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Name of Patient: Adelina reotutar DX: squamous cell carcinoma well differentiated supra glottis Stages 4 A.

DRUG Sodium chloride Dosages 1 tab TID x 5 day 8-1-6

CLASSIFICAT ION Electrolyte

ACTION Sodium is the major cation of the bodys extracellular fluid. It plays a crucial role in maintaining the fluid and electrolyte balance. Excess retention of sodium results in overhydration (edema, hypervolemia), which is often treated with diuretics. Abnormally low levels of sodium result in dehydration. Normally, the plasma contains 136-145 mEq/L and 98-1-6 mEq chloride/L. the average daily requirement of salt is approximately 5g.

INDICATION -Prophylaxis of heat prostration - Muscle cramps; -Chloride deficiency due to dieresis or salt restrictions; -Prevention or treatment of extracellular volume depletion

CONTRAINDICA TION -Congestive heart failure - Severely impaired -Renal function

ADVERSE EFFECT Hypernatremia Hypopotassem ia -Acidosis

NURSING CONSIDERATIONS -Monitor electrolytes, ECG, liver and renal function studies. -Note level of consciousness. -Assess the heart and lung sounds. -Observe S&S of hypernatremia, flushed skin, elevated temperature, rough dry tongue, and edema. -Monitor VS and I & O.

-Hypernatremia -Fluid retention -Fluid and solute overload leading to dilution of serum electrolyte level -CHF -Overhydration -Acute pulmonary edema

-Assess urine specific gravity and serum sodium levels

DRUG Ferrous sulfate Brand name: Feosol Dosages: 1 tab BID (8am-6pm)

CLASSIFICAT ION Essential Minerals/ Iron Preparation

ACTION Elevates the serum iron concentration which then helps to form High or trapped in the reticuloendotheli al cells for storage and eventual conversion to a usable form of iron.

INDICATION -Prevention and treatment of iron deficiency anemias. - Dietary supplement for iron.

CONTRAINDICA TION - Hypersensitivity - Severe hypotension. -In patients with Hemosiderosis -Peptic ulceration -Ulcerative colitis, or regional enteritis -Receiving repeated blood transfusions

ADVERSE EFFECT GI: nausea, epigastric pain, vomiting, constipation, black stools, diarrhea, anorexia Other: -Temporarily stained teeth from liquid forms -Dizziness -Nasal Congestion - Dyspnea - Hypotension - Muscle cramps - Flushing

NURSING CONSIDERATIONS - Advice patient to take medicine as prescribed. -Caution patient to make position changes slowly to minimize orhtostatic hypotension. - Instruct patient to avoid concurrent use of alcohol or OTC medicine without consulting the physician. -Advise patient to consult physician if irregular heartbeat, dyspnea, swelling of hands and feet and hypotension occurs. - Inform patient that angina attacks may occur 30 min. after administration due reflex tachycardia. - Encourage patient to comply with additional

intervention for hypertension like proper diet, regular exercise, lifestyle changes and stress management.

DRUG Celecoxi b

CLASSIFICATI ON -NSAID -Analgesic (nonopioid)

ACTION Exhibits anti inflammatory, analgesic, and antipyretic action due to inhibition of the enzyme COX-2

INDICATION -Acute and long-term treatment of signs and symptoms of rheumatoid arthritis and osteoarthritis -Reduction of the number of colorectal polyps infamilial adenomatous polyposis (FAP) -Management of acute pain -Treatment of primary dysmenorrhea l -Relief of signs and symptoms of anklylosingsp ondylitis -Relief of signs and symptoms of juvenile rheumatoid arthritis

CONTRAINDICA TION -Hypersensitivity to drug, sulfonamides, or other NSAIDs - Severe hepatic Impairment - Severe heartfailure -Inflammatory bowel disease -Peptic ulcer - History of asthma or urticaria -Advanced Renal disease

Brand name: Celebrex Dosages: 200mg /cup BID,PRN

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ADVERSE EFFECT CNS: dizziness, drowsiness, headache, insomnia, fatigue CV: peripheral edema EENT: , tinnitus, pharyngitis, rhinitis, sinusitis GI: nausea, diarrhea, constipation, abdominalpa in, dyspepsia, flatulence, dry mouth, GI bleeding GU: menorrhagia Hematologi c: decreased hemoglobin or hematocrit, eosinophilia, epistaxis,

NURSING CONSIDERATIONS Before: - Assess pts history of allergic reaction to the drug - Monitor complete blood count, Electrolyte levels, creatinine clearance, and occult fecal blood test and liver function test results every 6 to 12 months During: - Instruct patient to take drug with food or milk. - Teach patient to avoid aspirin and other NSAIDs (such as ibuprofen and naproxen) during therapy. After: - Advise patient to immediately report bloody stools, blood in vomit, or signs or symptoms of liver damage (nausea, fatigue, lethargy, pruritus, yellowing of eyes or skin, tenderness on Upper right side of abdomen, or flulike symptoms).

