MEDICATIONS Patient D.G.

Name of medication: Ciproflaxacin 1. Classification of medication anti-infective 2. Reason why the medication was ordered intraabdominal infection 3. When it will be administered 9:00 AM 4. Teaching what needs to be done relative to the medication Evenly spaced administration times and complete therapy as directed. Should not be taking with antacids. 5. Any special instructions regarding administration of this medication (nursing) Administer 2 hours before or after antacids and calcium, iron, zinc, magnesium, or aluminum containing products

Name of medication: Docusate Sodium 1. Classification of medication laxative 2. Reason why the medication was ordered prevent constipation 3. When it will be administered 9:00 AM 4. Teaching what needs to be done relative to the medication Should be used on a short-term basis, long term may cause dependency and electrolyte imbalance. Use not recommended with

abdominal pain, nausea,

vomiting , or fever present

5. Any special instructions regarding administration of this medication (nursing) N/A

Name of medication: Mesalamine 1. Classification of medication Gastrointestinal ani-inflammatory 2. Reason why the medication was ordered Maintanence of remission of ulcerative colitis 3. When it will be administered 9:00 AM 4. Teaching what needs to be done relative to the medication May cause dizziness 5. Any special instructions regarding administration of this medication (nursing) Do not coadminister with antacids

Name of medication: Rifaximin 1. Classification of medication anti-infective 2. Reason why the medication was ordered reduce risk of overt hepatic encephalopathy recurrence 3. When it will be administered 9:00 AM 4. Teaching what needs to be done relative to the medication Adherence to complete therapy per orders. Drug may cause

dizziness 5. Any special instructions regarding administration of this medication (nursing) N/A

Name of medication: Spironolactone 1. Classification of medication Potassium sparing diuretic 2. Reason why the medication was ordered Manage edema 3. When it will be administered 9:00 AM 4. Teaching what needs to be done relative to the medication Avoid use of salt substitutes, should be taken at the same time and adhered til therapy is complete 5. Any special instructions regarding administration of this medication (nursing) Administer in the AM

Name of medication: Lactulose 1. Classification of medication Laxative 2. Reason why the medication was ordered Adjunct in the management of hepatic encephalopathy 3. When it will be administered 9:00 AM 4. Teaching what needs to be done relative to the medication

Encourage additional forms of bowel regulation 5. Any special instructions regarding administration of this medication (nursing) Can be mixed with water, juice, or milk to improve taste

Name of medication: Pantoprazole 1. Classification of medication Antiulcer agent 2. Reason why the medication was ordered Decrease relapse rates of daytime and nightime heartburn symptoms 3. When it will be administered Before breakfast 4. Teaching what needs to be done relative to the medication Administer full course of therapy. Avoid GI irritants and report black, tarry stool, diarrhea, and abdominal pain 5. Any special instructions regarding administration of this medication (nursing) Should not be broken, crushed, or chewed

WHICH MEDICATION IS IMPORTANT TO GIVE ON TIME? Ciproflaxacin and Rifaximin WHICH MEDICATION CAN BE GIVEN TOWARD THE END OF THE WINDOW OF TIME AND STILL BE GIVEN "AT THE RIGHT TIME" WITHOUT ADVERSE EFFECTS? Lactulose and Docusate Sodium MEDICATIONS ADMINISTERED AT OTHER TIMES: Clonidine WHAT OTHER MEDICATIONS ARE PRESCRIBED FOR THE PATIENT THAT WERE ADMINISTERED ON THE PREVIOUS SHIFT OR WILL BE ADMINISTERED ON THE NEXT SHIFT?

