BSN4A (GROUP 2) 29 X.

Drug Study Drug Name Generic: Clonazepam Brand: Rivotril Classification: Anticonvulsant Antiepileptic Dosage Dosage: 0.5 mg per Tablet Frequency: OD Route: Per orem Mechanism of Action Clonazepam exerts its action by binding to the benzodiazepine site of the GABA receptors, which causes an enhancement of the electric effect of GABA binding on neurons, resulting in an increased influx of chloride ions into the neurons. This results in an inhibition of synaptic transmission across the central nervous system. (Pharmacology and the Nursing Process. 4th Ed. 2005. Mosby, Inc. USA) Indication Periodic leg movements during sleep, hypokinetic dysarthria, acute manic episodes, multifocal tic disorders, neuralgias Adverse Reaction Contraindication Contraindicated with hypersensitivity to benzodiazepines, psychoses, acute narrow-angle glaucoma, shock, coma, acute alcoholic intoxication with depression of vital signs. Use cautiously with impaired liver or kidney function, debilitation. Nursing Responsibility Assessment and Drug Effects Hypersensitivity to benzodiazepines; psychoses, acute narrow-angle glaucoma, shock, coma, acute alcoholic intoxication, liver renal impairment Monitor addictionprone patients carefully because of their predisposition to habituation and drug dependence Monitor liver function and blood counts periodically in patients on long tern therapy. Monitor patient for therapeutic drug levels: 20 80 ng/mL.

CNS: transient, mild drowsiness initially; sedation, depression, lethargy, apathy, fatigue, disorientation, anger, hostility, episodes of mania and Used alone or as hypomania, adjunct in treatment restlessness, crying, of Lennox-Gastaut delirium, slurred syndrome (petit mal speech, stupor, vivid variant), akinetic and dreams. myoclonic seizures; may be useful in CV: Bradycardia, patients with absence tachycardia, CV (petit mal) seizures, collapse, treatment of panic hypertension, disorder with or palpitations, edema without agoraphobia Integ: Urticaria, pruritus, rash, dermatitis EENT: Visual and auditory disturbances, diplopia, nystagmus, nasal congestion

BSN4A (GROUP 2) 30 GI: constipation, diarrhea, dry mouth, nausea, anorexia, gastric disorders GU: Incontinence, urinary retention, changes in libido Hema: blood dyscrasias, agranulocytosis, leucopenia Other: hiccups, fever, diaphoresis, paresthesias, gynecomastia. Patient & Family Education Take drug exactly as prescribed; do not take drug without consulting health care provider Avoid alcohol, sleep inducing or over the counter drugs Report severe dizziness, weakness, drowsiness that persists, rash or skin lesions, difficulty voiding, palpitations, swelling in the extremities.

BSN4A (GROUP 2) 31 Drug Name Generic: Polynerv Brand: Vitamin B Complex Classification: Per orem Vitamins and Minerals Dosage Dosage: 500 mg per Tablet Frequency: OD Route: Mechanism of Action A coenzyme that stimulate metabolic function and is needed for cell replication, hematopoiesis, and nucleoprotein and myelin synthesis. Vitamins B1, B6and B12 (Polynerv) oral drops is valuable in conditions where the requirements for B vitamins are increased as in growth, physiologic stress, decreased resistance to infection and chronic illnesses, metabolic disorder sand in certain diseases of the digestive tract and nervous system. (Roth, L.S. (2010). Mosbys Nursing Drug Reference, 23. USA: Mosby, Inc) Indication Rheumatic pains, alcoholism, cardiac disorders, low blood pressure. Contraindication Vitamin B complex should not be used in hypersensitivity to any of the vitamins hypersensitive to vitamin B12 or cobalt, containing in the preparation, as well as in patients with 2nd or 3rd degree arterial hypertension Adverse Reaction CV: peripheral vascular thrombosis, heart failure. GI: transient diarrhea. Respi: pulmonary edema. Skin: itching, transitory exanthema, urticaria. Other: anaphylaxis, pain. Nursing Responsibility Assessment and Drug Effects Determine reticulocyte count, hct, Vit. B12, iron, folate levels before beginning therapy. Obtain a sensitivity test history before administration Avoid I.V. administration because faster systemic elimination will reduce effectiveness of vitamin. Dont give large doses of vitamin B12 routinely; drug is lost through excretion. Protect Vit. B12 from light. Dont refrigerate or freeze. Monitor patient for hypokalemia for first 48 hours, as anemia correct

BSN4A (GROUP 2) 32 itself. Give potassium supplements, as needed.

