NCM 116-C ORTHOPEDIC NURSING DRUG STUDY –

OSTEOARTHRITIS
1. TRAMADOL HYDROCHLORIDE

Date and Time Ordered: 08/03/2021 8:00 a.m.

Generic Name: Tramadol
Brand Name: Ultram
Drug Classification: Opioid analgesic
Dosage, Route, Frequency: Tramadol 50 mg/ml IV PRN for pain
Mechanism of Action: Tramadol inhibits reuptake of norepinephrine, serotonin
and enhances serotonin release. It alters perception and response to pain by binding to
mu-opiate receptors in the CNS. Tramadol is similar to substances in the brain called
endorphins where they bind to receptors and the receptors then decrease the pain
messages that the body sends to the brain.
Desired Effect: This drug was given to relieve pain.

Nursing Responsibilities:
Nursing Responsibilities Rationale
1. Verify doctor’s order To avoid errors and to promote correct
administration of medication
2. Explain the drug to the client and to To gain cooperation and promote
significant others compliance
3. Observe the 12 R’s in drug To prevent error in drug administration
administration.
4. Discontinue drug and notify physician To prevent further complications.
if S&S of hypersensitivity occur.
5. Restrict visitors To allow the patient to rest
6. Dim the lights and reduce noise To provide comfort and promote sleep
7. Provide a cold compress To relieve pain
8. Encourage to practice relaxation such as To elicit a relaxation response that
deep breathings, listening to music decreases the effects of stress on pain.
9. Encourage patient to cough and breathe To prevent atelectasis and pneumonia.
deeply every 2 hr.
10. Provide safety measure such as raise To prevent injuries.
side rails
11. Document relevant data. To promote continuity of care, prevent
duplication of drug administration and for
legal purposes

2. CELECOXIB

Date and Time Ordered: 08/03/2021 8:00 a.m.

Generic Name: Celecoxib
Brand Name: Celebrex
 Drug Classification: Nonsteroidal Anti-Inflammatory Drug (NSAID)
Dosage, Route, Frequency: Celecoxib 200 mg PO BID
Mechanism of Action: Due to selective inhibition of cyclooxygenase-2 (COX-2),
which is responsible for prostaglandin synthesis, an integral part of the pain and
inflammation pathway. This pharmacologic activity gives celecoxib its analgesic, anti-
inflammatory, and antipyretic effects.
Desired Effect: This drug was given to reduce inflammation

Nursing Responsibilities:
Nursing Responsibilities Rationale
1. Verify doctor’s order To avoid errors and to promote correct
administration of medication
2. Explain the drug to the client and to To gain cooperation and promote
significant others compliance
3. Observe the 12 R’s in drug To prevent error in drug administration
administration.
4. Discontinue drug and notify physician To prevent further complications.
if S&S of hypersensitivity occur.
5. Administer with food if GI upset is To alleviate GI effects
severe. Provide small, frequent meals.
6. Check all drugs being taken for possible To avoid toxic levels
salicylate ingredients and monitor dose
7. Monitor for severe reactions if they To avoid problems and provide emergency
occur procedures such as gastric lavage,
induction of vomiting and administration of
charcoal
8. Restrict visitors To allow the patient to rest
9. Provide environmental control by To provide comfort
adjusting light or temperature of the
room
10. Ensure that the patient is well hydrated To decrease the risk of toxicity
during therapy
11. Encourage to practice relaxation such as To help the patient relax
deep breathings, listening to music
12. Provide safety measure such as raise To prevent injuries.
side rails
13. Document relevant data. To promote continuity of care, prevent
duplication of drug administration and for
legal purposes
 3. PREDNISONE
Date and Time Ordered: 08/03/2021 8:00 a.m.
Generic Name: Prednisone tablets, USP
Brand Name: Prednisone
Drug Classification: Corticosteroids
Dosage, Route, Frequency: Prednisone 20mg PO OD
Mechanism of Action: Prednisone decreases inflammation via suppression of the
migration of polymorphonuclear leukocytes and reversing increased capillary
permeability. It also suppresses the immune system by reducing the activity and the
volume of the immune system. They promote the up-regulation of anti-inflammatory
genes and down-regulation of pro-inflammatory genes. It inhibits the inflammatory
effects of circulating monocytes and eosinophils, thus contributing to relief of acute
symptoms.
Desired Effect: Prednisone helps to reduce the swelling and stiffness in the joints and
ease the pain.

