Dexamethasone Brand name/s: Decadron ; Dexamethasone Intensol; Dexpak Classification: corticosteroid Indications: reduce incidence of respiratory distress syndrome

in premature infants Mechanism of Action: decreases inflammation by inhibiting the migration of leukocytes and reversal of increased
capillary permeability; it suppresses normal immune response.

Contraindications: Existing gastrointestinal ulceration; Cushing's syndrome; Severe hypertension; Preexisting wide angle glaucoma; active untreated infections

Side Effects: upset stomach, stomach irritation, vomiting, headache, dizziness, insomnia, restlessness,
depression, anxiety, acne, increased hair growth, easy bruising,irregular or absent menstrual periods

Nursing Responsibilities:

Assess patients for signs of adrenal insufficiency (hypotension, weight loos, weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness) before and periodically during therapy. Monitor intake and output ratios and daily weights. Monitor serum electrolytes and glucose.
Observe the patient for peripheral edema, steady weight gain, rales or crackles or dyspnea. Notify the physician immediately if these clinical manifestations are noted. Periodic growth evaluation for children should be done time to time. For patients with cerebral edema, assess then for level of consciousness changes and headache during the therapy. Guaiac-test stools should be carried out. Guaiac-positive stools should be reported to the physician immediately. Administer with meals to minimize GI irritation. For patients with difficulty swallowing, tablets can be crushed and administered with fluids or food. However, capsules should be swallowed whole. Educate the patient to take missed doses as soon as remembered, unless almost time for the next dose skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. Instruct patient to avoid people with known infection and contagious illnesses ascorticosteroids causes immunosuppression and may mask symptoms of infection.

Magnesium Sulfate Brand Names: Epsom Salt Classification: anticonvulsant Indications: preterm labor; treatment of torsade de pointes; preeclampsia Mechanism of Action: Cofactor of many enzyme systemsinvolved in neurochemicaltransmission and muscularexcitability; prevents or controlsseizures by locking theneuromuscular transmission;attracts and retains the water inthe intestinal lumen and distendsthe bowel to promote massmovement and relieveconstipation Contraindications: heart block and myocardial damage Side Effects: weakness, drowsiness, dizziness, fainting, sweating, palpitations, decreased respiratory rate Nursing Responsibilities: Assess for contraindicated conditions. Monitor knee-jerk reflex before repeated parenteral administration. Reserve IV use in eclampsia for life-threatening conditions. Give IM route by deep IM injection. Monitor serum magnesium levels. Do not administer if knee-jerk reflexes are suppressed. Report sweating, flushing. Muscle tremors or twitching, inability to move extremities. Maintain urine output at a level of 100 ml every 4 hours during parenteral administration.