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CVD and Cellulitis

CVD and Cellulitis

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Published by: chexiangqin on Oct 03, 2010
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CEREBROVASCULAR DISEASE  Cerebrovascular disease (CVD) includes all disorders in which an area of the brain is transiently or permanently affected by ischemia or bleeding and one or more of the cerebral blood vessels are involved in the pathological process.  Classification: o Ischemic Stroke ± cerebrovascular accident (CVA) or ³brain attack´ is a sudden loss of function resulting from disruption of the blood supply to the part of the brain.  Risk Factors: y Hypertension y Heart disease y History of TIA y Increase hematocrit y Age (older) y Alcohol use y Smoking y Diabetes Mellitus  Symptoms occur suddenly and may include muscle weakness, paralysis, lost or abnormal sensation on one side of the body, difficulty speaking, confusion, problems with vision, dizziness, and loss of balance and coordination.  Diagnostic Exam: y Physical Examination ± history of event and identification of which artery is blocked based on symptoms. y CT Scan - helps distinguish an ischemic stroke from a hemorrhagic stroke, a brain tumor, an abscess, and other structural abnormalities. y Blood sugar levels ± to rule out hypoglycaemia which can cause similar symptoms. y Electrocardiography (ECG) ± to look for abnormal heart rhythms.

Blood tests ± to check for anemia, polycythemia, blood clotting disorders, vasculitis, and some infections (such as heart valve infections and syphilis) and for risk factors such as high cholesterol levels or diabetes. Managements: y First priority is to restore the person's breathing, heart rate, blood pressure (if low), and temperature to normal. y Maintain adequate tissue oxygenation: May require airway support and ventilatory assistance. Check for possible aspiration pneumonia. y Intravenous line for medication and fluids. y Acetaminophen or Ibuprofen for fever ± increase in body temperature by even a few degrees can dramatically worsen brain damage due to an ischemic stroke. y Mannitol ± to reduce swelling and increased pressure in the brain y Thrombolytic (Fibrinolytic) Drugs ± drug called tissue plasminogen activator (tPA) is given intravenously to break up clots and help restore blood flow to the brain.  Before tPA is given, CT is done to rule out bleeding in the brain. y Antiplatelet Drugs and Anticoagulants ± Antiplatelet drugs make platelets less likely to clump and form clots. Anticoagulants inhibit proteins in blood that help it to clot (clotting factors). y Surgical interventions like: Carotid Endarterectomy (CEA) ± surgical removal of the atheromatous plaque.  Reserved for patients with an ulcerated lesion or clot that occludes > 70% of blood flow in the carotid artery.  A general anesthetic or a local anesthetic (to numb the neck area) may be used. If people remain awake during the operation, the surgeon can better evaluate how the brain is functioning. The surgeon makes an incision in the neck over the area of the artery that contains the blockage and an incision in the artery. The blockage is removed, and the incisions are closed. For a few days afterwards, the neck may hurt, and swallowing may be difficult. Most people can stay in the hospital 1 or 2 days. Heavy lifting should be avoided for about 3 weeks. After several weeks, people can resume their usual activities. y

 Use of Cocaine  Alcohol consumption  High doses of anti-couagulants and antiplatelets y Signs and Symptoms:  Severe headache ± may be present or absent. If the amount of blood increases rapidly. The stent helps keep the artery open.  . Stent Placement . After the stent and filter are placed. and the filter catches blood clots and prevents them from reaching the brain and causing a stroke. A dye that can be seen on x-rays (radiopaque dye) is injected. Intracerebral hemorrhage usually occurs in selected parts of the brain including the basal ganglia.  Intracerebral Hemorrhage ± Non-traumatic or spontaneous intracerebral hemorrhage (ICH) occurs when a diseased blood vessel within the brain bursts.  After a local anesthetic is given.A wire mesh tube (stent) with an umbrella filter may be placed in the carotid artery. However.Carotid endarterectomy can trigger a stroke because the operation may dislodge clots or other material that can then travel through the bloodstream and block an artery. The sudden increase in pressure within the brain can cause damage to the brain cells surrounding the blood. a catheter is inserted through a small incision into a large artery near the groin or in the arm and is threaded to the internal carotid artery in the neck. the sudden build up in pressure can lead to unconsciousness or even death. but it cannot restore lost function because some brain tissue is dead. cerebellum. the catheter is removed. the risk of stroke is lower for several years than it is when drugs are used. y Risk Factors:  Chronic Hypertension ± weakens the small artery that causes it to burst. and x-rays are taken so that the narrowed area can be located. allowing blood to leak inside of the brain (the name means within the cerebrum or brain). brainstem or cortex. o Hemorrhagic Stroke .  It also reestablishes the blood supply to the affected area. after the operation.include bleeding within the brain (intracerebral hemorrhage) and bleeding between the inner and outer layers of the tissue covering the brain (subarachnoid hemorrhage).

