Nursing Care Plan Client: Bartolabac, Fidela Hospital No.: 0-800-22500-773 Age: 66 years old Room No.

: C414 Impression: cough, dyspnea Physician: Dr. R. Go Diagnosis: Community acquired pneumonia high risk in acute respiratory failure Nurses Signature: R.C.R. UCSN Clinical Portrait Assessment Upon assessment patient X, 66 years old, a Roman Catholic from 0671 Sitio Anagan, Apas, Cebu City, was seen lying on bed conscious and a febrile with the S.O. at the bedside. Patient had an IVF of D5NSS infused at right arm/hand running at 30 gtts/min + dopamine at 10gtts/min. A NGT was inserted and was aided with a mechanical ventilator. Pulse oximeter was connected at the right hand and FBC-UB was noted. Pertinent Data History of Present Illness

A case of Mrs. Fidela B. Bartolabac, 66 years old, born on April 24, 1942 at Berida, Leyte, Roman Catholic and is widowed for 3 years, residing at 0671 Sitio Amagan, Apas, Cebu City 6000 was admitted on November 29, 2008 at 1:44 pm at Chong Hua Hospital. Mrs. Bartolabac has Bronchial Asthma taking Seretide and Ventolin inhaler for treatment but is poorly compliant. She was taking vitamins. Family history of diabetes. Significant Findings Mrs. Bartolabac used to for about 30 packs per year and drinks alcohol occasionally. She was positive of pulmonary Patient was tachypniec with vital sighs of BP= 90/60 tuberculosis and was poorly taking anti TB medications for 2 mm/Hg. HR of 117 bpm and RR of 31 cpm. Roles positive at years. Months prior to admission weight loss was positive and binasal assessment and occasional wheeze BLF. Patient was occasional chest pains noted tachycardic with regular murmurs. Positive cyanosis on finger nail beds of both hands. With history of PTB. Chief Complaints Nursing Review of Systems Gordon's 11 Functional Health Patterns Cough, dyspnea Vital Signs Taken Upon Admission

1. Health perception/ Health management Patient had history of Pneumonia and Pulmonary Tuberculosis. Doctors prescribed her with medicines but the patient was not able to maintain it due to financial problem. She never Laboratory results complained about her condition though she experienced short of breathe and cough. Her family decided to admit her to Chong Hua X-Ray hospital when she cannot tolerate it anymore and when cyanosis 12/14/08 was observed by the family member. She used Wachichao plant for her maintenance. Conclusion 2. Nutrition/ Metabolic T= 36.2C P= 117 bpm R= 31 cpm BP= 90/60 mmHg

1. Chronic inflammation process in both lung fields 2. Modified silhouette Patient is choosy about her food. She usually eats rice and 3. Atherosclerosis of the thoracic aorta liver barbeque. She loves to eat fruits as long as they have. She 4. Calcified trachoebronchial tree seldom eats meat. She eats vegetables once in a while. In the 5. Generalized osteopenia/osteoporosis morning, she eats bread and ate breakfast and lunch (brunch) at around 11:00AM Few weeks before admission, she just want to eat porridge CBC for her meal. Now, she has Nasogastric tube attached. 12/13/08 3. Elimination Result reference unit WBC 6.28 4.8-10.8 10^3/ul Patient had normal elimination pattern but then, few days RBC 5.45 4.2-5.4 10^0/ul after her admission, she experienced constipation but had good HGB 16.5 12-16 g/dl urine output. Now, she defecates daily and maintain good urine HCT 50.6 37-47 % output. MCV 92.8 81.99 fl MCH 30.3 27-31 pg 4. Activity/ Exercise MCHC 32.6 33-37 g/dl Plt 193 130-140 10^3/ul

Patient usually does sedentary activities at home, like eating, watching television, talking with some friends, and sometimes does sweeping. On first contact with the patient, seen patient lying on bed, weak, and with limited movements. Eight days after admission, patient had great improvement, she can now smile, do sign language, move her extremities and with glow on her face. Though she still needs assistance, she can turn to sides now with ease. 5. Cognitive/ Perceptual Patient needs to be oriented with the time and date though she is aware that she is currently admitted in the hospital. She is responsive (through gestures), coherent, and can relate to conversations. She even smile with jokes and wave her hands when someone she used to see visited her. She speaks in a very low voice at present because the Endotracheal tube was just removed. 6. Sleep/Rest Patterns Patient usually sleeps between 8:00PM 9:00PM and wakes up around 5:00AM. She had afternoon nap everyday. Now that she is admitted, she could hardly sleep because of her condition. Her vital signs need to be monitored hourly. She is also disturbed by her cough. 7. Self Perception/ Self Concept Though the patient looses weight, she doesnt look under

