MINDANAO STATE UNIVERSITY

ILIGAN INSTITUTE OF TECHNOLOGY

COLLEGE OF NURSING

Resource Unit

TOPIC:

DEFINITION:

RESOURCE UNIT

OBJECTIVES CONTEXT STRATEGY TIME RESOURCES EVALUATIO

ALLOTTED N
General PATIENT’S NAME: Julieta Luzon Piñgol Question and
Objectives: Answer
SEX: Female
Specific
Objectives:
AGE: 50 years old
At the end of the Discussion using
activity, the visual aids
participants will be OCCUPATION: Vendor
able:
(Cognitive) RELIGION: Roman Catholic
1.) .
ADDRESS: Balamban, Cebu City
(Psychomotor)
DATE AND TIME OF ADMISSION:
(Affective)
2.)
February 17, 2018 at 7:30 pm
ROOM:

Orthopedic Ward

Nursing History

Chief complaint: Pain

Admitting Diagnosis: Fracture, Open III B, Left leg mangled extremity

at R foot

History of the Present Illness:

Last February 17, 2018 at 2 am the pt was riding a truck, she

was from the market buying products to sell, when suddenly the
truck lose its break and cause the accident. Pt complained about pain
in her lower limbs, characterized by an intermittent and squeezing
pain with a pain scale of >10 with no associated symptoms.

Past Health History:

Patient was diagnosed with asthma and treated with

salbutamol through nebulization. No records of hospitalization and
previous injuries.

Psychosocial History:

Patient was born on June 6, 1968 at Negros Oriental but

resided in Balamban, Cebu City. She is married and has 4 children.
She claimed that she is happy and contented with his life because he
was able to support and send her children in school
Nursing Assessment

Usual Pattern: Discussion using

visual aids
1. Health-perception health-management pattern:

Patient describes her body as fine and well and maintains good
health status for her family.

2. Nutritional Metabolic Pattern:

Patient’s usual intake consists of 1 cup of rice with preferred meat

and fish. Patient usually consumes 1000mL or more of water a day.

3. Elimination Pattern:

Patient usually micturates 8 times a day with urine in a little amount

and yellow in color and defecates twice a day with dark-brown in
color.

4. Activity Exercise

Patient is a vendor and a mother of 7 children. Her daily routine is

from 6am to 5pm to sell her goods in the market. Discussion using
visual aids
5. Sleep-Rest

Patient usually sleeps for about 6 hours and no use of sleeping aids.
Patient sleeps together with her family.
6. Cognitive-Perceptual

Patient is able to see, hear, taste, and smell without problem. Patient
is able to distinguished touch/pain receptors and able to convey to
the people.

7. Self-Perception/Self-Concept

Patient perceives herself as active. Patient usually goes to the market

and streets for a living. (-) impaired speech pattern and no problem
in posture and movement.

8. Role-Relationships

Patient is living together with her husband and 7 children.

9. Sexuality-Reproductive

Patient is on her menopause stage and has 7 children. Patient wasn’t

able to recall her menarche.

10. Coping-Stress

Patient’s support system is her family. Patient handles stress by going

out and selling goods to the market.

11. Values-Belief

Patient continues cultural beliefs and attends church every Sunday. .

Patient believes that with spiritual support, it helps them guides their
decisions and choices in life.
Initial Pattern:

1. Patient describes herself as useless and verbalized that

she is sad because she can’t do for a living for her family.
2. Patient’s food intake consists of preferred food upon
admission and consumes 6 glasses of water a day.
Patient wasn’t able to recall height and weight.
3.
4. Patient has difficulty upon bowel excretion due to
affected limbs and uses bed pan and control devices
upon excretion.
5. Patient perceives herself as no use and can’t able to do
activities of daily living due current condition.
6. Patient has disturbed sleeping routine due to pain and
uncomfortable position. With the support of the SO,
patient alleviates pain by repositioning and applying ice
packs to the affected limb.
7. Patient feels pain to her right and left lower limbs.
8. Patient was worried to her affected limbs, struggles for
the pain being felt and worries that she might have
difficulty in walking after hospitalization.
9. Patient is supported by her husband who is always by
her side.
10. Patient is on her menopause stage and has 7 children.
Patient wasn’t able to recall her menarche.
11. Patient handles stress by going out and selling goods to
the market. Patient’s support system is her family
especially her husband who is always by her side
supporting her to alleviate the pain being felt due to
current condition.
12. Patient is unable to go to the church but prays before
sleeping for her illness and for her family. Patient
believes that with spiritual support, pain will be
 alleviated and illness will improve.

Review of Systems

1. General (weight loss or gain; fever, chills, night sweats;

mood: stage of development, race, sex; signs of distress;
position; cooperative or not; stage if irritable, agitated or
pleasant; etc.)

-Patient is awake, appears lethargic with IVF #9 with the level

of 550 cc hooked well at arm infusing at 40 gtts/min. Skin is
intact and color is even. Facial features are symmetric with the
environment. Height and weight appears normal at range. Body
parts look equally bilateral and are in relative proportion to
each other. There are no obvious physical deformities. Negative
involuntary movements. Patient maintains eye contact,
cooperative and coherent. Dress is appropriate to climate.
Personal hygiene is fairly good; appears clean.

2. Head (headache, injury, tenderness, etc.); Eyes (change in

visual fields, glasses, blurring, diplopia, pain, loss of vision,
tearing, dry eyes, etc.); Ears (change in hearing, tinnitus,
discharge, dizziness, etc.); Nose (allergies, sinus problem,
obstruction, polyps, sneezing, epistaxis, etc.); Throat
(toothaches, loose teeth, bleeding gums, mouth sores,
hoarseness, difficulty swallowing, etc.)

-H – Normocephalic, positioned at midline, erect and still,

without lesions and nodules, unkempt hair, symmetric facial
expressions (-) facial weakness, has good focus on objects, (-)
enlargement of lymph nodes.

E – Eyebrows and eyelashes present and normal bilaterally,

eyelids are intact, eyeballs normally aligned in each socket

E – Ears equal in size bilaterally, ear’s skin is consistent with

facial skin color, (-) tenderness, (-) redness, (-) swelling, (-)
lesions, (-) discharge

N – Symmetric, in the midline and in proportion to other facial

features, patent sinus areas are firm with no pain, nasal septum
at the midline

T – Trachea at the midline, thyroid not palpable.

3. Integumentary System

- Patient skin integrity is disturbed due to incision in ® distal

tibia 8cm and left distal tibia 6cm and also visible wound
patches on her ® leg and left leg, also there are attached
external fixator on both ® and left lower limbs.

4. Respiratory System (chest pain, dyspnea, cough, amount

and color of sputum, hemoptysis, etc.)

-Patient has no complained chest pain and no sign/symptoms

for pneumonia, no discharges and no difficulty upon breathing.

5. Cardiovascular System

- Patient is no complained chest pain with ECG result; palpable

pulses, no jugular distention, no shortness of breath and (+)
edema on lower ® and left limbs

Rhythm: sinus PR interval: 0.1

QRS Complex: F2 at V2 QRS Complex: 0.9

T wave: upright Q-T interval: 0.4

ST Segment: isoelectric Electrical axis: 120

P wave: upright Electrical position: N

6. Digestive System (dysphagia, heartburn, ulcer, GERD,

indigestion, food intolerance, diarrhea, constipation, abdominal
pain, blood in stool, black tarry stools, changes in bowel habits,
reduced caliber of stools, hemorrhoids, etc.)

- Patient can tolerate any food and follows medication regimen.

Patient defecates once a day with stool yellow to dark-brown in
color. Patient reported difficulty on bowel elimination due to
affected limb. Used of devices like bed pan and diapers is
applied. Patient has no complain on abdominal pain and
constipation. Active bowel sound (+).

