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NAME OF DRUG ORDERED DOSE MECHANISM OF ACTOIN INDICATION CONTRAINDICATION SIDE EFFECTS &ADVERSE REACTONS NURSING RESPONSIBILITY
1 gm IV Q 12 hrs X 4 doses
Bactericidal: Inhibits synthesis of Bacterial cell wall, causing cell death
Contraindicated with allergy to cephalosporin or penicillins or penicillins
CNS: head ache,dizziness, lethargy,parestesia GI: nausea, vomiting, abdominal pain, flatulence, liver toxicity GU: nephrotoxicity Hematologic: bone marrow depression Hypersensitivity: ranging from rash, fever to anaphylaxis Local: pain, inflammation at IV site
> Know the 10 Rights in drug administration >Perform skin test before administering to detect if the patient is allergic to the drug >Assess for patient’s history of liver and renal depression, lactation and pregnancy >Have vitamin K available in case hperprothombinemia occurs >Discontinue if hypersensitivity occurs >Inform the patient about the side effects >Instruct patient to avoid alcohol while taking the drug and for 3 days because severe reactions often occur > Know the 10 Rights in drug administration >Get patient’s history of allergy to tramadol or opioids >Inform the patrient about the side effects if sweating or CNS effects
50 mg IV Q 8 hours
Binds to mu-opioid receptors and inhibits the reuptake of norepinephrine and serotonin; causes many effects similar to the opioids,dizziness, constipation
Relief of moderate to moderately severe pain
Contraindicated with allergy to tramadol or opioids or acute intoxication with alcohol, opioids or psychoactive drug
CNS: sedation, dizziness or vertigo, head ache, confusion, dreaming , sweating, anxiety and seizures CV: Hypotension, tachycardia, bradycardia
NAME OF DRUG
MECHANISM OF ACTOIN
SIDE EFFECTS &ADVERSE REACTONS
Occur >Limit use in patients with past/present history of addiction to or dependence to opioids Ketorolac 30 mg IV Q 8 hours Anti-inflammatory Short-term management and analgesic activity; of pain inhibits prostaglandins and leukotriene synthesis Contraindicated with significant renal impairment, during labor and delivery CNS: head ache, dizziness, insomnia, fatigue, tinnitus Dermatology: rash, pruritus, sweating, dry mucous membrane GI: nausea, vomiting, dyspepsia, gastro-intestinal pain, diarrhea, constipation GU: dysruia, renal impairment Respiratory: dyspnea, hemoptysis, pharyngitis, bronchospasm, Other: peripheral edema, anaphylactic reaction to anaphylactic shock >Know the 10 Rights in drug administration >Do not mix with morphine, sulfate, mepiridine >Instruct patient about the side effects
X. NURSING CARE PLAN
CUES S: “Nsakit pay lang toy sugat ko.” O: >with pain scale of 4/10 >with facial grimaces >weak appearance >guarding behavior V/S: T: 36.6 °C P: 67 bpm R: 16 cpm BP: 100/80 mmHg
NURSING DIAGNOSIS P: Pain, Acute E: t/t disruption of skin, tissue and muscle integrity secondary to Surgical incision (Appendectomy) S: AEB: patient’s verbalization of pain with a pain scale of 4/10, facial grimace, guarding behavior and weak appearance
ANALYSIS Appendectomy ↓ Surgical Incision ↓ Disruption of skin, tissue and muscle integrity ↓ Stimulation of sensory nerve endings ↓ Pain Medical Nursing Incredibly Easy, Pellico, L.H.,
GOAL Date: June 23, 2009 Shift: 7-3 Time: 8:00 am After 6 hrs of nursing intervention the patient will report that her pain is lessen from a pain scale of 4/10 to 1/10.
NURSING INTERVENTION Independent >Assess location, characteristic, onset, duration, frequency , quality and severity of pain >Note location of surgical incision >Perform assessment each time pain occurs, note and investigate changes from previous reports >Monitor V/S >Provide quiet environment and encourage adequate rest period >Encourage use of relaxation technique and diversional activities >Provide additional comfort measures such as back rub, changing patient’s position, change linen as necessary Dependent >Administer analgesic as ordered Collaborative >Instruct patient’s significant others to help patient divert pain into other things
RATIONALE >To assess the etiology or precipitating factors
EVALUATION Date: June 23, ‘09 Time:2:00 pm Goal met AEB: Patient reported that her pain was lessened from a pain scale of 4/10 to 1/10 after 6 hours of nursing intervention.
