PATIENT INITIALS: E.E.E.

SEX: Male AGE: 61 y/o WARD/BED: W3/B3 DATE: 02/27/19-3/01/19

MEDICAL DIAGNOSIS: ARF from APC from acute LV dysfunction; NSTEMI; TIMI 4; HfrEF (40%) FC III; chronic cardiovascular infarction

Piperacillin-tazobactam 4.5g every 6hr IV CLASSIFICATION: antibiotic

DRUG ACTION: Piperacillin inhibits cell wall synthesis by binding to bacterial cell membranes while tazobactam inactivates bacterial beta-
lactamase, protects piperacillin from enxymatic degradation, extends its spectrum of activity, and prevents bacterial growth.

DESIRED EFFECT ON CLIENT: NURSING RESPONSIBILITY

-Treatment of light growth of PREPARATION: ADMINISTRATION: MONITOR:
methicillin-resistant staphylococcus -IV Reconstitution: -Administer via IV -Monitor daily pattern of bowel
aureus Reconstitute each 4.5g infusion activity, stool consistency
with 25 mL D5W or -Rate of infusion: 30 -Mild GI effects may be tolerable,
0.9% NaCl. Further minutes but increasing severity may
SIDE EFFECT: dilute with at least 50mL -Food: Give without indicate onset of antibiotic-
-Food: None D5w or 0.9% NaCl. regard to food associated colitis
-Lab Values: May increase serum -IV incompatibilities: -Be alert for superinfection: fever,
sodium, alkaline phosphatise, Lactated Ringers vomiting, diahrrhea, anal/genital
bilirubin, LDH, AST, BUN, creatinine, pruritus, oral mucosal changes
PT, PTT. May decrease potassium. -monitor intake and output,
- Frequent: Diarrhea, headache, urinalysis
constipation, nausea, insomnia -Monitor serum electrolytes, esp.
-Occasional: Vomiting, dyspepsia, Potassium
pruritus, fever, agitation, edema, -Teach family importance of
dyspnea, anxiety, abdominal pain availability of medications
PATIENT INITIALS: E.E.E. SEX: Male AGE: 61 y/o WARD/BED: W3/B3 DATE: 02/27/19-3/01/19
MEDICAL DIAGNOSIS: ARF from APC from acute LV dysfunction; NSTEMI; TIMI 4; HfrEF (40%) FC III; chronic cardiovascular infarction

Omeprazole 40mg/cap 1 cap OD ac CLASSIFICATION: proton pump inhibitor

DRUG ACTION: Inhibits hydrogen-potassium adenosine triphosphatase, an enzyme on the surface of gastric parietal cells; increases
gastric pH, reduces gastric acid production

DESIRED EFFECT ON CLIENT: NURSING RESPONSIBILITY

-Prevention of NSAID-induced
ulcers, stress ulcer prophylaxis in
critically-ill patients
SIDE EFFECT:
-Food: none
-Lab Values: May increase serum
alkaline phosphatise, ALT, AST
-Frequent: headache
-Occasional: Diarrhea, abdominal
pain, nausea
-Rare: Dizziness, vomiting, back
pain, upper respiratory tract
infection, cough
PREPARATION: ADMINISTRATION: MONITOR:
-Do not break, crush, -Give before meals via -Monitor daily pattern of bowel
dissolve, or divide NGT activity, stool consistency
delayed-release -Administer within 30 -Mild GI effects may be tolerable,
-May open capsule, mix minutes after but increasing severity may
with water preparation indicate onset of antibiotic-
-Following associated colitis
reconstitution, allow to -Be alert for superinfection: fever,
thicken (2-3 minutes) vomiting, diahrrhea, anal/genital
pruritus, oral mucosal changes
-monitor intake and output,
urinalysis
-Patient/Family teaching: report
headache, onset of black, tarry
stools, diarrhea, abdominal pain;
avoid alcohol; take before eating;
swallow capsules whole
PATIENT INITIALS: E.E.E. SEX: Male AGE: 61 y/o WARD/BED: W3/B3 DATE: 02/27/19-3/01/19
MEDICAL DIAGNOSIS: ARF from APC from acute LV dysfunction; NSTEMI; TIMI 4; HfrEF (40%) FC III; chronic cardiovascular infarction