Result reference unit Neutrophil % 72 40-74 % Lymphocyte % 1707 19-48 % Monocyte 9.9 3.4-9 % Eosinophil .2 0-7 % Basophil .2 0-1.5 % Neutrophil # 4.53 1.9-8 10^3/ul Lymphocyte # 1.11 1.9-8 10^3\ul Monocyte .62 .16-1 10^3/ul Eusinophil .01 0-.8 10^3/ul Basophil .01 0-.2 10^3/ul RDW PDW MPV 14 9.8 9.5 11-16 9-14 % 7.2-11.1 % fl

Ionized calcium .75 1.09-1.33 mmol/L Na 121.9 135-148 mmol/L K 4.25 3.5-5.0 mmol/L Temperature Thb FIO2 pH pCo2 PO2 HCO3 +CO2 36.6 15.0 21 7.287 68 54.5 >80 31.8 33.9 C g/dl % 7.35-7.45 35-45 mmHg mmHg mmHg mmHg

weight at all. She is just weak because she is sick. She looks accommodating and friendly despite of her condition. 8. Role/ Relationship Patient lives in her own house with her daughter and two grandchildren. They have close family ties. She is open to them with her feelings. She is fond of talking. She spends most of her time at home with her family. 9. Sexuality/ Reproductive Health

SO2 U/A 12/13/08

84.4 95-98

Physical Characteristics Color dark yellow Transparency sly cloudy pH 6.0 5-6 Sp-gray1.030 1.003-1.005

random unit mg/dl mg/dl mg/dl mg/dl WBC/ul mg/dl mg/dl mg/dl mg/dl

Chemical Characteristics The patient has five children, two boys (deceased) and three Result reference girls. Her husband died long time ago. Protein 100 Glucose 10. Coping/ stress tolerance Ketone Urobilinogen normal up to 2 The patient is open to her family about her problems. But Leukocyte then, with regards to her sickness, she never complained about it. Bld She kept it to herself as long as she can tolerate it. Bilirubin Nitrite 11. Values and beliefs Vit C 40 * Patient is a Roman Catholic but didnt go to church. She Microscopic didnt join any religious community. RBC 2 Nursing Problems WBC 8 Bacteria Mucus 1.) Ineffective airway clearance Hyaline cast 2.) Impaired physical mobility

none 10

2-18 6.14 * *

/ul /ul /ul /ul

3.) Risk for aspiration 4.) Risk for impaired skin integrity 5.) Impaired verbal communication Nursing Diagnosis 1. Ineffective Airway Clearance related to increased sputum production as evidenced by cough. 2. Impaired Physical Mobility related to restrictive devices 3. Impaired Verbal communication r/t attachment to mechanical ventilator. 4. Risk for infection related to depressed immune system 5. Risk for aspiration r/t tube feedings and secretions.

Glucose Fasting Cholesterol Triglycerides VLDL LDL HDL Temperature FIO2 pCO2 pH PO2 HCO3 +CO2 BE SO2 Acid fast stain Specimen sputum

149 165 109 21.8 115.6 .0 27.6 36 14.2 21.0 7.335 60.4 238.1 33.7 3.8 99.8

60-110 mg/dl 150.0-240.0 45.0-150.0 .0-40.0 mg/dl 150.0 30.0-9.0

mg/dl mg/dl mg/dl mg/dl C g/dl %

7.35-7.45 35-45 780 95-98

mmHg mmol/L mmol/L mmol/L %

Report: no acid fast bacilli seen

Nursing Care Plan Cues Nursing Diagnosis Actual Ineffective Airway Clearance related to increased Scientific Basis A cough is a protective reflex that cleanses the lower airways by an explosive Goal and Outcome Criteria After 8 hours of nursing intervention, clients airway is free of secretions as Nursing Actions Rationale Evaluation

S: Giubo ug kutasan ako mama ug maglisod siya ug ginhawa As verbalized by the clients

To perform nursing care to help patient improved Airway Independent; 1. Assess respiratory Use of accessory

Goal Partially met After 8 hours of nursing intervention, clients

daughter. O: 1.Received patient lying on bed, conscious, coherent afebrile, tachypneic and with mechanical ventilator support. 2. Change in respiratory status. 3. Patient demonstrate persistent coughing and dyspnea 4. Abnormal lung sounds 5. With pulse oximeter attached

sputum production as evidenced by cough.

expiration. Inhaled particles, accumulated mucus, inflammation or presence of a foreign body initiates the reflex by stimulating the irritant receptors in the airway. The cough consists of inspiration, closure of glottis, and vocal cord, contraction of glottis, causing sudden, forceful expiration that removes the offending matter. The effectiveness of the cough

evidenced by eupnea and clear lung sounds after coughing or suctioning. Specifically: 1. Client will maintain a stable breathing. 2. Clients mucus will be thin and scant. 3. Clients breath sounds are clear.

movements and use of accessory muscles.

muscles to breathe indicates an abnormal increase in work of breathing. (Gulanickl et. al.: 2007,480). Patients may have ineffective cough due to fatigue or thick tenacious secretions. (Gulanickl et. al.: 2007,480). A sign of infection is discolored sputum. An odor may be present. (Gulanickl et. al.: 2007,480).

airway was free of secretions as evidenced by eupnea and clear lung sounds after coughing or suctioning. Specifically: 1. Client maintained a stable breathing. 2. Clients mucus wasthin and scant.

