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LYCEUM OF THE PHILLIPPINES UNIVERSITY-BATANGAS

COLLEGE OF NURSING

A CASE STUDY OF HYDRO -NEPHROSIS SECONDARY TO


UROLITHIASIS

PAREPARED BY: FREDIE RICK U. LUCE

PREPARED TO:DRA. ANNABELLE ITURRALDE


(CLINICAL INSTRUCTOR)
OBJECTIVES
General Objectives:

This study aims to develop the knowledge,


skills and attitude of the student nurses
through effective utilization of nursing
process in dealing with the course of
patient with HYDRONEPHROSIS.
SPECIFIC OBJECTIVES
At the end of this study the student nurse will be
able to:
Identify the patient’s profile, past medical history,
psychological, as well as the family history,
personal history, social history, and the patient’s
history of present illness for further
understanding her condition.
Analyze the physical appearance of the patient
using Inspection, Palpation, Percussion, and
Auscultation method that may help in
determining the clinical manifestation presented
by the disease.
Identify, interpret and analyze the laboratory and
diagnostic examination and it’s significant
findings to justify the presence of the disease.
Identify and enumerate the anatomical part of
the body that is involved and affected by the
disease and it’s respective functions.
Explain the nature and identity the causes and
predisposing factors that contribute to the
development of the disease.
Formulate Nursing Care Plan for better delivery
of care based on the client’s needs and
concerns.
Determine the effects of different drugs that
were administered to the patient.
Note changes in the condition of the patient and
the degree of development of her condition.
Enumerate all the references used to make the
case more effectively and much clearer.
INTRODUCTION
Hydronephrosis is the swelling of the
kidneys when urine flow is obstructed in
any of part of the urinary tract. Swelling of
the ureter, which always accompanies
hydronephrosis, is called hydroureter.
Hydronephrosis implies that a ureter and
the renal pelvis (the connection of the
ureter to the kidney) are overfilled with
urine.
The kidneys filter urine out of the blood as a
waste product. It collects in the renal pelvis and
flows down the ureters into the bladder. The
ureters are not simple tubes, but muscular
passages that actively propel urine into the
bladder. At their lower end is a valve (the
ureterovesical junction) that prevents urine from
flowing backward into the ureter. The bladder
stores urine. The prostate gland surrounds the
bladder outlet in males. Urine then flows
through the urethra and out of the body as a
waste product.
.
because the urinary tract is closed save for the
one opening at the bottom, urine cannot escape.
Instead, the parts distend. Rupture is rare unless
there is violent trauma like an automobile
accident.
obstructed flow anywhere along the drainage
route can cause swelling of the upper urinary
tract, but if the obstruction is below the bladder,
the ureterovesical valve will protect the upper
tract to a certain extent. Even then, with no place
to go, the urine will back up all the way to its
source. Eventually, the back pressure causes
kidney function to deteriorate.
obstruction need not be complete for problems to
arise. Intermittent or partial obstruction is far
more common than complete blockage, allowing
time for the parts to enlarge gradually.
Furthermore, if a ureterovesical valve is absent
or incompetent, the pressure generated by
bladder emptying will force urine backward into
the ureter and kidney, causing dilation even
without mechanical obstruction.
Mortality/Morbidity
Long-standing hydronephrosis may be
associated with obstructive nephropathy and
renal failure.
Urinary stasis may result in infection, renal
scarring, calculus formation, and sepsis.
Sex
In women, gynecologic cancers and pregnancy
are common causes. As such, among younger
patients (aged 20-60 y), the frequency of
hydronephrosis is higher in women than in men.
In men, obstruction secondary to prostatic
hypertrophy and prostate cancer are the major
causes of hydronephrosis. Consequently,
among older patients (>60 y), the frequency of
hydronephrosis is higher in men than in women.
Age
In young adults, calculi are the most common
causes of hydroureter and hydronephrosis.
In children, reflux and ureteropelvic junction
obstruction are common causes.
PATIENT’S PROFILE
NAME: Mrs. X