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DRUG

CLASSIFICAT ION

ACTION

INDICATION

CONTRAINDICA ADVERSE TION EFFECT

NURSING CONSIDERATIONS

Generic: Paracetamol Brand: Tylenol Dosages; Adults and children 5001000 mg orally every 4-6 hours.

-Analgesics (Nonopioid) -Antipyretics

Paracetamol may cause analgesia by inhibiting CNS prostaglandin synthesis. The mechanism of morphine is believed to involve decreased permeability of the cell membrane to sodium, which results in diminished transmission of pain impulses therefore analgesia.

-Temporary relief of pain and discomfort from headache, fever, cold, flu, minor muscular aches, overexertion, menstrual cramps, toothache, minor arthritic pain. - Analgesicantipyretic inpatients with aspirin allergy, hemostatic disturbances, bleeding diatheses, upper GI disease - Prophylactic for children receiving DPT vaccination to reduce incidence of fever and pain

-Contraindicated in patients hypersensitive to drug. -Use cautiously in patients with long term alcohol use.

CNS: Agitation, anxiety behavioral changes,confus ion, dizziness,insom nia. GI: Abdominal pain, diarrhea, enterocolitis, gastritis, glossitis, indigestion,nau sea. Hematologic: Agranulocytosi s, anemia, eosinophilia, leucopenia. Other: Hypersensitivit y reactions, angioedema, pruritus, rash, urticaria. Hematologic: hemolytic anemia, neutropenia, leucopenia, pancytopenia. Hepatic: Jaundice Metabolic: Hypoglycemia

- Assess patients pain or temperature before therapy and regularly thereafter. -Asses patients drug history and calculate total daily dosage accordingly. -Be alert for signs of reactions and drug interactions. -Monitor liver function studies, renal function studies and blood studies if patient is on long-term therapy. -Check I&O ratio - Assess for fever and pain -Assess hepatotoxicity: dark urine, clay-colored stools -Assess allergic reactions: rash, urticaria

Skin: rash.

DRUG Acetylcysteine Brand name: Mucomyst Fluimucil Dosages; 60gm dissolved in glass H2o 8pm in @hs night

CLASSIFICA TION Miscellaneous respiratory tract drugs/ Mucolytic

ACTION Mucolytic that reduces the viscosity of pulmonary secretions by splitting disulfide linkages between mucoprotein molecular complexes. Also, restores liver stores of glutathione to treat acetaminophen toxicity.

INDICATION Adjunct therapy for abnormal viscid or thickened mucous secretions in patients with pneumonia, bronchitis, bronchiectasis, primary amyloidosis of the lung, tuberculosis, cysticfibrosis, emphysema, atelectasis, - pulmonary complications of thoracic surgery, or CVsurgery

CONTRAINDICA TION -Contraindicated in patients hypersensitive to drug. -Use cautiously in elderly or debilitated patients with severe respiratory insufficiency. -Use I.V. formulation cautiously in patients with asthma or a history of bronchospasm. -Severe hypertension; -Severe. Coronary artery disease -Renal impairment.

ADVERSE EFFECT CNS: fever, drowsiness, abnormal thinking, gait disturbances CV: tachycardia, hypotension, hypertension, flushing, chest tightness EENT: rhinorrhea, ear pain, eye pain, pharyngitis, throat tightness GI: stomatitis, nausea, vomiting Respiratory: rhonchi, bronchospasm, cough, dyspnea Skin: rash, clamminess, diaphoresis, pruritus, urticaria Other: angioedema, chills, anaphylactoid reaction

NURSING CONSIDERATIONS -Use plastic, glass, stainless steel, or another nonreactive metal when giving by nebulization. -Hand-bulb nebulizers arent recommended because output is too small and particle size too large. -Drug is physically or chemically incompatible with tetracyclines, erythromycin lactobionate,amphotericin B, and ampicillin sodium. -If given by aerosol inhalation, nebulize these drugs. - Monitor effectiveness of therapy and advent of adverse/allergic effects. -Instruct patient in appropriate use and adverse effects to report.

DRUG Levothyroxine sodium

CLASSIFICA TION Thyroid hormone

ACTION Increases the metabolic rate of body tissues, thereby increasing oxygen consumption; respiration and heart rate; rate of fat, protein, and carbohydrate metabolism; and growth and maturation.

INDICATION -Replacement therapy in hypothyroidis m -Pituitary TSH suppression in the treatment - Prevention of euthyroid goiters -Management of thyroid cancer -Thyrotoxicosis in conjunction with antithyroid drugs - To prevent goitrogenesis, hypothyroidis m, and thyrotoxicosis during pregnancy

CONTRAINDICA TION -Contraindicated with allergy to active or extraneous constituents of drug, thyrotoxicosis, and acute MI uncomplicated by hypothyroidism. -Use cautiously with Addison's disease (treat hypoadrenalism with corticosteroids before thyroid therapy), lactation, patients with coronary artery disease or angina.