Salbutamol + 2mL ambroxtol nebulisation every 4 hours CLASSIFICATION: salbutamol-beta2-adrenergic agonist;

Ambroxtol-mucolytic agent
DRUG ACTION: Salbutamol is a short-acting beta2-adrenergic receptor agonist that activates Gs adenylyl-cyclase-cyclic AMP pathway
and produces reduction in smooth muscle tone. It also increases conductance of large Ca2 sensitive K+ channels in airway smooth
muscles and leads to membrane hyperpolarisation and relaxation of smooth muscles
resulting in relaxation of bronchial smooth muscle; relieves bronchospasm, reducing airway resistance
Ambroxtol hydrochloride decreases mucus viscosity by depolymerises mucopolysaccharides directly as well as by liberating
lysosomal enzymes and by breaking network of fibres in tenacious sputum.

DESIRED EFFECT ON CLIENT: NURSING RESPONSIBILITY

-Treatment of acute bronchospasm
-To reduce the thickness of sputum
and treat mucus secretion
SIDE EFFECT:
-Salbutamol: drowsiness, headache,
nervousness, tachycardia,
palpitations, tremors
-Ambroxtol: rhinorrhoea, gastric
irritation,
PREPARATION: ADMINISTRATION: MONITOR:
-Mix salbutamol + 2mL -Shake container well -Obtain baseline EKG and monitor
ambroxtol for changes. May prolong Qt
interval (can precipitate ventricular
arrhythmias).
-Monitor rate, depth, rhythm, type
of respiration, vital signs
PATIENT INITIALS: E.E.E. SEX: Male AGE: 61 y/o WARD/BED: W3/B3 DATE: 02/27/19-3/01/19
MEDICAL DIAGNOSIS: ARF from APC from acute LV dysfunction; NSTEMI; TIMI 4; HfrEF (40%) FC III; chronic cardiovascular infarction

Chlorhexidine Oral Care TID CLASSIFICATION: antimicrobial

DRUG ACTION: Chlorhexidine’s antimicrobial effects are associated with the attractions between chlorhexidine (cation) and negatively
charged bacterial cells. After chlorhexidine is absorpted onto the organism’s cell wall, it disrupts the integrity of the cell membrane and
causes the leakage of intracellular components of the organisms

DESIRED EFFECT ON CLIENT: NURSING RESPONSIBILITY

-To reduce risk of Ventilator PREPARATION: ADMINISTRATION: MONITOR:
Associated Pneumonia for intubated -No preparation needed -Must be gargled for -Monitor allergic reactions
patients 30 seconds and should -Patient/Family Teaching: To
not be swallowed decrease the effect on how food
-Do not rinse tastes, eat first, followed by tooth
SIDE EFFECT: brushing and then chlorhexidine
-Tooth/tongue staining rinse
-Mouth/throat irritation
-Dry mouth
-Change in taste of foods/mdrinks
PATIENT INITIALS: E.E.E. SEX: Male AGE: 61 y/o WARD/BED: W3/B3 DATE: 02/27/19-3/01/19
MEDICAL DIAGNOSIS: ARF from APC from acute LV dysfunction; NSTEMI; TIMI 4; HfrEF (40%) FC III; chronic cardiovascular infarction

Carvedilol 6.25mg/1tab ½ tab po BID CLASSIFICATION: antihypertensive

DRUG ACTION: Reduces cardiac output and tachycardia, causes vasodilation, and decreases peripheral vascular resistance, which
reduces blood pressure and cardiac workload.

