Capitol University

College of Nursing
Cagayan de Oro City

A Case Study on:

Complete Spinal Cord Injury at C4 Level Secondary to Compression
Submitted to: Mr. Michael Dennis Saab, RN, MN Submitted by: Lutchavez, Bryan Macabodbod, Fidel Macas, Erlin Grace J. Macatol, Ma. Teresa Maglasang, Jeffrey Magtajas, Cherielou Mahino, Jan Ritchly Malack, Xyza Malaque, Juromille Manatad, Juliet Manginsay, Bliss Maquilan, Keith Howard

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ACKNOWLEDGEMENT The student nurses would like to send their warmest gratitude to those people who had a great role in the success of the presentation of this case. First and foremost to our Almighty God who gave us wisdom and knowledge to get these pieces of thoughts and knowledge and put it into a meaningful output. To God is the glory! To our parents who supported us all through out the entire course of the study by means of providing us our financial needs and gave everything we needed. To our schoolmates who were always there whenever we needed penny of their thoughts and information and who were always there to provide us there opinions and critics about our work. To the staffs of Northern Mindanao Medical Center, Phase 3 Floor 2 (orthopaedic ward) who were so accommodating to our inquiries and who helped us so much in understanding some concerns about the patient’s chart’s. To our Clinical Instructor Mr. Michael Dennis Saab who gave us his motivation and support for this presentation. And lastly, to our patient, for without his cooperation, gathering of data about him wouldn’t be possible, and also for his willingness to be assessed. We will pray for his wellness. Thank you all.

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Introduction The spinal cord is a bundle of nerves that carries messages between the brain and the rest of the body. Complete spinal cord injury (SCI) is due to a traumatic injury that either results in a bruise (also called a contusion), a partial tear, or a complete tear (called a transection) in the spinal cord. SCI is a common cause of permanent disability and death in children and adults. About 11,000 people a year sustain a spinal cord injury. About 243,000 people in the US are living with a spinal cord injury. Fifty-three percent of all SCIs occur among young people between the ages of 16 and 30 years. The majority of SCI victims (82 percent) are male. Injuries affecting the spinal cord commonly results from trauma, gunshot wounds and motor vehicle accidents. Many cases of SCI are caused by falls, sports-related injury and minor trauma. The principal risk factors for SCI include age, gender, and alcohol and drug use. Males are affected four times more often than females. There are many causes of SCI. The more common injuries occur when the area of the spine or neck is bent or compressed, as in the following: birth injuries, which typically affect the spinal cord in the neck area, falls, motor vehicle accidents (where the person is either riding as a passenger in the car or is struck as a pedestrian), sports injuries, diving accidents, trampoline accidents, violence (gun shots or stab wounds). We have chosen this case because in the first place, because we know that this is an interesting condition to tackle. Also, among all the patients we were able to meet in the ward, he was the only one who seems to have case complexity. Others only have minor concerns compared to this case. The group believes that this topic will enhance our knowledge, skills and know-how as we’ll put ourselves in the world of interventions and considering that this is one of the rampant diseases in the country that affects the stable life of the people, as result of the changes of their lifestyle. All the things that we will be learning from this case will always become effective tools to becoming effective nurses someday.

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..... I. XI..TABLE OF CONTENTS Title Acknowledgement………………………………………………………………… Table of Contents………………………………………………………………. X.. Introduction……………………………………………………………………… II. Drug study……………………………… ……………………………………… IX. Health Teachings and Discharge Plan………………………………………... V. IX.... VII... Diagnostic Test and Laboratory Results……………………………………… VI......... Anatomy and Physiology …………………………………. 4 .... …... Related Learning Experience…………………………………………………. Nursing Care Planning………………………………………………………. Pathophysiology………………………………………………………………… VIII.. Goals and Objectives III……………………………………………………………… IV. Recommendation……………………………………………………………….. Clients Profile……………………………………………………………………....