heart rate. an abscess.  Dysarthria ± difficulty in speaking  Vision may be impaired or lost  Nausea. and loss of consciousness are common and may occur within seconds to minutes  ICP Diagnostic Exam:  Neurological exam may indicate increased intracerebral pressure such as swelling of the optic nerve or changes in eye movement. a brain tumor. seizures. o Intravenous line for medication and fluids. and other structural abnormalities. vasculitis. o Maintain adequate tissue oxygenation: May require airway support and ventilatory assistance. and some infections (such as heart valve infections and syphilis) and for risk factors such as high cholesterol levels or diabetes.y y  Weakness. blood clotting disorders. o Mannitol ± to reduce swelling and increased pressure in the brain o Anticoagulants (such as heparin and warfarin). thrombolytic drugs. paralysis. Management: o First priority is to restore the person's breathing.  Blood tests ± to check for anemia. vomiting. and antiplatelet drugs (such as aspirin) are not given because they make bleeding worse. . and temperature to normal. o Acetaminophen or Ibuprofen for fever ± increase in body temperature by even a few degrees can dramatically worsen brain damage due to an ischemic stroke.  Blood sugar levels ± to rule out hypoglycaemia which can cause similar symptoms. often affect only one side of the body. Check for possible aspiration pneumonia. blood pressure (if low). and numbness.helps distinguish an ischemic stroke from a hemorrhagic stroke. polycythemia. Localized abnormalities in the brain function are detected by observing abnormal reflexes or movement. loss of sensation.  CT Scan and MRI .

Aspiration by stereotactic surgery or endoscopic drainage may be used in basal ganglia hemorrhages. However. even if it may be life-saving. In such cases. avoiding invasive surgical procedures. o Tracheal intubation is indicated in patients with decreased level of consciousness or other risk of airway obstruction o Surgery: Surgery to remove the accumulated blood and relieve pressure within the skull.A subarachnoid hemorrhage is bleeding into the space (subarachnoid space) between the inner layer (pia mater) and middle layer (arachnoid mater) of the tissue covering the brain (meninges). A catheter may be passed into the brain vasculature to close off or dilate blood vessels. further damaging the brain and leading to severe disability. this operation may be effective for hemorrhage in the pituitary gland or in the cerebellum. Subarachnoid Hemorrhage . Also. although successful reports are limited. removing the accumulated blood can trigger more bleeding. y Risk Factors:  Head injury  Aneurysm or weakened blood vessels  Hypertension  Smoking y Signs and Symptoms:  Headache. a good recovery is possible. is rarely done because the operation itself can damage the brain. which may be unusually sudden and severe (sometimes called a thunderclap headache)  Facial or eye pain  Double vision  Loss of peripheral vision  Weakness or paralysis on one side of the body (most common)  Loss of sensation on one side of the body .

