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Calcium Gluconate Description : electrolyte Indication :     dietary supplement or treatment when calcium level is deficient (e.g.

tetany, hypoparathyroidism, postmenopausal, osteoporosis, rickets, osteomalacia) prevention of hypocalcemia during exchange transfusions for weak or ineffective myocardial contraction when epinephrine fails in cardiac resuscitation adjunctive therapy for:  insect bites or stings  sensitivity reactions (to reduce capillary permeability)  depression due to overdose of magnesium sulfate  acute symptoms of lead colic

Dosage and Administration: Adults : IV infusion preferred. 1 g contains 90 mg (4.5 mEq) calcium. 0.5 to 2 g as required; daily dose 1 to 15 g. Pediatrics: 500mg/kg/day IV given in divided doses. Side Effects : nausea, vomiting, constipation, pain, drowsiness, headache, muscle weakness, slowed heart rate, tingling sensation, sense of oppression or “heat waves”, peripheral vasodilation, local burning, decreased BP, bradycardia, cardiac arrhythmias, syncope, cardiac arrest, local irritation, severe necrosis, sloughing and abscess formation, hypercalcemia (anorexia, nausea, vomiting, constipation, abdominal pain, dry mouth, thrist, polyuria), rebound hyperacidity, milk-alkali syndrome (hypercalcemia, alkalosis, renal damage ) Special precautions: sensitivity to calcium, renal calculi, hypercalcemia, ventricular fibrillation during cardiac resuscitation, with risk of digitalis toxicity, use cautiously with renal impairement, pregnancy, lactation Nursing Considerations:   Note allergy to calcium, renal calculi, hypercalcemia, digitalis toxicity, renal impairment Baseline assessment of: vital signs (P, BP), ECG, signs of hypocalcemia (mouth twitching, tingling, numbness, facial spasm, laryngospasm, carpopedal spasm, muscle cramps, bleeding tendencies, weak cardiac contractions), signs of digitalis toxicity (nausea, vomiting, anorexia, bradycardia, cardiac dsyrhythmia, visual disturbances) Review drugs taken by patient (thiazide diuretics can increase calcium levels)

o metabolic alkalosis. Side Effects: anorexia.5 mg/day PO. clindamycin. arrhythmias. Pediatrics: Maintenance dose. use small needle inserted to a large vein. prednisone (to prevent precipitation) Use 5% dextrose in water and not saline solution (because saline produces calcium loss) Have patient remain recumbent for a short time after infusion Instruct patient and patient’s guardian to report pain.125 to 0. drowsiness. and protein-rich foods (to enhance calcium absorption) o eating fruits and fiber (for improving bowel elimination) Digoxin (Lanoxin) Description: cardiac glycoside Indications: treat congestive heart failure. atrioventricular block. phosphates.         Laboratory: serum electrolytes. amphotericin.125 to 0. diplopia. GI upset . cefazolin. sulfates. resume when symptoms disappear Avoid mixing calcium salt with carbonates. hypercalcemia: shortened ST segment & QT interval) Suggest to: o consume milk. headache. 20 % to 30% for premature infants.25 mg PO or 0. photophobia. weakness.125 to 0. Maintenance dose. infuse slowly (0. Usually 0. stop infusion if patient complains of discomfort. flutter or fibrillation Dosage and Administration: Adults: Loading dose. 20% to 30% of loading dose in divided daily doses. blurred vision (yellow-green halos). 0. o IV patency and site o cardiac response closely o ECG for onset of dysrhythmias or change in calcium levels (hypocalcemia: prolonged ST segment & QT interval. tartrates. dobutamin. 0.75 to 1. nausea.25 mg/day PO. confusion. fatigue. altered mental status.25 mg IV. bradycardia. atrial tachycardia.5 to 2mL/min). uncomfortable sensation or symptoms related to calcium excess or cardiac dysrhythmia experienced by patient Monitor: o serial serum calcium levels. urinalysis Assessment of intravenous site and patency of intravenous line Warm solution to body temperature. vomiting.

