Pines City Colleges

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RAMIREZ, SHIRLENE L.
Doctor’s Order /Generic Mode of Action
Name / Classification
A. Doctor’s Order Sodium Chloride is a source
PNSS 1L x KVO of water and electrolytes. It is
capable of inducing
B. Generic Name diuresis depending on the
Sodium Chloride clinical condition of the
patient. It is a crystalloid
C. Classification given intravenously in case of
Crystalloid Fluid shock, dehydration, and
diarrhea to increase the
plasma volume.
Magsaysay Ave. Baguio City 2600
Indication
Normal saline is a
cornerstone of intravenous
solutions commonly used in
the clinical setting. It is a
crystalloid fluid administered
via an intravenous solution.
Its indications include both
adult and pediatric
populations as sources of
hydration and electrolyte
disturbances. It can come in
various concentrations; the
two specifically addressed are
0.9% and 0.45%.  mL/kg/hour, poor
The following are primary
indications for the use of
normal saline infusion that
have been approved by the
FDA: 
 Extracellular fluid
replacement (e.g.,
dehydration,
hypovolemia,
hemorrhage, sepsis)
 Treatment of
metabolic alkalosis in
the presence of fluid
loss
 Mild sodium
depletion
Contraindication Adverse Effects Nursing Responsibilities
Contraindications for the use Reactions which may occur  Document baseline
of normal saline are evaluated because of the solution or the vital signs, edema,
clinically from patient to technique of administration lung sounds, and
patient. If the implementation include febrile response, heart sounds, and
of normal saline results in infection at the site of continue monitoring
dilution of serum electrolyte injection, venous thrombosis during and after the
concentrations, over or phlebitis extending from infusion.
hydration, congested states, the site of injection,
or pulmonary edema, then its extravasation and  Monitor for
use is strongly discouraged. hypervolemia. continued signs of
hypovolemia,
including urine
output < 0.5
skin turgor,
tachycardia, weak
pulse, and
hypotension.
 Monitor for signs of
hypervolemia such as
hypertension,
bounding pulse,
pulmonary crackles,
dyspnea, shortness of
breath, peripheral
edema, jugular vein
distension(JVD) and
extra heart sounds
such as S3.

RAMIREZ, SHIRLENE L.
Doctor’s Order /Generic Mode of Action
Name / Classification
A. Doctor’s Order Binds to an enzyme on gastric
Omeprazole 40 mg (IV) OD parietal cells in the presence
of acidic gastric pH,
B. Generic Name preventing the final transport
Omeprazole of hydrogen ions into the
gastric lumen. Diminished
C. Classification accumulation of acid in the
Proton-pump inhibitors gastric lumen with lessened
gastroesophageal reflux.
Healing of duodenal ulcers.
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Indication
GERD/maintenance of
healing in erosive
esophagitis. Duodenal ulcers
(with or without anti-
infectives for Helicobacter
pylori). Short-term treatment
of active benign gastric ulcer.
Pathologic hypersecretory
conditions, including
Zollinger-Ellison syndrome.
Reduction of risk of GI
bleeding in critically ill
patients.  problems and
Contraindication Adverse Effects Nursing Responsibilities
Contraindicated CNS: dizziness, drowsiness,  Monitor
in hypersensitivity; Metabolic fatigue, headache, weakness.  improvements in GI
alkalosis and hypocalcemia CV: chest pain.  symptoms (gastritis,
GI: abdominal pain, acid heartburn, and so
regurgitation, constipation, forth) to help
diarrhea, flatulence, nausea, determine if drug
vomiting.  therapy is successful.
Derm: itching, rash.   Assess dizziness that
Misc: allergic reactions. might affect gait,
balance, and other
functional activities.
Report balance
functional limitations
to the physician, and
caution the patient
and family/caregivers
to guard against falls
and trauma.
 Monitor other CNS
side effects
(drowsiness, fatigue,
weakness, headache),
and report severe or
prolonged effects.
 Monitor any chest
pain and attempt to
determine if pain is
drug induced or
caused by
cardiovascular
dysfunction (e.g.,
 Pines City Colleges
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RAMIREZ, SHIRLENE L.
angina that occurs
during exercise).
Patient Education
 Advise patient to
avoid alcohol and
foods that may cause
an increase in GI
irritation.
 Instruct patient to
report bothersome or
prolonged side
effects, including
skin problems
(itching, rash) or GI
effects (nausea,
diarrhea, vomiting,
constipation,
heartburn, flatulence,
abdominal pain).