Nursing Responsibilities:

Nursing Responsibilities Rationale

1. Verify doctor’s order For verification and to avoid errors
2. Assess for allergy or hypersensitivity To prevent further complication.
reaction to the drug.
3. Explain the drug to the client and to To gain cooperation and promote compliance
significant others
4. Observe the 12 Rs in drug administration. To prevent error in drug administration
5. Administer once-daily doses of prednisone To prevent further complications.
in the morning to match body’s normal
cortisol secretion schedule.
6. Because prednisone can produce many To get the desired effectiveness of the drug
adverse reactions, assess regularly for signs
and symptoms of such reactions as heart
failure and hypertension. Also monitor fluid
intake and output and daily weight.
7. Monitor growth pattern in children. To prevent further complications.
Prednisone may retard bone growth.
8. Be aware that prolonged use of prednisone To prevent further complications.
may cause hypothalamic-pituitary-adrenal
suppression
9. Involve in diversional activities appropriate Refocuses attention, provides stimulation and
for individual situation. enhances self-esteem and feelings of general
well-being.
10. Provide safety measures (e.g. adequate To prevent injuries.
lighting, raised side rails, etc.).
11. Increased intake of food and drink plenty of Provides feeling of well-being
water.
12. Educate client on drug therapy. To promote understanding and compliance.
 13. Document relevant data. To prevent error of drug administration

PREOPERATIVE MEDICATIONS
4. RANITIDINE
Date and Time Ordered: 08/04/2021 8:00 a.m.
Generic Name: Ranitidine
Brand Name: Zantac
Drug Classification: Antiulcer Agents
Dosage, Route, Frequency: Ranitidine 2 ml IV OD
Mechanism of Action: Inhibits the action of histamine at the H2-receptor site located
primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion.
Desired Effect: This drug is used to treat ulcers of the stomach and intestines.

Nursing Responsibilities:

Nursing Responsibilities Rationale

1. Verify doctor’s order
2. Assess for allergy or hypersensitivity
reaction to the drug.
3. Explain the drug to the client and to
significant others
4. Observe the 12 Rs in drug administration.
5. Assess patient for epigastric or abdominal
pain and frank or occult blood in the stool,
emesis, or gastric aspirate
6. Inform patient that medication may
temporarily cause stools and tongue to
appear gray black
7. Instruct patient not to take new medication
w/o consulting physician
8. Advise patient to avoid alcohol
9. Increased intake of food and drink plenty
of water.
10. Educate client on drug therapy.
11. Document relevant data.
For verification and to avoid errors
To prevent further complication.
To gain cooperation and promote compliance
To prevent error in drug administration
To provide critical information about her
internal organs
To prevent poor oral hygiene habits
To prevent patient in making medication
errors.
To prevent GI irritation
Provides feeling of well-being and prevent
constipation.
To promote understanding and compliance.
To prevent error of drug administration

5. HYDROXYZINE
Date and Time Ordered: 08/04/2021 8:00 a.m.
Generic Name: Hydroxyzine
Brand Name: Vistaril
Drug Classification: Antihistamine
Dosage, Route, Frequency: Hydroxyzine 50 mg IV OD
Mechanism of Action: Hydroxyzine works by blocking the action of histamine a
substance in the body that causes allergic symptoms.
 Desired Effect: This drug is used to control itching which is a common side effect of the
anesthesia.

Nursing Responsibilities:

Nursing Responsibilities Rationale

1. Verify doctor’s order For verification and to avoid errors
2. Assess for allergy or hypersensitivity To prevent further complication.
reaction to the drug.
3. Explain the drug to the client and to To gain cooperation and promote compliance
significant others
4. Observe the 12 Rs in drug administration. To prevent error in drug administration
5. Caution patient to avoid activities requiring To prevent further complication.
alertness.
6. Instruct patient to report other troublesome To closely monitor the patient’s condition
side effects such as severe or prolonged
headache, urinary retention, skin
redness/warmth, or GI problems
7. Provide safety measures (e.g. adequate To prevent injuries.
lighting, raised side rails, etc.).
8. Educate client on drug therapy. To promote understanding and compliance.
9. Document relevant data. To prevent error of drug administration

6. TRAMADOL HYDROCHLORIDE

Date and Time Ordered: 08/04/2021 8:00 a.m.

