60180538 case-study

homework help,online homework help,online tutors,online tutoring,research paper help,do my homework,

1. XI.DRUG STUDY




















DRUGS


ACTION


INDICATION

CONTRAINDICATION

ADVERSE EFFECT

NURSING
CONSIDERATION

Generic Name:
RANITIDINE


Brand Name:
Ranitac

Classification:
Gastro intestinal
agent; H-2 receptor
antagonist.

Dosage:
50 g IV q 8

 Potent
Anti-ulcer that
competitively and
reversibly inhibits
histamine actions
on parietal cells,
thus blocking
gastric acid
secretion.

 Short term (4-8
weeks)
Treatment of
active duodenal
ulcer.
 Short term
treatment of
active, benign
gastric ulcers.
 Gastro
esophageal
disease
 Maintenance of
healing of
gastric ulcers
 Maintenance
therapy for
duodenal ulcer
at reduce dosage

 Contra indicated
with allergy to
ranitidine, lactation
 Cirrhosis of the
liver
 Impaired renal or
hepatic function

 GI :
Constipation,
N&V, Diarrhea,
Abdominal pain
 CNS:
Head ache, dizziness,
insomnia, vertigo
 CV
Bradycardia or
tachycardia, cardiac
arrest
 Hepatic
Hepatotoxicity,
Jaundice
 Dermatologic
Rash, Alopecia





 Document
indications for
therapy, onset,
characteristics of
symptoms, other
agents used and
anticipated
treatment.
 Assess stomach
 Pain, noting
Characteristics,
frequency of
occurrence and
things that alter it
 Obtain CBC.

2. DRUGS

ACTION

INDICATION

CONTRAINDICATION

ADVERSE
EFFECT

NURSING
CONSIDERATIONS

Generic Name:
KETOROLAC
Thrometamine


Brand Name:
Toradol


CLASSIFICATION:
Non-Steroidal Anti-
Inflammatory Drug
(NSAID)


DOSAGE:
1 amp IV q 6









 Inhibit
prostaglandin
synthesis to
produce anti-
inflammatory,
analgesic and
anti-pyretic
effect.

 Short- term
management of
moderately
severe, acute
pain for single
dose treatment
 Short term
management of
moderately
severe, acute
pain for
multiple dose
treatment.

 Contraindicated in
patients hypersensitive
to drug and those with
active peptic ulcer
disease, recent GI
bleeding or perforation,
advance renal
impairment, cerebro
vascular bleeding,
hemorrhagic diathesis, or
incomplete hemostasis,
and those at risk for
renal impairement from
volume depletion or at
risk of bleeding.

 CNS:
Headache,
Dizziness,
Drowsiness,
Sedation
 CV:
Arrhythmias,
Edema,
Hypertension,
 Hematologic:
Decreased
platelet,
Adhesion,
Prolonged
bleeding time,
 Skin:
Diaphoresis,
Pruritus, Rash

 Correct
hypovolemia before
giving.
 Put pressure on site
for 15-30 seconds.
 Don’t give drug
epiduraly because of
alcohol content.
 Tell patient not to
take drugs for more
than 5 days in a
row.

3. DRUGS

ACTION

INDICATION

CONTRAINDICATIONS

ADVERSE EFFECT

NURSING
CONSIDERATION

Generic Name:
METRONIDAZOLE



Brand Name:
Cetaz


Classification:
Anti-infectives
Anti-protozoal





Dosage:
500mg IV q 8

 Disrupts DNA
and protein
synthesis in
susceptible
organism
 Bactericidal, or
amebicidal action

 Asymptomatic
and symptomatic
tricomoniasis in
females and
males; acute
intestinal
amebiasis and
amebic liver
abscess;
IV metronidazole
is used for the
treatment of
serious infection
caused by
susceptible
anaerobic bacteria
in intra abdominal
infections, skin
i9nfections,
gynecologic
infections,
septicemia, and
for both pre- and
postoperative
prophylaxis

 Blood dyscariasis;
active CNS disease;
first trimester of
pregnancy (catergory
B), lactation.