AGE: 65 years old

SEX: Female

DATE OF BIRTH: July10, 1943

CIVIL STATUS: Married

ADDRESS: Trapiche Tanauan Batangas City

NATIONALITY: Filipino
RELIGION Roman Catholic

DATE OF ADMISSION: December3, 2008

PHYSICIAN: Dr. Reyes

CHIEF COMPLAINT: Left flank pain

ADMITTING DIAGNOSIS: Hydronephrosis Left, probably


secondary to Urolithiasis

FINAL DIGNOSIS: Hydronephrosis secondary to


Urolithiasis
CLINICAL APPRAISAL
Past health History

According to Mrs. X, her childhood


immunization was not completed. When she got
sick she experience fever, cough, and colds. But
she doesn’t have any allergies to drugs and
food. She was not engage in any accident and
injuries. According to her / when she was 29
years old she undergone appendectomy which
was her first major hospitalization. She is also
positive in goiter but it was non-toxic. She also
mentioned her maintenance drug which is
Busopan as Anti cholinergic.
Family History

Mrs. X mentioned that her husband is a


cigarette smoker, and drink alcoholic beverages
occasionally. Mr. X is 67 years old, while Mrs. X is
65 years old her sons and daughter are all married,
Mrs. A is 36 years old the oldest among three is a
high school graduate she is not working because
she is the one taking care of their child, Mr. B, is 35
years old he is working as electrician in a company,
while Mr. C, is 32 years old he the youngest son of
Mrs. X , he doesn’t have a stable job he is the one
taking care of their small farm together with Mrs. X.
Personal History

Mrs. X is the one taking care of


the house, she manages all the house hold
chores, she is also working in their farm like
cultivating the plants and helping in harvesting
fruits and vegetables at the same time she goes
around to sell their harvest fruit and vegetables
in their barangay so that she will have an extra
money for their daily expenses.
Social History

Mrs. X is living in a usual


Barangay, Their house is structured in a
compound together with her sons and
daughter they have enough space to
mingle and socialize with the other people
in their community
Psychological History

According to Mrs. X, her


major stressor was , when problem
comes in their family like financial
problems, when she encounters
problems she always prays to God, she
also set a conversation regarding the
problem together with the family to
discussed about it , also she experienced
stress when one of the family member
got sick and requires hospitalization.
GENERAL SURVEY
When I assessed Mrs. X, I noticed that she has
limited motion when turning from side to side due to
her sensation of pain at the left side of her abdomen,
also I found out that Mrs. X, has tooth decay which
causes foul mouth odor , it indicates poor oral
hygiene. And with regards to her dress, grooming,
and personal hygiene, I see that it is clean and neat.
Also I assessed her mood and manner wherein I
found out that when she’s in the mood she answers
all my questions and we do have our conversation,
but if she’s not feeling well she shows the way she
felt pain in her left part of her abdomen, which
causes her not to mingle with other people, also
according to her she get stress when she thinks
about her present situation.
PATIENT’S VITAL SIGNS
Temp. 37C

Blood Pressure 110/70

Pulse Rate 80

Respiratory Rate 20
PHYSICAL ASSESSMENT
AREA ASSESSED METHOD FINDINGS ANALYSIS
Skin Inspection the color of skin NORMAL
is the same as
Palpation with other body
parts

NORMAL
>Absence of
edema

>Not tender NORMAL

Hair Inspection Long white hair NORMAL, with


aged and elder
client
Scalp Inspection >Absence of NORMAL
seborrhea

Nails Inspection >pinkish color NORMAL

>Long dirty nails ABNORMAL, it


indicates poor
personal hygiene
Head Inspection > symmetrical NORMAL
Palpation NORMAL
>Absence of
masses or
nodules
Face Inspection >facial NORMAL
features and
facial
movements are
symmetrical
Neck Inspection and No enlargement NORMAL
Palpation of lymph nodes

