Name: Pioquinto, Gian Carlo S.

Section: BSN IV-A

RLE ROTATION 2 DRUG STUDY (SURGICAL WARD)

TABLE OF CONTENTS

DRUG PAGE NUMBER

1 Cefuroxime 2

2 Ketorolac 4

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GENERIC NAME: MECHANISM OF ACTION: SIDE EFFECTS/ADVERSE NURSING RESPONSIBILITY
cefuroxime REACTION
Binds to bacterial cell membranes, inhibits cell wall
synthesis.
SIDE EFFECTS BASELINE ASSESSMENT
THERAPEUTIC EFFECT:
Frequent • Obtain CBC, renal function tests.
Bactericidal in susceptible microorganisms. Question for history of allergies,
• Discomfort with IM particularly cephalosporins,
administration, oral penicillins.
BRAND NAME: INDICATION:
candidiasis (thrush), mild
Treatment of susceptible infections due to group B diarrhea, mild abdominal
Ceftin streptococci, pneumococci, staphylococci, H. cramping, vaginal INTERVENTION/EVALUATION
influenzae, E. coli, Enterobacter, Klebsiella, candidiasis.
DRUG I LLUSTRATION: including acute/chronic bronchitis, gonorrhea, • Observe the 14 rights of medication
impetigo, early Lyme disease, otitis media, Occasional (5%-3%)
pharyngitis/tonsillitis, sinusitis, skin/skin structure, administration.
UTI, perioperative prophylaxis. • Nausea, serum sickness–like • Assess oral cavity for white patches
reaction (fever, joint pain;
on mucous membranes, tongue
usually occurs after second
course of therapy and (thrush).
resolves after drug is
discontinued). • Monitor daily pattern of bowel
activity, stool consistency. Mild GI
CLASSIFICATION: CONTRAINDICATION: Rare (2%-1%)
effects may be tolerable (increasing
PHARMACOTHERAPEUTIC: History of hypersensitivity/ anaphylactic reaction to • Allergic reaction (rash, severity may indicate onset of
cefuroxime, cephalosporins. pruritus, urticaria),
Second-generation cephalosporin antibiotic-associated colitis).
thrombophlebitis (pain,
redness, swelling at injection
CLINICAL: Antibiotic site).

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DOSAGE/FREQUENCY/ CAUTIONS: ADVERSE REACTIONS
ROUTE:
Severe renal impairment, history of penicillin Antibiotic-associated colitis, other
allergy. Pts with hx of colitis, GI malabsorption, superinfections (abdominal cramps,
• 750 mg, IVTT, q8h seizures. 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
PATIENT/FAMILY TEACHING
risk for developing a severe
hypersensitivity reaction (severe
pruritus, angioedema,
bronchospasm anaphylaxis).
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• Monitor I&O, renal function tests
for nephrotoxicity. Be alert for
superinfection: fever, vomiting,
diarrhea, anal/genital pruritus, oral
mucosal changes (ulceration, pain,
erythema).
• Discomfort may occur with IM
injection.
• Doses should be evenly spaced.
• Continue antibiotic therapy for full
length of treatment.
• May cause GI upset (may take with
food, milk)
GENERIC NAME: MECHANISM OF ACTION: SIDE EFFECTS/ADVERSE NURSING RESPONSIBILITY
ketorolac REACTION
Inhibits COX-1 and COX-2 enzymes, resulting
in decreased prostaglandin synthesis; reduces
SIDE EFFECTS BASELINE ASSESSMENT
prostaglandin levels in aqueous humor.

THERAPEUTIC EFFECT: Frequent (17%-12%) • Assess onset, type, location, duration

of pain.
Produces analgesic, antipyretic, and anti- • Headache, Nausea, • Obtain baseline renal/hepatic
inflammatory effect; reduces intraocular function tests.
abdominal cramps,
inflammation.
BRAND NAME: Indication dyspepsia. INTERVENTION/EVALUATION

PO: injection, nasal: Short-term (5 days or less) • Observe the 14 rights of medication
Acular, Acuvail Occasional (9%-3%)
relief of mild to moderate pain. administration
Ophthalmic: Relief of ocular itching due to
• Diarrhea, Nasal • Monitor renal function, LFT, urinary
DRUG I LLUSTRATION: seasonal allergic conjunctivitis. Treatment
output.
postop for inflammation following cataract discomfort, rhinalgia, • Monitor daily pattern of bowel
extraction, pain following incisional refractive
increased lacrimation, activity, stool consistency.
surgery
• Observe for occult blood loss.
throat irritation, rhinitis, • Assess for therapeutic response: relief
transient stinging, of pain, stiffness, swelling; increased
joint mobility; reduced joint
burning. tenderness; improved grip strength.
CLASSIFICATION: NSAID CONTRAINDICATION: Rare (3%-1%) • Monitor for bleeding (may also occur
with ophthalmic route due to systemic
PHARMACOTHERAPEUTIC: Hypersensitivity to ketorolac, aspirin, or other • Constipation, vomiting, absorption).
NSAIDs. Intracranial
Analgesic, Intraocular Anti- flatulence, stomatitis,
bleeding, hemorrhagic diathesis, incomplete
inflammatory hemostasis, high risk of bleeding; concomitant ocular irritation, allergic
use of aspirin, NSAIDs, probenecid, or