 Body as a whole:
hypersensitivity
(rash, urticaria,
pruritus, flushing)
fever, fleeting
joint pains,
overgrowth of
Candida.
 CNS: vertigo,
headache, ataxia,
confusion,
irritability,
depression,
restlessness,
weakness,
drowsiness,
insomnia
 GI: Nausea,
vomiting,
anorexia,
epigastric
distress,
abdominal
cramps, diarrhea,
constipation, dry,
maouth, metallic
or bitter taste,
proctitis.
 Urogenital:
Polyuria, dysuria,
pyuria,
incontinence
 CV:ECG changes
(flattening of T
wave)
 Administer with
food or milk to
minimize GI
irritation. Tablets
may be crushed
for patients with
difficulty in
swallowing
 Discontinue
therapy
immediate if
symptoms of
CNS toxicity
develop. Monitor
especially for
seizures and
peripheral
neuropathy (e.g.
numbness, and
parasthesia of
extremities)
 Lb test: Obtain
total and
differential WBC
counts before,
during, after
therapy,
especially if a
second course is
necessary
 Monitor for S&S
of sodium
retention,
especially in
patients on
corticosteroids
therapy or with a

4. history of CHF
 Monitor patients
on lithium for
elevated lithium
levels.
 Report
appearance of
candidiasis (milk-
vaginal discharge,
stomatitis, fury
tongue) or its
becoming more
prominent with
therapy to
physician
promptly.
 Repeat feces
examinations,
usually up to 3
months to ensure
that amebae have
been eliminated.
 Urine may appear
dark or reddish
brown (especially
with higher than
recommended
doses ). This
appears to have
no clinical
significance.

5. DRUGS

ACTION

INDICATION

CONTRAINDICATION

SIDE EFFECTS
NURSING
CONSIDERATION

Generic Name:
PARACETAMOL/
ACETAMINOPHEN


Brand Name:
Sinomol


Classification:
Non-narcotic analgesic;
Antipyretic




Dosage/Route:
300mg IV prn




 Decrease fever by
a hypothalamic
effect leading to
sweating and
vasodilatation.
Also inhibits the
effect of
pyrogenes on the
hypothalamic heat
regulating centers.
May cause
analgesia by
inhibiting CNS
prostaglandin
synthesis.



 Control of pain
due to headache,
dysmenorrhea,
 To reduce fever in
the bacterial or
viral infections
 Generally as
substitute when
latter is not
tolerated or is
contraindicated.



 Renal
insufficiency,
anemia.
 Clients with
cardiac or
pulmonary disease
are more
susceptible to
acetaminophen.



 Hematologic:
Hemolytic
Anemia
 Allergic:
Erythematous skin
reaction, fever
 Miscellaneous:
jaundice,
drowsiness,
glossitis



 Monitor for S/Sx
of:
hepatotoxicity,
even with
moderate
acetaminophen
doses, especially
in individuals
with poor
nutrition or who
have ingested
alcohol over
prolonged
periods; potential
abuse from
psychological
dependence.
 Give drugs with
food if GI upset
occurs.
 Avoid using
multiple
preparations
containing
acetaminophen.

6. DRUG

ACTION

INDICATION

CONTRAINDICATION

SIDE EFFECT

NURSING
RESPONSIBILITY

7. GENERIC:
Celecoxib

BRAND:
Celeberex

Classification:
Non steroidal
cyclooxegenase-2 (COX-
2) inhibitor, anti
inflammatory drug
(NSAID)

DOSAGE :
250 mg IV
p.r.n


 Exhibits anti-
inflammatory,
analgesic, and
antipyretic action
due to inhibition
of the enzyme
COX-2

 Adjunctive
treatment of
decrease the
number of
adenomatous
colorectal polyps
in familial
adenomatous
polyposis

 Hypersensitivity to
drug, sulfonamides,
or other NSAIDs
 Severe hepatic
impairment
 History of asthma or
urticaria
 Advanced renal
disease
 Late pregnancy
 Breastfeeding


 CNS : dizziness,
drowsiness,
headache,
insomnia, fatigue

 CV: peripheral
edema

 EENT:
ophthalmic
effects, tinnitus,
pharyngitis,
rhinitis, sinusitis

 GI: nausea,
diarrhea,,
constipation,
abdominal pain,
dyspepsia,
flatulence, dry
mouth, GI
bleeding

