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Introduction

Neonatal Pneumonia is a pulmonary infection presenting with a clinical picture of respiratory


distress, associated with chest radiological findings suggesting pneumonia and persisting for 48
hours. Infections may be transmitted via placenta, by aspiration or acquired postnatal. Neonatal
Pneumonia can be subdivided into 4 categories:

• Congenital Pneumonia: transplacentally acquired e.g. rubella, cytomegalovirus,


toxoplasma, listeria, herpes simplex, treponema pallidum
• Intrauterine Pneumonia: aspiration of infected amniotic fluid

• Early onset Pneumonia: due to ascending infection “vertically”

• Late onset Pneumonia: due to organism acquired nosocomially “horizontally” or within


the community

Early onset pneumonia presents at birth or soon afterwards. The following are the risk factors:
• Spontaneous onset of preterm labor
• Prolonged rupture of membrane (>18)
• Maternal Fever (>37.5’C)
• Chorioamnionitis- inflammation of the fetal membrane chorion and amnion due to
bacterial infection
• Offensive liquor
Microbes involved are group B haemolytic streptococcus (GBS) pneumonococcus and
coliforms.

Late onset pneumonia occurs at least 48 hours after delivery and later. Presents more
insidiously and may develop abdominal distention and feeding intolerance, microbes involved
are streptococci, staphylococci, E coli, Klebsiella, Viral and Chlamydial infection also associated
with neonatal pneumonia.
PATIENT’S PROFILE

Name: Baby Girl A


Age: 8 days old
Gender: Female
Address: 3A Natividad St. Malanday, San Mateo Rizal
Birthday: Nov. 13, 2009
Birthplace: Marikina City
Body Length: 50 cm
Body Weight: 2,600 g

Mother’s Name: Mrs A


Father’s Name: Mr. A

PRESENT HISTORY

With poor cry and fair activity normocephalic, open anterior fontanel, pink
conjunctiva, anicteric sclera cleft, NRR (Normal Rate Rhythm) no murmur. Seen and
examined (-) retraction, fair air entry, slight globular, soft, AVA, normal looking female
external genitalia.

FAMILY HISTORY
The Mother never had a pre-natal check-up during her last pregnancy. She didn’t
take any vitamins and did not have Tetanus Toxoid. She had cough and colds during
her pregnancy and did not take any medicine.
Course in the Ward

November 14, 2009, 4 am, baby Girl A had seizure and cyanosis. She was prescribed
by Dra. Navarro the following medicines:Ampicillin 260 mg TIV q 12’, Gentamicin 13 mg TIV,
OD; Phenobarbital 6.5 mg TIV q 12’. Intubation was done (CPAP) with the following setting:
PEEP- 4, FiO2 -100%, O2-4, CA-0. OGT was also inserter to draining bottle. IVF of D5IMB x 12’
for 2 doses was also given. She is for diagnostic test of CUTZ and ABG’s. On the same day at
2pm, her FiO2 decreased to 30% and was hooked by a pulse oxymeter and kept O2 sat > 90%.
Hgt monitoring was done q8’. She was for serum Na, K, Ca and was maintained FiO2 at 30%
and suctioned secretions when needed. She was on NPO diet.
November 15, 2009, she had seizure and was given Phenobarbital 13mg TIV. She also
had coffee-ground secretions and was given Omeprazole 2.6 mg IV, OD and she was for gastro
lavage with iced cold press. By 5pm, hypokalemia and hypocalcemia was diagnosed that’s why
her IVF was revised to D10W-116.2cc, NaCl-3cc,KCl-3.9, CaGluconate-10.4cc and A.A- 21.5cc
with a total of 155 cc to run for 24 hours.
November 16, 2009, 11am, her IVF changed to: D10W-21.5 cc,NaCl-3cc,KCl-
3.9cc,CaGluc-10.4cc,A.A-43.2cc with a total of 182cc at 7-8 cc/hr q 24 hours, for repeat CBC,
maintained CPAP settings, for repeat serum electrolytes, for gastric lavage and CUTZ.
Measure OGT output q shift.
November 17.2009, 7am, her IVF was revised to: D10W-129cc,NaCl-3.1cc,KCl-
0.8cc,CaGluc-10.4cc,A.A-64.7cc with a total of 208cc x 8-9 mgtts/min for 24 hours. Ampicillin
and Gentamicin was hold and shifted to Cefotaxime 130mg TIV q 12’ and Amikacin 40mg
TIV,OD. At 11:10am, IVF and CPAP was maintained and give Vitamin K 1 mg.Endotracheal
tube was removed.
PHYSICAL ASSESSMENT

