Nursing Care Plans for Community Acquired Pneumonia 2009

Nursing Care Plan

Client: Bartolabac, Fidela Hospital No.: 0-800-22500-773Age: 66 years old Room No.: C414Impression: cough, dyspnea Physician: Dr. R. GoDiagnosis: Community acquired pneumonia – high risk in acute respiratory failure Nurse’s Signature:

R.C.R. UCSN

Clinical Portrait Pertinent Data

Assessment

Upon assessment patient X, 66 years old, a Roman Catholic from 0671 Sitio Anagan, Apas, Cebu City, was seen lying on bed conscious and a febrile with the S.O. at the bedside. Patient had an IVF of D5NSS infused at right arm/hand running at 30 gtts/min + dopamine at 10gtts/min. A NGT was inserted and was aided with a mechanical ventilator. Pulse oximeter was connected at the right hand and FBC-UB was noted.

Significant Findings

Patient was tachypniec with vital sighs of BP= 90/60 mm/Hg. HR of 117 bpm and RR of 31 cpm. Roles positive at binasal assessment and occasional wheeze BLF. Patient was tachycardic with regular murmurs. Positive cyanosis on finger nail beds of

History of Present Illness

A case of Mrs. Fidela B. Bartolabac, 66 years old, born on April 24, 1942 at Berida, Leyte, Roman Catholic and is widowed for 3 years, residing at 0671 Sitio Amagan, Apas, Cebu City 6000 was admitted on November 29, 2008 at 1:44 pm at Chong Hua Hospital.

Mrs. Bartolabac has Bronchial Asthma taking Seretide and Ventolin inhaler for treatment but is poorly compliant. She was taking vitamins. Family history of diabetes.

Mrs. Bartolabac used to for about 30 packs per year and drinks alcohol occasionally. She was positive of pulmonary tuberculosis and was poorly taking anti TB medications for 2 years. Months prior to admission weight loss was positive and occasional chest pains noted

both hands. With history of PTB.

Nursing Review of Systems Gordon's 11 Functional Health Patterns

1. Health perception/ Health management

Patient had history of Pneumonia and Pulmonary Tuberculosis. Doctors prescribed her with medicines but the patient was not able to maintain it due to financial problem. She never complained about her condition though she experienced short of breathe and cough. Her family decided to admit her to Chong Hua hospital when she cannot tolerate it anymore and when cyanosis was observed by the family member.

She used Wachichao plant for her maintenance.

2. Nutrition/ Metabolic

Patient is choosy about her food. She usually eats rice and liver barbeque. She loves to eat fruits as long as they have. She seldom eats meat. She eats vegetables once in a while. In the morning, she eats bread and ate breakfast and lunch (brunch) at around 11:00AM

Few weeks before admission, she just want to eat porridge for her meal. Now, she has Nasogastric

Chief Complaints

Cough, dyspnea

Vital Signs Taken Upon Admission

T= 36.2◦C R= 31 cpmP= 117 bpm BP= 90/60 mmHg

Laboratory results

X-Ray12/14/08

Conclusion

1. Chronic inflammation process in both lung fields2. Modified silhouette3. Atherosclerosis of the thoracic aorta4. Calcified trachoebronchial tree5. Generalized osteopenia/osteoporosis

CBC12/13/08

Result reference unitWBC 6.28 4.8-10.8

10^3/ul

tube attached.

3. Elimination

Patient had normal elimination pattern but then, few days after her admission, she experienced constipation but had good urine output. Now, she defecates daily and maintain good urine output.

4. Activity/ Exercise

Patient usually does sedentary activities at home, like eating, watching television, talking with some friends, and sometimes does sweeping.

On first contact with the patient, seen patient lying on bed, weak, and with limited movements.

Eight days after admission, patient had great improvement, she can now smile, do sign language, move her extremities and with glow on her face. Though she still needs assistance, she can turn to sides now with ease.

5. Cognitive/ Perceptual

Patient needs to be oriented with the time and date though she is aware that she is currently admitted in the hospital. She is responsive (through gestures), coherent, and can relate to conversations. She even smile with jokes and wave her hands when

RBC 5.45 4.2-5.4 10^0/ulHGB 16.5 12-16 g/dlHCT 50.6 37-47 %MCV 92.8 81.99 flMCH 30.3 27-31 pgMCHC 32.6 33-37 g/dlPlt 193 130-140 10^3/ul

Result reference unitNeutrophil % 72 40-74 %Lymphocyte % 1707 19-48 %Monocyte 9.9 3.4-9 %Eosinophil .2 0-7 %Basophil .2 0-1.5 %Neutrophil # 4.53 1.9-8 10^3/ulLymphocyte # 1.11 1.9-8 10^3\ulMonocyte .62 .16-1 10^3/ulEusinophil .01 0-.8 10^3/ulBasophil .01 0-.2 10^3/ul

RDW 14 11-16 %PDW 9.8 9-14 %MPV 9.5 7.2-11.1 fl

Ionized calcium .75 1.09-1.33 mmol/LNa 121.9 135-148 mmol/LK 4.25 3.5-5.0 mmol/L

someone she used to see visited her. She speaks in a very low voice at present because the Endotracheal tube was just removed.

