Lab Results

HEMATOLOGYDate run: 9/01/10 – 7:31:06 A.M.

Examination Result Normal Value

White Blood Cells 17.5 M:5-10x10 9/L F:5-10x10 9

Red Blood cells 3.83 M:4.5-6x10 12/L F:4.5-5.5x10 12/L

Hemoglobin 116 M:130-160 g/L F:120-140g/L

Hematocrit 0.34 M:0.40-0.50 F:0.37-0.47

Platelet Count Adequate 150-350 g/L

DIFFERENTIAL COUNT

Segmenters 0.30 .40-.60%Lymphocytes 0.10 .20-.40%Eosionophil 0.00 .01-.04%Monocytes 0.00 .02-.04%

2 nd Hematology Date run: 9/02/10 – 3:41:13 P.M.

Remarks: Platelet Adequate

Examination Result Normal Value

White Blood Cells 11.0 M:5-10x10 9/L F:5-10x10 9

Red Blood cells 4.28 M:4.5-6x10 12/L F:4.5-5.5x10 12/L

Hemoglobin 130 M:130-160 g/L F:120-140g/L

Hematocrit 0.38 M:0.40-0.50 F:0.37-0.47

Platelet Count Adequate 150-350 g/L

DIFFERENTIAL COUNT

Segmenters 0.87 .40-.60%Lymphocytes 0.13 .20-.40%Eosionophil 0.00 .01-.04%Monocytes 0.00 .02-.04%

TOTAL: 100%

Remarks: Platelet Adequate

Blood ChemistryDate run:9/03/10 – 2:31:19 P.M.

Examination Result Normal Value

FBS(Fasting Blood Sugar) ↑8.45 3.89 - 5.84mmol/l

Creatinine 93.9 υmol/l 44.16-150.16 υmol/l

UrinalysisDate run: 9/1/2010 – 9:53:30 P.M.

Physical Microscopic

Color Dark-Yellow RBC:2-4 /HP

Turbidity Turbid WBC: Too numerous to count

Reaction Acidic Squamous: Moderate

Specific Gravity 1.020 Mucus: Moderate

Bacteria: Moderate

A.Urates: Moderate

Chemical Examination:

• Sugar: Negative

• Albumin: Negative

2 nd Urinalysis Date run: 9/2/2010 – 9:55:40 P.M.

Physical Microscopic

Color Yellow RBC:0-1 /HP

Turbidity Turbid WBC: >100 /HP

Reaction Acidic Squamous: Moderate

Specific Gravity 1.015 Mucus: Few

Bacteria: Rare

A.Urates: Few

Chemical Examination:

• Sugar: Negative

• Albumin: Trace

3 rd Urinalysis Date run: 9/4/2010 – 7:53:16 A.M.

Physical Microscopic

Color Yellow RBC:0-3 /HP

Turbidity Turbid WBC: >100 /HP

Squamous: Few

Specific Gravity 1.010 Mucus: Few

A.Urates: Few

Chemical Examination:

• Sugar: Negative

• Albumin: Negative

DRUG STUDY

Buscopan® [amp]- 10mg I.V q⁰8Classification : Antispasmodics

Mechanism of action:

To relieve pain in gastrointestinal and urogenital tract. Its targets are muscles in the walls of stomach and intestines. Buscopan helps those muscles to relax.

Indications : GIT spasm & hypermotility. Spastic pain in the biliary & urinary tract. Dyskinesia, peptic ulcer, spastic constipation & dysmenorrhea. Post-op vomiting.

Contraindications :

Tachycardia, megacolon (parenteral only); glaucoma, urinary or GI obstruction, intestinal atony, paralytic ileus, asthma, myasthenia gravis, ulcerative colitis, hiatal hernia, serious hepatic or renal disease.

Adverse Drug Reactions: Increased intraocular pressure, cycloplegia, mydriasis, dry mouth, blurred vision, flushing, urinary hesitancy & retention, tachycardia, palpitations, constipation, elevated body temp, CNS excitation, rash, vomiting, photophobia.

