DRUG STUDYNAME OF THE DRUGMECHANISM OF ACTIONDOSAGEINDICATIONSCONTRAINDICATIONSADVERSE EFFECTSNURSING RESPONSIBILITIES

Generic Name:

LEVOTHYROXINE SODIUM (T4)Brand Name: Levo-T Classifications:HORMONES AND SYNTHETIC SUBSTITUTES;THYROID AGENT Synthetically prepared monosodium salt and levo-isomer of thyroxine, with similar actions and uses (thyroxine, principal component of thyroid gland secretions, determines normal thyroid function).100mg 1 tab OD

Specific replacement therapy for diminished or absent thyroid function resulting from primary or secondary atrophy of gland, surgery, excessive radiation or antithyroid drugs, congenital defect. Administered orally for hypothyroid state; administered IV for myxedematous coma or other thyroid dysfunctions demanding rapid replacement, as well as in failure to respond to oral therapy.Hypersensitivity to levothyroxine; thyrotoxicosis, severe cardiovascular conditions, adrenal insufficiency.CNS:Irritability, nervousness,insomnia,headache (pseudotumor cerebri in children), tremors, craniosynostosis (excessive doses in children).CV:Palpitations, tachycardia, arrhythmias, angina pectoris, hypertension.GI:Nausea, diarrhea, change in appetite.Urogenital:Menstrual irregularities.Body as a Whole:Weight loss, heat intolerance, sweating, fever, leg cramps, temporary hair loss (children). Monitor pulse before each dose during dose adjustment. If rate is >100, consult physician.

Monitor for adverse effects during early adjustment. If metabolism increases too rapidly, especially in older adults and heart disease patients, symptoms of angina or cardiac failure may appear.

Lab tests: Baseline and periodic tests of thyroid function. Closely monitor PT/INR and assess for evidence of bleeding if patient is receiving concurrent anticoagulant therapy. A decrease in anticoagulant dosage may be needed 14 wk after concurrent levothyroxine is started.

Notify physician immediately of signs of toxicity (e.g., chest pain, palpitations, nervousness).

Avoid OTC medications unless approved by physician.

NAME OF THE DRUGMECHANISM OF ACTIONDOSAGEINDICATIONSCONTRAINDICATIONSADVERSE EFFECTSNURSING RESPONSIBILITIES

Generic Name:

Furosemide

Brand Name: Lasix

Classifications : ELECTROLYTIC AND WATER BALANCE AGENT;LOOP DIURETICRapid-acting potent sulfonamide "loop" diuretic and antihypertensive with pharmacologic effects and uses almost identical to those of ethacrynic acid. Exact mode of action not clearly defined; decreases renal vascular resistance and may increase renal blood flow.4Omg every 12 hours Treatment of edema associated with CHF, cirrhosis of liver, and kidney disease, including nephrotic syndrome. May be used for management of hypertension, alone or in combination with other antihypertensive agents, and for treatment of hypercalcemia. Has been used concomitantly with mannitol for treatment of severe cerebral edema, particularly in meningitis.History of hypersensitivity to furosemide or sulfonamides; increasing oliguria, anuria, fluid and electrolyte depletion states; hepatic coma; CV:Postural hypotension, dizziness with excessive diuresis, acute hypotensive episodes,circulatory collapse.Metabolic:Hypovolemia, dehydration, hyponatremiahypokalemia,hypochloremia metabolic alkalosis, hypomagnesemia, hypocalcemia (tetany), hyperglycemia, glycosuria, elevated BUN, hyperuricemia.GI:Nausea, vomiting, oral and gastric burning, anorexia, diarrhea, constipation, abdominal cramping, acute pancreatitis, jaundice.Urogenital:Allergic interstitial nephritis, irreversible renal failure, urinary frequency.Hematologic:Anemia, leukopenia, thrombocytopenic purpura;aplastic anemia, agranulocytosis(rare). Observe patients receiving parenteral drug carefully; closely monitor BP and vital signs. Sudden death from cardiac arrest has been reported.

Monitor for S&S of hypokalemia (see Appendix F).

Monitor BP during periods of diuresis and through period of dosage adjustment.

Observe older adults closely during period of brisk diuresis. Sudden alteration in fluid and electrolyte balance may precipitate significant adverse reactions. Report symptoms to physician.

Lab tests: Obtain frequent blood count, serum and urine electrolytes, CO2, BUN, blood sugar, and uric acid values during first few months of therapy and periodically thereafter.

Monitor I&O ratio and pattern. Report decrease or unusual increase in output. Excessive diuresis can result in dehydration and hypovolemia, circulatory collapse, and hypotension. Weigh patient daily under standard conditions.

