Brand name A L D A C T O N E

Generic name S P I R O N O L A C T O N E

Classification POTASSIUM SPARING DEURETIC

Indication and MOD INDICATION: Clinial conditions associated with augmented aldosterone production, refractory edema due to CHF. MOD:steroidal compound and specific pharmacological antagonist of aldosterone.presumbly acts by competing with aldosterone for cellular receptor sites in distal renal tubule.promote sodium chloride.exertion without concomitant.loss of potassium.

Contraindication,side effect,drug interaction CONTRAINDICATION: Contraindicated to patients suffering from anuria,acute renal insufficiency;progressing impairment of kidney function hyperkalemia. SIDE EFFECT: CNS:lethargy,mental confusion,fatigue,(with rapid weight loss).headache,drowsiness,ataxia. GI:Abdominal cramps,nausea,vomiting. SKIN:erythematous rash,urticauria. BODY AS A WHAOLE: Fever:hematological granulocytosis CV:hypertension

Actual dose 25 mg 1 tab OD

Usual dose 25-200 mg in divided dose,

DRUG INTERACTION:Combination of spinorolactone and acidifying doses of ammonium chloride may produce systemic acidosis:use these combination with caution.deuretic effect of

Nursing responsibilities >Observe 10 rights -check for bp below initiation of therapy >Monitor I and O and check for edema.report lack of diuretic response or development of edema;both may indicate tolerance to drug. >avoid excessive intake of potassium foods and salt substitute. >avoid replacing fluid losses with large amount of free water.

spironolactone may be an antagonized by aspirin and other salicylates.

NURSING CARE PLAN Date&time Assessment Objective Nursing Goal Nursing intervention >Establish Within short rapport. span of care >Take v/s & pt. will be able record. to report reduced pain >Monitor skin from pain color/temperature. scale of 5/10 to 2/10. >Provide comfort measures (repositioning), Quiet environment and calm activities. >Instruct use of relaxation techniques, such as focused breathing. >Encouraged verbalization of feelings. >Encouraged to rest. >Give analgesic as ordered. Rationale >To gain trust & cooperation. >To serve baseline information. >which are usually altered in acute pain. >To promote nonpharmacological pain management. >To distract attention and reduce tension. Evaluation Goal partially met, pt. was able to report reduced pain from pain scale of 5/10 to 3/10.

O c t o b e r 10, 2011

Subjective: masakit ang aking paa. As verbalized by the pt.

Acute pain r/t inflammatory process secondary to cellulitis

Objectives: >Irritability noted >Discomfort noted >Restlessness noted >Facial grimaced noted >Pain scale of 5/10

.>To know her concerns & to help alleviate of anxiety. >to prevent fatigue. >To reduce pain.

I.INTRODUCTION
This is a case of a 74 year old woman who was diagnosed with Community Acquired Pneumonia. Pneumonia is an inflammation or infection of the lungs most commonly caused by a bacteria or virus. Pneumonia can also be caused by inhaling vomit or other foreign substances. In all cases, the lungs' air sacs fill with pus , mucous, and other liquids and cannot function properly. This means oxygen cannot reach the blood and the cells of the body. Most pneumonias are caused by bacterial infections.The most common infectious cause of pneumonia in the United States is the bacteria Streptococcus pneumoniae. Bacterial pneumonia can attack anyone. The most common cause of bacterial pneumonia in adults is a bacteria called Streptococcus pneumoniae or Pneumococcus. Pneumococcal pneumonia occurs only in the lobar form. An increasing number of viruses are being identified as the cause of respiratory infection. Half of all pneumonias are believed to be of viral origin. Most viral pneumonias are patchy and the body usually fights them off without help from medications or other treatments. Pneumococcus can affect more than the lungs. The bacteria can also cause serious infections of the covering of the brain (meningitis), the bloodstream, and other parts of the body. Community-acquired pneumonia develops in people with limited or no contact with medical institutions or settings. The most commonly identified pathogens areStreptococcus pneumoniae, Haemophilus influenzae, and atypical organisms (ie, Chlamydia pneumoniae,Mycoplasma pneumoniae, Legionella sp). Symptoms and signs are fever, cough, pleuritic chest pain, dyspnea, tachypnea, and tachycardia. Diagnosis is based on clinical presentation and chest x-ray. Treatment is with empirically chosen antibiotics. Prognosis is excellent for relatively young or healthy patients, but many pneumonias, especially when caused by S. pneumoniae or influenza virus, are fatal in older, sicker patients.

II. PATIENT PROFILE

Name: E. Costales Age: 74 years old Sex: Female

Religion: Roman Catholic Date Admitted: September 17, 2009 at exactly 11:15 AM Admission diagnosis: COPD not in exacerbation Final diagnosis: Community Acquired pneumonia (CAP)moderate Risk

III. PATIENT HISTORY

Chief Complaint: Difficulty of Breathing General Data: This is a case of a 74 year old female Filipino, presently residing in Adelina 3 Binan, Laguna who was admitted in Perpetual Help Hospital on September 17, 2009.

History of Present Illness: 5 days prior to admission, patient had positive signs and symptoms of cough, yellowish pleghm, persistent fever and back pain. Knowing that these signs and symptoms were just forms of little discomforts, she self medicated with paracetamol. However, shenoticed no changes and experienced difficulty of breathing so she sought medical consultation.

IV. PHYSICAL ASSESSMENT

2009 Time Assessed: Vital Signs: Blood Pressure: 110/60 Temperature: 35.7 C Pulse rate: 78bpm Respiratory rate: 26 breaths/min General appearance: bed, conscious and coherent with an IVF of PNSS and side drip of D5W with incorporation of aminophylline on the right arm.