Drug Interactions: Anticholinergic activity may be increased by other parasympatholytics. Guanethidine, histamine & reserpine can antagonise the inhibitory effect of anticholinergics on gastric acid secretion. Antacids may impair absorption.

Nursing Responsibility:

-Drug compatibility should be monitored closely in patients requiring adjunctive therapy

-Avoid strict heat

Lanoxin® [amp]- .25 mg. I.VContents:Digoxin

Mechanism of Action:

Inhibits sodium potassium-activated adenosine triphosphatase, promoting movement of calcium from extracellular to intracellular cytoplasm and strengthening myocardial contraction. Also acts on CNS to enhance vagal tone, slowing conduction through the SA and AV nodes and providing an anti-arrhythmic effect.

IndicationsCardiac failure accompanied by atrial fibrillation; management of chronic cardiac failure where systolic dysfunction or ventricular dilatation is dominant; management of certain supraventricular arrhythmias, particularly chronic atrial flutter & fibrillation.

Contraindications Intermittent complete heart block or 2nd degree AV block esp if there is a history of Stokes-Adams attacks; arrhythmia caused by cardiac glycoside intoxication, supraventricular arrhythmia caused by Wolff-Parkinson-White syndrome; ventricular tachycardia or fibrillation; hypertrophic obstructive cardiomyopathy. Hypersensitivity to other digitalis glycosides.

Adverse Drug Reactions CNS disturbances, dizziness; visual disturbances (blurred or yellowish vision); arrhythmia, conduction disturbances, bigeminy, trigeminy, PR prolongation, sinus bradycardia; nausea, vomiting, diarrhea; urticarial or scarlatiniform w/ eosinophilia.

Drug Interactions Sensitivity is increased w/ agents causing hypokalemia

Classification:

Cardiac Drugs

Nursing Responsibility:

-Monitor apical pulse for 1 full min. before administering.

-Assess for peripheral edema,& auscultate lungs for rales/crackles through out therapy.

Nubain® [amp]- 10mg. I.V.Contents: Nalbuphine HCl

Indications:-For the relief of moderate to severe pain. Nalbuphine HCl can also be used for preoperative analgesia, as a supplement to balanced anesthesia, surgical anesthesia, for obstetrical analgesia during labor and for the relief of pain following acute myocardial infarction. Postoperative somatic and visceral pain.

ContraindicationsPatients who are hypersensitive to nalbuphine HCl.

Mechanism of Action:

-Clinical experience suggests that in some patients, analgesia may be longer lasting than from comparable doses of morphine, effects having been observed in acute and chronic pain for 3-8 hrs.

Nalbuphine HCl has the effect of lowering the cardiac work load and can be used immediately in myocardial infarction (use with caution where emesis is involved).

Adverse Drug Reactions-The most commonly occurring reactions are sedation, drowsiness, sweating, nausea, dry mouth and dizziness. Pain at injection site, headache, vomiting and lightheadedness occur less frequently. Restlessness, blurred vision, chills, euphoria and impaired respiration have been infrequent.-Nubain produces few if any psychotomimetic side effects eg, visual hallucinations and dysphoria.

Drug Interactions:-With Other Central Nervous System Depressants: Although nalbuphine HCl possesses narcotic antagonistic activity, there is evidence that in non-dependent patients, it will not antagonize a narcotic analgesic administered just before, concurrently, or just after an injection of nalbuphine HCl. Therefore, patients receiving narcotic analgesics, general anesthetics, phenothiazines or other tranquilizers, sedatives, hypnotics or other CNS depressants (including alcohol) concomitantly with nalbuphine HCl may exhibit an additive effect. When such combined therapy is contemplated, the dose of one or both agents should be reduced.

Classification:

Anaesthetics - Local & General / Analgesics (Opioid)

Nursing Resposibility:

-Caution patient to change positions slowly to minimize orthostatic hypotension

-Encourage patient to turn, cough, & breathe every 2 hrs. to prevent atelectasis

Micardis Plus® [40/12.5 mg tab] 1tab dailyIndications:-Treatment of essential hypertension for patients in whom combination therapy is appropriate.