o Doctors take measures (such as giving drugs and adjusting the amount of intravenous fluid given) to keep blood pressure at levels low enough to avoid further hemorrhage and high enough to maintain blood flow to the damaged parts of the brain. which can worsen the bleeding) are given to control the severe headaches. This procedure relieves pressure and prevents hydrocephalus. o A piece of plastic tubing (shunt) may be placed in the brain to drain cerebrospinal fluid away from the brain. Thus. Management: o Bed rest with no exertion is essential o Analgesics such as opioids (but not aspirin or other nonsteroidal anti-inflammatory drugs. dizziness. block off. or support the walls of the weak artery and thus reduce the risk of fatal bleeding later. A spinal tap is not done if doctors suspect that pressure within the skull is increased. It can detect any blood in the cerebrospinal fluid. o Stool softeners are given to prevent straining during bowel movements.y y  Difficulty understanding and using language (Aphasia)  Within 24 hours. causing a stiff neck as well as continuing headaches. involves inserting coiled wires into the aneurysm. and low back pain. Neuroendovascular surgery. blood and cerebrospinal fluid around the brain irritate the layers of tissue covering the brain (meninges). o A spinal tap (lumbar puncture) is done if CT is inconclusive or unavailable. o Nimodipine. o Cerebral angiography ± is done as soon as possible to confirm the diagnosis and to identify the site of the aneurysm or arteriovenous malformation causing the bleeding. o Surgery: For people who have an aneurysm. Diagnostic Exams: o Computed tomography (CT) ± is done to check for bleeding. a surgical procedure is done to isolate. The coils are placed using a catheter that is inserted into an artery and threaded to the aneurysm. By slowing blood flow . often with vomiting. is usually given by mouth to prevent vasospasm and subsequent ischemic stroke. this procedure does not require that the skull be opened. a calcium channel blocker.

the patient allegedly woke up from his sleep and had 1 episode of vomiting and then was noted to have left-sided weakness and loss of consciousness for about 5 minutes and was rushed to the hospital. Neuroendovascular surgery can often be done at the same time as cerebral angiography. History of Present Illness o 4hrs prior to admission. the coils promote clot formation. Laguna Date /Time Admitted: September 3.A Age: 49 years old Gender: Male Room/ Bed No.: 3202 Religion: Roman Catholic Residence: Parian. when the aneurysm is diagnosed. which seals off the aneurysm and prevents it from rupturing. ---none .through the aneurysm. CLINICAL SUMMARY A. Calamba. C. Past Medical History Allergies: Illnesses: Operations: Injuries: Adverse Drug Reaction: none Hypertension none. General Information Name: O. 2010 9:30am Chief Complaint *Slurring of Speech and left-sided weakness B.

E. Intracerebral Hemorrhage . Familial History Mother Father: (+) HPN (+)DM (-) Asthma (-) HPN (-)DM (-) Asthma O.A Patient: CVD.

99 . It is related to acute or chronic damage of the central nervous system (commonly seen in intracerebral hemorrhage). Blood Chemistry: September 15.6-5. CT Scan ± Right capsulothalamic acute hemorrhagic with intraventricular extension and mild communicating hydrocephalus most possibly due to hypertension.4 Interpretation CSWS is defined as ³true´ hyponatremia which occurs when there is a primary loss of sodium into the urine without an increase in total systemic volume. 2010 Sodium 137-145mmol/L Result 129.LABORATORY RESULTS Shoulder AP portable (X-Ray) ± no joint abnormalities noted in the visualized structure of the left shoulder. Can also be the result when the pituitary gland is affected which causes overproduction ADH that causes accumulation of fluids in the brain normal Potasium 3.0mmol/L 4.

0 Interpretation CSWS is defined as ³true´ hyponatremia which occurs when there is a primary loss of sodium into the urine without an increase in total systemic volume. It is related to acute or chronic damage of the central nervous system (commonly seen in intracerebral hemorrhage). Can also be the result when the pituitary gland is affected which causes overproduction ADH that causes accumulation of fluids in the brain .September 19. 2010 Sodium 137-145mmol/L Result 131.