Date Assesed: September 17,

The patient is awake, lying on

V. ANATOMIC AND PHYSIOLOGY OVERVIEW

The Lungs
The lungs are paired, cone-shaped organs which take up most of the space in our chests, along with the heart. Their role is to take oxygen into the body, which we need for our cells to live and function properly, and to help us get rid of carbon dioxide, which is a waste product. We each have two lungs, a left lung and a right lung. These are divided up into 'lobes', or big sections of tissue separated by 'fissures' or dividers. The right lung has three lobes but the left lung has only two, because the heart takes up some of the space in the left side of our chest. The lungs can also be divided up into even smaller portions, called 'bronchopulmonary segments'.

These are pyramidal-shaped areas which are also separated from each other by membranes. There are about 10 of them in each lung. Each segment receives its own blood supply and air supply. Air enters your lungs through a system of pipes called the bronchi. These pipes start from the bottom of the trachea as the left and right bronchi and branch many times throughout the lungs, until they eventually form little thin-walled air sacs or bubbles, known as the alveoli. The alveoli are where the important work of gas exchange takes place between the air and your blood. Covering each alveolus is a whole network of little blood vessel called capillaries, which are very small branches of the pulmonary arteries. It is important that the air in the alveoli and the blood in the capillaries are very close together, so that oxygen and carbon dioxide can move (or diffuse) between them. So, when you breathe in, air comes down the trachea and through the bronchi into the alveoli. This fresh air has lots of oxygen in it, and some of this oxygen will travel across the walls of the alveoli into your bloodstream. Travelling in the opposite direction is carbon dioxide, which crosses from the blood in the capillaries into the air in the alveoli and is then breathed out. In this way, you bring in to your body the oxygen that you need to live, and get rid of the waste product carbon dioxide.

ANATOMY OF THE AFFECTED SYSTEM RESPIRATORY SYSTEM

assification

Mode of Action _____________ Although its exact mechanism of action has not been fully elucidated, it appears to be a potent inhibitor of cyclooxygenase. Thereby, decreasing the synthesis of prostaglandins

INDICATION _______________ Analgesic and antipyretic in symptomatic treatment of Rheumatoid arthritis, osteoarthritis Treatment of acute pain

CONTRAINDICATION ________________ Hypersensitivity to diclofenac Na Pt. with asthma, urticaria, bronchospasm and severe rhinitis

USUAL DOSE _________________ 150-200mg/day in 3-4 divided dosage

ACTUAL DOSE ______________ 75mg IG q 8hours

SIDE EFFECTS _______________ CNS: Dizziness, headache, drowsiness Special senses: Tinnitus, Skin: rash, pruritus GI: Dyspepsia, nausea, vomiting and abdominal pain. CV: Fluid retention, hypertension HEME: Prolonged bleeding time

NSG. INTERVENTION _______________________ Observe 10 RS Of drug administration Monitor for therapeutic effectiveness up to 3 wks. Observe and report signs of bleeding Monitor BP for hypertension and blood sugar for hyperglycemia Monitor for weight gain, GI irritation and ulceration Instruct the pt. to take the drug after meals to minimize gastric irritation.

________

NSAIDS NALGESIC)

DRUG STUDY BRAND NAME GENERI C NAME CLASSIFICATION CONTRAINDICAT ION With Side Effects & Drug Interactions Indication: >Contraindicated in >Severe inflammation, pt. hypersensitive to drug or its Mode of Action: ingridients, in those >Not clearly defined. with systemic fungal Decrease inflammation, infections, in those mainly by stabilizing receiving leukocyte lysomal immunosuppressive membranes; supresses doses immune response;stimulates >Sleep bone marrow; and problems(insomia influences protein, fat ), mood changes; and carbohydrate acne, dry skin, metabolism. thinning skin, bruising or discoloration; slow wound healing; increase sweating; headache, dizziness, spinning sensation; nausea, stomach pain, INDICATION with MODE OF ACTION ACTUA L DOSE 100 mg IV now q6 USUA L DOSE NURSING RESPONSIBILIT Y

C O R T E F

H Y D R O C O R T I S O N E

CORTICOSTE ROID

100-500 >Observe 10 rights mg IV/ >Assess for IMq2 contraindications. > Assess body weight, skin color, V/S, urinalysis, serum electrolytes, X-rays, CBC. > Arrange for increased dosage when patient is subject to unusual stress. >Observe 10 rights

bloating; or changes in shape or location of body fat.

DRUG STUDY
BRAND NAME GENERIC NAME CLASSIFICATION INDICATION with MODE OF ACTION CONTRAINDICATI ON With Side Effects & Drug Interactions >Contraindicated in pts. Hypersensitivity to drug or other penicillin. >Use cautiously in pts. With other drug allergies(especially to cephalosporins) because of possible cross-sensitivity and in those with mononucleosis because of high risk of maculopapular rash. Side effects: >Nausea and vomiting, stomach pain, bloating. >Vaginal itching or ACTUAL DOSE USUAL DOSE NURSING RESPONSIBILITY Assess patient for infection (vital signs, wound appearance, sputum, urine, stool, and WBCs) at beginning and throughout therapy. Obtain a history before initiating therapy to determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response. Observe patients for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal

A M P I C I L L I N S O D U I M

U N A S Y N

ANTIINFECTIVE

Indication: >Intra-abdominal, gynecologic, and skinstructure infections caused by susceptible strains. Mode of action: >Inhibits cell-wall synthesis during bacterial multiplication.

750 mg IV q8 ANST

Adults 375-750 mg twice daily

discharge. >Headache >Thrush(white patches inside your mouth or throath.) >Interactions Drugdrug.Allupurinol: May increase risk of rash. Monitor pt for rash. Hormonal contraceptives: Oral anticoagulants: May increase risk of bleeding.

edema, wheezing). Discontinue the drug and notify the physician immediately if these occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction. Caution patient to notify physician if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional. May occur up to several weeks after discontinuation of medication. Instruct patient to notify physician if symptoms do not improve.

