IX. DRUG STUDY

Generic NameSpecific Action

Mechanism of Action

Specific Indication

Contra-indication

Adverse EffectNursing

Responsibility

Spironolactone50mg Tab OD

Brand name:

Aldactone

Aldosterone antagonistPotassium sparing diuretic

Competitively blocks the effect of aldosterone in the renal tubule, causing loss of sodium and water retention of potassium.

Diagnosis and maintenance of primary hyperaldosteronism

Adjunctive therapy in edema associated with heart failure, nephrotic syndrome, hepatic cirrhosis when other therapies are inadequate or inappropriate.

Treatment of hypokalemia or prevention of hypokalemia in patients who would be of high risk if hypokalemia occurred.

Contraindicated with allergy to spironolactone, hyperkalemia, renal disease, anuria, amiloride, or triamterene use.

Dizziness, headache, drowsiness, fatigue, ataxia, confusion

Rash, Urticaria Cramping,

diarrhea, dry mouth, thirst, vomiting

Impotence, irregular menses, amenorrhea, post-menopausal bleeding

Hyperkalemia, hyponatremia, agranulocytosis

Give daily doses early so that increased urination does not interfere with sleep.

Measure and record regular weight to monitor mobilization of edema fluid.

Clonidine HCl 75g/ml for BP >= 160/100

Brand name:

Catapres

Anti-hypertensive Centrally

acting antiadrenergic derivative. Stimulates alpha2-adrenergic receptors in CNS to inhibit sympathetic vasomotor centers. Central actions reduce plasma concentrations of norepinephrine. It decreases systolic and diastolic BP and heart rate. Also inhibits renin release from kidneys.

Treatment of hypertension, either alone or with diuretic or other antihypertensive agents.

Pregnancy, lactation and hypotensive patients

Hypotension peripheral edema, ECG changes, tachycardia, bradycardia, flushing, rapid increase in BP with abrupt withdrawal.

Dry mouth, constipation, abdominal pain, altered taste, nausea, vomiting,

Drowsiness, sedation, dizziness, headache, fatigue, weakness, sluggishness,

Rash, Dry eyes.

Monitor BP closely.

With epidural administration, frequently monitor BP and HR.

Monitor I&O during period of dosage adjustment.Report change in I&O ratio or change in voiding pattern.

Dertermine weight daily.

Supervise closely patients with history of mental depression, as they may be subject to further depressive episodes.

DiphenhydramineHCl

1amp (IV) 30 minutes prior to

BT

Brand name:

Benadryl

Antihistamine Completely block the effects of histamine at peripheral H1 receptor sites, have anticholinergic (atropine-like) antipruritic effect.

Amelioration of allergic reactions to blood or plasma.

Contraindicatedwith allergy to antihistamines,lactation and pregnancy.

Depression, nightmares, sedation.

Arrhythmias Alopecia,

angioedema, skin eruption and itching,

Dry mouth, GI upset, anorexia, increased appetite, nausea, vomiting, diarrhea

Bronchospasm, cough, thickening of secretions

Avoid excessive dosage.

Administer with food of GI upset occurs.

Provide mouth care, sugarless lozenges for dry mouth.

Amlodipine 10 mg OD

Brand name:

Ambesyl

Calcium Channel Blocker

Calcium channel blockers are antianginal and antihypertensive. It works by relaxing the blood vessels in the body, making it easier for the heart to pump blood around the body. It also widens the blood vessels leading to the heart and so help increase the supply of oxygen rich blood to the heart.

Treatment of angina pectoris caused by coronary artery spasm, chronic stable angina, hypertension, arrhythmias, subarachnoid hemorrhage.

Contraindicated with heart block, allergy to calcium channel blockers, sick sinus syndrome, ventricular dysfunction, pregnancy.

Dizziness, lightheadedness, headache, fatigue, sleep disturbance, blurred vision

Peripheral edema, hypotension, arrhythmias, AV block

Flushing, rash, dermatitis, pruritus, urticaria

Nausea, diarrhea, constipation, flatulence, cramps.

Do not chew or divide sustained release tablets. Swallow whole.

