributing to this patient’s current admitting
diagnosis? YES/ NO? Why or why not?
No

Reference:
NUTRITION CORRELATION TO

3
 MEDICAL CONDITION
Diet type: Diabetic in order to try to maintain or lower blood sugar

Supplement(s): No

Calorie Count: No

Aspiration Precautions: No

Feed: n/a

Enteral Feeding: n/A

• G-Tube
• J-Tube
• NGT

Feeding Pump/ Hourly Rate: N/a

• Continuous
• Intermittent
DESCRIBE MEDICAL TREATMENTS
(Physical Therapy, Respiratory Therapy, Ted hose, SCD, etc)

none

Reference:

4
DIAGNOSTIC TESTS
Test and Date Completed Results – ALL Correlate Results to Medical DX/ or
Medical Condition
Glucose 405 – High 60-110 Indicates diabetes
BUN 20 – High 7-17
SODIUM 136 – NORMAL 137-145
POTASSIUM 4.2 – NORMAL 3.6-5.0
CHLORIDE 97 – LOW 98-107
CO2 21 - LOW 22-30
ANION GAP 23 - HIGH 10-20
CREATININE 1.25 HIGH .6 -1.
CALCIUM 9.5 - NORMAL 8.4-10.2
WBC 19.3 - HIGH 3.5 – 10 Indicates infection possible related to cyst
RBC 4.53 - NORMAL - 4.00-5.50
HGB 13.6 - NORMAL - 11.4-15.4
HCT 41.2 – NORMAL – 32.8-45.6
MCV 90.9 - NORMAL – 80.0-95.0
MCH 30.1 - NORMAL – 26-34
MCHC 33.1 – NORMAL – 32.0-35.0
RDW 14.1 – NORMAL – 11.5-14.5
PLATELET COUNT 221 – NORMAL – 150-450
GFR Non African American 42 Abnormal < 60

Reference: chart

5

Drug Action and
Therapeutic
Dose
Insulin Lowers blood glucose by:
Regular stimulating glucose
uptake in skeletal muscle
and fat, inhibiting hepatic
glucose production. Other
actions of insulin:
inhibition of lipolysis and
proteolysis, enhanced
protein
synthesis. Therapeutic
Effects: Control of
hyperglycemia in diabetic
patients.
Subcut (Adults and
Children): 0.5–1
unit/kg/day in divided
dose
MEDICATION WORKSHEET
Side Effects Contraindications
ndo: HYPOGLYCEMIA. Local: lipodystrop Contraindicated
hy, pruritus, erythema, in: Hypoglycemia; Allergy
swelling. Misc: ALLERGIC REACTIONS or hypersensitivity to a
INCLUDING ANAPHYLAXIS. particular type of insulin,
preservatives, or other
additives.
Use Cautiously in: Stress
or infection—may
temporarily ↑ insulin
requirements;
Renal/hepatic impairment
—may ↓ insulin
requirements; OB: Pregna
ncy may temporarily ↑
insulin requirements.
RN parameters
High Alert: Insulin-related
medication errors have resulted
in patient harm and death. Clarify
ambiguous orders; do not accept
orders using the abbreviation “u”
for units, (can be misread as a
zero or the numeral 4; has
resulted in tenfold overdoses).
Assess patient periodically for
symptoms of hypoglycemia
(anxiety; restlessness; tingling in
hands, feet, lips, or tongue; chills;
cold sweats; confusion; cool,
pale skin; difficulty in
concentration; drowsiness;
nightmares or trouble sleeping;
excessive hunger; headache;
irritability; nausea; nervousness;
tachycardia; tremor; weakness;
unsteady gait)and hyperglycemia
(confusion, drowsiness; flushed,
dry skin; fruit-like breath odor;
rapid, deep breathing, polyuria;
loss of appetite; unusual thirst)
during therapy.Monitor body
weight periodically. Changes in
weight may necessitate changes
in insulin dose. Lab Test
Considerations: Monitor blood
glucose every 6 hr during
therapy, more frequently in
ketoacidosis and times of stress.
A1C may be monitered every 3–
6 months to determine
effectiveness. Toxicity and
Overdose: Overdose is
6