Mechanism of action:- A combination of an angiotensin II receptor antagonist, telmisartan and a thiazide

diuretic, hydrochlorthiazide. The combination of these ingredients has an additive antihypertensive effect, reducing blood pressure to a greater degree than either component alone. Micardis Plus once daily produces effective and smooth reductions in blood pressure across therapeutic dose range.

Administration:

-May be taken with or without food

Contraindications: -Cholestasis & biliary obstructive disorders. Severe hepatic & renal impairment.

Adverse Drug Reactions: -Telmisartan: Headache, upper resp tract infection, dizziness. Hydrochlorothiazide: Anorexia, gastric irritation, muscle spasm, sleep disturbances.

Classification:

-Angiotensin II Antagonists / Diuretics

Nursing Responsibility:

-Special precaution in patients with impaired hepatic and renal impairment

-Special precaution with volume and/or Na-depleted patients

Dilzem®- 30mg./tabContents: Diltiazem HCl

Mechanism of Action:

-Block calcium entrance into cardiac and vascular smooth muscle cells by blocking the L-type voltage sensitive calcium channel which is abundant in cardiac and smooth muscle. In smooth muscle, calcium binds to calmodulin resulting in activating myosin light chain kinase, an enzyme that phosphorylates the myosin light chain. This phosphorylation is essential for muscle contraction, thus by decreasing calcium levels in the vascular smooth muscle these agents lessen contraction. In the heart, calcium binding to troponin removes the inhibitory effect of troponin on the actin-myosin interaction thus allowing contraction. Thus, blockade of the slow calcium channel by these agents can result in negative inotropic effect. Indications:

-Treatment of angina pectoris due to coronary artery spasm. Treatment of spontaneous coronary artery spasm presenting as Prinzmetal's variant angina (resting angina with ST-segment elevation occurring during attacks).

-Treatment of hypertension: It may be used alone or in combination with other antihypertensive medication eg, diuretics.

Administration:

Should be taken on an empty stomach (Preferably taken before meals. SA & SR tab: Swallow whole, do not chew/crush.).

Contraindications:

Patients who are hypersensitive to diltiazem; with sick sinus syndrome except in the presence of a functioning ventricular pacemaker; with 2nd- or 3rd-degree AV block except in the presence of a functioning ventricular pacemaker; with hypotension (<90 mm Hg systolic); with acute myocardial infarction; with pulmonary congestion documented by x-ray on admission.

Classification: Calcium Antagonists

Nursing Responsibility:

-Monitor BP & Pulse before therapy, during titration, & periodically during therapy.

-Monitor intake & output ratios and daily weight.

Vastarel MR® [tab]- 35mg/tabContents:Trimetazidine

Mechanism of Action:

-Metabolic anti-ischemic agent.

-By preserving the energy metabolism in cells exposed to hypoxia or ischaemia, trimetazidine prevents a decrease in intracellular ATP levels, thereby ensuring the proper functioning of ionic pumps and transmembranous sodium-potassium flow while maintaining cellular homeostasis.

Indications

-Long-term treatment of episodes of coronary insufficiency; angina pectoris.

Administration

-Should be taken with food (Swallow whole, do not chew/crush.) 1 tab at mealtimes in the morning and evening.

Contraindications

-Hypersensitivity to any of the constituents of Vastarel MR

Side Effects:

Rare cases of gastrointestinal disorders (nausea and vomiting)

Classification:

-Anti-Anginal Drugs

Nursing Responsibility:

-use cautiously in patients with heart failure or hypertension and in elderly patients

Kremil-S (Reformulated)® [tab]- 1 tabIndications:

Symptomatic relief of hyperacidity associated w/ peptic ulcer, gastritis, esophagitis & dyspepsia. Supplement to H2-blockers or proton pump inhibitors for rapid relief of ulcer symptoms. Antiflatulent to alleviate the symptoms of gassiness, including post-op gas pain, associated w/ hyperacidity.