Monitor patient carefully while drug is being titrated to therapeutic dose.

Hydroxyzine 10grams 1 tab TID

Brand name:

Iterax

Antihistamine

Actions may be due to suppression of subcortical areas of the CNS.

Symptomatic relief of anxiety and tension associated with psychoneurosis, adjunct in organic disease states in which anxiety is manifested ; alcoholism and asthma; before dental procedure

Management of pruritus due to allergic condition, such as chronic urticaria, atopic and contact dermatosis, and in histamine mediated pruritus.

Contraindicated with allergy to hydroxyzine or cetirizine, pregnancy, lactation.

Drowsiness, involuntary motor activity, including tremor and seizures.

Dry mouth, reflux, constipation,

Urinary retention Wheezing,

dyspnea, chest tightness

Take as prescribeed. Avoid excessive dosage.

Report difficulty breathing, tremors, loss of coordination, sore muscles, or muscle spasm.

Drug Name Specific Action Mechanism of action Indication Contraindication

Adverse Effect Nursing responsibility

Godex Hepatic protector

Cholagogues promotes the discharge of bile from the system, purging it downward

Acute and chronic hepatitis

Cirrhosis drug-induced

hepatitis general and

alcoholic intoxication,

fatty liver

Contraindicated for patients who are hypersensitive to the drug

Galactosemia Bowel

obstruction

Monitor vital signs

Should be taken with foods

Drug Name Specific Action

Mechanism of action Indication Contraindication Adverse Effect Nursing responsibility

Laitun

Content: ciprofloxacin

fluoroquinolones

They interfere with DNA replication in susceptible gram-negative bacteria, preventing cell replication and leading to death of bacteria

Mild to moderate UTI

Infectious diarrhea

Hypersensitivity to quinolones

Nausea/vomiting

Restlessness Anorexia Dysphagia tachycardia

maintain adequate hydration

tell patient that it may impair ability to drive & operate machinery

Drug Name Specific Action Mechanism of action

Indication Contraindication Adverse Effect Nursing responsibility

Amoxapine

Brand name:

Asendin

Anxiolytics

Antidepressant

Inhibits reuptake of norepinephrine and serotonin in CNS leading to an increase in their effects

Relief symptoms of depression

Unlabeled use: Management

of chronic pain associated with migraine

Chronic tension headache

Peripheral neuropathy

Arhtritic pain

Hypersensitivity to tricyclic antidepressants

Not recommended for use during acute recovery phase of MI.

Orthostatic hypotension

tachycardia palpitations Arrhythmias Confusion Hallucination

and delusion Drowsiness Pruritus Blurred

vision

Use with caution in patients with history of seizures, pressure, CV disorders, hyperthyroid patients

Monitor vital signs for potentially fatal condition

Instruct patient to monitor food intake; weight gain can occur because of increased appetite and craving for sweets.

Emphasize importance of regular dental care because oral dryness can increase risk for dental caries.

Instruct patient to report the following symptoms to health care provider: Persistent dry mouth, constipation, urinary retention, fever, sore throat, or muscle rigidity.

Instruct patient to take sips of water frequently if dry mouth occurs. Suggest patient increase fluids and fiber in diet to alleviate constipation.

Do not take the medication in larger amount.

Drug Name Specific Action

Mechanism of action

Indication Contraindication Adverse Effect Nursing responsibility

Furosemide

Lasix

Loop Diuretic

Inhibits reabsorption of sodium and chloride from the proximal and distal tubules and ascending limb of Henle, leading to sodium-rich diuresis

Edema Hypertension

Contraindicatedin patientshypersensitiveto drug andthose withanuria

Use cautiouslyin patient whoAre allergic to sulfonamides.

CNS: headache,vertigo, dizziness,paresthesia,weakness,restlessness, fever

CV: orthostatichypotension,thrombophlebitis withIV administration

EENT: transient deafness,

blurred or yellowed vision, tinnitus GI: abdominal

discomfort and pain,diarrhea, anorexia,nausea, vomiting,constipation,pancreatitis

GU: nocturia, polyuria,frequent urination,oliguria

Monitor weight, bloodpressure, and pulse rateroutinely with long term use.