Humulin Lower blood glucose by :
70/30 stimulating glucose
uptake in skeletal muscle
and fat, inhibiting hepatic
glucose production. Other
actions: inhibition of
lipolysis and proteolysis,
enhanced protein
synthesis. Therapeutic
Effects: Control of
hyperglycemia in diabetic
patients.
Dose depends on blood
glucose, response, and
many other factors.
Subcut (Adults and
Children): 0.5–1
unit/kg/day
Endo: HYPOGLYCEMIA. Local: erythema
, lipodystrophy, pruritis,
swelling. Misc: ALLERGIC REACTIONS
INCLUDING ANAPHYLAXIS.
Contraindicated
in: Hypoglycemia; Allergy
or hypersensitivity to a
particular type of insulin,
preservatives, or other
additives.
Use Cautiously in: Stress
and infection (may
temporarily ↑ insulin
requirements);
Renal/hepatic impairment
(may ↓ insulin
requirements);
manifested by symptoms of
hypoglycemia. Mild
hypoglycemia may be treated by
ingestion of oral glucose. Severe
hypoglycemia is a life-threatening
emergency; treatment consists of
IV glucose, glucagon, or
epinephrine.
High Alert: Insulin-related
medication errors have resulted
in patient harm and death. Clarify
ambiguous orders; do not accept
orders using the abbreviation “u”
for units, (can be misread as a
zero or the numeral 4; has
resulted in tenfold overdoses).
Assess for symptoms of
hypoglycemia (anxiety;
restlessness; tingling in hands,
feet, lips, or tongue; chills; cold
sweats; confusion; cool, pale
skin; difficulty in concentration;
drowsiness; excessive hunger;
headache; irritability; nightmares
or trouble sleeping; nausea;
nervousness; tachycardia;
tremor; weakness; unsteady
gait) and hyperglycemia
(confusion, drowsiness; flushed,
dry skin; fruit-like breath odor;
rapid, deep breathing, polyuria;
loss of appetite; nausea;
vomiting; unusual thirst)
periodically during
therapy.Toxicity and
Overdose: Overdose is
manifested by symptoms of
hypoglycemia. Mild
hypoglycemia may be treated by
7
 ingestion of oral glucose. Severe
hypoglycemia is a life-threatening
emergency; treatment consists of
IV glucose, glucagon, or
epinephrine. Toxicity and
Overdose: Overdose is
manifested by symptoms of
hypoglycemia. Mild
hypoglycemia may be treated by
ingestion of oral glucose. Severe
hypoglycemia is a life-threatening
emergency; treatment consists of
IV glucose, glucagon, or
epinephrine.
Diovan Blocks vasoconstrictor CNS: dizziness, anxiety, depression, Contraindicated Assess blood pressure (lying,
160 and aldosterone- fatigue, headache, insomnia, in: Hypersensitivity; OB: C sitting, standing) and pulse
producing effects of weakness.CV: hypotension, chest pain, an cause injury or death of periodically during therapy. Notify
angiotensin II at receptor edema, fetus;Lactation: Discontinu health care professional of
sites, including vascular tachycardia. Derm: rashes. EENT: nasal e drug or provide formula. significant changes.Monitor
smooth muscle and the congestion, pharyngitis, rhinitis, Use Cautiously in: CHF frequency of prescription refills to
adrenal sinusitis. GI: abdominal pain, diarrhea, (may result in azotemia, determine adherence.Assess
glands. Therapeutic drug-induced hepatitis, dyspepsia, oliguria, acute renal failure patient for signs of angioedema
Effects:Lowering of blood nausea, vomiting. GU: impaired renal and/or death); Volume- or (dyspnea, facial swelling). May