BSN4A (GROUP 2) 33 Drug Name Generic: Diphenhydramine hydrochloride Brand: ODHS Benadryl Route: Classification: Anticholinergic, Antiparkinsonian drug Per orem Dosage Dosage: 50 mg per capsule Frequency: Mechanism of Action Competes with histamine for H1 receptor site. Antagonizes the effect of histamine at H1 receptor sites; does not bind or inactivate histamine. Prevents, but doesnt reverse, histamine mediated responses particularly those of bronchial tubes, GI tract, and blood vessels (Roth, L.S. (2010). Mosbys Nursing Drug Reference, 23. USA: Mosby, Inc) Indication Pseudoparkinsonism drug-induced extrapyramidal effects Used to treat anxiety, tension, sleeplessness or involuntary movements due to the side effects of certain psychiatric drugs Contraindications Contraindicated in patients with hypersensitivity to drug. Adverse Reaction CNS: drowsiness, confusion, insomnia, headache, vertigo, sedation, sleepiness, nervousness, restlessness Nursing Responsibilities Assessment and Drug Effects When taking these medications, the client needs to have blood cells counts, renal function, hepatic function, and blood pressure monitored. Assess for allergy Patient & Family Education Caution the client that the medication may cause drowsiness, creating difficulties or hazards or other activities that require alertness. Tell the client to take the medication with food to decrease GI upset. Explain to the client that arising quickly from a

Avoid use in patients taking MAO inhibitors CV: Palpitations, hypotension, Caution in patients tachycardia with asthma, COPD, cardiac disease or EENT: hypertension, blurred vision, glaucoma, and nasal gastric or duodenal congestion, ulcers tinnitus

GIT: nausea and vomiting, dry mouth, constipation, anorexia Urogenital: dysurea, urine retention, urinary frequency Hema: hemolytic anemia, thrombocytopenia, agranulocytosis

BSN4A (GROUP 2) 34 Respi: thickening of bronchial secretions Skin: Urticaria, photosensitivity, rash. Other : anaphylactic shock lying or sitting position may cause orthostatic hypotension. Explain to the client that use of these drugs in warm weather may increase the likelihood of heatstroke. Report difficulty of breathing Administer syrup form if patient is unable to take tablets Warn patient not to take this drug with any other products that contain diphenhydramine (including topical therapy) because of increased adverse reactions.

BSN4A (GROUP 2) 35 Drug Name Generic: Ascorbic Acid Brand: Nutri Cee Classification: Vitamins Dosage DOSAGE: 500 mg in tablet form FREQUENCY: OD ROUTE: Per orem Mechanism of Action The chemopreventive action of vitamin C is attributed to two of its functions. It is a water-soluble chain breaking antioxidant. As an antioxidant, it scavenges free radicals and reactive oxygen molecules, which are produced during metabolic pathways of detoxification. It also prevents formation of carcinogens from precursor compounds. The structure of ascorbic acid is reminiscent of glucose, from which it is derived in the majority of mammals (Wolters Kluwer, 2009) Indication Increases protection mechanism of the immune system, thus supporting wound healing. Necessary for wound healing and resistance to infection. Prevention and treatment of vitamin C deficiency Nursing Responsibility Use of sodium GI: Nausea, Assessment & Drug ascorbate in patients vomiting, heartburn, Effects on sodium restriction diarrhea, or Lab tests: abdominal cramps Periodic Hct & (high doses). Hgb, serum Use of calcium electrolytes. ascorbate in patients Hematologic: Acute Monitor for receiving digitalis. hemolytic anemia S&S of acute (patients with hemolytic deficiency of G6PD); anemia, sickle sickle cell crisis. cell crisis. CNS: Headache or insomnia (high doses). Urogenital: Urethritis, dysuria, crystalluria, hyperoxaluria, or hyperuricemia (high doses). Other: Mild soreness at injection site; dizziness and temporary faintness with rapid IV administration. Patient & Family Education Take large doses of vitamin C in divided amounts because the body uses only what is needed at a particular time and excretes the rest in urine. Megadoses can interfere with absorption of vitamin B12. Note: Vitamin C increases the absorption of iron when taken at the Contraindications Adverse Reaction

BSN4A (GROUP 2) 36 same time as ironrich foods.