If oliguria or azotemiadevelops or increases, drugmay need to be stopped.

Monitor fluid intake andoutput and electrolyte, BUN,and carbon dioxide levels.

Watch for signs ofhypokalemia.

Consult prescriber and dietitian about a high-potassium diet or potassiumsupplements. Foods rich inpotassium include citrusfruits, tomatoes, bananas,dates, and apricots.

HEMATOLOGIC:agranulocytosis,aplastic anemia

Drug Name

Classification Mechanism of action

Indication Contraindication Adverse Effect Nursing responsibility

Sodium chloride tab

electrolyte sodium is the major cation of the body's extracellular fluid. It plays a crucial role in maintaining the fluid and electrolyte balance. Excess retention of sodium results in overhydration (edema, hypervolemia), which is often treated with diuretics. Abnormally low levels of sodium result in dehydration.

prophylaxis of heat prostration or muscle cramps

chloride deficiency due to dieresis or saltrestrictions

prevention or treatment of extracellular volume depletion

congestive heart failure,

hypernatremia fluid retention

hypernatremia, hypopotassemia, acidosis.

Fluid and solute overload leading to dilution of serum electrolyte level

acute pulmonary edema

Monitor electrolytes, ECG, liver and renal function studies

Note level of consciousness

Assess the heart and lung sounds

Observe S&S of hypernatremia, flushed skin, elevated temperature, rough dry tongue, and edema.

Monitor VS and I&O Assess urine specific

gravity and serum sodium levels

X. NURSING CARE PLAN

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective:

“Nahihirapan akong huminga,” as verbalized by the patient.

Objective:

>flaring of nose

>inadequate chest expansion

>rapid shallow breathing

>pallor

V/S

T- 37.6 C

P- 110

Ineffective breathing pattern related to intra-abdominal fluid collection as evidenced by rapid shallow breathing.

After 8-hours of nursing intervention the patient will participate in actions to maximize oxygenation.

Independent:

1. Monitor respiratory rate, depth and effort.

2. Auscultate breath sounds, noting crackles, wheezes or ronchi.

3. Investigate changes in the level of consciousness.

1. Rapid shallow breathing may be present because of hypoxia and fluid accumulation in the abdomen.

2. Indicates developing of complications (adventitious sounds reflects accumulation of fluid; absent sounds suggest atelectasis.

3. Changes in mentation may reflect hypoxemia and respiratory failure which often accompany hepatic

Goal met.

After 8 hours of nursing intervention the patient participate in deep breathing and coughing exercises.

R-29

BP- 180/100 4. Keep head of the bed elevated.

5. Frequent repositioning and encourage deep-breathing exercises or coughing as appropriate.

6. Monitor temperature. Note presence of chills, increased coughing and changes in the color/character of sputum.

Collaborative:

1.Monitor serial ABG, pulse oximetry, vital capacity measurements and chest x-ray.

coma.

4. Facilitates breathing by reducing pressure on the diaphragm and minimizes risk of aspiration of secretions.

5. Aids in lung expansion and mobilizing secretions.

6. Indicative of onset of infection.

1.Reveals changes in respiratory status or developing

2.Provide supplemental oxygen as ordered.

3.Demonstrate and assist with respiratory adjuncts such as incentive spirometer.

pulmonary complications.

2.May be necessary to prevent hypoxia and decrease work of breathing.

3.Reduces incidence of atelectasis, and enhances mobilization of secretions.

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective:

“Nanlalambot ako,” as verbalized by the patient.

Objective:

>body malaise

>ambulation with assistance

> limited ROM

> weak in appearance

> needs assistance in positioning in bed

>minimal movement

V/S

T- 37.6 C

P- 110

R-29

Activity intolerance related to decreased endurance as evidenced by easy fatigability.

After 8-hours of nursing intervention the patient will achieve and maintain ability to perform activities without tolerance and fatigue.

Independent:

1.Assess level of activity intolerance and degree of fatigue when performing ADLs.

2.Assist with activities and hygiene when fatigued

3.Encourage rest when fatigued or when abdominal pain or discomfort occurs

4. Assist with selection and pacing of desired activities and exercise.

5. Provide diet high in carbohydrates with

1.Provides baseline for further assessment of effectiveness of interventions.

