DRUG STUDY

Generic Name Brand Name Classifications Recommended Dosage, Frequency, and route of Administration
Prescribed: 750 mg IVTT every 8 hours (-) ANST 500 mg 1 tab BID for 7 days Recommended: ORAL: 250 mg 500 mg BID for 710 days

Mechanism of Action

Indication

Contraindication

Adverse Reaction

Nursing Responsiblities

Cefuroxime (Ceftin, Zenacef) Antibiotic Cephalosporin (second generation)

Bactericidal: inhibits synthesis of bacterial cell wall, causing cell death.

Oral: y Pharyngitis, tonsillitis y Otitis media y Acute bacterial maxillary sinusitis y Lower respiratory infections y UTIs y Uncomplicated gonorrhea (urethral and endocervical) y Skin and skin structure infections, including impetigo y Treatment of early Lyme disease Parenteral: y Lower respiratory infections y Dermatologic infections

y Contraindicated with allergy of cephalosporin or penicillin y Use Cautiously with renal failure, lactation, pregnancy

y CNS: headache, dizziness, lethargy, paresthesias y GI: Nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, pseudomembra nous colitis, hepatotoxicity y GU: Nephrotoxicity y Hematologic: Bone marrow depression (decreased WBC, decreased platelets, decreased Hct) y Hypersensitivity : ranging from rash to fever to anaphylaxis, serum sickness reaction

y Culture infection site, and arrange for sensitivity tests before and during therapy if expected response is not seen. y Give oral drug with drug with food to decrease GI upset and enhance absorption y Have vitamin K available in case of hypoprothrombin emia occurs y Discontinue if hypersensitivity reaction occurs y Take full course of therapy if you are feeling better y This drug is specific for this infection and should not be used to self-treat

y UTI y Uncomplicated and disseminated gonorrhea y Septicemia y Meningitis y Bone and joint infections y Perioperative prophylaxis y Treatment of acute bacterial maxillary sinusitis in patients 3 mo-12 yr

y Local: pain, abscess at injection site, phlebitis, inflammation at IV site y Other: Superficial, disulfiram-like reaction with alcohol

other problems y Swallow tablets whole; do not crush them. y Store solution in the refrigerators. Shake well before each use. y You may experience these side effects: Stomach upset or diarrhea y Report severe diarrhea with food, pus,or mucus; rash; difficulty breathing; unusual tiredness, fatigue; unusual bleeding or bruishing; unusual itching or irritation. y Avoid alcohol while taking this drug and for 3 days after because severe reactions often occur

Generic Name Brand Name Classifications

Recommended Dosage, Frequency, and route of Administration

Prescribed: 30 mg IVTT every 8 hours or 3 doses Recommended: Single-dose treatment: 60 mg IM or 30 mg IV. Multiple-dose treatment: 30 mg IM or IV every 6 hours to a minimum 120 mg/day

Mechanism of Action

Indication

Contraindication

Adverse Reaction

Nursing Responsibilities

Ketorolac tromethamine (Acular LS, Acular PF) Antipyretic Nonopioid analgesic NSAID

Antiinflammatory and analgesic activity; inhibits prostaglandins and leukotriene synthesis

y Short-term management of pain (up to 5 days)

y Contraindicated with significant renal impairment, during labor and delivery, lactation; patients wearing soft contact lenses (ophthalmic); aspirin allergy; concurrent use of NSAIDS, active peptic ulcer disease, recent bleed or peroration, history of peptic ulcer disease or GI bleeding; hypersensitivity to ketorolac; as prophylactic analgesic before major surgery; treatment of Perioperative pain in CABG; suspended or confirmed cerebrovascular disease; hemorrhagic diathesis,

y CNS: headache, dizziness, somnolence, fatigue, insomnia, tinnitus, ophthalmologic effects. y GI: Nausea, dyspepsia, GI pain, vomiting, diarrhea, constipation, flatulence, gastric or duodenal ulcers. y GU: dysuria, renal impairment y Hematologic: bleeding, decreased platelets inhibition with higher doses, neutropenia, eosinophilia, leucopenia, agranulocytosis ,

y Every efforts will be made to administer the drug on time to control pain; dizziness, drowsiness can occur (avoid driving or using dangerous machinery); burning and stinging on application (ophthalmic). y Do not use ophthalmic drops with contact lenses y Report sore throat, fever, rash, itching, weight gain, swelling in ankles or fingers; changes in vision; black, tarry, stools, easy bruishing

incomplete granulocytopeni hemostasis, high a, aplastic risk of bleeding, anemia, use with decreased Hct probenecid, or Hgb, bone pentoxyphylline marrow depression, y Use Cautiously menorrhagia with impaired hearing; allergies; y Respiratory: hepatic, CV and GI Dyspnea, condition. hemoptysis, Pharyngitis, bronchospasm, rhinitis y Other: peripheral edema; anaphylactoid reactions to anaphylactic shock; local burning, stinging (ophthalmic)