Shoulders Inspection >symmetrically NORMAL


aligned
Thyroid Gland Inspection and >enlarged thyroid ABNORMAL, it
Palpation gland indicates inability of
the thyroid gland to
function ,it also
indicates GOITER

Eyes Inspection >symmetrically NORMAL


>Eyebrow Inspection aligned NORMAL
>Eyelashes Inspection >normal distribution NORMAL
>Conjunctiva >Pink NORMAL
>Pupillary reaction >constricting and
Inspection dilating
Ear Inspection And Auricles are mobile, NORMAL
Palpation firm, and not tender
>Symmetrically NORMAL
aligned
NORMAL
>color of the auricle
is the same as the
face ABNORMAL, it
>with foul smell and indicates ear
yellowish discharges problem

NORMAL
>Pinna recoils after
pinna is being folded
Nose Inspection > no discharges NORMAL
Palpation >symmetrically NORMAL
aligned NORMAL
>not tender
Sinuses Palpation >Frontal and NORMAL
maxillary
sinuses are not
tender

Mouth >dry with cracks ABNORMAL, it


>Lips Inspection >yellowish and indicates
>Teeth Inspection there’s a dehydration
presence of ABNORMAL, it
tooth decay indicates poor
oral hygiene
>Tongue Inspection >moist NORMAL
>Uvula Inspection >presence of NORMAL
uvula
Chest and Inspection and >without crackles NORMAL
Lungs Auscultation

Inspection >19 breaths per NORMAL


min.
Heart Inspection >80 beats per NORMAL
min.

Abdomen Inspection >symmetrically NORMAL


aligned

>Active bowel NORMAL


Auscultation sound occurring
every second
Percussion >dull sound
heard ABNORMAL,
due to
accumulation of
gas floating in
the abdomen
Palpation >Hard , left side ABNORMAL, it
of her abdomen indicates
problem of the
kidney
Upper Inspection >Strong grip NORMAL
extremities anPalpation
>Hands Inspection >Presence of ABNORMAL,
D5NSS fluids are
regulated at (10 regulated to
drops replace losses
/min.,KVO) and prevent
dehydration

>pulse >Palpation >distal pulses NORMAL


are palpable
>nail beds >Inspection >Pink NORMAL

>Capillary NORMAL
refill 3 sec.
(normal 2-3
sec)
Lower >Inspection and > no edema NORMAL
extremities Palpation
SUMMARY OF
PHYSICAL ASSESSMENT
When I assessed my patient’s skin color I
found out that the color is the same with her
other body parts and it is normal, also there is no
presence of edema and her skin is not tender
also I so the inspection of her hair and it is long
and white which is normal with aged people, in
her scalp there is also absence of seborrhea
which is normal and her nails are pink in color
,normal, but I see that she has a long dirty nails
both in hand and feet, it indicates poor personal
hygiene. In her head I do the inspection, and
there is no presence of masses and nodules her
head also is symmetrical which is normal . And
her facial features and movement are
symmetrical which is normal. In her neck there is
no enlargement of lymph nodes.
And her shoulders are symmetrically
aligned, but her thyroid gland is enlarged
which indicates problem such as goiter
and according to her it’s true she was
positive of having goiter because she was
diagnosed having goiter when she was not
yet married but according to the doctor it is
non toxic as she say’s to me. Assessing
her eyes I see that her eye brows are
symmetrical, and her eye lashes have
normal distribution
Also the color of her conjunctiva is pink and that’s all
are normal, in her ears upon inspection and
palpation I found out that her auricles are mobile,
firm, and it is symmetrically aligned also the color of
the auricle is the same with the face. And I do also
the inspection of presence of discharges and she
has yellowish foul smell discharges in her ears
which indicates poor personal hygiene, and the
pinna recoils after it is folded. The nose are
symmetrically aligned and there is no discharges
which is normal.
Also I do the Palpation of her sinuses and her
frontal and maxillary sinuses are not tender and
it is normal, also I see that her lips have cracks
which indicates dehydration, and her teeth are
yellowish in color which indicates poor oral
hygiene. And her tongue are moist and it is in
the middle. Upon inspection and auscultation of
my patient’s lungs there is no crackles and it is
normal, she has 19 breaths/min. normal, also
she has normal heart beat with 80 beats/min.
Her abdomen is symmetrically aligned, and she
has active bowel sound heard every min.
normal.
Also there is presence of dull sound which I heard
upon percussion, it is abnormal because it
indicates presence of gas floating inside the
abdomen, also her left side is hare upon
palpation. Inspection and palpation of her hand I
noted the presence of IV which is D5NSS which
help in replacing the fluid loss in the body she
has strong grip when I hold her other hand, her
distal pulse are palpable, normal. I also inspect
her nail beds for the capillary refill it is 2-3 sec.
and she has 3 sec. for the capillary refill and that
is normal, and lastly doing the inspection of her
lower extremities there is no presence of edema.
LABORATORY AND
DIAGNOSTIC
EXAMINATION
TEST RESULT NORMAL VALUES ANALYSIS
EXAMINATION

