BALIUAG UNIVERSITY

COLLEGE OF NURSING Gil Carlos St. Baliwag, Bulacan.

Name of Patient: Ricardo Belo Belonio Age: 40 years old Sex: Male Name of Student: Mark Julius S. Cruz Civil Status: Single (Cohabitating) Religion: Roman Catholic Area: NCMH- Pavilion 35 Male Forensic Ward Level/Block: IIIB-4 Address: Barangay. Buho, Panay, Capiz Rating:_________________________________________________ Date of Admission: February 26, 2005 Diagnosis: Undifferentiated/Unstable Schizophrenia; Manageable; Competent Medication Classification/Action
y GENERIC NAME: Chlorpromazine Hydrochloride BRAND NAME: Thorazine Zycloran USUAL DOSAGE/ FREQUENCY: 50-100mg/day PO. Usually given OD USUAL ROUTE: Oral, Intramuscular DRUG ORDER: CPZ 200 mg HS Classification: y Typical Antipsychotic y Anxiolytic y Antiemetic y Phenothiazine y Dopaminergic blocking agent Action: 3 Mechanism not fully understood; anti-anti psychotic drugs block postsynaptic dopamine receptors in the brain; depresses those parts of the brain involved in wakefulness and emesis; anticholinergic; antihistaminic (H1), and alphaadrenergic blocking.

Indications
Management of manifestations of psychotic disorders; symptoms such as hallucinations, delusions and hostility. Relief of preoperative restlessness and apprehension. Adjunct in treatment of tetanus. Severe behavioral problems in children (combativeness and hyperactivity). Control of nausea & vomiting and intractable hiccups. Possible effective treatment of nonpsychotic anxiety. y

Contraindications
Contraindicated with allergy to chlorpromazine, comatose or severely depressed states, bone marrow depression, circulatory collapse, subcortical brain damage, Parkinsons disease, liver damage, cerebral or coronary arteriosclerosis, severe hypo or hypertension. y

Side Effects
drowsiness (avoid driving and dangerous machinery) dry mouth (frequent fluid sips: avoid candies and carbonated drinks) sensitivity to sun (avoid prolonged sun exposure; apply sunscreen; wear protective garments) pink or reddish brown urine faintness & dizziness (change position slowly: caution in ambulation) EPS (Extrapyramidal symptoms) such as acute dystonia, pseudoparkinsonism, akathisia & tardive dyskinesia.)

Adverse Effects
y bronchospasm y laryngospasm (Provide adequate oxygenation) y y aplastic anemia neuroleptic malignant syndrome.

Nursing Responsibilities
5 Assess patient for patients swallowing reflex and ability to take oral drug preparations prior to administration. 5 Ascertain patients compliance to intake of medications by inspecting the mouth particularly the sublingual and buccal area as well as the interphalangeal spaces of the hands for possible drug hoarding, aversion and noncompliance. 5 Monitor patients for over activity in hot weather; risk for heat stroke; keep up fluid intake. 5 Be alert for possible aspiration induced by suppressed cough reflex, brocho and laryngospasm.

y y

y y

BALIUAG UNIVERSITY
COLLEGE OF NURSING Gil Carlos St. Baliwag, Bulacan.

Name of Patient: Ricardo Belo Belonio Age: 40 years old Sex: Male Name of Student: Mark Julius S. Cruz Civil Status: Single (Cohabitating) Religion: Roman Catholic Area: NCMH- Pavilion 35 Male Forensic Ward Level/Block: IIIB-4 Address: Barangay. Buho, Panay, Capiz Rating:_________________________________________________ Date of Admission: February 26, 2005 Diagnosis: Undifferentiated/Unstable Schizophrenia; Manageable; Competent Medication
GENERIC NAME: Fluphenazine Decanoate BRAND NAME: Prolixin Decanoate USUAL DOSAGE/ FREQUENCY: Depending on the severity and duration of symptoms, total daily dosage range initially from 2.5 to 10.0 mg and should be divided and given at six- to eighthour intervals. Determine subsequent doses and dosage intervals based on patients response. Dose should not exceed 100 mg. USUAL ROUTE: Intramuscular DRUG ORDER: Fluphenazine Decanoate 1cc IM injection

Classification/Action
y Classification: y Typical Antipsychotic y Phenothiazine y Dopaminergic blocking agent Action: 3 Mechanism not fully understood; anti-psychotic drugs block postsynaptic dopamine receptors in the brain involved in wakefulness and emesis; anticholinergic, antihistaminic (H1) and alphaadrenergic blocking activity my also contribute to some of its therapeutic and even adverse actions.

