XIV.

Treatment/Management

A.  Drugs
 
DRUG NAME MECHANISM OF INDICATION / ADVERSE EFFECT NURSING
ACTION CONTRAINDICATION RESPONSIBILITIES

Generic Name: Inhibits the cell-wall Indication:  CNS: Headache,

CEFUROXIME synthesis, promoting Susceptible mild to moderate dizziness, paresthesia, Before:
Brand Name: osmotic instability, infections including pharyngitis  GI: Abdominal cramps, Dx:
usually bactericidal. the /tonsillitis, acute maxillary anal pruritus, anorexia,
Axetil medication binds to the sinusitis, chronic bronchitis, diarrhea, dyspepsia, a. Check the doctor’s
penicillin-binding acute otitis media, glossitis, nausea order
Pharmacologic proteins and inhibits the uncomplicated skin and skin  GU: Candidiasis, b. Identify and verify
Class: final transpeptidation step structure, UTI. pruritus, the client’s identity.
of peptidoglycan Contraindication:  RESPIRATORY: c. Assess for the
·   Antibiotic synthesis; it results in Contraindicated in patients with dyspnea history of
cell-wall death. cephalosporin hypersensitivity hypersensitivity
 SKIN: erythematous
·   Second gene   or cephamycin hypersensitivity. reactions to
and maculopapular
ration cephalosporin,
rashes, urticarial,
Cephalosporin penicillin, and
Steven-Johnson
history of allergies
syndrome, and toxic
Therapeutic class: particularly to
epidermal necrolysis
Anti-infective drugs, before
 UROLOGIC: Renal therapy is initiated.
Dosage: dysfunction d. Obtain CBC, Renal
 Neurologic: Seizure function test.
250  mg /5 mL,    HEMA: Hemolytic
Twice a day anemia, leukopenia, Tx:
pancytopenia and
Route: thrombocytopenia a. Introduce self to the
Oral client's S/O and
gain trust.
b. Check for the
 expiration date of
medication.
c. Shake the bottle to
loosen the powder.
After reconstitution,
wait one hour
before
administering
suspension to the
patient. 
d.  Monitor the patient
for signs and
symptoms of
superinfection and
diarrhea and treat
appropriately. 

Edx:.

a. Explain the
procedure of
medication to the
patient’s S/O.
b. Inform the client’s
S/O regarding the
use and purpose of
the medication.
c. Instruct the patient
to notify the
prescriber about the
rash, loose stools
and diarrhea, and
presence of oral
candidiasis

During:
Dx:

a. Monitor intake and

output of the
patient.
b. Check the patient
for tolerance of
taking the
medication in tablet
form to avoid
choking from
occurring.

Tx:  

a. Assist the patient in

taking the drug.
b. Administer
medication with
food to minimize
GI upset.

Edx:

a. Teach the client

about the possible
side effects of the
drug and ways on
how to prevent
further
complications.

After
Dx:

a. Assess for any

 adverse effects of
the drug.
b. Monitor for
effectiveness as
exhibited by a
decrease of
symptoms.

Tx:

a. Provide oral care

after taking the
medication.
b. Position the patient
into a comfortable
position.

Edx:.