>As this can influence the amount of post-op experience >To rule out worsening of underlying condition or development of complication >V/S are usually altered in acute pain >To prevent fatigue >To encourage sense of control and improve coping activities/helps control or alleviate pain >To relieve general discomfort >To maintain acceptable level of pain >To help control or alleviate pain
S:”Medyo agsakitsakit gamin Toy sugat ko lalo no aggunay-gunay nak adding.” O: >Facial grimace
P: Activity Intolerance E: r/t limited mobility secondary to pain S: AEB: patient’s Appendectomy ↓ Surgical Incision ↓ Disruption of skin,
Date: June 23, 2009 Shift: 7-3 Time: 8:00 am After 6 hours of nursing intervention the patient will be able to move or
Independent >Assess patient’s ability to ambulate or move independently and safely >when standing allow legs to dangle first; support him from the side
>To assist in correcting/dealing with the situation >to prevent hypostatic hypertension
Date: June 23, ‘09 Time:2:00 pm Goal Met AEB: Patient was able to ambulate without
XII. DISCHARGE PLAN DIET DIET FOODS ALLOWED Without Restriction All Healthy and Nutritious foods especially green leafy vegetables In Moderation N/A FOODS TO BE AVOIDED
Regular Diet (Any food which will make the body healthy, provide growth of tissue, boost the immune system, and make the body stronger and healthier)
TAKE HOME MEDICATIONS NAME DOSAGE AND ACTION 700 mg, 1 cap TIME FREQUENCY DURATION SIDE EFFECTS AND ADVERSE REACTIONS CNS: sedation, dizziness or vertigo, head ache, confusion, dreaming , sweating, anxiety and seizures CV: Hypotension, tachycardia, bradycardia WHAT TO DO MEDICATIONS AND FOODS TO BE ALLOWED Alcohol. T ramadol may impair mental ability and physical coordination.Alcohol may intensify these effects and increase the risk of accidental injury.
8:00 am 12:00 noon 04:00 pm
Until there’s pain
Discontinue if hypersensitivity occurs
500 g Analgesic >inds to muopioid receptors and inhibits the reuptake of norepinephrine and serotonin; causes many effects similar to the opioids,dizziness, constipation
8:00 am 12:00 noon 04:00 pm
For 5 days
CNS: Headache, dizziness, lethargy, paresthesias Discontinue if GI: Nausea, hypersensitivity vomiting, diarrhea, reaction occurs anorexia, abdominal pain, flatulence, pseudomembranous colitis, liver toxicity Hematologic: Bone marrow depression: decreased WBC, decreased platelets, decreased Hct GU: Nephrotoxicity Hypersensitivity: Ranging from rash to fever to anaphylaxis, serum sickness reaction Local: Pain, abscess at injection site; phlebitis, inflammation at IV site Other: Superinfections, disulfiram-like reaction with alcohol
ACTIVITIES AND REHABILITATION ALLOWED NOT ALLOWED MODIFIED
>Doing light house hold chores
Avoid Repetitive Activities, Including Driving
Most doctors order limited activity following an appendectomy for at least 3 weeks. This includes no driving because of medications you may be taking. You must not do any strenuous activities, including anything that requires repetitive motions, including such things as pressing the foot pedals while driving a vehicle and bending up and down getting pots and pans out of low cabinets in your kitchen.
Keep a pillow handy at all times while you are recovering from an appendectomy. Use the pillow to splint your abdomen when you cough or sneeze. Press the pillow firmly against your lower abdomen (across your incision area) until your coughing or sneezing fit passes. This not only helps you comfortwise by minimizing pain from the strain of coughing and sneezing, but it also helps prevent popping stitches. You may also want to press a pillow against your lower abdomen when you get up and down, at least for the first couple of days.
No Heavy Lifting
While you are recovering from your surgery, you must not lift anything that weighs over 15 pounds. Heavy lifting puts too much strain on your lower abdomen and your abdominal muscles. Strain on your lower abdomen may rupture the repairs your surgeon accomplished on the inside while the tissues and muscles are healing. Heaving lifting may also pop the stitches in your incision.
SPECIAL CARE INSTRUCTION PROCEDURE AND TREATMENT Proper wound Care technique >Using aseptic technique when changing the dressing, be especially vigilant in performing hand hygiene thoroughly before and after changing the dressing and in adhering to standard precaution >Cleanse area around the incision site >Monitor incision for signs and symptoms of infection >Use one gauze square for each wipe, discarding each square by dumping in the plastic bag >Clean around drain, if present, moving from center outward in a circular motion, use one gauze square for each circular motion >Apply a layer of dry, appropriate sterile dressing over the wound TIME After taking a bath or before sleeping FREQUENCY DURATION
No standard frequency for how often Until the wound have healed and skin the dressing should be changed, it is intact depends on amount of drainage and nature of wound, so it can be as needed or daily