2.Promotes exercise and hygiene within patient’s level of tolerance.

3.Decreases energy expenditure.

4. Stimulates patient’s interest in selected activities.

5.Provides calories

Goal unmet.

After 8-hours of nursing interventions, the patient was not able to maintain strength and function.

BP- 180/100 protein intake consistent with liver function

.

6. Reposition every 2 hours, and provide good skin care

7. Increase activities as patient is able to tolerate.

8. Instruct patient and family on disease process and need for extended rest

Collaborative:

1.Administer supplemental vitamins

for energy and protein for healing

6. Decrease potential for skin breakdown.

7. Assist with return to optimal activity levels while enabling patient to have some measure of control over situation.

8. promotes knowledge and facilitates compliance with treatment.

1.To provide additional nutrients.

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective:

“Wala akong ganang kumain” as verbalized by the pt.

Objective:

>poor appetite

>pallor

>weak in appearance

V/S

T- 37.6 C

P- 110

R-29

BP- 180/100

Imbalanced nutrition: Less than body requirements related to inadequate diet as evidenced by poor appetite.

After 8-hours of nursing intervention the patient will demonstrate behaviors to maintain proper nutrition.

Independent:

1.Measure dietary intake by calorie count.

2.Encourage patient to eat. Explain reasons for types of diet. Consider preferences in food status.

3.Recommend small frequent meals.

4.Restrict intake of caffeine, gas forming, or spicy and excessively hot or

1.Provides information about intake, needs and deficiencies.

2.Improved nutrition is vital to recovery.

3.Poor tolerance to larger meals may due to increased intra-abdominal pressure.

4.Aids in reducing gastric irritation and abdominal discomfort that may impair oral

Goal met. After 8 hours of nursing intervention the patient verbalize desire to eat, “Gusto kong kumain para manumbalik ang lakas ko”.

cold foods.

5.Encourage frequent mouth care specially before meals

6.Promote undisturbed rest periods specially before meals.

Collaborative:

1.Monitor laboratory status such as serum glucose, albumin, total protein nutrition and ammonia.

2.Consult with

intake

5.Patient is prone to sore and bad taste in mouth which may contribute to anorexia

6.Conserving energy reduces metabolic demand on the liver and promotes cellular regeneration

1.Glucose may be decreased because of impaired glycogenesis, depleted glycogen or inadequate intake. Protein may be low because of impaired metabolism decrease hepatic synthesis or loss into peritoneal cavity. Elevation of ammonia level may require restriction of

dietician to provide diet that is high in calories and simple carbohydrate, low in fat, and moderate to high protein, limit sodium and fluid as necessary

3.Administer

Multivitamins and

Godex as prescribe.

protein intake to prevent serious complication

2.Dietician can provide detailed instruction, sample menus, and suggestions for improving the palatability and promoting intake

3.GODEX is a multicomponent drug containing Carnitine orotate, adenine HCl, B12,B6, and riboflavin which acts synergistically.

Assessment Diagnosis Planning Intervention Rationale Evaluation

SUBJECTIVE:

“Napansin ko nalumalaki ang tiyanko” asverbalized by thepatient.

OBJECTIVE:· Anasarca· Weight gain· Alteredelectrolytelevels

· V/S taken asfollows:

T- 37.6 C

P- 110

R-29

BP- 180/100

Fluid volume excess related to compromised regulatory mechanism as evidenced by edema and ascites formation

After 8 hours ofnursinginterventions,the patient willdemonstratestabilized fluidvolume anddecreasededema.

INDEPENDENT:

> Measure intake and output,weigh daily, andnote weight gainmore than 0.5kg/day.

> Assessrespiratorystatus, notingincreasedrespiratory rate,dyspnea.

>Monitor bloodpressure.

>Auscultatelungs, notingdiminished/absent breathsounds anddevelopingadventitioussounds.

>Reflects circulatingvolume status.Positive balance/weight gain oftenreflects continuingfluid retention.

> Indicative ofpulmonarycongestion.