7. Excretory System (urgency, frequency, nocturia, dysuria,

hematuria, recurrent UTIs, STD, incontinence, etc.)

-Patient micturates with bed pan and diapers. Urine is yellow in

color and micturates 4 times. No pain associated upon
micturation.

8. Musculoskeletal System (limitation in movement, stiffness,

joint pain, swelling or redness, arthritis, muscle spasms, muscle
weakness, etc.)

- Patient has limited ROM due to affected right and left lower
limbs with external fixators and spiral bandages is applied to
the affected limbs with ice packs on right distal tibia and pain
felt in a twisting, non-radiating and with 6/10 in scale per
episode on right distal tibia when no pain medication given.

9. Nervous System

-Patient is coherent and responsive to commands. Patient is

oriented with time and place with spontaneous eye movement.
(+) DTR on specified area, exception in quadriceps, babinski
and achilles reflexes.

10. Endocrine System (heat/cold intolerance, weight change,

fatigue, polydipsia, polyuria, polyphagia, changes in hair
distribution, etc.)

- Patient appears tired due to difficulty in positioning during

sleeping and pain felt to the affected limbs. Patient can tolerate
both heat and cold temperature, changes in hair color due to
age and hair is evenly distributed.

11. Reproductive System

-Patient wasn’t unable to recall her menarche. Patient is now

menopaused.
Medications

Generic Name: Cetirizine

Classification: Antihistamine

DOSAGE, ROUTE, FREQUENCY: 1 tab, 10mg for 7 days

INDICATION:
 Management of seasonal and perennial allergic rhinitis
 Treatment of chronic, idiopathic urticarial
 Treatment of year-round allergic rhinitis

MECHANISM OF ACTION:

Cetirizine competes with histamine for binding at H1-receptor

sites on the effector cell surface, resulting in suppression of
histaminic edema, flare, and pruritus

SIDE EFFECTS AND ADVERSE REACTIONS:

CNS:
 Somnolence
 sedation
CV:
 Palpitation
 edema
GI:
 Nausea
 Diarrhea
 abdominal
 Pain
 constipation
Respiratory:
 Bronchospasm
 pharyngitis
Other:
 Fever
 Photosensitivity
 Rash
 Myalgia
 Arthralgia
 angioedema

CONTRAINDICATION: Contraindicated with allergy to any

antihistamines, hydroxyzine.

NURSING RESPONSIBILITY:

Assessment

History: Allergy to any antihistamines, hydroxyzine; narrow-

angle glaucoma, stenosing peptic ulcer, symptomatic prostatic
hypertrophy, asthmatic attack, bladder neck obstruction,
pyloroduodenal obstruction; lactation

Physical: Skin color, lesions, texture; orientation, reflexes,

affect; vision examination; R, adventitious sounds; prostate
palpation; renal function tests

Teaching points: Take this drug without regard to meals.

GENERIC NAME: Folic Acid

Mechanism of Action: Vitamin B essential for nucleoprotein

synthesis and maintenance of normal erythropoiesis. Acts
against folic acid deficiency that delays the thymidylate
synthesis and resuts in production of defective DNA that leads
to megaloblast formation and arrest bone marrow maturation.

Indication:

Folate deficiency, macrocytic anemia and megaloblastic

anemias associated with malabsorption syndromes,
alcoholism, primary liver disease, inadequate dietary intake,
pregnancy and childhood.

Contraindication:

• Undiagnosed anemia

• Folic acidalone for pernicious anemia and other vitamin

B12 deficiency state.