Method of
Category Actual Findings Analysis
examination

• Skin Inspection acrocyanosis

Inspection and Nails are bluish in color,


• Nails
palpation capillary refill of 4 seconds

Open anterior and posterior


• Head and Inspection and
fontanelles, face is also
Face palpation
cyanotic
Sclera appears white, dark
• Eyes Inspection Normal
brown iris
Auricles are aligned with the
• Ears Inspection outer canthus of the eyes.
Normal
Able to hear in both ears
Nose Inspection Nasal flaring
• Mouth/lips Inspection Lips are cyanotic

• Pharynx Pink and smooth wall, gag


Inspection Normal
reflex present
Inspection and Symmetrical, no palpable
• Neck Normal
Palpation lymph nodes
• Breast and
Inspection Moist Normal
axilla
Inspection, Positive deep chest There is an
• Chest and
palpation and retraction, breathes through increase in
lungs
auscultation the diaphragm with crackles respiratory effort.
Internal organs of
infants are
proportionately
Inspection and
• Abdomen Globular, soft larger than those
palpation
of adults, so their
abdomens are
rounded
• Lower and Positive plantar and palmar
Inspection,
upper reflex. Extremities are
Palpation
extremities acrocyanotic

• Genitals Inspection Female genitalia. Normal



GORDON’S LEVEL OF FUNCTIONING

Functional Health Functional Health During Hospitalization Analysis


Pattern Pattern
1.Health Perception / Baby A’s mother had Baby A was born with a The mother doesn’t
Health Management just a few check-up poor APGAR score and frequently seek
during the pregnancy for had a nasal CPAP medical attention
Baby A and at a same during her stay at the during the pregnancy
time she doesn’t take hospital. She was that results to the
multivitamins during the administered mostly unmonitored progress
pregnancy. with antibiotics. or problem in the
pregnancy
2.Nutritional- Baby A is breast fed Baby A is not A patient who is
metabolic when she wants to breastfeeding hospitalized may
breast feed. She only effectively and is fed have a change in her
breast feed of her through an OGT. appetite because of
mother. the illness she has
and it may be due to
the contraption that is
with the patient.
3.Elimination Baby A consumes 3-4 She consumes 2 A patient who is
diapers a day and diapers a day and hospitalized will have
defecates 2 times a day. defecates once a day a changes or
her stool is darker due decrease in urination
to the bleeding she has. or defecation when ill
because of the
change in the intake
and course of
treatment.
4.Activity- exercise Baby A plays and She was not able to A patient who is
interacts with other play as she used to hospitalized will not
people when awake. because she was able to play because
always sleepy and of the illness and the
weak to do so. course of the
treatment.

5.Cognitive- NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE


perceptual
6.Sleep- rest The patient was able to Patient spends long There has been a
consume 15-17 hours hours of sleep due to change in the sleep
sleeping time, she is weakness; wakes up in rest pattern because
awake every 4 hours short periods time just of the changes in the
and if she wants to to breast feed. environment and the
breast feed. course of treatment.
7.Self- perception/ NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE
Self concept
8.Role- Relationship NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE
9.Sexuality- NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE
reproductive
10.Coping/ Stress NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE
Tolerance
11.Value- belief NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE





• LABORATORY

Hematology

Normal Values Result Interpretation


Hemoglobin W:7.4-9.9 mmol/L 3.36 Decrease due to GI
bleeding.
M:8.1-11.2 mmol/L

Hematocrit W:0.36-0.46 0.65 Increase due


to dehydration result
M:0.37-0.49 from electrolyte losses.
White blood cells 4.5-11.0x10 Liter 17.2 Increase due to
infection.
Segmenters 0.40-0.60 0.78 Increase due to
infection
Lymphocytes 0.16-0.46 0.16 Normal
Eosinophiles 0.0-0.08 0.02 Normal
Monocyte 0.04-0.11 0.04 Normal
Platelet count 130-400x10 Liter 368 Normal