2. Assess cough for effectiveness and productivity.

3. Observe sputum color, amount, and odor and report significant changes.

Dependent: 1. Monitor pulse oximeter

Hypoxemia may result from impaired gas

- T= 36.2oC - P= 81 bpm - R= MV - BP= 90/55 mmHg.

depends on the depth of the inspiration and the degree to which the airway narrow, increasing the velocity of the expiratory gas flow. Cough occurs frequently in healthy individuals. A persistent cough indicates presence of disorder or a disease. An acute non productive cough often indicates bronchitis or viral pneumonia. A persistent cough is

and ABGs.

2. Monitor chest x-ray reports.

exchange from build up of secretions. ABGs provide data about carbon dioxide levels in the blood. (Gulanickl et. al.: 2007,480). These determine progression of disease process. (Gulanickl et. al.: 2007,480).

Collaborative: 1. Consult the respiratory therapist for chest physiotherapy and nebulizer treatments, as appropriate and ordered.

Chest physiotherapy includes the techniques of postural drainage and chest percussion to loosen and mobilize secretions in smaller airways that cannot be removed by

commonly caused by a tumor, congestion, or hypertensive airways. A cough that produces purulent sputum usually indicates infection, whereas a cough that produces non purulent sputum is non specific and merely indicates irritation. (McCance, 2000:1150

coughing or suctioning. A nebulizer may be used to humidify the airway to thin secretions to facilitate their removal. (Gulanickl et. al.: 2007,481). Bronchoscopy is done to obtain lavage samples for culture and sensitivity and to remove mucous plugs; thoracentesis is done to drain associated pleural effusions. (Gulanickl et. al.: 2007,481). Intubation may be needed to facilitate deep suctioning efforts and to provide source for

2. Assist with bronchoscopy and thoracentesis, as appropriate.

3. Anticipate possible

need for intubation if patients condition deteriorates.

augmenting oxygenation. (Gulanickl et. al.: 2007,481). A variety of medications are available to treat specific problems. (Gulanickl et. al.: 2007,481).

4. Administer medications such as antibiotics and expectorants for productive coughs. Administe r inhaled bronchodilators and inhaled steroids, as prescribed, to open airway and decrease inflammation.

Nursing Care Plan

Cues

Nursing Diagnosis Potential Risk for aspiration r/t tube feedings and secretions.

Scientific Basis

Goal and Outcome Criteria After 8 hours of nursing intervention the patient will be able to maintain a patent airway Specifically the patient and s.o. will be able to: 1. Feel relief with concerns of secretions 2. Will be able to do basic suctioning procedures.

Nursing Actions To perform nursing care to prevent aspiration Independent: 1. Monitor level of consciousness.

Rationale

Evaluation

S- Patient pointing her throat. -no verbalizations O- NGT inserted Mechanical ventilator noted Suction machine at bedside. patient pointing on her neck.

Crackles indicate static pulmonary secretions that need to be mobilized. This also includes accumulation of saliva on the airways .When this obstructs the airway the pulmonary tissues beyond the collapses and massive atelectosis results. (Smeltzer,Bare,,Hinkle cheever;2008,534) Pulmonary complications from NGT intubation occur because coughing and cleaning of the pharynx is impaired , because gas build up can irritate the phrenic nerve and because tubes may dislodged, retracting the distal and

goal met: After 8 hours of nursing intervention the patient was able to maintain a patent airway. Specifically the patient and s.o. was able to: 1. Feel relief of concerns about secretions. 2. Able to do basic suctioning procedures. 3. Have a

A decreased level of consciousness is a prime factor for aspiration ( Gulanick/Mayers:2008 pp18) Decreased gastrointestinal mobility increases the risk of aspiration because foods and fluids accumulate in the stomach(Gulanick/ Mayers:2008;pp19 This decreases the risk of aspiration by promoting the drainage and secretions away

2. Auscultate bowel sounds to evaluate bowel motility and assess for abdominal distention and firmness. 3. Position patient in an

above the esophagogastric sphincter places the patient of risk for aspiration (Smeltzer,Bare,Hinkle, Cheever; 2008,1180-1181)

3. Have a secured NGT placement. 4. Have no abnormal breath sounds upon assessment. 5. Have normal breathing pattern.

elevated upper body or side lying.

from the airway. (Gulanick/Mayers:2008 pp.19) Reduces oropharyngeal secretions and reduces aspiration rising. ((Gulanick/Mayers:2008 pp.19) A placed tube may erroneously deliver tube feeding into the airway. ((Gulanick/Mayers:2008 pp.19)

4. In Patients with artificial airways. Perform oral suctioning as needed. 5. In patients with NGT

secured NGT placement 4.Have no abnormal breathe sounds upon assessment 5. Have a normal breathing pattern.