pressure. Slowed function. F and salt-depleted patients or rarely cause angioedema.Test
progression of diabetic E hyperkalemia.MS: arthralgia, back pain, patients receiving high Considerations: Monitor renal
nephropathy (irbesartan myalgia. Misc: ANGIOEDEMA. doses of diuretics (correct function and electrolyte levels
and losartan only). deficits before initiating periodically. Serum potassium,
Reduced cardiovascular therapy or initiate at lower BUN, and serum creatinine may
death and hospitalizations doses); Black patients be ↑.May cause ↑ AST, ALT, and
due to CHF in patients (may not be effective); serum bilirubin (candesartan and
with CHF (candesartan Impaired renal function olmesartan only).May cause ↑
and valsartan only). due to primary renal uric acid, slight ↓ in hemoglobin
Decreased risk of disease or CHF (may and hematocrit, neutropenia, and
cardiovascular death in worsen renal function); thrombocytopenia.Emphasize the
patients with left Obstructive biliary importance of continuing to take
ventricular systolic disorders (telmisartan) or as directed, even if feeling well.
dysfunction who are post- hepatic impairment Take missed doses as soon as
MI (valsartan only). (candesartan, losartan, or remembered if not almost time
Decreased risk of stroke telmisartan); Women of for next dose; do not double
in patients with childbearing potential; doses. Instruct patient to take
hypertension and left medication at the same time
8
ventricular hypertrophy
(effect may be less in
black patients) (losartan
only).
PO (Adults): Hypertensio
n—80 mg or 160 mg once
daily initially in patients
who are not volume-
depleted; may be ↑ to 320
mg once daily; CHF—40
mg twice daily, may be
titrated up to target dose
of 160 mg twice daily as
tolerated; Post-MI—20
mg twice daily (may be
initiated ≥ 12 hr after MI);
dose may be titrated up to
target dose of 160 mg
twice daily, as tolerated.
each day. Warn patient not to
discontinue therapy unless
directed by health care
professional.Caution patient to
avoid salt substitutes containing
potassium or food containing
high levels of potassium or
sodium unless directed by health
care professional. See Appendix
M.Caution patient to avoid
sudden changes in position to
decrease orthostatic
hypotension. Use of alcohol,
standing for long periods,
exercising, and hot weather may
increase orthostatic
hypotension.May cause
dizziness. Caution patient to
avoid driving or other activities
requiring alertness until response
to medication is known.Advise
patient to consult health care
professional before taking any
OTC or herbal cough, cold, or
allergy remedies or other
medications.Instruct patient to
notify health care professional if
swelling of face, eyes, lips, or
tongue occurs, or if difficulty
swallowing or breathing
occurs.Emphasize the
importance of follow-up exams to
evaluate effectiveness of
medication.Hypertension: Encour
age patient to comply with
additional interventions for
hypertension (weight reduction,
low-sodium diet, discontinuation
of smoking, moderation of
alcohol consumption, regular
exercise, stress management)
9
 Medication controls but dose not
cure hypertension.Instruct patient
and family on proper technique
for monitoring blood pressure.
Advise them to check blood
pressure at least weekly and to
report significant changes .