Blood Gas Values


Normal Values Result
pH 7.35-7.45 7.469
pC02 35-45 mmHg 28.2
P02 98-100 mmHg 192.2
HC03 22-26 mEq/L 20.2
Interpretation: Respiratory alkalosis

Electrolyte values
ANATOMY AND PHYSIOLOGY

RESPIRATORY SYSTEM

Normal Values Results Interpretation


Na 135-145 mmol/L 132.8 Decrease due to GI
bleeding or
malabsorption.
K 3.5-5.5 2.96 Decrease due to GI
bleeding or
malabsorption.
Ca 1.13-1.33 0.75 Decrease due to GI
bleeding or
malabsorption.
The respiratory system consists of all the organs involved in breathing. These include
the nose, pharynx, larynx, trachea, bronchi and lungs. The respiratory system does two very
important things: it brings oxygen into our bodies, which we need for our cells to live and
function properly; and it helps us get rid of carbon dioxide, which is a waste product of cellular
function. The nose, pharynx, larynx, trachea and bronchi all work like a system of pipes through
which the air is funneled down into our lungs. There, in very small air sacs called alveoli, oxygen
is brought into the bloodstream and carbon dioxide is pushed from the blood out into the air.
When something goes wrong with part of the respiratory system, such as an infection like
pneumonia, it makes it harder for us to get the oxygen we need and to get rid of the waste
product carbon dioxide.
The lungs are covered by smooth membranes that we call pleurae. The pleurae have
two layers, a 'visceral' layer which sticks closely to the outside surface of your lungs, and a
'parietal' layer which lines the inside of your chest wall (ribcage). The pleurae are important
because they help you breathe in and out smoothly, without any friction. They also make sure
that when your ribcage expands on breathing in, your lungs expand as well to fill the extra
space.

When you breathe in (inspiration), your muscles need to work to fill your lungs with air.
The diaphragm, a large, sheet-like muscle which stretches across your chest under the ribcage,
does much of this work. At rest, it is shaped like a dome curving up into your chest. When you
breathe in, the diaphragm contracts and flattens out, expanding the space in your chest and
drawing air into your lungs. Other muscles, including the muscles between your ribs (the
intercostal muscles) also help by moving your ribcage in and out. Breathing out (expiration)
does not normally require your muscles to work. This is because your lungs are very elastic,
and when your muscles relax at the end of inspiration your lungs simply recoil back into their
resting position, pushing the air out as they go.

Pharynx
The pharynx is part of both the gastrointestinal system and respiratory system. In the
respiratory system the pharynx functions in conducting air from the nasal cavities to the larynx.
In the digestive system the pharynx functions in the swallowing.

Larynx
The larynx is part of the respiratory system and is often described as our voice box. The
larynx acts as a funnel enabling the passage of fresh air down from the outside world into our
bodies.

Trachea
The trachea is a component of the respiratory system. The trachea is also described as
the windpipe and function as a funnel enabling the entry of fresh air down from the outside world
into our bodies.

Bronchi
Bronchi (singular bronchus) are the main two air ways which lead from the windpipe to
the lungs. The bronchi enable air to move in and out of the lungs.

Lungs
Lungs are paired, cone-shaped organs which take up most of the space in our chests,
along with the heart. Lungs are part of the respiratory system and are important in ensuring the
entry of oxygen into the body and the removal of carbon dioxide out of the body.
PATHOPHYSIOLOGY

Predisposing Factor: Precipitating Factor:


× Immunocompromised × No multivitamin intake
× Environment × No prenatal check-up
× High risk mother (42y/o) × Financial constraint