Indications
Management of manifestations of psychotic disorders (particularly schizophrenia); it is indicated for management of patients with chronic schizophrenia and requires prolonged parenteral therapy. Management of behavioral complications in patients with mental retardation. y

Contraindications
Contraindicated with allergy or hypersensitivity to fluphenazine, phenothiazines, tartrazine, or aspirin; coma or severe CNS depression, bone marrow depression, blood dyscrasia, circulatory collapse, subcortical brain damage, Parkinsons disease, liver damage, cerebral arteriosclerosis, coronary disease, severe hypotension or hypertension. y

Side Effects
drowsiness (avoid driving and dangerous machinery) dry mouth (frequent fluid sips: avoid candies and carbonated drinks) nausea & vomiting (provide adequate hydration) sensitivity to sun (avoid prolonged sun exposure; apply sunscreen; wear protective garments) headache & dizziness (change position slowly: caution in ambulation; rest) EPS such as acute dystonia, pseudoparkinsonism and akathisia. agitation, bizarre dreams

Adverse Effects
y bronchospasm y laryngospasm (Provide adequate oxygenation) NOTE: sudden death due to asphyxia and cardiac arrest has been reported y neuroleptic malignant syndrome. autonomic disturbances (rare, but fatal up to 20%) cardiac arrest refractory arryhtymias

Nursing Responsibilities
5 ssess the patient for any history of allergy to the drug, certain medical condition and history that may affect the potency or even produce opposite effect when given. 5Inform the patient that the drug may make him feel dizzy or drowsy or cause blurred vision. Do not drive, use machinery, or do any activity that requires alertness or clear vision until the patient is sure that he can perform such activities safely. void alcoholic beverages. 5 Instruct patient that to minimize dizziness and lightheadedness, get up slowly when rising from a seated or lying position. 5 Tell the patient that the drug does not work immediately. It may take 1-3 days to notice an effect from this drug, and up to 4 days to experience the full effect.

y y

BALIUAG UNIVERSITY
COLLEGE OF NURSING Gil Carlos St. Baliwag, Bulacan.

Name of Patient: Ricardo Belo Belonio Age: 40 years old Sex: Male Name of Student: Mark Julius S. Cruz Civil Status: Single (Cohabitating) Religion: Roman Catholic Area: NCMH- Pavilion 35 Male Forensic Ward Level/Block: IIIB-4 Address: Barangay. Buho, Panay, Capiz Rating:_________________________________________________ Date of Admission: February 26, 2005 Diagnosis: Undifferentiated/Unstable Schizophrenia; Manageable; Competent Medication Classification/Action
y GENERIC NAME: Biperiden Hydrochloride BRAND NAME: kineton Classification: y Antiparkinsonian (anticholinergic type)

Indications
Adjunct in the therapy of parkinsonism (postencephalitic, arteriosclerotic, and idiopathic types) Relief of symptoms of extrapyramidal disorders that accompany phenothiazine therapy. y

Contraindications
Contraindicated with allergy or hypersensitivity to benztropine; glaucoma, esp. angle closure glaucoma, pyloric or duodenal obstructions, stenosing peptic ulcers, achalasia, prostatic hypertrophy, bladder neck obstructions and myasthenia gravis.
y

Side Effects
Drowsiness, confusion, blurred vision (avoid driving and dangerous machinery or engaging in activities requiring alertness and visual acuity ) dry mouth (suck sugarless lozenges and ice chips) nausea & vomiting (eat frequent small meals.) painful or difficult urination (empty the bladder immediately after each dose) headache & dizziness (change position slowly: caution in ambulation; rest) constipation (maintain adequate fluid intake and exercise regularly.) allergic reaction fast & irregular heart beat.

