Running Head: FUNDAMENTALS CARE PLAN 1

Fundamentals Care Plan

Angela J. Powell
University of North Georgia
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FUNDAMENTALS CARE PLAN
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FUNDAMENTALS CARE PLAN
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FUNDAMENTALS CARE PLAN
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FUNDAMENTALS CARE PLAN
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Medication Action Indications Side effects Nursing implications

with dosage

Paxile 105 Inhibits CNS Major depressive Seizures, Assess:

mg p.o. neuron reuptake disorder, OCD, neuroleptic, ● !! Depression/OCD/anxiety/
b.i.d. of serotonin but panic disorder, malignant panic attacks: mental status: mood, sensorium, affect, suicidal tendencies, increase in
(Skidmore not of generalized syndrome-like psychiatric symptoms, decreasing obsessive thoughts, compulsive behaviors,
-Roth, norepinephrine or anxiety disorder, reactions, restrict amount available.
2017, p. dopamine PTSD, headache, ● Postural hypotension: if systolic B/P drops 20 mm Hg.
776) premenstrual drowsiness, ● Withdrawal symptoms: headache, nausea, vomiting, muscle pain, weakness; not
disorders, social anxiety, tremor, usual unless product discontinued.
anxiety disorder. dizziness, ● Hold dose until morning if there has been alcohol intake.
sedation, ● !! Serotonin, neuroleptic malignant syndrome: hallucinations, coma, headache,
nausea, agitation, shivering/sweating, tachycardia, diarrhea, tremor, hypertension,
diarrhea, dry hyperthermia, rigidity, delirium, coma, myoclonus, agitation, nausea, vomiting.
mouth, Administer:
constipation, ● Do not substitute Pexeva with Paxil or Paxil CR or generic Paroxetine.
sweating. ● Cont release tab: do not cut, chew, crush; do not give concurrently with antacids.
Perform/provide:
● Assistance with ambulation during therapy since drowsiness, dizziness occur.
Evaluate:
● Therapeutic response: decreased depression.
Teach patient/family:
● !! Depression may worsen, suicidal thoughts/behavior occur.
● Therapeutic effect may take 1-4 wk.
● Use caution in driving and other activities that require alertness.
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FUNDAMENTALS CARE PLAN

Atenolol Blocks Hypertension Profound Assess:

25 mg p.o. stimulation of (which helps to hypotension, ● I&O, weight daily; watch for CHF (rales/crackles, jugular vein distention, weight
daily beta-adrenergic prevent strokes,) bradycardia, gain, edema)
(Skidmore receptor within heart attacks, CHF, ● B/P, pulse q4hr; note rate, rhythm, quality; apical/radial pulse before
-Roth, vascular smooth kidney problems, mesenteric administration; notify prescriber of any significant changes (<50 bpm); ECG.
2017, p. muscle; decreases and angina. arterial ● Baselines in renal/hepatic studies before therapy begins.
84). rate of SA node thrombosis, Administer:
discharge and ischemic colitis, PO Route
increases agranulocytosis, ● Product before meals, at bedtime; tab may be crushed or swallowed whole.
recovery time, thrombocytopen Perform/provide:
slows conduction ia purpura, and ● Storage protected from light, moisture; place in cool environment.
of AV node, bronchospasm. Evaluate:
decreases heart ● Therapeutic response: decreased B/P after 1-2 wk, increased activity tolerance,
rate, decreases O2 decreased angina pain.
consumption in Teach patient/family:
myocardium, ● !! Do not discontinue product abruptly, taper over 2 wk, take at same time each
decreases RAA day as directed.
system at high ● Not to use OTC products unless directed by prescriber.
doses.
Assess:
Atorvastat Inhibits Primary Liver ● Diet, obtain diet history including fat, cholesterol in diet.
in 20 mg HMG-CoA hypercholesterole dysfunction, ● Cholesterol triglyceride levels periodically during treatment; check lipid panel 6-12
p.o. b.i.d. reductase mia, rhabdomyolysis wk after changing dose.
(Skidmore enzyme, which dysbetalipoprotein , abdominal ● Hepatic studies q1-2mo, at initiation, 6 wk, 12 wk after initiation or change in dose;
-Roth, reduces emia, elevated cramps, AST, ALT, LFTs may be increased.
2017, p. cholesterol triglyceride levels, constipation, ● Renal studies in patients with compromised renal system: BUN, I&O ratio,
87). synthesis; high prevention of CV diarrhea, flatus, creatinine.
doses lead to disease by heartburn. ● Bowel status; constipation, stool softeners, may be needed; if sever, add fiber/water
plaque regression. reduction of heart in diet.
risk in those with ● !! For muscle pain, tenderness, obtain CPK baseline and if markedly increased,
mildly elevated product may need to be discontinued.
cholesterol. Administer:
● Total daily dose any time of day without regard to meals.
Evaluate:
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FUNDAMENTALS CARE PLAN