Doctor’s Order /Generic Mode of Action Indication Contraindication Adverse Effects Nursing Responsibilities
Name / Classification
A. Doctor’s Order Its mode of action is to Ketorolac Trometamol 30 Hypersensitivity reactions, CNS: drowsiness, abnormal  Monitor signs of GI
Ketorolac 30 mg (IV) every inhibit the cyclo-oxygenase mg/ml solution for injection ranging from bronchospasm thinking, dizziness, bleeding, including
6 hours enzyme system and hence is indicated for the short- to anaphylactic shock, have euphoria, headache. abdominal pain, vomiting
prostaglandin synthesis, and term management of occurred and appropriate Resp: asthma, dyspnea. blood, blood in stools, or
B. Generic Name it demonstrates a minimal moderate to severe acute counteractive measures must CV: edema, pallor, black, tarry stools. Report
Ketorolac anti-inflammatory effect at post-operative pain. be available when vasodilation. these signs to the physician
its analgesic dose. administering the first dose GI: GI BLEEDING, immediately.
C. Classification of ketorolac injection. abnormal taste, diarrhea,  Monitor signs of allergic
Nonsteroidal Anti- Ketorolac is contraindicated dry mouth, dyspepsia, GI reactions and anaphylaxis,
Inflammatory Drug in patients with previously pain, nausea. including pulmonary
demonstrated GU: oliguria, renal toxicity, symptoms (laryngeal edema,
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RAMIREZ, SHIRLENE L.
hypersensitivity to ketorolac
or allergic manifestations to
aspirin or other nonsteroidal
anti-inflammatory drugs
(NSAIDs). ketorolac is
contraindicated in patients
with active peptic ulcer
disease, in patients with
recent gastrointestinal
bleeding or perforation, and
in patients with a history of
peptic ulcer disease or
gastrointestinal bleeding.
Elderly patients are at
greater risk for serious
gastrointestinal events.
Ketorolac is contraindicated
in patients with moderate or
severe renal impairment
(serum creatinine >160 µ
mol/l) or in patients at risk
for renal failure due to
volume depletion or
dehydration.  tests, including
urinary frequency. wheezing, cough, dyspnea)
Derm: EXFOLIATIVE or skin reactions (rash,
DERMATITIS, STEVENS- pruritus, urticaria). Be
JOHNSON SYNDROME, especially alert for
TOXIC EPIDERMAL exfoliation, dermatitis, and
NECROLYSIS, pruritus, other severe skin reactions
purpura, sweating, urticaria. that might indicate serious
Hemat: prolonged bleeding hypersensitivity reactions
time. (Stevens-Johnson syndrome,
Local: injection site pain. toxic epidermal necrolysis).
Neuro: paresthesia. Notify physician
Misc: allergic reactions, immediately if these
including, anaphylaxis. reactions occur.
 Assess pain and other
variables (range of motion,
muscle strength) to document
whether this drug is
successful in helping manage
the patient's pain and
decreasing impairments.
 Assess signs of paresthesia,
including numbness and
tingling. Perform objective
electroneuromyography and
sensory testing to document
any drug-related neuropathic
changes.
 Assess blood pressure (BP)
periodically and compare it
to normal values NSAIDs
can increase BP in certain
patients.
 Be alert for signs of
 Pines City Colleges
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RAMIREZ, SHIRLENE L.
prolonged bleeding time such
as bleeding gums,
nosebleeds, and unusual or
excessive bruising. Report
these signs to the physician.
 Assess peripheral edema
using girth measurements,
volume displacement, and
measurement of pitting
edema (See Appendix N).
Report increased swelling in
feet and ankles or a sudden
increase in body weight due
to fluid retention.
 Assess symptoms of
bronchospasm and asthma,
including wheezing,
coughing, dyspnea, and
tightness in chest. Perform
pulmonary function tests to
quantify suspected changes
in ventilation and respiration.
 Monitor signs of kidney
toxicity, including blood or
pus in urine, increased
urinary frequency, decreased
urine output, weight gain
from fluid retention, and
fatigue. Report these signs to
the physician.
 Assess dizziness and
drowsiness that might affect
gait, balance, and other
functional activities (See
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RAMIREZ, SHIRLENE L.
Appendix C). Report balance
problems and functional
limitations to the physician,
and caution the patient and
family/caregivers to guard
against falls and trauma.
 Monitor and report euphoria,
abnormal thinking, or other
psychic disturbances.
 Monitor the injection site for
pain, swelling, and irritation.
Report prolonged or
excessive injection site
reactions to the physician.

