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ORDERED: September 21-22, 2011

ACTION Binds to bacterial cell wall membrane, causing cell death. broad-spectrum Therapeutic Effects: Bacter icidal action against susceptible bacteria

INDICATION Perioperative prophylaxis, this includes the GI surgery. Treatment of the infections caused by susceptible organisms: Intraabdominal infections, Septicemia . Perioperative prophylaxis.

CONTRAINDICATION Contraindicate d in: Hypersensitiv ity to cephalosporins ; Serious hypersensitivity to penicillins . Use Cautiously in: History of GI disease, Pregnancy and lactation, Inflammation of the Large Intestine, Kidney Disease, Severe Bloody Diarrhea from Antibiotics

SIDE EFFECTS AND ADVERSE REACTION CNS: SEIZURES (HIGH DOSES). GI: PSEUDOMEMB RANOUS COLITIS, diarrhea, nausea, vomiting. Derm: rashes, urticaria Hemat: bleeding, eosinophilia, hemolytic anemia, leukopenia, thrombocytopenia. Local:,phlebitis at IV site. Misc: ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS,

NURDING CONSIDERATION Assessment Assess patient for infection (vital signs; appearance of wound, urine, and stool; WBC) at beginning of and throughout therapy. Before initiating therapy, obtain a history 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 patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify the physician or other health care professional immediately if these symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction .

Lab Test Considerations:

May cause positive

results for Coombs' test, especially in patients with azotemia.


IV: Reconstitute 1gram with at least 10 ml of sterile water for injection, 0.9% NaCl, or D5W. Do not use preparations containing benzyl alcohol for neonates.

DRUG NAME NAME: RANITIDINE BRAND NAME: Taladine, Zantac CLASSIFICATIO N: HistamineH2 receptor blocking drug DOCTORS ORDER: Ranitidine 50mg IV q8hrx3doses DATE ORDERED: September 2223, 2011

ACTION Inhibits gastric acid secretion by blocking the effect of histamine H2 receptors. Both daytime and nocturnal basal gastric acid secretion, as well as foodand pentagastrinstimulated gastric acid are inhibited.

INDICATION before general anesthesia in patients at risk of acid aspiration Perioperatively to suppress gastric acid secretion.

CONTRAINDICATIO N allergy to ranitidine lactation impaired renal hepatic function, pregnancy Liver cirrhosis

SIDE EFFECTS AND ADVERSE REACTION CNS: headache dizziness, confusion GI: abdominal pain, constipation, diarrhea, nausea and vomiting cardiac arrhythmias hypotension bradycardia, nausea if injected too rapidly urticaria at IV injection site

NURDING CONSIDERATION Assessment: History: allergy to ranitidine, impaired renal or hepatic function, lactation, pregnancy. Physical: skin lesions, orientation, affect, liver evaluation, abdominal examination, normal output, renal function tests, CBC Administration: Give antacids concomitantly for gastric pain although they may interfere with ranitidine absorption. The premixed injection does not require dilution; give by slow drip over 1520 min. if used with a primitive IV fluid system, discontinue primary infusion. Do not drive until drug effects are realized; dizziness or drowsiness may occur. Avoid alcohol, aspirin containing product, and beverages that contain caffeine. Report any evidence of yellow discoloration of skin or eyes, or diarrhea.

Maintain adequate hydration. Drug is stable for 48hrs. at room temperature when mixed with 0.9% NaCl, 5% or 10% dextrose injection, RL

DRUG NAME NAME: TRAMADOL BRAND NAME: Ultram CLASSIFICATION: Analgesic, centrally acting DOCTORS ORDER: Tramadol 50mg slow IV q8hrx3doses DATE ORDERED: September 22-23, 2011

ACTION May bind to muoipiod receptors and inhibit reuptake of norepinephrine and serotonin. Less respiratory depression than morphine.

INDICATION Management of moderate to moderately severe pain. Patients who requires aroundthe-clock pain therapy for an extended period of time. Analgesia during anesthesia

CONTRAINDICATION Hypersensitivity to tramadol or in cases of acute intoxication with alcohol, hypnotics, centrally acting analgesics, opioids or psychotropic drugs. Pregnancy lactation seizures concomitant use of CNS depressant renal dysfunction hepatic impairment.

SIDE EFFECTS AND ADVERSE REACTION Dizziness, psychoeas, anxiety, fear. Respiratory depression with apnea, cardiac arrest Orthostatic hypotension .