a. Instruct client to
verbalize feelings
and concerns. 
b.  Teach patient’s
S/O to store dry
powder in normal
room temperature
and/or after
reconstitution, store
in a refrigerator or
in a normal room
temperature. It
should be discarded
after 10 days.
Generic Name: Indication: CNS: Headache, dizziness, Before:
Salbutamol This medication binds to  Indicated to control paresthesia,
  beta2-adrenergic and prevent reversible GI: nausea Dx:
Brand Name: receptors in airway airway obstruction RESPIRATORY: dyspnea, throat
Proventil, Vospira smooth muscle, leading to caused by community- CV: Tachycardia a.    Check and verify with
ER, Accuneb, activation of adenyl acquired pneumonia. -Tends to increase blood glucose the doctor's order and
Ventodisk, Ventolin cyclase and increased  In relation to the level. Kardex.
levels of cyclic-3,′,5,′ patient’s case, since the  
Therapeutic adenosine monophosphate patient has a cough and b.    Observe rights in
Class (cAMP). Increases in crackles sound heard, medication administration
Bronchodilators cAMP activate kinases, we need to administer such as giving the right drug
  which inhibit the this medication to to the right patient using the
Dose: 750 mg phosphorylation of facilitate right route and at the right
myosin and decrease bronchodilation and time.
Route: intracellular calcium. able to open the
Decreased intracellular airways which will c. Check for the history of
Inhale
calcium relaxes smooth help the patient to hypersensitivity.
muscle airways. expectorate secretions.
Relaxation of airway d. Assess respiratory status:
smooth muscle with Contraindication: lung sounds (e.g., crackles),
subsequent respiratory rate, pattern and
bronchodilation.  Hypersensitivity to depth, 02 saturation, use of
Relatively selective for salbutamol accessory muscles.
beta2 (pulmonary)
receptors. e. Assess for pulse rate and
rhythm and BP.

f. Monitor for palpitations

and tachycardia.

g. Inspect the client’s nail

bed and oral mucosa for
pallor.

Tx:

a.    Position the patient to

Semi-Fowler’s or Sitting
position.

Edx:

a.    Instruct the patient to

take the medication after a
meal.

b.    Teach the patent to

perform oral inhalation
correctly.

c.  Encourage to take slow,

deep, inspiratory breaths
with 2-3 seconds pause
before passive exhalations
during nebulization.

During:

Dx:

a.    Recheck the

medication’s expiration
date, and name.

b.    Check for patency of

the tube and if the machine
or equipment is working.

Tx:

a.    Administer appropriate

dosage.

b.    Ensure proper

placement of the face mask
during the administration.

Edx:

a.    Teach the patient the

proper inhalation of the
medication.

After:

Dx:

a.    Reassess respiratory

status: lung sounds (e.g.,
crackles), respiratory rate,
pattern and depth, 02
saturation, use of accessory
muscles.

b.    Re-inspect the client’s

nail bed and oral mucosa for
pallor.

Tx:

a.    Provide oral care after

nebulization by using a
tongue depressor or cloth
damped with warm water or
gargling.

b.    Perform CPT (chest

percussion/vibration) and
coughing exercises after
nebulization.

c.     Raise the side rails up

to prevent accidents if
drowsiness or restlessness
occurs.

Edx:

a.    Educate the client about

avoiding stimuli that might
precipitate vertigo such as
too much light and too much
noise both in the form of
talking and loud music and
television.

b.    Instruct clients to rise

slowly from bed or when
changing positions from
lying to sitting to standing.

c.     Advise clients to have

small frequent feedings to
avoid increasing risk of
vomiting and heartburn.

d.    Instruct clients to report

palpitations and the
increasing difficulty of
 breathing.

e.    Instruct the patient or

the significant other to take
missed doses as much as
possible.