Check placement of tube before feeding by color or aspirate or listening for bubbling sounds upon air induction. On ineffective or over inflated cuff can increase Collaborative: the risk for aspiration. ((Gulanick/Mayers:2008

6.Collaborate with respiratory therapist, as needed to determine cuff pressure(tubes) 7. Collaborate with the dietitians about having blenderized diet for the patient. Dependent: 8. Suction hourly as ordered by the physician. 9. Administer drugs in appropriate preparation as ordered by the physician.

pp.19) Appropriate mixture of food as well as balanced meal provides nutrients needed. ((Gulanick/Mayers:2008 pp.63)

To eliminate secretions (Doenges 63)

Drugs in tablet forms must be crushed during administration (Doenges 63)

Nursing Care Plan Cues S: Patient wrote on a piece of Nursing Diagnosis Actual Impaired Scientific Basis In place mechanical devices are Goal and Outcome Criteria After 8 hours of nursing intervention the Nursing Actions To perform nursing care to help patient exercise in bed Rationale Evaluation Goal met After 8 hours of

paper gusto na ko mulakaw O: 1.Received patient lying on bed, conscious, coherent afebrile, tachypneic and with mechanical ventilator support. 2. Pulse oximeter at right hand 3. IVF infused at right hand 4. Weak muscles

Physical Mobility related to restrictive devices

common to non ambulatory patients but in cases where patients are able to walk, the devices would likely limit their activities provided that machines are easily altered by movement examples would be casts, neck support and ventilator. (Microsoft Encarta 2007)

patient will be relieved from discomfort Specifically 1. Patient will be free of complications of immobility, as evidenced by intact skin, absence of thrombophlebitis, & normal bowel pattern. 2. Patient will perform exercises in bed 3. Patient will move allowed body parts for exercise.

1. Assess patients ability to perform ADLs effectively and safely on a daily basis. 2 Assess ability to perform ROM to all joints.

>Restricted movement affects the ability to perform most ADLs .

nursing intervention the patient was relieved from discomfort Specifically 1. Patient was free of complications of immobility, as evidenced by intact skin, absence of thrombophlebitis, & normal bowel pattern. 2. Patient was able to perform exercises in bed 3. Patient moved allowed body parts for exercise.

3 Encourage & facilitate early ambulation & other ADLs when possible . 4 Provide positive reinforcement during activity.

>This provides baseline measurement for the future evaluation and guides therapy. >The sooner the patients becomes mobile, less chance that debilitation will occur. >Patients may be reluctant to move or initiate new activity due to fear of falling. A positive approach allows the learner

5 Evaluate patients performance in doing ADLs.

to feel good about learning accomplishments. > Evaluating performance helps in improving once abilities & maximizing activities. Even patients who are temporarily immobile are at risk for effects of immobility such as skin breakdown, muscle weakness, thrombophlebitis, constipation, pneumonia, & depression.

6 Assess patient or caregivers knowledge of immobility & its complication.

> Regular examination of skin (especially over bony prominences) will allow for prevention or early recognition & treatment of

pressure sores. 7 Assess skin integrity > Turning the patients optimizes circulation to all tissues & relieves pressure. > Immobility promotes constipation > It helps in evaluating patients outcome from nursing interventions. > It helps in determining factors that contributed to patients difficulty in moving > To reduce fatigue.

8 Assess elimination pattern. 9 Turn & position the patient every 2 hours or as needed. 10 Evaluate the patient free of complications of immobility.

11 Assess patients difficulty in walking. 12 Encourage walking exercise interspersed with rest periods

> To enhance

13 Involve client/ SO in care, assisting them to learn ways of managing deficits. 14 Instruct client/ SO in safety measures as individually.(eg. maintaining safe travel pathway, proper lightning.

safety for client & SO/ caregivers.

> To reduce risk of falls

> It helps in determining patients outcome to be effective or not.

Drug Study

Generic Name Omeprazol e

Brand Name Omepro n

Classificatio n Proton pump inhibitor

Mechanism of Action

Indication

Contraindicati on

Side Effects

How Supplie d

Dosage/ Frequenc y

Nursing Intervention

Thought to be a Short term gastric pump treatment inhibitor in that of active it blocks the duodenal final step of ulcer. acid production Short term inhibiting the (4-8 H+ an/K+ weeeks) ATPase system treatment at the secretory of erosive surface of the esophagiti gastric parietal s cell. Both basal diagnosed and stimulated by acid secretions endoscopy are inhibited. . Maintain Serum gastrin healing of levels are erosive increased esophagiti during the first s. 1 to 2 weeks of Treatment therapy and are of maintained at heartburn such levels and other during the symptoms

Lactation. Use Headache IV 40mg as maintenance , infusion Once a therapy for abdomina day duodenal ulcer l pain, disease. OTC diarrhea, use in those N&V, who have URTI, trouble of pain dizziness, swallowing rash. food, are vomiting blood, or excreting bloody or black stools.

