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Sotejo Hall, Pedro Gil Street, Ermita, Manila
NAME OF STUDENT: Ma. Stefanie P. Reyes DATE OF ASSIGNMENT: August 16-19, 2010 NAME OF PATIENT: Alfredo N. Frias CIVIL STATUS: Married WARD: 3 BED NO.: 26 DIAGNOSIS OR CLINICAL IMPRESSION: Acute Respiratory Failure secondary to Status Asthmaticus—Hypoxic Ischemic Encephalopathy AGE: 57 SEX: Male DRUG ORDER (Generic name, Dosage, Route, Frequency, etc.) Acetylcysteine • 200mg in 100 cc PNSS • PO • 1 sachet BID (8—6) DESIRED ACTION ON THE CLIENT To help liquefy and mobilize the client’s secretions .
TRADE/ BRAND NAME
PHARMACOLOGI C ACTION OF DRUG
• Mucolytic • Acts by
INDICATIONS AND CONTRAINDICATIONS
ADVERSE EFFECTS OF THE DRUG
NURSING RESPONSIBILITIES/ PRECAUTIONS
disrupting disulfide linkages of mucoproteins in purulent and nonpurulent secretions. • Lowers viscosity and facilitates the removal of secretions.
INDICATIONS: • Abnormal, viscid, or inspissated mucous secretions in acute and chronic bronchopulmonary diseases • Pulmonary complications of cystic fibrosis and surgery, tracheostomy, and atelectasis • Diagnostic bronchial studies • Antidote for acute acetaminophen poisoning CONTRAINDICATIONS: • Hypersensitivity • Patients at risk of gastric hemorrhage Caution with pregnancy (C), lactation, asthma, older adults, debilitated patients with severe respiratory insufficiency
• CNS: Dizziness,
drowsiness • GI: Nausea, vomiting, stomatitis, hepatotoxicity, urticaria • Resp: Bronchospasm, rhinorrhea, burning sensation in upper respiratory passages, epistaxis
Assessment & Drug Effects • Monitor for s/sx of aspiration of excess secretions, withhold drug and notify physician immediately if it occurs. • Lab tests: Monitor ABGs, pulmonary functions and pulse oximetry as indicated. • Have suction apparatus immediately available. Increased volume of respiratory tract fluid may be liberated—suction or endotracheal aspiration may be necessary to establish and maintain an open airway. Older adults and debilitated patients are particularly at risk. • Bronchospasm is most likely to occur in patients with asthma, and it may happen unpredictably. If it occurs, discontinue immediately. • Nausea and vomiting may occur, particularly when face mask is used, due to unpleasant odor of drug
Dosage.) Citicoline • 1g/tab • PO • 1 tab BID (8—6) TRADE/ BRAND NAME PHARMACOLOG IC ACTION OF DRUG • A derivative of INDICATIONS AND CONTRAINDICATIONS ADVERSE EFFECTS OF THE DRUG DESIRED ACTION ON THE CLIENT To aid in the client’s recovery phase of stroke NURSING RESPONSIBILITIES/ PRECAUTIONS choline and cytidine involved in the biosynthesis of lecithin • It is claimed to increase blood flow and oxygen consumption in the brain. somnolence. psychomotor slowing. nervousness. persistent intracranial hemorrhage • CNS: Insomnia. memory difficulty. difficulty concentrating. old • Migraine (prophylaxis) CONTRAINDICATIONS: • Hypersensitivity • Epilepsy • CNS: Dizziness. DRUG ORDER (Generic name. poor concentration. lactation. ataxia. • Monitor for s/sx of allergic reactions: GI disturbances • Caution with large doses which could aggravate increase in cerebral blood flow in episodes of intracranial hemorrhage. Patient & Family Education • Report adverse effects that might aggravate the client’s condition. Topiramate • 50mg/tab • PO • ½ tab BID (8—6) Topama x • Anticonvulsant. as an antiemetic may be indicated. CNS agent • Sulfamatesubstituted monosacchar ide with a broad spectrum of anticonvulsa INDICATIONS: • Partial-onset seizures in adults and children above 2 yrs. excitement. Patient & Family Education • Report difficulty with clearing the airway or any other respiratory distress. confusion. paresthesia. INDICATIONS: • Cerebrovascular impairment in acute and recovery phase • S/sx of cerebral insufficiency: dizziness. Frequency. headache. diziness. shock. parasympathetic stimulation • CVS: Hypotension • Syst: Hypersensitivity Assessment & Drug Effects • Monitor vital signs.and excess volume of liquefied bronchial secretions. • Report nausea. memory loss disorientation • Cranial trauma and sequelae • Parkinson’s disease CONTRAINDICATIONS: • Hypersensitivity • Hypertonia of parasympathetic nervous system Caution with pregnancy (C). Route. To prevent the onset of seizures on the client Assessment & Drug Effects • Monitor mental status and report significant cognitive impairment. nystagmus. • Drug must not be administered with medicaments containing meclophenoxate. Patient & Family Education . • Lab tests: Periodically monitor CBC with Hgb and Hct. etc.