015 Normal Normal Normal Normal Albumin Sugar Trace Negative Can mean that there is glomerular damage Normal .0-5.8 5. 2010 Values Hemoglobin levels are low therefore the client is anemic Hematocrit levels are low therefore the client is anemic Red Blood cells levels are low therefore the client is anemic WBC 149 Normal values 140-170 g/L Interpretation Normal .0 1.0 g/L Normal 10.9 4.42-0.0-10.50 g/L Normal 4.Hematology: September 15.0 g/L Can be a cause of inflammation or inflammation. Urinalysis Color Transparency pH Specific gravity yellow clear 8.44 0.

hydrochlorot hiazide Brand name: -micardis plus Doctor¶s order: -10mg 1tab OD Antihypertensive -blocks the -hypersensitivity to the drug vasoconstrictive and aldosterone-secreting effects of angotensin II by binding angiotensin II to the AT I receptor in many tissue. .DRUG STUDY DRUG INDICATION MECHANISM OF ACTION CONTRAINDICATION SIDE EFFECTS -diarrhea -anorexia -loss of appetite -gastric irritation -constipation NURSING CONSIDERATIONS -special precaution in patients with impaired hepatic and renal impairment -special precaution with volume and/or Nadepleted patients -may impair ability to drive or operate machineries Drug name: -telmisartan.

DRUG INDICATION MECHANISM OF ACTION -inhibits influx of calcium ion across cell membranes to produce relaxation of coronary vascular smooth muscle. decrease peripheral vascular resistance of smooth muscle ( BP) CONTRAINDICATION SIDE EFFECTS NURSING CONSIDERATIONS -monitor v/s especially the BP -should be administered with food or after eating Drug name: Antihypertensive -amlodipine Brand name: -vasalat Doctor¶s order: -10mg 1tab OD -low BP -CHF -hypersensitivity -hepatic impairment -headache -edema -dizziness -flushing -palpitation -fatigue -nausea -abdominal pain .

Contrainidicated with allergy to ranitidine. and pentagastrin CONTRAINDICATION SIDE EFFECTS NURSING CONSIDERATIONS -Administer oral drug with meals and at bedtime. vertigo CV: tachycardia. Provide concurrent antacid therapy to relieve pain. deep into large muscle group. benign gastric ulcer Short-term treatment of GERD Treatment of heartburn. acid indigestion. gastrin.DRUG INDICATION MECHANISM OF ACTION Competitively inhibits the action of histamine at the H2 receptors of the parietal cells of the stomach. local burning or itching at IV site 3. nausea. lactation Use cautiously with impaired renal or hepatic function. pregnancy -CNS: headcahe. Decrease doses in renal and liver failure. . cholinergic agonists. dizziness. vomiting. 4. diarrhea. abdominal pain LOCAL: pain at IM site. histamine. Drug name: Histamine2 antagonist Ranitidine -Short-term treatment of active duodenal ulcer Maintenance therapy for duodenal ulcer at reduced dosage Short-term treatment of active. insomia. bradycardia GI: constipation. 2. inhibiting basal gastric acid secretion and gastric acid secretion that is stimulated by food. somnolence. Adminsiter IM dose undiluted. malaise. insulin.

. including blood tests to evaluate effects.sour stomach 5. Arrange for regular followup.

K. aureus. Continue therapy for 2 days after signs and symptoms of infection are gone. including E. pregnancy. norfloxacin. coli. group D streptococci Contraindicated with allergy to ciprofloxacin. Encourage patient to complete full course of therapy. Monitor clinical response.DRUG INDICATION MECHANISM OF ACTION Bactericidal. P. lactation -headache -edema -dizziness -flushing -palpitation -fatigue -nausea -abdominal pain y y y y y . P. vulgaris. pneumoniae. if no improvement is seen or a relapse occurs. Citrobacter freundii. M. rettgeri. P. epidermidis. P. interferes with DNA replication in susceptible gramnegative bacteria preventing cell reproduction CONTRAINDICATION SIDE EFFECTS NURSING CONSIDERATIONS y Arrange for culture and sensitivity tests before beginning therapy. Enterobacter cloacae. mirabilis. repeat culture and sensitivity. aeruginosa. S. Drug name: ciprofloxacin Antibacterial Fluoroquinolones For the treatment of infections caused by susceptible gramnegative bacteria. Give antacids at least 2 hr after dosing. Ensure that patient is well hydrated. morganii. S.