Generic Name: Tramadol
Brand Name: Ultram
Drug Classification: Opioid analgesic
Dosage, Route, Frequency: Tramadol 50 mg/ml IV once?
Mechanism of Action: Tramadol inhibits reuptake of norepinephrine, serotonin
and enhances serotonin release. It alters perception and response to pain by binding to
mu-opiate receptors in the CNS. Tramadol is similar to substances in the brain called
endorphins where they bind to receptors and the receptors then decrease the pain
messages that the body sends to the brain.
Desired Effect: This drug was given to relieve pain.

Nursing Responsibilities:
Nursing Responsibilities Rationale
1. Verify doctor’s order To avoid errors and to promote correct
administration of medication
2. Explain the drug to the client and to To gain cooperation and promote
significant others compliance
3. Observe the 12 R’s in drug To prevent error in drug administration
 administration.
4. Discontinue drug and notify physician
if S&S of hypersensitivity occur.
5. Restrict visitors
6. Dim the lights and reduce noise
7. Provide a cold compress
8. Encourage to practice relaxation such as
deep breathings, listening to music
9. Encourage patient to cough and breathe
deeply every 2 hr.
10. Provide safety measure such as raise
side rails
11. Document relevant data.
To prevent further complications.
To allow patient to rest
To provide comfort and promote sleep
To relieve pain
To help the patient relax
To prevent atelectasis and pneumonia.
To prevent injuries.
To promote continuity of care, prevent
duplication of drug administration and for
legal purposes

7. CELECOXIB

Date and Time Ordered: 08/04/2021 8:00 a.m.

Generic Name: Celecoxib
Brand Name: Celebrex
Drug Classification: Nonsteroidal Anti-Inflammatory Drug (NSAID)
Dosage, Route, Frequency: Celecoxib 200 mg PO BID
Mechanism of Action: Due to selective inhibition of cyclooxygenase-2 (COX-2),
which is responsible for prostaglandin synthesis, an integral part of the pain and
inflammation pathway. This pharmacologic activity gives celecoxib its analgesic, anti-
inflammatory, and antipyretic effects.
Desired Effect: This drug was given to reduce swelling/inflammation

Nursing Responsibilities:
Nursing Responsibilities Rationale
1. Verify doctor’s order To avoid errors and to promote correct
administration of medication
2. Explain the drug to the client and to To gain cooperation and promote
significant others compliance
3. Observe the 12 R’s in drug To prevent error in drug administration
administration.
4. Discontinue drug and notify physician To prevent further complications.
if S&S of hypersensitivity occur.
5. Administer with food if GI upset is To alleviate GI effects
severe. Provide small, frequent meals.
6. Check all drugs being taken for possible To avoid toxic levels
salicylate ingredients and monitor dose
7. Monitor for severe reactions if they To avoid problems and provide emergency
occur procedures such as gastric lavage,
 induction of vomiting and administration of
charcoal
8. Restrict visitors To allow the patient to rest
9. Provide environmental control by To provide comfort
adjusting light or temperature of the
room
10. Ensure that the patient is well hydrated To decrease the risk of toxicity
during therapy
11. Provide safety measure such as raise To prevent injuries.
side rails
12. Document relevant data. To promote continuity of care, prevent
duplication of drug administration and for
legal purposes

INTRAOPERATIVE MEDICATION
8. PROPOFOL

Date and Time Ordered: 08/04/2021 9:00 a.m.

Generic Name: Propofol
Brand Name: Diprivan
Drug Classification: General Anesthetics
Dosage, Route, Frequency: Propofol 20 mg IV q 10 seconds until onset
Mechanism of Action: Propofol works by increasing GABA-mediated inhibitory tone
in the CNS.  Propofol decreases the rate of dissociation of the GABA from the receptor,
thereby increasing the duration of the GABA-activated opening of the chloride channel
with resulting hyperpolarization of cell membranes. 
Desired Effect: To induce and maintain anesthesia upon surgery.