Norvasc Inhibits the transport of CNS: headache, dizziness, Contraindicated Monitor blood pressure and pulse
5 mg calcium into myocardial fatigue. CV: peripheral edema, angina, in: Hypersensitivity; before therapy, during dose
and vascular smooth bradycardia, hypotension, Systolic blood pressure titration, and periodically during
muscle cells, resulting in palpitations. GI: gingival hyperplasia, <90 mmHg. therapy. Monitor ECG
inhibition of excitation- nausea. Derm: flushing. Use Cautiously in: Severe periodically during prolonged
contraction coupling and hepatic impairment therapy.Monitor intake and
subsequent (dosage reduction output ratios and daily weight.
contraction. Therapeutic recommended); Aortic Assess for signs of CHF
Effects: Systemic stenosis; History of CHF; (peripheral edema,
vasodilation resulting in Geri: Dose reduction rales/crackles, dyspnea, weight
decreased blood recommended; ↑ risk of gain, jugular venous
pressure. Coronary hypotension. distention) .Angina: Assess
vasodilation resulting in location, duration, intensity, and
decreased frequency and precipitating factors of patient’s
severity of attacks of anginal pain.Lab Test
angina. Considerations: Total serum
PO (Geriatric calcium concentrations are not
Patients): Antihypertensiv affected by calcium channel
e—Initiate therapy at 2.5 blockers.PO: May be
mg/day, ↑ as administered without regard to
required/tolerated (up to meals.Advise patient to take
10 mg/day); antianginal— medication as directed, even if
initiate therapy at 5 feeling well. Take missed doses
mg/day, ↑ as as soon as possible unless
required/tolerated (up to almost time for next dose; do not
10 mg/day). double doses. May need to be
discontinued gradually.Advise
patient to avoid large amounts
(6–8 glasses of grapefruit
juice/day) during therapy.Instruct
patient on correct technique for
monitoring pulse. Instruct patient
10
to contact health care
professional if heart rate is <50
bpm.Caution patient to change
positions slowly to minimize
orthostatic hypotension.May
cause drowsiness or dizziness.
Advise patient to avoid driving or
other activities requiring
alertness until response to the
medication is known.Instruct
patient on importance of
maintaining good dental hygiene
and seeing dentist frequently for
teeth cleaning to prevent
tenderness, bleeding, and
gingival hyperplasia (gum
enlargement).Instruct patient to
avoid concurrent use of alcohol
or OTC medications, especially
cold preparations, without
consulting health care
professional.Advise patient to
notify health care professional if
irregular heartbeats, dyspnea,
swelling of hands and feet,
pronounced dizziness, nausea,
constipation, or hypotension
occurs or if headache is severe
or persistent.Caution patient to
wear protective clothing and use
sunscreen to prevent
photosensitivity reactions.Advise
patient to inform health care
professional of medication
regimen before treatment or
surgery.Angina: Instruct patient
on concurrent nitrate or beta-
blocker therapy to continue
taking both medications as
directed and to use SL
nitroglycerin as needed for
11

