Drug Mechanism of Action

Indication Contraindication Side Effect/ Adverse Effect

Nursing Implications/Responsibilities

Generic Name:

Amlodipine Bensylate

Brand Name:

Norvasc

Classification:

Cardiovascular agent; Calcium channel blocker; Antihypertensive agent

Dose:

Inhibits calciumions from enteringthe slow channelsor select voltage sensitiveareas ofvascular smoothmuscle andmyocardiumduring depolarization

Hypertension and angina

Hypersensitivity to benazepril, to any other ACE inhibitor, or to amlodipine, lactation.

Caution:

With severe aortic stenosis and in severe renal or hepatic disease. In clients with CHF, with or without associated with renal insufficiency.

CNS:DizzinessLightheadednessFatigueLethargy

CV:Peripheral edemaArrhythmias

Dermatologic:Flushing, rash

GI:NauseaAbdominaldiscomfort

Assessment & Drug Effects

1. Monitor BP for therapeutic effectiveness. BP reduction is greatest after peak levels of amlodipine are achieved 6–9 h following oral doses.

2. Monitor for S&S of dose-related peripheral or facial edema that may not be accompanied by weight gain; rarely, severe edema may cause discontinuation of drug.

3. Monitor BP with postural changes. Report postural hypotension. Monitor more frequently when additional antihypertensive or diuretics are added.

4. Monitor heart rate; dose-related palpitations (more common in women) may occur.

5. Report significant swelling of face or extremities.

6. Take care to have support when standing & walking due to possible dose-related light-headedness/dizziness.

7. Report shortness of breath, palpitations, irregular heartbeat, nausea, or constipation to physician.

8. Do not breast feed while taking this drug without consulting physician.

Drug Mechanism of Action

Indication Contraindication

Side Effect/ Adverse Effect

Nursing Implications/Responsibilities

Generic Name:

Metoclopramide

Brand Name:

Maxolon

Classification:

Antiemetic, GI stimulant

Dose: PRN for nausea and vomiting

Stimulates motility of upper GI tract without stimulating gastric, biliary, or  pancreatic secretions; appears to sensitize tissues to action of acetylcholine; relaxes pyloric sphincter, which, when combined with effects on motility, accelerates gastric emptying and intestinal transit; little effect on gallbladder or colon motility; increases lower esophageal sphincter pressure; has sedative properties; induces release of  prolactin

Disturbance of GI motility

Relief of symptoms of acute and recurrent diabetic gastroparesis 

Metabolic diseases Short-term therapy

for adults with symptomatic gastroesophageal reflux who fail to respond to conventional therapy

Prophylaxis of  postoperative nausea and vomiting when nasogastric suction is undesirable

Contraindicated with allergy to metoclopramide, GI hemorrhage, mechanical obstruction or  perforation, epilepsy

Use cautiously

With previously detected breast cancer, lactation, pregnancy, fluid overload, renal impairment

CNS: restlessness, drowsiness, fatigue, insomnia, dizziness ,anxiety

CV: transient hypertension

GI: nausea and diarrhea

1. Report immediately the onset of restlessness, involuntary movements, facial grimacing, rigidity, or tremors. Be aware that during early treatment period, serum aldosterone may be elevated; after prolonged administration periods, it returns to pretreatment level.

2. Lab tests: Periodic serum electrolyte.3. Monitor for possible hypernatremia and

hypokalemia (see Appendix F), especially if patient has CHF or cirrhosis.

4. Adverse reactions associated with increased serum prolactin concentration (galactorrhea, menstrual disorders, gynecomastia) usually disappear within a few weeks or months after drug treatment is stopped.

5. Avoid driving and other potentially hazardous activities for a few hours after drug administration.

6. Avoid alcohol and other CNS depressants.7. Report S&S of acute dystonia, such as

trembling hands and facial grimacing (see Appendix F), immediately.

8. Do not breast feed while taking this drug without consulting physician.

Drug Mechanism of Action Indication Contraindication Side Effect/ Adverse Nursing

Effect Implications/Responsibilities

Generic Name: Ranitidine

Brand Name: Zantac

Classification:

Antacid/ H2 blocker

Dose: 50mg TIV q8○

• Inhibits the action of histamine at the H2 receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion.