or malabsorption. abdominal distension GU: Oliguria. To minimize risk of kidney stones. cardiac Assessment & Drug Effects • Monitor for and report signs of GI ulceration (esophageal or epigastric pain or hematemesis). diarrhea. INDICATIONS AND CONTRAINDICATIONS ADVERSE EFFECTS OF THE DRUG DESIRED ACTION ON THE CLIENT NURSING RESPONSIBILITIES/ PRECAUTIONS water balance agents. replacement solution • Principal intracellular cation • Essential for maintenance of intracellular isotonicity. Frequency. maintenance of normal kidney INDICATIONS: • Potassium deficit secondary to diuretic or corticosteroid therapy • Potassium depletion by severe vomiting. CVS: Hypotension. • The risk of hyperkalemia with potassium supplement increases (1) in older adults because of . irritability GI: Nausea. prolonged diuresis. transmission of nerve impulses. • Be alert for potassium intoxication (hyperkalemia). This may result from any therapeutic dosage.nt activity. skeletal. and the patient may be asymptomatic. bradycardia. Its precise mechanism of action is unknown. fistulas. contraction of cardiac. anuria Hema: Hyperkalemia Resp: Respiratory distress. etc. weight loss. Route.) Potassium Chloride • 10% solution • PO • 30 cc BID (8—6) TRADE/ BRAND NAME PHARMACOLOGI C ACTION OF DRUG • Electrolytic and • Pregnancy (C) Caution with renal and hepatic function impairments. diabetic acidosis • Hypokalemic alkalosis CONTRAINDICATIONS: • Severe renal impairment • Severe hemolytic reactions • • • • • • CNS: Mental confusion. fatigue • • • • Do not stop drug abruptly. and smooth muscles. Be aware that psychomotor slowing and speech/language problems may develop while on topiramate therapy. vomiting. Report adverse effects. lactation depression. anxiety. Dosage. intestinal drainage. as well as enhancing the ability of GABA to induce a flux of chloride ions into the neurons. DRUG ORDER (Generic name. • Lab test: Frequent serum electrolytes are warranted. drink at least 6–8 full glasses of water each day if fluid intake is not restricted. Exhibits sodium channelblocking action. thus potentiating the activity of this inhibitory neurotransmi tter (GABA). diarrhea. tremors • GI: Anorexia • Misc: Speech problems. Discontinue gradually to minimize seizures.
DRUG ORDER (Generic name. • Do not self-prescribe laxatives.function. These contain a substantial amount of potassium and electrolytes other than sodium. flaccid paralysis decremental changes in kidney function associated with aging. • Given special importance as therapeutic agents but are also dangerous if improperly prescribed and administered. lactation depression. fatigue. Route. • Report continuing signs of potassium deficit to physician: weakness. altered sensitivity to digitalis glycosides ECG changes in hyperkalemia: Tenting (peaking) of T wave (especially in right precordial leads). decreased amplitude and disappearance of P waves. and for enzyme activity. difficulty in swallowing. (2) when dietary intake of potassium suddenly increases. arrhythmias. • Untreated Addison's disease • Crush syndrome • Early postoperative oliguria (except during GI drainage) • Adynamic ileus • Acute dehydration • Heat cramps • Hyperkalemia • Patients receiving potassium-sparing diuretics Digitalis intoxication with AV conduction disturbance Caution with cardiac or kidney disease. Patient & Family Education • Teach about sources of potassium with special reference to foods and OTC drugs.) TRADE/ BRAND NAME PHARMACOL OGIC ACTION OF DRUG INDICATIONS AND CONTRAINDICATIONS ADVERSE EFFECTS OF THE DRUG DESIRED ACTION ON THE CLIENT NURSING RESPONSIBILITIES/ PRECAUTIONS . prolonged Q-T interval. prolonged P-R interval. or arrest. polyuria. signs of right and left bundle block. paresthesias of extremities. polydipsia. Plays a prominent role in both formation and correction of imbalances in acid–base metabolism. • Notify physician of persistent vomiting because losses of potassium can occur. muscle weakness and heaviness of limbs. lowering of R with deepening of S waves and depression of RST. slow-release potassium preparations in presence of delayed GI transit or Meckel's diverticulum. deterioration of QRS contour and finally ventricular fibrillation and death • MS: Pain. Frequency. extensive tissue breakdown (such as severe burns). etc. Utilized for treatment of hypokalemia. and (3) when kidney function is significantly compromised. • Do not use any salt substitute unless it is specifically ordered by the physician. widened QRS complex. systemic acidosis. Dosage. pregnancy (A). Chronic laxative use has been associated with diarrhea–induced potassium loss.
