XI.

DRUG STUDY
NAME OF ORDERED MECHANISM OF CONTRA- SIDE EFFECTS NURSING
DRUG DOSE ACTOIN INDICATION INDICATION &ADVERSE RESPONSIBILITY
REACTONS
Ceftriaxone 1 gm Bactericidal: Perioperative Contraindicated with CNS: head ache,dizziness, > Know the 10 Rights in
IV Inhibits synthesis of Prophylaxis allergy to cephalosporin lethargy,parestesia drug administration
Q 12 hrs Bacterial cell wall, or penicillins or GI: nausea, vomiting, >Perform skin test before
X 4 doses causing cell death penicillins abdominal pain, flatulence, administering to detect if
liver toxicity the patient is allergic to
GU: nephrotoxicity the drug
Hematologic: bone >Assess for patient’s
marrow depression history of liver and renal
Hypersensitivity: ranging depression, lactation and
from rash, fever to pregnancy
anaphylaxis >Have vitamin K
Local: pain, inflammation available in case
at IV site hperprothombinemia
occurs
>Discontinue if
hypersensitivity occurs
>Inform the patient about
the side effects
>Instruct patient to avoid
alcohol while taking the
drug and for 3 days
because severe reactions
often occur

Tramadol 50 mg Binds to mu-opioid Relief of moderate to Contraindicated with CNS: sedation, dizziness > Know the 10 Rights in
IV receptors and inhibits moderately severe pain allergy to tramadol or or vertigo, head ache, drug administration
Q 8 hours the reuptake of opioids or acute confusion, dreaming , >Get patient’s history of
norepinephrine and intoxication with sweating, anxiety and allergy to tramadol or
serotonin; causes alcohol, opioids or seizures opioids
many effects similar psychoactive drug CV: Hypotension, >Inform the patrient
to the tachycardia, bradycardia about the side effects if
opioids,dizziness, sweating or CNS effects
constipation
 NAME OF ORDERED MECHANISM OF CONTRA- SIDE EFFECTS NURSING
DRUG DOSE ACTOIN INDICATION INDICATION &ADVERSE RESPONSIBILITY
REACTONS
Occur
>Limit use in patients
with past/present history
of addiction to or
dependence to opioids

Ketorolac 30 mg Anti-inflammatory Short-term management Contraindicated with CNS: head ache, dizziness, >Know the 10 Rights in
IV and analgesic activity; of pain significant renal insomnia, fatigue, tinnitus drug administration
Q 8 hours inhibits prostaglandins impairment, during labor Dermatology: rash, >Do not mix with
and leukotriene and delivery pruritus, sweating, dry morphine, sulfate,
synthesis mucous membrane mepiridine
GI: nausea, vomiting,
dyspepsia, gastro-intestinal >Instruct patient about
pain, diarrhea, constipation the side effects
GU: dysruia, renal
impairment
Respiratory: dyspnea,
hemoptysis, pharyngitis,
bronchospasm,
Other: peripheral edema,
anaphylactic reaction to
anaphylactic shock
X. NURSING CARE PLAN
 CUES NURSING ANALYSIS GOAL NURSING RATIONALE EVALUATION
DIAGNOSIS INTERVENTION
S: “Nsakit pay lang P: Pain, Acute Appendectomy Date: June 23, 2009 Independent >To assess the etiology Date: June 23, ‘09
toy sugat ko.” ↓ Shift: 7-3 >Assess location, characteristic, or precipitating factors Time:2:00 pm
E: t/t disruption of Surgical Incision Time: 8:00 am onset, duration, frequency ,
O: skin, tissue and ↓ quality and severity of pain Goal met AEB:
>with pain scale of muscle integrity Disruption of skin, After 6 hrs of nursing >Note location of surgical Patient reported
4/10 secondary to tissue and muscle intervention the incision >As this can influence that her pain was
>with facial Surgical incision integrity patient will report the amount of post-op lessened from a
grimaces (Appendectomy) ↓ that her pain is lessen >Perform assessment each time experience pain scale of 4/10
>weak appearance Stimulation of sensory from a pain scale of pain occurs, note and investigate >To rule out worsening to 1/10 after 6
>guarding behavior S: AEB: patient’s nerve endings 4/10 to 1/10. changes from previous reports of underlying condition hours of nursing
verbalization of ↓ >Monitor V/S or development of intervention.
V/S: pain with a pain Pain complication
T: 36.6 °C scale of 4/10, facial >Provide quiet environment and >V/S are usually altered
P: 67 bpm grimace, guarding encourage adequate rest period in acute pain
R: 16 cpm behavior and weak Medical Nursing >Encourage use of relaxation >To prevent fatigue
BP: 100/80 mmHg appearance Incredibly Easy, technique and diversional
Pellico, L.H., activities
>To encourage sense of
>Provide additional comfort control and improve
measures such as back rub, coping activities/helps
changing patient’s position, control or alleviate pain
change linen as necessary >To relieve general
discomfort
Dependent
>Administer analgesic as >To maintain acceptable
ordered level of pain