● Therapeutic response: decrease in LDL and total cholesterol, triglycerides, CAD;

increase in HDL.
Teach patient/family:
● Blood work and eye exam necessary during treatment.
● Report blurred vision, severe GI symptoms, headache, muscle pain, weakness.

Cefdinir Binds to bacterial Treatment of Seizures, Asses:

300 mg cell wall community-acquir pseudomembran ● Assess for infection (VS, appearance of wound, sputum, urine and stool, WBC) at
p.o. q12h membrane of ed pneumonia ous colitis, beginning of and throughout therapy.
(Skidmore susceptible (adults only), acute anaphylaxis, ● Obtain history of previous use of and reactions to penicillins or cephalosporins.
-Roth, bacteria, causing exacerbations of headache, Persons with negative history of penicillin sensitivity may still have an allergic
2017, p. cell death. Active chronic bronchitis diarrhea, response.
182) against ​S. aureus, (adults only), acute vomiting, ● Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal
S. pneumonia, S. maxillary sinusitis, abdominal pain, edema, wheezing). Discontinue drug and notify physician or other health care
pyogenes,​ H. pharyngitis and nausea, rash, professional immediately if these symptoms occur. Keep epinephrine, an
influensae, ​H. tonsillitis, pruritus. antihistamine, and resuscitation equipment close by in case of an anaphylactic
parainfluenzae, uncomplicated reaction.
M. catarrhalis​. skin and skin ● Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools
NOT active structure should be reported to health care professional promptly as a sign of
against MRSA. infections, acute pseudomembranous colitis. May begin up to several weeks following cessation of
bacterial otitis therapy.
media (children Lab Test Considerations:
only.) ● May cause increased serum AST, ALT, alkaline phosphatase, bilirubin, LDH, and
BUN.
● May (rarely) cause leukopenia, eosinophilia, lymphocytosis, and thrombocytosis.
Teach patient/family:
● Instruct patient to notify health care professional if fever and diarrhea develop,
especially if diarrhea contains blood, mucus, or pus. Advise patient not to eat
diarrhea without consulting health care professional.
Assessment:
Vitamin D Promotes Osteoporosis, Headache, ● Vit deficiency prior to and periodically during therapy.
1000 DI intestinal Hypoparathyroidis irritability, ● Bone pain and weakness prior to and during therapy.
p.o. q.d. absorption of m, Rickets, somnolence, ● Evidence of hypocalcemia (paresthesia, muscle twitching, laryngospasm, colic,
(Vallerand calcium; Hypophosphatemi weakness, cardiac arrhythmias, and Chvostek’s or Trousseau’s sign.)
& stimulates a. arrhythmias, Lab test considerations:
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FUNDAMENTALS CARE PLAN

Sanoski, absorption of hypertension, ● Monitor serum calcium, phosphorus, and alkaline phosphatase periodically.
2015). phosphate and anorexia, ● Serum calcium times phosphate product (Ca X P) should not exceed 70 mg​²/dL²
magnesium ions; constipation, (patients may be at high risk of calcification).
stimulates the dry mouth, Toxicity and overdose:
expression of elevated liver ● Manifested as hypercalcemia, hypercalciuria, and hyperphosphatemia.
proteins in enzymes, Implementation:
transporting pancreatitis, ● PO: Administered without regard to meals.
calcium from the hypercalcemia, Teach patient/family:
lumen of the bone pain, ● Advise patient to take as directed. Take missed doses as soon as remembered. Do
intestines, across muscle pain. not double up on doses.
epithelial cells ● Avoid concurrent use of antacids containing magnesium.
and into the ● Explain that best source of vitamins is a well-balanced diet.
blood. ● Explain importance of sunlight exposure.