Allopurin Inhibits the production of
ol 200 uric acid by inhibiting the
mg action of xanthine
oxidase.Therapeutic
Effects: Lowering of
serum uric acid levels.
Management of Gout
PO (Adults and Children
>10 yr): Initially—100
mg/day; increase at
weekly intervals based on
serum uric acid (not to
exceed 800 mg/day).
Doses >300 mg/day
CV: hypotension, flushing, hypertension,
bradycardia, and heart failure (reported
with IV
administration). CNS: drowsiness. GI: diar
rhea, hepatitis, nausea,
vomiting. GU: renal failure,
hematuria. Derm: rash (discontinue drug
at first sign of rash),
urticaria. Hemat: bone marrow
depression. Misc: hypersensitivity
reactions.
anginal attacks.Advise patient to
contact health care professional
if chest pain does not improve or
worsens after therapy, if it occurs
with diaphoresis, if shortness of
breath occurs, or if severe,
persistent headache
occurs.Caution patient to discuss
exercise restrictions with health
care professional before
exertion.Hypertension: Encourag
e patient to comply with other
interventions for hypertension
(weight reduction, low-sodium
diet, smoking cessation,
moderation of alcohol
consumption, regular exercise,
and stress management).
Medication controls but does not
cure hypertension.Instruct patient
and family in proper technique for
monitoring blood pressure.
Advise patient to take blood
pressure weekly and to report
significant changes to health care
professional .
Use Cautiously in: Acute Monitor intake and output ratios.
attacks of gout; Renal Decreased kidney function can
insufficiency (dose cause drug accumulation and
reduction required if CCr toxic effects. Ensure that patient
<20 mL/min); Dehydration maintains adequate fluid intake
(adequate hydration (minimum 2500–3000 mL/day) to
necessary); Geri: lower minimize risk of kidney stone
dose formation.Assess patient for rash
or more severe hypersensitivity
reactions. Discontinue allopurinol
immediately if rash occurs.
Therapy should be discontinued
permanently if reaction is severe.
Therapy may be reinstated after
12
should be given in divided a mild reaction has subsided, at
doses; Maintenance dose a lower dose (50 mg/day with
—100–200 mg 2–3 times very gradual titration). If skin rash
daily. Doses of ≤300 mg recurs, discontinue
may be given as a single permanently .Gout: Monitor for
daily dose. joint pain and swelling. Addition
Management of of colchicine or NSAIDs may be
Secondary Hyperuricemia necessary for acute attacks.
PO (Adults and Children Prophylactic doses of colchicine
>10 yr): 600–800 mg/day or an NSAID should be
in 2–3 divided doses administered concurrently during
starting 1–2 days before the first 3–6 mo of therapy
chemotherapy or because of an increased
radiation. frequency of acute attacks of
gouty arthritis during early
therapy.Lab Test
Considerations: Serum and urine
uric acid levels usually begin to ↓
2–3 days after initiation of oral
therapy.Monitor blood glucose in
patients receiving oral
hypoglycemic agents. May cause
hypoglycemia.Monitor
hematologic, renal, and liver
function tests before and
periodically during therapy,
especially during the first few
months. May cause ↑ serum
alkaline phosphatase, bilirubin,
AST, and ALT levels. ↓ CBC and
platelets may indicate bone
marrow depression. ↑ BUN,
serum creatinine, and CCr may
indicate nephrotoxicity. These
are usually reversed with
discontinuation of therapy
.Instruct patient to take
allopurinol as directed. Take
missed doses as soon as
remembered. If dosing schedule
is once daily, do not take if
13
remembered the next day. If
dosing schedule is more than
once a day, take up to 300 mg
for the next dose.Instruct patient
to continue taking allopurinol
along with an NSAID or
colchicine during an acute attack
of gout. Allopurinol helps prevent,
but does not relieve, acute gout
attacks.Alkaline diet may be
ordered. Urinary acidification with
large doses of vitamin C or other
acids may increase kidney stone
formation (see Appendix M).
Advise patient of need for
increased fluid intake.May
occasionally cause drowsiness.
Caution patient to avoid driving
or other activities requiring
alertness until response to drug
is known.Instruct patient to report
skin rash, blood in urine, or
influenza symptoms (chills, fever,
muscle aches and pains, nausea,
or vomiting) to health care
professional immediately; skin
rash may indicate
hypersensitivity.Advise patient
that large amounts of alcohol
increase uric acid concentrations
and may decrease the
effectiveness of
allopurinol.Emphasize the
importance of follow-up exams to
monitor effectiveness and side
effects.