Mechanism of action:-May increase the intestinal absorption of aluminium by forming aluminium citrate, which is more soluble and absorbable, resulting in increased aluminium serum concentrations. This may lead to aluminium accumulation, encephalopathy and toxicity, especially in patients with renal failure. Fatalities have been reported in patients with renal failure, hence this combination should be strictly avoided in renal patients.

Dosage:Adult 1-2 tab 1 hr after each meal and at bedtime.

Administration:Should be taken on an empty stomach (Take 1 hr after each meal & at bedtime. Break/ chew before swallowing.)

Contraindications: Patients with renal failure. Partial intestinal obstruction, appendicitis, fecal impaction, gastric outlet obstruction & constipation. Phosphate depletion, low serum phosphate & osteomalacia.

Classification:

Antacids, Antireflux Agents & Antiulcerants

Nursing Responsibility:

-Advise patient that changing positions often and walking will help pass flatus.

-Tell patient to chew tablet before swallowing.

Rowagel® [gel]- CAP, P.O/ T.I.D.Contents:Carbenoxolone Na

Mechanism of action:

-Exerts a mineralocorticoid effect causing fluid retention and hypokalaemia. When co-administered with digoxin, carbenoxolone may theoretically increase the risk of digoxin toxicity (including arrhythmias) due to its hypokalaemic effect. If coadministration cannot be avoided, use with extreme caution and take steps to avoid hypokalaemia. Serum potassium should be monitored at regular

Indications:

Mouth ulcers, lip sores, cold sores, orofacial lesions, sores or blisters caused by herpes simplex, herpes labialis, herpes febrilis or herpes stomatitis.

Contraindications:

Severe cardiac, renal or hepatic failure. Patients on digitalis glycosides.

Classification:

ENT Drugs/ Mouth/Throat Preparations

Nursing Responsibility:

-Advise patient to avoid the use of herbal meds or to consult his prescriber.

-Encourage patient to eat potassium-rich foods.

Levofloxacin-200mg T.I.V. q⁰12Mechanism of action:

Microbiology: Antimicrobial Spectrum of Activity: Levofloxacin has antimicrobial activity against the following gram-positive and gram-negative aerobic and anaerobic bacteria, as well as Chlamydia pneumoniae and Mycoplasma pneumoniae:

Indications:

Treatment of adults ≥18 yr w/ mild, moderate & severe infections caused by susceptible strains of microorganisms in the following conditions: Community-acquired pneumonia, acute bacterial exacerbation of chronic bronchitis, acute maxillary sinusitis, complicated & uncomplicated skin & skin structure infections, acute pyelonephritis, complicated & uncomplicated UTI, nosocomial pneumonia, chronic bacterial prostatitis.

Contraindications:

Hypersensitivity to quinolones. IV Epilepsy, history of tendon disorders related to fluoroquinolone therapy. Childn, pregnancy & lactation.

Adverse Drug Reactions:

Diarrhea, abdominal discomfort, nausea, anorexia, abdominal pain, vomiting, stomatitis & heartburn; insomnia, headache & dizziness; rash, pruritus & eczema; muscle & joint pain; bone marrow depression. Increased liver enzymes. Pain, reddening at the inj site, phlebitis.

General Disorders: Ascites, allergic reaction, asthenia, edema, fever, headache, hot flashes, influenza-like symptoms, leg pain, malaise, rigors, substernal chest pain, syncope, multiple organ failure, changed temperature sensation, withdrawal symptoms.

Gastrointestinal Disorders: Dry mouth, dysphagia, esophagitis, gastritis, gastroesophageal reflux, GI hemorrhage, glossitis, intestinal obstruction, pancreatitis, tongue edema, melena, stomatitis.

Liver and Biliary System Disorders: Abnormal hepatic function, cholecystitis, cholelithiasis, increased hepatic enzymes, hepatic failure, jaundice.

Classification: Quinolones, Anti- infectives

Nursing Responsibiilty:

-Ensure that patient is well hydrated during course of therapy. -Report rash, visual changes, severe GI problems, weakness, tremors.