B. Drug Study Date ordered: February 13, 2006 1. Generic name: Ampicillin/Sulbactam Brand name: Unasyn Classification: Anti-infective, aminopenicillins/beta lactamase inhibitors Dosage, Frequency, Route: 1gm IVP every 8 hours Mechanism of action: This drug binds to bacterial cell wall, resulting in cell death. The addition of sulbactam increases resistance to beta-lactamases, enzymes produced by bacteria that may inactivate ampicillin. Indication: This drug is indicated for patients after undergoing surgery to prevent infection of skin and soft-tissue structures. Contraindication: This drug is contraindicated to patients who are hypersensitive to penicillins or sulbactam. Desired effect: This drug was given to our client as prophylaxis against possible infection. Side effects and adverse reactions CNS: seizures GI: pseudomembranous colitis, diarrhea, nausea, vomiting Derm: rashes, urticaria Hemat: blood dyscrasias
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Hepatic: hepatotoxicity, jaundice, hepatitis, increase in ALT
Dermatologic: pruritus, rash, alopecia
Nursing Responsibilities
1. Check for the doctor’s order and prepare drug aseptically.
2. Instruct patient to take without regard to meals because absorption is not
affected by food.
3. Remind patient taking prescription drug once daily to take it at bedtime for
best results.
4. Report any evidence of diarrhea and maintain adequate hydration.
5. Antacids decrease the absorption of ranitidine.
6. Instruct the watcher to assist patient in his activities of daily living because
patient may feel dizzy and easily fatigue.
7. Intstruct patient to take medicines as prescribed. Don’t overdose as this leads
to damage of hepatic cells.
8. Tell patient to avoid eating fruits like oranges to prevent hypersecretions of
gastric acids..
C. DRUG STUDY
GENERIC NAME: TheophyllineBRAND NAME: Respbid CLASSIFICATION: Bronchodilator ROUTE, DOSAGE & FREQUENCY: 200 mg 1 tab BIDMECHANISM OF ACTION: It prevents breakdown of Adenosine Monophosphate (AMP) which promotes smooth muscle relaxation causing bronchodilation.DESIRED EFFECT: This was given to our patient to promote bronchodilation- greater airway passage hence relieving difficulty of breathing. INDICATION: Symptomatic relief or prevention of bronchial asthma and reversible bronchspasm associated with chronic bronchitis and emphysema.CONTRAINDICATIONS & CAUTIONS:
Contraindicated with hypersensitivity to any xanthines, peptic ulcer, active gastritis, preganancy, underlying seizure disorders.
Use cautiously with cardiac arrhythmias, acute myocardial injury, CHF, cor pulmonale, severe HPN, severe hypoxemia, renal or hepatic disease, hyperthyroidism, alcoholism, labor (may inhibit uterine contractions), lactation, status asthmaticus
SIDE EFFECTS: diuresis, insomnia, nausea and vomiting, headacheADVERSE EFFECTS:
insomnia, lightheadedness, seizures, severe depression, stammering speech, abnormal behavior characterized by withdrawal, mutism and unresponsiveness alternating with hyperactive periods
1. Check doctors order. To verify and avoid error in giving the drug.
2. Check vital signs before and after administration.(to be check)
To evaluate cardiac response
3. Drug should be given on an empty stomach, 1 hour before or 2 hours after meals.
To decrease gastric irritation
4. Check for adverse reactions. If present, discontinue drug and notify the physician.
To prevent further complications
5. Teach the following:* Breathing techniques*Coughing techniques
To expand lung tissue and move secretions
6. Avoid excessive intake of coffee, tea, cocoa, cola beverages, and chocolate.
These contain theophylline-related substances that may increase side effects
GENERIC NAME: Salbutamol SulfateBRAND NAME: VentolinCLASSIFICATION: BronchodilatorDOSAGE, ROUTE, FREQUENCY: 2.5 cc ever 6 hours to be added for nebulizationMECHANISM OF ACTION: relaxes bronchial and uterine smooth muscle by acting on the beta 2-adrenergic receptors. Inhibit the release of mediators of immediate hypersensitivity reaction from mast cells. DESIRED EFFECT: To promote bronchodilation and help loss secretions.CONTRAINDICATION: contraindicated in patients hypersensitive to drug or its ingredients.SIDE EFFECTS: dizziness, insomia, headache, weakness, nausea and vomitingADVERSE REACTIONS:
Nursing responsibilities: Rationale:1. Verify the doctor’s order. To avoid error in giving the drug.2. Do chest physiotherapy as indicated after each nebulization.