Fluticasone Nasal Spray and Sodium Chloride Nasal Spray HOW WILL THOSE MEDICATIONS AFFECT THE PATIENT ASSESSMENTS AND THE CARE YOU WILL BE GIVING THIS SHIFT? Assess for signs and symptoms of hypersensitivity reactions (rash, pruritis, swelling of face and neck, dyspnea)

Patient S.S.
Name of medication: Enoxaparin (Lovenox) 1. Classification of medication Anticoagulant 2. Reason why the medication was ordered Prevent deep vein thrombosis and/or pulmonary embolism 3. When it will be administered 9:00 AM 4. Teaching what needs to be done relative to the medication Not to be taken in conjunction with aspirin, naproxen or ibuprofen. Unusual bleeding or bruising, dizziness, itching, rash, fever, swelling, or dyspnea should be reported 5. Any special instructions regarding administration of this medication (nursing) Rotate administration sites frequently

Name of medication: Famotidine 1. Classification of medication antiulcer agent 2. Reason why the medication was ordered Treat heartburn, acid indigestion, or sour stomach 3. When it will be administered 9:00 AM

4. Teaching what needs to be done relative to the medication Administer full course of therapy. Alcohol, aspirin, NSAIDS, or other gastric irritants should be avoided. Smoking should be avoided because it intefers with absorption. 5. Any special instructions regarding administration of this medication (nursing) To prolong effect administer with meals and at bedtime

Name of medication: Insulin 1. Classification of medication Antibiabetic 2. Reason why the medication was ordered Control hyperglycemia 3. When it will be administered PRN every 6 hours 4. Teaching what needs to be done relative to the medication Instruct patient on signs and symptoms of hypoglycemia and hyperglycemia and what to do if they occur. 5. Any special instructions regarding administration of this medication (nursing) Rotate injection sites. Administer into abdominal wall, thigh, or upper arm subcutaneously Insulins are available in different types and strengths. Check type, dose, and expiration date with another licensed nurse. Do not interchange insulins without consulting physician or other health care professional. Use only insulin syringes to draw up dose. The unit markings on the insulin syringe must match the insulin's units/mL. Name of medication: Nicotine Transdermal Patch 1. Classification of medication Smoking deterrents 2. Reason why the medication was ordered

management of nicotine withdrawal in patients desiring to give up cigarette smoking 3. When it will be administered 9:00 AM 4. Teaching what needs to be done relative to the medication Advise patient that redness, itching, and burning at application site usually subside within 1 hr. Instruct patient to notify health care professional and not apply new patch if signs of allergic reaction (urticaria, generalized rash, hives) or persistent local skin reactions (severe erythema, pruritus, edema) occur 5. Any special instructions regarding administration of this medication (nursing) Apply patch at the same time each day. Keep patch in sealed pouch until ready to apply. Apply to clean, dry skin of upper arm or torso free of oil, hair, scars, cuts, burns, or irritation. Press patch firmly in place with palm for 10 sec, making sure there is good contact, especially around the edges. Keep patch in place during showering, bathing, or swimming; replace patches that have fallen off. Wash hands with soap and water after handling patches. Do not trim or cut patch. No more than one patch should be worn at a time. Alternate application sites. Dispose of used patches by folding adhesive sides together and replacing in protective pouch or aluminum foil; keep out of reach of children

Name of medication: HydroMORPHONE 1. Classification of medication opiod analgesic 2. Reason why the medication was ordered Moderate to severe pain management 3. When it will be administered Every 4 hours PRN 4. Teaching what needs to be done relative to the medication Advise patient to change positions slowly to minimize

orthostatic hypotension. Instruct patient to avoid concurrent use of alcohol or other CNS depressants. Encourage patient to turn, cough, and breathe deeply every 2 hr to prevent atelectasis. 5. Any special instructions regarding administration of this medication (nursing) Administer slowly, at a rate not to exceed 2 mg over 35 min. High Alert: Rapid administration may lead to increased respiratory depression, hypotension, and circulatory collapse. Name of medication: metroNIDAZOLE 1. Classification of medication anti-infectives 2. Reason why the medication was ordered Treatment of Intra-abdominal infections 3. When it will be administered 9:00 AM 4. Teaching what needs to be done relative to the medication Caution patient to avoid intake of alcoholic beverages or preparations containing alcohol during and for at least 3 days after treatment with metronidazole. May cause a disulfiram-like reaction (flushing, nausea, vomiting, headache, abdominal cramps).Instruct patient to take medication as directed with evenly spaced times between doses, even if feeling better. Do not skip doses or double up on missed doses. 5. Any special instructions regarding administration of this medication (nursing) Monitor neurologic status during and after IV infusions. Inform health care professional if numbness, paresthesia, weakness, ataxia, or seizures occur.Assess for signs of infection.

