Patients Data: Name: Esther Catorce Age: 35 years old Admitting Diagnosis: Acute Gastritis with some Dehydration

r/o Intestinal Amoebiasis. Date of Admission: August 24, 2009 Drug Order: Norgesic Forte 2 tab TID Generic Name: Orphenadrine citrate Functional classification: Muscle relaxants/Antihistamine class Chemical classification: Paracetamol, combinations excluding psycholeptics; belongs to the class of anilide preparations. Use to relieve pain and fever. Indication: Relief of painful skeletal muscle spasm associated with chronic low back pain , sprains and strains, prolapsed intervertebral disc, muscle injury, non-articular rheumatism, whiplash injuries, acute torticollis, tension headache, dysmenorrheal and other acute or chronic painful muscular conditions. Contraindication: Contraindication to Norgesic/Norgesic Forte result from the parasypatolytic action of orphenadrine . it should not be given to patients with glaucoma, prostatic hypertrophy, bladder neck obstruction or myasthema gravis. It should be used with caution in patients with tachycardia. Norgesic/Norgesic Forte is not recommended for children below 12 years. Mode of Action: Anticholinergic drug/agent is a substance that blocks the neurotransmitter acetylcholine in the CNS and PNS. May be related on part to its analgesic effects also possess anticholinergic activity. Ideal dosage/Preparation and Supply form: Norgesic: 1-2 tab TID or as directed (35 mg, paracetamol 450 mg) Norgesic Forte: 1 tab TID (50 mg, paracetamol 650 mg) In severe cases, increase to a maximum of 2 tabs TID Adverse Effects: Nausea and vomiting, dry mouth, blurring of vision, insomia, orthostatic hypotension, lightheadedness, stomach cramps, constipation, dizziness and restlessness may occur in some patients susceptible to the parasympatholytic action or orphenadrine. Rarely, rash may also occur. Drug Interaction: Amantadine, some antihistamines butyrophenones and phenothiazines and tricyclic antidepressants may increase the antimuscarinic effects of orphenadrine. Orphenadrine may affect the absorption of other drugs. Rationale in giving the drug: Norgesic Forte is given to relieve discomfort of acute musculoskeketal conditions in adults. These drugs should be used to alleviate muscle spasm and pain. Nursing Interventions: 1. Provide additional measures to relieve discomfort heat, rest for the muscle, positioning. 2. Discontinue the drug at any sign of hypersensitivity reaction or liver dysfunction. 3. Monitor respiratory status. 4. Monitor for adverse effects. 5. Monitor the effectiveness of comfort measures and compliance with the regimen. 6. Patients should be cautioned to avoid alcohol while taking this muscle relaxant drug.

Patients Data: Name: Esther Catorce Age: 35 years old Admitting Diagnosis: Acute Gastritis with some Dehydration r/o Intestinal Amoebiasis. Date of Admission: August 24, 2009 Drug Order: Generic Name: Ranitidine hydrochloride Functional classification: Antiulcerants Antihistamnines, Antacids, Antireflex agents and

Chemical classification: H2 receptor antagonist Indication: Treatment of duodenal ulcer, benign gastric ulcer, post-operative ulcer, reflux esophagitis, prophylaxis of stress ulceration in seriously ill, prophylaxis of recurrent hemorrhage from peptic ulcer, prophylaxis from Mendelsons syndrome. Contraindication: Patients known to have hypersensitivity to ranitidine or to any component of Zantac injection. It is not recommended for use in children. Mode of Action: Ranitidine is a specific, rapidly acting histamine H2 antagonist. It inhibits basal and stimulated secretion of gastric acid, reducing both the volume and the acid and pepsin content of the secretion. Ideal dosage/Preparation and Supply form: Zantac injection is for IV and IM administration. May be given as: a slow (over a period of 2 min) IV injection of 50 mg diluted to a volume of 20 ml, which may be repeated every 6-8 hours. Adverse Effects: Adverse event frequencies have been estimated from spontaneous reports from post-marketing data. Blood and Lymphatic System Disorders: Very Rare: Blood count changes (leucopenia, thrombocytopenia). These are usually reversible. Agranulocytosis or pancytopenia, sometimes with marrow hypoplasia or marrow aplasia. Immune System Disorders: Rare: Hypersensitivity reactions (urticaria, angioneurotic edema, fever, bronchospasm, hypotension and chest pain). Very Rare: Anaphylactic shock. These events have been reported after a single dose. Psychiatric Disorders: Very Rare: Reversible mental confusion, depression and hallucinations. These have been reported predominantly in severely ill and elderly patients. Nervous System Disorders: Very rare: Headache (sometimes severe), dizziness and reversible involuntary movement disorders. Eye Disorders: Very Rare: Reversible blurred vision. There have been reports of blurred vision, which is suggestive of a change in accomodation. Cardiac Disorders: Very Rare: As with other H2-receptor antagonists bradycardia, A-V block and asystole (injection only). Vascular Disorders: Very rare: Vasculitis.

Gastrointestinal Disorders: Very Rare: Acute pancreatitis, diarrhea. Hepatobiliary Disorders: Rare: Transient and reversible changes in liver function tests. Very Rare: Hepatitis (hepatocellular, hepatocanalicular or mixed) with or without jaundice, these were usually reversible. Skin and Subcutaneous Tissue Disorders: Rare: Skin rash. Very Rare: Erythema multiforme, alopecia. Musculoskeletal and Connective Tissue Disorders: Very Rare: Musculoskeletal symptoms eg, arthralgia and myalgia. Renal and Urinary Disorders: Very Rare: Acute interstitial nephritis. Reproductive System and Breast Disorders: Very Rare: Reversible impotence, breast symptoms in men. It crosses the placenta and enters breast milk; caution should be used during pregnancy and lactation. Drug Interaction: Ranitidine has the potential to affect the absorption, metabolism or renal excretion of other drugs. The altered pharmacokinetics may necessitate dosage adjustment of the affected drug or discontinuation of treatment. Interactions occur by several mechanisms including: Inhibition of cytochrome P450linked mixed function oxygenase system: Ranitidine at usual therapeutic doses does not potentiate the action of drugs which are inactivated by this enzyme system eg, diazepam, lidocaine, phenytoin, propranolol and theophylline. There have been reports of altered prothrombin time with coumarin anticoagulants (eg, warfarin). Due to the narrow therapeutic index, close monitoring of increased or decreased prothrombin time is recommended during concurrent treatment with ranitidine. Competition for Renal Tubular Secretion: Since ranitidine is partially eliminated by the cationic system, it may affect the clearance of other drugs eliminated by this route. High doses of ranitidine (eg, those used in the treatment of Zollinger-Ellison syndrome) may reduce the excretion of procainamide and N-acetylprocainamide resulting in increased plasma levels of these drugs. Rationale in giving the drug: Zantac is given to patient to relief symptoms of heartburn, acid indigestion and sour stomach in adults. Nursing Interventions: 1. Monitor patient continually if giving intravenous doses to allow early detection of potentially serious adverse effects, including cardiac arrhythmias. 2. Provide comfort and safety measures, including analgesics, ready access to bathroom facilities, to ensure patient tolerance of the drug and drug effects. 3. Monitor patient response to the drug. 4. Monitor of adverse effects. 5. Monitor effectiveness of comfort measures and compliance with regimen.