• In addition, ranitidine bismuth citrate has some antibacterial action against H. pylori.

Treatment and prevention of heartburn, acid indigestion, and sour stomach.

Contraindicated in:

•Hypersensitivity, Cross-sensitivity may occur; some oral liquids contain alcohol and should be avoided in patients with known intolerance.

Use Cautiously in:

• Renal impair- ment• Geriatric patients (moresusceptible to adverse CNS reactions)• Pregnancy or Lactation

CV: ArrhythmiasCNS: Confusion,

dizziness, drowsiness, hallucinations, headache

GI: Altered taste, black tongue, constipation, dark stools, diarrhea, drug-induced hepatitis, nausea

GU: Decreased sperm count, impotence

ENDO: GynecomastiaHEMAT:

Agranulocytosis, Aplastic Anemia, neutropenia, thrombocytopenia

LOCAL:Pain at IM site

MISC:Hypersensitivity reactions, vasculitis

1. Assess patient for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate.

2. Nurse should know that it may cause false-positive results for urine protein; test with sulfosalicylic acid.

3. Inform patient that it may cause drowsiness or dizziness.

4. Inform patient that increased fluid and fiber intake may minimize constipation.

5. Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea; dizziness; rash; confusion; or hallucinations to health care professional promptly.

6. Inform patient that medication may temporarily cause stools and tongue to appear gray black.

Nursing

Drug Mechanism of Action Side Effect/ Adverse Effect

Contraindication Implications/Responsibilities

Generic Name:Cefuroxime

Brand Name:Ceftin, Zinacef

Classification:Second-generation Cephalosporin

Dose: 750 mg q8 x 6 doses (-) ANST

Bind to bacterial cell wall membrane, causing cell death. Spectrum:

Similar to that of first- generation cephalosporins but have increase activity

Not active against methicilin-resistant staphylococci or enterococci

Indication:

Treatment of: Urinary Tract Infection Preoperative prophylaxis

CNS: SeizuresGI: pseudomembranous colitis, nausea, vomiting, crampsDERM: rashes, Hemat: Hemolytic AnemiaLocal: pain

Contraindicated in: Hypersensitivity to

cephalosporin

Instruct pt. to take medication around the clock at evenly spaced times and to finish the medication completely, even if feeling better.

Advise pt. that report signs of super infection and allergy.

Instruct pt to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucous. Advise pt not to threat diarrhea without consulting health care professional.

Normal Values: Results: Significance:

Blood Urea Nitrogen 8-25 mg/dL 7.3 mg/dL Decreased BUN indicates

pregnancy due to increased plasma volume

Creatinine 0.5-1.7 mg/dL 0.4 mg/dL

Decreased indicates prolonged inactivity leads to decreased

muscle mass because the muscles get weaker if not used

regularly.

SGPT 0-42 U/L 46.8U/LIncreased indicates to traumatic

pregnancy labor.

SGOT 0-42 U/L 15.1U/LDecreased indicate to Vitamin

B6 deficiency

BLOOD CHEMISTRY

09-11-11

Hematology

Result Normal Findings SignificanceWBC 12.8 x10 9/L 5-10 x109/L Infection

Hemoglobin 132 g/L 120-140 g/L Normal

Hematocrit 0.39 % 0.44-0.48 %Decreased levels that indicates

over hydration

RBC 4.4 x 106/uL4.0-4.

5 x106/uLNormal

Platelet 260/cu.mm 150-400/cu mm. NormalBT 2,30 1-3 mins NormalCT 4,30 2.5 mins normal

Segmenters 0.78 0.40-0.60Increased indicates bacterial

infection

IV FLUID Classification Indication Mechanism of Cction

Side Effects Nursing Precaution

D5LR Hypertonic Solution

Replacement therapy particularly in extracellular fluid deficit accompanied by acidosis.

is used when intravascular volume is low or to maintain fluid volume during surgery or labor. Dehydration, burns, gastrointestinal fluid loss and acute blood loss may all dictate Lactated Ringer's administration to replace large fluid losses quickly.