Adverse Reaction:

• Slight flushing

• Feeling of warmth on IV Site following administration

Nursing Responsibilities:

• Obtain a careful assessment and history of the dietary

intake and drug allergies of the patient

• Monitor patient’s vital signs

• Report to the physician about the patient’s response to

the therapy
GENERIC NAME: Ferrous Sulfate

Mechanism of Action: An essential mineral found in

hemoglobin, myoglobin and many enzymes. Enters the blood-
stream and is transported the the organs of the reticulo-
endothelial system (liver, spleen, bone)

Indication: Prevention/treatment of non-deficiency anemia.

Contraindication: • Evidence of iron overload like

• Anemia of not due to iron deficiency

• Severe hepatic impairment

• Significant allergies or asthma

Adverse Reaction:

 Dizziness
 Constipation
 Black/Dark Stools
 Taste Disorders
 Flushing
 Cough
 Dyspnea
 Fever
 Sweating

Nursing Responsibilities:

 Assess nutritional status and dietary history

  Assess bowel function
 Monitor vital signs
 Assess patient for signs of anaphylaxis
 Inform

GENERIC NAME: Penicillin

Classifications: First Generation Antibiotics
Anti-Infective
Dosage, Route, Frequency: IVTT (ANST)
q8
Mechanism of Action:
Interferes with bacterial cell wall synthesis during active
multiplication, causing cell wall death and resultant bactericidal
activity against susceptible bacteria.
Indication:
• Severe infections caused by sensitive organisms.
• Prophylaxis of rheumatic fever and chorea
Contraindication:
• Allergy to Penicillin.
• Use safely for people with renal disorders, pregnant and is
breastfeeding.
Adverse Reaction:
• Lethargy
• Glossitis
• Pain
• Rashes
• Fever
• Nephritis
Nursing Responsibilities:
 Assess hypersensitivity to the drug.
 Drug is not for IV use.
 Avoid contact with the needle used for IM injection.
 Monitor client for at least 30 minutes after administration.
Generic Name: Celecoxib
Brand name: Celebrex
Drug Classification: Analgesics
Patients Dose: 200 mg 1 cap BIDPO
Availability
Capsules: 100 mg,200 mg, 400 mg
Routes of administration: P.O
Indication: General Indications
-Reduction of the number of colorectal polyps
infamilialadenomatouspolyposis (FAP)-Management of acute pain-
Treatment of primary dysmenorrhea-Relief of signs and symptoms
of ankylosing spondylitis-Relief of signs and symptoms of juvenile
rheumatoid arthritis
Patients Actual Indication
-Management of acute pain.

Mechanism of Action:
May selectively inhibitCOX-2, decreasing prostaglandin synthesis.
Therapeutic Effects:
Relieves pain and inflammation in joints and smooth muscle tissue.
Pharmacokinetics
Absorption:
Level peaks in about 3hrs.. If patient receives multiple doses,
expect steady-state level within 5 days. Elder lypts. Have higher
level than younger adults.
Distribution:
Extensive. High lyprotein-bound, mainly to albumin.
Metabolism:
By CYP 2C9. No active metabolites have been identified.
Excretion:
Mainly through hepatic metabolism, with less than 3% as
unchanged drug in urine and feces
Side Effects and Adverse Reactions:
CNS: headache, dizziness, stroke
CV: hypertension, MI, peripheral edema
EENT: pharyngitis, rhinitis, sinusitis
GI: abdominal pain ,diarrhea, dyspepsia, flatulence
Metabolic: hyperchloremia, hypophosphatemia
Musculoskeletal: back pain
Respi: URTI
Skin: erythema multiforme, exfoliativ edermatitis, rash
Other: accidentalinjur
Contraindications:
Contraindicated with allergies to sulphonamides, celecoxib,
NSAIDs, or aspirin; significant renal impairment; pregnancy (3
rd
trimester);lactation
Precautions
Use cautiously with impairedhearing, hepatic and CV conditions
Drug interactions
>drug to drug-Increased risk of bleeding if taken concurrently with
warfarin. Monitor patient closely and reduce warfarin dose as
appropriate.-Increased lithium levels and toxicity-Increased risk of
GI bleeding with long-term alcohol use, smoking
Nursing Interventions:
before
-
Assess patient for allergy to sulfonamides, aspirin, or NSAIDS.
Patients with these allergies should notreceive celecoxib.-Assess
patient’s range of motion, degree of swelling, and pain in affected
joints before and periodically throughout therapy.-Assess patient’s
and family’s knowledge of drug therapy-Obtain baseline
assessment beforestarting therapy-Rehydrate patient before therapy
During
-May be administered without regard to meals.-Administer right
dose-Administer to right patient-Administer to right route
After
-Instruct patient to take celecoxib exactly as directed. Do not take
more than prescribed dose. Increasing doses does not appear to
increase effectiveness.- Advise patient to notify health care
professional promptly if signs or symptoms of GI toxicity
(abdominal lpain, black stools), skin rash, unexplained weight gain,
edema occurs.-Instruct patient that she should discontinue
celecoxib and notify healthcare professional if signs and symptoms
of hepatotoxicity (nausea, fatigue, lethargy, pruritus, jaundice,
upper right quadrant tenderness, flu-like symptoms) occur

