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IX. MEDICATIONS, INFUSIONS, TREATMENTS GIVEN
Generic/
Trade
Name
Dosage/
Frequency
Classificati
on
Indicati
on
Contra-
indication
Side Effects Nsg. Responsibilities
• Parac
etamol
- Mild to
Moderate
Pain, Fever
Adult: PO
325–650 mg
q4–6h (max:
4 g/d) PR 650
mg q4–6h
(max: 4 g/d)
Child: PO 10–
15 mg/kg
q4–6h PR 2–5
y, 120 mg
q4–6h (max:
720 mg/d);
6–12 y, 325
mg q4–6h
(max: 2.6
g/d)
Neonate: PO
10–15 mg/kg
q6–8h
- nonnarcotic
/ nonopioid
analgesic,
antipyretic;
- Fever
reduction
.
-
Tempora
ry relief
of mild to
moderate pain.
-
Generall
y as
substitut
e for
aspirin
when the
latter is
not
tolerated
or is
contraind
icated
-
Hypersensit
ivity to
acetaminop
hen or
phenacetin;
use with
alcohol.
- Body as a
Whole: Negligible
with
recommended
dosage; rash.
- Acute
poisoning:
Anorexia,nausea,
vomiting,
dizziness,
lethargy,
diaphoresis,
chills, epigastric
or abdominal
pain, diarrhea;
- onset of
hepatotoxicity—
elevation of
serum
transaminases
(ALT, AST) and
- Monitor for S&S of:
hepatotoxicity, even
with moderate
acetaminophen doses,
especially in individuals
with poor nutrition or
who have ingested
alcohol over prolonged
periods; poisoning,usually from accidental
ingestion or suicide
attempts; potential
abuse from
psychological
dependence
(withdrawal has been
associated with restless
and excited responses).
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bilirubin;
hypoglycemia,
hepatic coma,
acute renal
failure (rare).
- Chronic
ingestion:
Neutropenia,
pancytopenia,
leukopenia,
thrombocytopeni
c purpura,hepatotoxicity in
alcoholics, renal
damage.
• Ofloxacin -
Uncomplicat
ed
Gonorrhea
Adult: PO
400 mg for 1dose
- Urinary
Tract,
Respiratory
Tract, and
Skin and Skin
- antibiotic,
quinolone
-
Chlamydi
a
trachoma
tis
infection,
-
uncompli
cated
gonorrhe
a,
-
Hypersensit
ivity to
ofloxacin or
other
quinoloneantibacteria
l agents;
- tendon
pain;
- sunlight
- CNS: Headache,
dizziness,
insomnia,
hallucinations.
- GI: Nausea,vomiting,
diarrhea, GI
discomfort.
- Urogenital:
Pruritus, pain,
irritation,
- Assessment & Drug
Effects
- Lab tests: Do C&S
tests prior to initial
dose. Treatment maybe implemented
pending results.
- Determine history of
hypersensitivity
reactions to quinolones
or other drugs before
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Structure
Infections
Adult: PO
200–400 mg
q12h x 7–10
d IV 400 mg
q12h x 7 d
- Prostatitis
Adult: PO
300 mg b.i.d.
x 6 wk
- Superficial
Ocular
Infections
Adult:
Ophthalmic
Instill 1–2
drops q2–4h
for first 2 d,
then q.i.d. forup to 5
additional d
- Otitis Media
with
Perforation
Adult: Otic
-
prostatiti
s,
respiratory tract
infection
s,
- skin
and skin
structure
infection
s,
- urinary
tract
infection
s due to
susceptib
le
bacteria,
-
superfici
al ocular
infection
s,
(UV)
exposure;
- QTprolongatio
n;
- viral
infection;
pregnancy
(category
C).
Cautious
Use
- Renal
disease;
- patients
with a
history of
epilepsy,
psychosis,
or increased
intracranial
pressure,
cerebrovasc
burning,
vaginitis, vaginal
discharge,
dysmenorrhea,
menorrhagia,
dysuria, urinary
frequency.
- Skin: Pruritus,
rash.
-Other: Cartilage
erosion.
therapy is started.
- Withhold ofloxacin and
notify physician at firstsign of tendon pain, a
skin rash, or other
allergic reaction.
- Monitor for seizures,
especially in patients
with known or
suspected CNS
disorders. Discontinue
ofloxacin and notify
physician immediately if
seizure occurs.
- Assess for signs and
symptoms of
superinfection (see
Appendix F).
Patient & Family
Education
- Drink fluids liberally
unless contraindicated.
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10 drops (0.5
mL) q12h for
14 d
Child ( 1 y):
Otic 5 drops
(0.25 mL)
q12h for 14 d
- Otitis
Externa
Adult: Otic
10 drops (0.5
mL) q12h for7 d
Child (6 mo–
13 y): Otic 5
drops (0.25
mL) q12h for
7 d
- Renal
ImpairmentClcr 20–
50mL/min:
dose should
be given
q24h; <20
mL/min: ½
the dose
- pelvic
inflamma
tory
disease.
- Otic:
otitis
externa,
otitis
media
with
perforate
d
tympanic
membra
nes.
Unlabele
d
Uses
- EENT
infection
s,
-
Helicoba
cter
ular
disease,
CNS
disorderssuch as
seizures,
epilepsy,
myasthenia
gravis;
- GI disease,
colitis,
dehydration
;
- syphilis;
- atrial
fibrillation;
-acute MI;
CVA;
- children
and
adolescents
<18 y
(except for
- Be aware that
dizziness or light-
headedness may occur;
use appropriatecaution.
- Avoid excessive
sunlight or artificial
ultraviolet light because
of the possibility of
phototoxicity.
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q24h
- Hepatic
Impairment
Severe
impairment:
400 mg qd
pylori
infection
s,
Salmonella
gastroen
teritis.
otic
preparation
).
• Tramadol - Pain
Adult: PO 50–
100 mg q4–
6h prn (max:
400 mg/d),
may start
with 25 mg/d
if not well
tolerated,
and increase
by 25 mg
q3d up to
200 mg/d
Geriatric: PO50–100 mg
q4–6h prn
(max: 300
mg/d), may
start with 25
mg/d if not
well
- analgesic;
narcotic
(opiate)
agonist;
-
Manage
ment of
moderat
e to
moderat
ely
severe
pain.
-
Hypersensit
ivity to
tramadol or
other opioid
analgesics;
- patients
on MAO
inhibitors;
- patients
acutely
intoxicated
with
alcohol,
hypnotics,
centrally
acting
analgesics,
opioids, or
- CNS:
Drowsiness,
dizziness,
vertigo, fatigue,
headache,
somnolence,
restlessness,
euphoria,
confusion,
anxiety,
coordination
disturbance,
sleep
disturbances,seizures.
- CV:
Palpitations,
vasodilation.
- GI: Nausea,
Assessment & Drug
Effects
- Assess for level of pain
relief and administer
prn dose as needed but
not to exceed the
recommended total
daily dose.
- Monitor vital signs and
assess for orthostatic
hypotension or signs of
CNS depression.
- Discontinue drug and
notify physician if S&S
of hypersensitivity
occur.
- Assess bowel and
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tolerated,
and increase
by 25 mg
q3d up to
200 mg/d
- Renal
Impairment
Clcr <30
mL/min:
decrease to
50–100 mg
q12h
- Hepatic
Impairment
Cirrhosis:
decrease to
50–100 mg
q12h
psychotropi
c drugs;
- substanceabuse;
- patients
on obstetric
preoperativ
e
medication;
- abruptdiscontinuat
ion;
- alcohol
intoxication;
- pregnancy
(category
C);
- lactation;
- children
<16 y.
Cautious
constipation,
vomiting,
xerostomia,
dyspepsia,
diarrhea,
abdominal pain,
anorexia,
flatulence.
- Body as a
Whole: Sweating,
anaphylactic
reaction (evenwith first dose),
withdrawal
syndrome
(anxiety,
sweating,
nausea, tremors,
diarrhea,
piloerection,
panic attacks,paresthesia,
hallucinations)
with abrupt
discontinuation.
- Skin: Rash.
bladder function; report
urinary frequency or
retention.
- Use seizure
precautions for patients
who have a history of
seizures or who are
concurrently using
drugs that lower the
seizure threshold.
- Monitor ambulation
and take appropriate
safety precautions.
Patient & Family
Education
- Exercise caution with
potentially hazardous
activities until response
to drug is known.
- Understand potential
adverse effects and
report problems with
bowel and bladder
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Use
Debilitated
patients;
- chronic
respiratory
disorders;
- respiratory
depression;
- olderadults;
- liver
disease;
- renal
impairment;
-myxedema,
hypothyroid
ism, or hyp
-
oadrenalism
- Special Senses:
Visual
disturbances.
- Urogenital:
Urinary
retention/freque
ncy, menopausal
symptoms.
function, CNS
impairment, and any
other bothersome
adverse effects tophysician.
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;
- GI disease;
- acute
abdominal
conditions;
- increased
ICP or head
injury,
increased
intracranialpressure;
- history of
seizures;
- patients
>75 y.
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• Ampicilli
n +
Sulbacta
m
- Systemic
Infections
Adult/Child
(> 40 kg):
IV/IM 1.5–3 g
q6h (max: 4
g
sulbactam/d)
Child ( 1 y):
IV 300
mg/kg/d (200
mg/kg
ampicillinand 100
mg/kg
sulbactam)
divided q6h
- Renal
Impairment
Clcr >30
mL/min: giveq6–8h; 15–29
mL/min: give
q12h; 5–14
mL/min: give
q24h
Dialysis: Give
dose after
- antibiotic;
aminopenicill
in
-
Treatme
nt of
infection
s due to
susceptib
le
organism
s in skin
and skin
structure
s,
-
intraabd
ominal
infection
s, and
-
gynecolo
gicinfection
s.
-
Hypersensit
ivity to
penicillins;
-
mononucleo
sis.
Cautious
Use
-
Hypersensitivity to
cephalospor
ins;
- GI
disorders;
- Renal
disease or
impairment;
- pregnancy
(category B)
or lactation.
- Body as a
Whole:
Hypersensitivity
(rash, itching,
anaphylactoid
reaction),
fatigue, malaise,
headache, chills,
edema.
- GI: Diarrhea,
nausea,
vomiting,abdominal
distention,
candidiasis.
- Hematologic:
Neutropenia,
thrombocytopeni
a.
- Urogenital:
Dysuria.
- CNS: Seizures.
- Other: Local
pain at injection
Assessment & Drug
Effects
- Determine previous
hypersensitivityreactions to penicillins,
cephalosporins, and
other allergens prior to
therapy.
- Lab tests: Baseline
C&S tests prior to
initiation of therapy;
start drug pending
results.
- Report promptly
unexplained bleeding
(e.g., epistaxis,
purpura, ecchymoses).
- Monitor patient
carefully during the first
30 min after initiation of
IV therapy for signs of
hypersensitivity and
anaphylactoid reaction
(see Appendix F).
Serious anaphylactoid
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dialysis site;
thrombophlebitis
.
reactions require
immediate use of
emergency drugs and
airway management.
- Observe for and report
symptoms of
superinfections (see
Appendix F). Withhold
drug and notify
physician.
- Monitor I&O ratio andpattern. Report dysuria,
urine retention, and
hematuria.
Patient & Family
Education
- Report chills,
wheezing, pruritus
(itching), respiratory
distress, or palpitations
to physician
immediately.
Treatment/ Classification Indication Contraindication Nursing
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Infusion Responsibilities
Plain Normal Saline
Solution (PNSS)
Isotonic *Hypovolemia
*Heat-related
emergencies
*Freshwaterdrowning
*Diabetic
ketoacidosis(DKA)
*CHF *Do not connect
flexible plastic
containers of
intravenoussolutions in series,
i.e., do not
piggyback
connections. Such
use could result
in air embolism due
to residual air being
drawn from one
container before
administration of
the fluid from a
secondary
container is
completed.
*Pressurizing
intravenous
solutions containedin flexible plastic
containers to
increase flow
rates can result in
air embolism if the
residual
air in the container
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is not fully
evacuated prior
to administration.
*Use of a vented
intravenousadministration
set with the vent in
the open position
could
result in air
embolism. Vented
intravenous
administration sets
with the vent in the
open
position should not
be used with
flexible
plastic contain.Dextrose 5% in H2O
(D5W)
Hypotonic dextrose
solution; Crystalloid
solution
*IV access for
emergency drug
administration*Dilution of drugs
to be given IVPB
*Provides free
water for
intravenous KVO
*Provides a modest
sugar source for
*Trauma
*Hypovolemia,
Hypotension*When Dilantin
(phenytoin) will be
given
*Patients at risk for
increased I.C.P.
* Patients who have
an acute
* Since the tonicity
is low, avoid using
in head injurypatients.
* Use sterile
technique in
venipuncture and
equipment
assembly, with all
venipunctures
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cellular metabolism neurological
dysfunction.
* Hypovolemic
states.
* Patients at risk forthird-space fluid
shifts.
* Elevated blood
glucose
concentrations.
* Do not administer
quantity in excess
of that required to
keep vein open or
administerappropriate dose of
medication.
* Do not use
solution if outdated,
cloudy or the seal is
not intact, as with
all IV solutions.
* Monitor E.C.G.
continuously.
* Monitor blood
pressure, pulse rate
and respiratory rate
frequently.Plain Lactated
Ringers Solution
(PLR)
Isotonic * This medication is
an intravenous (IV)
solution used to
supply waterandelectrolytes (e.g
., calcium,
potassium, sodium,
chloride) without
calories (dextrose),
to the body. It is
also used as a
* Renal failure
* Liver dysfunction
* Diabetes Mellitus
* Lactic acidosis* Alkalosis
* Never stop
hypertonic
solutions abruptly.
* Don’t giveconcentrated
solutions I.M. or
subcutaneously.
* Check vital signs
frequently. Report
adverse reactions.
* Monitor fluid
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mixing solution
(diluent) for other
IV medications.
intake and output
and weight
carefully. Watch
closely for signs
and symptoms of fluid overload.
* Monitor patient
for signs of mental
confusion
X. PROBLEM IDENTIFICATION AND PRIORITIZATION
NURSING DIAGNOSIS PRIORITY RATIONALE
Acute Pain related to
inflammation and presence of a
chest tube as manifested by
facial grimace upon position
changing, pain scale of 8/10,
guarding behavior, reported
unilateral chest pain aggravated
by coughing, moving, and
breathing, decreased breath
sounds on affected area of the
lungs.
High Priority This is an actual problem that needs to be
resolved immediately or be attended
urgently. The resolution of this problem will
also resolve the clients impaired gas
exchange as this will let client to easily
practice deep breathing exercise. Pain is a
5th vital sign and so this is of high priority.
This also of short term goal. Also pain is
something that triggers anxiety and mood
changes. As health care providers we want
to allay fears and anxiety especially it’s the
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patient’s first time to be confined in
hospital.Risk for Ineffective Breathing
Pattern related to decreased lungexpansion.
Low Priority This is not an actual problem.
Impaired Gas Exchange related to
altered oxygen supply secondary
to ventilation-perfusion
mismatch, presence of lung
secretions, as manifested by
tachypnea, difficulty of breathing.
Low Priority This is an actual problem that is related to
airway. Breathing exercises could be learnt
by patient but with difficulty still because of
pain felt by the client upon breathing
especially deep breathing. This problem will
easily be modified if pain is not presentupon deep breathing. This also does not
pose a life threat as patient can sort to
oxygen therapy.
XI. NURSING CARE PLAN
NURSING
DIAGNOSIS/
CUES
ANALYSIS GOAL/
OBJECTIVES
NURSING
INTERVENTION
RATIONALE EVALUATIO
N
Acute Pain
related to
inflammation
Pain affects the
entire body. It
can increase
GOAL:
After 1 hr of
nursing
After 1 hr of
nursing
intervention,
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and presence of
a chest tube as
manifested by
facial grimace
upon positionchanging, pain
scale of 8/10,
guarding
behavior,
reported
unilateral chest
pain aggravated
by coughing,
moving, and
breathing,
decreased
breath sounds
on affected area
of the lungs.
heart rate and
blood pressure
alter mood and
cause stress
and anxiety.Until the pain is
managed, it will
be difficult to
proceed with
other lower
priority nursing
interventions.
For example, a
patient recently
had knee
surgery and is
cleared to start
ambulating. He
is also being
discharged
soon and needs
to understandcare
instructions.
But his knee is
still causing
him a great
deal of pain. He
is not
intervention, the
client’s subjective
perception of pain
will decrease as
documented bypain scale.
Objective
indicators, such
as grimacing, will
be absent or
diminished.
OBJECTIVES:
After nursing
interventions,
client will be able
to:
Report pain is
relieved and/or
controlled.
At frequent
intervals, assess
patient’s degree of
discomfort using
patient’s verbal and
non-verbal cues.
Devise a pain scale
with a patient with 0
having no pain at all
and 10 having worst
pain.
Medicate with
These
assessments
monitor trend
of pain and
help
determine
effectiveness
of subsequent
pain
interventions.
This action
provide pain
the client’s
subjective
perception of
pain
decreases, asdocumented
by pain scale.
Objective
indicators,
such as
grimacing,
were
diminished.
GOAL MET
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interested in
trying to walk,
he doesn't want
to hear his
instructions, he just wants to
stop hurting.
Everything else
comes to a halt
until that pain
reaches a
manageable
level.
Follow prescribed
pharmacological
regimen.
Verbalize
methods that
provide relief.
Demonstrate use
of relaxation skills
and activities that
analgesics as
prescribed. Use also
pain scale to
evaluate and
document medicationeffectiveness.
Encourage patient to
request analgesic
before pain becomes
severe or
alternatively,administer at
scheduled intervals.
Pre-medicate patient30 minutes before
initiating coughing,
repositioning.
relief and
determine
effectiveness
of the
analgesia
.
Prolonged
stimulation of
pain receptors
results in
increased
sensitivity topainful stimuli
and increases
amount of
drug to
relieve pain
This
medication
provides
comfort to
client prior to
coughing and
repositioning.
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reduce level of
pain perceived.
Teach patient to
splint affected side
when coughing,
moving, or
repositioning, andlauging.
Facilitate
coordination among
health care providers
to provide rest
periods in betweencare activities.
Stabilize chest tube.
Tape chest tube
securely to thorax.
Position tube to
ensure there are no
dependent loops
This action
reduces
discomfort.
Relaxation
decreases
oxygen
demand and
reduces level
of pain.
These actions
reduce pull or
drag on latex
connectortubing,
prevent
discomfort
and help
facilitate
drainage and
appropriate
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functioning.
43