To help dislodge the secretions.
3. Encourage client to rinse mouth with H20 To minimize dry mouth.
after nebulization.4. Maintain adequate fluid intake. To liquefy the mucous secretions for easier
expectoration.5) Teach the ff: breathing techniques coughing techniques
To expand lung tissue and move secretions
6) Teach patient pursed-lip breathing This creates a resistance to the air flowing out of the lungs, thereby prolonging exhalation
GENERIC NAME: Ampicillin SulbactamBRANDNAME: UnasynCLASSIFICATION: anti-bacterialDESIRED DOSAGE, ROUTE & FREQUENCY: 750mg IV every 8 hoursDESIRED EFFECT: This was given to our patient prevent infection.MECHANISM OF ACTION: inhibits cell-wall synthesis during bacterial multiplication. Sulbactam inactivates bacterial beta-lactamase, which inactivates ampicillin, causing bacterial resistance to it. INDICATION: to prevent the proliferation of susceptible microorganisms during infection.CONTRAINDICATIONS:
Contraindicated in patients hypersensitive to the drug or other penicillin. Use cautiously in patients with other drug allergies because of possible cross-
sensitivity and in those with mononucleosis because of high risk in maculopapular rash.
eosinophilia, luekopenia, agranulocytis OTHER: hypersensitivity reactions, anaphylaxis, overgrowth of nonsusceptible
organisms, pain at injection site, vein irritation
Nursing responsibilities: Rationale:1. Check doctor’s order To avoid error in administering the drug2. Do skin testing and give only ANST. To determine any allergic reaction 3. Check the patency of the IV line. To make sure that the IV line is in the vein4. Administer the drug slowly and always observe aseptic technique.
To prevent irritation and facilitate absorption and also to avoid contamination of microorganism
5. Tell the patient to report any allergic reaction and notify the physician. Observe for any manifestation of allergic reaction.
To prevent further complication and give necessary intervention if allergic reaction occurs.
6. Provision of personal hygiene. Good personal hygiene aids in the retardation of growth and multiplication of pathogenic microorganisms.
7. Encourage patient to cough out secretions and dispose it properly.
To prevent the stasis of secretions in the respiratory tract which is good medium bacterial growth and proper disposal of secretions prevent the spread of microorganisms.
7. Encourage intake of vitamin C and mineral rich foods.
To increase body resistance
GENERIC NAME: HydrocortisoneBRAND NAME: Sodium SuccinateCLASSIFICATION: CorticosteroidsDESIRED DOSAGE, ROUTE & FREQUENCY: 100mg IV every 12 hoursMECHANISM OF ACTION: Decreases inflammation by entering target cells and binding to cytoplasmic receptors initiating many complex reactions thus resulting to blockage on the release of histamine, bradykinine and serotonin.DESIRED EFFECT: This drug is given to our patient to reduce inflammation.CONTRAINDICATIONS:
Contraindicated with fungal infections, amoebiasis, hepatitis b, varicella and antibiotic-resistant infections, immunosuppression
Use cautiously with kidney disease(risk to edema), liver disease, cirrhosis, hypothyroidism, ulcerative colitis with impending perforation, diverticulitis, resent GI surgery, active or latent peptic ulcer, inflammatory bowel disease(risk exacerbation or bowel perforation), hypertension, CHF, thrombophlebitis, osteoporosis, convulsive disorders, metastatic carcinoma, DM, TB, and lactation
SIDE EFFECT: headache, insomia, nausea and vomiting, weaknessADVERSE EFFECT:
CNS: vertigo, headache, paresthesia, insomnia, seizures, psychosis CV: hypotension, shock, hypertension, and CHF 2o to fluid retention,
EENT: cataracts, glaucoma(long term therapy), increase IDP
ENDOCRINE: amenorrhea, irregular menses, growth retardation, decreased carbohydrate tolerance and DM, cushingoid state(long-term therapy), HPA suppression systemic with therapy longer than 5 days
GI: peptic or esophageal ulcer, pacreatitis, abdominal distention, N/V, increase appetite and weight gain(long-term therapy)
HEMATOLOGIC: NA+ and fluid retention, hypokalemia, hypocalcemia,increase blood sugar, increase serum cholesterol, decrease serum T1 and T4 levels
HYPERSENSITIVITY: anaphylactoid or hypersensitivity reactions MUSCOSKELETAL: muscle weakness, steroid myopathy and loss of muscle
mass, osteoporosis, spontaneous fractures(long-term therapy) OTHER: immunosuppression, aggravation or masking of infections, impaired
wound healing
Nursing Intervention Rationale1. Check the doctors order To avoid error in giving the drug2. Observe the rights in administering the drug
To avoid error in giving the drug
3. Do skin testing and give ANST To determine any allergic reaction4. Check the patency of the IV line To make sure that it is in the vein5. Monitor I & O accurately To determine fluid and electrolyte