BSN4A (GROUP 2) 37

BSN4A (GROUP 2) 38 NURSING CARE PLAN # 2 Assessment Data Actual/Abnormal Cues: Difficulty falling asleep at night Clients verbalization hambal sang doctor side effect na kuno sang bulong ko Long hours of sleep at daytime (average of 3-5 hours) Fatigue on awakening Nursing Diagnosis Disturbed sleep pattern related to excessive daytime sleeping secondary to medications as evidenced by difficulty falling asleep at night, long hours of sleep at daytime and fatigue on awakening. Rationale Predisposing factors: History of substance abuse Expected Outcome After 32 hours of nurse-client interaction, the client will be able to: Nursing Intervention Justification Evaluation After 32 hours of nurse-client interaction, the client was able to:

Definition: Disturbed sleep Risk Factors: pattern is the state Side effects of in which an medications individual Environment experiences or is History of at risk of alcoholism experiencing a History of change in the chronic cigarette quantity or quality smoking of his or her rest pattern that causes discomfort or

Precipitating factors: History of alcoholism History of chronic 1. Identify cigarette smoking personal habits Environment that disrupt sleep pattern. Health care intervention Administration of medications Therapeutic Noneffects therapeutic effects Drowsiness and sleepiness during daytime Difficulty sleeping at night time Fatigue upon awakening in the morning Disturbed sleep pattern

1.1 Obtain a sleep1.1 Assessment of wake history sleep behavior including history and patterns are of sleep problems, an important changes in sleep part of any patterns, and use of health status medications and examination. stimulants. 1.2 Assess for use of alcohol or cigarettes prior to use of sleep medication or retiring for the evening. 1.2 Alcohol and nicotine should be avoided for several hours prior to sleep.

1. Goal met. Recognize that before he was admitted, prohibited drugs used to relax him; but now that he is under treatment, the medication he is taking causes him to have sleep disturbance. He verbalized that according to the doctor, what he is experiencing is one of the side effects of his medications. He also added that his cravings for drugs especially at night contribute to his sleep disturbance.

BSN4A (GROUP 2) 39 Strengths: Strong spiritual belief Disciplined Good interpersonal relationship Compliance to treatment regime Willingness to change to improve his health interferes with desired lifestyle. Source: Handbook of Nursing Diagnosis 13 Ed by Moyet pp 446-449 2. Verbalize ways that can help promote his sleeping pattern. 2.1 Initiate nonpharmacologic interventions for improved sleep including: Encourage client to have an increase in sunlight exposure Provide educational interventions to promote beneficial sleep hygiene (Including the impact of substance use on sleep quality, keeping regular waking and sleeping times, avoiding naps, refraining from caffeine, impact of exercise on sleep and environmental 2.1 Nonpharmacologic interventions have been found to improve sleep efficiency and increase satisfaction with sleep pattern while decreasing use of hypnotics. 2. Goal met. State that he usually watches television or have a chit-chat with his roommates to help him fall asleep and lessen the cravings of taking drugs. He added that he would sometimes write anything or read magazines and play with his friends so that he could divert his attention and he will not get sleepy during the day.