Impart health teachings to the patient’s family. Specific Objectives Student nurses will be able to: 1. The dates of the said weeks are as 5 . Scope of the Study This case study is reflected from the assessed data during the first. 8. 6. 7. 3.Goals and Objectives of the Study Goal Student nurses will be able to apply necessary knowledge and skills to render quality care and service to the patient. Monitor patient’s condition and refer any unusualities promptly. 9. 5. Implement nursing care. Prevent development of any complications. 11. Provide emotional support to the patient’s family. 2. Understand the patient’s condition. 4. Identify appropriate nursing diagnosis for patient care. 10. Assess the patient’s needs and know how to be of assistance. second and third week of our clinical exposure at Orthopedic Ward. Maintain and observe precautionary measures. Enhance and maintain the health of the patient. Gain sufficient knowledge about patient’s medical regimen. Northern Mindanao Medical Center.

smooth in texture with supple turgor. His uvula is in midline with no evident lympadenopathy.September 24-25. kicked and boxed until he fell to the ground. respiratory rate at 26cpm and temperature was 37. Week 3. and Week 3. respiratory rate at 30cpm and temperature was 38. As seen by a friend.October 1-2.Socio-demographic Profile This is a case of Patient X is. pulse rate of 65bpm. 2010 Patient X’s blood pressure was 90/60 mmHg.1 degree Celcius. His general skin color is dusky. He has missing teeth. Patient X was born on September 29.follows: Week 1-September 17-18 2010. As seen to have displayed deterioration while being admitted to the said hospital. 2010. Week 2. He is 162. married and is a Roman Catholic. he has been attacked by an unknown assaulter. The tongue is in midline.September 17-18. C.8 degree Celcius. respiratory rate at 28cpm and temperature was 38. palpable thyroid and neck engorgement. pulse rate of 63bpm. pulse rate of 72bpm. Week 2. this year with a diagnosis of Complete Spinal Cord Injury C4 Level Secondary to Compression.September 24-25. 1975. with pinkish mucosa and gums.October 1-2. he was being transferred to NMMC last September 15.4 cm and he weighs 63kg.8 degree Celcius. 2010 Patient X’s blood pressure was 90/60 mmHg. History of Present Illness A week prior to admission. Client’s Profile A. B. Vital Signs Week 1. Week 3 6 . 2010. 2010 Patient X’s blood pressure was 90/60 mmHg. His lips are dusky in color. he was immediately brought to Iligan City Hospital when patient X found out that he could no longer move his upper and lower extremities. a 35 year-old male Filipino. Nutrition and Metabolic Pattern Week 1 and 2 He was maintained to have NPO but an NGT was being placed.

He actually has a tracheostomy connected to a Tpiece with an oxygen flow maintained at 10L/min during the first two weeks and at 8L/min on the third week. His uvula is in midline with no evident lympadenopathy. Activities of Daily Living/ Mobility Status: LEGEND: 0. Bowel sounds are hypoactive. Activity and Exercise pattern Week 1. There is no noticed bladder distention.Assist with person 3. His general skin color is dusky. Rales can be heard when he breaths. He has missing teeth. There are no superficial veins noted in the abdomen. smooth in texture with supple turgor. Client has flat precordial area.Patient can now tolerate any diet plan with a fair appetite but is noted to have minimal difficulty of swallowing.Assist with device and person 4. Patient X has been catheterized. E. His lungs still equally expands when he inhales or exhales. 2 and 3 He is now unable to do regular exercises due to paralysis. 2and 3 Patient X has no evident defecation. He does not have nausea and vomiting.Assist with deviice 2. D. His urine color is between yellow to orange.Total independence 1. palpable thyroid and neck engorgement. The tongue is in midline. with pinkish mucosa and gums. Patient has no cough but copious secretions are noticed yet the client is suctioned as needed especially during the first and second week of the assessment. Elimination Pattern Week 1. His capillary refill is 2 seconds.Total dependence 7 . He has regular heart sounds and symmetrical peripheral pulses. His lips are dusky in color. Patient X will become dyspneic whenever oxygen sources are removed or if there is an inadequate oxygen source.