imbalance6. Monitor BP Because this drug cause vasoconstriction
effect thereby increasing BP7. Encourage patient to increase intake of protein
To prevent hyperglycemia and glycosuria
8. Weigh the patient daily with the same clothing and weighing scale
To determine if he gained weight and fluid retention
9. Encourage patient to increase intake of Vitamin C and potassium rich foods such as banana, cantaloupe, potato, etc.
To increase body resistance and to prevent the occurrence of hypokalemia
11. Tell the patient not to skip or suddenly stop medications
To attain the desired outcome more effectively and to avoid reoccurrence of inflammation
12. Provide emotional and psychological support
To elicit cooperation
GENERIC NAME: Budesonide BRAND NAME: Pulmicort TurbuhalerCLASSIFICATION: Corticosteroid DESIRED DOSAGE, ROUTE & FREQUENCY: 2 puffs ODDESIRED EFFECT: This drug is given to our patient in order to reduce inflammation.MECHANISM OF ACTION:
Anti – inflammatory effect: local administration into nasal passages maximizes beneficial on the tissues, while decreasing the likelihood of adverse effects from systemic absorption.
Anti-inflammatory corticosteroid that exhibits potent glucocorticoid activity and weak minerolocorticoid activity. The exact mechanism of the cortiosteroids isn’t known, but they have a wide range of inhibitory activity against such cell types such as mast cells and macrophages and mediators (such as leukotrienes) involved in allergic and non-allergic inflammation.
INDICATION: Prophylactic therapy in maintenance treatment of asthmaCONTRAINDICATIONS:
Contraindicated with hypersensitivity with drug or for relief of acute asthma bronchospasm. Use cautiously with TB, systemic infections and lactation.
Contraindicated with hypersensitivity with adrenergics, anines or formoterol, acute asthma attack, acute airway obstruction.
Use cautiously in the elderly and with pregnancy and lactation.SIDE EFFECT: headache, insomnia, nauseaADVERSE EFFECT:
Nursing Responsibilities Rationale1) Check doctor’s doctor’s order, To avoid error in administering the drug2) Observe the RIGHT’S in administering a drug
To avoid error in administering the drug
3) Use cautiously, if at all, in patients with active or quiescent TB of the respiratory tract, ocular herpes simplex, or untreated systemic fungal, bacteria, viral, or parasitic infections
To avoid further complications
4) If bronchospasm occurs after using budesonide, stop therapy and treat with a bronchodilator
To prevent further complications
5) Watch for candida infections of the pharynx
For immediate treatment of the said complication
6) Tell patient that budesonide inhaler isn’t a bronchodilator and isn’t intended to treat episodes of asthma
For precautionary measures
7) instruct patient to use inhaler at regular intervals as follows
Because effectiveness depends on twice-daily use on a regular basis
8) pulmicort turbuhaler must be kept up-right(mouthpiece on top) during loading
To provide correct dosage
9) instruct patient to place mouthpiece between lips and to inhale forcefully and deeply
To obtain the desired effect of the drug faster
10) Tell the patient that he may not taste the drug or sense it entering his lungs, but it doesn’t mean it isn’t effective.
To make the patient aware on the possible outcome of the drug given
11) instruct the patient to rinse his mouth with water and then spit out the water after each dose
To decrease the risk of developing oral candidiasis
12) Replace mouthpiece cover after use and always keep it clean and dry
To prevent the contamination from microorganisms, thereby preventing the occurrence of infection
13) Instruct the patient to carry or wear medical identification indicating need for supplementary corticosteroid during periods of stress or an asthma attack.