presence of contraindication Baseline assessment of: weight. edema. lidocaine. orientation. liver function test (ALT & AST). autoimmune disorders) o ocular and vascular inflammation o to relieve minor skin irritation. heart block. swelling of ankles. atropine. abdominal percussion. Weigh patient every other day with same clothing at the same time. status asthmaticus) o short term inflammatory and allergic disorders (e.5 to 2ng/mL. affect. Check dosage and preparation carefully (do not use if solution contains precipitates) Inject slowly over 5 minutes or longer. vision. asthma. SLE. and cardiac monitor (in case of toxicity) Take patient’s pulse at the same time each day. COPD. peripheral pulses. anaphylaxis. R). pemphigus. Monitor ECG for dysrhythmias. phenytoin.g. difficulty of breathing.           Hydrocortisone Description: adrenal cortical steroid Indications:  Replacement therapy in adrenal cortical insufficiency  To treat allergic or inflammatory states: o severe or incapacitating allergic conditions (e. cardiac and lung auscultation. reflexes. electrolyte abnormalities (decreased magnesium & potassium. legs or fingers. ECG. BP. vital signs. unusual tiredness or weakness. increased calcium) Nursing Considerations:   Note allergy to digitalis. and hemorrhoids . acute MI. renal and liver function & IV patency and site. peripheral perfusion. electrolyte imbalances Review drugs taken by patient (avoid mixing digoxin with dobutamine) Assessment of intravenous site and patency of intravenous line Monitor apical pulse for 1 minute before administering. Monitor therapeutic drug levels: 0. rashes due to seborrheic dermatitis. visual disturbances. vomiting. urinary output Laboratory: renal function test (BUN & creatinine). Instruct patient and patient’s guardian to report loss of appetite. sick sinus syndrome. psoriasis. nausea. ventricular tachycardia. ventricular fibrillation. Have emergency equipment ready: potassium salts.Special Precautions: sensitivity to digitalis. bowel sounds. vital signs (P.g. IHSS. renal insufficiency. rheumatoid arthritis.

sweating. Give daily before 9a. heart failure. abdominal distention. recent Gi surgery. spontaneous fractures (long term therapy). cataracts. immunosuppression. hypokalemia. muscle weakness. at intervals until lowest clinically satisfactory dose is reached. discoloration. mood changes. decreased carbohydrate tolerance. cushingoid state (longterm therapy). cushing’s syndrome. P. fat embolism. steroid myopathy. ophthalmologic examination. vital signs (T. hypocalcemia. organ transplant to prevent organ rejection) Dosage and Administration: Adults: Individualized dosage. hypothalamus-pituitary-adrenal axis suppression (therapy longer than 5 days). liver disease. headache. growth retardation. cardiac arrhythmias secondary to electrolyte disturbance. BP. and antibiotic-resistant infections. peptic or gastroesophageal ulcer. heart failure secondary to fluid retention. inflammatory bowel disease with exacerbations or impending perforation. thromboembolism. reflexes. flush. surgery (e. active or latent peptic ulcer. osteoporosis. hypothyroidism. headache. hypertension. pain. striae. metastatic carcinoma. anaphylactoid or hypersensitivity reactions. immunosuppression. amebiasis. fragile skin. increased intra-ocular pressure. loss of muscle mass. purpura. diarrhea. tuberculosis. . thromboembolic tendencies. seizures. peripheral perfusion. paresthesia. lactation Nursing Considerations:  Have baseline assessment of weight. diabetes mellitus. vaccinia. prominence of superficial vessels. cibvulsive disorders. cirrhosis. After long-term therapy. increased serum cholestrerol. shock: trauma. osteoporosis. Pediatrics: Individualized dosage based on severity and response rather than on formulae that correct adult doses for age or weight. increased appetite. aggravation or masking of infections.g. If long-term therapy is needed. bilateral grip strength. use cautiously with kidney disease. alternate-day therapy should be considered. depression. recent intestinal surgery. weight gain (long term therapy)sodium and fluid retention. to minimize adrenal suppression. auscultation of lung sounds. fungal infections.m. insomnia. ulcerative colitis with impending perforation. increased blood sugar. For maintenance therapy. amernorrhea. herpes simplex skin infections. thrombophlebitis. ecchymoses. hypertension. irregular menses. hepatitis B. psychosis. hyperglycemia. varicella. liver palpation. thin. subcutaneous fat atrophy. vertigo. impaired wound healing Special Precautions: sensitivity to any component of drug. pancreatitis. petechiar. based on severity and response. affect. shock. glaucoma (long-term therapy). diverticulitis. Carefully observe growth and development in infants and children on prolonged therapy. throbophlebitis. R). hypotension. withdraw drug slowly to avoid adrenal insufficiency. decreased serum T3 and T4 levels. Side Effects: nausea. reduce initial dose in small increments. diabetes mellitus.

