DRUG STUDY

ADVERSE
DRUG MECHANISM OF INDICATION CONTRAINDICATION REACTION / NURSING
ACTION SIDE EFFECTS RESPONSIBILITIES

Generic Name: Chemical Effect: Prevention of Seizure Known hypersensitivity CNS: 1. Observe 12 rights in
phenytoin Elevates the seizure to hydantoin products Dizziness giving medication
threshold in the motor because of its effect on Ataxia
cortex by limiting the ventricular automaticity Slurred speech, 2. Continually monitor
Brand Name: post- tetanic Mental confusion patient's cardiac
Dilantin potentiation n (PTP) Decreased rhythm and check BP
of synaptic coordination frequently and
transmission on. It Somnolence regularly during IV
Dosage: exerts this effect by infusion.
10 mg/kg at 25 preventing the EENT:
mg/min excessive blurred vision 3. Monitor serum drug
accumulation of levels.
Frequency: intracellular sodium GI:
PRN during tetanic Constipation 4. Inform patient what
stimulation by either possible adverse
Route: reducing the passive effects.
IV influx of sodium or
increasing the
efficiency of the
Classification sodium pump.
Pharmacologic Class:
Hydantoin derivative Therapeutic effect:
Prevents and stops
Therapeutic Class: seizure activity
anticonvulsant
 ADVERSE
DRUG MECHANISM OF INDICATION CONTRAINDICATION REACTION / NURSING
ACTION SIDE EFFECTS RESPONSIBILITIES

Generic Name: Chemical Effect: For hypertension Contraindicated in CNS: 1. Follow the 12 rights
nifedipine May inhibit calcium patients hypersensitive to Dizziness in administering
ion influx across the drug or any of its Weakness medication.
cardiac and smooth- components
Brand Name: muscle cells, GI: 2. Monitor patient
Adalat decreasing Constipation carefully (BP, cardiac
myocardial rhythm, and output).
contractility and
Dosage: oxygen demand; may 3. Inform the patient
20 mg dilate coronary about any potential
arteries and arterioles side effects.
Frequency:
BID 4. Report if the patient
Therapeutic effect: experiencing
Route: Reduces blood pronounced dizziness.
PO/NGT pressure

Classification
Pharmacologic Class:
Calcium channel
blocker

Therapeutic Class:
antihypertensive
 ADVERSE
DRUG MECHANISM INDICATION CONTRAINDICATION REACTION / NURSING
OF ACTION SIDE EFFECTS RESPONSIBILITIES
Generic Name: Chemical Effect:
mannitol Elevates blood To reduce Intra Contraindicated in patients 1. Observe 12 rights in
osmolality, Cranial Pressure hypersensitive to the drug or CNS: giving medication
enhancing water any of its components; and Dizziness,
Brand Name: and sodium flow Cerebral Edema with severe dehydration Confusion 2. Assess skin turgor,
Osmitrol into extracellular Hypertension mucous membranes and
fluid Fluid Retention mental status before
CV: administration of drug.
Dosage: Tachycardia
10% at 1.25 g/kg Therapeutic 3. Assess signs for
effect: EENT: electrolyte imbalance.
Frequency: Increases water Blurred vision
q6 excretion, 4. Monitor Vital signs
decreases including central venous
Route: intracranial pressure and output.
IV pressure
5. Be alert for adverse
reactions and drug
Classification interactions.
Pharmacologic Class:
Osmotic diuretic 6. Monitor IV site carefully
to avoid extravasations
Therapeutic Class: and tissue necrosis.
diuretic
7. Do not add to other IV
solutions or mix with
other medications.

8. Watch for excessive fluid

loss and signs and
symptoms of
hypovolemia and
dehydration.
 ADVERSE
DRUG MECHANISM OF INDICATION CONTRAINDICATION REACTION / NURSING
ACTION SIDE EFFECTS RESPONSIBILITIES

Generic Name: Chemical Effect: Acute Ischemic Contraindicated in patients CNS: 1. Observe 12 rights in
alteplase Coverts plasminogen Stroke hypersensitive to the drug Dizziness medication
to plasmin, which in or any of its components; Fever administration
turn breaks down and used cautiously in
Brand Name: fibrin and fibrinogen, patients with hypertension 2. Observe and frequently
Activase monitor patients for
neurologic changes, as
Dosage: Therapeutic effect: well as any signs
0.9 mg/kg dissolving thrombus adverse drug reactions

Frequency: 3. Perform neurologic

First 10% bolus over assessment every 15
1 minute, and the minutes during the 1-
remainder dose hour infusion
infused over 60
minutes 4. Monitor blood pressure
every 15 minutes
Route: during the 1-hour
IV infusion