H. visual acuity grossly normal and peripheral vision intact or full. Eyelids are symmetrical. 2 and 3 Patient X is conscious. alert and oriented to time place and person. Week 3 Patient has improved sleeping hours for 6-8 hours. conjuctiva is pale. periorbital regions are sunken. Both eyes are briskly reactive to light with uniform constriction and convergence to accommodation. Patient’s nasal septum is in midline with pinkish mucosa and both nares are patent. His gross smelling ability is normal. Cognitive Perceptual Pattern Week 1. Sleep Rest Pattern Week 1and 2 Patient inadequately sleeps as he was disturbed by the increasing secretions he has this time. He appears irritable. and fontanels were closed. Ears are normoset and gross hearing is normal. sclera is anicteric.Activities of Daily Living Feeding Bathing Dressing Grooming Meal Preparation Cleaning Laundry Toileting Bed Mobility Chair/ toilet transfer Ambulation ROM Mobility Status 0 0 0 0 0 0 0 0 0 0 0 0 G. thus he demands suctioning of the said secretions. hair is fine. I. and pupils are equal in size of 2mm. facial movements are symmetrical. His head is normocephalic. Self Perception and Self Concern Pattern 8 .

K.He described himself as physically weak nowadays but according to him. Value-Belief Pattern Patient X was a Roman Catholic and says that his religion plays an important role in his life Anatomy and Physiology 9 . Role Relationship Pattern Patient is married with no known family illness and lives with his family. J. he fights for his life and for his family.

You should notice that the name is somewhat misleading. and is enlarged in the cervical and lumbar regions. It is about 45 cm (18 in) long in men and around 43 cm (17 in) in women. handles sensory input and motor output coming from and going to the legs. However. ovoid-shaped. terminating in a fibrous extension known as the filum terminale. is where sensory input comes from and motor output goes to the arms.The spinal cord is the main pathway for information connecting the brain and peripheral nervous system. The human spinal cord extends from the medulla oblongata and continues through the conus medullaris near the first or second lumbar vertebra. 10 . The length of the spinal cord is much shorter than the length of the bony spinal column. this region of the cord does indeed have branches that extend to the lumbar region. The lumbar enlargement. located between T9 and T12. located from C4 to T1. The cervical enlargement.

contains cerebro spinal fluid. butterfly-shaped central region made up of nerve cell bodies. The three meninges that cover the spinal cord—the outer dura mater. The dural sac ends at the vertebral level of the second sacral vertebra. Laboratory Results 11 . Internal to this peripheral region is the gray. and the innermost pia mater—are continuous with that in the brainstem and cerebral hemispheres. This central region surrounds the central canal. which extend from the enveloping pia mater laterally between the dorsal and ventral roots. the peripheral region of the cord contains neuronal white matter tracts containing sensory and motor neurons. like the ventricles. which is an anatomic extension of the spaces in the brain known as the ventricles and.In cross-section. cerebrospinal fluid is found in the subarachnoid space. The cord is stabilized within the dura mater by the connecting denticulate ligaments. Similarly. the arachnoid mater.

0 % 0.0 10^6/uL RED BLOOD CELLS g/FdL HEMOGLOBIN HEMATOCRIT MCV MCH RDW-CV PDW MPV DIFFERENTIAL COUNT: % LYMPHOCYTE NEUTROPHIL MONOCYTE EOSINIPHIL 5.0 .5 Fl 7.2 43.69 4.5 % 9.9-47.0 % 12.0-10.8 % 54.0 REFERENCE 17.2-5.6 Fl 7.0-17.4-48.0 9.0 12.0-3.6 fL 66.5 1.0 27.4 12.7 UNIT 10^3/uL REFERENCE 5.0-12.7 3.2 4.9 Pg 29.4-76.0 82.0-98.3 % 32.0-31.0-16.7 12 11.5-10.Hematology Test September 15. 2010 Test WHITE BLOOD CELLS RESULT 13.0 37.0-16.0 8.