Failure to penetrate the


pathogen Activation of defense mechanism
Infecting organism
enters in the airway

Affects both airways and lung


parenchyma

Lung invasion

Pathogen reached the lungs Infection of


epithelial cells

Pathogen multiplies in the Macrophages


alveoli and leukocytes

Inflammation Irritation of
airway
Infectious organism
lodges ↑ goblet cells

Stimulation in bronchioles Mucus and


phlegm
production
Narrowing of air passages Ineffective
Productive airway
cough clearance
Difficulty of breathing
Impaired O2
and CO2
exchange

PRIORITIZATION

NURSING
STATUS RATIONALE
DIAGNOSIS/PROBLEMS
Ineffective airway clearance
Ineffective airway clearance
related to increase secretion
is the inability to clear
production as evidence by
High secretions or obstructions
ineffective cough with sputum,
from respiratory tract to
abnormal breath sounds,
maintain a clear airway.
dyspnea

Ineffective breathing pattern


related to increase secretion
production and Is the inspiration /expiration
bronchoconstriction as Medium that does not provide
manifested by productive adequate ventilation
cough and difficulty of
breathing.

An excess or deficit in
Impaired Gas Exchange
oxygenation and/or CO2
related to ventilation perfusion
elimination at the alveoli
imbalance due to inflammation
Low capillary membrane
of the lungs as evidenced by
interrelated between
irritability, being sleepy,
ineffective airway clearance
dyspnea, & restlessness
and sputum production.

Ineffective infant feeding


For the infant’s age, the only
pattern related to illness as
means for her to be
manifested by inability to Low
nourished is by
initiate or sustain an effective
breastfeeding.
suck and breast feed.

Infection related to inadequate


Infant’s immune system is
secondary defenses as
not yet well established to
manifested by decreased Low
fight of invading
hemoglobin and
microorganism
immunocompromised

DISCHARGE PLANNING

M-edication

Advise the mother to give the necessary medications prescribed by the physician after the
patient is discharged, if applicable, especially antibiotics to prevent resistance in the said
medication.
E-xercise

Since exercise is not applicable to the patient, then teach the mother to perform some exercises
that will combat her flagging energy levels while taking care of her baby.

T-reatment

Teach the mother to do all the instructions given by the physician so that the patient will fully
recover from the disease.

H-ygiene

Teach the mother to do cord care to prevent further risk for another infection. As well as do baby
bath and other hygienic measures if it is applicable to the patient.

O-ut patient

Remind the mother to return to the hospital for post partum check-up after two weeks. To
assess for the development of the baby and for continuity of care.

D-iet

Encourage the mother to exclusively breastfeed her baby. For it is not only economical but best
for her baby. It boosts the immune system that will helps the patient fight infection.

S-piritual

Encourage the mother to go to church together with the whole family and ask for divine
providence. For it is one of the factors one should have to be considered a healthy individual.
ASSESSMENT NURSING SPECIFIC PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS EXPLANATION
Short term:
S/O: Impaired Gas An excess or Short Term Independent: After 30
Exchange deficit on Goal: -Assess respiratory -Manifestations of respiratory minutes of
-Cyanotic skin related to oxygenation Within 30 rate, depth & ease distress are dependent &/on nursing
color ventilation &/or CO2 minutes of indicative of the degree of lung intervention the
-fair activity perfusion elimination at nursing involvement & underlying general secretions has
-dyspnea (RR- imbalance the alveoli- intervention health status. lessened as
70 cpm) due to capillary secretions evidenced by
-crackles increase membrane, with will be -Observe color of the -Cyanosis may represent the absence of
-poor cry secretions as an interrelated lessened. skin, mucous vasoconstriction or the body’s crackles and
evidenced by process membranes, & nail response to fever/chills; can be an RR of 50cpm.
dyspnea , RR between Long Term bed, noting presence indication of systemic hypoxemia
of 70cpm and ineffective Goal: of cyanosis. Long Term:
crackles. airway Within the After the
clearance due patient’s -Suctioning of -to remove secretions patient’s
to sputum hospital secretions hospital stay
production & stay the the patient has
other signs & patient will -keep the patient -to maintain thermoregulation improved gas
symptoms have an warm and dry. exchange as
mentioned, improved evidenced by
results to gas Dependent: pinkish skin
Impaired Gas exchange. - Endotracheal -These measures promote color and good
Exchange. Intubation maximal inspiration & improve activity.
- Ambubagging with ventilation.
O2 at 5 Lpm