Generic Name: Omeprazole

Brand Name: Losec
Classification: Antisecretory drug; Proton Pump Inhibitor

DOSAGE, ROUTE, FREQUENCY: 110mg, IVTT, OD

INDICATION: Indicated for:
 Short-term treatment of activeduodenal ulcer; First-line therapy in
treatment of heartburn or symptoms of gastroesophageal reflux
disease (GERD);
 Short-term treatment of active benign gastric ulcer;
 GERD, severe erosive esophagitis, poorly
responsive symptomatic GERD;
 Long-term therapy: Treatment of pathologic hypersecretory
conditions (Zollinger-Ellison syndrome, multiple adenomas,
systemic mastocytosis);
Eradication of H. pylori with amoxicillin or metronidazole and
clarithromycin
MECHANISM OF ACTION:
Gastric acid-pump inhibitor: Suppresses gastric acid secretion by
specific inhibition of the hydrogen-potassium ATP as enzyme
system at the secretory surface of the gastric parietal cells; blocks
the final step of acid production
SIDE EFFECTS AND ADVERSE REACTIONS:
CNS:
 Headache
 Dizziness
 Asthenia
 Vertigo
 Insomnia
 Apathy
 Anxiety
 Paresthesia
 Dream abnormality
Dermatologic:
 Rash
 Inflammation
 Urticaria
 Pruritus
 Alopecia
 Dry skin
GI:
 N/V
 Diarrhea
 Abdominal pain
 Constipation
 Dry mouth
 Tongue atrophy
Respiratory:
 URI symptoms
 Cough
 Epistaxis
Other:
 Cancer in preclinical studies
 Back pain
Fever

CONTRAINDICATION: Contraindicated with hypersensitivity

to omeprazole or its components;
Use cautiously with pregnancy,
lactation.
NURSING RESPONSIBILITY:
• Assess vital signs,
• Check for abdominal pain, emesis, diarrhea or constipation.
 Evaluate fluid intake and output.
 Watch for elevated liver function test results.
 Tell patient to take 30 – 60 minutes before a meal,
preferably in morning.
 Instruct patient to swallow capsules or tablets whole and not
to chew or crush them.
 Caution patient to avoid driving and other hazardous
activities

Generic Name: Metronidazole

Brand Name: Cetax

Drug Classification: Antiprotozoal

Dosage, Route, Frequency: 500 mg tab BID x7 days

INDICATION:

Acute infection with susceptible anaerobic bacteria

Mechanism of Action:

Disrupts DNA and protein synthesis in susceptible organisms

Bactericidal, or amebicidal action

Side Effects and Adverse Reactions:

CNS: Dizziness, Headache, Ataxia, Vertigo and Insomnia

GI; Nausea, Vomiting, Diarrhea, Abdominal pain and Anorexia

CONTRAINDICATION/S:

Hypersensistivity to drug, other nitromidazole derivatives, or

parabens (topical form only)

Nursing Responsibilities:

-Inform patient to report fever, sorethroat, bleeding or bruising.