1.Consider dosage adjustment in those with impaired hepatic function especially when used for maintaining clients with erosive esophagitis. 2.List reason for therapy, triggers, frequency, characteristics of S&S, other agents trialed. 3.Record abdominal assessment, radiographic/endoscop ic findings, and H. pylori result. 4.Administer one hr before giving meal. 5. Report any changes in urinary elimination, pain, discomfort, or persistent diarrhea. 6. Avoid activities that

course of therapy. (Spratto et.al.:2008:115 9)

associated with GERD.

require mental alertness until drug effects realized; may cause dizziness. 7. For short term use only, drug inhibits total gastric acid secretion. Side effects of prolonged therapy and suppression of acid secretion alter bacterial colonization and lead to hypoclorhydria and hypergastrenemia which may cause an increase risk for gastric tumors.

Drug Study Generic Name Brand Name Classificatio n Antibiotic, Penicillin Mechanism of Action A combination of Piperacillin sodium and Tazobactam sodium, a betalactamase Indication Contraindicati on Side Effects Diarrhea, constipatio n, N&V, dyspepsia, headache, rash, How Supplie d IV infusion Dosage/ Frequenc y 4.5 gm IV q 8 hours Nursing Intervention 1.For IV administration or infusion, reconstitute the powder for injection with 5 ml

Piperacillin Zosyn sodium and , Tazobacta Peptaz m sodium

(1)Appendicit Hypersensitivit is complicated y to penicillins, by rupture or cephalosporins abscess and , or betaperitonitis lactamase caused by inhibitors.

inhibitor. Tazobactam inhibits betalactamases, thus ensuring activity of piperacillin against betalactamaseproducing microorganism s. Thus Tazobactam broadens the antibiotic spectrum or piperacillin to those bacteria normally resistant to it. (Spratto et.al.:2008:126 9)

piperacillinresistant, betalactamase producing strains of Escherichia coli, Bacteroides fragillis. (2)Communit y Acquired Pneumonia of moderate severity caused by piperacillinresistant, betalactamase producing strains of Haemophilus influenzae. (3)Moderate to severe nosocomial pneumonia caused by piperacillin-

rhinitis, dyspnea, abdominal pain.

suitable diluent/gram piperacillin. IV diluents that can be used include 0.9% NaCl, sterile water for injection, dextran 6% in saline,D5W,KCl 40mEq, bacteriostatic saline/parabens, bacteriostatic water/parabens, bacteriostatic saline/benzyl alcohol,bacteriostati c water/benzyl alcohol. 2.Note reasons for therapy, type, location, characteristics of S&S. 3. List any sensitivity to penicillins, cephalosporins, beta-lactamase inhibitors, or other

resistant, betalactamase producing strains of Acinetobacter baumanii. (4) Infections caused by piperacillinsusceptible organisms for which piperacillin is effective may also be treated with this combination.

allergens. 4. List drug prescribed to ensure none interact unfavorably. Use of heparin and oral anticoagulants may require dosage adjustments. 5. Monitor C&S, lytes, urinalysis, hematologic, coagulation profile, renal, LFTs; reduce dosage with renal impairment. 6. Inform family to report any pain at injection site, fever/chills, rash, diarrhea, GI upset, lack of response or worsening of condition.

Drug Study Generic Name Brand Name Classificatio n Anti-platelet drug Mechanism of Action Indication Contraindicatio n Lactation, active pathological bleeding such us peptic ulcer or intracranial hemorrhage Side Effects Appendag e disorders, headache, chest pain, flu-like symptoms How Supplied Tablets 75 mg Dosage/ Frequency Clopidogra l 75 mg i tab, PO,OD Nursing Intervention >Do not cofuse with antidepreesant > Document otheros dehoric event or established peripheral arterial disease requiring therapy. > Asses for active bleeding as with ulcers or intracranial bleeding. > list all drugs prescribed/consume d esp. OTC. > Consider 5 rights in giving meds. > Explain the purpose of the medication. > obtain baseline

clopidogrel wintop

Inhibits Reduction of platelet MI, stroke aggregation and ucercular by inhibiting death in binding of patients with adenosine atherosclerosi diphosphate s documented (ADP) to its by recent platelet stroke, MI or receptor and established susbsequent peripheral ADP arterial meditative disease activation of glycoprotein GPII/IIa complex. Effect on receptors is irreversible thus

platelets are affected for remainder of their lifespan. (MIMS.com )

V/S. > Document the procedure.

