Name of Patient: W.P.

Problem: Bronchial Asthma w/ AE

Age: 55

Sex: M

Room: Male Medicare Ward

Student Nurse: BAUTISTA, Jesther Rowen B. (BSN III-1)

NAME OF DRUG Generic: Cefuroxim e Brand: Ceftin Dosage: 750 mg IV q8

GENERAL INDICATIONS, CLASSIFICA CONTRAINDICAT TION IONS cephalosporin Indicated for: antibiotic o bacterial infections, such as: o bronchitis o gonorrhea o Lyme disease o infections of the ears, throat, sinuses, urinary tract, and skin Contraindicated to: o allergy to cephalosporin antibiotics

MECHANISM OF ACTION Ceftin is a lactam type antibiotic. More specifically, it is a secondgeneration cephalosporin. Cephalosporins work the same way as penicillins: they interfere with the peptidoglycan synthesis of the bacterial wall by inhibiting the final transpeptidation needed for the cross-links.

SIDE EFFECTS o CNS: Headache, dizziness, lethargy, paresthesias o GI: Nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, pseudomembranous colitis, liver toxicity o Hematologic: Bone marrow depression: decreased WBC, decreased platelets, decreased Hct o GU: Nephrotoxicity o Hypersensitivity: Ranging from rash to fever to anaphylaxis, serum sickness reaction o Other: Superinfections, disulfiram-like reaction with alcohol

NURSING CONSIDERATIONS o Determine history of hypersensitivity reactions to cephalosporins, penicillins, and history of allergies, particularly to drugs, before therapy is initiated. o Inspect IM and IV injection sites frequently for signs of phlebitis. o Report onset of loose stools or diarrhea. Although pseudomembranous colitis. o Monitor I&O rates and pattern: Especially important in severely ill patients receiving high doses. Report any significant changes. o Prior to reconstitution, protect drug from light. The power and reconstituted drug may darken without affecting potency. o Continue therapy for at least 10 days in infections due to Streptococcus pyogenes.

Name of Patient: W.P. Problem: Bronchial Asthma w/ AE

Age: 55

Sex: M

Room: Male Medicare Ward

Student Nurse: BAUTISTA, Jesther Rowen B. (BSN III-1)

NAME OF DRUG Generic: Captopril Brand: Capoten Dosage: 25 mg q6

GENERAL CLASSIFICA TION Angiotensinconverting enzyme (ACE) inhibitor

INDICATIONS, CONTRAINDICAT IONS Indicated for: o Treatment of hypertension alone or in combination with thiazidetype diuretics o Treatment of CHF in patients unresponsive to conventional therapy; used with diuretics and digitalis o Treatment of diabetic nephropathy o Treatment of left ventricular dysfunction after MI Contraindicated to: o Contraindicated with allergy to captopril, history of angiodema. o Use cautiously with impaired renal function; CHF; salt or volume depletion, lactation, pregnancy.

MECHANISM OF ACTION Blocks ACE from converting angiotensin I to angiotensin II, a powerful vasoconstrictor, leading to decreased blood pressure, decreased aldosterone secretion, a small increase in serum potassium levels, and sodium and fluid loss; increased prostaglandin synthesis also may be involved in the antihypertensive action.

SIDE EFFECTS

NURSING CONSIDERATIONS Assessment o History: Allergy to captopril, history of angioedema, impaired renal function, CHF, salt or volume depletion, pregnancy, lactation o Physical: Skin color, lesions, turgor; T; P, BP, peripheral perfusion; mucous membranes, bowel sounds, liver evaluation; urinalysis, renal and liver function tests, CBC and differential Interventions o Administer 1 hr before or 2 hr after meals. o Alert surgeon and mark patient's chart with notice that captopril is being taken; the angiotensin II formation subsequent to compensatory renin release during surgery will be blocked; hypotension may be reversed with volume expansion. o Monitor patient closely for fall in BP secondary to reduction in fluid volume (excessive perspiration and dehydration, vomiting, diarrhea); excessive hypotension may occur. o Reduce dosage in patients with impaired renal function. Teaching points o Take drug 1 hr before or 2 hr after meals; do not take

o CV: Tachycardia, angina

pectoris, MI, Raynaud's syndrome, CHF, hypotension in salt- or volume-depleted patients o Dermatologic: Rash, pruritus, pemphigoid-like reaction, scalded mouth sensation, exfoliative dermatitis, photosensitivity, alopecia o GI: Gastric irritation, aphthous ulcers, peptic ulcers, dysgeusia, cholestatic jaundice, hepatocellular injury, anorexia, constipation o GU: Proteinuria, renal insufficiency, renal failure, polyuria, oliguria, urinary frequency o Hematologic: Neutropenia, agranulocytosis, thrombocytopenia, hemolytic anemia, pancytopenia o Other: Cough, malaise, dry mouth, lymphadenopathy