Take missed doses as soon as possible. Common side effects Confusion. Geriatric patients (because of age-related in renal function).Generic Name gabapentin Trade Name Neurontin Classification analgesic adjuncts Why is your patient getting this medication Chronic neck pain. May affect transport of amino acids across and stabilize neuronal membranes. Do not double doses. Mechanism of action and indications Mechanism of action is not known. Gabapentin may cause dizziness and drowsiness. Advise patient not to take gabapentin within 2 hr of an antacid. ataxia. drowsiness. depression. Instruct patient to notify health care professional of medication regimen before treatment or surgery. Caution patient to avoid driving or activities requiring alertness until response to medication is known. . Be sure to teach the patient the following about this medication Be sure to teach the patient the following about this medication. Instruct patient to take medication exactly as directed. if less than 2 hr until next dose. take dose immediately and take next dose 1-2 hr later. then resume regular dosing schedule. Advise patient to carry identification describing disease process and medication regimen at all times. Nursing Implications (what to focus on) Contraindications/warnings/interac tions Hypersensitivity.

recovery of phospholipids in consciousness the neuronal and overcoming membrane. as well as a fleeting and discrete hypotensor effect y . increases cerebral metabolism and increases the level of various neurotransmitters. Citicoline may exert a stimulating action of the parasympathetic. motor deficit. the biosynthesis of parasympathetic accelerates the structural hypertonia. Citicoline has shown neuroprotective effects in situations of hypoxia and ischemia.GENERIC NAME Citicoline BRAND NAME DOSAGE INDICATION MECHANISM OF ACTION CONTRAINDICATION ADVERSE EFFECT NURSING RESPONSIBILITIES y atch out for hypotensive effects Somazine must not be administered along with medicaments containing   Zynapse 100mg/cap Cerebrovascular Citicoline activates Patients with q12° Diseases. including acetylcholine and dopamine.

When infusing 20% or 25% mannitol concentrations. It raises the osmotic pressure of the plasma allowing water to be drawn out of body tissues. . metabolic oedema with abnormal capillary fragility. Discard unused portion. chills. mannitol administration may obscure and intensify inadequate hydration or hypovolemia.  By sustaining diuresis. at least 20 mEq of sodium chloride should be added to each liter of mannitol solution to avoid pseudoagglutination.  Edema Fluid and electrolyte imbalance.  The cardiovascular status of the patient should be carefully evaluated before rapidly administering mannitol since sudden expansion of the extracellular fluid may lead to fulminating congestive heart failure. the administration set should include a filter. solutions of mannitol may crystalize.  When exposed to low temperatures. blurred vision.  Promotion of urinary excretion of toxic materials. If it is essential that blood be given simultaneously.  Shift of sodium-free intracellular fluid into the extracellular compartment following mannitol infusion may lower serum sodium concentration and aggravate pre-existing hyponatremia. severe dehydration. Nausea. Dose: Frequency: Promotion of diuresis in the prevention or treatment of the oliguric phase of acute renal failure before irreversible renal failure becomes established. acute renal failure. tachycardia. chest pain.Name of Drug Generic: Mannitol Brand: Osmitrol. Do not administer Mannitol 25% if the Fliptop vial seal is not intact. acidosis (with high doses). Side-effects Nursing Responsibilities Diuretic Action: Mannitol increases urinary output by inhibiting tubular reabsorption of water and electrolytes. skin necrosis. then cooled to body temperature before administering. See NOTE under how supplied. headache. fever. the container should be warmed to redissolve. Reduction of intracranial pressure and brain mass. vomiting. anuria due to severe renal disease. Do not infuse mannitol solution if crystals are present.  Do not administer unless solution is clear and container is undamaged. convulsions. CHF. Resctisol Route: Classification Indication Contraindication Pulmonary congestion or oedema. dizziness. urticaria and hypotension or hypertension. thirst. If crystals are observed.  Electrolyte-free mannitol solutions should not be given conjointly with blood. intracranial bleeding. thrombophloebi tis. Reduction of high intraocular pressure when the pressure cannot be lowered by other means.