DRUG STUDY
BRAND NAME GENERIC NAME CLASSIFICATION INDICATION with MODE OF ACTION CONTRAINDICATI ON With Side Effects & Drug Interactions >Contraindicated in pts. Hypersensitive to drug. Breast feeding isnt recommended during losartan therapy. >Use cautiously in pts. With impaired renal or hepatic function. Side effects: CNS: asthenia, fatigue, fever, hypesthesia ACTUAL DOSE USUAL DOSE NURSING RESPONSIBILITY

L O S A R T A N P O T A S S U

L I F E Z A R

ANTIHYPERTENSIV E

Indication: >indicated for the treatment of hypertension. It may be use alone or combination with other antihypertensive agents including diuretics. Mode of action: >inhibits vasoconstrictive and aldosterone secreting action of angiotensin ll by blocking angiotensin ll receptor on surface of vascular smooth muscle

50 mg 1 tab OD

Adult; 50 mg PO,OD increase dosage to 100 mg OD based on BP response

>observed for 10 rights. >Drug can be used alone or with other antihypertensive drugs. > >Monitor pt. blood pressure closely. >Monitor pt. who is taking diuretics for symptomatic hypotension. >Regularly assess the pt. renal function(via creatinine and BUN

I M

and other tissue cells.

CV: chest pain, hypotension, orthostatic hypotenion EENT: sinusitis, cataract GI: diarrhea, dyspepsia, gastritis GU: UTI Hematologic: anemia, hyperglycemia, hypoglycemia. Weight gain Musculoskeletal: back pain, muscle weakness Respiratory: cough, bronchitis Skin:cellulitis Interaction: Drug-drug. Lithium: May increase lithium level. NSAIDs: Maydecrease antihypertensive. Supplements: May cause hyperkalemia

levels). >Tell pt. to avoid salt substitutes; these products may contain potassium level in pts taking losartan >Active pt to immediately report swelling of the face, eyes, lips, or tongue or any breathing difficulty

DRUG STUDY
BRAND NAME GENERIC NAME CLASSIFICATION INDICATION with MODE OF ACTION CONTRAINDICATI ON With Side Effects & Drug Interactions >Contraindicated to pts. Hypersensitive to drug and those with digitalis induced toxicity, ventricular fibrillation, or ventricular tachycardia unless caused by heart failure. ACTUAL DOSE USUAL DOSE NURSING RESPONSIBILITY

D I G O X I N

L A N O X I N

CARDIAC ANTIDYSRHY TMIC

Indication: >Heart Failure, paroxysmal supraventricular tachycardia, atrial fibrillation and flutter. Mode of Action: >Inhibits sodiumpotassium-activated adenosine triposphatase, promoting movement of

0.25 g tablet BID

0.10.375 mg PO/IV

>Observe for 10 rights. > Monitor apical pulse before administering. > Monitor intake and output ratios and daily weights. > Observe patient for signs and symptoms of toxicity.

calcium from extracellular to intracellular cytoplasm and strengthening myocardial contraction. Also acts on CNS to enhance vegal tone, slowing conduction through the SA and VA nodes.

Side effects: >mild nausea, vomiting, diarrhea; >feeling weak or dizzy; >headache; >enlarged breasts in men; or >mild skin rash Interaction: Drug to drug, Amiloride: May decrease dogoxin effect increase digoxin excretion. Antibiotics: May increase risk of

> Oral preparations can be administered without regard to meals.

toxicity. Anticholinergics: May increase digoxin absorption.

DRUG STUDY BRAND NAME GENERIC NAME CLASSIFI CATION INDICATION with MODE OF ACTION CONTRAINDICTAIO N With SIDE EFFECTS & Drug Interactions >Contraindicated in patients hypersensitive to the drug pts with angle closure glaucoma, stenosining peptic ulcer, bladder ACTUAL USUAL NURSING DOSE DOSE RESPONSIBILITY

D I P H E N

B E N A D R

ANTIHISTAMI NE

>allergy symptoms, Action: Competes with histamine for H1 receptor sites. Prevents, but doesnt

50 mg IV now then q8 -D/C

25-50 mg PO,TID or QID

>Observe for 10 rights >Check for doctors order >Tell pt that dizziness, excessive

H Y D R A M I N E H C L

Y L

reverse, histamine medlated responses, particullrly to those of bronchial tubes, GI tract, uterus, and blood vessels. Structurally related to local anesthetics, drug provides local anesthesia & suppresses cough reflex.

neck obstruction; and those having an acute asthmatic attack >Avoid use in pts taking MAO inhibitors. >Use cautiously in pts with asthma, COPD, increased intraocular pressure , hyperthyroidism, CV disease and hypertension Side Effects; CNS: Drowsiness, sedation, sleepiness, dizziness, incoordination, seizures, confusion, insomnia, vertigo, headache, tremor CV: palpitations, hypotension, tachycardia, EENT: Diplopia, blurred vision, nasal congestion, tinnitus GI; Dry mouth, nausea, epigastric distress, vomiting, constipation, diarrhea, anorexia

sedation, syncope, toxicity, paradoxical stimulation,& hypotension are more likely to occur in the elderly >Warn pt not to take this drug with any other products that contain diphenhydramine (including topical therapy) because of increased adverse reactions. >Tell pt that coffee or tea may reduce drowsiness urge caution if palpitations develop >Inform pt that sugar gum, hard candy, or ice chips may relieve dry mouth but take with caution since pt has DM >Tell pt to notify prescriber if

GU: Dysuria, urine retention, urinary frequency HEMATOLOGIC: thrombocytopenia, agranulocytosis, hemolytic anemia, photosensitivity rash Other; Anaphylactic shock

tolerance develops because a different antihistamine >Warn pt possible photosensitivity reactions.