8 % 54.0 10^6/uL RED BLOOD CELLS g/FdL HEMOGLOBIN HEMATOCRIT MCV MCH RDW-CV PDW MPV DIFFERENTIAL COUNT: % LYMPHOCYTE NEUTROPHIL MONOCYTE 13 5.0-16.0 12.0-12.0-16.69 4.9-47.2-5.5 . 2010 Test WHITE BLOOD CELLS RESULT 11.7 % 32.0-98.0 8.2 4.0 27.0 82.6 fL 79.0-17.5-10.4-76.% BASOPHIL 0.7 UNIT 10^3/uL REFERENCE 5.0-10.0-2.0 Hematology Test September 16.0 0.9 3.0 37.5 Fl 8.0-31.6 Pg 29.2 43.0 % 12.5 % 11.0 9.4 12.4-48.3 Fl 7.0 REFERENCE 17.

9. bone.0 WBC Increased: • • • • • • • • • RBC: Decreased: • • • • • • Hemorrhage Hemolysis Anemia Chronic illness Organ failure Dietary deficiency Infection Stress Inflammation Tissue necrosis Trauma Hemorrhage Malignancies(particularly gastrointestinal. live.0-3.7 % 0.0 % EOSINIPHIL BASOPHIL 0. and metastasis) Toxins Serum sickness Hemoglobin Decreased: • • • • • • • Anemia Hemolysis Severe hemorrhage Cancer Kidney disease Chronic hemorrhage Nutritional deficiency 14 .0 0.0-2.0 1.

Toxic effects of lead and other toxic elements. 2010 15 . low stomach acid. sideroblastic) Iron deficiency (blood loss. Hereditary (thalassemias. parasites. Vitamin C insufficiency. poor intake. Rheumatoid arthritis.• • Lymphoma Hemoglobinopathies Hematocrit: Decreased: • • • • • • Anemia Cirrhosis Hemolytic reaction Dietary deficiency Malnutrition Hemorrhage Mean Corpuscular Volume (MCV) Decreased: • • • • • • • • • • Copper deficiency Low stomach acid (Hypochlorhydria). younger platelets are larger than older Hematology Report September 20. etc) After a splenectomy Hemolytic anemia Platelet distribution width (PDW) • An indication of variation in platelet size which can be a sign of active platelet release. Mean Platelet Volume (MPV) • Vary with platelet production. Vitamin B6 deficiency.

0 13.0-16.0 27.66 4.4-48.0 REFERENCE 17.0 16 .2 4.0 8.2 43.0-2.5-10.0 37.0 % 16.0-10.0-31.5 1.0 4.0 9.1 % 0.0-12.0-17.0 % 74.4 12.6 Pg 29.4 % 0.6 Fl 9.4-76.0 0.0-98.Test WHITE BLOOD CELLS RESULT 17.0 10^6/uL RED BLOOD CELLS g/FdL HEMOGLOBIN HEMATOCRIT MCV MCH RDW-CV PDW MPV DIFFERENTIAL COUNT: % LYMPHOCYTE NEUTROPHIL MONOCYTE EOSINIPHIL BASOPHIL 9.9-47.0 82.9 fL 85.0-3.0-16.6 % 39.2-5.7 UNIT 10^3/uL REFERENCE 5.0 12.0 % 12.5 Fl 9.

WBC Increased: • • • • • • • • • Infection Stress Inflammation Tissue necrosis Trauma Hemorrhage Malignancies(particularly gastrointestinal.005 Chemical Properties: Proteins: trace 17 . and metastasis) Toxins Serum sickness Urinalysis Report September 24. bone.0 Specific Gravity: 1. 2010 Physical Properties Color: yellow Clarity: Cloudy Odor: pH: 8. live.