Keppra Decreases Partial onset Stevens-Johnso Assess:

500 mg incidence and seizures; primary n Syndrome, ● Location, duration, and characteristics of seizure activity.
p.o. b.i.d. severity of generalized toxic epidermal ● Monitor mood changes. Assess for suicidal tendencies, especially during early
(Vallerand seizures; inhibits tonic-clonic necrolysis, therapy. Restrict amount of drug available to patient.
& burst firing seizures, suicidal ● Assess for rash periodically during therapy. May be Stevens-Johnson syndrome.
Sanoski, without affecting myoclonic seizures thoughts, Discontinue therapy if severe or if accompanied with fever, general malaise,
2015). normal neuronal in patients with aggression, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis, and/or
excitability and juvenile myoclonic agitation, anger, eosinophilia.
may selectively epilepsy. anxiety, apathy, Lab Test Considerations:
prevent depersonalizatio ● May cause decrease in RBC and WBC and abnormal liver function tests.
hypersynchroniza n, depression, Teach patient/family:
tion of dizziness, ● Advise patient and family to notify health care professional if thoughts about
epileptiform burst hostility, suicide or dying, attempts to commit suicide; new or worse depression; new or
firing and irritability, worse anxiety; feeling very agitated or restless; panic attacks; trouble sleeping; new
propagation of personality or worse irritability; acting aggressive; being angry or violent; acting on dangerous
seizure activity. disorder, impulses; an extreme increase in activity and talking; other unusual changes in
weakness, behavior or mood is skin rash occurs.
drowsiness,
dyskinesis,
fatigue.

Assess:
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FUNDAMENTALS CARE PLAN

Melatonin Hormone secreted Sleep disorders Hypotension; ● Sleep patterns before and periodically throughout therapy.
3 mg p.o. from pineal gland (insomnia, jet lag, drowsiness, Lab Test Considerations:
q.n. PRN in 24-hour and circadian headache, ● Monitor blood glucose, coagulation panel, hormone panel, and lipid panel
(Vallerand circadian rhythm, rhythm disorders.) dizziness; periodically during therapy.
& regulating the nausea, Implementation:
Sanoski, normal vomiting, ● Administer before bedtime.
2015). sleep/wake cycle; abdominal Teach patient/family:
regulates the cramps. ● Take at bedtime as directed.
secretion of ● Causes drowsiness. Avoid driving and other activities requiring alertness until
growth hormone response to medication is known.
and gonadotropic ● Avoid concurrent use of alcohol or other CNS depressants.
hormones.

Cyanocob Coenzyme for Vitamin B12 Anaphylaxis/hy Assess:

alamin metabolic deficiency; persensitivity ● Signs of vitamin B12 deficiency (pallor; neuropathy; psychosis; red, inflamed
1000 mcg processes, pernicious anemia. reactions; tongue) before and periodically during therapy.
p.o. q.d. including fat and Part of diagnostic headache, heart Lab Test Consideration:
(Vallerand carbohydrate test for vitamin failure, ● Monitor plasma folic acid, vitamin B12, and iron levels, hemoglobin, hematocrit,
& metabolism and B12 absorption diarrhea, and reticulocyte count before treatment, 1 month after start, and then every 3-6
Sanoski, protein synthesis. test. itching, months.
2015). Corrects swelling of the ● Evaluate serum potassium level for hypokalemia during first 48 hr of treatment.
manifestations of body, Teach patient/family:
pernicious anemia hypokalemia, ● Comply with diet recommendations of health care professional; the best source of
and for vitamin thrombocytosis, vitamins is a well-balanced diet.
B12 deficiency. pulmonary ● Foods high in vit B include meats, seafood, egg yolk, and fermented cheeses; few
edema, pain at vitamins are lost with ordinary cooking.
IM site.