Monitor urine and blood glucose & HbA1Cclosely in diabetics and patients with decompensated hepatic cirrhosis. Drug may cause hyperglycemia.

Note: Excessive dehydration is most likely to occur in older adults, those with chronic cardiac disease on prolonged salt restriction, or those receiving sympatholytic agents.

NAME OF THE DRUGMECHANISM OF ACTIONDOSAGEINDICATIONSCONTRAINDICATIONSADVERSE EFFECTSNURSING RESPONSIBILITIES

Generic Name:

Sodium Chloride (Nacl)

Classifications:electrolyte

sodium is the major cation of the bodys extracellularfluid. It plays a crucial role inmaintaining 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 indehydration. Normally, the plasma contains 136-145 mEq/L and 98-1-6 mEq chloride/L. the averagedaily requirement of salt is approximately 5g.

1 tab TID

prophylaxis of heat prostration or muscle cramps; chloride deficiency due to dieresis or saltrestrictions; prevention or treatment of extracellular volume depletion

congestive heart failure, severely impaired renal function, hypernatremia, fluidretentionhypernatremia, hypopotassemia, acidosis. Fluid and solute overload leading to dilution ofserum electrolyte level, CHF, overhydration, acute pulmonary edema Monitor electrolytes, ECG, liver and renal function studiesb. Note level of consciousnessc. Assess the heart and lung soundsd. Observe S&S of hypernatremia, flushed skin, elevated temperature, rough dry tongue, andedemae. Monitor VS and I&Of. Assess urine specific gravity and serum sodium levels

NAME OF THE DRUGMECHANISM OF ACTIONDOSAGEINDICATIONSCONTRAINDICATIONSADVERSE EFFECTSNURSING RESPONSIBILITIES

Generic Name: AmlodopineBrand Name:

Norvasc

Classifications: CARDIOVASCULAR AGENT;CALCIUM CHANNEL BLOCKER;ANTIHYPERTENSIVE AGENTAmlodipine is a calcium channel blocking agent that selectively blocks calcium ion reflux across cell membranes of cardiac and vascular smooth muscle without changing serum calcium concentrations. It predominantly acts on the peripheral circulation, decreasing peripheral vascular resistance, and increases cardiac output.10mg 1 tab OD

Treatment of mild to moderate hypertensionHypersensitivity to amlodipine;CV:Palpitations, flushing tachycardia,peripheral or facial edema, bradycardia, chest pain, syncope, postural hypotension.CNS:Light-headedness, fatigue,headache.GI:Abdominal pain, nausea, anorexia, constipation, dyspepsia, dysphagia, diarrhea, flatulence, vomiting.Urogenital:Sexual dysfunction, frequency, nocturia.Respiratory:Dyspnea.Skin:Flushing, rash.Other:Arthralgia, cramps, myalgia. Monitor BP for therapeutic effectiveness. BP reduction is greatest after peak levels of amlodipine are achieved 69 h following oral doses.

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.

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

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

NAME OF THE DRUGMECHANISM OF ACTIONDOSAGEINDICATIONSCONTRAINDICATIONSADVERSE EFFECTSNURSING RESPONSIBILITIES

Generic Name:

Albuterol

Brand Name: Salbutamol

Classifications : UTONOMIC NERVOUS SYSTEM AGENT;BETA-ADRENERGIC AGONIST (SYMPATHOMIMETIC);BRONCHODILATOR (RESPIRATORY SMOOTH MUSCLE RELAXANT)Inhibits histamine release by mast cells. Produces bronchodilation, regardless of administration route, by relaxing smooth muscles of bronchial tree.every 8 hours TID

-to relieve bronchospasm associated with acute or chronic asthma, bronchitis, or other reversible obstructive airway diseases

-also used to prevent exercise-induced bronchospasmContraindicated in persons with a history of hypersensitivity reaction (urticaria, angioedema, rash) to salbutamol, or any of its components. Salbutamol is also contraindicated in patients with pre-existing cardiac tachyarrhythmias.CNS: anxiety, nervousness, restlessness, weakness, headache

CV:Palpitation, hypertension, tachycardia.

Monitor therapeutic effectiveness which is indicated by significant subjective improvement in pulmonary function within 6090 min after drug administration.

Monitor lab tests: Periodic ABGs, pulmonary functions, and pulse oximetry.

Avoid contact of inhalation drug with eyes.

Notify physician if salbutamol fails to provide relief because this can signify worsening of pulmonary function and a re-evaluation of condition/therapy may be indicated.