Collaborative
>Instruct patient’s significant >To help control or
others to help patient divert pain alleviate pain
into other things

S:”Medyo agsakit- P: Activity Date: June 23, 2009 Independent

sakit gamin Intolerance Shift: 7-3 >Assess patient’s ability to >To assist in
Toy sugat ko lalo no Time: 8:00 am ambulate or move independently correcting/dealing with Date: June 23, ‘09
aggunay-gunay nak E: r/t limited Appendectomy and safely the situation Time:2:00 pm
adding.” mobility secondary
to pain
↓
Surgical Incision
After 6 hours of
nursing intervention ,
>when standing allow legs to >to prevent hypostatic Goal Met AEB:
O: ↓ the patient will be dangle first; support him from hypertension Patient was able to
>Facial grimace S: AEB: patient’s Disruption of skin, able to move or the side ambulate without
XII. DISCHARGE PLAN

 DIET

DIET FOODS ALLOWED FOODS TO BE AVOIDED

Without Restriction In Moderation

Regular Diet All Healthy and Nutritious foods N/A N/A
(Any food which will make the body especially green leafy vegetables
healthy, provide growth of tissue, boost
the immune system, and make the
body stronger and healthier)

 TAKE HOME MEDICATIONS

NAME DOSAGE AND TIME FREQUENCY DURATION SIDE EFFECTS WHAT TO DO MEDICATIONS
ACTION AND ADVERSE AND FOODS TO
REACTIONS BE ALLOWED

Tramadol 700 mg, 1 cap 8:00 am TID Until there’s pain CNS: sedation, Discontinue if Alcohol. T ramadol
12:00 noon dizziness or hypersensitivity may impair mental
04:00 pm vertigo, head ache, occurs ability and physical
confusion, coordination.Alcohol
dreaming , may intensify these
sweating, anxiety effects and increase
and seizures the risk of accidental
CV: Hypotension, injury.
tachycardia,
bradycardia
 CNS: Headache,
Cefuroxime 500 g 8:00 am TID For 5 days dizziness, lethargy, N/A
Analgesic 12:00 noon paresthesias Discontinue if
>inds to mu- 04:00 pm GI: Nausea, hypersensitivity
opioid receptors vomiting, diarrhea, reaction occurs
and inhibits the anorexia,
reuptake of abdominal pain,
norepinephrine flatulence,
and serotonin; pseudomembranous
causes many colitis, liver
effects similar to toxicity
the Hematologic:
opioids,dizziness, Bone marrow
constipation depression:
decreased WBC,
decreased platelets,
decreased Hct
GU:
Nephrotoxicity
Hypersensitivity:
Ranging from rash
to fever to
anaphylaxis, serum
sickness reaction
Local: Pain,
abscess at injection
site; phlebitis,
inflammation at IV
site
Other:
Superinfections,
disulfiram-like
reaction with
alcohol
  ACTIVITIES AND REHABILITATION

ALLOWED NOT ALLOWED MODIFIED

>Doing light house hold chores
Avoid Repetitive Activities, Including
Driving
Most doctors order limited activity following an
appendectomy for at least 3 weeks. This includes no
driving because of medications you may be taking.
You must not do any strenuous activities, including
anything that requires repetitive motions, including
such things as pressing the foot pedals while driving
a vehicle and bending up and down getting pots and
pans out of low cabinets in your kitchen.
No Heavy Lifting
Pillow Talk
Keep a pillow handy at all times while you are
recovering from an appendectomy. Use the pillow to
splint your abdomen when you cough or sneeze.
Press the pillow firmly against your lower abdomen
(across your incision area) until your coughing or
sneezing fit passes. This not only helps you comfort-
wise by minimizing pain from the strain of coughing
and sneezing, but it also helps prevent popping
stitches. You may also want to press a pillow against
your lower abdomen when you get up and down, at
least for the first couple of days.

While you are recovering from your surgery, you

must not lift anything that weighs over 15 pounds.
Heavy lifting puts too much strain on your lower
abdomen and your abdominal muscles. Strain on
your lower abdomen may rupture the repairs your
surgeon accomplished on the inside while the tissues
and muscles are healing. Heaving lifting may also
pop the stitches in your incision.
  SPECIAL CARE INSTRUCTION

PROCEDURE AND TREATMENT TIME FREQUENCY DURATION

Proper wound Care technique After taking a bath or before sleeping No standard frequency for how often Until the wound have healed and skin
>Using aseptic technique when the dressing should be changed, it is intact
changing the dressing, be especially depends on amount of drainage and
vigilant in performing hand hygiene nature of wound, so it can be as needed
thoroughly before and after changing or daily
the dressing and in adhering to
standard precaution
>Cleanse area around the incision site
>Monitor incision for signs and
symptoms of infection
>Use one gauze square for each wipe,
discarding each square by dumping in
the plastic bag
>Clean around drain, if present,
moving from center outward in a
circular motion, use one gauze square
for each circular motion
>Apply a layer of dry, appropriate
sterile dressing over the wound