Name of Student: Mariñas, Frianeza Mae M.

Year/Section: Section 2

Patient: Case: Vacuum Extraction and Shoulder Dystocia

Drug Study

Medication Classification Mechanism Side Effects/ Nursing

of Action Adverse Implications/Responsibilities
Reactions

Generic Pharmacotherapeutic: Binds to Frequent: Baseline Assessment:

Name: Second-generation bacterial Discomfort with  Obtain CBC, renal function
Cefuroxime cephalosporin cell IM tests.
membranes administration,  Question for history of
Clinical: Antibiotic , inhibits cell oral candidiasis allergies, particularly
Brand wall (thrush), mild Cephalosporins, penicillins.
Name: synthesis diarrhea, mild
Ceftin abdominal Intervention/ Evaluation:
Therapeutic cramping,  Assess oral cavity for white
Dosage: Effect: vaginal patches on mucous
750 mgs Bactericidal candidiasis. membranes, tongue
(thrush).
Route: Occasional:  Monitor daily pattern of
TIV Nausea, serum bowel activity, stool
sickness–like consistency. Mild GI
reaction (fever, effects may be tolerable
joint pain; (increasing severity may
usually occurs indicate onset of
after second antibiotic-associated
course of colitis).
therapy and  Monitor I&O, renal
resolves after function tests for
drug is nephrotoxicity.
discontinued).  Be alert for superinfection:
fever, vomiting, diarrhea,
Rare: Allergic anal/genital pruritus, oral
reaction (rash, mucosal changes
pruritus, (ulceration, pain,
urticaria), erythema).
thrombophlebitis
(pain, redness, Patient/ Family Teaching:
swelling at  Discomfort may occur with
injection site). IM injection.
 Doses should be evenly
Adverse spaced.
 Reactions:  Continue antibiotic
Antibiotic- therapy for full length of
associated treatment.
colitis, other  May cause GI upset (may
super-infections take with food, milk).
(abdominal
cramps, severe
watery diarrhea,
fever) may result
from altered
bacterial balance
in GI tract.
Nephrotoxicity
may occur, esp.
in pts with
preexisting renal
disease. Pts with
history of
penicillin allergy
are at increased
risk for
developing a
severe
hypersensitivity
reaction (severe
pruritus,
angioedema,
bronchospasm
anaphylaxis).

Medicatio Classification Mechanism of Side Effects/ Nursing

n Action Adverse Reactions Implications/Responsibili
 ties

Generic Pharmacotherapeu Anesthetic: CNS effects Baseline Assessment:

Name: tic: Amide Inhibits generally dose-  Question for
Lidocaine anesthetic. conduction of related and of hypersensitivity to
nerve short duration. lidocaine, amide
Clinical: impulses. anesthetics.
Brand Class 1B anti- Occasional:  Obtain baseline B/P,
Name: arrhythmic,anesthe Therapeutic Effect: Infiltration/Nerve pulse, respiratory
Xylocaine tic. Causes temporary rate, ECG, serum
loss of Block: Pain at electrolytes.
feeling/sensation. injection site.
Intervention/ Evaluation:
Antiarrhythmic: Topical: Burning,  Monitor ECG, vital
Suppresses stinging, signs closely during
automaticity of tenderness at and following drug
conduction tissue; application site. administration for
increases electrical cardiac performance.
stimulation Rare: Generally  If ECG shows
threshold of associated with arrhythmias,
ventricle, His high dose: prolongation of PR
Purkinje system; Drowsiness, interval or QRS
and spontaneous dizziness, complex, inform
depolarization of disorientation, physician
ventricle during light-headedness, immediately.
diastole. Blocks tremors,  Assess pulse for
initiation/conducti apprehension, rhythm, rate, quality.
on of nerve euphoria,  Assess B/P for
impulses by sensation of heat, evidence of
decreasing cold, numbness; hypotension.
neuronal blurred or  Monitor for
membrane’s double vision, therapeutic serum
permeability to tinnitus, nausea. level (1.5–6 mcg/mL).
sodium ions.  For lidocaine given by
Adverse Reactions: all routes, monitor
Therapeutic Serious adverse vital signs, LOC.
Effect: Inhibits reactions to  Drowsiness should be
ventricular lidocaine considered a warning
arrhythmias. are uncommon, sign of high serum
but high dosage by levels of lidocaine.
any route may  Therapeutic serum
produce level: 1.5–6 mcg/mL;
cardiovascular toxic serum level:
depression, greater than 6
bradycardia, mcg/mL.
hypotension,
arrhythmias, heart
block, Patient/ Family Teaching:
cardiovascular Local anesthesia:
collapse, cardiac  Due to loss of feeling
arrest. Potential or sensation,
for malignant protective measures
hyperthermia, CNS may be needed until
toxicity may occur, anesthetic wears off
esp. with regional (no ambulation,
anesthesia use, including special
progressing rapidly positions for some
from mild side regional anesthesia).
effects to tremors, Oral mucous membrane
drowsiness, anesthesia:
seizures, vomiting,  Do not eat, drink,
respiratory chew gum for 1hr
depression. after application
Methemoglobine (swallowing reflex
mia (evidenced by may be impaired,
cyanosis) has increasing risk of
occurred following aspiration; numbness
topical application of tongue, buccal
of lidocaine for mucosa may lead to
teething bite trauma).
discomfort IV infusions:
and laryngeal  Report dizziness,
anesthetic spray. numbness, double
vision, nausea,
pain/burning,
respiratory difficulty.
Topical:
 Report irritation,
pain, numbness,
swelling, blurred
vision, tinnitus,
respiratory difficulty.
Medication Classification Mechanism of Side Effects/ Nursing
Action Adverse Reactions Implications/Responsibilities