DRUG STUDY BRAND NAME C O R T E F GENERI C NAME H Y D R O C O R T I S O N E CLASSIFICATION CORTICOSTE ROID CONTRAINDICATION With Side Effects & Drug Interactions Indication: >Contraindicated in pt. >Severe inflammation, hypersensitive to drug or its ingridients, in those Mode of Action: with systemic fungal >Not clearly defined. infections, in those Decrease inflammation, receiving mainly by stabilizing immunosuppressive doses leukocyte lysomal membranes; supresses >Sleep immune problems(insomia), response;stimulates mood changes; acne, dry bone marrow; and skin, thinning skin, influences protein, fat bruising or and carbohydrate discoloration; slow metabolism. wound healing; increase sweating; headache, dizziness, spinning sensation; nausea, stomach pain, bloating; or changes in shape or location of body fat. INDICATION with MODE OF ACTION ACTUA L DOSE 100 mg IV now q6 USUA NURSING L RESPONSIBILIT DOSE Y 100-500 >Observe 10 rights mg IV/ >Assess for IMq2 contraindications. > Assess body weight, skin color, V/S, urinalysis, serum electrolytes, X-rays, CBC. > Arrange for increased dosage when patient is subject to unusual stress. >Observe 10 rights

DRUG STUDY
BRAND NAME GENERIC NAME CLASSIFICATION INDICATION with MODE OF ACTION CONTRAINDICATI ON With Side Effects & Drug Interactions >Contraindicated in pts. Hypersensitivity to drug or other penicillin. >Use cautiously in pts. With other drug allergies(especially to cephalosporins) because of possible cross-sensitivity and in those with mononucleosis because of high risk of maculopapular rash. Side effects: >Nausea and vomiting, stomach pain, bloating. ACTUAL DOSE USUAL DOSE NURSING RESPONSIBILITY Assess patient for infection (vital signs, wound appearance, sputum, urine, stool, and WBCs) at beginning and throughout therapy. Obtain a history before initiating therapy to determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response. Observe patients for signs and symptoms of anaphylaxis (rash,

A M P I C I L L I N S O D U I M

U N A S Y N

ANTIINFECTIVE

Indication: >Intra-abdominal, gynecologic, and skinstructure infections caused by susceptible strains. Mode of action: >Inhibits cell-wall synthesis during bacterial multiplication.

750 mg IV q8 ANST

Adults 375-750 mg twice daily

>Vaginal itching or discharge. >Headache >Thrush(white patches inside your mouth or throath.) >Interactions Drugdrug.Allupurinol: May increase risk of rash. Monitor pt for rash. Hormonal contraceptives: Oral anticoagulants: May increase risk of bleeding.

pruritus, laryngeal edema, wheezing). Discontinue the drug and notify the physician immediately if these occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction. Caution patient to notify physician if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional. May occur up to several weeks after discontinuation of medication. Instruct patient to notify physician if symptoms do not improve.

DRUG STUDY
BRAND NAME GENERIC NAME CLASSIFICATION INDICATION with MODE OF ACTION CONTRAINDICATI ON With Side Effects & Drug Interactions >Contraindicated in pts. Hypersensitive to drug. Breast feeding isnt recommended during losartan therapy. >Use cautiously in pts. With impaired renal or hepatic function. Side effects: CNS: asthenia, fatigue, fever, hypesthesia CV: chest pain, hypotension, ACTUAL DOSE USUAL DOSE NURSING RESPONSIBILITY

L O S A R T A N P O T A S S U I M

L I F E Z A R

ANTIHYPERTENSIV E

Indication: >indicated for the treatment of hypertension. It may be use alone or combination with other antihypertensive agents including diuretics. Mode of action: >inhibits vasoconstrictive and aldosterone secreting action of angiotensin ll by blocking angiotensin ll receptor on surface of vascular smooth muscle and other tissue cells.

50 mg 1 tab OD

Adult; 50 mg PO,OD increase dosage to 100 mg OD based on BP response

>observed for 10 rights. >Drug can be used alone or with other antihypertensive drugs. > >Monitor pt. blood pressure closely. >Monitor pt. who is taking diuretics for symptomatic hypotension. >Regularly assess the pt. renal function(via creatinine and BUN levels). >Tell pt. to avoid salt

orthostatic hypotenion EENT: sinusitis, cataract GI: diarrhea, dyspepsia, gastritis GU: UTI Hematologic: anemia, hyperglycemia, hypoglycemia. Weight gain Musculoskeletal: back pain, muscle weakness Respiratory: cough, bronchitis Skin:cellulitis Interaction: Drug-drug.Lithium: May increase lithium level. NSAIDs: Maydecrease antihypertensive. Supplements: May cause hyperkalemia

substitutes; these products may contain potassium level in pts taking losartan >Active pt to immediately report swelling of the face, eyes, lips, or tongue or any breathing difficulty

DRUG STUDY
BRAND NAME D I G O X I N GENERIC NAME L A N O X I N CLASSIFICATION CARDIAC ANTIDYSRHY TMIC INDICATION with MODE OF ACTION Indication: >Heart Failure, paroxysmal supraventricular tachycardia, atrial fibrillation and flutter. Mode of Action: >Inhibits sodiumpotassium-activated adenosine triposphatase, promoting movement of calcium from CONTRAINDICATION With Side Effects & Drug Interactions >Contraindicated to pts. Hypersensitive to drug and those with digitalis induced toxicity, ventricular fibrillation, or ventricular tachycardia unless caused by heart failure. Side effects: >mild nausea, vomiting, diarrhea; >feeling weak or dizzy; >headache; >enlarged breasts in men; or ACTUAL DOSE 0.25 g tablet BID USUAL DOSE 0.10.375 mg PO/IV NURSING RESPONSIBILITY >Observe for 10 rights. >Monitor apical pulse before administering. > Monitor intake and output ratios and daily weights. > Observe patient for signs and symptoms of toxicity. > Oral

extracellular to intracellular cytoplasm and strengthening myocardial contraction. Also acts on CNS to enhance vegal tone, slowing conduction through the SA and VA nodes.