Drug Study Generic Name Brand Name Classificatio n Mucolytics Mechanism of Action Decrease the Indication Acute and chronic Contraindicatio n Side Effects How Supplied 100 mg / 200mg Dosage/ Frequency 200 mg 1 sachet + Nursing Intervention asses drug expiration

Acytylcystien Flulmucil sachet

Contraindicated Urticaria to patients bronchospasm

production respiratory having asthma. , nausea, of mucus at tract Patients with vomiting. respiratory affections history of peptic tracts by with ulcer. stimulating abundant the mucus production secretions. of glutathianc e thus decreasing the viscosity of secretions.

sachet Inhalation 100mg/ml Syrup 100mg/5ml x 150 ml

socc h20 NGT bid

date >asses for drug tolerance characterized >obtain baseline v/s >take the drug with meals >advice increase fluid intake >consider patients safety >evaluate effectiveness of drug >chart procedure

Drug Study Generic Name Brand Name Classificatio n Dyslipidemi c Agent Mechanism of Action Reduction of low density lipprotien cholesterol in that Indication Contraindicatio n Active liver disease or unexplained persistent elevations of serum trans Side Effects How Supplied Tablet 10 mg,20 mg, 30 mg,40 mg Dosage/ Frequenc y Vidastat 40g I tab NGT OD q8hr Nursing Intervention Asses drug expiration date >consider the 5 rights of drug administration.

Simvastatin Vidastat

In CHD: Reduce risk of death and non fatal MI. Reduce risk of strike and transient ischemic

Constipatio n dyspepsia flatulence

following inhibition of the HWGCOA reductase activity, the LDL receptor activity on the liver is increased and this leads to increased removal of LDD cholesterol. (KIMS.com )

attacks. In hypelipidemia: an adjuct to the diet to reduce elevated total-c, LDL-C , apolipoprotien B and TG in patients with primary hyper choles terolemia, hanozygous familial hyrecholesterogou s or mixed hyperlipidemia. (MIMS.co

aminoses parphyria, pregnancy lactation

>obtain baseline data >dissolve solution thoroughly > encourage high fiber diet, fluid. > inform patient about the mechanism of drugs >chart the procedure >evaluate effectiveness of drugs.

Drug Study Generic Name Midozalam Brand Name Dormicu m Classification Mechanism of Action Inhibits sympatheti c nervous system activation and initiates sedation hyponotics Indication Contraindicatio n Premature infants myasthenia gravis Side Effects Insomnia in psychosis severe depressio n How Supplied Ampule 5mg/1ml 5mg/5ml,1 5 mg/3ml Film coated tablet 15 mg Dosage/ Frequenc y IVTT 2.8 mg OD Nursing Intervention 1. Assess level of sedation and level of consciousness through out and for 2-6 hour following administration 2. Monitor blood

Benzodiazepines s sedative hyponotics

Disturbance s of sleep rhythm, insomnia esp.difficult y in falling asllep either initially or after premature awakening.

Sedation in premed before surgical or diagnostic procedures, induction and maintenance of anesthesia. (MIMS.com )

pressure, pulse and respiration continuously during administration 3. Administer IM doses deep into muscle 4. In form the patient that this medication will decrease mental recall of the procedure 5. Instruct patient to inform health care professional prior to administration if pregnancy is suspected

Drug Study Generic Name Ciprofloxacin Brand Name ciprobay Classification fluroquinolone Mechanism of Action Has a rigid action in the ploriferation phase of a bacterium, a segmental twisting and untwisting of chromosomes take place. (MIMS.com) Indication For acute uncomplicated urinary tract infections Contraindication Contraindicated to patients having hypersensitivity to ciprofloxacin or other quilone chemotherapeutic Side Effects Nausea, diarrhea, vomiting, dyspepsia, abdominal pain, flatulence, dizziness How Supplied Tablet 250 mg, 500 mg Infusion 100 mg/30 ml 200 mg/20 ml Film coated tablet 500 mg Dosage/ Frequency Nursing Intervention

Ciprobay >asses drug 500 g 1 expiration tab PO bid date >asses for drug tolerance characterized >obtain baseline v/s >instruct the patients to remain in a stable position for 2-3 hrs. >advice increase fluid intake >consider patients safety >evaluate effectiveness of drug >chart procedure

Drug Study Generic Name Brand Name Classification Mechanism of Action Indication Contraindication Side Effects How Supplied Dosage/ Frequency Nursing Intervention

rebamipide

Mucusta

ANTACIDS

Rebamipide is a mucosal protective agent and is postulated to increase gastric blood flow, prostaglandin biosynthesis and decrease free oxygen radicals.

For acute gastritis and exacerbation of chronic gastritis, gastric ulcers

Lactation.

Rash, pruritus, constipation, diarrhoea, nausea.