Generic Functional: Promotes Pain, soreness,  Monitor PT,

Name: antihemorrhagic hepatic swelling at IM international normalized
Phytonadion formation of injection site, ratio (INR) routinely in
e Chemical: Fat- coagulation pruritic erythema those taking
soluble vitamin factors II, VII, (with repeated anticoagulants.
IX, X. Essential injections), facial  Assess skin for
Brand Name: for normal flushing, altered ecchymoses, petechiae.
Vitamin K clotting of taste.  Assess gums for gingival
blood. Readily bleeding.
Dosage: absorbed from Adverse Reactions:
0.01 mL GI tract Newborns Erythema:
(duodenum) (especially  Assess urine for
Route: after IM, premature infant) hematuria.
IM subcutaneous may develop  Assess Hct, platelet
administration. hyperbilirubinemia. count, urine/stool
Metabolized in Severe reaction culture for occult blood.
liver. Excreted (cramp-like pain,  Assess for decrease in
in urine; chest-pain, B/P, increase in pulse
eliminated by dyspnea, facial rate, complaint of
biliary system. flushing, dizziness, abdominal/back pain,
Onset of action rapid/weak pulse, severe headache (may
(increased rash, diaphoresis, be evidence of
coagulation hypotension hemorrhage).
factors). progressing to  Assess for increase in
shock, cardiac amount of discharge
arrest) occurs during menses.
rarely. Immediately  Assess peripheral pulses.
after IV  Check for excessive
administration bleeding from minor
cuts, scratches.
Medication Classification Mechanism of Side Effects/ Nursing
Action Adverse Reactions Implications/Responsibil
ities

Generic Pharmacologic Hepatitis B vaccine pain, severe itching, Nursing Diagnosis

Name: class: Hepatitis has been shown to reddening of Pain, Acute, related to
Hepatitis B B vaccine elicit antibodies to the skin, weakness, IM injection of the
vaccine hepatitis B virus as feeling unwell (malai vaccine
(recombinant) Therapeutic measured by ELISA. se), nausea,
class: Anti- Antibody vomiting, abdominal Knowledge, Deficient,
Brand Name: hepatitis concentrations pain/cramps, related to hepatitis B
Engerix-B, vaccine ≥10mIU/mL against difficult or vaccination
Hepaccine, HBsAg are labored breathing,
HBV, recognized as diminished appetite, Intervention and
Recombivax conferring stuffy nose, Rationale:
protection against influenza, cough,  Communicate or
Dosage: hepatitis B sweating, achiness, assure patient that
0.5 mL infection. Infection sensation of the pain due to
with hepatitis B warmth, injection is mild and
Route: virus can have lightheadedness, generally tolerable.
IM serious chills, flushing Rationale: To make
consequences diarrhea, sore patient more
including acute throat, upper comfortable
massive hepatic respiratory infection,  Provide
necrosis and burning, nodules, immunization
chronic active headache, fever, schedule to client
hepatitis. spinning sensation (Vaccination
Chronically (vertigo), numbness requires three IM
infected persons or tingling, skin injections at
are at increased swelling, hives, prescribed
risk for cirrhosis muscle pain, back intervals.)
and hepatocellular pain, neck pain, Rationale: For family to
carcinoma. shoulder pain, understand dosing
stiff neck, earache schedule and the health
inability worker to be assured
to sleep (insomnia), completion of the
irritability, joint pain, vaccination
constipation, Lupus-  Administer dosage
like syndrome (rash, correctly. (Vaccine
joint pain must be
and fatigue), administered
Systemic Lupus intramuscularly.)
Erythematous Rationale: To prevent
(autoimmune side effects like pain and
disease), fever as well as
polyarthritis underdosing/overdosing
nodules,
enlargement of
lymph nodes, fast Client Education:
heart rate, fainting,  Instruct client to
inflammation of the return at 1 month
cornea, after the first
inflammation of the injection for the
optic nerve, ringing second dose and at
in the ears (tinnitus), 6 months after the
pink eye first injection for the
(conjunctivitis), third dose.
visual disturbance,
inflammation of the Instruct client about:
eye, agitation,  That pain and
sleepiness, inflammation at the
increased injection site are the
erythrocyte most common side
sedimentation rate effects.
(ESR), deficiency of  To rest arm and
platelets in the apply heat for
blood, Steven symptoms of
Johnson syndrome, discomfort and to
hair loss, red or take anti-
brown round spots inflammatory
on the skin eczema. medications for
pain.