Doctor’s Order /Generic Mode of Action Indication Contraindication Adverse Effects Nursing Responsibilities
Name / Classification
A. Doctor’s Order Thought to produce analgesia Indicated to patients with Contraindicated in patients CNS: agitation (I.V.),  Check that the patient
Paracetamol (Anesan) 1 g by inhibiting prostaglandin mild pain or fever, mild to hypersensitive to the drug. anxiety, fatigue, headache, is not taking any
(IV) every 8 hours and other substances that moderate pain; mild to I.V. form is contraindicated insomnia, pyrexia other medication
sensitize pain receptors. Drug moderate pain with in patients with severe CV: HTN, hypotension, containing
B. Generic Name may relieve fever through adjunctive opioid analgesics; hepatic impairment or severe peripheral edema, periorbital paracetamol.
Paracetamol central action in the fever. active liver disease. edema, tachycardia (I.V.)  Check doctor’s order.
hypothalamic heat-regulating GI: nausea, vomiting,  Observe rights in
C. Classification center. abdominal pain, diarrhea, medication
Analgesic constipation (I.V.) administration.
GU: oliguria (I.V.)  Inform patient on the
Hematologic: hemolytic purpose and
anemia, leukopenia, anticipated effect of
neutropenia, pancytopenia paracetamol.
Hepatic: jaundice  Do not exceed
Metabolic: hypoalbuminemia
 Pines City Colleges
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RAMIREZ, SHIRLENE L.
(I.V.), hypoglycemia, prescribed dosage.
hypokalemia, hypervolemia,  Monitor patient’s
hypomagnesemia, response and for any
hypophosphatemia (I.V.) symptoms of diarrhea
Musculoskeletal: muscle or liver damage.
spasms, extremity pain (I.V.)
Respiratory: abnormal
breath sounds, dyspnea,
hypoxia, atelectasis, pleural
effusion, pulmonary edema,
stridor, wheezing (I.V.)
Skin: rash, urticaria; infusion
site pain (I.V.), pruritus

Doctor’s Order /Generic
Name / Classification
A. Doctor’s Order
Tramadol 100 mg (IV) every
8 hours
B. Generic Name
Tramadol
C. Classification
Opioid (narcotic) analgesics
Mode of Action
Thought to bind to opioid
receptors and inhibit reuptake
of norepinephrine and
serotonin.
Indication Contraindication
Tramadol is used to relieve Contraindicated in patients
moderate to moderately hypersensitive to drug or
severe pain. opioids, in patients with
severe renal or hepatic
impairment, and in those with
acute intoxication from
alcohol, hypnotics, or
analgesics.
Also in patients with GI
obstruction, with significant
respiratory depression.
Adverse Effects
CNS: dizziness, headache,
seizures, anxiety, confusion,
nervousness, malaise,
nervousness, fever,
paresthesia
CV: vasodilation, HTN
EENT: visual disturbances,
pharyngitis, rhinitis, sinusitis
GI: constipation, nausea,
vomiting, abdominal pain,
diarrhea, dry mouth
GU: proteinuria, urinary
frequency, urine retention,
UTI
Metabolic: weight loss
Musculoskeletal: hypertonia,
neck pain, myalgia
Nursing Responsibilities
 Assess the vital signs
of the patient.
 Check the prescribed
dosage, route, and
form of medication.
 Ensure to administer
at the right time.
 Provide exact amount
of dosage prescribed.
 Monitor patient’s
vital signs regularly.
 Advise patient to