Source: Handbook of Nursing Diagnosis 13 Ed by Moyet Pp 446-449

BSN4A (GROUP 2) 40 adjustments to promote sleep) Provide diversional activities to provide stimulation (talking to coresidents, play games) 3. Achieve optimal amounts of sleep as evidenced by verbalization of feeling rested and improved sleeping pattern. 3.1 Evaluate learning outcomes using patient verbalizations of following the treatment recommendations and experiencing enhanced sleep. 3.1 Evaluation serves as an assessment of the effectiveness of care and allows opportunity for adjustments to the plan of care 3. Goal partially met. Verbalize biskan makatulug ko sa aga..makatulug naman ko amatamat kung gabemakapahu way naman ko sang maayo kag ga amat-amat naman dula ang sakit sa kalawasan ko

Source: http://www. pterrywave. com/nursing/ care%20plans/ 51.aspx

BSN4A (GROUP 2) 41 NURSING CARE PLAN # 3 Assessment Data Risk factors: Physical isolation Social isolation Affectional deprivation Substance abuse Strengths: Extrovert personality Good interpersonal relationship Being participative and active during group sessions Good family support Nursing Diagnosis Risk for loneliness related to therapeutic isolation secondary to substance abuse. Rationale Expected Outcome Predisposing factors: After 32 hours of Gender nurse-client interaction, the client Precipitating factors: will be able to: Substance abuse Admission to the 1. Verbalize institution feelings of loneliness and Physical isolation express desire to socialize more. Social isolation Impaired social interaction Definition: Risk for Loneliness Affectional The state in which an deprivation individual is at risk for experiencing Risk for loneliness discomfort associated with a desire or need for contact with others. Nursing Intervention Justification Evaluation After 32 hours of nurse-client interaction, the client was able to: 1. Goal met. Verbalize,Nasub on ko di kay wala kami di masyado may ginahimo, lalo na bi kung wala kamo, subo gid ya eh! Sadya kung ari kamo di kag kung wala na kami himo-on ga lantaw kami tv or ga hampang diri sa may polan.

1.1 Work with the 1.1 To begin patient to identify changing factors and behaviors that behaviors that may have have contributed alienated others. to loneliness. 1.2 Help client identify feelings associated with loneliness. 1.2 This lessens the impact of feelings and mobilizes energy to counteract them. 1.3 To establish a trusting relationship.

1.3 Spend sufficient time with the patient to allow him to express his feelings. 1.4 Encourage client to address his needs assertively.

Source: Handbook of Nursing Diagnosis 13 Ed by Moyet

Source: Handbook of Nursing Diagnosis 13 Ed by Moyet Pp 273-277

1.4 By being assertive, client assumes responsibility for meeting his

BSN4A (GROUP 2) 42 Pp 273-277 needs without anger or guilt. 2. Identify people who will likely support and accept him. 2.1 Inform client that assistance is available to help him express feelings of loneliness and identify ways to increase social activity. 2.2 Help client curb feelings of loneliness by encouraging oneon-one interaction with others who are likely to accept him. 2.1 To bring issue into open and help client understand that you want to help him. 2. Goal met. State kung daw ka subo na gid, ga isturya na lang ko sa mga upod ko lalo na kay JR kay migo ko na siya di. Dayun ga pasalamat man ko kay ginadu-aw ko di kag ginasuportahan ko sang akun amay kag iloy kag kung kis-a upod man nila ang bata ko. Masadyahan naman ko na dayun kay maisturya ko sila kag makamusta man. Ga pasalamat man ko kay ari kamo di para may ma isturya man ko. 3. Goal met. Encourage his colleagues to join

2.2 To promote feelings of acceptance and support.

3. Formulate plans on how to comfortably

3.1 As clients comfort level improves,

3.1 To promote the use of social skills.

BSN4A (GROUP 2) 43 interact with peers and on how to continue involvement with others through recreational activities or social interaction groups. encourage him to attend to group activities and social functions. 3.2 Refer client and family to social service agencies, mental health center and appropriate support groups. 3.2 To ensure continued care and maintain social involvement. the morning worship and join the activities lead by the students. Also, he always try to play with his colleagues so as to maintain his good interpersonal relationship with them.