>mild skin rash Interaction: Drug to drug, Amiloride: May decrease dogoxin effect increase digoxin excretion. Antibiotics: May increase risk of

preparations can be administered without regard to meals.

toxicity. Anticholinergics: May increase digoxin absorption.

DRUG STUDY BRAND NAME GENERIC NAME CLASSIFI CATION INDICATION with MODE OF ACTION CONTRAINDICTAIO N With SIDE EFFECTS & Drug Interactions >Contraindicated in patients hypersensitive to the drug pts with angle closure glaucoma, stenosining peptic ulcer, bladder neck obstruction; and ACTUAL USUAL NURSING DOSE DOSE RESPONSIBILITY

D I P H E N H

B E N A D R Y

ANTIHISTAMI NE

>allergy symptoms, Action: Competes with histamine for H1 receptor sites. Prevents, but doesnt reverse, histamine

50 mg IV now then q8 -D/C

25-50 mg PO,TID or QID

>Observe for 10 rights >Check for doctors order >Tell pt that dizziness, excessive sedation, syncope,

Y D R A M I N E H C L

medlated responses, particullrly to those of bronchial tubes, GI tract, uterus, and blood vessels. Structurally related to local anesthetics, drug provides local anesthesia & suppresses cough reflex.

those having an acute asthmatic attack >Avoid use in pts taking MAO inhibitors. >Use cautiously in pts with asthma, COPD, increased intraocular pressure , hyperthyroidism, CV disease and hypertension Side Effects; CNS: Drowsiness, sedation, sleepiness, dizziness, incoordination, seizures, confusion, insomnia, vertigo, headache, tremor CV: palpitations, hypotension, tachycardia, EENT: Diplopia, blurred vision, nasal congestion, tinnitus GI; Dry mouth, nausea, epigastric distress, vomiting, constipation, diarrhea, anorexia GU: Dysuria, urine

toxicity, paradoxical stimulation,& hypotension are more likely to occur in the elderly >Warn pt not to take this drug with any other products that contain diphenhydramine (including topical therapy) because of increased adverse reactions. >Tell pt that coffee or tea may reduce drowsiness urge caution if palpitations develop >Inform pt that sugar gum, hard candy, or ice chips may relieve dry mouth but take with caution since pt has DM >Tell pt to notify prescriber if tolerance develops

retention, urinary frequency HEMATOLOGIC: thrombocytopenia, agranulocytosis, hemolytic anemia, photosensitivity rash Other; Anaphylactic shock

because a different antihistamine >Warn pt possible photosensitivity reactions.

NURSING CARE PLAN Date&time Assessment Objective Nursing Goal Within short span of Nursing intervention >Establish rapport. >Take v/s & Rationale >To gain trust & cooperation. >To serve Evaluation Goal partially met, pt.

S E

Subjective: Acute pain masakitangakingpaa. r/t

P T E M B E R 20, 2011

As verbalized by the pt.

inflammatory process secondary to cellulitis

Objectives: >Irritability noted >Discomfort noted >Restlessness noted >Facial grimaced noted >Pain scale of 5/10

care pt. will be able to report reduced pain from pain scale of 5/10 to 2/10.

record.

baseline information. >Monitor skin >which are color/temperature. usually altered in acute pain. >Provide comfort >To promote measures non(repositioning), pharmacological Quiet pain environment and management. calm activities. >Instruct use of >To distract relaxation attention and techniques, such reduce tension. as focused breathing. >Encouraged .>To know her verbalization of concerns & to feelings. help alleviate of anxiety. >Encouraged to >to prevent rest. fatigue. >Give analgesic >To reduce as ordered. pain.

was able to report reduced pain from pain scale of 5/10 to 3/10.

NURSING CARE PLAN Date&time S Assessment Subjective: Objective Impaired skin Nursing Goal Within short Nursing intervention >Establish Rationale >To gain trust Evaluation >Goal partially

E P T E M B E R 20, 2011

nangangatiako. As verbalized by the pt.

integrity r/t inflammation secondary to cellulitis

span of care pt. able to verbalized reduce of itching.

rapport >take v/s and record

Objectives: >Irritability noted >Discomfort noted >warm to touch >scratching noted

>keep the area clean/dry and carefully dress if ordered. >use appropriate barrier dressings, wound covering or skin protective agents. >provide divertional activities such as watching t.v, listening music and etc.

and cooperation. >To serve baseline data or detect any abnormalities. >To prevent infection manage >To protect the wound and/or surroundings tissues.

met, pt. was able to verbalized reduced of itching.

>To prevent patient from constant scratching of affected parts.

Generic Name

Brand name _________

Classification __________ B R O N C H O D I L A T O R

Mode of Action ____________ Synthetic sympathomimeti c amine and moderately selective beta2adrenergic agonist with comparatively long action. Acts more permanently on beta2 receptors on bronchi by promoting dilation to improve airway. It inhibits histamine release by mast cells

INDICATION ___________ To relieve bronchospasm associated with acute or chronic asthma, bronchitis or other reversible obstructive airway disease Also used to prevent exerciseinduced bronchospasm

CONTRAINDICATION ________________ Pregnancy and lactation

USUAL DOSE __________ 2 times/day q 4-6 hours

ACTUAL DOSE __________ Combivent nebulizer now and then q 8 hours

SIDE EFFECTS _______________ Body as a whole: Hypersensitivity reaction, CNS: tremors, anxiety, nervousness, restlessness, convulsion, weakness and headache CV: Palpitation, hypertension, hypotension,bradycar dia. Special senses: Blurred vision, dilated pupils.