5. Discontinue infusion
Classification and obtain an
Pharmacologic Class: emergency CT scan if
enzyme the patient develops
severe headache, acute
Therapeutic Class: hypertension, nausea,
Thrombolytic enzyme or vomiting, or has a
worsening neurologic
examination

6. Repeat ICP reading 2-4

hours after
administration
 HEALTH TEACHING PLAN

LEARNING NEED: Stress Management Technique

GOAL: The patient-significant others will be able to learn things about stress management techniques in the care of patient with Cerebrovascular
Accident CVA/ Stroke, Hypertension
LEARNING LEARNING CONTENT LEARNING TIME RESOURCES Method of
OBJECTIVES STRATEGIES/ ALLOTMENT NEEDED EVALUATION
ACTIVITIES
After 30 minutes of - When the - Materials:
student nurse- patient is paper, pen,
patient interaction, awake Nurse
the patient will be
able to:
 What is Stress Management technique  Verbal/ oral  2 minutes  pamphlet  Question and
1. Briefly define - Stress management is a wide discussion (visible text Answer
stress spectrum of techniques and (lecture) and images)
management psychotherapies aimed at 1. The awareness
technique and controlling a person's level of of patient to the
importance in stress, especially chronic stress, topic.
own words usually for the purpose of and for 2. Understand the
correctly the motive of improving everyday effect of stress to
functioning. health.
 Verbal/ oral  2 minutes  pamphlet 3. Spend time and
discussion (visible text gain knowledge
(lecture) and images) as well as the
2. Identify the family members.
effects of  Effects of stress 4. Instant feedback
stress. - Stress disrupts nearly every from the patient
system in your body. It can and significant
suppress your immune system, others.
upset your digestive and
reproductive systems, increase  Verbal/ oral  6 minutes  Visual aids  Demonstrate
the risk of heart attack and stroke, discussion Video/music beginning skills
and speed up the aging process. (demonstration) of stress
management
3. Enumerate technique.
different
stress
management
technique  STRESS MANAGEMENT
correctly TECHNIQUE
A. GUIDED IMAGERY
- Also known as visualization
- Using one’s imagination in
specific way to achieve a specific
positive effect. Guided imagery
for relaxation and relief may
consist of combining slow,
rhythmic breathing with a mental
image of relaxation and comfort.
With each slowly exhaled breath,
the patient imagines muscle
tension and discomfort being
breathed out, carrying away the
stress and tension leaving behind
a relaxed and comfortable body
- It can help to eliminate negative
thoughts.
B. DEEP BREATING EXERCISES  Demonstration  Observation/
- Breathing deeply will help and return  20 minutes  Human return
releases endorphins which are the demonstration resources: demonstration
body’s natural feel good. (ROM time and
C. MUSIC THERAPY exercises to effort of the
- Listening to the favourite music is patient with nurse and
excellent because it can involve the significant family
4. Enumerate both thought and feelings. others.) member
other stress D. DIVERSIONAL
management ACTIVITIES/DISTRACTION
technique - Watching TV
correctly - Distraction help relieve which
involves focusing the patient’s
attention on something other than
on the condition, may be a
 mechanism responsible for other
effective cognitive techniques.
- Distraction is thought to reduce
the perception of the condition by
stimulating the descending
control system, resulting in fewer
stimuli being transmitted to the
brain.

 There are also number of things that can

relieve stress such as:
a. Frequent positioning changes
b. Proper body alignment and
correct body mechanics
c. Rest period
d. Support such as pillows to the
affected area.
e. Instruct patient to perform
exercises to evaluate range of
motion, strength on the affected
and unaffected side, bed mobility,
and transfer from bed, balance
and gait.
REFERENCES:

Hinkle J.L., & Cheever K. (2014). The 13th edition of Brunner& Suddarth’s Textbook of Medical- Surgical Nursing. Lippincott, Williams &
Wilkins, Philadelphia Pa.

Jeanne Segal, Ph.D., et al. (May 2020) Stress management. Retrieved from https://www.helpguide.org/articles/stress/stress-symptoms-signs-
and-causes.htm

Regents of the university of Michigan. (n.d.). Managing Stress. Retrieved From https://en.m.wikipedia.org/wiki/Stress_management
 NURSING
ASSESSMENT PLANNING IMPLEMENTATION EVALUATION
DIAGNOSIS
Subjective Cue:  Impaired Goal of Care: At the end of 8 hours  Goal Met! Patient
 As described by physical mobility of nursing interventions, the patient showed interest in performing
the daughter, the related to will manifest signs of improved the range of motion exercises
patient is, “sleeping limitations imposed physical mobility as evidenced by throughout the 4-hour nursing
most of the time, less by physical active participation in range of intervention.
responsive”. condition motion exercises.