Generic Name: Indication: Acetaminophen Before

Paracetamol Paracetamol has a central helps to reduce fever and to Side effects: Low fever with
analgesic effect that is relieve a headache with mild to nausea, stomach pain, loss of Dx
Brand Name: mediated through moderate pain. It is also used appetite, dark urine and jaundice.
Tylenol, Excedrin, activation of descending with other pain medications to A. Read the
Calpol and Panadol serotonergic pathways. treat low back pain, cold and paracetamol label
Debate exists about its toothache.  carefully.
Class primary site of action, Adverse effects B. Monitor BP
Therapeutic: which may be inhibition Contraindication: Paracetamol carefully during the
Analgesic, of prostaglandin (PG) is contraindicated with the CNS: headache titration period.
antipyretic synthesis or through an following patients that have C. Check for allergies.
active metabolite caloric undernutrition, acute
influencing cannabinoid liver failure, liver problems, Tx
Pharmacologic:
Acetaminophen receptors. severe renal impairment and CV: chest pain, dyspnea,
  allergy to acetaminophen. myocardial damage when doses A. Use acetaminophen
Source: Jones & Bartlett of 5 – 8g/day are ingested daily cautiously in
Dose: patients with
500 mg 1 tab every Learning, Nurse’s Drug Drug to drug interaction: The for several weeks or when doses
Handbook 2015 most important of 4g/day are ingested for 1 year hepatic impairment
4 hours or active hepatic
  pharmacodynamic drug
interaction with paracetamol is disease, alcoholism,
Route: chronic
Oral   that of acetylcysteine in
attenuating the hepatotoxicity GI: hepatic toxicity and failure, malnutrition, severe
that results from jaundice hypovolemia, or
supratherapeutic intake and severe renal
overdose of paracetamol. impairment.
B. Periodically assess
dose.
Drug to food interaction: If HEME: hemolytic anemia,
stomach upset occurs, take this leukopenia, neutropenia,
medication with food or milk. Edx
pancytopenia
A. Tell the patient that
tablets may be
crushed or
GU: acute renal failure, renal swallowed whole.
tubular necrosis B. Instruct the patient
to read the
manufacturer's label
and follow dosage
SKIN: acute generalized guidelines
exanthematous pustulosis, precisely.
jaundice, pruritus, rash, urticaria C. Caution patients to
avoid hazardous
activities until the
drug's effects are
OTHER: anaphylaxis, known.
angioedema, hypersensitivity
reaction, hypoglycemic coma During

Dx

A. Assess the patient's

skin routinely for
rash or other
evidence of
hypersensitivity
reactions.
B. Assess for fecal
occult blood and
nephritis.
C. Monitor liver
function test results.
D. Monitor for adverse
effects.
Tx

A. Administer major
portion of dose.
B. Assist patient in
taking medication.

Edx

A. Urge the patient to

seek immediate
medical attention if
signs or symptoms
occur such as rash,
fever or other signs
of hypersensitivity.
B. Encourage the
patient to report
paleness, weakness
and heartbeat skips.
C. Instruct the patient
to verbalize
concerns.

After

Dx

A. Teach the patient to

minimize
constipation by
increasing her
intake of fluids.
B. Monitor for
effectiveness. 
C. Advise her to notify
the prescriber if she
 misses taking the
medicine.

Tx

A. Take safety
precautions.
B. Provide comfort
measures.
C. Give the drug with
food if GI upset
occurs.

Edx

A. Caution the patient

not to exceed
recommended
dosage or take other
drugs containing
acetaminophen at
the same time
because of risk of
liver damage.
B. Teach the patient to
recognize signs of
hepatotoxicity, such
as bleeding, easy
bruising, and
malaise, which
commonly occurs
with chronic
overdose.
C. Advise him to
contact the
 prescriber before
taking other
prescription or OTC
products because
they may contain
acetaminophen.

Generic name: Indication: Mild side effects such as: Before: 

Vitex Negundo Lagundi is the only  dizziness, Dx:
  extensively studied cough  Relief of cough due to  drowsiness
Brand Name: remedy herbal preparation common colds, and  nausea a. Determine the
Plemex, RiteMed, in the Philippines today. mild to moderate acute  Vomiting. history of drug
Lagundex, and The National Integrated bronchitis  Diarrhea allergies.
Astrol Research Program on  Reversible mild to  Itchiness b. Monitor respiratory
  Medicinal Plants moderate status
Dose: (NIRPROMP) has bronchospasm in Precautions There may be people c. Assess lung
600 mg TID validated scientifically the children with allergic to the lagundi plant or expansion 
ancient popular obstructive airway medication that has it as a
Route: knowledge and practices disease and chronic component. Tx:
Oral of our traditional healers. bronchitis
They have established in a. Assist in deep
both animal and human Contraindication: breathing exercise
studies, the wide margin
of safety and efficacy of  Hypersensitivity to Edx:
Lagundi as a Cough drugs
Remedy. a. Explain to the
patient and watcher
that there will be
mild side effects of
medication.

