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DRUG STUDY

GENERIC NAME Dopamine Hydrochloride

BRAND NAME

DOCTORS ORDER November 25, 2007 (3:00 PM) Start Dopamine 200 mg/250 cc Premix @ 86 gtts/min

CLASSIFICATION Sympathomimetic, Direst & Indirect Acting

INDICATION To increased renal blood flow & sodium excretion

SIDE EFFECT Tachycardia Anginal pain Palpitstions Hypotension Bradycardia Dyspnea N/V headache

NURSING CONSIDERATION Must be diluted before use. Prevent fluid overload, may use more concentrated solutions with higher doses. When discontinuing, gradually decrease dose; sudden cessation may cause mark hypotension.

GENERIC NAME Metoclopramide

BRAND NAME Maxolon

DOCTORS ORDER November 25, 2007 (12:55 PM) Metoclopramide 1 amp IV PRN for N/V

CLASSIFICATION Gastrointestinal Stimulant

INDICATION To treat acute & recurrent diabetic gastroparesis, gastroesophageal reflux

SIDE EFFECTS Restlessness, drowsiness, fatigue, anxiety, insomnia, confusion, headache, dizziness Nausea, bowel disturbances Hypertension , hypotension

NURSING CONSIDERATION Inject slowly IV over 1-2 mins. To prevent transient feelings of anxiety & restlessness. Metoclopramide is physically & chemically incompatible with a number of drugs.

GENERIC NAME Ranitidine

BRAND NAME Zantac

DOCTORS ADVERSE ORDER CLASSIFICATION INDICATION EFFECTS November 25, Histamine H2 Maintenance Constipation 2007 (12:55 receptor blocking treatment of Bradycardia/tachycardia PM) drug duodenal ulcer Dizziness Malaise Ranitidine 50 Insomnia mg IV q 8 Vertigo

NURSING CONSIDERATION Avoid alcohol, aspirin-containing products, & beverages that contain caffeine (tea, cola, coffee); these increase stomach acid. Avoid things that may aggravate symptoms, i.e., alcohol, aspirin, NSAIDS, caffeine, & black pepper. Do not smoke; interferes with healing & drugs effectiveness. Report any evidence of yellow discoloration of skin or eyes, or diarrhea. Maintain adequate

hydration. Report any confusion or disorientation. GENERIC NAME Paracetamol BRAND NAME Aeknil DOCTORS ORDER November 25, 2007 (8:00 PM) Paracetamol 300 mg IV now CLASSIFICATION Antipyretic INDICATION Mild pain & fever ADVERSE EFFECT jaundice NURSING CONSIDERATION Excessive alcohol use may increase the risk of liver damage. Contraindicated in pt. with hypersensitive to drug.

GENERIC NAME Furosemide

BRAND NAME Lasix

DOCTORS ORDER November 26, 2007 PM Furosemide 1 amp IV push now with BP precaution

CLASSIFICATION Loop Diuretic

INDICATION To treat edema & fluid retention

ADVERSE EFFECTS Headache, dizziness, weakness, restlessness, fever Abdominal discomfort & pain, diarrhea, anorexia, N/V

NURSING CONSIDERATION Take the BP before giving the drug. Measure & record weight daily to monitor fluid changes. Monitor I&O

GENERIC NAME Vitamin K

BRAND NAME Mephyton

DOCTORS ORDER November 25, 2007 (2:15 PM) Vit. K 1 amp IV Now

CLASSIFICATION Hormones & synthetic substitute

INDICATION Antidote for over dosage of oral anticoagulants. Prophylaxis of & therapy for hemorrhagic disease.

ADVERSE NURSING EFFECTS CONSIDERATION Facial Aspirate carefully to flushing, avoid intravascular chills, fever, injection. diaphoresis, Maintain consistency in dizziness diet & avoid significant Headache increase in daily intake of Vit. K rich foods. dyspnea

GENERIC NAME Pen G

DOCTORS ORDER November 25, 2007 (2:15 PM) Pen G 3,000,000 U q 4 IV ANST ( ) start this PM

CLASSIFICATION Antibiotic

INDICATION Prophylactic therapy for rheumatic heart disease & acute glomerulonephritis.

ADVERSE NURSING EFFECT CONSIDERATION Local pain, Report immediately tenderness, to physician the onset chills, of allergic reaction. fever. There is great risk of severe prolonged reactions because drug is absorbed slowly.