NAME: Carljean Apple B. Argonza Course/Yr and Sec.: BSN III-A Patients Data: Name: Milagrosa Efondo Age: 51 years old Admitting Diagnosis: Cerebrovascular Cardiovascular Disease Date of Admission: September 01, 2009 Drug Order: one Catapres 5mg IVTT stat Generic Name: Clonidine hydrochloride Functional classification: antihypertensive

CI: Ms. Kamille Claizzen Amonceda, RN Date Submitted: September 07, 2009

Accident

secondary

to

Hypertensive

Chemical classification: Clonidine ; Belongs to the class of imidazoline receptor agonists, centrally-acting antiadrenergic agents. Used in the treatment of hypertension. Indication: Catapres (clonidine hydrochloride) is indicated in the treatment of hypertension. Catapres may be employed alone or concomitantly with other antihypertensive agents. Catapres (clonidine hydrochloride) should be used with caution in patients with severe coronary insufficiency, conduction disturbances, recent myocardial infarction, cerebrovascular disease or chronic renal failure. Contraindication: Catapres (clonidine hydrochloride) Tablets should not be used in patients with known hypersensitivity to clonidine. Mode of Action: Clonidine is a centrally acting alpha-agonist hypotensive agent. Treatment of essential hypertension; chronic pain; to ease opiate withdrawal. Ideal dosage/Preparation and Supply form: When substituting CATAPRES-TTS transdermal therapeutic system for oral clonidine or for other antihypertensive drugs, physicians should be aware that the antihypertensive effect of CATAPRES-TTS transdermal therapeutic system may not commence until 2-3 days after initial application. Therefore, gradual reduction of prior drug dosage is advised. Some or all previous antihypertensive treatment may have to be continued, particularly in patients with more severe forms of hypertension. Adverse Effects: Dizziness, headache, paraesthesia, sedation, gynaecomastia, confusion state, delussional perception, depression, hallucination, decreased libido, nightmare, sleep disorder, accomodation disorder, decreased lacrimation atrioventricular block, bradyarrythmia, sinus bradycardia, orthostatic hypotension. Raynauds's phenomenon, nasal dryness, alopecia, pruritus, rash, urticaria, erectile dysfunction, fatigue, malaise, colonic pseudo-obstruction, constipation, dry mouth, nausea, salivary gland pain, vomiting. Drug Interaction: Enhanced antihypertensive effects by diuretics, vasodilators & blockers. Lower heart rate & dysrhythmia w/ -blockers &/or cardiac glycosides. Reduction in BP-lowering effect w/ tricyclic antidepressants. Rationale in giving the drug: Clonidine is used to treat essential hypertension as a step 2 drug. It should be used carefully with any patient because it can also cause extreme hypotension, congestive heart failure, and bradycardia owing to its centrally mediated effects.

Nursing Interventions: 1. Assess for any known allergies to the drug, which would require cautious use. 2. Monitor blood pressure, pulse, rhythm, and cardiac output regularly. 3. Arrange for supportive care and comfort measures, including rest and environmental control to decrease CNS irritation and safety measures if CNS effects occur to protect the patient from injury. 4. Provide thorough patient teaching, including dosage, potential adverse effects and safety measures, to enhance patient knowledge about the drug therapy and to promote compliance. 5. Offer support and encouragement to help the patient deal with the drug regimen. 6. Monitor patient response to the drug, to know if there are any improvements in condition being treated. 7. Monitor for adverse effects.

NAME: Carljean Apple B. Argonza Course/Yr and Sec.: BSN III-A Patients Data: Name: Milagrosa Efondo Age: 51 years old Admitting Diagnosis: Cerebrovascular Cardiovascular Disease Date of Admission: September 01, 2009

CI: Ms. Kamille Claizzen Amonceda, RN Date Submitted: September 07, 2009

Accident

secondary

to

Hypertensive

Drug Order: Mannitol 100cc FD every 4 hours Generic Name: Mannitol (Osmitrol) Functional classification: Muscle relaxants/Antihistamine class Chemical classification: Paracetamol, combinations excluding psycholeptics; belongs to the class of anilide preparations. Use to relieve pain and fever. Indication: Prevention and treatment of oliguric phase of renal failure; reduction of intracranial pressure and treatment of cerebral edema; relieve pressure in brain injury. Contraindication: 1. Well established anuria due to severe renal disease. 2. Severe pulmonary congestion or frank pulmonary edema. 3. Active intracranial bleeding except during craniotomy. 4. Severe dehydration. 5. Progressive renal damage or dysfunction after institution of Mannitol therapy, including increasing oliguria and azotemia. 6. Progressive heart failure or pulmonary congestion after institution of Mannitol therapy. 7. Do not administer to patients with a known hypersensitivity to mannitol. Mode of Action: Mannitol is a diuretic. Elevates the osmolarity of the glomerular filtrate, leading to loss of water, sodium, and chloride Ideal dosage/Preparation and Supply form: Mannitol I.V. (Mannitol Injection, USP) should be administered only by intravenous infusion. The total dosage, concentration and rate of administration should be governed by the nature and severity of the condition being treated, fluid requirement and urinary output. The usual adult dosage ranges from 50 to 200 g in a 24-hour period, but in most instances an adequate response will be achieved at a dosage of approximately 100 g/24 hours. The rate of administration is usually adjusted to maintain a urine flow of at least 30 to 50 mL/hr. Adverse Effects: Pulmonary congestion, fluid and electrolyte imbalance, acidosis, electrolyte loss, dryness of mouth, thirst, marked diuresis, urinary retention, edema, headache, blurred vision, convulsions, nausea, vomiting, rhinitis, arm pain, skin necrosis, thrombophlebitis, chills, dizziness, urticaria, dehydration, hypotension, tachycardia, fever and angina-like chest pains. Drug Interaction: Lithium toxicity (with diuretic-induced hyponatremia)

Rationale in giving the drug: Mannitol is the mainstay for treatment of elevated intracranial pressure and acute renal failure.