Famotidin Inhibits action of Short-term Agranulocytosis Assess:

e 20 mg histamine at the treatment of active , aplastic ● For epigastric or abdominal pain and frank or occult blood in the stool, emesis, or
p.o. b.i.d. H2-receptor site duodenal ulcers anemia, gastric aspirate.
PRN located primarily and benign gastric arrhythmias, ● Geriatrics: Assess elderly and debilitated patients routinely for confusion. Report
(Vallerand in gastric parietal ulcers; confusion, promptly.
& cells, resulting in gastroesophageal dizziness, Lab Test Considerations:
inhibition of reflux disease drowsiness, ● May cause increase in serum creatinine.
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FUNDAMENTALS CARE PLAN

Sanoski, gastric acid (GERD); hallucinations, ● May cause false-positive results for urine protein.
2015). secretion. Heals heartburn, acid headache, ● Histamine antagonists should be discontinued 24 hours prior to skin tests; may
and prevents indigestion and constipation, cause false-negative results.
ulcers. Decreases sour stomach. diarrhea, Teach patient/family:
symptoms of Prevention of nausea, erectile ● Take med as directed for full course of therapy, even if feeling better.
gastroesophageal stress-induced dysfunction, ● May cause drowsiness or dizziness; caution patient to avoid driving or activities
reflux. Decreases upper GI bleeding pain at IM site, that require alertness until response to drug is known.
secretion of in critically ill hypersensitivity ● Avoid alcohol, aspirin or NSAIDS, and foods that may cause increase in GI
gastric acid. patients. reactions. irritation.
● Report onset of black, tarry stools; fever; sore throat; diarrhea; dizziness; rash;
confusion; or hallucinations to health care professional promptly.

Vimpat Mechanism not Adjunctive therapy Suicidal Assess:

100 mg known but may of of partial-onset thoughts, Drug ● Monitor closely for notable changes in behavior that could indicate the emergence
p.o. Q12h involve seizures. reaction with or worsening of suicidal thoughts or behavior or depression.
(Vallerand enhancement of eosinophilia and ● Assess patient for skin rash frequently during therapy. Discontinue at first sign of
& slow inactivation systemic rash; may be life-threatening. Stevens-Johnson syndrome; symptoms of depression,
Sanoski, of sodium symptoms, unusual changes in mood, or emergence of suicidal thoughts, behavior, or thoughts
2015). channels with Stevens-Johnso of self-harm should be reported to health care professional immediately.
resultant n Syndrome,
membrane Toxic epidermal
stabilization; necrolysis,
decreased agranulocytosis.
incidence and
severity of
partial-onset
seizures.
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References

Ackley, B., Ladwig, G., & Makic, M. (2017). ​Nursing diagnosis handbook: An evidence-based guide to planning care ​(11th ed.). Maryland Heights,
Missouri: Mosby Elesvier.
Dubois, S. ​(n.d.). Fiber for the elderly. ​Healthy eating | SF Gate​. Retrieved from http://healthyeating.sfgate.com/fiber-elderly-1011.html.

Mayo Clinic. (n.d.). Vascular dementia-overview. Retrieved from

https://www.mayoclinic.org/diseases-conditions/vascular-dementia/symptoms-causes/syc-20378793.
Skidmore-Roth, L. (2017). ​Mosby’s drug guide for nursing students ​(12​th​ ed.). St. Louis, MO: Mosby Elsevier.
Potter, P. A., Perry, A. G., Hall, A., & Stockert, P. A. (2017). ​Fundamentals of nursing ​(9​th​ ed.). St. Louis, MO: Mosby Elsevier.

Vallerand, A.H. & Sanoski, C.A. (2015). Calcitriol. Retrieved from https://davisplus.fadavis.com/3976/meddeck/pdf/calcitriol.pdf.
Vallerand, A.H. & Sanoski, C.A. (2015). Cholecalciferol. Retrieved from https://davisplus.fadavis.com/3976/meddeck/pdf/cholecalciferol.pdf.
Vallerand, A.H. & Sanoski, C.A. (2015). Cyanocobalamin​.​ Retrieved from https://davisplus.fadavis.com/3976/meddeck/pdf/calcitriol.pdf.
Vallerand, A.H. & Sanoski, C.A. (2015). Famotidine. Retrieved from https://davisplus.fadavis.com/3976/meddeck/pdf/famotidine.pdf.
Vallerand, A.H. & Sanoski, C.A. (2015). Lacosamide.​ ​ Retrieved from https://davisplus.fadavis.com/3976/meddeck/pdf/lacosamide.pdf.
Vallerand, A.H. & Sanoski, C.A. (2015). Levetiracetam​. ​Retrieved from https://davisplus.fadavis.com/3976/meddeck/pdf/levetiracetam.pdf.
Vallerand, A.H. & Sanoski, C.A. (2015). Melatonin. Retrieved from https://davisplus.fadavis.com/3976/meddeck/pdf/melatonin.pdf.