GENERIC NAME Tramadol Hydrochloride

BRAND NAME Godex

DOCTORS ORDER November 26, 2007 Godex 1 cap BID November 30, 2007 Godex 1 cap BID x 7 days (6 am & 6 pm)

ADVERSE EFFECT CLASSIFICATION Narcotic Analgesic INDICATION Management of moderate to moderately severe pain.

NURSING CONSIDERATION Drowsiness, Dosage reduction dizziness, is recommended vertigo,fatigue, for pts with renal headache, insufficiency & restlessness,seizure, hepatic sleep disturbances impairment. Palpitation, Assess for level vasodilation pain of relief. N/V, constipation, Assess bowel & dyspepsia abdominal bladder function; pain, anorexia report urinary frequency or retention. Exercise caution with potentially hazardous activities until response to drug is known.

GENERIC NAME Pantoprazole Sodium

BRAND NAME Ulcepraz

DOCTORS ORDER November 30, 2007


Ulcepraz 20 mg OD x 7 days (6 am)

CLASSIFICATION Gastrointestinals; Proton pump inhibitors

INDICATION To treat mild to severe hepatic impairment & severe renal impairment

ADVERSE EFFECTS Headache, back pain, chest pain, neck pain, flu syndrome, infection, pain Migraine Diarrhea, flatulenc e, abdomin al pain, constipati on, dyspepsi a, gastroent eritis, gastroint estinal disorder, nausea,

NURSING CONSIDERATION Administration with food may delay its absorption up to 2 hours or longer It may be taken without regard to timing of meals. Patients should be cautioned that delayed-release tablets should not be split, crushed or chewed. The tablets should be swallowed whole, with or without food in the stomach. Concomitant administration of antacids does not

rectal disorder, vomiting. Hyperglycemia, hyperlipemia Insomnia, anxiety, dizziness Urinary frequency and urinary tract infection.

affect the absorption of Ulcepraz.

GENERIC NAME Ampicillin

BRAND NAME Sumapen

DOCTORS ORDER November 30, 2007 Sumapen 500 mg QID p.c x 3 days ( 6 am, 12 noon, 6 pm, 10 pm)

CLASSIFICATION Antibiotic

INDICATION Used to treat moderately severe to severe infections.

ADVERSE EFFECT Hemolytic anemia Seizures Diarrhea, nausea & vomiting Severe pain rash

NURSING CONSIDERATION Give wit a full glass of water on an empty stomach (at least 1 before or 2 after meals) for maximum absorption. Food hampers rate & extent of oral absorption. Report diarrhea to physician; do not self-

medicate.

NURSING CARE PLAN Date: November 27, 2007 ASSESSMENT


S: Nasakit ti bakrang ko as verbalized by the pt. Pain at the RUQ with a pain scale of 6/10 O: Abdominal pain Abdominal tenderness

NURSING DIAGNOSIS
Alteration in comfort, moderate abdominal pain r/t liver inflammation 2 disease condition

PLANNING
After 30 minutes of nursing intervention, the pt. will be able to relieve from pain, to be comfortable & be able to know ways on how to control pain.

INTERVENTION
Monitor V/S Assess pain in RUQ.

RATIONALE
Baseline data & comparison. Baseline data to relate on worsening of underlying condition. To divert attention from pain. To prevent

EVALUATION
After 30 minutes of nursing interventions, the pt. was comfortable & relieved from pain & gain knowledge on how to control pain.

Encouraged used of relaxation technique such as deep breathing exercise. Provide rest period to

Weak & pale in appearance Guarding behavior grimace

facilitate comfort. Sleep or relaxation such as proper ventilation, wrinkle free bed & quiet environment. Encouraged verbalization of pain. Encouraged high fowlers position. Administered pain medication as ordered.

aggravation of pain by frequent disturbances.

To determine appropriate nursing intervention. To relieve pain & enhance circulation. Inhibits the action of prostaglandin that initiates pain.

Date: November 28, 2007 NURSING DIAGNOSIS S: Agkakapsutak Activity intolerance pay laeng as r/t body weakness verbalized by the pt. 2 disease process O: Weak & pale in appearance Myalgia Body weakness Limited movement ASSESSMENT PLANNING After 5 of nursing intervention, the pts level of tolerance to activities will increase. INTERVENTION Monitor V/S Monitor physiologic activities. Assess physiological & emotional factors affecting RATIONALE Baseline data & comparison. To denote degrees of fatigue & intolerance to activities. To determine factors that contributing to activity EVALUATION After 5 of nursing intervention, the pts level of tolerance to activities gradually increased & was able to do light activities such as sitting, stretching.