use of acid-citrate-dextrose (ACD)converted blood (may contain heparin). heat. last trimester. all patients > 60 y. anaphylaxis Assessment & Drug Effects • Lab tests: Baseline blood coagulation tests. itching. suppressed renal function. ecchymoses. dark brown. and other s/sx of hemorrhage. hemophilia. lacrimation. patients with indwelling catheters. “White clot syndrome” • Integ: Injection site reactions (pain. liver. hypofibrinogenemia. RBC. during menstruation.. thereby blocking the conversion of prothrombin to thrombin and fibrinogen to fibrin. brain. . red or black stools. INDICATIONS: • Venous thrombosis • Pulmonary embolism • Thromboembolic complication prevention • Disseminated intravascular coagulation (DIC) • Atrial fibrillation with embolization • Anticoagulant in blood transfusions and dialysis procedures CONTRAINDICATIONS: • Hypersensitivity • Active bleeding • Bleeding tendencies: purpura. transient thrombocytopenia. and patients with liver disease or renal insufficiency. rebound hyperlipidemia (following termination of heparin therapy) • GI: Increased AST. • Exerts direct effect on blood coagulation (clotting) by enhancing the inhibitory actions of antithrombin III (heparin cofactor) on several factors essential to normal blood clotting. chills. Inhibits formation on new clots. • Do not take aspirin or any other OTC medication without physician's approval. • Observe all needle sites daily for hematoma and signs of inflammation (swelling. chest pains. hematoma.o. thrombocytopenia • Jaundice • Ascorbic acid deficiency • Inaccessible ulcerative lesions • Visceral carcinoma • Open wounds • Extensive denudation of skin • Suppurative thrombophlebitis • Advanced kidney. Patient & Family Education • Protect from injury and notify physician of pink. ALT • GU: Priapism (rare) • Syst: Fever. hypoaldosteronism. itching and burning sensations of feet • MS: Numbness and tingling of hands and feet • CVS: Elevated BP. reversible transient alopecia (usually around temporal area). red or dark brown vomitus. Hct. skin rashes. and platelet counts prior to initiation of therapy and at regular intervals throughout therapy. hyperkalemia. rapid pulse. • Antidote: Have on hand protamine sulfate (1% solution). • Monitor vital signs: Report fever. specific heparin antagonist. tissue irritation and sloughing). • Teach correct technique for SC administration if discharged from hospital on heparin. or biliary disease • Active tuberculosis • Bacterial endocarditis • Continuous tube drainage of stomach or small intestines • Threatened abortion • Intracranial hemorrhage • Severe hypertension • Recent surgery of eye. older adults. bleeding gums or oral mucosa. Hgb. pain).Heparin • 5000U/ml in 8L • SC • BID (8—6) • Anticoagulant • Does not lyse already existing thrombi but may prevent their extension and propagation. • Patients vary widely in their reaction to heparin: risk of hemorrhage appears greatest in women. • CNS: Headache • EENT: Nasal congestion. cyanosis and pains in arms or legs (vasospasm). cerebral embolism • Hema: Spontaneous bleeding. conjunctivitis • Resp: Bronchospasm • Endo: Osteoporosis. redness. history of allergy (asthma). epistaxis. urticaria. or cloudy urine. bloody sputum. pruritus. pregnancy (C) esp. immediate postpartum period. red. drop in BP. or spinal cord • Spinal tap • Shock Caution with alcoholism. ecchymoses.