ADVERSE EFFECT CNS: Tremors, headache, nervousness, insomnia CV: Palpitations, tachycardia, angina, cardiac arrest Dermatologic: Allergic skin reactions, partial loss of hair in first few months of therapy in children GI: Diarrhea, nausea, vomiting

NURSING CONSIDERATIONS -Monitor response carefully at start of therapy, adjust dosage. Full therapeutic effect may not be seen for several days. - Do not change brands of T4 products, due to possible bioequivalence problems. - Do not add IV doses to other IV fluids. - Use caution in patients with CV disease. - Administer oral drug as a single daily dose before breakfast. - Arrange for regular, periodic blood tests of thyroid function. - For children and other patients who cannot swallow tablets, crush and suspend in a small amount of water or formula, or sprinkle over soft food. Take immediately.

DRUG GENERIC NAME: Ipratropium+ salbutamol TRADE NAME: (Combivent)

CLASSIFICA TION Classification: Anticholinergi c

ACTION The ipratropium ingredient is an anticholinergic drug which relaxes smooth muscle in the lung. The salbutamol ingredient is a beta-2agonist whichstimulat esbeta-2 sites in the lungs to relax the bronchi. TE: Relieves bronchospasm s.

INDICATION -To relieve bronchospasm s and open airways. Bronchodilator for maintenance therapy of bronchospasm

CONTRAINDICA TION Contraindicated with hypersensitivity to atropine or its derivatives

ADVERSE EFFECT CNS: dizziness, blurred vision GI: nausea, drymouth Respiratory: dyspnea, bronchospasms , horseness CV: palpitations, chest pain

- Most CV and CNS adverse effects indicate that the dose is too high. Stop drug for several days and reinstitute at a lower dose NURSING CONSIDERATIONS -Monitor the patients vital signs, noting hypotension and an irregular or abnormal pulse. -Maintain a quiet, comfortable environment to minimize anxiety and perhaps decrease palpitations. - Teach the patient pursed lip breathing, diaphragmatic breathing, and chest splinting.

Dosages: Nebulizer Q8

DRUG GENERIC NAME: CALCITRIOL ORAL (KAL-siTRYE-ol) BRAND NAME(S): Rocaltrol Dosages: 0.25 OD 1tab *am

CLASSIFICA TION

ACTION Supply of vitamin D depends mainly on exposure to UV rays of the sun for conversion of 7dehydrocholes terol in the skin to vitamin D3 (cholecalcifero l). Vitamin D 3 is activated in the liver and kidney before fully active as a regulator of calcium and phosphorus metabolism at target tissues. The mechanism of action in the treatment of

INDICATION -Hypocalcemia and resultant metabolic bone disease in patients on chronic renal dialysis. hyperparathyr oidism and resultant metabolic bone disease in patients with moderate to severe chronic renal failure .

CONTRAINDICA TION -Hypercalcemia or patients with vitamin D toxicity -Hypersensitivity to any component of this product.

ADVERSE EFFECT -Psoriasis , pruritus ,acute blistering dermatitis, erythema, skin burning sensations, skin discomfort -Elevated serum creatinine levels. -Urine abnormality -Hypercalciuria -Hypercalcemia -Skin discomfort

NURSING CONSIDERATIONS ORAL: -Administer prescribed dose without regard to meals, but administer with food if GI upset occurs. -Administer dose in the morning to patient with hypoparathyroidism. -Administer prescribed dose of oral solution using disposable graduated oral dispensers supplied with medication. Injection: -For IV bolus injection only. Do not administer if particulate matter,

psoriasis has not been established.

cloudiness, or discoloration noted. -Discard any unused solution. Do not save for future use. Ointment -The topical ointment should not be applied to the eyes, lips, or face. -Not for oral, opthalmic, or intravaginal use.

DRUG Calcium Carbonate (Caltrate Plus) 1 tab TID

CLASSIFICA TION Calcium salt

ACTION Reduces total acid load in GI tract, elevates gastric pH to reduce pepsin activity, strengthens gastric mucosal barrier, and increases esophageal sphincter tone

INDICATION Acid indigestion, calcium supplement

CONTRAINDICA TION -Contraindicated in patients with ventricular fibrillation or hypercalcemia-Use cautiously, if at all, if patients takes a cardiacglycoside or has sarcoidosis or renal or cardiac disease

ADVERSE EFFECT -Headache -irritability,

NURSING CONSIDERATIONS -Record amount and consistency of stools -Monitor calcium level

-weakness -nausea -constipation -flatulence -Watch out for evidence of hyercalcemia (NV,headache, confusion and anorexia)