Student Nurse: Hazel Rianne S.

Base Level/Section: BSN/4/C Date: May 13-14, 2024

DRUG STUDY
Patient (Initials only): J.P. Age: 13 Gender: Male Ward/Room/Bed: 4 Allergy to: None
Diagnosis/Impression: To Consider Moderate Traumatic Brain Injury Secondary to Vehicular Accident
m

Generic Name:Citicoline Brand Name: Fornerv Dosage, Route & Timing: 500mg, IVTT, q12hrs

CLASSIFICATION: MECHANISM OF ACTION: PHARMACODYNAMICS

Pharmacologic Class: Nootropics Citicoline is derivative of choline and cytidine involved in the biosynthesis of lecithin. It is claimed to increase
Onset:
blood flow and oxygen consumption in the brain. 1-2 hours
Therapeutic Class: Neuroprotective Agents Peak: 4-6 hours
Pregnancy Category: Unknown Duration: 24-36 hours

CATEGORY NURSING RESPONSIBILITIES / CONSIDERATIONS RATIONALE PATIENT / FAMILY EDUCATION

INDICATION:
CVA in acute and recovery phase. Symptoms and signs of cerebral Administering the medication according to the This is essential to ensure that the patient Take citicoline as directed by your doctor for
insufficiency i.e., dizziness, headache, poor concentration, memory loss, prescribed dosage and route. receives the appropriate amount of memory and brain health.
disorientation. Recent cranial trauma and their sequence. medication in the correct manner.

CONTRAINDICATIONS / PRECAUTIONS

Contraindicated in patients with hypertonia of the parasympathetic nervous
system
Contraindicated in patients with hypersensitivity to the medication.
Monitoring the patient for any adverse reactions or side Closely monitoring the patient for any signs Report any unusual symptoms to your
effect. or symptoms of such reactions, healthcare healthcare provider.
providers can promptly identify and address
them to ensure the patient's safety and well-
being.

DRUG INTERACTIONS (Drug-Drug / Drug-Food / Drug-Diagnostics / Drug-Herb)

Citicoline may interact with certain medications, including blood thinners like Assessing the patient's cognitive function and Citicoline is a compound that may be used Keep it out of reach of children and store it
warfarin, antiplatelet drugs, and drugs that affect blood pressure or heart neurological status to evaluate the medication's to support cognitive function and properly.
function. Additionally, it may interact with other supplements or herbs that effectiveness. neurological health. Therefore, assessing
affect brain function. Always consult with a healthcare professional before aspects such as cognitive function, memory,
starting citicoline, especially if taking other medications or supplements. attention, and neurological status can help
healthcare providers determine whether the
 medication is having the desired therapeutic
effects.

CATEGORY NURSING RESPONSIBILITIES / CONSIDERATIONS RATIONALE PATIENT / FAMILY EDUCATION

SIDE EFFECTS / ADVERSE REACTIONS / ADVERSE EFFECTS (By System)

Cardiac disorders: Bradycardia, tachycardia, Documenting the administration and the patient's Proper documentation is crucial for Educating the patient/family member about
response to citicoline properly. maintaining a comprehensive record of the the medication's purpose, dosage regimen,
patient's treatment and progress. This and potential effects
includes recording details such as the date
and time of medication administration, the
dosage given, the route of administration,
any observed adverse reactions or side
effects, and the patient's response to
treatment.
Gastrointestinal disorders: Diarrhea, epigastric discomfort, stomach pain,
General disorder: Fatigue,
Nervous system disorders: Dizziness, headache,
Skin and subcutaneous tissue disorder: rashes,
Vascular disorders: Hypotension.
REFERENCES:
 Student Nurse: Hazel Rianne S. Base Level/Section: BSN 4-C Date:MAY 13-14, 2024
DRUG STUDY
Patient (Initials only): A. G. Age:61 Gender:MALE Ward/Room/Bed: 8 Allergy to: None
Diagnosis/Impression:Nephrolithiasis, Bilateral

Generic Name:SODIUM BICARBONATE Brand Name:Rhea Dosage, Route & Timing: 1 tablet (650mg), PO, TID

CLASSIFICATION: MECHANISM OF ACTION: PHARMACODYNAMICS

Pharmacologic Class: Alkalinizing agents Increases plasma bicarbonate, which excess buffer H ion concentrations; reverses metabolic acidosis; 15 minutes
Onset:
neutralizes gastric acid, which forms water, NaC1, CO2; raises blood Ph.
Therapeutic Class: Antacids Peak:Unknown
Pregnancy Category: C Duration:1-3 hours