Nursing Interventions: 1. Assess any known allergies to diuretics and fluid or electrolyte disturbances, which could be exacerbated by the diuretic or render the diuretic ineffective. 2. Administer intravenous drugs slowly, to prevent severe changes in fluid and electrolytes. 3. Continuously monitor urinary output, cardiac response, and heart rhythm of patients receiving intravenous diuretics, to monitor for rapid fluid switch and potential electrolyte disturbances leading to cardiac arrhythmia. 4. Monitor the patient response to the drug, to evaluate the effectiveness of the drug and monitor adverse effects. 5. Provide thorough patient teaching, including dosage, potential adverse effects and safety measures, to enhance patient knowledge about the drug therapy and to promote compliance. 6. Monitor for adverse effects.

NAME: Carljean Apple B. Argonza Course/Yr and Sec.: BSN III-A Patients Data:

CI: Mrs. Melisa Abing, RN Date Submitted: September 19, 2009

Name: Harold Barsalote Apas Age: 14 years old Admitting Diagosis: Fracture, closed, complete, displaced, distal radius left, neglected Date of Admission: Drug Order: Brand Name: Fentanyl Generic Name: Duragesic Functional classification: Analgesics (Opioid) Chemical classification: - Fentanyl; Belongs to the class of opioid anesthetics. Used as general anesthetics. - Fentanyl; Belongs to the class of phenylpiperidine derivative opioids. Used to relieve pain. Indication: - Analgesic action of short duration during anesthesia and immediate postoperative period. - Analgesic supplement in general or regional anesthesia. - Administration with a neuroleptic as an anesthetic premedication, for induction of anesthesia, and as an adjunct in maintenance of general and regional anesthesia. - For use as an anesthetic agent with oxygen in selected high-risks patients. - Treatment of breakthrough pain in cancer patients being treated with and tolerant to opioids. Contraindication: - Hypersensitivity - Use cautiously with bradycardia, history of seizures, lactation, renal dysfunction. Mode of Action: Fentanyl is a potent opioid analgesic that increases pain threshold, alters pain reception and inhibits ascending pain pathways by binding to stereospecific receptors within the CNS. Onset: Rapid. Duration: Short. Distribution: Rapidly into tissues; appears in the CSF, crosses the placenta and small amounts enter the breast milk. Protein-binding: 80% Metabolism: Hepatic via N-dealkylation and hydroxylation. Excretion: Urine (as metabolites and unchanged drug); 4 hrs (elimination half-life). Ideal dosage/Preparation and Supply form: Oral Breakthrough cancer pain Adult: For patients who are already receiving and tolerant to opioid treatment: As a loz: Initially, 200 mcg over 15 minutes for an episode of breakthrough pain; may repeat once after 15 minutes if needed. Titrate subsequent doses based on response up to 1.6 mg

per dose. Once the effective dose has been identified, no more than 4 unit doses should be taken daily. Elderly: and debilitated patients: Dose reduction may be needed.

Intravenous Adjunct to general anaesthesia Adult: For patients with spontaneous respiration: Initially, 50-200 mcg followed by supplements of 50 mcg. To be injected over 3-5 minutes. Possible increased risk of resp depression following doses >200 mcg. For patients with assisted ventilation: Initially, 300-3,500 mcg (up to 50 mcg/kg) followed by supplements of 100-200 mcg depending on the patient's response. To be injected over 3-5 minutes. Child: For patients with spontaneous respiration: >2 yr: 3-5 mcg/kg IV, supplements of 1 mcg/kg may be given. For patients with assisted ventilation: >2 yr: Initially, 15 mcg/kg with supplements of 1-3 mcg/kg. Elderly: and debilitated patients: Dose reduction may be needed. Intramuscular Premedication before anaesthesia Adult: 50-100 mcg, to be given 30-60 minutes before induction of anaesthesia. Elderly: and debilitated patients: Dose reduction may be needed. Transdermal Intractable chronic pain Adult: Patches deliver fentanyl in doses that range from 12-100 mcg/hr. Doses should be individually titrated based on previous use of opioids. For opioid-naive patients: Initiate with patches that deliver not more than 25 mcg/hr of fentanyl. Recommended for opioid-naive patients to start with low doses of short-acting opioids before starting on fentanyl patches. For patients who have been receiving a strong opioid, the initial dose should be based on the previous 24-hr opioid requirement. Elderly: and debilitated patients: Dose reduction may be needed. Adverse Effects: Nausea, vomiting; bradycardia, oedema, CNS depression, confusion, dizziness,drowsiness, headache, sedation, transient hypotension, peripheral vasodilation; increased intracranial pressure. High IV dose may cause chest wall rigidity. Transdermal: Rash, erythema and itching. Potentially Fatal: Respiratory depression, trunk rigidity, laryngospasm, bronchoconstriction. Drug Interaction: Drug-drug: - Potentiation of effects when given with other CNS acting drugs or barbiturates anesthetics; decrease dose when coadministering. Drug-food: - Decreased metabolism and risk of toxic effects if taken with grapefruit juice. Rationale in giving the drug: This narcotic agonist drug is for analgesia used before, during, and after surgery. It is used as antitussives and as adjuncts to general anesthesia to produce rapid analgesia, sedation, and respiratory depression. Nursing Interventions: 1. Provide a narcotic antagonist and equipment for assisted ventilation on standby during IV administration to support the patient in case severe reaction occurs. 2. Monitor injection sites for irritation and extravasation to provide appropriate supportive care if needed. 3. Use extreme caution when injecting a narcotic into any body area that is chilled or has poor perfusion or shock because absorption may be delayed.