14
Valsartan Blocks vasoconstrictor
10 mg and aldosterone-
producing effects of
angiotensin II at receptor
sites, including vascular
smooth muscle and the
adrenal glands. Reduced
cardiovascular death and
hospitalizations due to
CHF in patients with CHF
(candesartan and
valsartan only).
Decreased risk of
cardiovascular death in
patients with left
ventricular systolic
dysfunction who are post-
MI (valsartan only).
Hypertension—80 mg or
160 mg once daily initially
in patients who are not
volume-depleted; may be
↑ to 320 mg once
daily; CHF—40 mg twice
daily, may be titrated up
to target dose of 160 mg
twice daily as
tolerated; Post-MI—20
mg twice daily (may be
initiated ≥ 12 hr after MI);
dose may be titrated up to
target dose of 160 mg
twice daily, as tolerated.
CNS: dizziness, anxiety, depression,
fatigue, headache, insomnia,
weakness.CV: hypotension, chest pain,
edema,
tachycardia. Derm: rashes. EENT: nasal
congestion, pharyngitis, rhinitis,
sinusitis. GI: abdominal pain, diarrhea,
drug-induced hepatitis, dyspepsia,
nausea, vomiting. GU: impaired renal
function. F and
E hyperkalemia.MS: arthralgia, back pain,
myalgia. Misc: ANGIOEDEMA.
Use Cautiously in: CHF
(may result in azotemia,
oliguria, acute renal failure
and/or death); Volume- or
salt-depleted patients or
patients receiving high
doses of diuretics (correct
deficits before initiating
therapy or initiate at lower
doses); Black patients
(may not be effective);
Impaired renal function
due to primary renal
disease or CHF (may
worsen renal function);
Obstructive biliary
disorders (telmisartan) or
hepatic impairment
(candesartan, losartan, or
telmisartan); Women of
childbearing potential;
Assess blood pressure (lying,
sitting, standing) and pulse
periodically during therapy. Notify
health care professional of
significant changes. Assess
patient for signs of angioedema
(dyspnea, facial swelling). May
rarely cause
angioedema.CHF: Monitor daily
weight and assess patient
routinely for resolution of fluid
overload (peripheral edema,
rales/crackles, dyspnea, weight
gain, jugular venous
distention)Lab Test
Considerations: Monitor renal
function and electrolyte levels
periodically. Serum potassium,
BUN, and serum creatinine may
be ↑.May cause ↑ AST, ALT, and
serum bilirubin (candesartan and
olmesartan only).May cause ↑
uric acid, slight ↓ in hemoglobin
and hematocrit, neutropenia, and
thrombocytopenia. Correct
volume depletion, if possible,
prior to initiation of therapy.
PO: May be administered without
regard to meal Emphasize the
importance of continuing to take
as directed, even if feeling well.
Take missed doses as soon as
remembered if not almost time
for next dose; do not double
doses. Instruct patient to take
medication at the same time
each day. Warn patient not to
discontinue therapy unless
directed by health care
professional. aution patient to
avoid salt substitutes containing
15
potassium or food containing
high levels of potassium or
sodium unless directed by health
care professional. See Appendix
M. Caution patient to avoid
sudden changes in position to
decrease orthostatic
hypotension. Use of alcohol,
standing for long periods,
exercising, and hot weather may
increase orthostatic hypotension.
Advise patient to consult health
care professional before taking
any OTC or herbal cough, cold,
or allergy remedies or other
medications. Instruct patient to
notify health care professional if
swelling of face, eyes, lips, or
tongue occurs, or if difficulty
swallowing or breathing occurs.
Emphasize the importance of
follow-up exams to evaluate
effectiveness of medication.
Hypertension: Encourage patient
to comply with additional
interventions for hypertension
(weight reduction, low-sodium
diet, discontinuation of smoking,
moderation of alcohol
consumption, regular exercise,
stress management) Medication
controls but dose not cure
hypertension. Instruct patient and
family on proper technique for
monitoring blood pressure.
Advise them to check blood
pressure at least weekly and to
report significant changes .