and pain in the affected areas. tender. Occasionally. warmth. red streaks may radiate outward from the cellulitis. cut. warm. insect bite. laceration. animals. The involved area may rapidly become deeper red. and increase in size as the infection spreads.athlete's foot is a skin infection caused by a kind of mold called a fungus o Patients with Lymphatic Obstruction  Risk Factors: o Diabetes o Lymphedema o Skin wounds o Chronic lower leg swelling (edema) o Athlete's foot (tinea pedis) o Bites from insects.  Cellulitis usually follows a break in the skin.DISEASE OVERVIEW: CELLULITIS  Cellulitis is the infection of the skin and soft tissues typified by swelling. o Patients with Tinea Pedis . redness. or puncture wound  Types: o Facial cellulitis of odontogenic origin may also occur. swollen. The severity of the infection depends on its opportunity to spread and affect other parts of the skin or body. Blisters or pus-filled bumps may also be present. such as a fissure. or other humans o Obesity o Poor circulation in the legs (peripheral vascular disease) o Weakened immune system due to underlying illness or medication o Intravenous drug abuse or alcoholism  Signs and Symptoms: o Cellulitis initially appears as pink to red. minimally inflamed skin.  Diagnostic Studies: o Medical History Review o Physical Exam .

incidence. Affected area will probably be: red. o Blood test o Culture and Gram stain of draining material is helpful if blisters or abscesses are present. topical (skin applied).The goal in cellulitis diagnosis process is examining the affected area. or IV ( intravenous) antibiotics drugs may be used for cellulitis treatment. which means swelling of the lymph passages. Lymph nodes may be enlarged for any reason. and risk factors: o Infections with parasites such as filariasis o Injury (trauma) o Radiation therapy o Skin infections such as cellulitis (more common in obese patients) o Surgery o Tumors  Signs and Symptoms: o Swollen lymph vessels o Swollen lymph nodes o Chronic arm swelling o Chronic leg swelling . warmth and painful.vessels that drain fluid from tissues throughout the body and allow immune cells to travel where they are needed. the place where bacteria could may entered into patient's organic structure.  Management:  o Oral. ulcers). scrapes.  Causes. LYMPHATIC OBTRUCTION  Lymphatic obstruction is a blockage of the lymph nodes -. swollen. or combination both locations. medicines are given in the infirmary. Medical adviser must look for eventually breaks in the skin (bruises. Hardness of infection will also determine whether antibiotics drugs are distributed through IV or orally. It depends on the severity and body region involved by infection. at household. Treatment with antibiotics also calling treatment of choice. cuts.  Lymphatic obstruction is also called lymphedema.

but it has limited success. o Treatment also includes skin care to prevent injuries. It should help drainage without leading to swelling from overexertion. and skin breakdown. as well as light exercise and movement programs.  Management: o Manual lymph drainage is a light massage therapy technique in which the skin is moved in certain directions based on the structure of the lymphatic system. and are often done experimentally.o Chronic swelling o Skin hyperkeratosis . The surgeon must have a lot of experience with this type of procedure. A biopsy may be necessary if cancer is a possibility.in long-standing cases o Warts . the surgeon will bypass abnormal lymph tissue using vein grafts.  Types of surgery include: y Liposuction y Removal of abnormal lymphatic tissue y Transplant of normal lymphatic tissues to areas with abnormal lymphatic drainage (less common) o Rarely. .in long-standing cases  Diagnostic Exams: o Doctors frequently discover enlarged lymph nodes as part of a routine physical exam.in long-standing cases o Papillomas . o Surgery is used in some cases. You will still need physical therapy after surgery to reduce lymphedema. Doctors who suspect enlarged lymph nodes may order CT or MRI scans. Your doctor and physical therapist will decide which compression methods are best. These procedures are not usually successful. This helps the fluid and waste drain through the right channels. infection. which could make your condition worse. Exercise should be carefully designed by a physical therapist. o Wearing compression stockings on the affected area or using a pneumatic compression pump on and off may be helpful.in long-standing cases o Increased skin pigmentation .

M Age: 43 years old Gender: Male Room/ Bed No. History of Present Illness o 1 day prior to admission the patient complained of swelling at the left side of his face and dizziness thuc prompted to consult and admission at CMC. Los Banos. ---none . Laguna Date /Time Admitted: September 22. F.: 3203 Religion: Roman Catholic Residence: Timugan. 2010 9:30am Chief Complaint *swelling at the left side of the face E.CLINICAL SUMMARY D. General Information Name: A. Past Medical History Allergies: Illnesses: Operations: Injuries: Adverse Drug Reaction: none none none.