4. Use additional measures for relief of pain, such as back rubs, stress reduction, hot packs, and ice packs to increase the effectiveness of the narcotic and reduce pain. 5. Monitor patient response to the drug. 6. Monitor for adverse effects. 7. Evaluate the effectiveness of the teaching plan. 8. Monitor the effectiveness of comfort measures and compliance with the regimen.

NAME: Carljean Apple B. Argonza Course/Yr and Sec.: BSN III-A Patients Data:

CI: Mrs. Melisa Abing, RN Date Submitted: September 19, 2009

Name: Harold Barsalote Apas Age: 14 years old Admitting Diagosis: Fracture, closed, complete, displaced, distal radius left, neglected Date of Admission: Drug Order: Brand Name: Generic Name: nalbuphine hydrochloride Functional classification: Anaesthetics - Local & General, Analgesics (Opioid) Chemical classification: Nalbuphine ; Belongs to the class of morphinan derivative opioids. It is used to relieve pain. Indication: For the relief of moderate to severe pain. Nalbuphine HCl can also be used for preoperative analgesia, as a supplement to balanced anesthesia, surgical anesthesia, for obstetrical analgesia during labor and for the relief of pain following acute myocardial infarction. Postoperative somatic and visceral pain. Contraindication: - Patients who are hypersensitive to nalbuphine HCl. - Use cautiously with emotionally unstable patients or those with a history of narcotic abuse, bronchial asthma, COPD, respiratory depression, anoxia, increased intracranial pressure. Mode of Action: Nalbuphine HCl is a potent analgesic, 10 mg of which is comparable in analgesic potency to 8-10 mg of morphine sulfate, whether administered IV, SC or IM. The onset of action occurs within 2-3 min after IV administration of nalbuphine HCl and in <10 min following SC or IM injection. Clinical experience suggests that in some patients, analgesia may be longer lasting than from comparable doses of morphine, effects having been observed in acute and chronic pain for 3-8 hrs. The half-life of nalbuphine is 5 hrs. Nalbuphine HCl has the effect of lowering the cardiac work load and can be used immediately in myocardial infarction (use with caution where emesis is involved). Hemodynamic studies in patients with severe arteriosclerotic heart changes reveal that nalbuphine HCl has circulatory effects similar to those of morphine ie, a minimal decrease in oxygen consumption, cardiac index, left ventricular end diastolic pressure and cardiac work. Ideal dosage/Preparation and Supply form: - Usual Recommended Dose: Adults: 0.15-0.2 mg/kg body weight. Children: 0.10.2 mg/kg up to a total single dose of 10 mg.

Nubain may be administered SC, IM or IV. The doses may be repeated every 3-6 hrs or as needed. Dosage should be adjusted according to severity of pain and physical status of the patient.

Adverse Effects: CNS - sedation, clamminess, sweating, headache, nervousness, restlessness, depression, crying, confusion, faintness, hostility, unusual dreams, hallucinations, dizziness, vertigo, numbness, tingling, flushing, warmth, blurred vision. CV hypotension, hypertension, bradycardia, tachycardia Dermatologic - itching, burning, uticaria GI GU urinary urgency Respiratory - respiratory depression, dyspnea, asthma Drug Interaction: Drug-drug: Potentiation of effects with barbiturate anesthetics Phenothiazines, alcohol, CNS depressants Rationale in giving the drug: This drug which is formulated in SQ, IM, and IV preparations should not be given to patients who are allergic to sulfites. Nursing Interventions: 1. Keep opioid antagonists and facilities for assisted or controlled respiration readily available in case of respiratory depression. 2. Reassure patient about addiction liability because most patients who receive opiates for medical reasons do not develop dependence syndrome. 3. Monitor injection sites for irritation and extravasation to provide appropriate supportive care if needed. 4. Use extreme caution when injecting a narcotic into any body area that is chilled or has poor perfusion or shock because absorption may be delayed. 5. Use additional measures for relief of pain, such as back rubs, stress reduction, hot packs, and ice packs to increase the effectiveness of the narcotic and reduce pain. 6. Institute comfort and safety measures, such as siderails and assistance with ambulation to ensure patient safety. 7. Monitor patient response to the drug. 8. Monitor for adverse effects. 9. Evaluate the effectiveness of the teaching plan. 10. Monitor the effectiveness of comfort measures and compliance with the regimen. nausea, vomiting, cramps, dyspepsia, bitter taste, dry mouth

NAME: Carljean Apple B. Argonza Course/Yr and Sec.: BSN III-A Patients Data: Name: Lorna Tanquerido Age: 50 years old Chief complaint: Hypertension Drug Order: Generic Name: Captopril Brand Name: Capoten Functional classification: ACE Inhibitors

CI: Doc. Orlando Llandino, RN Date Submitted: September 28, 2009

Chemical classification: Captopril belongs to the class of ACE inhibitors. Used in the treatment of cardiovascular disease. Indication: Hypertension, Heart Failure, Left Ventricular Dysfunction After Myocardial Infarction, Diabetic Nephropathy Contraindication: ACE inhibitors are contraindicated in the presence of allergy to any of the ACE inhibitors; with impaired renal function, which could be exacerbated by the effects of this drug in decreasing renal blood flow; with pregnancy, because of the potential for adverse effects on the fetus; and during lactation, because of potential decrease in milk production and effects on the neonate. Mode of Action: Block ACE from converting Angiotensin I to Angiotensin II, leading to a decrease in blood pressure, a decrease in aldosterone production, and a small increase in serum potassium levels along with sodium and fluid loss. Ideal dosage/Preparation and Supply form: The recommended dose of captopril is 25-150 mg two or three times daily. The maximum dose is 450 mg daily. It should be taken on an empty stomach one hour before or two hours after meals since absorption of captopril is reduced when it is taken with food. CAPOTEN is available in potencies of 12.5 mg, 25 mg, 50 mg, and 100 mg as scored tablets for oral administration. Adverse Effects: feeling light-headed fainting urinating more or less than usual fever, chills, body aches, flu symptoms pale skin, easy bruising or bleeding fast, pounding, or uneven heartbeats chest pai swelling, rapid weight gain cough loss of taste sensation, loss of appetite