Abnormal Heart Rhythm

Muscle Weakness of the Arms or Legs

Low Energy

Numbness

Tingling of Hands or Feet

Trouble Breathing

High Amount of Potassium in the Blood

Confused

Anxious

1. Never stop hypertonic solutions abruptly.

2. Don’t give concentrated solutions I.M. or subcutaneously.

3. Monitor glucose level carefully.

4. Check vital signs frequently. Report adverse reactions.

5. Monitor fluid intake and output and weight carefully. Watch closely for signs and symptoms of fluid overload.

6.Monitor patient for signs of mental confusion.

Assessment Diagnosis Planning Nursing Intervention Rationale Evaluation

Subjective :

“Mataas daw po yung BP ko” as verbalized by the patient

Objective: Restlessne

ss V/S:

BP- 150/90

Elevated blood pressure related to labor pain

After 8 hours of my nursing intervention the patient will decrease the blood pressure from 150/90 to 130/80

INDEPENDENT:•Monitor patient vital sign especially blood pressure and pulse

•Position patient in semi fowlers (45 degree) •Encourage patient to maintain head/neck in neutral position and support the neck during movement. •Suggest frequent position changes, leg exercises when lying down.

•Teach and encourage the patient to do a deep breathing exercise

•Encourage patient to decrease or eliminate caffeine like in tea, coffee, cola and chocolates.

•Stress importance of accomplishing daily rest periods.

•Encourage patient to rest in bed

DEPENDENT:•Give due medications

•High blood pressure and pulse indicate patient having pain. •To promote comfort to patient.

•To avoid hypertension of neck and prevent stress on the suture line.

•Decreases peripheral venous pooling that may be potentiated by vasodilators and prolonged sitting or standing.

•For muscle relaxation and reduce pain.

•Caffeine is a cardiac stimulant and may adversely affect cardiac function.

•Alternating rest and activity increases tolerance to activity progression.

•To minimize patient movement. Extra movement will trigger more pain.

•Refer to drug study.

After 8 hours of my nursing intervention the patient’s blood pressure is still 150/90.

Assessment Diagnosis Planning Implementation Rationale Evaluation

S-“mainit ang pakiramdam ko”, as verbalized by the patient

O- febrile (38.8◦C) -warm to touch -BP 160/100

Hyperthermia r/t infection

After 4 hours of rendering nursing interventions, the patient’s body temperature will decrease from 38.9◦C to 37.0◦C

1.Identify underlying cause (e.g excessive heat production, such as impaired heat dissipation, such as heatstroke, infection)

2. Monitor V/S.

3. Promote surface cooling by means of undressing, cool environment; cool TSB especially in groin and axillae.

4. Administer antipyretics as prescribed.

5. Administer medication as prescribed such as antibiotics for infection.

6. Administer replacement fluids and electrolytes.

7. Maintain bed rest.

-To asses causative /contributing factors.

-T o evaluate effects /degree of hyperthermia and to obtain baseline data.

-To assist with measures to reduce body temperature and restore normal body function.

-To reduce body temperature and shivering.

-To treat underlying cause.

-To support circulating volume and tissue perfusion.

-To reduce metabolic demands/ oxygen consumption.

After 4 hours of rendering nursing interventions, the patient’s body temperature was decrease from 38.9◦C to 37.4◦C.

-Goal met.

Drug Mechanism of Action

Side Effect/

Adverse Effect

Contra-indication

Nursing Implications/

Responsibilities

Generic Name:

Tramadol

Brand Name:

Ultram

Classification:

Analgesics

This medication is used to help relieve moderate to moderately severe pain. Tramadol is similar to narcotic analgesics. It works in the brain to change how your body feels and responds to pain.

Tramadol is generally well tolerated, and side effects are usually transient. Commonly reported side effects include nausea,constipation, dizziness, headache, drowsiness, and vomiting. Less commonly reported side effects include itching, sweating, dry mouth, diarrhea, rash, visual disturbances, and vertigo. Some patients who received tramadol have reported seizures. Abrupt withdrawal of tramadol may result in anxiety, sweating, insomnia, rigors, pain, nausea, diarrhea, tremors, and hallucinations.