>Blood pressureelevation usuallyassociated withfluid volumeexcess but maynot occur becauseof fluid shifts out ofthe vascularspace.

>Increasingpulmonarycongestion mayresult inconsolidation,impaired gasexchange, andcomplications.

Goal unmet.After 8 hours ofnursinginterventions, thepatient wasn’t ableto demonstratestabilized fluidvolume anddecreasededema.

>Assess degreeof peripheral/dependentedema.

> Measureabdominal girth.

> Encourage bedrest whenascites ispresent.

DEPENDENT:>Administermedications asindicated. Suchas diuretics, Albumin, Aldacton, Furosemide (Lasix)

>MonitorElectrolytes.

>Fluid shift intotissues as a resultof sodium andwater retention,decreasedalbumin, andincreased antidiuretic hormone(ADH).

>Reflectsaccumulation offluid (ascites)resulting from lossof plasma proteinsor fluid intoperitoneal space.

>May promoteRecumbency induceddiuresis.

> To control edemaand ascites. Promotes excretion of fluid through the kidneys and maintenance of normal fluid and electrolyte balance.

>To correct further imbalances.

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective:

“Mabigat at masakit ang tyan ko” as verbalized by the patient.

Objective:

>facial grimace

>with a painscale of 6/10

>irritable

>with guarding behavior

>with massive ascites

Acute pain and discomfort related to enlarged tender liver and ascites as evidenced by facial grimace and painscale of 6/10.

After 8 hours of effective nursing intervention, the patient will be able to demonstrate divertional activities to lessen pain.

INDEPENDENT:

1. Maintain bed rest when patient experiences abdominal discomfort.

2. Observe, record, and report presence and character of pain and discomfort.

3. Reduce sodium and fluid intake if prescribed.

4. Teach patient divertional activities such as deep breathing excercises and provide reading materials.

5. Prepare patient and assist with paracentesis.

DEPENDENT:

6.Administer antispasmodic and sedative agents as

1. Reduces metabolic demands and protects the liver.

2. Provides baseline to detect further deterioration of status and to evaluate interventions.

3. Minimizes further formation of ascites.

4. Provide venous return and promotes relaxation to the patient.

5. Removal of ascites fluid may decrease abdominal discomfort.

Goal met. After 8 hours of effective nursing intervention, patient seen doing the divertional activities instructed and patient’s pain lessened from 6/10 to 4/10.

prescribed. 6. Reduces irritability of the gastrointestinal tract and decreases abdominal pain and discomfort.

Assessment Diagnosis Planning Intervention Rationale Evaluation

“Madalas akong hapuin lalo na kapag lagi nakahiga” as verbalized by the patient.

Objective:

>Use of accessory muscles when breathing

>with labored breathing (shallow breathing)

RR- 29 cycles per minute

(+) crackles

Impaired Gas Exchange r/t accumulation of fluid in pleural space secondary to underlying physiologic condition.

After 8 hours of giving effective nursing intervention and health teaching, the patient will be able to know positioning techniques that improve ventilation.

INDEPENDENT:1. Position client in

either semi-fowlers position or side lying position.

2. Encourage client to cough as tolerated.

3. Monitor respiratory rate, depth, and effort, including use of accessory muscles, nasal flaring, and thoracic or abdominal breathing.

4. Monitor client’s behavior and mental status for onset of restlessness, agitation, confusion and in the late stages, extreme lethargy

5. Observe for cyanosis in skin: note especial color of tongue

1. Promote good ventilation and breathing.

2. Will promote mucoid or sputum excretion from the lungs

3. Proper assessment will help identify early problems.

4. Changes in behavior and mental status can be early signs of impaired gas exchange.

5. Central cyanosis in tongue and oral mucosa is indication of

Goal met. After 8 hours of giving effective nursing intervention and health teaching, the patient was able to know positioning techniques that improve ventilation.

and oral mucous membrane.

Dependent:

1. Administer oxygen inhalation appropriately.

2. Administer salbutamol

serious hypoxia and is a medical emergency; peripheral cyanosis seen in extremities may not be serious.

1. To promote enough oxygen supply

2. To provide bronchodilation.