Part2 Drug Analysis

8/8/2019 Part2 Drug Analysis

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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).

25



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

26



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.

27



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.

28



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

29



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

30



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.

31



;

- GI disease;

- acute

abdominal

conditions;

- increased

ICP or head

injury,

increased

intracranialpressure;

- history of

seizures;

- patients

>75 y.

32



• 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

33



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

34



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

35



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

36



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

37

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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

38



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,

39



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

40

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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.

41



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

42



functioning.

43

Documents

Part2 Drug Analysis