Adverse Effects
y bronchospasm y laryngospasm (Provide adequate oxygenation) NOTE: sudden death due to asphyxia and cardiac arrest has been reported y neuroleptic malignant syndrome. autonomic disturbances (rare, but fatal up to 20%) cardiac arrest refractory arryhtymias

Nursing Responsibilities
5 Assess the patient for any history of allergy to the drug, certain medical condition and history that may affect the potency or even produce opposite effect when given. 5 Give the drug with caution, and reduce dosage in hot weather (per MDs order). Drug interferes with sweating and ability of the body to maintain heat equilibrium. 5 Decrease dosage as well, (per MDs order) or discontinue temporarily if dry mouth makes swallowing or speaking difficult. 5Instruct patient to avoid the use of alcohol, sedative and other OTC drugs which can cause dangerous effects. 5 Tell the patient to report difficult or painful urination, constipation, rapid or pounding heartbeat, confusion, eye pain or rash.

Action: 3 nti cholinergic activity in the CNS that is believed to USUAL DOSAGE/ help normalize the FREQUENCY: hypothesized imbalance of the 2 mg IM or IV; repeat q cholinergic and dopaminergic 30 minutes until neurotransmission in the basal symptoms are resolved. ganglia in the brain of a Do not give more than 4 parkinsonism patient. Reduces consecutive doses per 24 severity of rigidity, and to hours. lesser extent akinesia, and tremor characterizing USUAL ROUTE: parkinsonism; less effective Intramuscular overall than levodopa; peripheral anti cholinergic DRUG ORDER: effects suppress secondary symptoms of parkinsonism Biperiden HCl 2mg such as drooling. OD p.r.n

y y

y y

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BALIUAG UNIVERSITY
COLLEGE OF NURSING Gil Carlos St. Baliwag, Bulacan.

Name of Patient: Ricardo Belo Belonio Age: 40 years old Sex: Male Name of Student: Mark Julius S. Cruz Civil Status: Single (Cohabitating) Religion: Roman Catholic Area: NCMH- Pavilion 35 Male Forensic Ward Level/Block: IIIB-4 Address: Barangay. Buho, Panay, Capiz Rating:_________________________________________________ Date of Admission: February 26, 2005 Diagnosis: Undifferentiated/Unstable Schizophrenia; Manageable; Competent Medication Classification/Action
y GENERIC NAME: Diphenhydramine Hydrochloride BRAND NAME: Benadryl USUAL DOSAGE/ FREQUENCY: Nighttime sleep aid: (adults) 20-50 mg PO h.s USUAL ROUTE: Oral, Intramuscular, Intravenous DRUG ORDER: Diphenhydramine 80 mg for impaired sleep Classification: y Antiparkinsonian/AntiEPS y Sedative-hypnotic y Anti-histamine y Anti-motion sickness y Cough suppressant Action: 3 Competitively blocks the effects of histamine at H1 receptor-sites, has atropine like, anti-pruritic and sedative effects.

Indications
Parkinsonism (including druginduced Parkinsonism and extra- pyramidal reactions), in the elderly intolerant of more potent agents, for milder forms of disorders in other age groups, and in combination with centrally acting anti-cholinergic anti-parkinsonian drugs. Night time sleep aid Relief of allergic symptoms Active and prophylactic treatment of motion sickness Cough due to colds. y

Contraindications
Contraindicated with allergy or hypersensitivity to any anti-histamines, third trimester of pregnancy and lactation. Use cautiously with narrow-angled glaucoma, stenosing peptic ulcer, prostatic hypertrophy, asthmatic attack, bladder neck obstruction, pyloroduodenal obstruction.
y

Side Effects
Drowsiness, sedation, disturbed coordination (use caution in driving or performing task requiring alertness and mental acuity ) headache & dizziness (change position slowly: caution in ambulation; rest) constipation (maintain adequate fluid intake and exercise regularly.) epigastric distress thickening of bronchial secretions palpitations dryness of nasal mucosa (use humidifier if present)

Adverse Effects
y anaphylactic shock

Nursing Responsibilities
5 Assess the patient for any history of allergy to the drug, certain medical condition and history that may affect the potency or even produce opposite effect when given. 5 Administer with food if epigastric discomfort occurs. 5 Monitor patients response and arrange for adjustment of dosage to lowest possible effective dose. 5Instruct patient to avoid the use of alcohol, serious sedation may occur. 5 Tell the patient to report difficulty breathing, hallucinations, tremors, loss of coordination, unusual bleeding or bruising, visual disturbances and irregular heart beats.

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