 dizziness, drowsiness, headache sleep problems (insomnia) dry mouth, sores in the mouth or on the lips nausea, diarrhea, constipation mild skin itching or rash Drug Interaction: Drug-Drug - The risk of hypersensitivity reactions increases if these drugs are taken with allopurinol. Drug-Food - Absorption of oral ACE inhibitors decreases if they are taken with food. Rationale in giving the drug: This drug is given basically for treatment of hypertension. Not advisable for pregnant women. Nursing Interventions: 1. Encourage the patient to implement lifestyle changes, including weight loss, smoking cessation, s\decreased alcohol and salt in the diet, and increased exercise, to increase the effectiveness of antihypertensive therapy. 2. Monitor the patient carefully in any situation that might lead to a drop in fluid volume, to detect and treat excessive hypotension that may occur. 3. Provide comfort measures to help the patient tolerate drug effects. 4. Administer on an empty stomach, 1 hour before or 2 hours after meals, to ensure proper absorption of the drug. 5. Monitor patients response to the drug. 6. Monitor for adverse effects. 7. Monitor the effectiveness of comfort measures and compliance with the treatment regimen.

Generic Name: Dopamine Hydrochloride Brand Name: Myocard Functional classification: Cardiac Drugs Chemical classification: Dopamine belongs to the class of adrenergic and dopaminergic cardiac stimulants excluding glycosides. Used in the treatment of heart failure. Indication: Correction of hemodynamic imbalances present in shock due to MI, trauma, endotoxic septicemia, open-heart surgery, renal failure & chronic cardiac decompensation due to refractory CHF. Contraindication: Pheochromocytoma, uncorrected tachyarrhythmias or ventricular fibrillation. Mode of Action: Dopamine is a natural catecholamine formed by the decarboxylation of 3,4-dihydroxyphenylalanine (DOPA). It is a precursor to norepinephrine in noradrenergic nerves and is also a neurotransmitter in certain areas of the CNS, especially in the nigrostriatal tract and in a few peripheral sympathetic nerves. Ideal dosage/Preparation and Supply form: Individualised IV dosages. Adverse Effects: Ectopic beats; GI upset; tachycardia, anginal pain, palpitation; dyspnea; headache; hypotension, vasoconstriction. Infrequently, aberrant conduction, bradycardia; azotemia; elevated BP. Drug Interaction: Cyclopropane or halogenated hydrocarbon anesthetics increase cardiac autonomic irritability and may sensitize the myocardium to the action of certain IV administered catecholamines eg, dopamine. This interaction appears to be related both to pressor activity and to the -adrenergic stimulating properties of these catecholamines and may produce ventricular arrhythmias. Therefore, extreme caution should be exercised when administering dopamine HCl to patients receiving cyclopropane or halogenated hydrocarbon anesthetics. Results of studies in animals indicate that dopamine-induced ventricular arrhythmias during anesthesia can be reversed by propranolol. Rationale in giving the drug: In giving this drug we should always remember that its a cardiac drug and this drugs is used for the correction of hemodynamic imbalances present in shock. Nursing Interventions: 1. Monitor patient response closely and adjust dosage accordingly to ensure the most benefit with the least amount of toxicity. 2. Use extreme caution in calculating and preparing doses of this drug because even in small errors could have serious effects. 3. Monitor patient response to the drug. 4. Monitor for adverse effects.

NAME: Carljean Apple B. Argonza Course/Yr and Sec.: BSN III-A Patients Data: Name: Dexter Operio Age: 19 years old Chief complaint: Inflammation of right arm

CI: Doc. Orlando Llandino, RN Date Submitted: October 7, 2009

Drug Order: Cefazolin Sodium 500mg every 6 hours, IVTT, ANST Generic Name: Cefazolin Sodium Brand Name: Hazolin Functional classification: Cephalosporins Chemical classification: antibacterial Indication: Treatment of infections due to susceptible organisms including biliary tract infection, endocarditis & peritonitis. Contraindication: Hypersensitivity Mode of Action: Cefazolin binds to one or more of the penicillin-binding proteins (PBPs) which inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death. Absorption: Poorly absorbed from the GI tract (oral). Distribution: Bile (high concentrations); bone; ascitic, pleural and synovial fluids; CSF (small amounts). Crosses the placenta into the foetal circulation; enters the breast milk (low concentrations). Protein-binding: 85% Excretion: Via the urine by glomerular filtration, with some renal tubular secretion (as unchanged); 80% of a dose within 24 hr (IM). Removed to some extent by haemodialysis. Ideal dosage/Preparation and Supply form: - Adult Usual dose: 0.5-1 g 6-12 hrly. Max: 6-12 g for severe life-threatening infections. - Children >1 mth 25-50 mg/kg body wt daily in divided doses. Max: 100 mg/kg daily in severe infections. Adverse Effects: Superinfection; nausea, vomiting, abdominal pain, anorexia, diarrhoea; rash, leukopenia, thrombocytopaenia, haemorrhage, elevated transaminases. Drug Interaction: Probenecid reduces tubular secretion of cefazolin thereby prolonging its half-life. Disulfiram-like reaction with alcohol. Rationale in giving the drug: This drug is for treating infections caused by susceptible bacteria. We should know that it prevents bacteria from biosynthesizing the framework of their cell walls.

Nursing Interventions: 1. Check culture and sensitivity reports, to ensure that this is the drug of choice for this patient. 2. Monitor the site of infection and presenting signs and symptoms throughout the course of drug therapy. 3. Monitor patient for any signs of superinfection to arrange for treatment if superinfection occurs. 4. Monitor injection site regularly to provide warm compresses and gentle massage to injection site if painful or swollen. 5. Initiate safety measures, including adequate lighting, siderails on the bed, and assistance with ambulation to protect the patient from injury if CNS effects occur. 6. Monitor patient response to the drug. 7. Monitor for adverse effects.