Source: http://nandanursing diagnosis.org/ nursing-diagnosisrisk-loneliness/

BSN4A (GROUP 2) 44 X. Drug Study Drug Name Generic: Clonazepam Brand: Rivotril Classification: Anticonvulsant Antiepileptic Dosage Dosage: 0.5 mg per Tablet Frequency: OD Route: Per orem Mechanism of Action Clonazepam exerts its action by binding to the benzodiazepine site of the GABA receptors, which causes an enhancement of the electric effect of GABA binding on neurons, resulting in an increased influx of chloride ions into the neurons. This results in an inhibition of synaptic transmission across the central nervous system. (Pharmacology and the Nursing Process. 4th Ed. 2005. Mosby, Inc. USA) Indication Periodic leg movements during sleep, hypokinetic dysarthria, acute manic episodes, multifocal tic disorders, neuralgias Adverse Reaction Contraindication Contraindicated with hypersensitivity to benzodiazepines, psychoses, acute narrow-angle glaucoma, shock, coma, acute alcoholic intoxication with depression of vital signs. Use cautiously with impaired liver or kidney function, debilitation. Nursing Responsibility Assessment and Drug Effects Hypersensitivity to benzodiazepines; psychoses, acute narrow-angle glaucoma, shock, coma, acute alcoholic intoxication, liver renal impairment Monitor addictionprone patients carefully because of their predisposition to habituation and drug dependence Monitor liver function and blood counts periodically in patients on long tern therapy. Monitor patient for therapeutic drug levels: 20 80 ng/mL.

CNS: transient, mild drowsiness initially; sedation, depression, lethargy, apathy, fatigue, disorientation, anger, hostility, episodes of mania and Used alone or as hypomania, adjunct in treatment restlessness, crying, of Lennox-Gastaut delirium, slurred syndrome (petit mal speech, stupor, vivid variant), akinetic and dreams. myoclonic seizures; may be useful in CV: Bradycardia, patients with absence tachycardia, CV (petit mal) seizures, collapse, treatment of panic hypertension, disorder with or palpitations, edema without agoraphobia Integ: Urticaria, pruritus, rash, dermatitis EENT: Visual and auditory disturbances, diplopia, nystagmus, nasal congestion

BSN4A (GROUP 2) 45 GI: constipation, diarrhea, dry mouth, nausea, anorexia, gastric disorders GU: Incontinence, urinary retention, changes in libido Hema: blood dyscrasias, agranulocytosis, leucopenia Other: hiccups, fever, diaphoresis, paresthesias, gynecomastia. Patient & Family Education Take drug exactly as prescribed; do not take drug without consulting health care provider Avoid alcohol, sleep inducing or over the counter drugs Report severe dizziness, weakness, drowsiness that persists, rash or skin lesions, difficulty voiding, palpitations, swelling in the extremities.

BSN4A (GROUP 2) 46 Drug Name Generic: Polynerv Brand: Vitamin B Complex Classification: Per orem Vitamins and Minerals Dosage Dosage: 500 mg per Tablet Frequency: OD Route: Mechanism of Action A coenzyme that stimulate metabolic function and is needed for cell replication, hematopoiesis, and nucleoprotein and myelin synthesis. Vitamins B1, B6and B12 (Polynerv) oral drops is valuable in conditions where the requirements for B vitamins are increased as in growth, physiologic stress, decreased resistance to infection and chronic illnesses, metabolic disorder sand in certain diseases of the digestive tract and nervous system. (Roth, L.S. (2010). Mosbys Nursing Drug Reference, 23. USA: Mosby, Inc) Indication Rheumatic pains, alcoholism, cardiac disorders, low blood pressure. Contraindication Vitamin B complex should not be used in hypersensitivity to any of the vitamins hypersensitive to vitamin B12 or cobalt, containing in the preparation, as well as in patients with 2nd or 3rd degree arterial hypertension Adverse Reaction CV: peripheral vascular thrombosis, heart failure. GI: transient diarrhea. Respi: pulmonary edema. Skin: itching, transitory exanthema, urticaria. Other: anaphylaxis, pain. Nursing Responsibility Assessment and Drug Effects Determine reticulocyte count, hct, Vit. B12, iron, folate levels before beginning therapy. Obtain a sensitivity test history before administration Avoid I.V. administration because faster systemic elimination will reduce effectiveness of vitamin. Dont give large doses of vitamin B12 routinely; drug is lost through excretion. Protect Vit. B12 from light. Dont refrigerate or freeze. Monitor patient for hypokalemia for first 48 hours, as anemia correct

BSN4A (GROUP 2) 47 itself. Give potassium supplements, as needed.