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DOSAGE/FREQUENCY/ pentoxifylline; labor and delivery, advanced
renal impairment or risk of renal failure, active
ROUTE:
or history of peptic ulcer disease, chronic
inflammation of GI tract, recent or history of GI
• 30 mg, IV, q8h PRN bleeding/ ulceration. Perioperative pain in ADVERSE REACTIONS
setting of CABG surgery. Prophylaxis before
major surgery.
CAUTIONS:
Hepatic impairment, history of GI tract disease,
asthma, coagulation disorders, receiving
anticoagulants, fluid retention, HF, renal
impairment, inflammatory bowel disease,
smoking, use of alcohol, elderly, debilitated.
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reactions, superficial PATIENT/FAMILY TEACHING
ocular infection, keratitis
• Avoid aspirin, alcohol.
• Report abdominal pain, bloody
stools, or vomiting blood.
• If GI upset occurs, take with food,
Peptic ulcer, GI bleeding,
milk.
gastritis, severe hepatic reaction
• Ophthalmic: Transient stinging,
(cholestasis, jaundice) occur
burning may occur upon instillation.
rarely. Nephrotoxicity
Do not administer while wearing soft
(glomerular nephritis, interstitial
contact lenses.
nephritis, nephrotic syndrome)
may occur in pts with preexisting
renal impairment. Acute
hypersensitivity reaction (fever,
chills, joint pain) occurs rarely.
14 RIGHTS OF DRUG ADMINISTRATION

1. Right Drug - the nurse should make sure that the client receives the right drug that was prescribed by the doctor according to the doctor’s order sheet, and should
be signed by an authorized person.

2. Right Client - the nurse should make sure to check the client’s ID bracelet, have client state his or her name, address the person by name before giving the drug,
double check orders that the client questions, and verify any allergies that the patient has.

3. Right Route - the nurse should make sure to check the route of administration of the drugs being prescribed wherein the client is able to take the entire dose and
receive maximum benefits. Additionally, since the patient has Cerebral Palsy, the nurse must first gain the client’s cooperation before administering, to check the
client’s developmental level, and to check the ability to swallow.

4. Right Dose - the nurse should make sure to check the appropriate measuring device for the drug being given, to always remember the rule of the point of meniscus,
to shake all suspensions and emulsions, and to observe proper techniques when attempting to measure with a dropper.

5. Right Time/Frequency - the nurse should make sure to check the scheduled time the medications are to be administered, to check whether the client is scheduled
for diagnostic purposes, and to check the expiration date of the medication.

6. Right Assessment - the nurse should make sure to check if the client actually needs the medication, to check for contraindications, to do tests to determine if the
medication is safe for the patient, and to always document any medication that was not given.

7. Right Approach - the nurse should make sure to gain first the client’s cooperation and to always explain the need to complete any medication regimen to the
patient.

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8. Right to Education - the nurse should make sure to observe the principle of informed consent, to provide education to the client regarding with the information
regarding the medication (name, purpose, how and when to take the medication, how to measure its effectiveness, drug interactions, any adverse effects, and any signs
and symptoms that may alert the physician.

9. Right Evaluation - the nurse should make sure to assess any adverse effects, to measure the effectiveness, to compare the patient’s prior status with the post-
medication status, and to document the client’s response to medication of the drugs being administered.

10. Right Documentation - the nurse should make sure to check each time a medication is administered and to document it on the medication log. The nurse should
also make sure to apply principle of documentation such as to never document before medication is administered.

11. Right to Refuse - the nurse should make sure to remember that the client has the right to refuse medication. If that occurs, the nurse must explain and inform the
client or the client’s family any implication that the refusal of medication may have, to notify the physician of the refusal, and to document it on the nurse’s notes.

12. Right Principle of Care - the nurse should make sure to check how they administer the drug if they encompass the 14 rights of drug administration.

13. Right Prescription - the nurse should make sure to check client’s name, name of medication, name and telephone number of the licensed practitioner, time of
administration, and dosage, method, and duration of the medication.

14. Right Nurse Clinician - the nurse should make sure to know that the medications are only to be administered by the licensed nurse who has prepared them.

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REFERENCES:

ELECTRONIC

Cefuroxime | Side effects, dosage, uses & more. (n.d.). Healthline. https://www.healthline.com/health/cefuroxime-oral-tablet#side-effects

Cefuroxime: MedlinePlus drug information. (n.d.). MedlinePlus - Health Information from the National Library of

Medicine. https://medlineplus.gov/druginfo/meds/a601206.html

Ketorolac oral: Uses, side effects, interactions, pictures, warnings & dosing. (n.d.). WebMD - Better information. Better

health. https://www.webmd.com/drugs/2/drug-3919/ketorolac-oral/details

BOOKS

Kizior, R. J., & Hodgson, B. B. (2021). Saunders nursing drug handbook 2021 E-book. Elsevier Health Sciences.