-Administration of
Medications such as
antibiotics.
NURSING SPECIFIC
ASSESSMENT PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS EXPLANATION

S/O: Ineffective An inability to Short term Independent: Short term:


Airway clear secretions or Goal: -Assess rate of -tachypnea, shallow -After 30 mins.
- RR-70 cpm Clearance obstruction from Within 30 mins respirations & chest respirations, & of nursing
-nasal flaring related to the respiratory of nursing movements. asymmetric chest intervention,
-increased increased tract to maintain a intervention, movements are excess mucus
mucus mucus clear airway, due mucus frequently present due secretion had
secretions secretions as to sputum secretions will to discomfort of moving expelled.
-Dyspnea manifested by production, lessened, chest wall&/or fluid in
-cyanotic Skin crackles, excessive mucus, the lungs. Long term:
-deep chest dyspnea and & retained Long term After the
retraction, cyanotic skin, secretions, results Goal: -Auscultate lung -decreased airflow & patient’s
crackles in an Ineffective fields, noting areas of bronchial breath sounds, hospital stay,
-O2 inhalation Airway Clearance. Within hospital decreased/absent occur in consolidated nasal flaring
- Endotracheal stay, patient’s airflow & adventitious areas. disappeared
intubation nasal flaring breath sounds. and ventilation
will improved.
disappeared - Suction secretions - to remove excessive
and improved regularly mucus secretion
ventilation

Dependent:
- Administer O2 - to improve ventilation
inhalation at 5 Lpm as
prescribed by the
doctor
- Endotracheal
intubation as per
doctor’s order

-Administer antibiotics - to kill susceptible


as prescribed by the bacteria
doctor
ASSESSMENT DIAGNOSIS SCIENTIFIC GOAL INTERVENTION RATIONALE EVALUATION
EXPLANATION
Short term: Independent: Short term:
S/O Ineffective The signs and After 2 hrs. of After 2 hrs. of
- Inability to initiate infant feeding symptoms nursing -Assess signs of stress -To note predisposing nursing
or sustain an pattern related manifested by the intervention, the when feeding. factors. intervention
effective suck. to illness as patient have the client will be the client has
manifested by effect in the ability able to promote - Demonstrate - to prevent aspiration the initiate or
-Inability to breast inability to of the client to adequate infant techniques/procedures sustain an
feed initiate or breastfeed. The intake. for feeding. effective suck
sustain an client becomes and the
effective suck irritable because of Long term: Dependent: mother was
and breast feed. this she was not Within hospital -Note/type scheduling of - May cause sedative able to
able to have the stay, the client medication. effect/impair feeding breastfed the
initiate or sustain an will be able to activity. client. Goal
effective suck. promote partially met.
wellness. - Alter medication -To minimize sedative
feeding schedules as effect. Long term:
indicated. After hospital
stay, the client
- Provide food - To increase weight has gained
supplements or vitamins and maintain proper weight and
as per doctor’s order. nutrition. was able to
maintain food
Collaborative: supplements
- Determine appropriate -To enhance specific and vitamins.
method for feeding. method for feeding.

-Refer mother to -For assistance and


lactation specialist. support.
ASSESSMENT DIAGNOSIS SCIENTIFIC GOAL INTERVENTION RATIONALE EVALUATION
EXPLANATION

S/O: Ineffective Irritation at airway Short term: Independent: Short term:


breathing clearance. After 1 hr. of After 1hr. of nursing
× Dyspne pattern related ↓ nursing -Assess respiratory -Manifestations of intervention, client
a to increase Stimulation and intervention the rate, depth and respiratory distress are has less recurrence
× RR = secretion increase of goblet client’s recurrence ease dependent &/on of deep chest
70cpm production and cells. of deep chest indicative of the degree retraction
× Chest bronchoconstri ↓ retraction will of lung involvement &
retraction ction as Mucus and phlegm decrease. underlying general Long term:
manifested by production. health status. Within long stay of
difficulty of ↓ Long term: client to the hospital,
breathing and Productive Within hospital -Keep patient dry -To promote she has improved her
chest coughing stay the client will and warm. thermoregulation breathing pattern as
retraction ↓ have a evidenced by the
Narrowing of air normal/effective absence of difficulty
passage. breathing pattern. of breathing.
↓ Dependent:
Bronchoconstriction -ET intubation -Helps to improve the
↓ breathing and ventilation
Difficulty of
breathing Collaborative:
- Giving - To promote fluid
intravenous fluid. management.