BSN4A (GROUP 2) 48 Drug Name Generic: Diphenhydramine hydrochloride Brand: ODHS Benadryl Route: Classification: Anticholinergic, Antiparkinsonian drug Per orem Dosage Dosage: 50 mg per capsule Frequency: Mechanism of Action Competes with histamine for H1 receptor site. Antagonizes the effect of histamine at H1 receptor sites; does not bind or inactivate histamine. Prevents, but doesnt reverse, histamine mediated responses particularly those of bronchial tubes, GI tract, and blood vessels (Roth, L.S. (2010). Mosbys Nursing Drug Reference, 23. USA: Mosby, Inc) Indication Pseudoparkinsonism drug-induced extrapyramidal effects Used to treat anxiety, tension, sleeplessness or involuntary movements due to the side effects of certain psychiatric drugs Contraindications Contraindicated in patients with hypersensitivity to drug. Adverse Reaction CNS: drowsiness, confusion, insomnia, headache, vertigo, sedation, sleepiness, nervousness, restlessness Nursing Responsibilities Assessment and Drug Effects When taking these medications, the client needs to have blood cells counts, renal function, hepatic function, and blood pressure monitored. Assess for allergy Patient & Family Education Caution the client that the medication may cause drowsiness, creating difficulties or hazards or other activities that require alertness. Tell the client to take the medication with food to decrease GI upset. Explain to the client that arising quickly from a

Avoid use in patients taking MAO inhibitors CV: Palpitations, hypotension, Caution in patients tachycardia with asthma, COPD, cardiac disease or EENT: hypertension, blurred vision, glaucoma, and nasal gastric or duodenal congestion, ulcers tinnitus

GIT: nausea and vomiting, dry mouth, constipation, anorexia Urogenital: dysurea, urine retention, urinary frequency Hema: hemolytic anemia, thrombocytopenia, agranulocytosis

BSN4A (GROUP 2) 49 Respi: thickening of bronchial secretions Skin: Urticaria, photosensitivity, rash. Other : anaphylactic shock lying or sitting position may cause orthostatic hypotension. Explain to the client that use of these drugs in warm weather may increase the likelihood of heatstroke. Report difficulty of breathing Administer syrup form if patient is unable to take tablets Warn patient not to take this drug with any other products that contain diphenhydramine (including topical therapy) because of increased adverse reactions.

BSN4A (GROUP 2) 50 Drug Name Generic: Ascorbic Acid Brand: Nutri Cee Classification: Vitamins Dosage DOSAGE: 500 mg in tablet form FREQUENCY: OD ROUTE: Per orem Mechanism of Action The chemopreventive action of vitamin C is attributed to two of its functions. It is a water-soluble chain breaking antioxidant. As an antioxidant, it scavenges free radicals and reactive oxygen molecules, which are produced during metabolic pathways of detoxification. It also prevents formation of carcinogens from precursor compounds. The structure of ascorbic acid is reminiscent of glucose, from which it is derived in the majority of mammals (Wolters Kluwer, 2009) Indication Increases protection mechanism of the immune system, thus supporting wound healing. Necessary for wound healing and resistance to infection. Prevention and treatment of vitamin C deficiency Nursing Responsibility Use of sodium GI: Nausea, Assessment & Drug ascorbate in patients vomiting, heartburn, Effects on sodium restriction diarrhea, or Lab tests: abdominal cramps Periodic Hct & (high doses). Hgb, serum Use of calcium electrolytes. ascorbate in patients Hematologic: Acute Monitor for receiving digitalis. hemolytic anemia S&S of acute (patients with hemolytic deficiency of G6PD); anemia, sickle sickle cell crisis. cell crisis. CNS: Headache or insomnia (high doses). Urogenital: Urethritis, dysuria, crystalluria, hyperoxaluria, or hyperuricemia (high doses). Other: Mild soreness at injection site; dizziness and temporary faintness with rapid IV administration. Patient & Family Education Take large doses of vitamin C in divided amounts because the body uses only what is needed at a particular time and excretes the rest in urine. Megadoses can interfere with absorption of vitamin B12. Note: Vitamin C increases the absorption of iron when taken at the Contraindications Adverse Reaction

BSN4A (GROUP 2) 51 same time as ironrich foods.