 GU: constipation,
dry mouth, tongue
atrophy

 Respiratory:
URI symptoms, cough,
epistaxis

 OTHER: Cancer
in preclinical
studies, back pain,
fever

Before:

 Asses pt. history
of allergic
reaction to the
drug
 Monitor CBC,
electrolyte
levels, creatinine
clearance, and
occult fecal
blood test and
liver function
test results every
6-12 months
During :

 Instruct pt. to
take drug with
food or milk
 Teach pt. to
avoid aspirin and
other NSAIDs
(such as
Ibuprofen and
Naproxen)
during therapy

8. Drug Name

Action

Indication

Contraindication

Adverse effect

Nursing Responsibility

GENERIC:
Cefixime

BRAND:
Suprax


Classification:
Antibiotic
cephalosporin

DOSAGE :
250 mg IV
p.r.n


Cefixime binds to one or
more of the penicillin-
binding proteins (PBPs)
which inhibits the final
transpeptidation step of
peptidoglycan synthesis
in bacteria cell wall, thus
inhibiting biosynthesis
and arresting cell wall
assembly resulting in
bacterial cell death.

 Uncomplicated
urinary tract
infections caused
by Escherichia coli
and Proteus
mirabilis,
 Otitis media
caused by
Haemophilus
influenzae (Beta-
lactamase positive
and negative
strains), Moraxella
catarrhalis (most
of which are beta-
lactamse positive),
and S.pyrogenes
 Acute bronchitis
and acute
exacerbations of
chronic bronchitis
caused by
streptococcus
pneumonia and
Haemophilus
infuenzae( beta-
lactamase positive
and negative
strains), and
 Uncomplicated
gonorrhea

 Hypersensitivity to
cephalosporin.
 History of allergy to
penicillins;
pregnancy,
lactation; renal
failure; GI disease.

DIARRHEA:
 Difficulty
breathing or
swallowing
 Headache
 Hives
 Itching
 Mild skin rash
 Severe skin rash
 Upset stomach
 Vaginal infection
 Vomiting
 Wheezing




 Assess patient’s
previous reaction
to penicillin or
other
cephalosporins.
Cross sensitivity
between penicillin
is common.
 Assess patient for
signs and
symptomsof
infection before
and during
treatment; fever,
earache,
characteristics of
wounds, sputum,
urine, stool, and
WBC>10,000/mm
 Obtain C&N
before beginning
drug therapy to
identify if correct
treatment has
been initiated
 Assess for allergic
reactions
 Assess renal
function before
and during
therapy; urine

9. (cervical/urethral)
caused by
Neisseria
gonorrheae
(penicillinase- and
non-penicillinase-
producing strains)
output.BUN and
creatinine.

10. DRUG

ACTION

INDICATION

CONTRAINDICATIO
N

ADVERSE EFFECT

NURSING
MANAGEMENT

11. Generic Name:
Omeprazole


Brand Name:
Prilosec


Classification:
Proton pump inhibitor


Dosage:
40mg IV OD



 Inhibits activity of
acid(proton)pump and
binds to hydrogen
potassium adenosine
triphosphatase at
secretory surface of the
gastric parietal cells to
block formation of
gastric acid.

 Symptomatic
gastroesophagea
l reflux disease.
 Duedunal
ulcer(short term
treatment)
 Short term
treatment of
active benign
gastric ulcer.
 Frequent heart
burn (2 or more
days a week).

 Contraindicated
in patient
hypersensitive
to drug or its
components.
 Use cautiously
in patients with
Barther
syndrome,
hypocalemia,
and respiratory
alcalosis.
 Long term
administration
of bicarbonate
with calcium or
milk can cause
milk alkaline
syndrome.

 CNS: Dizziness,
headache.
 GI: abdominal
pain,
constipation,
diarrhea,
flatulence,
nausea and
vomiting,
 Musculoskeletal
: back pain.
 Respiratory:
cough, upper
respiratory tract
infection.
 Skin: rash
 Other: cancer in
preclinical
studies, back
pain, fever.

 Assessment
History:
 Hypersensitivit
y to omeprazole
or any of its
components
;pregnancy

Physical:
 Skin lesion:
reflexes, affect,
urinary output,
abdominal
exam,
respiratory
auscultation
intervention.