WBC 7.36 4.5-10.0X10g/L NORMAL

LYMPHOCYTES 0.260% 20.5-51.1% ABNORMAL,


decrease in
lymphocytes may
indicate infection
especially VIRAL
infection.

MONOCYTE 0.086% 0.1-0.5X10g/L ABNORMAL,


decrease in
monocyte indicates
Infection that causes
Neutropenia
3.47 26-34% ABNORMAL, decrease
RBC in RBC count indicates
dietary insufficiency
that are essential in

Production of RBC

HEMOGLOBINN 89.0g/L 120-160g/L ABNORMAL, decrease


in hemoglobin count

indicates anemia

HEMATOCRIT 34-37% ABNORMAL, decrease


0.282% in Hematocrit count
indicates chronic

disease .
25.66pg/cell ABNORMAL, decrease
MHC 26-34pg/cell in MHC indicates

microcytic anemia .

MCHC 0.31g/dL 32-36g/dL ABNORMAL, decrease


in MCHC indicates

hypo chronic anemia


MCV 81.47fL ABNORMAL, decrease
82-98fL in MCV indicates
anemia

13% 11.5-14.5% NORMAL


RDW

PLATELET 135X10g/L 140-400g/L ABNORMAL, decrease


in platelet count
indicates hemolytic

anemia
NEUTROPHILS 3-7X10g/L ABNORMAL, decrease
0.640 in Neutrophil indicates
neutropenia,

septicemia.
EOSINOPHILS 0-0.7X10g/L ABNORMAL,
0.012 Decrease in Eosinophil
indicates Eosionopenia,
and acute bacterial
infection
BASOPHILS 0.002 ABNORMAL, decrease
0.02-0.05X10g/L in Basophil count
indicates Basopenia,

acute phase of
infection
MPV 7fL ABNORMAL, decrease
7.4-10.4fL in MPV indicates Renal