RAMIREZ, SHIRLENE L.
Doctor’s Order /Generic Mode of Action
Name / Classification
A. Doctor’s Order Ceftriaxone works by
Ceftriaxone inhibiting the mucopeptide
synthesis in the bacterial cell
B. Generic Name wall. The beta-lactam moiety
Ceftriaxone of ceftriaxone binds to
carboxypeptidases,
C. Classification endopeptidases, and
Cephalosporin antibiotics transpeptidases in the
bacterial cytoplasmic
membrane. These enzymes
are involved in cell-wall
synthesis and cell division.
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Indication
Treatment of Skin and skin
structure infections, Bone
and joint infections,
Complicated and
uncomplicated urinary tract
infections, Uncomplicated
gynecologic infections,
including gonorrhea, Lower
respiratory tract infections,
intra-abdominal infections,
septicemia, Meningitis, otitis
media. Perioperative
prophylaxis.
Respiratory: bronchitis
Skin: diaphoresis, rash
Other: chills, accidental
injury
Contraindication Adverse Effects
Contraindicated in patients CNS: SEIZURES (HIGH
with known allergy to DOSES).
cephalosporin group of GI:
antibiotics. PSEUDOMEMBRANOUS
COLITIS, diarrhea,
cholelithiasis, sludging in the
gallbladder.
Derm: rashes, urticaria.
Hemat: bleeding,
eosinophilia, hemolytic
anemia, leukopenia,
thrombocytosis.
Local: pain at IM site,
phlebitis at IV site.
Misc: ALLERGIC
REACTIONS, INCLUDING
ANAPHYLAXIS,
superinfection.
report any signs and
symptoms that are
irregular.
 Inform patient on its
purpose and the side
effects it may cause.
Nursing Responsibilities
 Watch for seizures;
notify physician
immediately if patient
develops or increases
seizure activity.
 Monitor signs of
pseudomembranous
colitis, including
diarrhea, abdominal
pain, fever, pus or mucus
in stools, and other
severe or prolonged GI
problems (nausea,
vomiting, heartburn).
Notify physician or
nursing staff
immediately of these
signs.
 Monitor signs of allergic
reactions and
anaphylaxis, including
pulmonary symptoms
(tightness in the throat
 Pines City Colleges
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RAMIREZ, SHIRLENE L.
and chest, wheezing,
cough dyspnea) or skin
reactions (rash, pruritus,
urticaria). Notify
physician or nursing
staff immediately if
these reactions occur.
 Monitor signs of blood
dyscrasias, including
eosinophilia (fatigue,
weakness, myalgia),
hemolytic anemia
(malaise, dizziness,
jaundice, abdominal
pain), leukopenia (fever,
sore throat, mucosal
lesions, signs of
infection),
thrombocytopenia
(bruising, nose bleeds,
bleeding gums, other
unusual bleeding), or
thrombocytosis
(headache, dizziness,
chest pain, fainting,
visual disturbances,
numbness or tingling in
the hands and feet).
Report these signs to the
physician.
 Monitor injection site for
pain, swelling, and
irritation. Report
prolonged or excessive
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RAMIREZ, SHIRLENE L.
injection site reactions to
the physician.
Interventions
 Always wash hands
thoroughly and disinfect
equipment (whirlpools,
electrotherapeutic
devices, treatment tables,
and so forth) to help
prevent the spread of
infection. Use universal
precautions or isolation
procedures as indicated
for specific patients.
Patient/Client-Related
Instruction
 Instruct patient to notify
physician immediately
of signs of
superinfection, including
black, furry overgrowth
on tongue, vaginal
itching or discharge, and
loose or foul-smelling
stools.
 Instruct patient and
family/caregivers to
report other troublesome
side effects such as
severe or prolonged
fever, skin problems
(rash, hives), diarrhea, or
signs of gallstones.