Name of medication: Ertapenem 1. Classification of medication anti-infective

2. Reason why the medication was ordered Treat complicated intra-abdominal infection 3. When it will be administered 9:00 AM 4.Teaching what needs to be done relative to the medication Advise patient to report the signs of superinfection (black, furry overgrowth on the ongue; vaginal itching or discharge; loose or foul-smelling stools) and allergy. caution patient to notify if fever and diarrhea occur especially if stool contains blood, pus, or mucus. 5. Any special instructions regarding administration of this medication (nursing) Observe patient for signs and symptoms of anaphylaxis. Assess for infection WHICH MEDICATION IS IMPORTANT TO GIVE ON TIME? Insulin, Metronidazole, and Ertapenem WHICH MEDICATION CAN BE GIVEN TOWARD THE END OF THE WINDOW OF TIME AND STILL BE GIVEN "AT THE RIGHT TIME" WITHOUT ADVERSE EFFECTS? Famotidine MEDICATIONS ADMINISTERED AT OTHER TIMES: Ondansetron WHAT OTHER MEDICATIONS ARE PRESCRIBED FOR THE PATIENT THAT WERE ADMINISTERED ON THE PREVIOUS SHIFT OR WILL BE ADMINISTERED ON THE NEXT SHIFT? N/A HOW WILL THOSE MEDICATIONS AFFECT THE PATIENT ASSESSMENTS AND THE CARE YOU WILL BE GIVING THIS SHIFT? N/A

Patient M.M.
Name of medication: Enoxaparin (Lovenox)

1. Classification of medication Anticoagulant 2. Reason why the medication was ordered Prevent deep vein thrombosis and/or pulmonary embolism 3. When it will be administered 9:00 AM 4. Teaching what needs to be done relative to the medication Not to be taken in conjunction with aspirin, naproxen or ibuprofen. Unusual bleeding or bruising, dizziness, itching, rash, fever, swelling, or dyspnea should be reported 5. Any special instructions regarding administration of this medication (nursing) Rotate administration sites frequently

Name of medication: Acetaminophen 1. Classification of medication Nonopiod analgesic 2. Reason why the medication was ordered Mild pain treatment 3. When it will be administered Every 4 hours PRN for pain 4. Teaching what needs to be done relative to the medication Avoid alcohol, should not be taken longer than 10 days and not to excess daily recommended 4g/day 5. Any special instructions regarding administration of this medication (nursing) Do not exceed recommended 4g in a day

Name of medication: Oxycodone/Acetaminophen (Percocet) 1. Classification of medication Opiod analgesic 2. Reason why the medication was ordered For moderate to severe pain 3. When it will be administered Every 4 hours PRN for pain 4. Teaching what needs to be done relative to the medication Avoid concurrent use of alcohol and CNS depressants. Encourage turn, cough, and deep breathing ever 2 hours to prevent atelectasis 5. Any special instructions regarding administration of this medication (nursing) Administer with food or milk to minimize GI irritation

Name of medication: Docusate Sodium 1. Classification of medication laxative 2. Reason why the medication was ordered prevent constipation 3. When it will be administered 9:00 AM 4. Teaching what needs to be done relative to the medication Should be used on a short-term basis, long term may cause dependency and electrolyte imbalance. Use not recommended with abdominal pain, nausea, vomiting , or fever present 5. Any special instructions regarding administration of this medication (nursing) N/A

Name of medication: Magnesium Hydroxide 1. Classification of medication Antiulcer agent 2. Reason why the medication was ordered Indigestion 3. When it will be administered 9:00 AM 4. Teaching what needs to be done relative to the medication Not recommended to be administered within two hours of other medications 5. Any special instructions regarding administration of this medication (nursing) Shake suspension well before administration