S A L B U T A M O L

V E N T O L I N

Name of patient: Age:

Diagnosis: UTI

HEMATOLOGY
Name of Lab. Test Normal result Result Indication Significance

Hemoglobin, mass Cone

120-150g/l

120g/l

Decrease/below normal

Kidney disease

Hematocrit

0.37-0.47

0.42

Within normal limit

Lymphocyte

0.23-0.35

0.36

Increase/above normal

Chronic infection

Segmenter

0.50-0.70

0.70

Within normal limit

Common brand names are Apo-Cal, Calbone, Calcid, Calsan, Caltrate, Calvit, Contylan, Dicarbosil, Esvical, Exofat, Gaviscon, Megavit, Oscal, Osteofos, Titralac, Tums, and Ultima. Calcium carbonate is classified as Electrolyte replenisher, antacid, antihypocalcemic, antihyperkalemic, antihypermagnesemic, antihyperphosphatemic.Indication for Calcium Carbonate Calcium carbonate may be used for Acute hypocalcemia, electrolyte depletion, cardiac arrest, hyperkalemia, and hypermagnesemia. It can also be used in Chronic hypocalcemia, calcium deficiency, and as an antacid. It is also used in the treatment of hyperphosphatemia. Routes and Dosage of Calcium Carbonate Hypocalcemia PO: ADULTS, ELDERLY: 1-2 g/day in 3-4 divided doses. CHILDREN: 45-65 mg/kg/day in 3-4 divided doses. Antacid PO: ADULTS, ELDERLY: 1-2 tabs (5-10 ml) every 2 hours as needed. Osteoporosis PO: ADULTS, ELDERLY: 1,200 mg/day. Action of Calcium Carbonate Calcium is essential for function, integrity of nervous, muscular, and skeletal systems. It plays an important role in normal cardiac and renal functions, respiration, blood coagulation, cell membrane, and capillary permeability. It assists in regulating the release and storage of neurotransmitters and hormones. Calcium neutralizes or reduces gastric acid production. Side Effects and Adverse Reactions of Calcium Carbonate Side Effects of Calcium Carbonate

Hypotension Flushing Warmth Nausea Vomiting Pain Rash Redness Burning at the injection site Sweating Decreased blood pressure

Chalky taste Mild constipation Fecal impaction Swelling of the hands or feet Metabolic alkalosis Milk-alkali syndrome (headache, decreased appetite, nausea, vomiting, unusual tiredness) Difficult or painful urination

Adverse Reactions of Calcium Carbonate Hypercalcemia (Early Signs: Constipation, headache, dry mouth, increased thirst, irritability, decreased appetite, metallic taste, fatigue, weakness, depression.)

Hypercalcemia (Late signs: Confusion, drowsiness, increased blood pressure, light sensitivity, urination, irregular heartbeat, nausea, vomiting)

Nursing Considerations for Clients Taking Calcium Carbonate

Assess blood pressure, ECG readings, renal function, magnesium, phosphate, and potassium concentrations. Take tablets with full glass of water 30 minutes to 1 hour after meals. Give syrup diluted in juice or water. Chew chewable tablets well before swallowing. Monitor blood pressure, ECG, renal function, magnesium, phosphate, potassium, serum, and urine calcium concentrations. Monitor for signs of hypercalcemia.

Patient Teachings for Clients Taking Calcium Carbonate

Stress importance of diet. Take tablets with full glass of water, 30 minutes to 1 hour after meals. Give liquid before meals. Do not take within 1-2 hours of other oral medications, fiber-containing foods. Avoid excessive alcohol, tobacco, and caffeine.

Contraindications Patients with Ca renal calculi or history of renal calculi; hypercalcaemia; hypophosphataemia

Drug Interactions Co-administration with thiazide diuretics or vit D may lead to milk-alkali syndrome and hypercalcaemia. Decreased absorption with corticosteroids. Decreases absorption of tetracyclines, atenolol, iron, quinolones, alendronate, Na fluoride, Zn and calcium-channel blockers. Enhances cardiac effects of digitalis glycosides and may precipitate digitalis intoxication. Adverse Drug Reactions Constipation, flatulence; hypercalcaemia; metabolic alkalosis; milk-alkali syndrome, tissue-calcification. Gastric hypersecretion and acid rebound (with prolonged use). Adverse Drug Reactions Constipation, flatulence; hypercalcaemia; metabolic alkalosis; milk-alkali syndrome, tissue-calcification. Gastric hypersecretion and acid rebound (with prolonged use).

Acute Uncomplicated Urinary Tract Infection in Women Stephan D. Fihn, M.D., M.P.H. N Engl J Med 2003; 349:259-266July 17, 2003 Article This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. A 28-year-old woman telephones her physician to report dysuria and urinary urgency during the preceding three days. She has had several previous urinary tract infections, including three during the past year. She is otherwise healthy, takes no medications, and is sexually active, using spermicide-coated condoms for contraception. She says she does not have fever, chills, vaginal discharge, or flank pain. How should she be evaluated and treated?