6. Sleep/Rest Patterns

Patient usually sleeps between 8:00PM – 9:00PM and wakes up around 5:00AM. She had afternoon nap everyday.

Now that she is admitted, she could hardly sleep because of her condition. Her vital signs need to be monitored hourly. She is also disturbed by her cough.

7. Self Perception/ Self Concept

Though the patient looses weight, she doesn’t look under weight at all. She is just weak because she is sick. She looks accommodating and friendly despite of her condition.

8. Role/ Relationship

Patient lives in her own house with her daughter and two grandchildren. They have close family ties. She is open to them with her feelings. She is fond of talking. She spends most of her time at home with her family.    

Temperature 36.6 CThb 15.0 g/dlFIO2 21 %pH 7.287 7.35-7.45pCo2 68 35-45 mmHgPO2 54.5 >80 mmHgHCO3 31.8 mmHg+CO2 33.9 mmHgSO2 84.4 95-98 %

U/A12/13/08

Physical CharacteristicsColor dark yellowTransparency sly cloudypH 6.0 5-6Sp-gray1.030 1.003-1.005 random

Chemical CharacteristicsResult reference unit

Protein 100 - mg/dlGlucose - - mg/dlKetone - - mg/dlUrobilinogen normal up to 2

mg/dlLeukocyte - - WBC/ulBld - - mg/dlBilirubin - - mg/dl

9. Sexuality/ Reproductive Health

The patient has five children, two boys (deceased) and three girls. Her husband died long time ago.

10. Coping/ stress tolerance

The patient is open to her family about her problems. But then, with regards to her sickness, she never complained about it. She kept it to herself as long as she can tolerate it.

11. Values and beliefs

Patient is a Roman Catholic but didn’t go to church. She didn’t join any religious community.

Nursing Problems

1.) Ineffective airway clearance2.) Impaired physical mobility3.)Risk for aspiration4.)Risk for impaired skin integrity5.) Impaired verbal communication

Nursing Diagnosis

1. Ineffective Airway Clearance related to increased

Nitrite - -mg/dl

Vit C 40 * mg/dl

Microscopic

RBC 2 2-18 /ulWBC 8 6.14 /ulBacteria Mucus none * /ulHyaline cast 10 * /ul

Glucose Fasting 149 60-110 mg/dlCholesterol 165 150.0-240.0

mg/dlTriglycerides 109 45.0-150.0

mg/dlVLDL 21.8 .0-40.0 mg/dlLDL 115.6 .0 150.0 mg/dlHDL 27.6 30.0-9.0 mg/dl

Temperature 36 CFIO2 14.2 g/dlpCO2 21.0 %pH 7.335 7.35-7.45PO2 60.4 35-45 mmHgHCO3 238.1 780 mmol/L+CO2 33.7 mmol/L BE 3.8 mmol/LSO2 99.8 95-98 %

sputum production as evidenced by cough.2. Impaired Physical Mobility related to restrictive

devices3. Impaired Verbal communication r/t attachment to

mechanical ventilator.4. Risk for infection related to depressed immune

system5. Risk for aspiration r/t tube feedings and

secretions.

Acid fast stain

Specimen – sputum

Report: no acid fast bacilli seen

Nursing Care Plan

Cues Nursing Diagnosis

Scientific Basis

Goal and Outcome Criteria

Nursing Actions Rationale Evaluation

S: “Giubo ug kutasan ako mama ug maglisod siya ug ginhawa” As verbalized by the clients daughter.

O: 1.Received patient lying on bed, conscious, coherent

Actual

Ineffective Airway

Clearance related to increased sputum

production as

evidenced by

cough.

A cough is a protective reflex that cleanses the lower airways by an explosive expiration. Inhaled particles, accumulated mucus, inflammation or presence of a foreign

After 8 hours of nursing intervention, client’s airway is free of secretions as evidenced by eupnea and clear lung sounds after coughing or

To perform nursing care to help patient improved Airway

Independent;

1. Assess respiratory movements and use of accessory muscles.

Use of accessory muscles to breathe indicates an abnormal increase in work of breathing. (Gulanickl et. al.: 2007,480).

Goal Partially met

After 8 hours of nursing intervention, client’s airway was free of secretions as evidenced by eupnea and clear lung

afebrile, tachypneic and with mechanical ventilator support.

2. Change in respiratory status.

3. Patient demonstrate persistent coughing and dyspnea

4. Abnormal lung sounds

5. With pulse oximeter attached - T= 36.2oC

- P= 81

body initiates the reflex by stimulating the irritant receptors in the airway. The cough consists of inspiration, closure of glottis, and vocal cord, contraction of glottis, causing sudden, forceful expiration that removes the offending matter. The effectiveness of the cough depends on the depth

suctioning.

Specifically:

1. Client will maintain a stable breathing.

2. Client’s mucus will be thin and scant.

3. Client’s breath sounds are clear.

2. Assess cough for effectiveness and productivity.

3. Observe sputum color, amount, and odor and report significant changes.

Dependent:

1. Monitor pulse oximeter and ABGs.

Patients may have ineffective cough due to fatigue or thick tenacious secretions. (Gulanickl et. al.: 2007,480).