RAMIREZ, SHIRLENE L.
Doctor’s Order /Generic
Name / Classification
A. Doctor’s Order
Plain LRS 1L x 12 hours
B. Generic Name
Sodium chloride, Sodium
lactate, Potassium chloride,
Calcium chloride
C. Classification
Intravenous nutritional
products
Mode of Action
Sodium chloride, potassium
chloride, sodium lactate, and
calcium is a sterile solution
for fluid and electrolyte
replenishment. It restores
fluid and electrolyte balances,
produces diuresis, and acts as
an alkalizing agent (reduces
acidity).
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Indication
Plain LRS is largely used in
aggressive volume
resuscitation from blood loss
or burn injuries; however, it
is a great fluid for aggressive
fluid replacement in many
clinical situations, including
sepsis and acute pancreatitis.
Contraindication Adverse Effects
Severe metabolic alkalosis or Significant: Fluid or solute
acidosis, conditions overload resulting in
associated with increased overhydration, congested
lactate levels (e.g. lactic states (e.g. pulmonary
acidosis) or impaired lactate congestion, edema);
utilization, CHF, electrolyte imbalance, acid-
hyperkalemia, hypervolemic base imbalance,
or overhydrated patient. hypersensitivity reactions
Severe hepatic and renal (e.g. urticaria, pruritus).
impairment. Cardiac disorders: Chest
tightness or pain with
tachycardia or bradycardia.
General disorders and
administration site
conditions: Febrile response,
infusion site reactions (e.g.
phlebitis, venous thrombosis,
inflammation, rash, erythema,
pruritus, pain, burning).
Respiratory, thoracic, and
mediastinal disorders:
Cough, sneezing, nasal
congestion, difficulty of
breathing.
Nursing Responsibilities
 Do not administer
unless solution is
clear and container is
undamaged.
 Caution must be
exercised in the
administration of
parenteral fluids,
especially those
containing sodium
ions to patients
receiving
corticosteroids or
corticotrophin.
 Solution containing
acetate should be
used with caution as
excess administration
may result in
metabolic alkalosis.
 Solution containing
dextrose should be
used with caution in
patients with known
subclinical or overt
diabetes mellitus.
 Discard unused
portion.
 In very low birth
weight infants,
excessive or rapid
administration of
 Pines City Colleges
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RAMIREZ, SHIRLENE L.
dextrose injection
may result in
increased serum
osmolality and
possible intracerebral
hemorrhage.
 Properly label the IV
Fluid
 Observe aseptic
technique when
changing IV fluid.

Doctor’s Order /Generic Mode of Action Indication Contraindication Adverse Effects Nursing Responsibilities
Name / Classification
A. Doctor’s Order Fentanyl is a synthetic opioid Clinically, its most common Contraindicated in patients Nausea, vomiting;  Assess respiration,
Fentanyl 25 mcg IV agonist, which acts primarily use is as a sedative in with known intolerance to the bradycardia, edema, CNS and notify physician
at the μ-opioid receptor. It intubated patients and in drug or other opioid agonists. depression, confusion, immediately if patient
B. Generic Name acts in the central nervous severe cases of pain in dizziness, drowsiness, exhibits any
Fentanyl system (CNS) or brain to patients with renal failure due headache, sedation, transient interruption in
relieve pain. to its primarily hepatic hypotension, peripheral respiratory rate
C. Classification elimination. At times, vasodilation; increased (apnea) or signs of
Opioid analgesic fentanyl may also be intracranial pressure. High IV respiratory
indicated to treat chronic pain dose may cause chest wall depression, including
patients who have developed rigidity. Transdermal: Rash, decreased respiratory
tolerance to opiates. erythema and itching. rate, confusion,
Potentially Fatal: bluish color of the
Respiratory depression, trunk skin and mucous
rigidity, laryngospasm, membranes
bronchoconstriction. (cyanosis), and
difficult, labored
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RAMIREZ, SHIRLENE L.
breathing (dyspnea).
Monitor pulse
oximetry and perform
pulmonary function
tests to quantify
suspected changes in
ventilation and
respiratory function.
Apnea or excessive
respiratory depression
requires emergency
care.
 Monitor signs of
laryngeal spasm and
bronchospasm,
including tightness in
the throat and chest,
wheezing, cough, and
severe shortness of
breath. Notify
physician or nursing
staff immediately if
these reactions occur.
 Be alert for excessive
sedation or changes
in mood and behavior
(confusion,
restlessness). Notify
physician or nurse
immediately if patient
is unconscious or
extremely difficult to
arouse.
 Use appropriate pain
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RAMIREZ, SHIRLENE L.
scales (visual
analogue scales,
others) to document
whether this drug is
successful in helping
manage the patient's
pain.
 Assess heart rate,
ECG, and heart
sounds, especially
during exercise (See
Appendices G, H).
Report slow heart rate
(bradycardia) or
symptoms of other
arrhythmias,
including
palpitations, chest
discomfort, shortness
of breath, fainting,
and fatigue/weakness.
 Assess dizziness that
might affect gait,
balance, and other
functional activities
(See Appendix C).
Report balance
problems and
functional limitations
to the physician and
nursing staff, and
caution the patient
and family/caregivers
to guard against falls
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RAMIREZ, SHIRLENE L.
and trauma.
 Be alert for residual
muscle rigidity and
decreased thoracic
and limb movements.
Report a prolonged or
sustained increase in
muscle tone.
 Monitor patch
application site for
pain, swelling, and
irritation. Report
prolonged or
excessive application
site reactions to the
physician.
Interventions
 Implement
appropriate manual
therapy techniques,
physical agents, and
therapeutic exercises
to reduce pain and
help wean patient off
opioid analgesics as
soon as possible.