-Advice mother for -To monitor the


follow-up check progress/development of
ups of baby. disease.

ASSESSMENT DIAGNOSIS SCIENTIFIC GOAL INTERVENTION RATIONALE EVALUATION


EXPLANATION
Short term:
S/Objective: Infection related to Pathogenic Short term: Independent: After 8 hrs. of
- Increase white inadequate organisms invades After 8 - Stress proper hand -A first-line defense nursing
blood cell secondary the lungs and the GI hours of washing techniques by all against nosocomial intervention,
count. defenses as tract. Since the nursing caregivers between infections. there is no
manifested by gastrointestinal tract intervention, therapies/clients. untoward signs
-Jaundice decrease of neonates are patient will and symptoms
hemoglobin and sterile and their not - Provide for -Reduces the risk of noted.
-Coffee-ground immunocompromis immune system is manifests isolation as cross contamination.
secretions ed. not yet fully any other indicated. Long term:
established. It will further -To prevent further After 3-4 days of
damaged stomach. complication -Maintain sterile complications. nursing
Compensatory s. technique for invasive intervention,
mechanism of the procedures. patients condition
body results to Long term: is stable. No
bleeding. This After 3-4 Dependent: -To determine further
results to a days of - Administer/monitor effectiveness of complications
decrease in nursing medication regimen. therapy/presence of and progress in
hemoglobin which is intervention, side effects. infection is noted.
one of the patient’s
secondary defenses condition will
of the body. This be stable. Collaborative: -To monitor for
decrease results to - Monitor for any progress of infection.
further damage and untoward signs and
one of them is symptoms.
infection.
Drug Study

Generic / Brand Indication/ Classification Action Contraindication Side effects Nursing


name Dosage Consideration
Generic: -Respiratory tract - aminopenicillin - inhibits cell-wall -in patient CNS: seizures -obtain hx of pt.
ampicillin or skin and skin- -antibiotic synthesis during hypersensitive to drug CV: vein irritation, infection before
Brand name: structure microorganism or other penicillins thrombophlebitis therapy.
Novo- Ampicillin infection multiplication -use cautiously in pt. Hematologic: -give atleast 1
- Bacterial -kills susceptible with other drug anemia, hour before
meningitis or bacteria, allergies. Esp. to thrombocytopenia, bacteriostatic
septicemia including non- cephalosporin(possible- leucopenia antibiotics
-GI infection penicillinase- cross-sensitivity), and -call the
producing gram- in those with prescriber if rash,
*260 mg TIV q positive bacteria mononucleosis(high fever, chills
12’ and many gram- risk of maculopapular develop
negative rash)
organisms.
Generic / Brand Indication/ Classification Action Contraindication Side effects Nursing
name Dosage Consideration
Generic: -meningitis -aminoglycoside -inhibits protein - in patient CNS: headache, -assess pt.
Gentamicin sulfate -serious infections -antibiotic synthesis by hypersensitive to seizures, infection and
Brand name: caused by binding to drug or other numbness hearing before
Cidomycin sensitive strains of ribosomes aminoglycosides Hematologic: starting therapy
Pseudomonas -kills susceptible -use cautiously in thrombocytopenia, -obtain specimen
aeruginosa,E.coli bacteria(many pt. with renal leucopenia, for c&s test before
aerobic gram impairements or giving the first
*13 mg TIV, OD negative neuromuscular dose.
organisms and disorders -Be alert for
some aerobic adverse and drug
gram positive interaction
organisms). Drug
may act against
some
aminoglycoside
resistant bacteria
Generic / Brand Indication/Dosage Classification Action Contraindication Side effects Nursing
name Consideration
Generic: - all forms of -barbiturate - unknown, may - in patient -CV:bradycardia -assess pt.
phenobarbital epilepsy except -anticonvulsant, depress CNS hypersensitive to -Respiratory: condition before
Brand name: absence seizures; sedative hypnotic synaptic drug respiratory starting therapy.
Solfoton febrile seizures in transmission and - use cautiously in depression, apnea - Monitor drug
children increase seizure debilitated pt. and level closely
-sedative activity threshold in pt, with acute or - be alert for
in motor cortex. chronic pain adverse reactions
*6.5 mg TIV q 12’ As sedative, may
interfere with
transmission of
impulses from
thalamus to brain
cortex
- prevents and
stop seizure
activity; promotes
calmness and
sleep.