A sign of infection is discolored sputum. An odor may be present. (Gulanickl et. al.: 2007,480).

Hypoxemia may result from impaired gas exchange from build up of secretions.

sounds after coughing or suctioning.

Specifically:

1. Client maintained a stable breathing.

2. Client’s mucus wasthin and scant.

bpm- R= MV- BP=

90/55 mmHg.

of the inspiration and the degree to which the airway narrow, increasing the velocity of the expiratory gas flow. Cough occurs frequently in healthy individuals.

A persistent cough

indicates presence of disorder or a disease. An acute

non productive cough often

indicates

2. Monitor chest x-

ray reports.

Collaborative:

1. Consult the respiratory therapist for chest physiotherapy and nebulizer treatments, as appropriate and ordered.

ABGs provide data about carbon dioxide levels in the blood. (Gulanickl et. al.: 2007,480).

These determine progression of disease process. (Gulanickl et. al.: 2007,480).

Chest physiotherapy includes the techniques of postural drainage and chest percussion to loosen and mobilize

bronchitis or viral

pneumonia. A persistent

cough is commonly

caused by a tumor,

congestion, or

hypertensive airways. A cough

that produces purulent sputum usually

indicates infection, whereas a cough that produces

non purulent

sputum is non specific and merely indicates

2. Assist with bronchoscopy and thoracentesis, as appropriate.

secretions in smaller airways that cannot be removed by coughing or suctioning. A nebulizer may be used to humidify the airway to thin secretions to facilitate their removal. (Gulanickl et. al.: 2007,481).

Bronchoscopy is done to obtain lavage samples for culture and sensitivity and to remove mucous plugs; thoracentesis is done to drain associated pleural effusions.

irritation. (McCance, 2000:1150

3. Anticipate possible need for intubation if patient’s condition deteriorates.

4. Administer medications such as antibiotics and expectorants for productive coughs. Administe r inhaled bronchodilators and inhaled steroids, as prescribed, to open airway and decrease inflammation.

(Gulanickl et. al.: 2007,481).

Intubation may be needed to facilitate deep suctioning efforts and to provide source for augmenting oxygenation. (Gulanickl et. al.: 2007,481).

A variety of medications are available to treat specific problems. (Gulanickl et. al.: 2007,481).

Nursing Care Plan

Cues Nursing Diagnosis

Scientific Basis Goal and Outcome Criteria

Nursing Actions

Rationale Evaluation

S- Patient pointing her throat.-no verbalizationsO- • NGT inserted •Mechanical ventilator noted •Suction machine at

PotentialRisk for

aspiration r/t tube feedings

and secretion

s.

Crackles indicate static pulmonary secretions that need to be mobilized. This also includes accumulation of saliva on the airways .When this obstructs the airway the pulmonary tissues beyond the collapses and

After 8 hours of nursing intervention the patient will be able to maintain a patent airway

Specifically the patient and s.o.

To perform nursing care to prevent aspiration

Independent:1. Monitor level of consciousness.

A decreased level of consciousness is a prime factor for aspiration ( Gulanick/Mayers:2008

goal met:

After 8 hours of nursing intervention the patient was able to maintain a patent airway.

bedside. •patient pointing on her neck.

massive atelectosis results. (Smeltzer,Bare,,Hinkle cheever;2008,534)Pulmonary complications from NGT intubation occur because coughing and cleaning of the pharynx is impaired , because gas build up can irritate the phrenic nerve and because tubes may dislodged, retracting the distal and above the esophagogastric sphincter places the patient of risk for aspiration(Smeltzer,Bare,Hinkle,Cheever;2008,1180-1181)

will be able to:

1. Feel relief with concerns of secretions

2. Will be able to do basic suctioning procedures.

3. Have a secured NGT placement.

4. Have no abnormal breath sounds upon assessment.

2. Auscultate bowel sounds to evaluate bowel motility and assess for abdominal distention and firmness.

3. Position patient in an elevated upper body or side lying.

4. In Patients with artificial airways.

• Perform oral suctioning as needed.

5. In patients with NGT

pp18)

• Decreased gastrointestinal mobility increases the risk of aspiration because foods and fluids accumulate in the stomach(Gulanick/Mayers:2008;pp19

• This decreases the risk of aspiration by promoting the drainage and secretions away from the airway. (Gulanick/Mayers:2008pp.19)

•Reduces oro- pharyngeal secretions and reduces aspiration rising. ((Gulanick/Mayers:2008

Specifically the patient and s.o. was able to:

1. Feel relief of concerns about secretions.2. Able to do basic suctioning procedures.3. Have a secured NGT placement 4.Have no abnormal breathe sounds upon assessment5. Have a normal

5. Have normal breathing pattern.

• Check placement of tube before feeding by color or aspirate or listening for bubbling sounds upon air induction.

Collaborative:

6.Collaborate with respiratory therapist, as needed to determine cuff pressure(tubes)

7. Collaborate with the dietitians about having

pp.19)

•A placed tube may erroneously deliver tube feeding into the airway. ((Gulanick/Mayers:2008pp.19)

•On ineffective or over inflated cuff can increase the risk for aspiration. ((Gulanick/Mayers:2008pp.19)

breathing pattern.

blenderized diet for the patient.