16
Zyloprim Inhibits the production of
300mg uric acid by inhibiting the
action of xanthine
oxidase.Therapeutic
Effects: Lowering of
serum uric acid levels.
PO (Adults and Children
>10 yr): Initially—100
mg/day; increase at
weekly intervals based on
serum uric acid (not to
exceed 800 mg/day).
Doses >300 mg/day
should be given in divided
doses; Maintenance dose
—100–200 mg 2–3 times
daily. Doses of ≤300 mg
may be given as a single
daily dose.
CV: hypotension, flushing, hypertension,
bradycardia, and heart failure (reported
with IV
administration). CNS: drowsiness. GI: diar
rhea, hepatitis, nausea,
vomiting. GU: renal failure,
hematuria. Derm: rash (discontinue drug
at first sign of rash),
urticaria. Hemat: bone marrow
depression. Misc: hypersensitivity
reactions.
Use Cautiously in: Acute Monitor intake and output ratios.
attacks of gout; Renal Decreased kidney function can
insufficiency (dose cause drug accumulation and
reduction required if CCr toxic effects. Ensure that patient
<20 mL/min); Dehydration maintains adequate fluid intake
(adequate hydration (minimum 2500–3000 mL/day) to
necessary) minimize risk of kidney stone
formation. Assess patient for
rash or more severe
hypersensitivity reactions.
Discontinue allopurinol
immediately if rash occurs.
Therapy should be discontinued
permanently if reaction is severe.
Therapy may be reinstated after
a mild reaction has subsided, at
a lower dose (50 mg/day with
very gradual titration). If skin rash
recurs, discontinue
permanently .Gout: Monitor for
joint pain and swelling. Addition
of colchicine or NSAIDs may be
necessary for acute attacks.
Prophylactic doses of colchicine
or an NSAID should be
administered concurrently during
the first 3–6 mo of therapy
because of an increased
frequency of acute attacks of
gouty arthritis during early
therapy.Lab Test
Considerations: Serum and urine
uric acid levels usually begin to ↓
2–3 days after initiation of oral
therapy.Monitor blood glucose in
patients receiving oral
hypoglycemic agents. May cause
hypoglycemia. Monitor
hematologic, renal, and liver
function tests before and
periodically during therapy,
17
especially during the first few
months. May cause ↑ serum
alkaline phosphatase, bilirubin,
AST, and ALT levels. ↓ CBC and
platelets may indicate bone
marrow depression. ↑ BUN,
serum creatinine, and CCr may
indicate nephrotoxicity. These
are usually reversed with
discontinuation of
therapy .PO: May be
administered after milk or meals
to minimize gastric irritation; give
with plenty of fluid. May be
crushed and given with fluid or
mixed with food for patients who
have difficulty swallowing.
Instruct patient to take allopurinol
as directed. Take missed doses
as soon as remembered. If
dosing schedule is once daily, do
not take if remembered the next
day. If dosing schedule is more
than once a day, take up to 300
mg for the next dose.Instruct
patient to continue taking
allopurinol along with an NSAID
or colchicine during an acute
attack of gout. Allopurinol helps
prevent, but does not relieve,
acute gout attacks. Alkaline diet
may be ordered. Urinary
acidification with large doses of
vitamin C or other acids may
increase kidney stone formation
(see Appendix M). Advise patient
of need for increased fluid intake.
May occasionally cause
drowsiness. Caution patient to
avoid driving or other activities
requiring alertness until response
18
 to drug is known. Instruct patient
to report skin rash, blood in urine,
or influenza symptoms (chills,
fever, muscle aches and pains,
nausea, or vomiting) to health
care professional immediately;
skin rash may indicate
hypersensitivity. Advise patient
that large amounts of alcohol
increase uric acid concentrations
and may decrease the
effectiveness of allopurinol.
Emphasize the importance of
follow-up exams to monitor
effectiveness and side effects.