2010 Creatinine: 0.53 Sodium: 132.plenty Triple phosphate.2 mgs% 18 .Glucose: negative SEDIMENT MICROSCOPIC EXAMINATION Epithelial cells: few Pus cells: 0-1 Red blood cells: plenty Bacteria: moderate Others: Amorphous phosphate.6-1. 2010 Blood Sugar: 90.moderate BLOOD CHEMISTRY RESULT FORM September 16.85 September 19.44 September 18. 2010 Potassium: 4.2 mgs% Normal: 0.5-5.0 mgs% Creatinine: 0.75 Normal: 3.6-1.3 mmol/L Normal: 135-148 mmol/L Interpretation: Hyponatremia Normal: 60-110mgs% Normal: 0.

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This is in place to meet the patient’s need after discharge. Give significant other/s written information regarding expected effects and side effects of the medication Instruct significant other/s not to substitute a prescribed drug.DISCHARGE PLANNING Objective This discharge plan aims to continue the care of the client by involving the significant others to participate in the plan of care. • • . that the disease process. condition. Strict and follow orders for Home Medication upon discharge as prescribed by the physician 20 Rationale/Citations According to Bare (2002) patient needs to understand the occurrence of its effects in order for them to know when and whom to report. Area MEDICATIONS • • Instructions Discuss or reinforce the importance of taking medications as prescribed. prognosis and management regimen are understood. It is presented in such a way that the patient is viewed holistically and as a unique individual.

Encourage consistency in the environment without distraction.D. and prevent contracture development.EXERCISE • Implement doing of passive range of motion exercises in a cephalocaudal manner this promotes circulation.  Adduction-movement toward the midline of the body. encourage active ROM as able. and return to hospital for scheduled follow-up visits to M. regain motor control. According to Bare (2000) providing full range of motion four or five times a day maintain joint mobility. Conserve energy by balancing activity and rest periods. Instruct client and family on these as well as proper positioning.  Abduction-movement away from the midline of the body.D. Instruct the significant other/s regarding strict medication compliance Frequent oral hygiene—to reduce ruinous breath odor. Have a regular turning and positioning schedule.  Rotation-turning or movement of a part around its axis. usually every 2 hours. Care must be used to minimize shear and friction forces. Use lip balms / petroleum jelly to moisten cracked lips and mucous membranes. Teach the family on how to facilitate 21 • TREATMENT • HEALTH TEACHINGS • • • • • • . • Exercise the affected extremities passively through range of motion 45 times a day while on bed rest to maintain joint mobility and enhance circulation. Educate the client and family about proper positioning to prevent joint deformities.  Flexion-bending of a joint so that the angle of the joint diminishes. enhance circulation and prevent venous stasis. Teach also the family to adapt home environment that is safe from fall and injuries. Continue pharmacologic therapy as prescribed by M.

the equipments  Clean the external end of the tracheostomy tube with 2 gauze sponges with hydrogen peroxide. character of secretions.  Examine neck for subcutaneous emphysema. using visual cues and gestures. and reinforce attempts as well as correct responses.communication with the client by:  Speaking slowly.  Assemble needed.  Using alternative methods of communication other than verbal.  Wash hands thoroughly. words. swelling. and repeat if necessary.  Suction the trachea and pharynx thoroughly before tracheostomy care  Explain procedure to the patient. • Discuss and instruct the family in providing the tracheostomy care  Assess condition of stoma before tracheostomy care (redness. gestures or pictures. be consistent. Make only a single sweep with each gauze sponge before discarding.  Clean the stoma area with 2 peroxide-soaked gauze sponges. presence of purulence and bleeding).  Clean the stoma area using the 22 .  Loosen and remove crust wit sterile cotton swabs.  Giving plenty of time for response.  Speaking directly to the patient while facing him. discard sponges. such as written.