For identification purposes
GENERIC NAME: Formoterol Fumarate Inhalation BRAND NAME: foradil aerolizerCLASSIFICATION: beta2 adrenergic agonistDESIRED DOSSAGE, ROUTE & FREQUENCY: 2 puffs once a dayDESIRED EFFECT: This drug is given to out patient in order to promote bronchodilation, thus relieving dyspnea MECHANISM OF ACTION: Beta agonists relax smooth muscle in the bronchioles by activating adenylate cyclase and increasing intracellular concentration of cyclic Adenosine Monophosphate. This increasing cAMP, beta agonist inhibits release of muscle mediators such as histamine and leukotrine (degranulation) which is inhibits smooth muscle contraction, thus bronchodilation occurs. INDICATION:
Maintenance treatment and prevention of bronchospasm in patients with reversible obstructive airway disease or nocturnal asthma, who usually require treatment with short-acting inhaled beta2 adrenergic agonist
Prevention of exercised –induced bronchospasmCONTRAINDICATIONS: contraindicated in patients hypersensitive to drug or its componentADVERSE EFFECTS
Nursing Responsibilities Rationale1) Check doctor’s order To administer the correct drug t o be given2) Observe the RIGHT’S in administering the drug
To avoid error
3) Watch for immediate hypersensitivity reactions, such as anaphylaxis, urticaria, angioedema, rash and bronchospasm
To know when to stop the medication to prevent further complications
4) Monitor patient for tachycardia, hypertension and other CV adverse effects. If these occurs, drug may need to be discontinue
To prevent further complications
5) Foradil capsules should only given via oral inhalation and used only with the Aerolizer Inhaler. They aren’t for oral ingestion. Patient shouldn’t exhale into the device. Capsules should remain in the unopened blister until administration time and only removed immediately before use.
Inhalation is preferred because of minimal systemic absorption
6) Tell patient not to increase the dosage or frequency of use without medical advice.
To prevent over dosage
7) Tell patient to report nausea, vomiting, shakiness, headache, fast or irregular heart beat, or sleeplessness.
To know if the drug is to be discontinued
8) Instruct the patient not to use the Foradil Aerolizer with a spacer device or to exhale or blow into the Aerolizer inhaler.
Spacer is not applicable when an inhaler is held at the level of the mouth because in this position, large droplets tend to be delivered to the oropharynx and throat, rather than moving down into small airways.
GENERIC NAME: Isosorbide DinitrateBRAND NAME: IsordilCLASSIFICATION: Anti-anginaDESIRED DOSE, ROUTE AND FREQUENCY: 60mg ½ tab OD MECHANISM OF ACTION: dilates the blood vessels by relaxing the muscles in their walls. Oxygen flow improves as the vessels relax, and chest pain subsidesINDICATION: Isosorbide dinitrate reduces the blood pressure as well as the capillary pressure (vascular resistance), improving the heart's efficiency. It is used for the treatment and prevention of angina.DESIRED EFFECT: This was given to our patient to help relieve chest pain.
SIDE EFFECTS: headache, dizziness, light-headedness, low blood pressure and weakness, nausea and vomiting, constipationADVERSE EFFECTS: Collapse, fainting, flushed skin, high blood pressure, pallor, perspiration, rash, restlessness, skin inflammation and flaking, vomiting, blurred vision and irregular heartbeat.CONTRAINDICATIONS:
Use with caution if you have anemia, glaucoma, a previous head injury or heart attack, heart disease or thyroid disease.
People taking diuretic medication or those who have low blood pressure should use the drug with caution.
Do not use sildenafil while taking the drug because the combination could cause severe or life- threatening low blood pressure.
Nursing interventions: Rationale:1. Verify doctor’s order. To prevent error.2. Position client in a sitting or lying position when taking in the drug.
Since the drug may cause fainting or dizziness cause by hypotension.
3. Encourage patient to consume a high-fiber diet and drink plenty of fluids.
To prevent constipation.
4. Provide oral care to the patient. To decrease likelihood of carries and periodontal disease caused by decreased salivation.
5. Instruct client to report recurrence of pain and if pain is present, notify the doctor immediately.
To see whether the pain was relieved by the drug and for the doctor to know since this may indicate coronary occlusion.
6. Monitor the vital sign of the patient at regular intervals.
Since the drug causes hypotension.
GENERIC NAME: Aspirin (ASA)BRAND NAME:CLASSIFICATION: Non-Steroidal Anti-inflammatory Drug (NSAID)DESIRED DOSE, ROUTE AND FREQUENCY: 80mg one tab a dayMECHANISM OF ACTION: Its thought to relieve fever by central cation in the hypothalamic heat-regulating center. Exerts its anti-inflammatory by inhibiting prostaglandin synthesis; also may inhibit the synthesis or action of other mediators of the inflammatory response.DESIRED EFFECT: The drug is given to our patient to reduce inflammation.SIDE EFFECTS: ADVERSE EFFECTS:
EENT: tinnitus, hearing loss GI: nausea, GI distress, occult bleeding, GI bleeding HEMATOLOGIC: leukopenia, thrombocytopenia, prolonged bleeding time HEPATIC: hepatitis SKIN: rash, bruising, urticartia Other: angioedema, hypersensitivity reactions, Reye’s syndrome
CONTRAINDICATIONS:Contraindicated in patients hypertensitive to drug and in those with NSAID-
induced sensitivity reactions and bleeding disorders, such as hemophilia.