Nursing Care PlanASSESSMENTNURSING DIAGNOSISPLANNINGNURSING INTERVENTIONSRATIONALEEVALUATION

Subjective:

no verbal cues

Objective:

O2 at 2 L/min

Presence of ETT and NGT

Excessive mucous secretions

Frequent coughing noted

Ineffective airway clearance related excessive mucous secretionAfter 8 hours of appropriate nursing interventions the patient will be able to maintain patent airway, and free from aspiration.

Specifically, the patient will be able to:

acquire basic knowledge of disease condition

effectively cough up secretions

mobilize secretions

demonstrate proper deep breathing exercisesIndependent:

1. Monitor respiratory rate, depth, and work of breathing.

2. Auscultate breath sounds, noting presence of rhonchi.

3. Assess for dyspnea, stridor, crowing and cyanosis.

4. Keep head of bed elevated 30-45 degrees. Caution client to avoid bending neck; support head with pillows in the immediate postoperative period.

5. Assist with repositioning, deep breathing exercises and or coughing as indicated.

6. Suction as indicated, noting color and characteristics of sputum.

Collaborative:

1. Provide steam inhalation.1. Respirations may remain somewhat rapid because of hyperthyroid state, but development of respiratory distress is indicative of tracheal compression from edema or hemorrhage.

2. Rhonchi may indicate airway obstruction/ accumulation of copious thick secretions.

3. Indicators of tracheal obstruction/laryngeal spasm, requiring prompt evaluation and intervention.

4. Enhances breathing.

5. Maintains clear airway and ventilation.

6. to maintain the airway patency.

1. Reduces discomfort of sore throat and promotes expectoration of secretions.

After 8 hours of appropriate nursing interventions the patient was not able to maintain patent airway.

ASSESSMENTNURSING DIAGNOSISPLANNINGNURSING INTERVENTIONSRATIONALEEVALUATION

Subjective:

no verbal cues

Objective:

Dec. 28, 2014 weight: 49kgs.Current weight:

44kgs

BMI: 20Presence of denturesImbalanced Nutrition: less than body requir ements related to inability to ingest food as evidenced by loss of 5kgs.After 8 hours of appropriate nursing interventions the patient will be able to:Verbalize and demonstrate selection of foods or meals will achieve a cessation of weight loss.Independent:

1. Suggests ways to assist patient with meals as needed: ensure a pleasant environment, facilitate proper position, and provide good oral hygiene and dentition.

2. Provide companionship during mealtime

3. Discourage beverages that caffeinated or carbonated.

4. Suggest liquid drinks for supplementa; nutrition.l

Collaborative:

1. Monitor laboratory studies, e.g., BUN, prealbumin/albumin, transferring, sodium and potassium.

2. Consult dietician for further assessment and recommendations regarding food preferences and nutritional support.

Head of bed elevated 30 degrees aids in swallowing and reduces risk of aspiration

Attention to the social aspects of eating is important in both hospital and home setting

May decrease appetite and may lead to early satiety

Indicators of nutritional needs, restrictions and necessity for effectiveness of therapy.

Dieticians have a greater understanding of the nutritional value of foods and may be helpful in assessing specific ethnic or cultural foods.

After 8 hours of appropriate nursing interventions the patient was verbalized and demonstrated selection of foods or meals will achieve a cessation of weight loss.

CUES/ EVIDENCESNURSING DIAGNOSISOUTCOME CRITERIANURSING INTERVENTIONSRATIONALEEVALUATION

Subjective:

no verbal cues

Objective:

-with Tracheostomy Tube

-stressful appearance noted

-increased WBC with a result of 11.3 1O^3/uL

Risk for infection related to presence of susceptible condition, presence of Tracheostomy Tube

After 8 hours of nursing intervention the patient will be free from any signs of infection .

Independent:

1. note risk factors for occurrence of infection such as environmental exposure and skin integrity

2. observe for localized signs of infection at insertion site

3. assess and document skin conditions noting inflammation, secretions and drainage.

4. note signs and symptoms like fever, chills and excessive sweating.

5. stress proper handwashing techniques by all caregivers between therapies.

6. monitor laboratory tests like WBC count.

Dependent:

1. administer cefuroxime (Zinacef) 750 mg IVTT now, then every 8 hours ANST

- this will determine the probable contributing factors that could cause infection on the incision site and these will serve as a guide for preventive measures.

-for early identification of onset of infection for prompt intervention.

-informs the nurse for the occurrence of infection and the appropriate interventions to manage the infected site.

-identifies for the proper treatment.

-lessens possibility of contracting nosocomial infections towards the client.

-for early and/ or accurate determination for possible occurrence of infection

-given prophylactically for suspected infection.

Goal met

After 8 hours of nursing intervention the patient was free from any signs of infection as evidenced of:

-a temperature of 36C at the end of the shift

-and displayed positive attitude to prevent infection such as hand washing and disinfection of hands after every activities.