DESIRED EFFECT ON CLIENT: NURSING RESPONSIBILITY

-To control hypertension and reduce
cardiac workload
SIDE EFFECT:
-Depression, dizziness, fatigue,
angina, bradycardia, edema, heart
failure, hypertension, orthostatic
hypotension, palpitations, peripheral
vascular disorders, decreased PT,
UTI,
PREPARATION: ADMINISTRATION: NURSING CONSIDERATIONS:
-Do not crush -Instruct patient to -Use carvedilol cautiously in
swallow capsule whole patients with peripheral vascular
or open capsule and disease because it may aggravate
sprinkle beads without symptoms of arterial insufficiency
chewing -Patient/Family Teaching: Tell
patient with heart failure to notify
prescriber if he gains 5lb or more
in 2 days or if shortness of breath
increases, which may signal
worsening heart failure
PATIENT INITIALS: E.E.E. SEX: Male AGE: 61 y/o WARD/BED: W3/B3 DATE: 02/27/19-3/01/19
MEDICAL DIAGNOSIS: ARF from APC from acute LV dysfunction; NSTEMI; TIMI 4; HfrEF (40%) FC III; chronic cardiovascular infarction

N-acetylcysteine 600mg/tab 1 tab every 12 hours BID CLASSIFICATION: mucolytic

ACTION: Decreases viscosity of pulmonary secretions by breaking disulfide links that bind glycoproteins in mucus.

DESIRED EFFECT ON CLIENT: NURSING RESPONSIBILITY

-To liquefy abnormal, viscid, or PREPARATION: ADMINISTRATION: MONITOR:
thickened mucus secretions -Mix 1 tablet with ½ -Administer po -Assess type, frequency, and
glass of water -Food: Give without characteristics of patient’s cough.
regard to food Particularly note sputum. If cough
does not clear secretions, prepare
SIDE EFFECT: to perform mechanical suctioning.
-Nausea, vomiting, hypotension, -Monitor for tachycardia.
dyspnea, wheezing -Warn patient about the unpleasant
smell of the drug; reassure him
that it subsides as treatment
progresses.
PATIENT INITIALS: E.E.E. SEX: Male AGE: 61 y/o WARD/BED: W3/B3 DATE: 02/27/19-3/01/19
MEDICAL DIAGNOSIS: ARF from APC from acute LV dysfunction; NSTEMI; TIMI 4; HfrEF (40%) FC III; chronic cardiovascular infarction

Doxofylline 200mg/5mL 10mL BID CLASSIFICATION: bronchodilator

DRUG ACTION: Inhibits phosphodiesterase activity thus increasing the levels of cAMP and promoting smooth muscle relaxation; via
mediating actions of beta-2 adrenoceptors, doxofylline induces blood vessel relaxation and airway smooth muscle relaxation

DESIRED EFFECT ON CLIENT: NURSING RESPONSIBILITY

-Treatment of pulmonary disease PREPARATION: ADMINISTRATION: MONITOR:
with spastic bronchial component -Assess lung sounds, pulse, and
BP before administration. Note
amount, color, and character of
sputum produced
SIDE EFFECT:
-Nausea, vomiting, insomnia,
tachycardia, tachypnea,
hyperglycemia, albuminuria
PATIENT INITIALS: E.E.E. SEX: Male AGE: 61 y/o WARD/BED: W3/B3 DATE: 02/27/19-3/01/19
MEDICAL DIAGNOSIS: ARF from APC from acute LV dysfunction; NSTEMI; TIMI 4; HfrEF (40%) FC III; chronic cardiovascular infarction

Isosorbide dinitrate 10g/tab 1 tab TID CLASSIFICATION: nitrate vasodilator

DRUG ACTION: Isosorbide is converted to nitric oxide an active intermediate compound which activates the enzyme guanylate cyclise.
This stimulates the synthesis of cGMP which then activates a series or protein kinase-dependent phosphorylations in smooth muscle cells,
eventually resulting in the dephosphorylation of the myosin light chain of the smooth muscle fiber. The subsequent release of calcium ions
results in the relaxation of smooth muscle cells and vasodilation.