CATEGORY NURSING RESPONSIBILITIES / CONSIDERATIONS RATIONALE PATIENT / FAMILY EDUCATION

INDICATION:

Treatment of metabolic acidosis; promotion of gastric, systemic and urine Monitor and maintain the patient’s acid-base Metabolic acidosis can lead to serious Explain the importance of maintaining a
alkalinization in the case of intoxication with weak organic acids; in order to balance and electrolyte levels, as well as the complications, including organ dysfunction balance acid base status and the role of
improve the solubility of drug substances that are poorly soluble in neutral effectiveness of treatment. and shock. By promoting alkalization, the alkalinization in treatment.
acid medium; and in the case of hemolysis. solubility of drugs and substances can be
improved, aiding in their elimination from the
body. Alkalinization of urine can also help in
the excretion of certain toxic substances. In
the case of hemolysis, alkalinization can
help prevent kidney damage due to release
of hemoglobin.
Discuss the possible causes of metabolic
acidosis and the need for ongoing
monitoring and treatment.

Teach family about medications used for

alkalinization and the importance of adhering
to the prescribed regimen.

CONTRAINDICATIONS / PRECAUTIONS

Hypoventilation, hypocalcemia, increased serum osmolarity, further in all Monitor the patient’s respiratory status, calcium levels, Hypoventilation can lead to respiratory Explain the importance of maintaining
situations where sodium intake must be restricted. and serum osmolarity closely. Provide education on acidosis, which can further decrease serum adequate ventilation and how

DRUG INTERACTIONS (Drug-Drug / Drug-Food / Drug-Diagnostics / Drug-Herb)
Do not take drug together with Aspirin and other salicylates (such as
salsalate), corticosteroids (such as prednisone), memantine, medications
with a special coating to protect the stomach (enteric coating).
CATEGORY NURSING RESPONSIBILITIES / CONSIDERATIONS
SIDE EFFECTS / ADVERSE REACTIONS / ADVERSE EFFECTS (By System)
GI: belching, gastric distention, flatulence,
dietary sodium restrictions and ensure compliance.
Administer sodium bicarbonate separately from
aspirin, salicylates, and corticosteroids, as concurrent irritation and bleeding.
use may increase the risk of gastrointestinal irritation
and bleeding
Monitor signs of gastrointestinal bleeding.
osmolarity. Restricting sodium intake is
important to manage conditions such as
hypertension, heart failure, and edema.
Helps reduce the risk of gastrointestinal
RATIONALE
Allows for early detection and intervention, Educate the family about signs and
which can prevent serious complications. symptoms of gastrointestinal bleeding, such
hypoventilation can affect the body’s acid-
base balance.
Discuss symptoms of hypocalcemia, such as
muscle cramps and numbness, and the
need for monitoring treatment.
Educate the family on the reasons for
restricting sodium intake and provide
guidance on low-sodium diet options.
Explain to family the importance of ensuring
the patient takes sodium bicarbonate at least
1-2hours before or taking aspirin or other
salicylates.
Emphasize the significance of the following
prescribed medication schedule and
ensuring that the patient does not skip doses
of sodium bicarbonate.
Educate the family on signs of
gastrointestinal bleeding, such as black,
tarry stools or abdominal pain.
PATIENT / FAMILY EDUCATION
as black, tarry stools or vomit, and the
importance of seeking medical attention
promptly if these symptoms occur.
 Monitor fluid intake and output. Sodium overload can lead to fluid retention Educate family members about the signs of
Metabolic: metabolic alkalosis, electrolyte imbalance, sodium and edema. Monitoring intake and output fluid retention and edema, which may
overload, hypocalcemia, hypokalemia, milk-alkali syndrome, helps assess fluid balance and guide indicate sodium overload.
dehydration. interventions to maintain or restore balance.