Tablet 100 mg

Mucosta 1 1. Chedk renal tab OD studies to TID check renal function is normal 2. Check the pattern of bowel elimination. 3. Record the gastric pain being experienced. 4. report for coffee ground stools 5. if the patient is pregnant has edema or hypertensive, use low sodium antacids

Drug Study Generic Name prednisone Brand Name pred Classification corticosteroids Mechanism of Action The antiinflammatory effect is due to inhibition of prostaglandin synthesis, the drug also Indication Allergis and edematous respiratory and neoplastic diseases Contraindication Gastric & duodenal ulcers, systemic fungal & certain viral infections, glaucoma, psychoses or severe Side Effects Insomia, nosia and vomiting, GI upset, fatique, dizziness, muscle weakness, How Supplied tablets:1mg, 5mg, 10mg, 20 mg, 50 mg Oral solution: 5mg/5ml; syrup Dosage/ Frequency 20 mg 1 tab NGT BID Nursing Intervention 1. note reasons for therapy, type, onset, characteristics of signs and symptoms, clinical presentation

inhibits accumulation of machrophages and leukocytes at sites of inflammation and inhibits phagocytosis and lysosomal enzyme release.

psychoneuroses; increased live vaccines; hunger/thirst, hypersensitivity joint pain, to decreased glucocorticoids. diabetic control.

5mg/5ml;

2. monitor CBC, ESR, electrolytes, BP, blood sugar, weights and mental status. 3. with COPD provide rescue doses and instruct client how and when to use. 4. with chronic pain, titrate dose to assess for relief

Drug Study Generic Name Ivabradine HCl Brand Name coralan Classification Antiangina Ivabradine Mechanism of Action Ivabradine is a pure heart ratelowering agent, acting by selective and specific inhibition of the cardiac pacemaker /current that controls the spontaneous diastolic depolarisation in the sinus node and regulates heart rate. The cardiac effects are specific to the sinus node Indication Chronic angina pectotis Contraindication Side Effects How Supplied filmcoated tablet 5 mg, 7.5 mg Dosage/ Frequency Nursing Intervention

Resting heart Luminous rate <60 bpm phenomena prior to (phosphenes), treatment, blurred cardiogenic vision, shock, acute MI, bradycardia, severe 1st degree hypotension AV block, (<90/50 mmHg), ventricular severe hepatic extrasystoles, insufficiency, headache, sick sinus dizziness. syndrome, SA block, severe heart failure, pacemakerdependent patient, unstable angina, 3rd degree AVblock.

5 mg 1 tab 1. Assess the NGT OD client for gastrointestinal upset and peripheral edema. 2. Assess pain and limitation of movement ; note type, location & intensity prior to & at the peak following administration. 3. Monitor vital signs and check for peripheral edema. d. Dont breastfeed while

with no effect on intra-atrial, atrioventricular or intraventricular conduction times, nor on myocardial contractility or ventricular repolarisation.

Concomitant potent CYP3A4 inhibitors. Pregnancy & lactation.

taking this drug. 4. Discontinue drug and notify physician if signs and symptoms of hypersensitivity occur. 5. Caution the patient to avoid concurrent use of alcohol with this medication.

Drug Study Generic Name Co amoxiclav Brand Name Agcomen Classification Amoxicillin and enzyme inhibitor Mechanism of Action Prevents the plorefiration of of infecting bacteria by Indication Bacterial infections caused by amoxicillinresistant Contraindication Pregnancy & lactation. Elderly & neonates. Severe renal Side Effects Diarrhea, hepatitis & cholestatic jaundice. Erythema How Supplied tablet 625 mg Dosage/ Frequency Nursing Intervention

625 mg 1 a. Assess for tab NGT q allergy to 8 hrs penicillin. b. Instruct to take the

inhibitng synthesis of bacterial capcule. (mims.com)

lactamase producing strains.These include actinomycosis, biliary tract infections, bronchitis, endocarditis, gastroenteritis, typhoid & para typhoid fever & UTI.

impairment.

multiforme, StevensJohnson syndrome, toxic epidermal necrolysis & exfoliative dermatitis.

entire quantity of drug exactly as prescribed even after she feels better. c. Encourage to increase fluid intake. d. Take the medication in full stomach. e. Report for any signs of unusualities. ( Wilson, et. al,2004 page 1415).

Drug Study Generic Name Brand Name Classification Mechanis m of Action Indication Contraindicatio n Side Effects How Supplied Dosage/ Frequency Nursing Intervention 1. Obtain record and baseline vital sings 2. Assess the presence of palpitations and dysrhythmias 3. Perform assessment of the patients mental status 4. Warm patient about possible

Ipratropium Duavent salbutamol sulfate,

Antiasthmati c

Stimulates Management Hypertrophic Headache,pain Pulmoneb 1 neb now beta 2 of reversible obstructive , influenza, solution receptors bronchospas cardiomyopathy chest pain; 2.5 mL on the m associated or nausea. bronchi. w/ obstructive tachyarrythmia. Bronchitis, Causes less airway Hypersensitivit dyspnea, tachycardia diseases eg y to soya coughing, and is bronchial lecithin or pneumonia, longer asthma, related food bronchospasm, acting. COPD products (for pharyngitis, (Woods, MDI). sinusitis, Sratto, 28) rhinitis.

paradoxical bronchospasm 5. use cautiously to patients with CV disorders, hypertension, renal disease and diabetes.