DESIRED EFFECT ON CLIENT: NURSING RESPONSIBILITY

-Prevention of angina pectoris due to PREPARATION: ADMINISTRATION: MONITOR:
coronary artery disease -No preparation needed -Administer via NGT -Monitor for headache, dizziness,
lightheadedness, nausea
-Patient/Family Teaching:
Headache is often a sign that this
SIDE EFFECT: medication is working. If
-Headache, light-headedness headaches continue or become
occasionally related to blood severe, inform the physician.
pressure changes
-Rare: hypotension
PATIENT INITIALS: E.E.E. SEX: Male AGE: 61 y/o WARD/BED: W3/B3 DATE: 02/27/19-3/01/19
MEDICAL DIAGNOSIS: ARF from APC from acute LV dysfunction; NSTEMI; TIMI 4; HfrEF (40%) FC III; chronic cardiovascular infarction

Atorvastatin 40mg/tab 1 tab @ HS CLASSIFICATION: lipid-lowering agent

DRUG ACTION: inhibits 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, an enzyme which is responsible for catalyzing an
early step in the synthesis of cholesterol

DESIRED EFFECT ON CLIENT: NURSING RESPONSIBILITY

-To lower lipids with decreased
progression of atherosclerosis
SIDE EFFECT:
-myopathy (musculoskeletal pain,
muscle weakness) dizziness, fatigue,
cough, hyperkalemia
PREPARATION: ADMINISTRATION: MONITOR:
-No preparation needed -Administer as single -Monitor cholesterol level
dose any time of the -Patient/Family Teaching:
day without regard to Medication does not cure but helps
food control elevated serum cholesterol
-Swallow tablets whole level. Advise patient that this
medication should be used in
conjunction with diet restriction,
exercise, and cessation of
smoking. If unexplained muscle
pain, tenderness, weakness
occurs, report to the health care
professional.
PATIENT INITIALS: E.E.E. SEX: Male AGE: 61 y/o WARD/BED: W3/B3 DATE: 02/27/19-3/01/19
MEDICAL DIAGNOSIS: ARF from APC from acute LV dysfunction; NSTEMI; TIMI 4; HfrEF (40%) FC III; chronic cardiovascular infarction

Ivabradine 5mg/tab 1 tab BID CLASSIFICATION: bradycardia-causing agent

DRUG ACTION: Selectively inhibiting If channels channels in the heart in a concentration-dependent manner without affecting any other
cardiac ionic channels (including calcium or potassium); binds by entering and attaching to a site on the channel pore from the intracellular
side and disrupts If ion current flow, which prolongs diastolic depolarization, lowering heart rate.

DESIRED EFFECT ON CLIENT: NURSING RESPONSIBILITY

-To reduce the risk of hospitalization PREPARATION: ADMINISTRATION: MONITOR:
for worsening heart failure in patients -No preparation needed -Administer with meals -Monitor BP and heart rate
with stable, symptomatic chronic to increase plasma -Patient/Family Teaching:
heart failure with left ventricular concentration grapefruit juice consumption is not
ejection fraction <35%, who are in recommended as it increases
sinus rhythm with resting heart rate exposure
>70bpm
-To improve oxygen supply and
reduce angina episodes
SIDE EFFECT:
-Bradycardia, hypertension
PATIENT INITIALS: E.E.E. SEX: Male AGE: 61 y/o WARD/BED: W3/B3 DATE: 02/27/19-3/01/19
MEDICAL DIAGNOSIS: ARF from APC from acute LV dysfunction; NSTEMI; TIMI 4; HfrEF (40%) FC III; chronic cardiovascular infarction

Spironolactone 25mg/tab 1 tab OD CLASSIFICATION: potassium-sparing diuretic

DRUG ACTION: acting primarily through competitive binding of receptors at the aldosterone-dependent sodium-potassium exchange site
in the distal convoluted renal tubule. Spironolactone causes increased amounts of sodium and water to be excreted, while potassium is
retained. Spironolactone acts both as a diuretic and as an antihypertensive drug by this mechanism