M.E. Patient: Cellulitis with Lymphatic obstruction . Familial History Mother: Father: (-) HPN (-)DM (-) Asthma (+) HPN (-)DM (-) Asthma A.

LABORATORY RESULTS CT Scan ± Left nasal deviation. Urinalysis September 23.3 16. left maxillary sinus mucosal thickening with opacified left ethmoid complexes. left frontal recess and left frontal sinus concha bullosa .0 g/L Interpretation Normal Normal Can be a result of renal problem and tissue hypoxia Can be a cause of inflammation or inflammation. 2010 Values Haemoglobin Hematocrit RBC WBC 149 .0 g/L 5.0 Normal Normal Normal . left middle turbinate.50 g/L 4. 2010 Chloride 98-107mmol/L Result 110.0-5. 2010 Color Transparency pH Dark yellow clear 8.8 Normal values 140-170 g/L 0.44 5.0 Interpretation Increased levels of blood chloride (called hyperchloremia) usually indicate dehydration Hematology: September 23. Blood Chemistry: September 22.0-10.42-0.

010 Can mean that there is renal problem Albumin Sugar +1 Negative Can mean that there is glomerular damage Normal DRUG STUDY Brand name: Serc Generic name: Betahistine dihydrochloride Indication: Meniere¶s disease.Specific gravity 1. Drug Classification: Anti emetics and Anti vertigo Mechanism of Action: Betahistine was found to have a histamine-like action in animals. are improved (guinea pigs). Betahistine mesylate has a vasodilating effect on the carotid artery and thereby improves cerebral blood flows Adverse Effects: Gastrointestinal: rarely. tinnitus and sensorineural deafness) and vertigo of peripheral origin. Meniere-like syndrome (with symptoms of vertigo. Betahistine mesylate has a long persistent peripheral vasodilating activity. raise bed rails. Hypersensitivity including eruption Contraindication: Gastro intestinal Ulcer. institute safety measure . asthma Nursing Responsibilities: Assist with ambulation. Beside them. It particularly increases blood flow of the vertebral-basilar arteries¶system. by which micro-circulations at the labyrinthine and vestibular apparatus of the ears. nausea and vomiting.

Check the patient's vital signs frequently to determine if low blood pressure is constant or intermittent. CV: hypotension. Keep the patient's room clean-smelling by removing bedpans and emesis basins promptly after use. Culture infection before therapy. history of asthma or other allergies. 1 cap TID PO Pharmacologic class: Lincomycin derivative Inhibits protein synthesis in susceptible bacteria. causing cell death. diarrhea Dermat: urticaria To treat infection. TE: Hinders or kills susceptible bacteria. Contraindicated with allergy to clindamycin. vomiting. cardiac arrest GI: nausea.DRUG ORDER PHARMACOLOGI C ACTION INDICATIONS CONTRAINDICATIONS ADVERSE EFFECTS DESIRED ACTION NURSING RESPONSIBILITIES Clindamycin hydrochloride (Cleocin) 300 mg/cap. Treatment of infections caused by susceptible strains of bacteria. Administer oral drugs with a full glass of water or with food to prevent esophageal irritation. .

wound characteristics. Nursing Responsibilities >Obtain patient s history of allergy >Assess patient for signs and symptoms of infection. sputum.Name of Drug Co-Amoxiclav Classification Anti-Infectives Indication Infections of GUT CONTRAINDICATIONS Side Effects Diarrhea. Mucocutaneous candidiasis. history of asthma or other allergies. vomiting. fever and WBC count >Assess patient for previous sensitivity reaction to penicillin or other cephalosporins >Obtain C&S before beginning drug therapy for assessment >Assess for allergic reactions during treatment >Monitor for signs of nephrotoxicity >Assess for bowel patterns >Assess for signs of dehydration >Monitor for bleeding >Assess for overgrowth of infection . Contraindicated with allergy to Antibiotics. nausea. urine stool. dizziness and headache.

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