-Inform patient thata drug may cause metallic taste and may
discolor urine deep brown-red.
GENERIC NAME: Clindamycin
Brand Name: Cleocin, Dalacin-C
Drug Classification: Antibiotic, Lincosamide

DOSAGE, ROUTE, FREQUENCY (prescribed and recommended):

Per Orem: 150-300 mg q6h

For severe infections: 300-450 mg q6h
Life-threatening infections: 4.89g/IV
Topical: Apply a thin film on the affected area.
INDICATION:
Treatment of serious infections caused by susceptible strains of
anaerobes streptococci, staphylococci, pneumococci.

MECHANISM OF ACTION:
-Suppresses protein synthesis by microorganisms by binding to
ribosomes.
-Prevents peptide formation
-Does not diffuse adequately to the CSF.

SIDE EFFFECTS and ADVERSE REACTIONS (by system):

CNS: cardiac arrest (with rapid IV transfusion)

GI: pseudomembranous colitis
Hematologic: neutropenia, leukopenia
Hypersensitivity: rashes
Local: following injection, thrombophlebitis after IV use.

CONTRAINDICATIONS:

-Hypersensitivity
-Use in threatening minor bacterial infections
-Use in clients with a history of regional enteritis, ulcerative
colitis, meningitis, antibiotic associated colitis
-Use for treating viral infections
-Lactation

NURSING RESPONSIBILITIES:

1. Use parenteral form for anaerobic infections.

2. Reduce dosage in severe renal impairment.

3. Give parenteral dosage for hospitalized clients only.

4. Administer IV over 20-60 minutes.

5. Assess for diarrhea and possible colitis.

6. Assess extent of infections and if improvement occurs.

7. Monitor liver and renal function.

8. With Iv, keep in bed for 30 minutes following infusion to

prevent hypotension.

9. Take orally with a full glass of water to prevent stomach

distress.

10. Assess for allergy to Clindamycin.

GENERIC NAME: Gentamicin

Brand Name: Garamycin, Cidomycin, Septopal (obsolete)
Drug Classification: Antiinfective; Aminoglycoside antibiotic

DOSAGE, ROUTE, FREQUENCY (prescribed and recommended):

Injection:10, 40 mg/mL
Ophthalmic Solution: 3 mg/mL
Ophthalmic ointment: 3 mg/g Topical ointment: 0.1%
Topical cream:0.1% Ointment:1 mg
Cream: 1 mg

INDICATION:

Parenteral use restricted to treatment of serious infections of

GI, respiratory, and urinary tracts, CNS, bone, skin, and soft
tissue (including burns) when other less toxic antimicrobial
agents are ineffective or are contraindicated. Has been used in
combination with other antibiotics. Also used topically for
primary and secondary skin infections and for superficial
infections of external eye and its adnexa.

MECHANISM OF ACTION:

Gentamicin is an aminoglycoside that binds to 30s and 50s

ribosomal subunits of susceptible bacteria disrupting protein
synthesis, thus rendering the bacterial cell membrane defective.

SIDE EFFFECTS and ADVERSE REACTIONS (by system):

-Dizziness or vertigo
-Acute renal failure
-Interstitial nephritis
-Acute tubular necrosis
-Electrolyte imbalances
-Transient elevation of serum bilirubin and aminotransferases
-Purpura
-Nausea/vomiting
-Convulsions
-Mental depression and hallucinations
-Atrophy or rat necrosis at injection sites.

Potentially Fatal: Nephrotoxicity, ototoxicity and

neuromuscular blockade (may unmask or aggravate
myasthaenia gravis).