taper dosage slowly (to prevent adrenal insufficiency). nausea. headache. meperidine. the recommended single maximum dose is 20 mg. colds. anorexia. worsening of symptoms. muscle weakness. vomiting. In non-tolerant patients. or another opioid with similar duration of activity. complete blood count. fever. dysphoria. vomiting. upper GI X-ray. sedations. intake and output. Pediatrics: Not recommended to children younger than 18 years old Side Effects: dizziness. feeling of . urinary urgency. or subcutaneously every 3 to 6 hours as needed. 2-hr postprandial blood glucose. Instruct patient and patient’s guardian to report muscle and joint pains. crying. with a maximum total daily dose of 160 mg. restlessness. dry mouth. If no untoward symptoms occur. epigastric burning. depression. floating feeling. If the previous opioid was morphine. When discontinuing. and observe for signs of withdrawal. bitter taste. Individualized dosage. abdominal cramps. euphoria. dizziness. nausea. IV. diarrhea. vertigo. dizziness. sedation. clammy skin. Assessment of intravenous site and patency of intravenous line Give daily before 9a. hostility.        Laboratory: Chest X-ray. thyroid function test. Nalbuphine Hydrochloride Description: opioid agonist-antagonist analgesic Indications:    for control or relief of moderate to severe pain preoperative anesthesia or as adjunct to anesthesia prevention and treatment of intrathecal morphine-induced pruritus after cesarean section Dosage and Administration: Adults: Usual dose is 10 mg for a 70-kg (154 lb) person IM. control by small increments of morphine by slow IV administration until relief occurs. serum cholesterol Review drugs taken by patient. wound healing. blurred vision. confusion. nervousness. unusual dreams. unusual weight loss or gain (swelling of lower extremities. serum electrolyte. sweating. urinalysis.m. black or tarry stools. codeine. fatigue. progressively increase doses until analgesia is obtained. blood glucose. Monitor vital signs. headache. Patients dependent on opioids may experience withdrawal symptoms with administration of nalbuphine. clamminess. puffy face). flushing. weight. hallucinations. administer one-fourth the anticipated nalbuphine dose initially. (to mimic normal peak diurnal corticosteroid levels and minimize HPA suppression) Space multiple doses evenly throughout the day.

tachycardia. vision. constipation. ALT). duration. dizziness. gastro-esophageal reflux disease. reflexes.heaviness. asthma Special Precautions: sensitivity to nalbuphine. dyspnea. renal function test (BUN. flushing. pruritus. bilateral grip strength. sour stomach prevent acid reflux. acute MI. sulfites. auscultation of heart and lung sounds. bronchial asthma. shortness of breath.g. blurred vision. R). hallucinations. aspiration pneumonitis pathologic hypersecretory conditions (e. erosive esophagitis. use cautiously with emotionally unstable patients or with history of narcotic abuse. respiratory depression Suggest to lie quietly and have frequent small meals          Ranitidine Hydrochloride Description: Histamine2 Antagonist Indications:    treatment of gastric and duodenal ulcers. sulphites. respiratory depression. acid indigestion. dry mouth. rash. check bowel sounds and date of last bowel movement (to identify constipation) normal urine output and pain (type. anoxia. tachycardia. labor or delivery. pupil size. increased intracranial pressure. respiratory depression. ketorolac. COPD. Zollinger-Ellison syndrome) Dosage and Administration: . bradycardia. heartburn. affect. hypertension. respiratory depression. cramps. barbiturates) Laboratory: liver function test (AST. BP. biliary tract surgery. biliary tract surgery Physical (baseline): orientation. lactation Nursing Considerations:   History: allergy to nalbuphine. dysuria. location) Review drugs taken by patient (avoid mixing with nafcillin. warmth. bronchial asthma. anoxia. dyspepsia. vital signs (P. vomiting. increased intracranial pressure. renal or hepatic dysfunction. headache. emotional instability. burning. palpitations. hypotension. MI. stress ulcers. creatinine) Assessment of intravenous site and patency of intravenous line Taper dosage when discontinuing after prolonged use (to avoid withdrawal symptoms) Keep opiod antagonist and facilities for assited or controlled respiration (in case of respiratory depression) Reassure patient’s guardian about addiction liability Monitor vital signs or changes in respiration Instruct patient to report nausea. urticaria. tingling. difficulty of breathing.

local burning or itching at IV site. nausea. granulocytopenia. blood dyscrasia. Individualized dose with patient’s response. dizziness. tarry stools. vertigo. liver evaluation. electrolyte imbalances Review drugs taken by patient (avoid mixing ranitidine with amphotericin B) Assessment of intravenous site and patency of intravenous line Instruct patient and patient’s guardian to report pain. Do not exceed 6 g/day. bradycardia. rash. alopecia. confusion. vomiting. abdominal pain. blurred vision. severe renal disease. insomnia. rash. hallucinations. severe liver disease Nursing Considerations:      Have baseline assessment of skin lesions. renal and liver function & IV patency and site  . premature ventricular contraction. abdominal examination. thrombocytopenia. unusual bruising or bleeding. increased alanine amino transaminase levels. somnolence. depression. constipation. pain at injection site. diarrhea. impotence. hepatitis. gynecomastia. ECG. pancytopenia. severe headache. renal function test (BUN & creatinine). constipation or diarrhea. coughing or vomiting of blood.Adults: 75 to 150 mg bid PO or 50 mg IM or IV every 6 to 8 hours. dizziness. orientation. vital signs (P). malaise. muscle or joint pain Monitor ECG for dysrhytmias. affect. decreased libido. tachycardia. liver function test (ALT & AST). leucopenia. sore throat. arthralgia Special Precautions: sensitivity to ranitidine. Pediatrics: safety and efficacy not established Side Effects: headache. urine output Laboratory: complete blood count.