.
insufficiency

BLOOD UREA 6.26-8.33mmol/L ABNORMAL, decrease


NITROGEN 4.01mmol/L in BUN indicates
malnutrion low

Carbohydrate diet .
1.08mg/dL NORMAL
FT4 0.71-1.85mg/dL

FSH 0.548 0.4-4.2 NORMAL


BLEEDING TIME 3min. 2-6min. NORMAL

CLOTTING TIME 2min. 1-3min. NORMAL

GLUCOSE 4.09mmol/L 3.8-5.83 NORMAL


SUMMARY OF DAIGNOSTIC
AND LABORATORY
EXAMINATION
For her WBC count she has 7.36 and it is
normal, Lymphocyte is 0.260%, it is abnormal
because decrease in lymphocyte indicates
infection especially viral infection, Monocyte
0.086%, it is also abnormal because decrease in
the monocyte indicates infection also .For the
Red Blood Cells 3.47, it is abnormal because it
indicates dietary insufficiency, Hemoglobin
89.0g/L, it is abnormal because it indicates
anemia, Hematocrit 0.282% it is abnormal
because it indicates chronic disease, MCH 25.66
it is abnormal because decrease in MCH
indicates microcytic anemia, MCHC 0.31 it is
abnormal because it indicates hypochronic
anemia ,MCV81.47 it is abnormal because it
indicates anemia of chronic disease, RDW13% it
is normal.
Platelet 135 it is abnormal because it
indicates hemolytic anemia, Neutrophils 0.640 it
is abnormal because it indicates neutropenia,
septicemia, Eosinophils 0.012 it is abnormal
because it indicates eosinopenia, Basophils
0.002 it is abnormal because it indicates
basopenia, MPV 7 it is abnormal because it
indicates renal insufficiency. And for the clotting
time she has 3min. And it is normal because the
normal is 2-6min. For the bleeding time she has
2min. And it is normal because the normal
bleeding time is 1-3 min. she also has normal
glucose with 4.09mmol/L.But her BUN is
abnormal with 4.01mmol/L , FT4 with 1.08 mg/dl
and lastly TSH with 0.548 MIu/L ,Normal
ANATOMY AND
PHYSIOLOGY
The kidneys are bean-shaped organs that lie in the abdominal cavity attached
to the dorsal wall on either side of the spine. An artery from the dorsal aorta

called the renal artery supplies blood to them and the renal vein drains them.

The excretory system consists of paired kidneys and associated blood supply.
Ureters transport urine from the kidneys to the bladder and the urethra with associated
sphincter muscles controls the release of urine.
The kidneys have an important role in maintaining homeostasis in the body.
They excrete the waste product urea, control the concentrations of water and salt in the
body fluids, and regulate the acidity of the blood.
A kidney consists of an outer region or cortex, inner medulla and a cavity called
the pelvis that collects the urine and carries it to the ureter.
The tissue of a kidney is composed of masses of tiny tubes called kidney
tubules or nephrons. These are the structures that make the urine.
PROGNOSIS
The prognosis is fair, because of the
continuous care that is given to the client.
Although there is a high risk for infection as well
as other problem that may arise because o the
client’s condition, it is also depends on how
severe the condition is.
DISCHARGE PLANNING
M Instructed the patient and significant others to give home medications that
the physician will prescribe upon discharge.
>Ceftriaxome Sodium 125mg, 2x a day
>ketorolac 15mg, every 6 hrs.
>Buscopan 0.3-0.8mg, once a day
E Taught the patient about the appropriate passive range of motion and
exercise for the client.
T Encourage the patient to have a therapy that is suited for her condition.
H Encourage and advised the patient to have good personal hygiene.

O Encourage the patient to have a follow- up check-up after 1 week to Dr.


Reyes

D Advised the patient and significant other’s to provide foods rich in protien,
iron, vit. C, etc.

S Advised the whole family to keep their faith in God and never forget to ask
for guidance and good health.
ACKNOWLEDGEMENT
First and foremost I want to thank God for
giving me the knowledge, strength, and courage to do this
case study. Also to my parents for being supportive, for
giving me advices all the time, and for their love and trust on
everything that I wanted to do. As well as to my brother’s and
sister’s who helps me financially or emotionally. And of
course to my friends and love ones who makes me laugh
and inspires me to focus on my studies and not to take the
wrong path which will make my life miserable. Also to the
librarian for letting me lend books in the library and also to
my group mates THANK YOU for your willingness to answer
my questions all the time. And to my beautiful and loving
clinical instructor thank you so much for sharing your
knowledge and for the love and care that you gave to our
group. THANKS FOR ALL MAAM WE LOVE YOU.
BIBLIOGRAPHY
Medical Surgical Nursing, Smeltzer, et al.
MEDICAL Surgical Nursing Critical Thinking for
Collaborative care 15th Edition
Health assessment and Physical Examination,
Estes
Laboratory and Diagnostic Test with Nursing
Implication 7th Edition
Nurse’s Pocket Guide 11th Edition
Human Anatomy and Physiology
Drug Handbook
PATHOPHYSIOLOGY
NON –MODIFIABLE RISK FACTOR MODIFIABLE RISK FACTOR