Name of medication: Methocarbamol 1. Classification of medication Skeletal muscle relaxant 2. Reason why the medication was ordered Adjunctive treatment of muscle spasm associated with acute painful musculoskeletal conditions 3. When it will be administered Every 8 hours IV 4. Teaching what needs to be done relative to the medication Use of CSN depressants and alcohol should be avoided. Urine may turn black, brown, or green. Additional musculoskeletal interventions should be applied and precautions to minimize orthostatic hypotension. 5. Any special instructions regarding administration of this medication

(nursing) Provide safety measures and supervise with ambulation and transfer Name of medication: Famotidine 1. Classification of medication antiulcer agent 2. Reason why the medication was ordered Treat heartburn, acid indigestion, or sour stomach 3. When it will be administered 9:00 AM 4. Teaching what needs to be done relative to the medication Administer full course of therapy. Alcohol, aspirin, NSAIDS, or other gastric irritants should be avoided. Smoking should be avoided because it intefers with absorption. 5. Any special instructions regarding administration of this medication (nursing) To prolong effect administer with meals and at bedtime

WHICH MEDICATION IS IMPORTANT TO GIVE ON TIME? N/A WHICH MEDICATION CAN BE GIVEN TOWARD THE END OF THE WINDOW OF TIME AND STILL BE GIVEN "AT THE RIGHT TIME" WITHOUT ADVERSE EFFECTS? Magnesium Hydroxide and Docuate Sodium MEDICATIONS ADMINISTERED AT OTHER TIMES: N/A WHAT OTHER MEDICATIONS ARE PRESCRIBED FOR THE PATIENT THAT WERE ADMINISTERED ON THE PREVIOUS SHIFT OR WILL BE ADMINISTERED ON THE NEXT SHIFT? Famotidine IV HOW WILL THOSE MEDICATIONS AFFECT THE PATIENT ASSESSMENTS AND

THE CARE YOU WILL BE GIVING THIS SHIFT? I would assess for the common side effect of confusion and for epigastric and bdominal pain

Step 3
Prioritize which patient you should care for first, second, third. Why? Priority #1- Patient 1 D.G.- Patient is on anti-infectives which are important to administer on time and the patient also needs toileting assistance which may place the patient at risk for impaired skin integrity if not addressed in a timely manner Priority #2- Patient 2 S.S.- Patient is also on anti-infectives yet freely ambulates. Insulin can be administered without regard to food tray timing because patient is on TPN and glucose is assessed every 6 hours and glucose is administered if necessary Priority #3- Patient 3 M.M.- Patient is planned for discharged and is on the lower priority, though patient still is exhibiting pain, I assess the situation on a lower level on priority because patient is not incontinent

What are the primary assessments/data collection that should be completed first for each patient? Why? Patient D.G.- Assess fluid status. Due to patient's edema, patient is on restrictive fluids and lasix. It is important to assess fluid status if excess fluid status is indicated. Patient S.S.- Assess risks for malnutrition and related to total parenteral nutrition. Patient may not be recieving adequate nutrion through TPN Patient M.M.- Assessment of pain. Patient is presented with multiple fracturing and trauma causing pain which can effect the patient's ROM and ability to assist in ADLs.

What nursing interventions need to be carried out for each patient?

Patient D.G.- daily weight and input/output, providing perineum care after toileting and applying barrier cream to prevent skin breakdown, vital signs Patient S.S.- Weight patient daily, Monitor Labs and glucose every 6 hours, vital signs Patient M.M.- Patient is to recieve an ordered opiod analgesic, vital signs What interventions will you do first? I would prioritize it by Maslow's hierarchy of needs by providing the perineum care to first because patient is at risk for skin breakdown, then I would assess the nutrional status of the patient S.S., and then give the pain medication to patient M.M. Which of the above interventions can be delegated and to whom? Why? Providing perineum care, weighing, vital signs, and input/output can be delegeted to unlicensed assistive personal because it does not require assessment and is within the scope of skills that can be delegated What information will be given to the person who the task is delegated and what information will be collected after the task is finished? Information on what is to be reported(weight, input/output), description of the activities to be performed, expected obervations, and what needs immediate reporting. I will collect the input/output, weight, and vital signs