Nursing Responsibilities:
Nursing Responsibilities Rationale
1. Verify doctor’s order To avoid errors and to promote correct
administration of medication
2. Assess for allergy or hypersensitivity To prevent further complication.
reaction to the drug.
3. Explain the drug to the client and to To gain cooperation and promote
significant others compliance
4. Observe the 12 R’s in drug To prevent error in drug administration
administration.
5. Assess for the cautions and To prevent any untoward complications.
contraindications (e.g. drug allergies,
hepatic and renal impairment, etc.) of
the drug.
6. Monitor vital signs continually during To assess systemic response to CNS
administration depression and provide appropriate support
as needed
7. Monitor temperature and maintain For prompt detection and treatment of
dantrolene on standby malignant hyperthermia
8. Offer support and encouragement To help the patient cope with the procedure
and the drugs being used
9. Raise side rails and monitor patient until To ensure patient safety and prevent
recovery phase is complete, and the injuries
patient is conscious and able to move
and communicate
10. Document relevant data. To promote continuity of care, prevent
duplication of drug administration and for
legal purposes

POSTOPERATIVE MEDICATIONS
9. TRAMADOL HYDROCHLORIDE

Date and Time Ordered: 08/04/2021 11:00 a.m.

Generic Name: Tramadol
Brand Name: Ultram
Drug Classification: Opioid analgesic
Dosage, Route, Frequency: Tramadol 50 mg/ml IV PRN for pain
Mechanism of Action: Tramadol inhibits reuptake of norepinephrine, serotonin
and enhances serotonin release. It alters perception and response to pain by binding to
mu-opiate receptors in the CNS. Tramadol is similar to substances in the brain called
endorphins where they bind to receptors and the receptors then decrease the pain
messages that the body sends to the brain.
Desired Effect: This drug was given to relieve pain

Nursing Responsibilities:
Nursing Responsibilities Rationale
1. Verify doctor’s order To avoid errors and to promote correct
administration of medication
2. Explain the drug to the client and to To gain cooperation and promote
significant others compliance
3. Observe the 12 R’s in drug To prevent error in drug administration
administration.
4. Discontinue drug and notify physician To prevent further complications.
if S&S of hypersensitivity occur.
5. Restrict visitors To allow the patient to rest
6. Provide environmental control by To provide comfort and promote sleep
adjusting the light or temperature of the
room

7. Provide a cold compress To relieve pain

8. Provide safety measure such as raise To prevent injuries.
side rails
9. Document relevant data. To promote continuity of care, prevent
duplication of drug administration and for
legal purposes

10. IBUPROFEN

Date and Time Ordered: 08/04/2021 11:00 a.m.

Generic Name: Ibuprofen
Brand Name: Caldolor IV
Drug Classification: Non-Steroidal Anti-inflammatory Drug (NSAID)
Dosage, Route, Frequency: Ibuprofen 500 mg IV q 6 hrs
Mechanism of Action: Naproxen blocks arachidonate binding to completely
inhibit both cyclooxygenase (COX) isoenzyme, COX-1 and COX-2 resulting in analgesic
and anti-inflammatory effects.
Desired Effect: This drug was given to reduce swelling/inflammation.

Nursing Responsibilities:
Nursing Responsibilities Rationale
1. Verify doctor’s order To avoid errors and to promote correct
administration of medication
2. Explain the drug to the client and to To gain cooperation and promote
significant others compliance
3. Observe the 12 R’s in drug To prevent error in drug administration
administration.
4. Discontinue drug and notify physician To prevent further complications.
if S&S of hypersensitivity occur.
5. Monitor blood pressure Drug can lead to new-onset HTN or
preexisting HTN, which may contribute to
the increased incidence of CV events.
6. Check all drugs being taken for possible To avoid toxic levels
salicylate ingredients and monitor dose
7. Monitor for severe reactions if they To avoid problems and provide emergency
occur procedures such as gastric lavage,
induction of vomiting and administration of
charcoal
8. Restrict visitors To allow the patient to rest
9. Provide environmental control by To provide comfort and promote sleep
adjusting light or temperature of the
room
10. Provide safety measure such as raise To prevent injuries.
side rails
11. Document relevant data. To promote continuity of care, prevent
duplication of drug administration and for
legal purposes