Dependent:

8. Suction hourly as ordered by the physician.

9. Administer drugs in

appropriate preparation

as ordered by the physician.

• Appropriate mixture of food as well as balanced meal provides nutrients needed. ((Gulanick/Mayers:2008pp.63)

•To eliminate secretions (Doenges 63)

• Drugs in tablet forms must be crushed during administration (Doenges 63)

Nursing Care Plan

Cues Nursing Diagnosi

s

Scientific Basis

Goal and Outcome Criteria

Nursing Actions

Rationale Evaluation

S: Patient wrote on a piece of paper “gusto na ko mulakaw”

Actual

Impaired Physical Mobility related

to restrictiv

In place mechanical devices

are common to non

ambulatory patients

After 8 hours of nursing intervention the patient will be relieved from discomfort

To perform nursing care to help patient exercise in bed

1. Assess

>Restricted movement affects the

Goal met

After 8 hours of nursing intervention the patient was relieved from discomfort

O: 1.Received patient lying on bed, conscious, coherent afebrile, tachypneic and with mechanical ventilator support.

2. Pulse oximeter at right hand

3. IVF infused at right hand

4. Weak muscles

e devices

but in cases where

patients are able to walk,

the devices would

likely limit their

activities provided

that machines are easily altered by movemen

t examples would be

casts, neck

support and

ventilator. (Microsoft ® Encarta ® 2007)

Specifically

1. Patient will be free of complications of immobility, as evidenced by intact skin, absence of thrombophlebitis, & normal bowel pattern.

2. Patient will perform exercises in bed

3. Patient will move allowed body parts for

exercise.

patient’s ability to perform ADL’s effectively and safely on a daily basis.

2 Assess ability to perform ROM to all joints.

3 Encourage & facilitate early ambulation & other ADL’s when possible.

4 Provide positive reinforcement during activity.

ability to perform most ADL’s .

>This provides baseline measurement for the future evaluation and guides therapy.

>The sooner the patients becomes mobile, less chance that debilitation will occur.

>Patients may be reluctant to move or initiate new activity due to fear of falling. A positive approach allows

Specifically

1. Patient was free of complications of immobility, as evidenced by intact skin, absence of thrombophlebitis, & normal bowel pattern.

2. Patient was able to perform exercises in bed

3. Patient moved allowed body parts for exercise.

5 Evaluate patient’s performance in doing ADL’s.

6 Assess

the learner to feel good about learning accomplishments.

> Evaluating performance helps in improving once abilities & maximizing activities.Even patients who are temporarily immobile are at risk for effects of immobility such as skin breakdown, muscle weakness, thrombophlebitis, constipation, pneumonia, & depression.

> Regular

patient or caregiver’s knowledge of immobility & its complication.

7 Assess skin integrity

8 Assess elimination pattern.

9 Turn & position the patient every 2 hours or as needed.

10 Evaluate

examination of skin (especially over bony prominences) will allow for prevention or early recognition & treatment of pressure sores.

> Turning the patients optimizes circulation to all tissues & relieves pressure.

> Immobility promotes constipation

> It helps in evaluating patient’s outcome from nursing interventions.

the patient free of complications of immobility.

11 Assess patient’s difficulty in walking.

12 Encourage walking exercise interspersed with rest periods

13 Involve client/ SO in care, assisting them to learn ways of managing deficits.

14 Instruct client/ SO in

> It helps in determining factors that contributed to patient’s difficulty in moving

> To reduce fatigue.

> To enhance safety for client & SO/ caregivers.

> To reduce risk of falls

safety measures as individually.(eg. maintaining safe travel pathway, proper lightning.

> It helps in determining

patient’s outcome to be

effective or not.

Drug Study

Generic Name

Brand Name

Classification

Mechanism of Action

Indication

Contraindication

Side Effects

How Suppli

ed

Dosage/

Frequency

Nursing Intervention

Omeprazole

Omepron

Proton pump

Thought to be a gastric

Short term

Lactation. Use as

Headache,

IV infusio

40mgOnce a

1.Consider dosage

inhibitor pump inhibitor in

that it blocks the final

step of acid production inhibiting the H+ an/K+ ATPase

system at the

secretory surface of the gastric

parietal cell. Both basal

and stimulated

acid secretions

are inhibited.

Serum gastrin

levels are increased during the first 1 to 2

treatment of

active duodenal ulcer. Short

term (4-8

weeeks) treatme

nt of erosive

esophagitis

diagnosed by

endoscopy.

Maintain healing

of erosive

esophagitis.

Treatment of

heartburn and other

maintenance therapy

for duodenal

ulcer disease.

OTC use in those who

have trouble of

pain swallowing food, are vomiting blood, or excreting bloody or

black stools.

abdominal

pain, diarrhea, N&V, URTI,

dizziness, rash.

n day adjustment in those with impaired hepatic function especially when used for maintaining clients with erosive esophagitis.2.List reason for therapy, triggers, frequency, characteristics of S&S, other agents trialed.3.Record abdominal assessment, radiographic/endoscopic findings, and H. pylori result.4.Administer one hr before giving meal.5. Report any changes in urinary

weeks of therapy and

are maintained

at such levels during the course of therapy.

(Spratto et.al.:2008:1

159)

symptoms

associated with GERD.

elimination, pain, discomfort, or persistent diarrhea.6. Avoid activities that require mental alertness until drug effects realized; may cause dizziness.7. For short term use only, drug inhibits total gastric acid secretion. Side effects of prolonged therapy and suppression of acid secretion alter bacterial colonization and lead to hypoclorhydria and hypergastrenemia which may cause an increase risk for gastric

tumors.

Drug Study

Generic Name

Brand

Name

Classification

Mechanism of Action

Indication Contraindication

Side Effects

How Suppli

ed

Dosage/

Frequency

Nursing Intervention

Piperacillin

sodium and

Tazobactam

sodium

Zosyn,

Peptaz

Antibiotic,

Penicillin

A combination

of Piperacillin sodium and Tazobactam sodium, a

beta-lactamase inhibitor.

Tazobactam inhibits beta-

lactamases, thus

ensuring activity of piperacillin

against beta-

lactamase-producing

microorganis

(1)Appendicitis complicated by rupture or abscess and peritonitis caused by piperacillin-resistant, beta-lactamase producing strains of Escherichia coli, Bacteroides fragillis. (2)Community Acquired Pneumonia

Hypersensitivity to

penicillins, cephalosporins, or beta-lactamase inhibitors.

Diarrhea, constipation, N&V, dyspepsi

a, headache, rash, rhinitis,

dyspnea, abdominal pain.

IV infusio

n

4.5 gm IV q 8 hours

1.For IV administration or infusion, reconstitute the powder for injection with 5 ml suitable diluent/gram piperacillin. IV diluents that can be used include 0.9% NaCl, sterile water for injection, dextran 6% in saline,D5W,KCl 40mEq, bacteriostatic saline/parabens, bacteriostatic water/parabens

ms. Thus Tazobactam

broadens the

antibiotic spectrum or piperacillin

to those bacteria normally

resistant to it. (Spratto

et.al.:2008:1269)

of moderate severity caused by piperacillin-resistant, beta-lactamase producing strains of Haemophilus influenzae. (3)Moderate to severe nosocomial pneumonia caused by piperacillin-resistant, beta-lactamase producing strains of Acinetobacter baumanii.

(4)

, bacteriostatic saline/benzyl alcohol,bacteriostatic water/benzyl alcohol.2.Note reasons for therapy, type, location, characteristics of S&S.3. List any sensitivity to penicillins, cephalosporins, beta-lactamase inhibitors, or other allergens.4. List drug prescribed to ensure none interact unfavorably. Use of heparin and oral anticoagulants may require dosage adjustments.

Infections caused by piperacillin

-susceptible organisms for which

piperacillin is effective may also

be treated with this

combination.

5. Monitor C&S, lytes, urinalysis, hematologic, coagulation profile, renal, LFTs; reduce dosage with renal impairment.

6. Inform family to report

any pain at injection site, fever/chills,

rash, diarrhea, GI upset, lack of response or worsening of

condition.

Drug Study

Generic Name

Brand

Name

Classification

Mechanism of

Action

Indication Contraindication

Side Effects

How Suppli

ed

Dosage/ Frequen

cy

Nursing Intervention

clopidogrel

wintop

Anti-platelet

drug

Inhibits platelet

aggregation by

inhibiting binding of adenosin

e diphosphate (ADP)

to its platelet receptor

and susbsequent ADP

meditative

activation of

glycoprotein

Reduction of MI,

stroke and ucercular death in patients

with atheroscler

osis documented by recent stroke, MI

or established peripheral

arterial disease

Lactation, active

pathological bleeding such us

peptic ulcer or

intracranial hemorrhage

Appendage

disorders,

headache, chest pain, flu-

like sympto

ms

Tablets 75 mg

Clopidogral 75

mg i tab, PO,OD

>Do not cofuse with antidepreesant > Document otheros dehoric event or established peripheral arterial disease requiring therapy.> Asses for active bleeding as with ulcers or intracranial bleeding.> list all drugs prescribed/consumed esp. OTC.> Consider 5 rights in giving meds.

GPII/IIa complex. Effect on receptors

is irreversib

le thus platelets

are affected

for remainder of their lifespan. (MIMS.co

m)

> Explain the purpose of the medication.> obtain baseline V/S.> Document the

procedure.

Drug Study

Generic Name

Brand Name

Classification

Mechanism of

Action

Indication

Contraindication

Side Effects How Supplied

Dosage/ Frequen

cy

Nursing Interventio

n

Acytylcystien

Flulmucil

sachet

Mucolytics

Decrease the

production of

mucus at respiratory tracts

by stimulatin

g the productio

n of glutathiance thus decreasin

g the viscosity

of secretion

s.

Acute and

chronic respiratory tract affection

s with abundant mucus secretio

ns.

Contraindicated to

patients having

asthma. Patients with

history of peptic ulcer.

Urticaria bronchospasm, nausea,

vomiting.

100 mg /200mg sachetInhalation 100mg/ml

Syrup 100mg/5ml x 150

ml

200 mg 1 sachet + socc

h20 NGT bid

asses drug expiration date>asses for drug tolerance characterized >obtain baseline v/s>take the drug with meals>advice increase fluid intake >consider patients safety>evaluate

effectiveness of drug>chart procedure

Drug Study

Generic Name

Brand Name

Classification

Mechanism of

Action

Indication Contraindication

Side Effects

How Suppli

ed

Dosage/ Frequen

cy

Nursing Interventio

n

Simvastatin

Vidastat

Dyslipidemic Agent

Reduction of low density

lipprotien cholesterol in that following inhibition

of the HWG-COA

reductase

activity, the LDL receptor activity on the liver is

increased and this

In CHD: Reduce risk of death and non fatal MI. Reduce risk of strike and transient ischemic attacks. In hypelipidemia: an adjuct to the diet to reduce elevated total-c, LDL-C , apolipoprotien B and TG in patients with primary hyper choles terolemia, hanozygous

Active liver disease or

unexplained persistent

elevations of serum trans

aminoses parphyria, pregnancy lactation

Constipation

dyspepsia

flatulence

Tablet 10

mg,20 mg, 30 mg,40

mg

Vidastat 40g I

tab NGT OD q8hr

Asses drug expiration date >consider the 5 rights of drug administration.>obtain baseline data >dissolve solution thoroughly> encourage high fiber diet, fluid.> inform patient about the mechanism

leads to increase

d removal of LDD

cholesterol.

(KIMS.com)

familial hyrecholesterogous or mixed hyperlipidemia.

(MIMS.co

of drugs>chart the procedure>evaluate effectiveness of drugs.

Drug Study

Generic Name

Brand Name

Classification Mechanism of

Action

Indication Contraindication

Side Effects

How Supplied

Dosage/ Frequen

cy

Nursing Interventio

n

Midozalam

Dormicum

Benzodiazepiness sedative

hyponotics

Inhibits sympath

etic nervous system

activation and

initiates sedation hyponoti

cs

Disturbances of sleep rhythm, insomnia esp.difficulty in falling asllep either initially or after premature awakening.Sedation

in premed before

surgical or

Premature infants

myasthenia gravis

Insomnia in

psychosis severe depressi

on

Ampule 5mg/1ml5mg/5ml,15 mg/3ml

Film coated tablet 15 mg

IVTT 2.8 mg OD

1. Assess level of sedation and level of consciousness through out and for 2-6 hour following administration2. Monitor blood pressure, pulse and respiration continuously during administrat

diagnostic procedure

s, induction

and maintena

nce of anesthesi

a. (MIMS.co

m)

ion 3. Administer IM doses deep into muscle4. In form the patient that this medication will decrease mental recall of the procedure5. Instruct patient to inform health care professional prior to administration if pregnancy is suspected

Drug Study

Generic Name

Brand Name

Classification

Mechanism of Action

Indication

Contraindication

Side Effects

How Suppli

ed

Dosage/ Frequen

cy

Nursing Interventio

n

Ciprofloxacin

ciprobay

fluroquinolone

Has a rigid action in

the ploriferation phase of

a bacterium,

a segmental

twisting and

untwisting of

chromosomes take

place. (MIMS.com

)

For acute

uncompli-cated urinary tract

infections

Contraindicated to patients

having hypersensitivit

y to ciprofloxacin

or other quilone

chemotherapeutic

Nausea, diarrhea

, vomiting

, dyspepsi

a, abdominal pain,

flatulence,

dizziness

Tablet 250 mg, 500 mg Infusion 100 mg/30 ml200 mg/20 ml

Film coated tablet 500 mg

Ciprobay 500 g 1 ½ tab PO bid

>asses drug expiration date>asses for drug tolerance characterized >obtain baseline v/s>instruct the patients to remain in a stable position for 2-3 hrs. >advice

increase fluid intake >consider patients safety>evaluate effectiveness of drug>chart procedure

Drug Study

Generic Name

Brand Name

Classification

Mechanism of Action

Indication Contraindication

Side Effects

How Suppli

ed

Dosage/ Frequen

cy

Nursing Interventio

n

rebamipide

Mucusta

ANTACIDS Rebamipide is a

mucosal protective agent and

is postulated to increase

gastric blood flow, prostaglan

din biosynthes

is and decrease

free oxygen radicals.

For acute gastritis

and exacerbati

on of chronic

gastritis, gastric ulcers

Lactation. Rash, pruritus,

constipation,

diarrhoea, nausea.

Tablet100 mg

Mucosta 1 tab

OD TID

1. Chedk renal studies to check renal function is normal2. Check the pattern of bowel elimination.3. Record the gastric pain being experienced.4. report for coffee ground

stools5. if the patient is pregnant has edema or hypertensive, use low sodium antacids

Drug Study

Generic Name

Brand

Name

Classification

Mechanism of Action

Indication

Contraindication

Side Effects

How Supplied

Dosage/ Frequen

cy

Nursing Interventio

n

prednisone

pred corticosteroids

The anti-inflammatory effect is

due to inhibition

of prostaglan

din synthesis, the drug

also inhibits

accumulation of

machrophages and

leukocytes at sites of inflammati

on and

Allergis and

edematous

respiratory and

neoplastic

diseases

Gastric & duodenal

ulcers, systemic fungal &

certain viral infections, glaucoma,

psychoses or severe

psychoneuroses; live vaccines;

hypersensitivity to

glucocorticoids.

Insomia, nosia and vomiting, GI upset, fatique,

dizziness, muscle

weakness, increased hunger/thirst, joint

pain, decreased diabetic control.

tablets:1mg, 5mg, 10mg, 20

mg, 50 mgOral

solution: 5mg/5ml;

syrup 5mg/5ml;

20 mg 1 tab NGT

BID

1. note reasons for therapy, type, onset, characteristics of signs and symptoms, clinical presentation2. monitor CBC, ESR, electrolytes, BP, blood sugar, weights and mental

inhibits phagocytos

is and lysosomal enzyme release.

status.3. with COPD provide rescue doses and instruct client how and when to use.4. with chronic pain, titrate dose to assess for relief

Drug Study

Generic Name

Brand Name

Classification

Mechanism of Action

Indication

Contraindication

Side Effects How Suppli

ed

Dosage/ Frequen

cy

Nursing Intervention

Ivabradine HCl

coralan

AntianginaIvabradine

Ivabradine is a pure heart rate-lowering agent, acting by selective and specific inhibition of the cardiac pacemaker /current that controls the spontaneous diastolic depolarisation in the sinus node and regulates

Chronic angina pectotis

Resting heart rate <60 bpm prior to

treatment, cardiogenic shock, acute MI, severe

hypotension (<90/50 mmHg), severe hepatic

insufficiency, sick sinus syndrome, SA block,

severe heart failure,

pacemaker-

Luminous phenomena (phosphenes), blurred

vision, bradycardia

, 1st degree AV

block, ventricular extrasystol

es, headache, dizziness.

film-coated tablet 5 mg, 7.5 mg

5 mg 1 tab NGT

OD

1. Assess the client for gastrointestinalupset and peripheral edema.2. Assess pain and limitation of movement ; note type, location & intensity prior to & at the peak following administration.

heart rate. The cardiac effects are specific to the sinus node with no effect on intra-atrial, atrioventricular or intraventricular conduction times, nor on myocardial contractility or ventricular repolarisation.

dependent patient, unstable

angina, 3rd degree AV-

block. Concomitant

potent CYP3A4

inhibitors. Pregnancy &

lactation.

3. Monitor vital signs and check for peripheral edema.d. Don’t breastfeed while taking this drug.4. Discontinue drug and notify physician if signs and symptoms of hypersensitivity occur.5. Caution the patient to avoid concurrent use of alcohol with this medication.

Drug Study

Generic Name

Brand Name

Classification

Mechanism of

Action

Indication Contraindication

Side Effects

How Supplie

d

Dosage/ Frequen

cy

Nursing Interventi

on

Co amoxicl

av

Agcomen

Amoxicillin and

enzyme inhibitor

Prevents the

plorefiration of of infecting bacteria

by inhibitng synthesis

of bacterial capcule. (mims.co

m)

Bacterial infections caused by amoxicillin-resistant β-lactamase producing

strains.These include

actinomycosis, biliary

tract infections, bronchitis,

endocarditis,

gastroenteritis, typhoid

& para typhoid

Pregnancy & lactation. Elderly & neonates.

Severe renal impairment.

Diarrhea, hepatitis

& cholestati

c jaundice. Erythema multiform

e, Stevens-Johnson syndrome, toxic

epidermal

necrolysis &

exfoliative

dermatiti

tablet 625 mg

625 mg 1 tab

NGT q 8 hrs

a. Assess for allergy to penicillin.b. Instruct to take the entire quantity of drug exactly as prescribed even after she feels better.c. Encourage to increase fluid intake.

fever & UTI. s. d. Take the medication in full stomach.e. Report for any signs of unusualities. ( Wilson, et. al,2004 page 1415).

Drug Study

Generic Name

Brand Name

Classification

Mechanism of Action

Indication Contraindication

Side Effects How Supplie

d

Dosage/ Frequen

cy

Nursing Interventio

n

Ipratropium

salbutamol

sulfate,

Duavent

Antiasthmatic

Stimulates beta 2 receptors on the bronchi. Causes less tachycardia and is longer acting. (Woods, Sratto, 28)

Management of

reversible bronchosp

asm associated

w/ obstructive

airway diseases

eg bronchial asthma, COPD

Hypertrophic

obstructive cardiomyop

athy or tachyarryth

mia. Hypersensitivity to soya lecithin or

related food products (for MDI).

Headache,pain,

influenza, chest pain;

nausea. Bronchitis, dyspnea, coughing,

pneumonia, bronchospa

sm, pharyngitis,

sinusitis, rhinitis.

Pulmoneb

solution 2.5 mL

1 neb now

1. Obtain record and baseline vital sings2. Assess the presence of palpitations and dysrhythmias3. Perform assessment of the patient’s mental status4. Warm patient about

possible paradoxical bronchospasm5. use cautiously to patients with CV disorders, hypertension, renal disease and diabetes.

IVF STUDY

Student’s Name: Group 4 Section R Date of Submission: January 8, 2009Area: Chong Hua Hospital Cliinical Instructor: Benita Edelia D.

AgramonPatient’s Name: Patient X Doctor: Dr. R. GoRoom/Bed No.: C-414 Date of Admission: December 13, 2008Age: 66 years old Hospital No.: 0-800-22500-773Status: Widowed Diet: Liquid diet

Type of solutio

n

Classification

Content Mechanism of

action

Indications Contraindications

How supplie

d

Dosage Nursing Responsibiliti

es

0.9% Sodium chlorid

e solutio

n

Isotonic Each 1000 mL contains 900mg of Sodium ChlorideOsmolarity:308 mOsm/L

Electrolytes in 1000

Replaces sodium

and chloride

and maintains

levels (Lippincott Williams & Wilkins:

2005, 879).

Fluid and electrolyte

replacement in

hyponatremia caused by electrolyte loss or in

severe salt depletion.

Contraindicated in patients with conditions in which sodium chloride administration is detrimental. >contraindicated in patients

with with increased,

normal, or only

I.V. 1 liter

IVF PNSS 1 liter @

30 gtts/mi

n

1. Monitor electrolyte levels (Lippincott Williams & Wilkins: 2005, 879).2. Explain use and Administration of drug to patient and family

mL:Sodium… 154 mmolChloride…154 mmol

slightly decreased electrolyte

levels.

(Lippincott Williams & Wilkins: 2005, 879).3.Tell Patient to report adverse reactions promptly (Lippincott Williams & Wilkins: 2005, 879).4.Regulate flow rate as ordered (Lippincott Williams & Wilkins: 2005, 879).6.Check on skin integrity for redness, edema, swelling and pain (Lippincott Williams & Wilkins: 2005,

879).7.Do not let the bottle be consumed totally to prevent air embolism (Lippincott Williams & Wilkins: 2005, 879).8.Check mfor any bubbles present on the I.V. line (Lippincott Williams &

Wilkins: 2005, 879).

Type of solution

Classification Content Mechanism of action

Indications Contraindications

How suppli

ed

Dosage Nursing Responsibiliti

es

Dopamine

Sympathomimetic, direct acting and

indirect acting

Synthetic

Dopamine

Dopamine is the

immediate precursor of epinephrine in the body. Exogenously administered,

it produces direct

stimulation of beta-1

receptors and variable (dose-

dependent) stimulation of

alpha receptors

(peripheral vasoconstricti

on). Will cause a

release of

Adjunct to standard measures

to improve:

BP, Cardiac output, urine

output, in treatment of shock,

unresponsive to fluid replaceme

nt.

Pheochromocytoma,

uncorrected tachycardia, ventricular

fibrillation, or arrhythmias.

Pediatric clients.

IVF 500 ml

PB Dopamine IV @

30 gtts/min

1. Dilute just prior to administration, solution stable for 24 hr at room temperature, protect from light.2. To prevent fluid overload, may use more concentrated solutions with higher doses.3. Administer using an electronic infusion device. Carefully reconstitute

norepinephrine from, as its storage sites. These action

results in increased

myocardial contraction,

CO, and SV as well as

increased renal blood

flow and sodium

excretion. Exert little effects on DBP and

induces fewer

and calculate dosage.4. When discontinuing, gradually decrease dose, sudden cessation may cause marked hypotension.5.Monitor VS, I&O, and ECG; titrate infusion to maintain SBP as ordered.6. Be prepared to monitor CVP and PAWP. Report ectopy, palpitations, anginal pain, or vasoconstriction.

7. Explain to the family that drug administered IV to improve cardiac function thus increasing BP and improving urine output.8. Report any

chest pain, increase

SOB, headaches,

or IV site pain.

Type of solutio

n

Classification

Content Mechanism of action

Indications

Contraindications

How supplie

d

Dosage Nursing Responsibiliti

es

D5NSS Hypertonic Each 1000 mL contains 1000mg of Sodium ChlorideOsmolarity:500 mOsm/L

Electrolytes in 1000 mL:Sodium… 354 mmolChloride…354 mmol

The solution has a higher sodium concentration than to the intracellular area thus by virtue of osmosis the water is taken out of the cell the cell shrinks. This increases the plasma volume of

Rehydrate; has free

water, salt and calories

Contraindicated in patients with conditions in which sodium chloride administration is detrimental. >contraindicated in patients

with with increased,

normal, or only slightly

decreased electrolyte

levels.

I.V. 1 liter

IVF D5NSS 1 liter @ 30

gtts/min

1. Monitor electrolyte levels (Lippincott Williams & Wilkins: 2005, 879).2. Explain use and Administration of drug to patient and family (Lippincott Williams & Wilkins: 2005, 879).3.Tell Patient

the blood. to report adverse reactions promptly (Lippincott Williams & Wilkins: 2005, 879).4.Regulate flow rate as ordered (Lippincott Williams & Wilkins: 2005, 879).

6.Check on skin integrity for redness,

edema, swelling and

pain (Lippincott