Diltiazem Inhibits transport of Sick sinus syndrome; 2nd- or 3rd-degree Sick sinus syndrome; 2nd- Monitor blood pressure and pulse
30 mg calcium into myocardial AV block (unless an artificial pacemaker is or 3rd-degree AV block prior to therapy, during dose
and vascular smooth in place); Systolic blood pressure <90 (unless an artificial titration, and periodically during
muscle cells, resulting in mmHg; Recent MI or pulmonary pacemaker is in place); therapy. Monitor ECG
inhibition of excitation- congestion; Concurrent use of rifampin. Systolic blood pressure periodically during prolonged
contraction coupling and <90 mmHg; Recent MI or therapy. May cause prolonged
subsequent pulmonary congestion; PR interval. Monitor intake and
contraction. Therapeutic Concurrent use of rifampin. output ratios and daily
Effects: Systemic Use Cautiously in: Severe weight.Assess for signs of CHF
vasodilation resulting in hepatic impairment (↓ dose (peripheral edema,
decreased blood recommended); Geri: ↓ rales/crackles, dyspnea, weight
pressure. Coronary dose; slower IV infusion gain, jugular venous distention).
vasodilation resulting in rate recommended; ↑ risk Monitor frequency of prescription
decreased frequency and of hypotension; consider refills to determine adherence.
severity of attacks of age-related decrease in Patients receiving digoxin
angina. Reduction of body mass, ↓ concurrently with calcium
ventricular rate in atrial hepatic/renal/cardiac channel blockers should have
fibrillation or flutter. function, concurrent drug routine serum digoxin levels
PO (Adults): 30–120 mg therapy and other disease checked and be monitored for
3–4 times daily or 60–120 states); Severe renal signs and symptoms of digoxin
mg twice daily as SR impairment; Serious toxicity . Angina: Assess location,
capsules or 180–240 mg ventricular arrhythmias or duration, intensity, and
once daily as CD or XR CHF; precipitating factors of patient’s
capsules or LA tablets (up anginal pain.
19
to 360 mg/day). Arrhythmias: Monitor ECG
continuously during
administration. Report
bradycardia or prolonged
hypotension promptly.
Emergency equipment and
medication should be available.
Monitor blood pressure and pulse
before and frequently during
administration. Lab Test
Considerations: Total serum
calcium concentrations are not
affected by calcium channel
blockers. Monitor serum
potassium periodically.
Hypokalemia ↑ the risk of
arrhythmias and should be
corrected. Monitor renal and
hepatic functions periodically
during long-term therapy. May
cause ↑ in hepatic enzymes after
several days of therapy, which
return to normal on
discontinuation of therapy .
PO: May be administered without
regard to meals. May be
administered with meals if GI
irritation becomes a problem. Do
not open, crush, break, or chew
sustained-release capsules or
tablets Empty tablets that appear
in stool are not significant. Crush
and mix diltiazem with food or
fluids for patients having difficulty
swallowing . Advise patient to
take medication as directed at
the same time each day, even if
feeling well. Take missed doses
as soon as possible unless
almost time for next dose; do not
double doses. May need to be
20
discontinued gradually. Advise
patient to avoid large amounts
(6–8 glasses of grapefruit
juice/day) during therapy. Instruct
patient on correct technique for
monitoring pulse. Instruct patient
to contact health care
professional if heart rate is <50
bpm. Caution patient to change
positions slowly to minimize
orthostatic hypotension. Instruct
patient on importance of
maintaining good dental hygiene
and seeing dentist frequently for
teeth cleaning to prevent
tenderness, bleeding, and
gingival hyperplasia (gum
enlargement). Instruct patient to
avoid concurrent use of alcohol
or OTC medications, especially
cough and cold preparations,
without consulting health care
professional. Caution patient to
wear protective clothing and use
sunscreen to prevent
photosensitivity reactions.
Hypertension: Encourage patient
to comply with other interventions
for hypertension (weight
reduction, low-sodium diet,
smoking cessation, moderation
of alcohol consumption, regular
exercise, and stress
management). Medication
controls but does not cure
hypertension. Instruct patient and
family in proper technique for
monitoring blood pressure.
Advise patient to take blood
pressure weekly and to report
significant changes to health care
21
 professional .

Referenc
e: Davis
Drug
2010

INTRAVENOUS THERAPY
IV Therapy n/a Correlate to Medical Conditions
IV Solution n/a

Hourly rate n/a

IV Site location and condition n/a

IV Solution n/a

Hourly rate n/a

IV Site and condition n/a

IV Solution n/a

Hourly rate n/a

IV Site and condition n/a

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