CONTRAINDICATIONS:

History of hypersensitivity to or toxic reaction with any

aminoglycoside antibiotic. Safe use during pregnancy (category
C) or lactation is not established

NURSING RESPONSIBILITIES:
1. Cleanse area before application of dermatologic
preparations.

2. Ensure adequate hydration of patient before and during

therapy.

3. Monitor hearing with long-term therapy; ototoxicity can

occur.

4. Monitor renal function tests, CBCs, serum drug levels during

long-term therapy. Consult with prescriber to adjust dosage.

5. Report pain at injection site, severe headache, dizziness, loss

of hearing, changes in urine pattern, difficulty breathing, rash
or skin lesions; itching or irritation (ophthalmic preparations);
worsening of the condition, rash, irritation (dermatologic
preparation).

Generic Name: sodium lactate and calcium chloride

Brand Name: Lactated Ringer's solution
Classification: Hypertonic, Nutrient replenisher

DOSAGE, ROUTE, FREQUENCY:

PNSS 1L,
30 gtts/min

INDICATION: indicated as a source of water and electrolytes or

as an alkalinizing agent.

MECHANISM OF ACTION: It restores fluid and electrolyte

balances, produces diuresis, and acts as alkalizing agent
(reduces acidity).
SIDE EFFECTS AND ADVERSE REACTIONS:

Immune System Disorders:

 chest pain
 chest discomfort,
 decreased heart rate
 Tachycardia
 blood pressure decreased
 respiratory distress,
 Bronchospasm
 rash,
 throat irritation
 headache

Metabolic:

Hyperkalemia

General Disorders and Administration Site Conditions:

phlebitis, infusion site inflammation, infusion site swelling,
infusion site rash, infusion site pruritus, infusion site erythema,
infusion site, pain, infusion site burning

CONTRAINDICATION:
 severe metabolic acidosis or alkalosis
 severe liver disease
 anoxic states
NURSING RESPONSIBILITY:
 Do not administer unless solution is clear and container is
undamaged.
 Caution must be exercised in the administration of parenteral
fluids, especially those containing sodium ions to patients
receiving corticosteroids or corticotrophin.
 Solution containing acetate should be used with caution as
excess administration may result in metabolic alkalosis.
 Solution containing dextrose should be used with caution in
patients with known subclinical or overt diabetes mellitus.
 Discard unused portion.
 In very low birth weight infants, excessive or rapid
administration of dextrose injection may result in increased
serum osmolality and possible intracerebral hemorrhage.
 Properly label the IV Fluid
Observe aseptic technique when changing IV fluid
Generic Name: Ciprofloxacin
Dosage, Route, Frequency: 200 mg
IV
INDICATION: Ciprofloxacin is used to treat infections of the skin,
lungs, airways, bones, and joints caused by susceptible bacteria.
Mechanism of Action: Inhibits bacterial DNA synthesis by
inhibiting DNA gyrase.

Therapeutic Effects:
Death of susceptible bacteria.

Spectrum: Broad activity includes many gram-positive pathogens.

SIDE EFFECTS & ADVERSE REACTIONS:
• sudden pain, swelling, bruising, tenderness, stiffness,
movement problems, or a snapping or popping sound in any of your
joints
• numbness, tingling, burning pain, or being more sensitive to
temperature, light touch, or the sense of your body position

• nausea, vomiting, diarrhea, stomach pain;

• vaginal itching or discharge;
• headache; or
• abnormal liver function tests.
CONTRAINDICATIONS:
Contraindicated in hypersensitivity, cross-sensitivity among agents
may occur.