65y/o
LIFESTYLE

FEMALE ENVIRONMENT

INTERRUPTION OF URINE FLOW

KIDNEY

URETHRAL MEATUS

URETERAL PRESSURE
URINARY TRACT
GLUMERULAR FILTRATION

DECLINES SIGNIFICANTLY TUBULAR FUNCTION

IMPAIRED TRANSPORT OF SODIUM ,


POTASSIUM,AND PROTONS
DISRUPTION CONCENTRATE AND DILITE URINE

TUBULAR ATROPHY

NEPHRON LOSS

SWELLING OF THE KIDNEY

HYDRONEPHROSIS
SUMMARY OF
PATHOPHYSIOLOGY
Hydronephrosis can result from anatomic and
functional process interrupting the flow of urine.
This interruption can occur anywhere along the
urinary tract from the kidney to the urethral
meatus. The rise in ureteral pressure leads to
marked changes in glomerular filtration, tubular
function, and renal blood flow. The GFR declines
significantly within hours following obstruction.
This significant decline in GFR causes inability
of the renal tubular to transport sodium,
potassium, and protons and concentrate and to
dilute urine is severely impaired. The existence
of persistence of these can cause tubular
atrophy and permanent nephron loss and then
lead to swelling of the kidney that causes
HYDRONEPHROSIS.
NURSING CARE PLANS
ASSESS NURSIN SCIENTI PLANNI INTERV RATION EVALUA
MENT G FIC NG ENTION ALE TION
DIAGNO EXPLAN
SIS ATION
S>Hindi Anxiety A state in After 2hrs. >monitored >serve as The client
ako related to which a of nursing vital signs a baseline expressed
mapakali perceived person interventio data her
hindi ko health experience n patient >Promote >reduces feelings
alam kung threat to uneasiness will identify expression anxiety and
maoopera health /apprehens ways to of feelings attributable participate
han ako as status. ion and deal with and fears to fear of in her
verbalized application anxiety. the health care
by the of ANS in >explain
purposes unknown
patient. response diagnosis
to a vague tests and
O>poor procedures and
eye non- prognosis
contact specific >encourag
ed family >reassures
>restless threat.
member to client that
>facial treat client role in the
tension as before family has
not been
altered
ASSESS NURSIN SCIENTI PLANNIN INTERVE RATION EVALUA
MENT G FIC G NTION ALE TION
DIAGNO EXPLAN
SIS ATION

