Medical management

Aguilar, Dan Joseph V.

Date/Time Dec 06, 2013

Doctors Order Please admit to ICU under the service of Dr. Gonzales Secure Consent for admission and management TPR q shift and record Diet: DAT IVF, PNSS 1L x 120cc/hr Laboratory: CBC w/ Platelet count, Na, K, CREA, BUN, Hgt, LDH

Rationale

For Legality & Documentation

To start hydration

To determine blood coagulopathies, Electrolyte imbalance, and Renal function

Cranical CT SCAN w/ contrast ECG

To aid in diagnosing and determine possible brain mets Cardiovascular drug For frank seizures For pain relief Anti-emetic To lower uric acid NSAIDs Proton pump inhibitors Vitamin supplement For anemia

Medications: Neuquinon 1 TAB OD Diazepam 5mg IV PRN Dolcet tab, 1 TAB TID PRN Plasil 1 amp q 8 PRN Alopurinol 100mg 1 TAB 2x/day Prednisone 10mg 1 tab BID Omeprazole 40mg 1 TAB OD Ascorbic Acid 1 TAB OD FeSO4 325mg 1 TAB TID

Monitor UO q shift & record Monitor VS q1 and record Complete patients database Dr. Gonzales informed of this admission Refer Accordingly May transfer patient to private room

Dec 06, 2013 2pm

Shift procedure to hydrocortisone 100mg IV q 8 5:33pm Start Keppra 500mg tab OD For cranial MRI w/ gadolinium contrast Continue present management AP Updated Cetrizine 10mg 1 TAB now Continue Meds Discontinue Alopurinol Anti-convulsant

7:15pm

for itchiness & allergy

DIAGNOSTIC EXAMS

Complete Blood Count

12/06/13 1:31pm

Test Name Hemoglobin Hematocrit RBC WBC Segmenters

Result 107 gm/L 0.36 gm/L 4.51 x10^12/1 7.78 x10^9/1 0.86 x10^9/1

Reference Values 110-140 0.37-0.47 4-5.5 5.0-10.0

Interpretation

Significance Indicates anemia

0.50-0.70 0.09 x10^9/1 0.20-0.40 0-0.05 0-0.01 80-98 23.7pg 26-32 293 g/L 320-360 150-400

Lymphocytes

Increase with malignant disease Decrease in use of corticosteroid

Monocytes Basophiles MCV MCH

0.04 x10^9/1 0.01 x10^9/1 80.2 n

MCHC

Platelet Count

569 x10/L

Indicates hypochromic RBCs Indicates hypochromic anemia Increase in malignancy

Lab

Serology Result 3.57mmol/L 32.70umol/L

12/06/13

4:48pm Interpretation Significance Indicates efficient kidney function Indicates hyponatremia

Test Name BUN CREATININE

Reference Values 2.5-7.2 37-96.0

LDH SODIUM POTASSIUM

351.00 U/L 132.50mmol/L 3.64 mmol/L

<480 U/L 137-145 3.5-5.1

DRUG STUDY

DRUG GENERIC NAME: Ubidecarenone

BRAND NAME: Nequinon

MECHANISM OF ACTION Inhibits lipid peroxidation by preventing the production of lipid peroxyl radicals

INDICATION Heart Failure Angina pectoris

CONTRAINDICATION SIDE EFFECTS Hypersensitivity Nausea Gastric discomforts

NURSING INTERVENTION Take after meals Instruct patient to report for worsening symptoms.

CLASSIFICATION: Cardiovascular Drugs

DOSAGE: 1 TAB OD

ROUTE: Oral

DRUG

MECHANISM OF ACTION GENERIC NAME: Enhances the Diazepam effect of the neurotransmitter GABA by binding BRAND NAME: to the Anxiol benzodiazepine site on the GABA leading to CNS CLASSIFICATION: depression Benzodiazepines

INDICATION Anxiety Panic Insommia Seizures

CONTRAINDICATION SIDE EFFECTS Respiratory Sedation depression

NURSING INTERVENTION Assess patient for respiratory depression

DOSAGE: 5mg IV PRN

ROUTE: IV

DRUG

MECHANISM OF ACTION GENERIC NAME: Binds to mu opioid Tramadol HCl receptors and inhibits the reuptake of BRAND NAME: norepinephrine Dolcet and serotonin causes many effects similar to CLASSIFICATION: the opioids. Analgesics

INDICATION Relief of moderate to moderately severe pain

CONTRAINDICATION SIDE EFFECTS Contraindicated with Sedation allergy to tramadol or Dizziness opioids Hypotension Bradycardia

NURSING INTERVENTION Explain to the patient that they may feel dizzy Report for severing symptoms

DOSAGE: 1 Tab TID PRN

ROUTE: Oral

DRUG

MECHANISM OF INDICATION ACTION GENERIC NAME: Stimulates motility Vomitting Metoclopromide of upper GI tract without stimulating gastric, biliary or BRAND NAME: pancreatic Plasil secretions. And increase lower esophageal CLASSIFICATION: sphincter pressure Anti-emetics

CONTRAINDICATION SIDE EFFECTS Hypersensitivity Restlessness Drowsiness Fatigue

NURSING INTERVENTION Monitor BP during IV administration Monitor extrapyramidal reactions.

