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Doctor s Order Generic Name Brand Name Functional Classification Chemical Classification Indication

Contraindication

Mode of Action

Ideal Dosage Preparation and Supply Form

Adverse Effect

Drug Interaction

Mannitol 150cc IV q8 Mannitol Osmitrol Diuretics Osmotic Diuretics y To reduce intracranial pressure and brain mass y Test dose for marked oliguria or suspected inadequate renal function y To prevent oliguria during cardiovascular and other surgeries y Acute oliguria y To reduce intraocular pressure y To promote diuresis in drug toxicity y Irrigation during transurethral resection of prostate (TURP) y Active intracranial bleeding (except during craniotomy) y Anuria secondary to severe renal disease y Progressive heart failure, pulmonary congestion, renal damage, or renal dysfunction after mannitol therapy begins y Severe pulmonary congestion or pulmonary edema y Severe dehydration Increases osmotic pressure of plasma in glomerular filtrate, inhibiting tubular reabsorption of water and electrolytes (including sodium and potassium). These actions enhance water flow from various tissues and ultimately decrease intracranial and intraocular pressures; serum sodium level rises while potassium and blood urea levels fall. Also protects kidneys by preventing toxins from forming and blocking tubules. 0.5 to 2 g/kg I.V. infusion as 15% to 25% solution given over 30 to 60 minutes Mannitol (Osmitrol) 150cc IV q8 CNS: dizziness, headache, seizures CV: chest pain, hypotension, hypertension, tachycardia, thrombophlebitis, heart failure, vascular overload EENT: blurred vision, rhinitis GI: nausea, vomiting, diarrhea, dry mouth GU: polyuria, urinary retention, osmotic nephrosis Metabolic: dehydration, water intoxication, hypernatremia, hyponatremia, hypovolemia, hypokalemia, hyperkalemia, metabolic acidosis Respiratory: pulmonary congestion Skin: rash, urticaria Other: chills, fever, thirst, edema, extravasation with edema and tissue necrosis Drug-drug: Digoxin: increased risk of digoxin toxicity Diuretics: increased therapeutic effects of mannitol Lithium: increased urinary excretion of Lithium

Nursing Responsibilities

Rationale for Giving the Medication

Monitor I/O strictly. Assess V/S, esp. BP and PR, before, during, and after administration. Monitor I.V. site carefully to avoid extravasation and tissue necrosis. In comatose patient, insert indwelling urinary catheter as ordered to monitor urine output. y Monitor sodium and potassium levels. y Watch for excessive fluid loss and signs and symptoms of hypovolemia and dehydration. y Assess for evidence of circulatory overload, including pulmonary edema, water intoxication, and heart failure. y Position pt. @ Semi-Fowler s to High Fowler s position. y Position head at neutral angle to promote CSF drainage through venous circulation. y Monitor the level of consciousness for comatose pts. y Assess pupillary reaction. y Perform and interpret Glasgow Coma Scale (GCS) Patient was diagnosed of Cerebrovascular accident probably bleeding. His CT scan results revealed a cerebral hemorrhage amounting about 90cc. Upon assessment, pt s. GCS score is 6/15 which was interpreted to be in a deep coma. This drug, as an osmotic diuretic, was given to the pt. to shift the fluid from the interstitial cells of the brain to intravascular space and deliver it to the kidney for urinary excretion thereby reducing the intracranial pressure and improving the pt s. level of consciousness. y y y y