 Place a gauze pad between the stoma site and the tracheostomy tube to absorb secretions and prevent irritation.  Change the tracheostomy tie tapes: o Cut soiled tape while holding tube securely with other hand.sterile water-soaked gauze sponges then dry sponges. o Ties should be tight enough to keep tube securely in the stoma. o Grasp slit of clean tape and pull it through opening on side of the tracheostomy tube. Tap it gently to dry it and replace it with your sterile hand. o Remove old tapes carefully. o Tie the tapes at the side of the neck in a square knot. using brush or pipe cleaners with your sterile hand. 23 . Use care not to cut the pilot balloon tubing. but loose enough to permit two fingers to fit between the tapes and the neck. o Pull other end of tape securely through the slit end of the tape. Encouraging the patient to assist in self-care activities prevents further complications. If inner cannula is reusable. remove it with your contaminated hand and clean it in hydrogen peroxide solution. Alternate knot from side to side each time tapes are changed. drop it into sterile saline solution and agitate it to rinse thoroughly with your sterile hand.  Change a disposable inner cannula. o Repeat on the other side. and lock it securely into place. When clean. touching only the external portion.

my heart trusting.” 24 . DIET SPIRITUALITY • • Encourage family to attend mass every Sunday or anytime when they are free. relies on and confidently leans on Him. keeping followup appointments with health care providers for monitoring to prevent and detect complications. Reflect on this verse: • • • PSALM 28:7 “The Lord is my strength and my shield. • According to Bare (2002). Instruct the family to report to the physician for any recurrence or severity of symptoms. Encourage the family to read the Bible and meditate on God’s word. Advise client and family to Trust the Lord and place her Faith in Him.OUTPATIENT • Advice the significant other/s to attend to the scheduled follow-up check-up of the client with the physicians to evaluate client’s overall health condition. and any development of complications. any adverse effects of the medications taken. According to Hawk (2005). and to pray for healing and restoration of health. and I am helped therefore my heart greatly rejoices and with my song will I praise Him. the physical and the psychological status of the patient and the ability of the family to cope with any alterations in the patient status are best monitored with the nurse during home visits. This will enhance spiritual growth thus it will lessen client’s anxiety and hopelessness.

We had a good stay at that institution with the help of our duty mates. It feels good that little by little we’ve learned new things. We’re glad that we were able to extend help to our patients although in a little way. interesting and challenging though it was tiresome during those days but seems it cover up all the good memories we had. In making this case 25 . we’ve worked very hard. Though we were tired from our duty. still we have to settle this matter. This case study wasn’t that easy for us. gave our very best in order to make this case. We were able to perform new sets of procedures in which we haven’t done before in our previous rotations. It was fun. Although we were not that good enough we were able to give our best just to perform procedures. We were able to face and experience the different scenario in the Orthopedic Ward at Northern Mindanao Medical Center. Every minute and second count that we have to manage our time wisely so that we will be able to work in our other subjects. We really challenge ourselves to accomplish this task.Related Learning Experience This rotation was memorable for us. PCI as well as with the guidance of our clinical instructor.

many things have happened that are sad and happy things. Mary Frances Moorhouse. First and foremost. Doenges. Alice C. Alice C. that despite the obstacles encountered during the duty. REFERENCES: Book References: Nursing Care Plans Guidelines for Individualizing Client care Across the Life Span 7th edition by Marilynn E. As for us. We would like to extend our heartfelt gratitude to those people who have encouraged us. Prioritized Interventions and Rationales by Marilynn E. Jane Hokanson Hawks Internet Source: 26 . Clinical Management for Positive Outcomes by Joyce M. Therefore learning is not just in classrooms but learning is everywhere. Doenges. Black. we were able to prove to ourselves that we can do it despite of the obstacles encountered during those days. Murr Nurse’s Pocket Guide Diagnoses. Wherever you go. patience is always a virtue. whatever you do. Sad! For having many mistakes and learning from those mistakes. and how you do things there is always a way for learning. Murr Medical Surgical Nursing. Mary Frances Moorhouse.study. we would like to thank our almighty God for the guidance and enlightenment he has given.