IVF STUDY

Students Name: Group 4 Section R Area: Chong Hua Hospital Patients Name: Patient X Room/Bed No.: C-414 Age: 66 years old Status: Widowed Type of solution 0.9% Sodium chloride solution Classification Isotonic Content Each 1000 mL contains 900mg of Sodium Chloride Osmolarity: 308 mOsm/L Electrolytes in 1000 mL: Sodium 154 mmol Chloride 154 mmol Mechanism of action Replaces sodium and chloride and maintains levels (Lippincott Williams & Wilkins: 2005, 879). Indications Fluid and electrolyte replacement in hyponatremia caused by electrolyte loss or in severe salt depletion.

Date of Submission: Cliinical Instructor: Doctor: Date of Admission: Hospital No.: Diet: Contraindications Contraindicated in patients with conditions in which sodium chloride administration is detrimental. >contraindicated in patients with with increased, normal, or only slightly decreased electrolyte levels.

January 8, 2009 Benita Edelia D. Agramon Dr. R. Go December 13, 2008 0-800-22500-773 Liquid diet Dosage IVF PNSS 1 liter @ 30 gtts/min Nursing Responsibilities 1. Monitor electrolyte levels (Lippincott Williams & Wilkins: 2005, 879). 2. Explain use and Administration of drug to patient and family (Lippincott Williams & Wilkins: 2005, 879). 3.Tell Patient to report adverse reactions promptly (Lippincott

How supplied I.V. 1 liter

Williams & Wilkins: 2005, 879). 4.Regulate flow rate as ordered (Lippincott Williams & Wilkins: 2005, 879). 6.Check on skin integrity for redness, edema, swelling and pain (Lippincott Williams & Wilkins: 2005, 879). 7.Do not let the bottle be consumed totally to prevent air embolism (Lippincott Williams & Wilkins: 2005, 879). 8.Check mfor any bubbles present on the I.V. line

(Lippincott Williams & Wilkins: 2005, 879).

Type of solution Dopamine

Classification

Content

Mechanism of action Dopamine is the immediate precursor of epinephrine in the body. Exogenously administered, it produces direct stimulation of beta-1 receptors and variable

Indications Adjunct to standard measures to improve: BP, Cardiac output, urine output, in treatment of shock, unresponsive to fluid

Contraindications Pheochromocytoma , uncorrected tachycardia, ventricular fibrillation, or arrhythmias. Pediatric clients.

How supplied IVF 500 ml

Dosage PB Dopamine IV @ 30 gtts/min

Nursing Responsibilities 1. Dilute just prior to administration, solution stable for 24 hr at room temperature, protect from light. 2. To prevent fluid overload, may use more

Sympathomimetic, Synthetic direct acting and Dopamine indirect acting

(dose-dependent) stimulation of alpha receptors (peripheral vasoconstriction). Will cause a release of norepinephrine from, as its storage sites. These action results in increased myocardial contraction, CO, and SV as well as increased renal blood flow and sodium excretion. Exert little effects on DBP and induces fewer

replacement.

concentrated solutions with higher doses. 3. Administer using an electronic infusion device. Carefully reconstitute and calculate dosage. 4. When discontinuing, gradually decrease dose, sudden cessation may cause marked hypotension. 5.Monitor VS, I&O, and ECG; titrate infusion to maintain SBP as ordered. 6. Be prepared to monitor CVP and PAWP. Report ectopy, palpitations, anginal pain, or vasoconstriction.

7. Explain to the family that drug administered IV to improve cardiac function thus increasing BP and improving urine output. 8. Report any chest pain, increase SOB, headaches, or IV site pain.

Type of solution D5NSS

Classification Hypertonic

Content Each 1000 mL contains 1000mg of Sodium Chloride Osmolarity: 500 mOsm/L Electrolytes in 1000 mL: Sodium 354 mmol Chloride 354 mmol

Mechanism of action The solution has a higher sodium concentration than to the intracellular area thus by virtue of osmosis the water is taken out of the cell the cell shrinks. This increases the plasma volume of the blood.

Indications Rehydrate; has free water, salt and calories

Contraindications Contraindicated in patients with conditions in which sodium chloride administration is detrimental. >contraindicated in patients with with increased, normal, or only slightly decreased electrolyte levels.

How supplied I.V. 1 liter

Dosage IVF D5NSS 1 liter @ 30 gtts/min

Nursing Responsibilities 1. Monitor electrolyte levels (Lippincott Williams & Wilkins: 2005, 879). 2. Explain use and Administration of drug to patient and family (Lippincott Williams & Wilkins: 2005, 879). 3.Tell Patient to report adverse reactions promptly (Lippincott Williams & Wilkins: 2005, 879). 4.Regulate flow rate as ordered (Lippincott Williams & Wilkins: 2005, 879). 6.Check on skin integrity for redness, edema, swelling and

pain (Lippincott