DESIRED EFFECT ON CLIENT: NURSING RESPONSIBILITY

-To manage edema and sodium PREPARATION: ADMINISTRATION: MONITOR:
retention -Tablets may be -Administer via NGT -Monitor for serum potassium and
-To lower blood pressure and reduce pulverized -Food: Give without creatinine because patients with
risk of cardiovascular events such as regard to food severe heart failure are with
stroke and myocardial infarction increased risk of hyperkalemia
-To increase survival and reduce -Give daily dosese early so that
need for hospitalization for heart increased urination does not
failure (NYHA Class III) interfere with sleep
SIDE EFFECT:
-ulceration, gastric bleeding, nausea,
vomiting, leukopenia
PATIENT INITIALS: E.V.B. SEX: Female AGE: 67 y/o WARD/BED: W3/B3 DATE: 10/08/18-10/11/18
MEDICAL DIAGNOSIS: ARF from HAP with aspiration component; multiple intercranial masses, right parieto-occipital, right temporal,
likely metastatic liver, lung primary; lung cancer stage IV

Enalapril 5mg/tab 1 tab BID CLASSIFICATION: ACE inhibitor

ACTION: Enalaprilat is a potent, competitive inhibitor of ACE, the enzyme responsible for the conversion of angiotensin I (ATI) to
angiotensin II (ATII). ATII regulates blood pressure and is a key component of the renin-angiotensin-aldosterone system (RAAS).

DESIRED EFFECT ON CLIENT: NURSING RESPONSIBILITY

-Treatment of symptomatic PREPARATION: ADMINISTRATION: MONITOR:
congestive heart failure -Do not break, crush, -Administer via NGT -Monitor BP, heart rate
dissolve, or divide -Monitor patient closely in any
delayed-release situation that may lead to drop in
-No preparation BP secondary to reduced fluid
SIDE EFFECT: necessary volume because excessive
-Headache, dizziness, fatigue, hypotension may occur
insomnia, gastric irritation, -Patient/Family Teaching: report
decreased hct and hgb mouth sores, fever, chills, swelling
of hands, feet
PATIENT INITIALS: E.V.B. SEX: Female AGE: 67 y/o WARD/BED: W3/B3 DATE: 10/08/18-10/11/18
MEDICAL DIAGNOSIS: ARF from HAP with aspiration component; multiple intercranial masses, right parieto-occipital, right temporal,
likely metastatic liver, lung primary; lung cancer stage IV

Racemic epinephrine nebulisation every 6 hours CLASSIFICATION: bronchodilator

ACTION: Stimulates beta2-adrenergic receptors in lungs, resulting in relaxation of bronchial smooth muscle; relieves bronchospasm,
reducing airway resistance

INDICATION: NURSING RESPONSIBILITY

-Prevention of bronchospasm in
patients with reversible obstructive
airway disease
CONTRAINDICATION:
-Acute episodes of COPD
PREPARATION: ADMINISTRATION: MONITOR:
-No preparation needed -Shake container well -Obtain baseline EKG and monitor
for changes. May prolong Qt
interval (can precipitate ventricular
arrhythmias).
-Monitor rate, depth, rhythm, type
of respiration, vital signs
PATIENT INITIALS: E.V.B. SEX: Female AGE: 67 y/o WARD/BED: W3/B3 DATE: 10/08/18-10/11/18
MEDICAL DIAGNOSIS: ARF from HAP with aspiration component; multiple intercranial masses, right parieto-occipital, right temporal,
likely metastatic liver, lung primary; lung cancer stage IV

Furosemide 40mg every 12 hours CLASSIFICATION: loop diuretic

ACTION: Inhibits sodium and chloride reabsorption in the ascending loop of Henle thus increasing renal excretion of sodium, chloride, and
water

DESIRED EFFECT ON CLIENT: NURSING RESPONSIBILITY

-To treat edema due to heart failure PREPARATION: ADMINISTRATION: MONITOR:
-To decrease BP -Tablets may be -May be taken with -Assess fluid status during therapy,
crushed if patient has food to minimize amount and location of edema,
difficulty swallowing gastric irritation lung sounds, skin turgor, mucous
-IV Push: Diluent: membranes
SIDE EFFECT: administer undiluted. -Monitor BP and pulse before and
-dizziness, encephalopathy, Administer at a rate of during administration
headache, nervousness, hearing 20mg/min. -Monitor electrolytes
loss, hypotension -Compatibility: -Patient/Family Teaching: Advise
piperacillin/tazobactam to take antihypertensive regimen
even if feeling better.