com/article/1148570-overview http://www.com/spinalcord.apparelyzed.html 27 .http://emedecine.medscape.

confusion.Hypersensitivity to aminoglycosides CNS: dizziness. neurotoxicity • Monitor results of peak and trough drug blood levels. respiratory tract infections. ataxia. neuromuscular blockade. tinnitus GI: nausea. • Assess for secondary superinfections. . route. particularly upper . headache. protein. splenomegaly. depression. tremor. numbness. • Evaluate for signs and symptoms of ototoxicity (hearing loss. output. and vertigo). and specific gravity. dosage. brand name. tinnitus. Mechanism of Action Indications Contraindications Adverse Effects Nursing Responsibilities ototoxicity. leading to bacterial cell death Severe systemic infections . increased 28 salivation. • Monitor kidney function test results and urine cultures. vomiting. ataxia. lethargy. stomatitis.Interferes with protein synthesis in bacterial cells by binding to 30S ribosomal subunit. hypertension. palpitations EENT: nystagmus and other visual disturbances. vertigo. paresthesia. hearing loss. frequency) Generic name: amikacin sulfate Brand name: Amikin Classification: Anti-infective Route: IVTT Dosage: 500mg Frequency: Q12 CV: hypotension. classification. seizures.Drug order(generic name. anorexia GU: azotemia.

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constipation. classification. insomnia. palpitations. Watch for hypersensitivity reaction. interfering with Acute bacterial exacerbation of chronic bronchitis Hypersensitivity to drug. frequency) Mechanism of Action Indications Contraindications Adverse Effects Nursing Responsibilities Generic name: levofloxacin Brand name: Quixin Inhibits the enzyme DNA gyrase in susceptible gramnegative and grampositive aerobic and anaerobic bacteria. hypotension EENT: photophobia. flatulence. pharyngitis • Check vital signs. Assess for severe diarrhea. or other quinolones CNS: dizziness. Too-rapid infusion can cause hypotension. • Monitor blood glucose Classification: Anti-infective Route: PO Dosage: 750mg Frequency: OD bacterial DNA synthesis GI: nausea. • Closely monitor patients with renal insufficiency. dosage. sinusitis. which may indicate pseudomembranous colitis. Watch for signs and symptoms of tendinitis or tendon rupture. brand name. headache. route. its components. 30 Metabolic: . vomiting.Drug order(generic name. pseudomembranous colitis GU: vaginitis Hematologic: lymphocytopenia level closely in diabetic patients. abdominal pain. seizures CV: chest pain. Discontinue drug immediately if rash or other signs or symptoms occur. dyspepsia. diarrhea. especially blood pressure.

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Drug order(generic name. route. seizures CV: hypotension. classification. dry mouth. bisulfites. myocardial rupture after recent myocardial infarction. peptic ulcer. cushingoid appearance Monitor blood glucose level closely in diabetic patients receiving drug orally. psychiatric disturbances. anorexia. increased intracranial pressure. or methylparaben CNS: headache. malaise. Dosage must be tapered gradually. thromboembolism EENT: cataracts GI: nausea. hyperglycemia. EDTA. • Assess for occult blood loss. dosage. In long-term therapy. benzyl alcohol. thrombophlebitis. creatinine. • Monitor hemoglobin and potassium levels. vertigo. abdominal distention. vomiting. pancreatitis. Classification: Anti-inflammatory Route: IVTT Dosage: 500mg Frequency: q12 leukocyte lysosomal membranes. and stabilizing Allergic and inflammatory conditions Hypersensitivity to drug. reversing increased capillary permeability. never discontinue drug abruptly. bowel perforation. polysorbate 80. 32 . brand name. ulcerative esophagitis Metabolic: decreased carbohydrate tolerance. frequency) Mechanism of Action Indications Contraindications Adverse Effects Nursing Responsibilities Generic name: dexamethasone Brand name: Dexasone Reduces inflammation by suppressing polymorphonuclear leukocyte migration.

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