DOSAGE: 1 amp q 8 PRN

ROUTE: IV

DRUG GENERIC NAME: Allopurinol

BRAND NAME: Zyloprim

MECHANISM OF ACTION Prevents the production of uric acid by blocking the activity of the enzyme that convert purines to uric acid

INDICATION Management of patients with leukemia, lymphoma and malignancies who are receiving cancer therapy which causes elevations of serum and urinary uric acid levels

CONTRAINDICATION SIDE EFFECTS Drug allergy Skin rash and itching nausea, diarrhea

NURSING INTERVENTION Administer drug after meals Promote increased fluid intake Check urine alkalinity

CLASSIFICATION:

DOSAGE: 100mg TAB, BID

ROUTE: Oral

DRUG GENERIC NAME: Prednisone

BRAND NAME:

MECHANISM OF ACTION Prevents the release of substances in the body that cause inflammation and suppresses the immune system.

INDICATION Allergic disorders Skin conditions Ulcerative colitis Arthritis Lupos Psoriasis Breathing disorders

CONTRAINDICATION SIDE EFFECTS Drug allergy Increased Fungal infection appetite preset Gradual weight gain Insomia

NURSING INTERVENTION Take drug with food Do not crush chew or break a delayed release tablet. Swallow it whole.

CLASSIFICATION: NSAIDs

DOSAGE: 10mg 1 TAB BID

ROUTE: Oral

DRUG GENERIC NAME: Omeprazole

MECHANISM OF ACTION Block the production of acid by the stomach

INDICATION GERD Acid induced inflammation Prevention of UGIB

CONTRAINDICATION SIDE EFFECTS Allergies to PPIs Stomach pain Nausea vomiting Diarrhea

NURSING INTERVENTION Administer before meals Report if worsening of symptoms

BRAND NAME: Prilosec

CLASSIFICATION: Protonn pump inhibitors

DOSAGE: 40mg 1 TAB OD

ROUTE: Oral

DRUG

MECHANISM OF ACTION GENERIC NAME: Water soluble Ascorbic Acid vitamin essential for synthesis ad maintenance of BRAND NAME: collagen and Cecon intercellular ground substance of body tissue CLASSIFICATION: cells, blood Vitamin vessels, cartilage, bones teeth skin and tendons DOSAGE: 1 TAB OD

INDICATION Prophylaxis and treatment of scurvy

CONTRAINDICATION SIDE EFFECTS Use of sodium Yellow acidic ascorbate in patients urine on sodium restriction Patients receiving digitalis

NURSING INTERVENTION Take drug with meal

ROUTE: Oral

DRUG

MECHANISM OF ACTION GENERIC NAME: Elevates serum FeSO4 iron concentration which then helps to form high or BRAND NAME: trapped in reticuloendothelial cells for storage and eventual CLASSIFICATION: conversion to a Iron Prep usable form of iron

INDICATION Prevention of IDA Dietary supplement of Irom

CONTRAINDICATION SIDE EFFECTS Hypersensitivity Constipation Severe hypotension Dizziness Hypotension

NURSING INTERVENTION Take drug with meals or with orange juice Increase oral fluid intake

DOSAGE: 325mg 1 TAB TID

ROUTE: Oral

DRUG GENERIC NAME: Leviteracetam

MECHANISM OF ACTION Provides an antiepileptic effect

INDICATION Used to treat partial onset of seizures Treats tonic-clonic

CONTRAINDICATION SIDE EFFECTS Hypersensitivity Somnolence Hostility Nervousness

NURSING INTERVENTION Give drug with food Establish safety precautions

BRAND NAME: Keppra

CLASSIFICATION: Anticonvulsant

DOSAGE: 500mg TAB OD

ROUTE: OP

DRUG

MECHANISM OF INDICATION ACTION GENERIC NAME: Inhibit histamine Allergies & Cetrizine HCl release and pruritus eosinophil chemotaxis during BRAND NAME: inflammation Zyrtec leading to reduced swelling and decreased CLASSIFICATION: inflammatory Anti-histamine response

CONTRAINDICATION SIDE EFFECTS Hypersensitivity Drowsiness Sedation Dizziness

NURSING INTERVENTION Take this drug without regard to meals Explain to patient, that drowsiness may occur. Limit activity after taking the drug

DOSAGE: 10mg 1 TAB

ROUTE: OP