NURDING CONSIDERATION Monitor vital signs Monitor injection site for irritation and extravasation Monitor timing of analgesic doses. Use extreme caution when injecting into any body aprts that is chilled or has poor perfusion Use additional pain relief such as back rubs, stress reduction, hot packs and ice packs Reassure patient that the risk of addiction is minimal

DRUG NAME GENERIC NAME: Ketorolac BRAND NAME: Toradol, Toradol IM, Toradol IV/IM CLASSIFICATI ON: nonsteroidal antiinflammatory agents, carboxylic acid DOCTORS ORDER: Ketorolac 1amp IV q8hrsx3dose s DATE ORDERED: September 22-23, 2011

ACTION Inhibits prostagl andin synthesi s, produci ng peripher ally mediate d analgesi a. Also antipyre tic and anti inflamm atory properti es. Therapeutic: decreased pain

INDICATION Shortterm managem ent of pain in adults(not to exceed 5days total for all routes combined ) It is usually used after surgery

CONTRAINDICATION Hypertensively; cross sensitivity with other NSAIDs may exist Patients with peptic ulcer, GI bleeding, renal impairment, cerebrovascular bleeding As prophylactic analgesic before any major surgery or intraoperatively when hemostasis. Labor and delivery

SIDE EFFECTS AND ADVERSE REACTION Head ache, dizziness, drowsiness, diarrhea, nausea, indigestion, epigastric pain. Allergic reation: difficulty breathing; swelling of your face, lips, tongue, or throat serious side effects: chest pain, weakness, shortness of breath, slurred speech, problems with vision or balance; black, bloody, or tarry stools; swelling or rapid weight gain; urinating less than usual or not at all;

NURDING CONSIDERATION Assess for pain prior to and 12hr administration. Use as part of a regular analgesic rather than on an asneeded basis. Not to be used for minor pain conditions. Administer over at least 15seconds. May cause dizziness, advise patient to avoid driving or activities requiring alertness. Should not exceed 120mg in a day normally given for 5 days or less can increase your risk of lifethreatening heart or circulation problems, including heart attack or stroke can also increase your risk of serious effects on the stomach or intestines, including bleeding or perforation Place the medicine at room temperature. May take milk if GI upset occur Avoid activities that require alertness until drug effects released.

DRUG NAME GENERIC NAME: Nalbuphine BRAND NAME: Nubain CLASSIFICATION: Therapeutic: opiod analgesic DOCTORS ORDER: Nalbuphine 10mg IV now DATE ORDERED: 9/22/11

ACTION Binds to opiate receptors in the CNS. Alters the perception of the response to painful stimuli while producing generalized CNS depression. Therapeutic effects: decrease pain

INDICATION Moderate to severe pain. used as a supplement to balanced anesthesia, for preoperative and postoperative analgesia, and for obstetrical analgesia during labor and delivery. block the effects of other narcotics and cause withdrawal symptoms in people dependent on narcotics

CONTRAINDICATION Hypersensitivit y. Patient who are physically dependent on opiods and have not been detoxified(may participate withdrawal) diarrhea associated with toxins, pseudomembr anous colitis, respiratory depression (< 12 bpm) Acute asthma, bradycardia, respiratory impairment

SIDE EFFECTS AND ADVERSE REACTION CNS: dizziness, headache, sedation, confusion, hallucination GI: dry mouth, nausea and vomiting Derm: clammy feeling, sweating

NURDING CONSIDERATION Don not exceed 160mg dose in a day Assess type, location and intensity of pain before and 1hour after 30 minutes after IV administration. Assess blood pressure, pulse and respiration before and periodically during administration. If respiratory rate is less than 10 per minute, assess level of sedation. Physical stimulation may be sufficient to prevent significant hypoventilation . Dose may need to decreases by 25-50%. Prolonged use may lead to physical and psychological

dependence and tolerance. Regularly administered doses may be more effective than PRN administration. Analgesic is more effective if administered before pain becomes severe. IV administration: administer slowly, each 10 mg over 3-5min Caution patient to change position slowly to minimize orthostatic hypotension. Advise patient that frequent mouth rinses, good oral hygiene, and sugarless gum or candy may decrease dry mouth. Encourage patient to turn, cough and breathe deeply every 2hours to prevent atelectasis.