SUMMARY OF MEDICATION Date 1-22-12 (Pre-op) 1-22, 23, 24-12 (post-op) 1-25-12 1-22,23-12 1-22,23-12 1-22,23,24-12 1-22-12 1-23-12 1-24,25-12 1-24,25-12 Medication Cefuroxime 750 mg IVTT every 8 hours (-) ANST Cefuroxime 750 mg IVTT every 8 hours (-) ANST Cefuroxime 500 mg 1 tab BID for 7 days Ketorolac 30 mg IVTT every 8 hours or 3 doses Tramadol 50 mg IVTT every 6 hours or 4 doses Ranitidine 50 mg IVTT every 12 hours whole on NPO Metoclopromide 10 mg IVTT every 8 hours for vomiting Paracetamol 300 mg IVTT now then every 4 hours x T:37.5C Mefenamic acid 500 mg 1 tab every 6 hours PRN x PAIN Multivitamins + FeSO4 1 tab OD Remarks Given and tolerated Given and tolerated Given and tolerated Given and tolerated Given and tolerated Given and tolerated Given and tolerated Given and tolerated Given and tolerated Given and tolerated

SUMMARY OF INTRAVENOUS FLUID Date/Time Started INRA-OP: 1-22-12 1-22-12 1-22-12 POST-OP 1-22-12 1-23-12 1-24-12 1-25-12 Intravenous Fluids & Volume Drop Rate 30 gtts/min 30 gtts/min No. of Hours Date/Time Consumed

# 1 D5LR 1L 12:45 PM # 2 D5LR 1L 5:20 PM PLR 1L 7:15 PM PLR 1L 8:45 PM # 1 D5LR 1L # 2 D5NM 1L 1:00 PM # 4 D5LR 1L 1:00 PM # 5 D5NM 1L

30 gtts/min 30 gtts/min 30 gtts/min 30 gtts/min 30 gtts/min

IDEAL

ACTUAL Hypogastric pain: y Received patient per wheelchair, conscious and coherent, referred from Dr. Uy Hospital with c/c of hypogastric pain T/C ectopic pregnancy by TVS, G2P1, BP= 120/80 mmHg, with on-going IVF D5LR 1L at 790 cc on Left arm from Dr. Uy. y Vital signs taken and recorded, seen and examined by Dr. Valenzuela with orders made and carried out. y Instructed on NPO, Labs: Hct, Hgb, pregnancy test taken and requested, to follow-up IVS instructed SO, watch for any unusualities. y For pelvic lap, consent for surgery secured, OR and anestheologist informed, to secure 500 cc FWB of patients blood type of crossmatch y Transported to OB ward per wheelchair with v/s BP=120/80 mmHg HR=21 RR=21 endorsed of NOD Post transferred assessments: y Received patient from per garney ride, awake, no in respiratory distress, afebrile, with dry-intact dressing, with FBC to urobag with PLP 1L at 30 gtts/min with 300 cc level left, with initial v/s of BP= 118/67 HR=76 RR=22 T=36.5C O2 Sat=100% y Transferred to bed carefully, put flat on bed, v/s checked and recorded, kept thermoregulator, I and O monitored and recorder, meds given Pre-endorsement assessment: y Awake, able to move both lower extremities, not in respiratory distress, afebrile, with dry intact dressing, with FBC to urobag, with #1 D5LR 1L at 30 gtts/min y Endorsed to OB gyne nurse on duty Post-transfer assessment: y Patient awake and coherent with patent IVF, with FBC to urobag, with dry and intact dressings over post-op site, on NPO y Instructed diet, monitored I and O, regulated IVF,

y y y y

instructed flat on bed until 1:30 am (1/23/12), kept watched or any unusualities altered. Instructed perineal care and proposed proper handwashing Carried out above Dressing checked, instructed handwashing, perineal care and early ambulation, kept watched for any unusualities Report Hgb and Hct result referred to Dr. Abedin with order carried out, new read prescribed.