swelling. chills. GI diseases (colitis). Frequency. myoclonus. LDH. drainage. • Lab tests: Review culture and sensitivity studies. urticaria. anaphylaxis. electrolyte and hepatic status. Angioedema may also appear. Hct. patients at risk and exogenous vitamin K administration convulsion. alk phosphatase and Coomb’s test. meningococci. immunosuppression: infected burns • Prostatic surgery (prophylaxis) CONTRAINDICATIONS: • Hypersensitivity to cephalosporins and other beta-lactam antibiotics • Pregnancy (B) Caution with lactation and allergy to penicillins. cephalosporin • Semisynthetic. transient changes • Integ: Rash. hemorrhagic colitis. gastroenteritis. redness. malaise. pseudomembranou s colitis.g. Hepatic: ALT. INDICATIONS AND CONTRAINDICATIONS ADVERSE EFFECTS OF THE DRUG DESIRED ACTION ON THE CLIENT To treat the client’s Pseudomo nas aeruginosa infection NURSING RESPONSIBILITIES/ PRECAUTIONS antibiotic. paresthesia • GI: Nausea. • Report any signs or symptoms of superinfection promptly. vaginitis • Hema: Phlebitis. Route. aminoglycoside and potent diuretics. hematuria. • Preferentially binds to one or more of the penicillinbinding proteins (PBP) located on cell walls of susceptible microbes.. leading to cell death of the bacterium. monitor hematologic. • If severe diarrhea occurs and is severe. • Most strains of gonococci. • Be alert to onset of rash. stool guaiac. • If administered concomitantly with another antibiotic. maculopapules • Syst: Fever. fever. etc. diarrhea. • If on long-term therapy. severe diarrhea and changes in sputum. rash. • Monitor for superinfection: perineal itching. inflammation. joint pain and dyspnea. . Epinephrine and resuscitation equipment should be available for possible anaphylactic reaction. poor nutritional state. urine and stool. pruritus.) Ceftazidime • 1g/5ml • IV • q12h (8—8) TRADE/ BRAND NAME PHARMACOLOGI C ACTION OF DRUG • Antiinfective. oral thrush • GU: Candidiasis. monitor renal function and report if symptoms of dysfunction appear (e. Hematologic: Ecchymosis. fever. earache. increased WBC. dysuria). changes in I&O ratio and pattern.DRUG ORDER (Generic name. Dosage. encephalopathy. with peritoneal and hemodialysis. suspect pseudomembranous colitis (caused by Clostridium difficile). headache. characteristics of wounds. WBC counts. abdominal pain. CBC. third generation broadspectrum cephalosporin antibiotic similar to cefotaxime but more active against Pseudomonas aeruginosa and less active against Staphylococci and Bacteroides fragilis. and INDICATIONS: • Serious infections caused by susceptible organisms in the: urinary tract lower respiratory tract bones and joints skin and skin structures intraabdominal gynecologic CNS EENT mixed infections • Septicemia • Bacteremia • Peritonitis • Infections associated • CNS: Dizziness. superinfections Assessment & Drug Effects • Monitor for signs of infection: fever. AST. itching. angioedema. renal and hepatic impairments. vomiting. pain. Cl. K. Electrolyte: Na. urticaria. bilirubin. This inhibits third and final stage of bacterial cell wall synthesis. bleeding gums. sputum. Patient & Family Education • Report loose stools or diarrhea promptly. tremors.
hallucinations • Resp: Paradoxical bronchospasms. tremors. hypotension. insomnia.5% solution • Neb • q8h (8—4—12) TRADE/ BRAND NAME PHARMACOLOGI C ACTION OF DRUG • Bronchodilator. May be used concomitantly with other antibiotics. bronchitis • CVS: Palpitations. reflex. uterus. etc. Acts more prominently on beta2 receptors (particularly smooth muscles of bronchi. bradycardia. GI symptoms. • Monitor for: s/sx of fine tremor in fingers. CNS stimulation (hyperactivity. • Avoid contact of inhalation drug with eyes. Patient & Family Education • Review directions for correct use of medication and nebulizer. tachycardia. Emergence of resistance during treatment has been reported. GI discomfort. blurred vision. cough. Frequency. dizziness. • Provide frequent moth care. . dilated pupils Assessment & Drug Effects • Monitor therapeutic effectiveness which is indicated by significant subjective improvement in pulmonary function within 60–90 min after drug administration. and vascular supply to skeletal INDICATIONS: • Bronchospasms in mild. restlessness. moderate and severe asthma • Chronic bronchitis • Emphysema and other reversible obstructive pulmonary diseases • Co-existing heart disease or hypertension CONTRAINDICATIONS: • Hypersensitivity to salbutamol and to atropine and its derivatives • Cardiac arrhythmia associated with tachycardia caused by Digitalis intoxication • Hypertrophic obstructive cardiomyopathy or tachyarrhythmia • CNS: Headache. mouth and throat irritation. peripheral vasodilation. hypertension. vomiting. pulmonary functions. insomnia). DRUG ORDER (Generic name. flushing • Hema: Hypokalemia • GI: Nausea.) Salbutamol • 0. hyperactivity. dyspepsia • EENT: Epistaxis.Hemophilus influenzae are highly susceptible. • Do not increase number or frequency of inhalations without advice of physician. nervousness. • Lab tests: Periodic ABGs. Dosage. tachycardia. Listeria monocytogenes organisms are resistant. excitement. INDICATIONS AND CONTRAINDICATIONS ADVERSE EFFECTS OF THE DRUG DESIRED ACTION ON THE CLIENT To relieve the client’s bronchospasms and mobilize his retained secretions NURSING RESPONSIBILITIES/ PRECAUTIONS sympathomim etic • Synthetic sympathomim etic amine and moderately selective beta2adrenergic agonist with comparatively long action. convulsions. Route. heartburn. Report promptly to physician. and pulse oximetry.