S>Uulitin Deficient It is a After 1hr. >Monitored >serves as a The patient


vital signs baseline data was able to
na naman Diversiona decrease Of nursing express her
>NPI rendered >it builds a
ang aking l activity in interventio rapport with feelings and
X-RAY, related to stimulation n the client the client engaged in
reading news
naiinip na prolonged for/interest will be >Encouraged paper and
ako dito hospitaliza or able to the patient to >Offering magazines.
participate in different
lalo lang tion engageme engage in mix activities activities helps
tumatagal nt in activities like reading client to try
ang recreation within her news paper out new ideas
and and develop
pagtigil ko or leisure personal magazines new interest
dito. activity limitation >Incorporated >encourage
O>seen activities involvement
appropriate to and helps to
on bed present stimulate
restless situation client mentally
and physically
>irritable to improve
>facial overall
condition and
expression sense of well
connotes being
pain
ASSESSM NURSING SCIENTIFI PLANNIN INTERVE RATIONA EVALUATI
ENT DIAGNOS C G NTION LE ON
IS EXPLANA
TION
S>Nakakara Pain It is the After 1hr. >monitored >serve as The clint’s
mdam ako related to sense of Of nursing vital signs a baseline level of
ng kirot sa tissue physical interventio >monitor data pain was
aking and
kaliwang
swelling of pain it is a n the >variation minimized
document
tagiliran the kidney typical client’s of as
characteristi
O> experience feeling of c of pain, appearanc evidenced
P: sitting at
that may pain will noting e and by a
the bedside be be verbal and behavior relaxed
Q: stabbing describe minimized/ non-verbal of client’s demeanor.
as the reduced to cues
pain pain may
R: left lower unpleasant a tolerable >obtain full present a
quadrant of awareness level description
change in
of pain from
the of a assessme
abdomen client
noxious on including nt
S: 5-6 pain bodily location,
scale
>pain is
harm intensity, subjective
T: duration,
intermittent experienc
characteristi
c and e and
radiation must be
describe
by client
DRUG STUDY
NAME OF CLASSIFICATI INDICATI CONTRAIN ADVERSE NURSING MONITO
DRUG ON AND ON DICATION REACTION RESPONSI RING
PARAM
ACTION BILITIES ETERS
Anti cholinergic >Spastic >To patient >Disorientat >raise side >None
states hyper sensitive ion rails reported
Buscopan Action: to drug
Inhibits >to >restlessne >tolerance
>to patient with
Generic muscarinic prevent glaucoma ss may develop
name: actions of nausea >to patient with >irritability when
acetylcholine on and obstructive >dizziness therapy is
autonomic vomiting uropathy, and prolonged
Scopolamin obstructive >drowsines
effectors s
e Butyl innervated by
disease of the
bromide G.I. tract >head ache
post ganglionic
>to patient
Dosage: cholinergic >palpitation
hypersensitive
neurons. to
0.3-0.8mg belladonna/bar
biturates
Rout:
>use
cautiously in
PO children
Frequency:

T.I.D.
NAME OF CLASSIFICATI INDICATION ADVERS CONTRAINDICAT NURSI MONITO
ON E ION NG RING
DRUG REACTIO RESPO PARAM
N NSIBILI
ETERS
TY
NSAID’s >Short term >head ache >Contraindicated >correct >May
Action: management >dizziness to patient hypovol increase
Ketorolac May inhibit of moderately >drowsines hypersensitive to emia ALT and
severe acute s drug and those before AST
prostaglandin
pain for single >edema with active peptic giving>
Generic synthesis, to >May
dose treatment >nausea ulcer disease us increase
name: produce anti-
>Short term >constipati >Contraindicated single bleeding
inflammatory, on
analgesics and management in children dose in time
Toradol >vomiting young
anti pyretic of moderately younger than 2y/o
effects severe acute and for patient children
Dosage: pain for with history of
multiple dose peptic ulcer
treatment disease
15mg/ml
>Use cautiously in
patient especially
Rout: I.V. elders

Frequency
:q6
DRUG CLASSIFICATIO INDICATI ADVERSE CONTRAIN NURSING MONITORI
NAME N ON REACTIO DICATION RESPONSI NG
N BILITY PARAMETE
RS
Third Generation >UTI >fever >Contra >Obtain >May
cephalosporin >Meningiti >head indicated to specimen increase
Ceftriaxom Action: s ache patient for culture alkaline
e sodium Third generation >Acute >dizziness hypersensiti and phosphate,
cephalosporin bactericida >phlebitis ve to drug sensitivity ALT, AST,
that inhibits cell- l and other test before and BUN.
Generic >diarrhea cephalospor giving first
name: wall synthesis, >May falsely
promoting in >Use dose increase
osmotic cautiously >Before serum/urine
Rocephin instability, in patient giving first creatinine
usually hypersensiti dose ask level
Dosage: bactericidal ve to patient if
penicillin>U he/she has
se any
125mg cautiously allergies
in breast
Rout: feeding
women
I.M.

Frequency
:
B.I.D.