Nursing Responsibilities Rationale1.Check Doctors order To prevent committing mistakes2.Assess the patient’s allergy to drug To prevent hypersensitivity reactions3.Encourage patient to take drugs with food, milk or water
To reduce GI reactions
4. Encourage patient to take aspirin after meal
To avoid GI distress
XIII.DRUG STUDY
Date of administration: January 6 – January 14, 2006
Dosage, Route, Frequency: 0.12 mg IV every 120 / 0.25-mg/tab ½ tab every 12o
Mechanism of Action: Prolongs refractory period of the AV node. Decreases
conduction through the SA and AV node
Desired Effect: This drug was given to our patient to increase the force of
myocardial contraction.
Nursing Responsibilities Rationale1. Inform to the patient and significant others the
mechanism of action of the drug and possible side
effects such as headache, weakness, drowsiness,
and vision changes, GI upset and anorexia, and
arrhythmias.
To alleviate anxiety and to gain cooperation. This is also necessary for the client and significant others to appreciate the importance of taking the drug.
2. Monitor apical pulse for 1 full minute prior to
administering. Withhold dose and notify physician if
pulse rate is <70 bpm.
The drug has negative
chronotropic effect.
3. Monitor blood pressure before and throughout
the therapy.
To observe for increased blood pressure and to prevent further complications.
4. Monitor for cardiac arrhythmias, including sinus
bradycardia.
To detect early signs of
digoxin toxicity.
5. Administer the drug with the correct dosage at an
appropriate time.
To avoid digoxin toxicity and to ensure the effectivity of the drug.
6. Avoid administering with food or antacids. To avoid delays in absorption.
7. Missed doses should be taken within 12o of
scheduled dose or not taken at all. Do not double
doses. Do not discontinue medication without
consulting the physician.
To ensure the effectivity of the drug and to prevent drug toxicity.
8. Instruct patient to keep digoxin tablets in their
original container and not mix in pillboxes with
other medications, as they may look similar and
maybe mistaken for other medications.
They may look similar and maybe mistaken for other medications.
9. Teach patient and a responsible family member
about the dosage regimen, how to take the pulse,
reportable signs, and follow up care.
To promote independence on the patient and significant others,
10. Instruct patient to report adverse reactions
promptly such as nausea, vomiting diarrhea,
appetite loss, and visual disturbances.
These are early indicators of
drug toxicity.
11. Monitor potassium levels carefully. Take
corrective action before hypokalemia occurs.
Encourage patient to eat potassium-rich foods.
To prevent hypokalemia which predispose the patient in development of toxicity.
12. Advice patient to have a small frequent feeding. To minimize nausea and vomiting.
13. Advice patient to have adequate rest and sleep. To decrease metabolic
demands.
Date of administration: January 4 – January 14, 2006
Generic Name: Spironolactone
Brand Name: Aldactone
Classification: Potassium-sparing diuretics
Dosage, Route, Frequency: 25 mg/tab 1 tab BID
Mechanism of Action: Acts at distal renal tubule to antagonize the effects of
aldosterone, causing excretion of sodium, bicarbonate,
and calcium while conserving potassium and hydrogen
ions.
Desired Effect: This drug is given to our patient to promote excretion of excess
fluids in the body, thus, relieving edema. It also lowers blood
pressure.
Nursing Responsibilities Rationale1. Monitor I and O, weight, BP and PR before and
throughout the therapy.
To have a baseline data and to monitor for possible hypotension.
2. Administer drug early AM and early PM. So as not to interfere with
sleep.
3. Administer the drug with food. To enhance absorption.
4. Emphasize the importance of continuing to take this medication even if feeling better. Instruct patient to take medication at the same time each day. If dose is missed, take as soon as remembered unless almost time for the next dose.
To gain cooperation.
5. If dose is missed, take as soon as remembered
unless almost time for the next dose.
To ensure effectivity of the drug.
6. Advice patient to change position slowly. To minimize hypotension and
dizziness.
7. Caution patient to avoid activities requiring alertness until response to medication to known.
Spironolactone may cause
dizziness.
8. Avoid eating an excessive amount of foods that
are high in potassium, such as citrus fruits,
tomatoes, bananas, and apricots. Avoid salt
substitutes containing potassium and potassium
To prevent hyperkalemia.
supplements, unless otherwise directed.
Date of administration: January 4 – January 14, 2006