NAME: Carljean Apple B. Argonza Course/Yr and Sec.: BSN III-A Generic Name: Ambroxol hydrochloride Brand Name: Mucosolvan

CI: Doc. Orlando Llandino, RN Date Submitted: October 7, 2009

Functional classification: cough and cold preparations Chemical classification: mucolytic Indication: Respiratory tract diseases associated w/ abnormal bronchial secretions, particularly in exacerbations of asthmatic bronchitis & chronic bronchitis, bronchial asthma; pre- & post-op treatment. Amp Esp suitable for the prevention of pulmonary complications in intensive medicine. Contraindication: dry mouth, drowsiness, restlessness, mytmares, dizziness, ringing in ears, blurred or double vision, upset stomach, vomiting, stuffy nose and itching, hyperactivity Mode of Action: It makes phlegm in the airways thinner and less sticky. It does this by increasing the bodys natural production of surfactant. Ideal dosage/Preparation and Supply form: Adult and pedia greater than 10 years old 1 tab TID. Adverse Effects: Mild GI effects and allergic reactions Drug Interaction: cardiac glycosides, corticosteroids, bronchospasmolytics, diuretics, antibiotics Rationale in giving the drug: This drug is given for the treatment of respiratory disorders associated with viscid or excessive mucus. Nursing Interventions: 1. Avoid combining with other drugs in the nebulizer to avoid the formation of precipitates and potential loss of effectiveness of the drug. 2. Dilute the concentrate with sterile water for injection. 3. Monitor patient response to the drug. 4. Monitor for adverse effects. 5. Monitor the effectiveness of comfort and safety measures and compliance with the regimen.

NAME: Carljean Apple B. Argonza Course/Yr and Sec.: BSN III-A Patients Data: Drug Order: Brand Name: Prozac Generic Name: Fluoxetine hydrochloride Functional classification: Antidepressants Chemical classification: This drug belongs to the class of selective serotonin reuptake inhibitors. Used in the management of depression. Indication: Treatment of depression, obsessive-compulsive disorders, bulimia nervosa, and panic disorders. Contraindication: - Fluoxetine should not be used in combination with a monoamine oxidase inhibitor (MAOI). - The Selective Serotonin Reuptake Inhibitors (SSRIs) are contraindicated in the presence of allergy and during pregnancy and lactation. Mode of Action: Inhibits CNS neuronal reuptake of serotonin with little effect on norepinephrine and little affinity for cholinergic, histaminic, or alpha-adrenergic sites. Ideal dosage/Preparation and Supply form: - Depression: Adults and Elderly: 20-80 mg/day. Recommended Initial Dose: 20 mg/day. - Obsessive-Compulsive Disorder: 20-60 mg/day. Recommended Initial Dose: 20 mg/day. - Bulimia Nervosa: Adults and Elderly: Recommended Dose: 60 mg/day. Adverse Effects: Digestive System: Gastrointestinal disorder (diarrhea, nausea, vomiting, dysphagia, dyspepsia, taste perversion). Very rare idiosyncratic hepatitis. Nervous System: Abnormal movement/tremor, anorexia including weight loss, anxiety and associated symptoms (palpitation, nervousness, psychomotor restlessness), dizziness, fatigue (somnolence, asthenia), impairment of concentration or thought process, manic reaction, sleep abnormalities (insomnia), seizures. Skin and Appendages: Alopecia. Urogenital System: Abnormalities of micturition (includes urinary frequency, urination impaired). Priapism/prolonged erection. Sexual dysfunction (decreased libido, delayed or absent ejaculation, anorgasmia, impotence). Special Senses: Abnormal vision (blurred vision, mydriasis). Endocrine System: Inappropriate secretion of ADH. Hemic and Lymphatic System: Ecchymosis. Respiratory System: Pharyngitis, dyspnea. Pulmonary events (including inflammatory processes of varying histopathology and/or fibrosis) have been reported rarely. Dyspnea may be the only preceding symptom. Yawn.

Drug Interaction: The risk of serotonin syndrome if SSRIs are used with MAOIs, this combination should be avoided, and at least 2 to 4 weeks should be allowed between use of the two types of drugs if switching from one to the other. Rationale in giving the drug: This drug should be given for the treatment of depression, bulimia, OCDs and panic disorders. Fluoxetine may be administered with or without food. Nursing Interventions: 1. Arrange for lower dosage in elderly patients and in those with renal or hepatic impairment because of the potential for severe adverse effects. 2. Monitor patient for up to 4 weeks to ascertain onset of full therapeutic effect before adjusting dosage. 3. Provide comfort measures to help patients tolerate drug effects. May include voiding before dosing, taking food with the drug if GI upset is severe. 4. Monitor patient response to the drug. 5. Monitor for adverse effects. 6. Administer drug in the morning to achieve optimal therapeutic effects.

NAME: Carljean Apple B. Argonza Course/Yr and Sec.: BSN III-A Patients Data: Drug Order: Generic Name: Oxycodone hydrochloride Brand Name: OxyContin Functional classification: Analgesics (Opioid)

CI: Doc. Orlando Llandino, RN Date Submitted: October 7, 2009

Chemical classification: Belongs to the class of natural opium alkaloids. Used to relieve pain. Indication: Relief of moderate to severe pain in adults. Contraindication: 1. Contraindicated in patients hypersensitive to drug. 2. Contraindicated in patients suspected of having paralytic ileus. 3. Use with extreme caution in patients with head injury, increased intracranial pressure, seizures, asthma, COPD, prostatic hyperplasia, severe hepatic or renal disease, acute abdominal conditions, urethral stricture, hypothyroidism, Addison disease, and arrhythmias. 4. Use with extreme caution in geriatric or debilitated patients. Mode of Action: Binds with opiate receptors in the CNS, altering both perception of and emotional response to pain through an unknown mechanism. Ideal dosage/Preparation and Supply form: Adults: 5 mg P.O. q 6 hours. Or, 1 to 3 suppositories P.R. daily, p.r.n., or 10 mg (controlled-release tablets) P.O. q 12 hours for patients not currently receiving opiates who need continuous around-the-clock analgesics for an extended time period. Increase dose every 1 to 2 days p.r.n. The 80-mg tablet is for opioid-tolerant patients only. Adverse Effects: CNS: sedation, somnolence, clouded sensorium, euphoria, dizziness, light-headedness. CV: hypotension, bradycardia. GI: nausea, vomiting, constipation, ileus. GU: urine retention. Respiratory: respiratory depression. Skin: diaphoresis, pruritus. Other: physical dependence. Drug Interaction: Drug-drug. Anticoagulants: oxycodone hydrochloride products containing aspirin may increase anticoagulant effect. Monitor clotting times. Use together cautiously. CNS depressants, general anesthetics, hypnotics, MAO inhibitors, other narcotic analgesics, sedatives, tranquilizers, tricyclic antidepressants: may have additive effects. Use together with extreme caution. Reduce oxycodone dose and monitor patient response. Drug-lifestyle. Alcohol use: may additive effects. Advise patient to use together cautiously. Rationale in giving the drug: This drug is for relief of moderate to severe pain in adults.