Ultram should not be administered to patients who have previously demonstrated hypersensitivity to tramadol or in cases of acute intoxication with alcohol, hypnotics, centrally acting analgesics, opioids or psychotropic drugs.

• Assess type, location, and intensity of pain before and 2-3 hr (peak) after administration.

• Assess BP & RR before and periodically during administration. Respiratory depression has not occurred with recommended doses.

• Assess bowel function routinely. Prevention of constipation should be instituted with increased intake of fluids and bulk and with laxatives to minimize constipating effects.

• Assess previous analgesic history. Tramadol is not recommended for patients dependent on opioids or who have previously received opioids for more than 1 wk; may cause opioid withdrawal symptoms.

• Prolonged use may lead to physical and psychological dependence and tolerance, although these may be milder than with opioids. This should not prevent patient from receiving adequate analgesia. • Tramadol is considered to provide more analgesia than codeine 60 mg but less than combined aspirin 650mg/codeine 60 mg for acute postoperative pain.

• Monitor patient for seizures. May occur within recommended dose range. Risk increased with higher doses and inpatients taking antidepressants, opioid analgesics, or other durgs that decrese the seizure threshold.

• Overdose may cause respiratory depression and seizures. Maintain adequate respiratory exchange.

• Encourage patient to cough and breathe deeply every 2 hr to prevent atelactasis and pneumonia.

ASSESS-MENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

Subjective:

“Masakit pa din yung tahi ko ” as verbalized by the patient

Objective:

C pain scale of 7/10 below the umbilicus

C guarding behavior

C facial grimace

Acute pain related to post-surgical incision

After 8 hours of nursing intervention the patient will be able to report decrease of pain from 7/10 to 3/10.

INDEPENDENT:

1. Monitor and record vital signs and assess for pain scale

2. Assess incision site and change dressing as needed

3. Document bowel sounds, passing of flatus and bowel movements.

4. Place client in semi-fowlers to fowlers position

5. Place an ice bag  

6. Watch closely for possible surgical complications

7. Encourage deep breathing and frequent turning.

DEPENDENT:

1. Give analgesic as ordered.

2. Assist with medication regimen as necessary, noting potential presence of side effects.

  COLLABORATIVE:

1. Assist/support family with care of the patient

1. To obtain baseline data

2. To assess for signs of infection. Changing the soiled dressing will prevent infection and discomfort.

3. In patient with nausea and abdominal rigidity have subsided, this signs indicate e]readiness to resume oral fluids.

4. To reduce pain.

5. Never apply heat to the site because it will cause pain.

6. Fever and continuing pin would indicate abscess.

7. To promote lung expansion and prevent pulmonary complications

8. To reduce pain

9. To aid fast recovery of the patient and to prevent complications.

After 8 hours of nursing intervention the patient was able to report decrease of pain from 7/10 to 3/10.

ASSESS-MENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

Subjective:

“minsan hirap ako huminga dahil sa ubo ko” as verbalized by the patient

Objective:

(+) crackles

c productive cough

pale in appearance

RR- 22cpm

Ineffective Airway Clearance related to bronchial secretion.

After 8 hours of nursing intervention, airway patency maintained and there is improvement in the airway clearance as evidenced by “medyo maluwag na paghinga ko”

Independent:

1. Establish rapport

2. Vital signs monitored and recorded.

3. Assess respiratory quality, rate, depth, effort and pattern.

4. Assisted in semi-fowlers position.

5. Encouraged deep breathing exercise.

6. Instruct patient to increase fluid intake

7. Encourage the patient to rest, limit the activities of level of respiratory tolerance

Dependent:

1. Administered prescribed medications.

2. Provided supplemental humidification via use of nebulizer.

To gain cooperation of the patient

To obtain baseline data.

Provide basis for evaluating adequacy of ventilation.

To maintain open airway and maximize lung expansion.

To promote proper lung expansion

To liquefy viscous secretions and improve secretion clearance.

To reduce fatigue Prescribed meds such

as bronchodilators helps in aiding effective airway clearance

Nebulization aids in bronchodilation.

After 8 hours of nursing intervention, airway patency maintained and there is improvement in the airway clearance as evidenced by “medyo maluwag na paghinga ko”