Client Goals and

Expected Outcomes:
The client will:
 Adhere to
recommended
immunization
schedule.
 Verbalize methods
to decrease pain
related to injection.
 Be free from
adverse drug
reactions.

Outcomes Evaluation:
 Evaluate the
effectiveness of
drug therapy by
confirming that
client goals and
expected outcomes
 have been met.
 The client verbalizes
the importance of
adhering to the
immunization
schedule
 The client verbalizes
methods to
decrease pain at the
injection site.
 The client is free of
adverse drug
reactions.
 The client
demonstrates an
understanding of
the drug’s action by
accurately
describing drug side
effects and
precautions.
Medication Classification Mechanism of Side Effects/ Nursing
Action Adverse Reactions Implications/Responsibili
ties

Generic Pharmacotherapeu Diffuses into Frequent: Baseline Assessment:

Name: tic: Nitroimidazole organism, Systemic: Anorexia,  Obtain baseline CBC,
Metronidaz derivative. interacting with nausea, LFT.
ole DNA causing a dry mouth, metallic  Question for history
Clinical: loss of helical taste. of hypersensitivity to
Brand Antibacterial, DNA structure metronidazole,
Name: antiprotozoal, and strand Vaginal: other nitroimidazole
(Flagyl, amebicide. breakage, Symptomatic derivatives and
MetroCrea inhibiting protein cervicitis/vaginitis, parabens with
m, synthesis. abdominal cramps, topical.
MetroGel, uterine pain.  Obtain specimens
MetroGel- Therapeutic for diagnostic tests,
Vaginal, Effect: Produces Occasional: cultures before
NidaGel, bactericidal, Systemic: Diarrhea, giving first dose
Noritate, antiprotozoal, constipation, (therapy may begin
Vandazole) amebicidal, vomiting, dizziness, before results are
trichomonacidal erythematous rash, known).
Dosage: effects. Produces urticaria, reddish-
500 mg anti- brown urine. Intervention/ Evaluation:
inflammatory,  Monitor daily
Route: immunosuppress Topical: Transient pattern of bowel
IV ive effects when erythema, mild activity, stool
applied topically. dryness, burning, consistency.
irritation, stinging,  Monitor I&O.
tearing when  Assess for urinary
applied problems.
too close to eyes.  Be alert to
neurologic
Vaginal: Vaginal, symptoms (dizziness,
perineal, vulvar paresthesia of
itching; vulvar extremities).
swelling.  Assess for rash,
urticaria.
Rare: Mild,  Monitor for onset of
transient superinfection
leukopenia; (ulceration/change
thrombophlebitis of oral mucosa, furry
with IV therapy. tongue, vaginal
discharge,
Adverse Reactions: genital/anal
Oral therapy may pruritus).
result in furry Patient/ Family
tongue, Teaching:
glossitis, cystitis,  Urine may be red-
dysuria, brown or dark.
pancreatitis.  Avoid alcohol,
Peripheral alcohol-containing
neuropathy preparations (cough
(manifested as syrups, elixirs) for at
numbness, tingling least 48 hrs after last
of hands/feet) dose.
usually  Avoid tasks that
require alertness,
is reversible if motor skills until
treatment is response to drug is
stopped established.
immediately upon  If taking
appearance of metroNIDAZOLE for
neurologic trichomoniasis,
symptoms. Seizures refrain from sexual
occur occasionally. intercourse until full
treatment is
completed.
 For amebiasis,
frequent stool
specimen checks will
be necessary.
Topical:
 Avoid contact with
eyes.
 May apply cosmetics
after application.
 Metronidazole acts
on erythema,
papules, pustules
but has no effect on
rhinophyma
(hypertrophy of
nose), telangiectasia,
ocular problems
(conjunctivitis,
keratitis,
blepharitis).
 Other
recommendations
for rosacea include
avoidance of
hot/spicy foods,
alcohol, extremes of
hot/cold
temperatures,
excessive sunlight.