Nursing Interventions: 1. Oxycontin isn't intended to be used p.r.n. or for immediate postoperative pain, unless the patient was receiving it before surgery or if pain is expected to persist for an extended period. 2. For full analgesic effect, give drug before patient has intense pain. 3. To minimize GI distress, give drug after meals or with milk. 4. Single-drug oxycodone solution or tablets are especially useful for patients who shouldn't take aspirin or acetaminophen. 5. Monitor circulatory and respiratory status. Withhold dose and notify prescriber if respirations are shallow or if respiratory rate falls below 12 breaths/minute. 6. Monitor patient's bladder and bowel patterns. Patient may require a laxative because drug has a constipating effect. 7. Instruct patient to ask for drug before pain is intense. 8. Tell patient to take drug with milk or after eating. 9. Advise patient to swallow extended-release tablets whole. 10. Caution ambulatory patient about getting out of bed or walking. Warn outpatient to avoid driving and other potentially hazardous activities that require mental alertness until drug's CNS effects are known. 11. Advise patient to avoid alcohol during therapy. 12. Advise patient that drug shouldn't be stopped abruptly.

Patients Data: Drug Order: Brand Name: Vaponefrin Generic Name: Epinephrine hydrochloride Functional classification: Cardiac Drugs, Antiglaucoma Preparations Chemical classification: Belongs to the class of adrenergic inhalants, alpha- and betaadrenoreceptor agonists. Indication: This drugs are indicated for the treatment of hypotensive states or shock, bronchospasm, and some types of asthma. Contraindication: Preexisting hypertension; occlusive vascular disease; angle-closure glaucoma (eye drops); hypersensitivity; cardiac arrhythmias or tachycardia. When used in addition to local anaesthetics: Procedures involving digits, ears, nose, penis or scrotum. Mode of Action: Epinephrine, an active principle of the adrenal medulla, is a directacting sympathomimetic. It stimulates - and -adrenergic receptors resulting in relaxation of smooth muscle of the bronchial tree, cardiac stimulation and dilation of skeletal muscle vasculature. It is frequently added to local anaesthetics to retard diffusion and limit absorption, to prolong the duration of effect and to lessen the danger of toxicity. Ideal dosage/Preparation and Supply form: Anaphylactic shock Adult: 0.5 mg (5 mL of a 1:10,000 solution) given at a slow rate of 100 mcg/minute, stopping when a response is achieved. Acute asthma Adult: As 1:1,000 aqueous solution: 0.3-0.5 ml (300-500 mcg). Dose may be given via IM or SC inj. Advanced cardiac life support Adult: Initially, 1 mg may repeat as often as every 2-3 minutes throughout the resuscitation process. May also be given via intraosseous route at the same dosage. For endotracheal doses: 2-3 times of the IV dose. Adverse Effects: Central Nervous System: nervousness, tremor, vertigo, pain, headache, disorientation, agitation, drowsiness, fear, dizziness, weakness, cerebral hemorrhage, CVA. Cardio Vascular system: palpitations, widened pulse pressure, tachycardia, ventricular fibrillation, shocks, anginal pain, altered ECG GI: nausea and vomiting Skin: urticaria, hemorrhage at injection site, pallor Respiratory System: dyspnea Other: tissue necrosis Drug Interaction: Increased effects of tricyclic antidepressants and MAOIs can occur because of the increased norepinephrine levels or increased receptor stimulation that occurs with both drugs. There is an increased risk of hypertension if alpha- and betaadrenergic agonists are given with any other drugs that cause hypertension. hypertension,

Rationale in giving the drug : This drug is used therapeutically in the treatment of shock, when increased blood pressure and heart contractility are essential; as one of the primary treatments for bronchospasm; as an ophthalmic agent; and to produce a local vasoconstriction that prolongs the effects of local anesthetics. Nursing Interventions: 1. Epinephrine therapy interfere with tests for urinary catecholamines. 2. Epinephrine is a drug of choice in emergency treatment of acute anaphylactic reactions. 3. Massage site after IM injection to counteract possible vasoconstriction. Repeated local injection can cause necrosis caused by vasoconstriction at injection site. 4. Observe patient closely for adverse reactions. Drug adjustment or drug discontinuation may be necessary. 5. teach patient to perform oral inhalation correctly. 6. Monitor patients response to the drug.

Patients Data: Drug Order: Brand Name: Ketamine Generic Name: Nitrous oxide Functional classification: Anesthetics Local and General Chemical classification: This drug belongs to the class of other agents used as general anesthetics. Indication: This drug is indicated for producing sedation, hypnosis, anesthesia, amnesia, and unconsciousness to allow performance of painful surgical procedures. Contraindication: Patient in whom a significant BP elevation would constitute a serious hazard. Contraindicated with status asthmaticus because of the difficulty in providing ventilatory support to these patients and the risk of exacerbation of the problem with CNS depression. Mode of Action: Depresses the CNS, causing anesthesia, relaxes muscles, sentisizes the myocardium to the effects of norepinephrine and epinephrine. Ideal dosage/Preparation and Supply form: IV Induction: Initially 1-4.5 mg/kg administered slowly over a period of 60 sec. Adverse Effects: Circulatory depression; hypotension; shock; decreased cardiac output; arrhythmias; respiratory depression, including apnea, laryngospasm, bronchospasm, hiccups, and coughing; headache; nausea and vomiting; prolonged somnolence; and in some cases delirium. The halogenated hydrocarbons may cause malignant hyperthermia, with extreme muscle rigidity, severe hyperpyrexia, acidosis, and in some cases death. Drug Interaction: If Ketamine and halothane are used in combination, severe cardiac depression with hypotension and bradycardia may occur. Ketamine may also potentiate the muscular blocking of NMJ blockers, and the patient may require prolonged periods of respiratory support. Rationale in giving the drug: This drug is a very potent analgesic, it is the weakest of the gas anesthetics and the least toxic. Nitrous oxide is usually combined with other agents for anesthetic use. Nursing Interventions: 1. Monitor temperature for prompt detection and treatment of malignant hyperthermia. 2. Monitor pulse, respiration, blood pressure, ECG, and cardiac output continually during administration. 3. Monitor the patient until the recovery phase is complete and the patient is conscious and able to move and communicate to ensure patient safety. 4. Provide comfort measures to help the patient tolerate drug effects. 5. Monitor patient response to the drug. 6. Monitor for adverse effects.