2. Administer before
meals. Caution patient to
swallow capsules whole,
not to open chew, or
crush them

12. DRUGS

ACTION

INDICATION

CONTRAINDICATION

ADVERSE EFFECT

NURSING
MANAGEMENT

GENERIC NAME :
Amino acid sorbitol

BRAND NAME:
Celemin


CLASSIFICATION:
Parenteral
Nutritional
Products

Dosage:
Incorporate to IVF(250cc
q8x2doses)

 Amino acids
promote the
production of
proteins
(anabolism)
needed for
synthesis of
structural
components,
reduce the rate of
the protein
breakdown
(anabolism),
promote wound
healing and act as
a buffers in the
extracellular and
intracellular
fluids.
 Sorbitol is a
source of calories.
Non protein
calories are
required for
efficient
utilization of
amino acid. It
decreases protein
and nitrogen
losses, promotes
glycogen
deposition and
prevents ketosis.
 Electrolytes are
provided to
compensate for
normal sensible

 Celemin 10-plus is
highly used as a
parenteral
nutrition
supplement in the
following
condition:
prophylaxis and
therapy for protein
deficiency; pre-
and post-operative
conditions; in
adequate or
impossible oral
feeding, eg.
Following
operative
procedure on GIT,
GI
bleeding,corrosive
injury to
esophagus or
stomach; stenosis
in the GIT;
inflammatory
bowel disease and
short-gut
syndrome; chronic
diarrhea and
vomiting;
malabsorption
syndrome; sepsis;
diffuse peritonitis;
fistulas; chylous
ascites;
malnutrition and
clinical outcomes;

 Disturbances of
the amino acid
metabolism;
hepatic coma;
serious renal
disturbances;
hypernatremia and
hyperkalemia;
congestive cardiac
failure;
hyperhydration;
metabolic
acidosis; sorbitol
intolerance

 Occasional chest
discomfort and
palpitations.
Nausea, vomiting,
chill, fever and
vasalgia may
occur if the
recommended rate
of infusion is
exceeded.

 Monitor for S/Sx
of hepatotoxicity.
 Do not administer
simultaneously
with blood
through the same
infusion site
because of
possible
pseudoagglutinati
on. Antibiotics,
steroids and
pressor agents
should not be
added to these
solutions.

13. and insensible
losses as well as
the additional
losses often
present in patient
requiring
parenteral nutrion.
persistent pyrexial
state; nephrosis;
amyloidosis;
immunocompromi
sed patients; HIV
infection;
transplantations;
cancer and related
cachexia ; burns;
pregnancy; head
injuries;prolonged
,

14. DRUGS

ACTION

INDICATIONS

CONTRAINDICATIONS

ADVERSE EFFECT

NURSING
MANAGEMENT

GENERIC:
Cefuroxime




CLASSIFICATION:
Antibiotic cephalosporins




Dosage and Route:
750 mg IV q8

 Inhibits cell wall
synthesis,
promoting
osmotic
instability;
usually
bactericidal.

 Serious lower
respiratory
infection, UTI,
skin or skin-
structure
infections, bone
or joint infections,
septicemia,
meningitis and
gonorrhea

 Hypersensitivity to
drug or other
cephalosporins.
 Use cautiously in
patients
hypersensitivity to
penicillin because
of possibility of
cross-sensitivity
with other beta-
lactam antibiotics


 CV: phlebitis,
thrombophlrbitis
 GI: diarrhea,
nausea, vomiting
 Hematologic:
hemolytic anemia,
thrombocytopenia,
transient
neutropenia,
eosinophilia
 Skin:
maculopapular
and erythematous
rashes, urticaria,
pain, induration,
sterile abscess,
+temperature
elevation,
 Other:
anaphylaxis,
serum suckness

 Obtain specimen
for culture and
sensitivity test
before giving first
dose.Therapy may
begin while
awaiting results.
 Monitor patient
for signs and
symptoms of
superinfection
 Advise patient
receiving drug IV
to report
discomfort at IV
insertion site
 Instruct patient to
notify prescriber
about rash, loose
stools, diarrhea,
or evidence of
superinfection