During:

Dx:
 a. Monitor for adverse
effects.

Tx:

a. Give medication
after meals

Edx:

a. Encouraged client
to drink plenty of
water.

After:

Dx:

a. Assess the
condition of the
client.

Tx:

a. Provide comfort
and rest

Edx:

a. Instruct client to
report any severe
side effects. 

Generic Name: Indication: Before:

Ascorbic Acid In humans, an exogenous  Used to prevent GI: Nausea, vomiting, heartburn,
  source of ascorbic acid is diarrhea
Brand Name: vitamin C deficiency Dx:
Vitamin C required for collagen and it has also been Hematologic: Acute hemolytic  
  formation and tissue suggested to be an anemia a. Check for the
Route: Per Oral repair by acting as a effective antiviral physician's order
cofactor in the agent since the patient CNS: Headache (high doses) b. Check for
Dosage: posttranslational has PCAP-C. nutritional status
500mg OD formation of 4- Urogenital: Urethritis, dysuria, c. Monitor vital signs
hydroxyproline in -Xaa- Contraindication: crystalluria
Pro-Gly- sequences in  Tx:
collagens and other  Use of sodium Others: Mild soreness, a. Assist client in a
proteins. Ascorbic acid is ascorbate in patients on dizziness, faintness with rapid IV comfortable
reversibly oxidized to sodium restriction administration position to take the
dehydroascorbic acid in  Use of calcium vitamin. 
the body. These two ascorbate on patient
forms of the vitamin are receiving digitalis. Edx:
believed to be important
in oxidation-reduction a. Inform patient
reactions. The vitamin is about the benefits
involved in tyrosine and purpose of the
metabolism, conversion drug.
of folic acid to folinic
acid, carbohydrate  During:
metabolism, synthesis of
lipids and proteins, iron Dx:
metabolism, resistance to a. Assess the
infections, and cellular condition of the
respiration. patient.
Tx:
a.
Give medication
after meals.
b. Assist patient to
take his medication.
Edx:
a. Encourage adequate
fluid intake.

After: 
 Dx:
a. Assess the
condition of the
patient.
Tx:
a. Provide comfort
and rest
Edx:
a. Instruct patient to
verbalize any
concerns.

B.  IV Fluids
 

NAM CLASSIFICATION COMPONENTS USE & EFFECTS NURSING

E RESPONSIBILITIES
BMM Water Infusion works by providing
S basic substances needed for the
synthesis of vital structural
constituents; infusing intravenously to
maintain body pH; works for nerve
conduction, muscle contraction, kidney
function, and heart beating; stimulating
the bowels to move; auto oxidizing
thus producing free radicals;
Each 100ml contains 5g of
Dextrose Monohydrate, 234
mg of Sodium Chloride, 128
mg of Potassium Acetate,
32.2mg of Magnesium
Acetate Tetrahydrate, and
30mg (approx. 1.6mmol/L) of
Sodium Metabisulfite.
The solution is indicated for Dx:
parenteral maintenance of routine
daily fluid and electrolytes a. Check for
requirements with minimal physician’s order
carbohydrate calories from b. Before performing
dextrose. Magnesium in the venipuncture, the
formula may help to prevent nurse carries out
iatrogenic magnesium deficiency in hand hygiene,
patients receiving prolonged applies gloves, and
parenteral therapy. informs the patient
about the
If you experience drowsiness, procedure.
dizziness, hypotension, or a c. Check for the
headache as side-effects when correct site of iv
using.
Tx:

a. Regulate IV flow
and compute drop
per minute
b. Monitor for signs
of edema during
the IV infusion

Edx:
a. Instruct the patient
to report if she/he
experiences
drowsiness and
dizziness.