REFERENCES:
https://www.webmed.com/drugs/2/drug-11325/sodium-bicarbonate-oral/details
 Student Nurse: Hazel Rianne S. Base Level/Section: BSN 4-C Date:MAY 13-14, 2024
DRUG STUDY
Patient (Initials only): A. G. Age:61 Gender:Male Ward/Room/Bed: 8 Allergy to: None
Diagnosis/Impression:Nephrolithiasis, Bilateral

Generic Name:KETOROLAC Brand Name: Oradol Dosage, Route & Timing: 15mg, IVTT, q8hrs

CLASSIFICATION: MECHANISM OF ACTION: PHARMACODYNAMICS

Pharmacologic Class: Non-steroidal anti-inflammatory drug (NSAID) Anti-Inflammatory and analgesic activity; inhibits prostaglandins and leukotriene synthesis. Onset: 30 minutes
Therapeutic Class: Antipyretic; analgesic Peak:1-2 hours
Pregnancy Category: C Duration:6 hours

CATEGORY NURSING RESPONSIBILITIES / CONSIDERATIONS RATIONALE PATIENT / FAMILY EDUCATION

INDICATION:

Moderately severe acute pain. Administer pain medications as prescribed, and Proper administration of analgesics can Administer the medication exactly as
monitor the patient effectiveness and any help in relieving pain, improving patient prescribed by the healthcare provider.
adverse reactions. comfort, and enabling participation in Do not adjust the dose or frequency without
necessary activities. consulting the doctor.

CONTRAINDICATIONS / PRECAUTIONS

Contraindicated with significant renal impairment, aspirin allergy;
concurrent use of NSAIDs; active peptic ulcer diseases.
Monitor for contraindications and adverse reactions.
Patient with significant renal impairment, Educate the patient and family to
aspirin allergy, concurrent use of NSAIDs, or immediately report symptoms like unusual
active peptic ulcer disease are at high risk of bleeding, severe stomach pain, rash,
adverse reactions when taking certain swelling, or difficulty in breathing
medication. Monitoring ensures early
detection of complications and allows for
timely intervention to prevent serious health
issues.

DRUG INTERACTIONS (Drug-Drug / Drug-Food / Drug-Diagnostics / Drug-Herb)

 Drug-drug: increased risk for nephrotoxicity with other nephrotoxins
(aminoglycosides, cyclosporine); increased risk of bleeding with anti-
coagulants(warfarin), aspirin.
Monitor renal function. Regularly check serum Early detection of renal impairment can help Inform about the need for regular blood
creatinine, BUN (blood urea nitrogen), and urine output. in preventing further damage and adjusting tests to monitor kidney function and blood
medications accordingly. coagulation levels to detect any adverse
effects early.
.

CATEGORY NURSING RESPONSIBILITIES / CONSIDERATIONS RATIONALE PATIENT / FAMILY EDUCATION

SIDE EFFECTS / ADVERSE REACTIONS / ADVERSE EFFECTS (By
System)

Regularly check blood pressure, heart rate, and oxygen Changes in vital signs can indicate Advised family to change patient
CNS: headache, dizziness, somnolence, insomnia, saturation. underlying issues such as infection, positions slowly to avoid sudden drop of
dehydration, or pain-related stress. blood pressure.
Assess the rash for characteristics such as color, texture, Determine the appropriate treatment and Advised on avoiding hot showers, harsh
Dermatologic: rash, pruritus, distribution and any associated symptoms (e.g; itching, identify any underlying conditions. soaps, and tight clothing that can exacerbate
pain). itching.
GI: nausea, dyspepsia, GI pain, constipation, gastric or duodenal Administer medications as prescribed to manage For constipation, laxatives or stool softeners Educate patient and families about foods
ulcers, symptoms. may be indicated. that may worsen symptoms, such as spicy
foods, citrus fruits, and caffeinated
beverages. Encourage a diet rich in fruits,
vegetables, and whole grains.
GU: renal impairment, Monitor fluid balance. Monitoring intake and output is crucial to Educate patient and families about foods
prevent complications like fluid overload or high in potassium, phosphorus, and sodium
electrolyte imbalances. that should be limited or avoided.
Hematologic: decreased Hgb or Hct, bone marrow depression, Regular monitoring of hemoglobin and hematocrit levels, Monitoring these levels helps in detecting Patients should take prescribed medications
menorrhagia, vital signs and signs of bleeding or infection. and managing anemia. as directed by healthcare providers and
report side effects or concerns promptly.
Respiratory: dyspnea, hemoptysis Assess patient’s respiratory rate, depth, and effort, as Helps in early detection of worsening Encourage the patient to cough
well as oxygen saturation levels, lung sounds, and overall respiratory distress. effectively to help clear the airways of blood
respiratory status. and reduce the risk of aspiration.
Other: peripheral edema, anaphylactoid reactions to anaphylactic Monitor for signs of worsening edema, such as pitting Helps in evaluating the effectiveness of Advised family member to prepare low-
shock edema or increased swelling. nutrition therapy and detecting any sodium meals and monitor fluid intake to
deficiencies. prevent fluid retention and worsening
edema.

REFERENCES: