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IX.

DRUG STUDY

Specific Mechanism Specific Contra- Nursing


Generic Name Adverse Effect
Action of Action Indication indication Responsibility

Spironolactone Aldosterone Competitively  Diagnosis Contraindica  Dizziness,  Give daily


50mg Tab OD antagonist blocks the and ted with headache, doses early
Potassium effect of maintenance allergy to drowsiness, so that
sparing aldosterone in of primary spironolacto fatigue, ataxia, increased
Brand name: diuretic the renal hyperaldoste ne, confusion urination
tubule, ronism hyperkalemi  Rash, Urticaria does not
Aldactone causing loss a, renal  Cramping, interfere with
of sodium and  Adjunctive disease, diarrhea, dry sleep.
water therapy in anuria, mouth, thirst,
retention of edema amiloride, or vomiting  Measure and
potassium. associated triamterene  Impotence, record regular
with heart use. irregular weight to
failure, menses, monitor
nephrotic amenorrhea, mobilization
syndrome, post- of edema
hepatic menopausal fluid.
cirrhosis bleeding
when other  Hyper
therapies kalemia,
are hyponatremia,
inadequate agranulocytosi
or s
inappropriat
e.
 Treatmen
t of
hypokalemia
or prevention
of
hypokalemia
in patients
who would
be of high
risk if
hypokalemia
 Monitor BP
Clonidine HCl Anti- occurred. Pregnancy, closely.
75g/ml for BP hypertensive Centrally lactation and  With
>= 160/100 acting Treatment of hypotensive  Hypotension epidural
antiadrenergic hypertension, patients peripheral administratio
derivative. either alone or edema, ECG n, frequently
Stimulates with diuretic or monitor BP
changes,
Brand name: alpha2- other and HR.
adrenergic antihypertensiv tachycardia,
 Monitor I&O
Catapres receptors in e agents. bradycardia, during
CNS to inhibit flushing, rapid period of
sympathetic increase in BP dosage
vasomotor with abrupt adjustment.
centers. withdrawal. Report
Central change in
actions reduce  Dry mouth, I&O ratio or
plasma constipation, change in
concentrations voiding
abdominal pain,
of pattern.
norepinephrin altered taste,
 Dertermine
e. It decreases nausea, weight daily.
systolic and vomiting,  Supervise
diastolic BP closely
and heart rate.  Drowsiness,
patients with
Also inhibits sedation, history of
renin release dizziness, mental
from kidneys. headache, depression,
fatigue, as they may
weakness, be subject to
sluggishness, further
depressive
 Rash, Dry eyes. episodes.
Diphenhydramine Antihistamine Completely Amelioration of Contraindica  Depression, Avoid
HCl block the allergic ted nightmares, excessive
1amp (IV) 30 effects of reactions to with allergy sedation. dosage.
minutes prior to histamine at blood or to  Arrhythmias
BT peripheral H1 plasma. antihistamin  Alopecia,  Administer
receptor sites, es,lactation angioedema, with food of
have and skin eruption
Brand name: GI upset
anticholinergic pregnancy. and itching,
(atropine-like) occurs.
 Dry mouth, GI
Benadryl antipruritic upset,
effect.  Provide
anorexia,
mouth care,
increased
appetite, sugarless
nausea, lozenges for
vomiting, dry mouth.
diarrhea
 Bronchospasm
, cough,
thickening of
secretions
Amlodipine 10 Calcium Calcium Treatment of Contraindica  Dizziness,  Do not chew
mg OD Channel channel angina pectoris ted with lightheadedness or divide
Blocker blockers are caused by heart block, , headache, sustained
Brand name: antianginal coronary artery allergy to fatigue, sleep
release
and spasm, chronic calcium disturbance,
Ambesyl antihypertensi stable angina, channel blurred vision tablets.
ve. It works hypertension, blockers,  Peripheral Swallow
by relaxing the arrhythmias, sick sinus edema, whole.
blood vessels subarachnoid syndrome, hypotension,
in the body, hemorrhage. ventricular arrhythmias, AV  Monitor
making it dysfunction, block patient
easier for the pregnancy.  Flushing, rash, carefully
heart to pump dermatitis, while drug is
blood around pruritus, being
the body. It urticaria
also widens titrated to
 Nausea,
the blood therapeutic
diarrhea,
vessels constipation, dose.
leading to the flatulence,
heart and so cramps.
help increase
the supply of
oxygen rich
blood to the
heart.
Hydroxyzine Antihistamin Actions may  Symptomatic Contraindica  Drowsiness,  Take as
10grams 1 tab e be due to relief of ted with involuntary motor prescribeed.
TID suppression of anxiety and allergy to activity, including Avoid
subcortical tension hydroxyzine tremor and excessive
Brand name: areas of the associated or cetirizine, seizures. dosage.
CNS. with pregnancy,  Dry mouth,  Report
Iterax psychoneuro lactation. reflux, difficulty
sis, adjunct constipation, breathing,
in organic  Urinary retention tremors, loss
disease  Wheezing, of
states in dyspnea, chest coordination,
which tightness sore
anxiety is muscles, or
manifested ; muscle
alcoholism spasm.
and asthma;
before dental
procedure

 Management
of pruritus
due to
allergic
condition,
such as
chronic
urticaria,
atopic and
contact
dermatosis,
and in
histamine
mediated
pruritus.
Drug Name Specific Action Mechanism of action Indication Contraindication Adverse Effect Nursing
responsibility

Godex Hepatic • Cholagogues • Acute and • Contraindicate • Galactosemia • Monitor vital


protector promotes the chronic d for patients • Bowel signs
discharge of bile from hepatitis who are obstruction • Should be
the system, purging it • Cirrhosis hypersensitive taken with
downward • drug-induced to the drug foods
hepatitis
• general and
alcoholic
intoxication,
• fatty liver

Drug Name Specific Mechanism of action Indication Contraindication Adverse Effect Nursing
Action responsibility

Laitun fluoroquinolo They interfere with DNA • Mild to • Hypersensitivit • Nausea/vomiti • maintain
nes replication in moderate UTI y to quinolones ng adequate
Content: susceptible gram- • Infectious • Restlessness hydration
ciprofloxacin negative bacteria, diarrhea • Anorexia • tell patient that
• Dysphagia it may impair
preventing cell
• tachycardia ability to drive
replication and leading & operate
to death of bacteria machinery
Drug Name Specific Action Mechanism of Indication Contraindication Adverse Effect Nursing responsibility
action

Amoxapine Anxiolytics Inhibits • Relief • Hypersensitivit • Orthostatic • Use with caution in


reuptake of symptoms of y to tricyclic hypotension patients with history of
Antidepressant norepinephrine depression antidepressant • tachycardia seizures, pressure, CV
and serotonin s • palpitations disorders, hyperthyroid
Brand name:
in CNS leading Unlabeled use: • Not • Arrhythmias patients
recommended • Confusion • Monitor vital signs for
Asendin to an increase for use during • Hallucination potentially fatal condition
in their effects • Management acute recovery • Instruct patient to
of chronic and delusion
phase of MI. • Drowsiness monitor food intake;
pain weight gain can occur
associated • Pruritus
because of increased
with migraine • Blurred
appetite and craving for
• Chronic vision
sweets.
tension • Emphasize
headache importance of regular
• Peripheral dental care because oral
neuropathy dryness can increase risk
• Arhtritic pain for dental caries.
• Instruct patient to
report the following
symptoms to health care
provider: Persistent dry
mouth, constipation,
urinary retention, fever,
sore throat, or muscle
rigidity.
• Instruct patient to
take sips of water
frequently if dry mouth
occurs. Suggest patient
increase fluids and fiber
in diet to alleviate
constipation.

• Do not take the


medication in larger
amount.

Drug Name Specific Mechanism Indication Contraindication Adverse Effect Nursing responsibility
Action of action

Furosemide Loop Inhibits • Edema •Contraindicated • CNS: headache, • Monitor weight, blood
Diuretic reabsorption • Hypertension in patients vertigo, pressure, and pulse rate
of sodium hypersensitive dizziness, routinely with long term
and chloride to drug and paresthesia, use.
Lasix weakness, • If oliguria or azotemia
from the those with
anuria restlessness, develops or increases,
proximal fever drug
•Use cautiously
and distal
in patient who • CV: orthostatic may need to be stopped.
tubules and Are allergic to hypotension, • Monitor fluid intake and
ascending sulfonamides. thrombophlebitis output and electrolyte,
limb of with BUN,
Henle, IV administration and carbon dioxide
leading to • EENT: transient levels.
• deafness, • Watch for signs of
sodium-rich
blurred or hypokalemia.
diuresis
• yellowed vision, • Consult prescriber and
• tinnitus dietitian about a high-
• GI: abdominal potassium diet or
discomfort and potassium
pain, supplements. Foods rich
diarrhea, in
anorexia, potassium include citrus
nausea, fruits, tomatoes,
vomiting, bananas,
constipation, dates, and apricots.
pancreatitis
• GU: nocturia,
polyuria,
frequent
urination,
oliguria
• HEMATOLOGIC:
agranulocytosis,
aplastic anemia

Drug Classification Mechanism of Indication Contraindication Adverse Effect Nursing responsibility


Name action

Sodium electrolyte sodium is the • prophylaxis • congestive •hypernatremia, • Monitor electrolytes, ECG,
chloride major cation of heat heart failure, hypopotassemia liver and renal function
tab of the body's prostration or • hypernatremia , acidosis. studies
extracellular muscle • fluid •Fluid and solute • Note level of
fluid. It plays a cramps retention overload leading consciousness
crucial role in • chloride to dilution of • Assess the heart and
maintaining deficiency serum lung sounds
the fluid and due to electrolyte level • Observe S&S of
electrolyte dieresis or • acute hypernatremia, flushed
balance. salt pulmonary skin, elevated
Excess restrictions edema temperature, rough dry
retention of • prevention or tongue, and edema.
sodium results treatment of • Monitor VS and I&O
in extracellular • Assess urine specific
overhydration volume gravity and serum sodium
(edema, depletion levels
hypervolemia)
, which is
often treated
with diuretics.
Abnormally
low levels of
sodium result
in
dehydration.
X. NURSING CARE PLAN

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Ineffective After 8-hours of Independent: Goal met.


breathing pattern nursing
“Nahihirapan related to intra- intervention the 1. Monitor 1. Rapid shallow After 8 hours of
akong huminga,” abdominal fluid patient will respiratory rate, breathing may be nursing
as verbalized by collection as participate in depth and effort. present because intervention the
the patient. evidenced by actions to of hypoxia and patient
rapid shallow maximize fluid participate in
breathing. oxygenation. accumulation in deep breathing
Objective: the abdomen. and coughing
exercises.
>flaring of nose
2. Auscultate
>inadequate breath sounds, 2. Indicates
chest expansion noting crackles, developing of
wheezes or complications
>rapid shallow ronchi. (adventitious
breathing sounds reflects
accumulation of
>pallor fluid; absent
sounds suggest
atelectasis.

3. Investigate
V/S changes in the 3. Changes in
T- 37.6 C level of mentation may
consciousness. reflect
P- 110 hypoxemia and
respiratory failure
R-29
which often
BP- 180/100 accompany
4. Keep head of hepatic coma.
the bed elevated.

4. Facilitates
breathing by
reducing
pressure on the
diaphragm and
minimizes risk of
5. Frequent aspiration of
repositioning and secretions.
encourage deep-
breathing
exercises or 5. Aids in lung
coughing as expansion and
appropriate. mobilizing
secretions.

6. Monitor
temperature.
Note presence of
chills, increased
coughing and
changes in the 6. Indicative of
color/character of onset of
sputum. infection.

Collaborative:

1.Monitor serial
ABG, pulse
oximetry, vital
capacity
measurements
and chest x-ray. 1.Reveals
changes in
respiratory status
or developing
pulmonary
complications.

2.Provide
supplemental
oxygen as
ordered.

2.May be
necessary to
3.Demonstrate prevent hypoxia
and assist with and decrease
respiratory work of
adjuncts such as breathing.
incentive
spirometer.

3.Reduces
incidence of
atelectasis, and
enhances
mobilization of
secretions.
Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Activity After 8-hours of Independent: Goal unmet.


intolerance nursing
“Nanlalambot related to intervention the 1.Assess level of 1.Provides After 8-hours of
ako,” as decreased patient will activity baseline for nursing
verbalized by the endurance as achieve and intolerance and further interventions, the
patient. evidenced by maintain ability degree of fatigue assessment of patient was not
easy fatigability. to perform when performing effectiveness of able to maintain
activities without ADLs. interventions. strength and
Objective: tolerance and function.
fatigue.
>body malaise 2.Assist with 2.Promotes
>ambulation with activities and exercise and
assistance hygiene when hygiene within
fatigued patient’s level of
> limited ROM tolerance.

> weak in 3.Decreases


appearance 3.Encourage rest energy
when fatigued or expenditure.
> needs when abdominal
assistance in pain or
positioning in bed discomfort occurs

>minimal
movement
4. Assist with
selection and 4. Stimulates
pacing of desired patient’s interest
in selected
V/S activities and activities.
exercise.
T- 37.6 C

P- 110
5. Provide diet
R-29 high in 5.Provides
carbohydrates calories for
BP- 180/100 energy and
with protein
intake consistent protein for
with liver healing
function

6. Reposition
every 2 hours,
and provide good 6. Decrease
skin care potential for skin
breakdown.

7. Increase
activities as
patient is able to
tolerate. 7. Assist with
return to optimal
activity levels
while enabling
patient to have
some measure of
control over
situation.

8. Instruct patient
and family on
disease process 8. promotes
and need for knowledge and
extended rest facilitates
compliance with
treatment.

Collaborative:

1.Administer
supplemental
vitamins 1.To provide
additional
nutrients.

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Imbalanced After 8-hours of Independent:


nutrition: Less nursing
“Wala akong than body intervention the 1.Measure 1.Provides Goal met. After 8
ganang kumain” requirements patient will dietary intake by information about hours of nursing
as verbalized by related to demonstrate calorie count. intake, needs and intervention the
the pt. inadequate diet behaviors to deficiencies. patient verbalize
as evidenced by maintain proper desire to eat,
poor appetite. nutrition. 2.Encourage “Gusto kong
Objective: patient to eat. 2.Improved kumain para
Explain reasons nutrition is vital manumbalik ang
>poor appetite for types of diet. to recovery. lakas ko”.

>pallor Consider
preferences in
>weak in food status.
appearance

3.Recommend 3.Poor tolerance


small frequent to larger meals
meals. may due to
V/S increased intra-
abdominal
T- 37.6 C pressure.
P- 110

R-29

BP- 180/100 4.Restrict intake


of caffeine, gas
forming, or spicy 4.Aids in
and excessively reducing gastric
hot or cold foods. irritation and
abdominal
discomfort that
may impair oral
intake
5.Encourage
frequent mouth
care specially
before meals
5.Patient is prone
to sore and bad
taste in mouth
which may
6.Promote contribute to
undisturbed rest anorexia
periods specially
before meals.
6.Conserving
energy reduces
metabolic
demand on the
Collaborative: liver and
promotes cellular
1.Monitor
regeneration
laboratory status
such as serum
glucose, albumin,
total protein
nutrition and
ammonia. 1.Glucose may
be decreased
because of
impaired
glycogenesis,
depleted
glycogen or
inadequate
intake. Protein
may be low
because of
impaired
metabolism
decrease hepatic
2.Consult with synthesis or loss
dietician to into peritoneal
provide diet that cavity. Elevation
is high in calories of ammonia level
and simple may require
carbohydrate, restriction of
low in fat, and protein intake to
moderate to high prevent serious
protein, limit complication
sodium and fluid
as necessary 2.Dietician can
provide detailed
instruction,
sample menus,
3.Administer
and suggestions
Multivitamins and for improving the
palatability and
Godex as promoting intake
prescribe.
3.GODEX is a
multicomponent
drug containing
Carnitine orotate,
adenine HCl,
B12,B6, and
riboflavin which
acts
synergistically.

Assessment Diagnosis Planning Intervention Rationale Evaluation

SUBJECTIVE: Fluid volume After 8 hours of INDEPENDENT:


excess related to nursing
“Napansin ko na compromised interventions, > Measure intake >Reflects Goal unmet.
lumalaki ang the patient will and output,weigh circulating After 8 hours of
regulatory
tiyan demonstrate daily, andnote volume status. nursing
ko” as mechanism as stabilized fluid Positive balance/ interventions, the
evidenced by weight gainmore
verbalized by the volume and weight gain often patient wasn’t
edema and than 0.5kg/day. able
patient. decreased reflects
ascites formation edema. continuing to demonstrate
fluid retention. stabilized fluid
OBJECTIVE: volume and
> Assess
· Anasarca decreased
respiratory
edema.
· Weight gain status, noting > Indicative of
· Altered increased pulmonary
electrolyte respiratory rate, congestion.
levels dyspnea.

· V/S taken as >Monitor blood


follows: pressure.
>Blood pressure
T- 37.6 C elevation usually
associated with
P- 110 fluid volume
excess but may
R-29 not occur
because
BP- 180/100 of fluid shifts out
>Auscultate of
lungs, noting the vascular
diminished/ space.
absent breath
sounds and >Increasing
developing pulmonary
adventitious congestion may
sounds. result in
consolidation,
impaired gas
exchange, and
complications.

>Assess degree
of peripheral/
dependent
edema.
>Fluid shift into
tissues as a
result
of sodium and
water retention,
decreased
> Measure albumin, and
abdominal girth. increased anti
diuretic hormone
(ADH).
>Reflects
accumulation of
fluid (ascites)
resulting from
> Encourage bed loss
rest when of plasma
ascites is proteins
present. or fluid into
peritoneal space.
DEPENDENT:
>Administer
medications as >May promote
indicated. Such Recumbency
as diuretics, induced
Albumin, diuresis.
Aldacton,
Furosemide
(Lasix)

> To control
edema
>Monitor and ascites.
Electrolytes. Promotes
excretion of fluid
through the
kidneys and
maintenance of
normal fluid and
electrolyte
balance.

>To correct
further
imbalances.

Assessment Diagnosis Planning Intervention Rationale Evaluation

INDEPENDENT:

After 8 hours of 1. Maintain bed 1. Reduces Goal met. After 8


Subjective: Acute pain and effective nursing rest when patient metabolic hours of effective
discomfort intervention, the experiences demands and nursing
“Mabigat at related to patient will be abdominal protects the liver. intervention,
masakit ang tyan enlarged tender able to discomfort. patient seen
ko” as verbalized liver and ascites demonstrate doing the
by the patient. as evidenced by divertional 2. Observe, divertional
record, and 2. Provides
Objective: facial grimace activities to baseline to activities
and painscale of lessen pain. report presence instructed and
and character of detect further
>facial grimace 6/10. deterioration of patient’s pain
pain and lessened from
>with a painscale discomfort. status and to
evaluate 6/10 to 4/10.
of 6/10
interventions.
>irritable
3. Reduce sodium 3. Minimizes
>with guarding and fluid intake if further formation
behavior prescribed. of ascites.

>with massive 4. Teach patient


ascites divertional
activities such as 4. Provide venous
deep breathing return and
excercises and promotes
provide reading relaxation to the
materials. patient.

5. Prepare
patient and assist
with
paracentesis.

DEPENDENT: 5. Removal of
ascites fluid may
6.Administer decrease
antispasmodic abdominal
and sedative discomfort.
agents as
prescribed. 6. Reduces
irritability of the
gastrointestinal
tract and
decreases
abdominal pain
and discomfort.
Assessment Diagnosis Planning Intervention Rationale Evaluation

Goal met. After 8


INDEPENDENT: hours of giving
“Madalas akong Impaired Gas After 8 hours of 1. Position effective nursing
hapuin lalo na Exchange r/t giving effective client in 1. Promote
intervention and
kapag lagi accumulation of nursing either semi- good
ventilation health teaching,
nakahiga” as fluid in pleural intervention and fowlers
and the patient was
verbalized by the space secondary health teaching, position or
side lying breathing. able to know
patient. to underlying the patient will positioning
position.
physiologic be able to know 2. Will techniques that
condition. positioning 2. Encourage promote improve
techniques that client to mucoid or
Objective: ventilation.
improve cough as sputum
ventilation. tolerated. excretion
>Use of
from the
accessory lungs
muscles when
breathing 3. Monitor
respiratory 3. Proper
>with labored rate, depth, assessment
breathing and effort, will help
(shallow including use identify early
breathing) of accessory problems.
muscles,
RR- 29 cycles per nasal flaring,
minute and thoracic
or abdominal
(+) crackles breathing.

4. Monitor 4. Changes in
client’s behavior and
behavior and mental status
mental status can be early
for onset of signs of
restlessness, impaired gas
agitation, exchange.
confusion and
in the late
stages,
extreme
lethargy
5. Observe 5. Central
for cyanosis cyanosis in
in skin: note tongue and
especial color oral mucosa
of tongue and is indication
oral mucous of serious
membrane. hypoxia and
is a medical
emergency;
peripheral
cyanosis seen
in extremities
may not be
serious.

Dependent:

1. Administer
oxygen 1. To
inhalation promote
appropriately enough
. oxygen
supply
2. Administer
salbutamol 2. To provide
bronchodilatio
n.