The Clinical Problem During any given year, 11 percent of women report having had a urinary tract infection, and more than half of all women have at least one such infection during their lifetime.1 Each year in the United States, acute cystitis is responsible for 3.6 million office visits by women 18 to 75 years old, accounting for direct costs of $1.6 billion.2,3 Most acute lower urinary tract infections (also termed acute bacterial cystitis) are uncomplicated that is, they are not associated with signs or symptoms of upper urinary tract infection (fever, chills, or flank pain) or other characteristics suggesting a high risk of upper urinary tract or complicated infection (e.g., diabetes, pregnancy, immunosuppression, previous pyelonephritis, symptoms lasting >14 days, or structural abnormalities of the urinary tract). After an initial infection, most women have sporadic recurrences, and a quarter to half have another infection within one year. Three to 5 percent have recurrent urinary tract infections that is, symptomatic infections that follow the clinical resolution of a previous episode, generally (but not necessarily) after treatment.4 Escherichia coli causes 75 to 90 percent of episodes of acute uncomplicated cystitis, and Staphylococcus saprophyticus accounts for 5 to 15 percent, mainly in younger women.5 Enterococci and aerobic gram-negative rods other than E. coli, such as klebsiella species and Proteus mirabilis, are isolated in the remainder of the cases.

Article on treatment of urinary tract infection in general practice 04 October 2011 Article on treatment of urinary

tract infection in general practice 04 October 2011

BMC Family Practice 2011, 12:108. [Epub ahead of print]

Antimicrobial management and appropriateness of treatment of urinary tract infection in general practice in Ireland. Vellinga A, Cormican M, Hanahoe B, Bennett K and Murphy, AW. Abstract BACKGROUND: Urinary tract infections (UTIs) are the second most common bacterial infections in general practice and a frequent indication for prescription of antimicrobials. Increasing concern about the association between the use of antimicrobials and acquired antimicrobial resistance has highlighted the need for rational pharmacotherapy of common infections in general practice. METHODS: Management of urinary tract infections in general practice was studied prospectively over 8 weeks. Patients presenting with suspected UTI submitted a urine sample and were enrolled with an opt-out methodology. Data were collected on demographic variables, previous antimicrobial use and urine samples. Appropriateness of different treatment scenarios was assessed by comparing treatment with the laboratory report of the urine sample. RESULTS: A total of 22 practices participated in the study and included 866 patients. Bacteriuria was established for 21% of the patients, pyuria without bacteriuria for 9% and 70% showed no laboratory evidence of UTI. An antimicrobial agent was prescribed to 56% (481) of the patients, of whom 33% had an isolate, 11% with pyuria only and 56% without laboratory evidence of UTI. When taking all patients into account, 14% patients had an isolate identified and were prescribed an antimicrobial to which the isolate was susceptible. The agents most commonly prescribed for UTI were co-amoxyclav (33%), trimethoprim (26%) and fluoroquinolones (17%). Variation between practices in antimicrobial prescribing as well as in their preference for certain antimicrobials, was observed. Treatment as prescribed by the GP was interpreted as appropriate for 55% of the patients. Three different treatment scenarios were simulated, i.e. if all patients who received an antimicrobial were treated with nitrofurantoin, trimethoprim or ciprofloxacin only. Treatment as prescribed by the GP was no more effective than treatment with nitrofurantoin for all patients given an antimicrobial or treatment with ciprofloxacin in all patients. Prescribing cost was lower for nitrofurantoin. Empirical treatment of all patients with trimethoprim only was less effective due to the higher resistance levels.

CONCLUSIONS:There appears to be considerable scope to reduce the frequency and increase the quality of antimicrobial prescribing for patients with suspected UTI.

Generic Name

Brand name _________ P R I S O L E C

Classification __________

Mode of Action _____________ An antisecretory compound that is a gastric acid pump inhibitor. Suppresses gastric acid secretion by inhibiting the H+, K+ ATPase enzyme system in the parietal cells.

INDICATION _______________ Duodenal and gastric ulcer, GERD Long term treatment for pathologic hypersecretory conditions.

CONTRAINDICATION ________________ Long term use for GERD, duodenal ulcers; lactation

USUAL DOSE _________________ 20mg/ day for 14 days

ACTUAL DOSE ______________ 20 mg I cap OD

SIDE EFFECTS _______________ CNS: Dizziness, headache, Gi: Diarrhea, nausea, abdominal pain, indigestion Skin: rash Body as a whole: Arthralgia

O M E P R A Z O L E

Proton pump inhibitor

What is metoclopramide? Metoclopramide increases muscle contractions in the upper digestive tract. This speeds up the rate at which the stomach empties into the intestines. Metoclopramide is used short-term to treat heartburn caused by gastroesophageal reflux in people who have used other medications without relief of symptoms. Metoclopramide is also used to treat slow gastric emptying in people with diabetes (also called diabetic gastroparesis), which can cause nausea, vomiting, heartburn, loss of appetite, and a feeling of fullness after meals.Metoclopramide may also be used for other purposes not listed in this medication guide You should not take this medication if you are allergic to metoclopramide, or if you have bleeding or blockage in your stomach or intestines, epilepsy or other seizure disorder, or an adrenal gland tumor (pheochromocytoma). Before taking metoclopramide, tell your doctor if you have kidney or liver disease, congestive heart failure, diabetes, or a history of depression. Avoid drinking alcohol. It can increase some of the side effects of metoclopramide. There are many other medicines that can interact with metoclopramide.

Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you. Do not take it in larger amounts than recommended, or for longer than 3 months. High doses or long-term use of metoclopramide may cause tremors or other uncontrollable muscle movements, especially in older women. Stop using metoclopramide and call your doctor at once if you have tremors or uncontrolled muscle movements, fever, stiff muscles, confusion, sweating, fast or uneven heartbeats, rapid breathing, depressed mood, thoughts of suicide or hurting yourself, hallucinations, anxiety, agitation, seizure, or jaundice (yellowing of your skin or eyes). After you stop taking metoclopramide, you may have unpleasant withdrawal symptoms such as headache, dizziness, or nervousness. Talk to your doctor about how to avoid withdrawal symptoms when stopping the medication. You should not take this medication if you are allergic to metoclopramide, or if you ha a perforation (hole) in your stomach or intestines; epilepsy or other seizure disorder; or an adrenal gland tumor (pheochromocytoma). If you have any of these other conditions, you may need a dose adjustment or special tests to safely take metoclopramide:

kidney disease; liver disease (especially cirrhosis); congestive heart failure;

high blood pressure; Parkinson's disease; diabetes (your insulin dose may need adjusting); or a history of depression. FDA pregnancy category B. metoclopramide is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Metoclopramide can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Cholesterol Why it's so important to manage your cholesterol levels. Aluminum is a naturally occurring mineral. Aluminum hydroxide is an antacid. Aluminum hydroxide is used to treat symptoms of increased stomach acid, such as heartburn, upset stomach, sour stomach, or acid indigestion. Aluminum hydroxide is also used to reduce phosphate levels in people with certain kidney conditions. Aluminum hydroxide may be used for other purposes not listed in this medication guide. What is the most important information I should know about aluminum hydroxide? Ask a doctor or pharmacist before taking this medication if you have kidney disease, kidney stones, severe constipation, if you are dehydrated, or if you drink alcohol frequently. Do not take aluminum hydroxide for longer than 2 weeks without your doctor's advice. Avoid taking other medications at the same time you take aluminum hydroxide. Antacids can make it harder for your body to absorb certain other drugs.

What should I discuss with my healthcare provider before taking aluminum hydroxide? Ask a doctor or pharmacist if it is safe for you to take this medication if you have: kidney disease, a history of kidney stones; severe constipation; if you are dehydrated; or if you drink alcohol frequently. It is not known whether aluminum hydroxide is harmful to an unborn baby. Before taking this medication, tell your doctor if you are pregnant or plan to become pregnant during treatment. Aluminum hydroxide may pass into breast milk and could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.ore detail) What is magnesium sulfate? Related Video Hypertension What does 140 over 90 mean? Learn about high blood pressure numbers. Magnesium is a naturally occurring mineral. Magnesium is important for many systems in the body especially the muscles and nerves. Magnesium sulfate also increases water in the intestines, which may induce defecation. Magnesium hydroxide is used as a laxative to relieve occasional constipation (irregularity). Magnesium sulfate may also be used for purposes other than those listed in this medication guide. What is the most important information I should know about magnesium sulfate?

Before taking magnesium sulfate, tell your doctor if you have any other medical conditions, allergies, or if you take other medicines or other herbal/health supplements. Magnesium sulfate may not be recommended in some situations. Do not use magnesium sulfate as a laxative if you have stomach (abdominal) pain, nausea, or vomiting, unless directed by a doctor. If you notice a sudden change in bowel habits that persists over a period of 2 weeks, consult your healthcare provider before using a laxative. Magnesium sulfate should not be used for longer than one week, unless otherwise directed by your healthcare provider. Rectal bleeding or failure to have a bowel movement after use of a laxative may indicate a more serious condition; stop using magnesium sulfate and contact your healthcare provider. What should I discuss with my healthcare provider before taking magnesium sulfate?

Do not take magnesium sulfate without first talking to your doctor if you have kidney disease. Do not use magnesium sulfate as a laxative if you have stomach (abdominal) pain, nausea, or vomiting, unless directed by a doctor. If you notice a sudden change in bowel habits that persists over a period of 2 weeks, consult your healthcare provider before using a laxative. Magnesium sulfate should not be used for longer than one week, unless otherwise directed by your healthcare provider. Rectal bleeding or failure to have a bowel movement after use of a laxative may indicate a more serious condition; stop using magnesium sulfate and contact your healthcare provider. Before taking magnesium sulfate, tell your doctor if you have any other medical conditions, allergies, or if you take other medicines or other herbal/health supplements. Magnesium sulfate may not be recommended in some situations. It is not known whether magnesium sulfate will be harmful to an unborn baby. Do not take magnesium sulfate without first talking to your doctor if you are pregnant or planning a pregnancy. It is not known whether magnesium sulfate will be harmful to an nursing baby. Do not take magnesium sulfate without first talking to your doctor if you are breast-feeding a baby. Take magnesium sulfate exactly as directed by your doctor or as directed on the package. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you. Magnesium sulfate may be used orally or as a rectal enema. Follow your doctor's instructions or the directions on the package.

Do not use magnesium sulfate as a laxative if you have stomach (abdominal) pain, nausea, or vomiting, unless directed by a doctor. If you notice a sudden change in bowel habits that persists over a period of 2 weeks, consult your healthcare provider before using a laxative. Magnesium sulfate should not be used for longer than one week, unless otherwise directed by your healthcare provider. Rectal bleeding or failure to have a bowel movement after use of a laxative may indicate a more serious condition; stop using magnesium sulfate and contact your healthcare provider. Do not take more magnesium sulfate than is directed. Store magnesium sulfate at room temperature away from moisture and heat. What happens if I miss a dose? Take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the dose you missed and take only the next regularly scheduled dose. Do not take a double dose of this medication. What happens if I overdose? Symptoms of an magnesium sulfate overdose include nausea, vomiting, flushing, low blood pressure, a slow heartbeat, drowsiness, coma, and death. What should I avoid while taking magnesium sulfate? There are no restrictions on food, beverages, or activity while taking magnesium sulfate unless otherwise directed by your doctor. Magnesium sulfate side effects Stop taking magnesium sulfate and seek emergency medical attention if you experience an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives). Other, less serious side effects may be more likely to occur. Continue to take magnesium sulfate and talk to your doctor if you experience diarrhea or upset stomach.