Generic / Brand Indication/ Classification Action Contraindication Side effects Nursing


name Dosage Consideration
Generic: -GERD -substituted - inhibits acid - in patient -CNS: headache, - assess pt.
omeprazole benzimidazole (proton) pump and hypersensitive to dizziness condition before
Brand name: *2.6mg TIV, OD -proton pump binds to hydrogen- drug -Respiratory: starting therapy.
Losec inhibitor potassium cough - be alert on
adenosine adverse effetcs
triphophatase on
secretory surface
of gastric parietal
cell to block
formation of
gastric acid.
- relieves
symptoms caused
by excessive
gastric acid

Generic / Brand Indication/ Classification Action Contraindication Side effects Nursing


name Dosage Consideration
Generic: -serious infection -third- generation -inhibits cell wall - in patient -CNS: fever - assess pt.
Cefotaxime of lower cephalosporin synthesis, hypersensitive to -Respiratory: condition before
sodium respiratory and - antibiotic promoting osmotic drug. dyspnea starting therapy
Brand name: urinary tracts, instability; usually -use cautiously in -obtain specimen
Claforan CNS,intra- bactericidal pt. with renal for c&s test before
abdominal - hinders or kills impairment. the first dose.
infection and susceptible -Be alert on
septicemia bacteris adverse reactions.

*130 mg TIV q12’

Generic / Brand Indication Classification Action Contraindication Side effects Nursing


name Consideration
Generic: - serious -aminoglycoside - inhibits protein - in patient -CNS: headache, - assess pt.
amikacin sulfate infections caused -antibiotic synthesis by hypersensitive to neuromuscular infection, weight
Brand name: by sensitive binding directly to drug blockage and renal function
Amikin strains of 30S ribosomal - use cautiously in test values before
Pseudomonas subunit. Generally pt. with renal therapy.
aeruginosa,E.coli bactericidal impairment. -watch for signs of
- kills susceptible ototoxicity
*40mg TIV OD bacteria many -Monitor amikacin
aerobic gram level
negative
organisms and
some aerobic
gram positive
organisms).

Generic / Brand Indication/ Classification Action Contraindication Side effects Nursing


name Dosage Consideration
Generic: -RDA -synthetic analog .-an - in patient -CNS: seizurelike -assess pt. hx
Phytonafione -to prevent of vitamin K antihemorrhagic hypersensitive to movements before therapy
(vitamin K) hemorrhagic -blood coagulation factor that drug -Monitor PT to
Brand name: disease of modifier promotes hepatic determine dosage
aquaMephyton newborns formation of active effectiveness
prothrombin
*0.1 ml IM, vastus -controls abnormal
lateralis bleeding

Generic / Brand Indication Classification Action Contraindication Side effects Nursing


name Consideration
Generic: -mild to moderate -macrolide -inhibits bacterial - in patient -CNS: fever -obtain hx of pt.
Erythromycin severe respiratory -antibiotic protein synthesis hypersensitive to -Hepatic: infection before
Brand name: tract, skin, soft- by binding to 50S drug cholestatic starting therapy
Apo-Erythro tissue infection subunit of hepatitis -be alert on
-Pneumonia of ribosomes. adverse reaction
infancy -inhibits bacterial -Monitor liver
growth function