Guarded movement

the pts situation. Provided passive exercise. Encouraged the pt to eat carbohydrate rich foods & protein rich foods. Encouraged frequent rest periods. Provided positive atmosphere while acknowledging difficulty of the situation for the pt. Encouraged deep breathing exercise. Administered medications as ordered.

intolerance. To maintain wellness of the extremities. To increase physical wellness & strength; for the consistency of liver function. To prevent & reduce fatigue. To minimize frustrations & rechannel energy.

To enhance wellness. For treatment regimen.

Date: November 27, 2007 NURSING DIAGNOSIS S: Marigatanak Sleep pattern nga maturok as disturbance r/t verbalized by the pt. abdominal pain on RUQ O: Pale & weak in appearance Frequent yawning ASSESSMENT PLANNING After 4 of nursing intervention, the pt will be able to sleep comfortably & free from pain. INTERVENTION Monitor V/S Established a quiet, peaceful environment during sleep periods. Observe/obtain feedback from pt RATIONALE Baseline data & comparison. A quiet & peaceful environment promotes restful sleep. To determine usual sleep EVALUATION After 4 of nursing intervention, the pt was able to sleep comfortably & soundly & free from pain.

Presence of eye bag Irritable Abdominal pain on RUQ Sleep hours: 2-3 with interval

regarding usual bedtime routine. Instructed the pt to avoid caffeine containing foods such as cola beverages 4 before bed sleep. Advised the pt to drink hot milk at bedtime. Instructed the pt to decrease & limit fluid intake before bedtime. Encouraged to do deep breathing exercise when with pain.

pattern & provide comparative baseline. Caffeine containing foods & beverages attribute sleep pattern disturbances because they are stimulants. To promote sleep. To prevent the need to awaken for frequent voiding. To divert the pain.

Date: November 27, 2007 NURSING DIAGNOSIS S: Nasakit ti tiyan Pain r/t ko as verbalized by hepatomegaly the pt. Pain Scale: 6/10 O: Abdominal ASSESSMENT PLANNING After 30 minutes of nursing intervention, the pt. will be able to relieve from pain & be able to know ways on how to control pain. INTERVENTION Monitor V/S Assess pain in RUQ. RATIONALE Baseline data & comparison. Baseline data to relate on worsening of underlying condition. EVALUATION After 30 minutes of nursing intervention, the pt. was relieved from pain & be able to know ways on how to control pain.

tenderness Weak & pale in appearance Guarding behavior grimace

Encouraged used of relaxation technique such as deep breathing exercise. Encouraged verbalization of pain. Encouraged high fowlers position. Administered pain medication as ordered.

To divert attention from pain. To determine appropriate nursing intervention. To relieve pain & enhance circulation. Inhibits the action of prostaglandin that initiates pain.

Date: November 28, 2007 ASSESSMENT


O: Bloody sputum Episodes of epistaxis jaundice

NURSING DIAGNOSIS
Risk for hemorrhage r/t internal (gastrointestinal) bleeding

PLANNING
After 8 of nursing intervention, the pt will develop no episodes of bleeding & hemorrhage.

INTERVENTION
Monitor V/S Assess pt for evidence of bleeding or hemorrhage.

RATIONALE
Baseline data & comparison. Allows early detection of signs & symptoms of bleeding & hemorrhage.

EVALUATION
After 8 of nursing intervention, the pt was free from episodes of bleeding & hemorrhage.

Encouraged pt to avoid activities that increases intraabdominal pressure (straining, turning).

Avoid sneezing/coughing & assist pt to turn.

Encouraged to use measures to prevent constipation such as adequate fluid intake: stool softeners

Encouraged to eat small frequent feeding.

Minimizes increase in intraabdominal pressure that could lead to rupture & bleeding of esophageal or gastric varices. Minimizes increase in intraabdominal pressure that could lead to rupture & bleeding of esophageal or gastric varices. Minimizes increase in intraabdominal pressure that could lead to rupture & bleeding of esophageal or gastric varices. Minimizes increase in intraabdominal pressure that could lead to rupture & bleeding of esophageal or gastric varices.

Monitor pt for recurrence of bleeding & hemorrhage.

Administered medications as ordered.

Risk of rebleeding is high with all treatment modalities used to halt gastrointestinal bleeding. For treatment regimen.