Doctor’s Order /Generic Mode of Action Indication Contraindication Adverse Effects Nursing Responsibilities
Name / Classification
A. Doctor’s Order Cefoxitin is a bactericidal Cefoxitin injection is used to Significant: Fungal or  Watch for seizures;
Cefoxitin (Monwel) 1 g IV agent that acts by inhibiting treat bacterial infections in Hypersensitivity to cefoxitin bacterial superinfection notify physician
every 8 hours bacterial cell wall synthesis. many different parts of the or other cephalosporins; (prolonged use); increased immediately if patient
Cefoxitin has activity in the body. This medicine is also history of severe risk of encephalopathy or develops or increases

RAMIREZ, SHIRLENE L.
B. Generic Name presence of some beta-
Cefoxitin lactamases, both
penicillinases, and
C. Classification cephalosporinases, of Gram-
Cephalosporin antibiotics negative and Gram-positive
bacteria.
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given before certain types of
surgery to prevent
infections.
hypersensitivity (e.g.
anaphylactic reaction) to any
other type of β-lactam
antibacterial (e.g. penicillin,
monobactams,
carbapenems).
seizures (high doses or in
reduced renal function).
Eosinophilia and elevated
AST (higher doses in
children ≥3 months).
Blood and lymphatic
system disorders:
Leucopenia, agranulocytosis,
anaemia, haemolytic
anaemia, thrombocytopenia,
bone marrow failure.
Gastrointestinal disorders:
Diarrhoea, nausea, vomiting.
General disorders and
administration site
conditions: Pyrexia; local
thrombophlebitis (after IV
administration); pain,
induration and tenderness
(following IM inj).
Immune system disorders:
Angioedema.
Investigations: Increased
ALT, serum lactate
dehydrogenase, serum
alkaline phosphatase, BUN
and serum creatinine levels.
Musculoskeletal and
connective tissue disorders:
Myasthenia gravis
exacerbation.
Renal and urinary
disorders: Interstitial
nephritis.
seizure activity.
 Monitor signs of
pseudomembranous
colitis, including
diarrhea, abdominal
pain, fever, pus or mucus
in stools, and other
severe or prolonged Gi
problems (nausea,
vomiting, heartburn).
Notify physician or
nursing staff
immediately of these
signs.
 Monitor signs of allergic
reactions and
anaphylaxis, including
pulmonary symptoms
(tightness in the throat
and chest, wheezing,
cough dyspnea) or skin
reactions (rash, pruritus,
urticaria). Notify
physician or nursing
staff immediately if
these reactions occur.
 Monitor signs of blood
dyscrasias, including
eosinophilia (fatigue,
weakness, myalgia),
thrombocytopenia
(bruising, nose bleeds,
bleeding gums, other
bleeding problems),
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RAMIREZ, SHIRLENE L.
Skin and subcutaneous tissue
disorders: Rash, pruritus,
urticaria, toxic epidermal
necrolysis.
Potentially Fatal:
Hypersensitivity reactions;
Clostridium difficile-
associated diarrhoea and
pseudomembranous colitis.
Patient/Client-Related
Instruction
hemolytic anemia
(malaise, dizziness,
jaundice, abdominal
pain), and leukopenia
(fever, sore throat,
mucosal lesions, signs of
infection). Report these
signs to the physician.
 Monitor injection site for
pain, swelling, and
irritation. Report
prolonged or excessive
injection-site reactions to
the physician.
 instruct patient to notify
physician immediately
of signs of
superinfection, including
black, furry overgrowth
on tongue, vaginal
itching or discharge, and
loose or foul-smelling
stools.
 instruct patient and
family/caregivers to
report other troublesome
side effects such as
severe or prolonged skin
problems (rash, hives) or
GI problems (nausea,
vomiting, diarrhea).
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RAMIREZ, SHIRLENE L.