Patients Name: Drug Order: Generic Name: Brand Name: Functional classification: Chemical classification: Indication:

Mingas, Jasper James Cefuroxime 250mg IV q8 ANST 6-2-10 Cefuroxime Axetil Zinacef Cephalosporins Anti-infectives Treatment of serious infections of the lower respiratory and urinary tracts; skin and skin-structure infections; bone and joint infections; septicemia; meningitis; and gonorrhea; and for perioperative prophylaxis. Contraindicated in patients hypersensitive to drug or other cephalosporin. Second-generation that inhibits cell-wall synthesis, promoting osmotic instability: usually bactericidal. Drug-drug - Aminoglycosides: may cause synergistic activity against some organisms; may create potential for increased nephrotoxicity. Monitor BUN and creatinine levels. - Diuretics: may increase risk of adverse renal reactions. Monitor BUN and creatinine levels. - Probenecid: may inhibit excretion and increase levels of cefuroxime. Monitor patient for adverse reactions. Drug-food - may increase drug absorption. Give drug with food .

Contraindication: Mode of action: Drug interaction:

Adverse effects:

CV: phlebitis, thrombophlebitis. GI: pseudomembranous colitis, nausea, anorexia, vomiting, diarrhea. Hematologic: transient neutropenia, eosinophilia, hemolytic anemia, thrombocytopenia. Skin: maculopapular and erythematous rashes, urticaria, pain, induration, sterile abscesses at injection site, temperature elevation, tissue sloughing at I.M. injection site. Other: hypersensitivity reactions, serum sickness, anaphylaxis. Ideal dosage/ drug Adults and children age 12 and older: supply/ available form: Usual dosage of cefuroxime sodium is 750 mg to 1.5 g I.M. or I.V. q 8 hours for 5 to 10 days. Available forms: Infusion: 750 mg, 1.5-g premixed, frozen solution Injection: 750 mg, 1.5 g Rationale for giving To treat respiratory and urinary tract infection. medication: Nursing 1. Use cautiously in patients with history of Responsibilities: sensitivity to penicillin and in breast-feeding women. Also use cautiously and with reduced dosage in patients with impaired renal function. Monitor renal function. 2. Obtain specimen for culture and sensitivity tests before giving first dose. Therapy may begin pending results. 3. For I.M. administration, inject deeply into a large

muscle mass, such as the gluteus maximus or the lateral aspect of the thigh. 4. Absorption of cefuroxime sodium is enhanced by food. 5. Keep in mind that cefuroxime sodium tablets may be crushed for patients who cannot swallow tablets. Tablets may be dissolved in small amounts of apple, orange, or grape juice or chocolate milk. However, the drug has a bitter taste that is difficult to mask, even with food. 6. With large doses or prolonged therapy, monitor for superinfection, especially in high-risk patients. 7. Tell patient to take the entire drug as prescribed, even after he feels better. 8. Instruct patient to take oral form with food. If patient has difficulty swallowing tablets, tell him how to dissolve or crush tablets but warn him that the bitter taste that results is hard to mask, even with food. If suspension is being used, tell patient to shake container well before measuring dose. 9. Tell patient to notify prescriber if rash or signs and symptoms of superinfection occur. 10. Tell patient to notify prescriber if he has loose stools or diarrhea.

Patients Data: Mingas, Jasper James Drug Order: Salbutamol one tab q6 6-12-6-12 Brand Name: Ventolin nebules Generic Name: Salbutamol Functional classification: Antiasthmatic & COPD Preparations / Drugs Acting on the Uterus Chemical classification: Belongs to the class of adrenergic inhalants, selective beta-2adrenoreceptor agonists. Used in the treatment of obstructive airway diseases. Indication: This drug is indicated to patients with bronchospasm and asthma. Contraindication: Contraindicated in patients hypersensitive to drug. Use cautiously in patients with CV disorder, or diabetes mellitus and in those who are unusually responsive to adrenergics. Mode of Action: Salbutamol is a direct-acting sympathomimetic with -adrenergic activity and selective action on 2 receptors, producing bronchodilating effects. It also decreases uterine contractility. Ideal dosage/Preparation and Supply form: Children: capsules for inhalation (200mcg inhaled q4-6 hours) Adverse Effects: CNS: tremor, nervousness dizziness, insomnia, headache, malaise CV: tachycardia, palpitations, hypertension EENT: dry and irritated nose and throat, nasal congestion, epistaxis, hoarseness GI: heartburn, nausea and vomiting, anorexia, altered taste, increased appetite Metabolic: hypokalemia Musculoskeletal: muscle cramps Respiratory: bronchospasm, cough, wheezing, dyspnea, bronchitis, increased sputum Drug Interaction: Drug-Drug: CNS stimulants (May increase CNS stimulation. Avoid using together.) Digoxin (May decrease digoxin level) Rationale in giving the drug: This drug is given to prevent or treat bronchospasm in patients with reversible obstructive airway disease. Nursing Interventions: 1. Warn patient about risk of paradoxical and to stop drug immediately if it occurs. 2. Teach patient to perform oral inhalation correctly. 3. If prescriber orders more than 1 inhalation, tell patient to wait atleast 2 minutes before repeating procedure. 4. Use minimal doses for minimal periods; drug tolerance can occur with prolonged use. 5. Maintain a beta-adrenergic blocker on standby in case cardiac arrythmias occur. 6. Observe patient closely for adverse reactions. Drug adjustment or drug discontinuation may be necessary. 7. Monitor patients response to the drug. 8. Do not exceed recommended dosage; adverse effects or loss of effectiveness may result.