Use cautiously in underlying CNS pathology, renal impairment,

cirrhosis
NURSING RESPONSIBILITIES:
* Instruct patient to take all medication prescribed for the length of
time ordered. The drug must be taken around the clock to maintain
adequate blood levels.
* Advise patient to report occurrence of any adverse reaction
* Teach patient to report sore throat, bruising, bleeding and joint
pain which may indicate blood dyscrasias (rare)
* Advise patient to report perineal itching, fever, malaise, redness,
pain, swelling, drainage, rash, diarrhea and change in cough or
sputum. Severe diarrhea may indicate pseudomembranous colitis.
*Advise patient to rinse mouth frequently, use sugarless candy or
gum for dry mouth

SURGICAL MANAGEMENT

Open Reduction and External fixation

- is a surgical method of immobilizing bones to allow a fracture
to heal properly. It is used to provide stability to bone and soft
tissue after a serious break but can also be applied as a
procedure to correct bone misalignment, restore limb length, or
protect soft tissue after a serious burn or injury.
External fixation is accomplished by placing pins or screws into
the bone on both sides of the fracture.
The pins are secured together outside of the skin using a series
of clamps and rods known as the external frame.
An external fixation is performed by an orthopedic surgeon and
is usually done under a general anesthetic. The procedure itself
typically follows the following steps:
1. Holes are drilled into the undamaged areas of bones
around the fracture.
2. Special bolts are screwed into the holes.
3. Outside of the body, rods with ball-and-socket joints are
joined with the bolts.
4. Adjustment can be made to the ball-and-socket joint to
ensure the bone is aligned properly with as little, if any,
shortening of a bone.
The areas of skin that have been pierced by the procedure need
to be cleaned regularly to prevent infection. In some cases, a
cast may need to be applied. The removal of the bolts and
external frame can usually be done in a doctor’s office with no
anesthesia. Fractures have been known to occur at the drill
sites and, as such, extended protection may be needed after
removal of the device.

Nursing Management:
- Assess pin site and provide pin site care.
- Maintain alignment
- Ensure that weights hang free/correct weight
- Assess Vital signs
VAC Therapy is a therapeutic technique using a vacuum
dressing to promote healing in acute or chronic wounds and
enhance healing of second- and third-degree burns. The
therapy involves the controlled application of sub-atmospheric
pressure to the local wound environment, using a sealed wound
dressing connected to a vacuum pump. The use of this
technique in wound management increased dramatically over
the 1990s and 2000s and a large number of studies have been
published examining, appears to be useful for diabetic ulcers
and management of the open abdomen but further research is
required for other wound types. Promotes wound healing by
applying a vacuum through a special sealed dressing. The
continued vacuum draws out fluid from the wound and
increases blood flow to the area.[3] The vacuum may be applied
continuously or intermittently, depending on the type of wound
being treated and the clinical objectives

XRAY 02/17/18

Procedure: CHEST PA
Impression:
- Consider pulmonary nodule right upper lung
- Atherosclerosis @ thoracic aorta

Procedure: Right Leg APL

Impression:
- comminuted displaced fracture, distal third, right tibia with
soft tissue irregularity, middle third and distal third, right leg,
right ankle

Procedure: Right Ankle APL

Impression:
- comminuted displaced fracture, distal third, right tibia, right
calcaneus with soft tissue irregularity, distal third, right leg,
right ankle

Procedure: Left Ankle APL

Impression:
- fracture, left lateral malleolus
- left ankle, joint dislocation
- soft tissue swelling left ankle with medial, soft tissue
irregularity

Procedure: Right Foot APL

Impression:
- comminuted fracture, right calcaneus with soft tissue swelling
- incomplete fracture, left cuboid

Procedure: Left Leg APL

Impression:
- fracture, left lateral malleolus with internal and external bone
fixations in place
- slight medial tibiotalar joint subluxation, left
- soft tissue swelling and subcutaneous emphysema, left ankle

Procedure: Left Ankle APL

Impression:
- fracture, left lateral malleolus with internal and external bone
fixations in place
- slight medial tibiotalar joint subluxation, left
- soft tissue swelling and subcutaneous emphysema, left ankle

Procedure: Right Front APL

Impression:
- comminuted displaced fracture, right calcaneus with external
bone fixations in place

Mechanism of

Mechanism of

Action

Mechanism of

Action