P - Keep side rails up and bed in low  Made sure that the  Goal Met! Side rails
Objective Cues: position. side rails of the bed are up on both sides of the bed were
 Extremities: 2+ R - To promote safe environment. and the bed positioned in a maintained except for
scores in both upper 30o angle before proceeding exercises that would hinder
and 3+ scores in both with the ROM exercises. the activity to be done.
lower areas for
resistance  Goal Met! Patient
P - Allow patient to perform tasks at  Allotted more time consumed more time in
 Cannot raise his or her own rate. to the activities to be performing the said ROM
arms and legs R - Hospital workers and family completely done especially exercises and some assistance
independently caregivers are often in a hurry and do to those that the patient was made.
more for patients than needed, finds difficult to execute
 spasms on the thereby slowing patient's recovery such as abduction and
right arm and leg and reducing his or her self-esteem. adduction of the arms and
dorsiflexion and plantar
 Diagnosed of flexion of the feet.
Cerebrovascular
Accident/Stroke P - Provide positive reinforcement  Provided positive  Goal Met! The patient
during activity. feedback and words of showed determination in
 Confined to bed R - Patients may be reluctant to encouragement throughout accomplishing the ROM
move or initiate new activity from a the activities like, “Yes, exercises even with the
 Need of fear of falling. that’s it. I see that you are apparent display of little
assistance when turning doing it just fine, Mrs. A” frustration from time to time.
to sides and “Go on, Mrs. A. You
can do it.”.

P - Turn and position every 2 hours,  Assisted the patient  Goal Met! Patient was
or as needed. in bed positioning every 2 able to be turned from side to
R - To optimize circulation to all hours. side every 2 hours with some
tissues and to relieve pressure. assistance.
P - Perform passive or active  Performed head  Goal Met! Patient was
assistive ROM exercises to all turns from side to side, knee able to carry out all
extremities. and elbow flexion one at a the activities however
R - To promote increased venous time. with minimal
return, prevent stiffness, and assistance needed.
maintain muscle strength and
endurance.

P - Dangle the legs from the bed
side for 10 to 15 minutes.
R - Prevents orthostatic hypotension.
 Assisted the patient  Goal Partially Met!
to move slowly to one side Patient was only able to
of the bed while in a sitting tolerate the position for about
position, enabling both feet 7 minutes.
to dangle freely on the sides
of the bed.

P - Encourage early ambulation.  Encourage the  Goal Unmet! Plan was

R - Early progressive ambulation can patient to get out of bed and not implemented since the
decrease the risk of complications. walk just around the room patient verbalized feeling of
with assistance. “dizziness”.

P - Promote independence during  Promoted

exercises and activities. independence to completely  Goal Partially! Some
R - Assisting only in necessary steps execute the exercises. of the ROM exercises was not
prevents the patient from becoming able to perform by the patient
dependent. The goal is to further all alone.
independence and maximize the
patient’s capabilities.

P - Minimize cardiovascular,  Assisted patient in a

neuromuscular and skeletal
deconditioning by positioning the
patient in an upright position several
times a day while performing simple
range of motion.
R - Physical inactivity leads to
deconditioning of the skeletal,
neuromuscular and cardiovascular
systems, which can lead to impaired
high Fowler’s position,
afterwards instructing
patient to do dorsiflexion
and plantar flexion of her
feet as well as extending
and flexing the hands one at
a time.
 Goal Met!
Patient was able to tolerate
the high Fowler’s position for
about 2 minutes however
asked that she will be moved
to a lower position (Semi-
Fowlers position: 45o)
afterwards.
quality of life.
P – Constant tracking of vital signs
before and after activities.
R – Continuous monitoring of vital and after the exercises.
signs provides early detection of
preventable outcomes of clinical
deterioration.
 Checked the vital
signs of the patient before  Goal Met! Vital signs
showed some minimal
fluctuations ranging from
normal to above normal
readings of PR: 98 bpm to
106 bpm; RR: 18 br/min to 21
br/min; BP: 130/100 mmHg
to 140/90 mmHg.

P – Educate the patient about the  Conducted a health  Goal Met! The
importance of physical mobility. teaching to the patient and SO was able to enumerate 3
R - Knowledge promotes awareness the SO regarding the important reasons why
to prevent the complication of importance of mobility. physical mobility is important
overexertion. (prevention of bed ulcers,
contractures, atelectasis) and
the patient, 2 (prevention of
thrombus development and
pressure sores).
References:
Matt, V. (2017, September 24).
Activity intolerance nursing care
plan. https://nurseslabs.com/activity-
intolerance/

Nurses Zone. (2016). Impaired

physical Mobility.
https://thenurseszone.com/nursing-
care-plan-ncp/impaired-physical-
mobility/

RNlessons. (2021). Impaired

Physical mobility nursing diagnosis
and care plan
Written by RNlessons in Care Plans.
https://rnlessons.com/impaired-
physical-mobility-nursing-diagnosis-
care-plan/