Doctor’s Order /Generic Mode of Action Indication Contraindication Adverse Effects
Name / Classification
A. Doctor’s Order CNS: blurred vision,
Furosemide 20 mg IV dizziness, headache, vertigo.
EENT: hearing loss, tinnitus.
B. Generic Name CV: hypotension.
Furosemide GI: anorexia, constipation,
diarrhea, dry mouth,
C. Classification dyspepsia, nausea,
Loop diuretics pancreatitis, vomiting.
GU: excessive urination.
Derm: photosensitivity,
pruritus, rash.
Endo: hyperglycemia,
hyperuricemia.
F and E: dehydration,
hypocalcemia,
hypochloremia, hypokalemia,
hypomagnesemia,
hyponatremia, hypovolemia,
metabolic alkalosis.
Hemat: APLASTIC
ANEMIA,
AGRANULOCYTOSIS,
hemolytic anemia,
leukopenia,
thrombocytopenia.
MS: muscle cramps.
Neuro: paresthesia.
Misc: fever, increased BUN,
nephrocalcinosis
Nursing Responsibilities
 Monitor signs of
aplastic anemia
(fatigue, weakness,
shortness of breath,
pale skin, dizziness),
agranulocytosis
(fever, sore throat,
mucosal lesions,
signs of infection), or
other symptoms and
bleeding problems
that might be due to
other blood
dyscrasias. Report
these signs to the
physician
immediately.
 Monitor signs of
fluid, electrolyte, or
acid-base imbalances,
including dizziness,
drowsiness, blurred
vision, confusion,
hypotension, or
muscle cramps and
weakness. Report
excessive or
prolonged symptoms
to the physician.
 Assess dizziness and
vertigo that might
affect gait, balance,
 Pines City Colleges
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RAMIREZ, SHIRLENE L.
and other functional
activities (See
Appendix C). Report
balance problems and
functional limitations
to the physician, and
caution the patient
and family/caregivers
to guard against falls
and trauma.
 Assess blood
pressure periodically
and compare to
normal values (See
Appendix F) to help
determine
antihypertensive
effects. Report low
blood pressure
(hypotension),
especially if patient
experiences dizziness
or syncope.
 When used to treat
edema, help
determine drug
effects by assessing
peripheral edema
using girth
measurements,
volume displacement,
and measurement of
pitting edema (See
Appendix N). Also
 Pines City Colleges
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RAMIREZ, SHIRLENE L.
monitor signs of
pulmonary edema
such as dyspnea and
rales/crackles (See
Appendix K).
Document whether
peripheral and
pulmonary symptoms
are controlled
adequately by
diuretic therapy.
 Monitor signs of
hyperglycemia such
as drowsiness, fruity
breath, increased
urination, and
unusual thirst.
Patients with diabetes
mellitus should check
blood glucose levels
frequently.
 Interventions
 Implement fall-
prevention strategies,
especially in older
adults or if patient
exhibits sedation,
dizziness, blurred
vision, or other
impairments that
affect gait and
balance.
 Use caution during
aerobic exercise,
 Pines City Colleges
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RAMIREZ, SHIRLENE L.
especially in hot
environments.
Increased sweating
will cause fluid and
electrolyte loss, and
may exaggerate
diuretic side effects
(dizziness, muscle
cramps, and so forth).
 To minimize
orthostatic
hypotension, patient
should move slowly
when assuming a
more upright
position.

Doctor’s Order /Generic Mode of Action Indication Contraindication Adverse Effects Nursing Responsibilities
Name / Classification
A. Doctor’s Order
Losartan 100 mg 1 tab OD

B. Generic Name
Losartan

C. Classification
Angiotensin II receptor
antagonists

Doctor’s Order /Generic Mode of Action Indication Contraindication Adverse Effects Nursing Responsibilities
Name / Classification
A. Doctor’s Order
Carvedilol 25 mg 1 tab BID
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RAMIREZ, SHIRLENE L.

B. Generic Name
Carvedilol

C. Classification
Alpha and beta-blockers