hx of seizures. DRUG ORDER (Generic name. by relaxing smooth muscles of bronchial tree. Frequency. angina pectoris. elderly. hypokalemia.. regardless of administration route. CV disease.muscles) than on beta1 (heart) receptors. and skeletal muscle tremors. pregnancy (C) and lactation • Notify physician if salbutamol fails to provide relief because this can signify worsening of pulmonary function and a reevaluation of condition/therapy may be indicated. Dosage.) TRADE/ BRAND NAME PHARMACOLOGI C ACTION OF DRUG • Thyrotoxicosis • Threatened abortion during 1st and 2nd trimester • Integ: Rash • MS: Fine skeletal muscle tremor. INDICATIONS AND CONTRAINDICATIONS ADVERSE EFFECTS OF THE DRUG DESIRED ACTION ON THE CLIENT NURSING RESPONSIBILITIES/ PRECAUTIONS . • Do not use OTC drugs without physician approval. increased diuresis and gastric acid secretion.g. etc. • Also causes CNS and cardiac stimulation. unstable vasomotor systems. and increases vital capacity. facilitates mucus drainage. cold remedies) contain drugs that may intensify albuterol action. psychoneurotic patients. • Provide mouth care. CAD. • Inhibits histamine release by mast cells. • Minimal or no effect on alphaadrenergic receptors. • Salbutamol produces bronchodilatio n. myocardialinsufficiency. Many medications (e. degenerative heart disease developed by long-standing BA and emphysema patients. closed angle glaucoma. Route. if drug-induced insomnia is a problem. prostatic hypertrophy. • Consult physician about giving last salbutamol dose several hours before bedtime. This decreases airway resistance. leg cramps Caution with hyperthyroidism.
between inhalations. • Treatment is not used for acute asthma attacks. glaucoma. • Fluticasone is a glucocorticoid with a high antiinflammatory potency. histamine) from mast cells. INDICATIONS: • Bronchospasms in mild. Patient & Family Education • Notify physician immediately of worsening asthma or failure to respond to the usual dose. insomnia. • Provide mouth care. cardiac arrhythmias or hypertension. • Prevents nocturnal asthma symptoms.e. rapid heartbeat or palpitations. corticosteroid • Salmeterol is a long-acting beta2adrenorecept or agonist and an analog of albuterol. • Use exactly as directed. onset and characteristic s/sx. Report tachycardia. • Monitor cardiovascular status. and allow at least 1 min. CVS disorders esp. . sympathomim etic. • Administration: Shake aerosol container well. thus facilitating expectoration. pregnancy (C) and lactation • CNS: Headache. • Withhold drug and notify physician immediately if bronchospasms occur following its use. and eosinophils. exhale. Do not use more often than recommended (excessive use may result in tolerance. then place the mouthpiece/spacer in trache mask. It has a strong affinity for and agonist activity at human glucocorticoid receptors. • Notify physician for unresolved GI upset. overdose) and do not discontinue without consulting the physician. coronary insufficiency. Antiinflammatory. Stimulation of beta2adrenorecept ors relaxes bronchospas m and increases ciliary motility.Salmeterol/Flutica sone • 25mcg • MDI • BID (8—6) Seretide • Bronchodilator. thyrotoxicosis. active and quiescent PTB. anaphylaxis To relieve the client’s bronchospasms Assessment & Drug Effects • Assess for client’s condition before therapy. • Remind to use for acute asthma attacks. • It inhibits the release of mediators (i. muscle cramping or skin rash. Document indications for therapy. ask patient to exhale. macrophages. candidiasis and dryness of mouth and throat. • Provide frequent moth care. inhale slowly remove. tremors • Resp: Paradoxical bronchospasms • CVS: Palpitations • EENT: Cataract. moderate and severe asthma • Asthma (treatment and prophylaxis) • Chronic bronchitis • Emphysema • Allergic rhinitis (prophylaxis) CONTRAINDICATIONS: • Hypersensitivity • Acute asthmatic attacks or status asthmaticus (not used as primary treatment) Caution with acute asthma attacks. hoarseness • Syst: Suppression of adrenal function. hyperactivity..
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