Drug Study Generic Name: Diclofenac Sodium Brand Name: Voltaren Pharmacologic Classification: Anti-inflammatory, Antipyretic, NSAID, Analgesic

Dose, Route and frequency: 75 mg IV every 8 hours (-) ANST Date ordered: July 2, 2011 Mechanism of action: Inhibits prostaglandin synthesis to cause antipyretic and anti-inflammatory effects. Desired Effect: It is given to our patient to decrease the severity of the pain. Nursing Responsibilities Verify doctors order Rationale To confirm order of drug administration and prevent incorrect administration as to dosage, route and time To prevent allergic reactions To administer correct amount of drug to the patient To prevent accidents because this drug may cause drowsiness and dizziness. To be able to alert physician immediately when hypersensitivity reactions such rashes. To prevent double administration of drug and for legal purposes (anything not documented is considered undone)

Perform skin test prior to drug administration Compute for the amount of drug to be administered Advise patient to call for assistance when ambulating Watch for signs and symptoms of hypersensitivity Document

Generic Name: Ciprofloxacin Brand Name: Apo-Ciproflox Pharmacologic Classification: Anti-infectives, Fluroquinolones, Anti-bacterial Dose, Route and frequency: 200mg IV every 12 hours (-) ANST Date ordered: July 2, 2011 Mechanism of action: Bactericidal, interferes with DNA replication in susceptible bacteria preventing cell reproduction. Desired Effect: It serves as a prophylaxis to treat infection.

Nursing Responsibilities Verify doctors order

Perform skin test prior to drug administration

Rationale To confirm order of drug administration and prevent incorrect administration as to dosage, route and time To prevent allergic reactions

Compute for the amount of drug to be To administer correct amount of drug to the administered patient Encourage patient to drink plenty of fluids To reduce risk of urine crystals. Encourage patient to increase intake of foods To boost immune system rich in Vit C Watch for signs and symptoms of To be able to alert physician immediately when hypersensitivity hypersensitivity reactions such as rashes. To prevent double administration of drug and for Document legal purposes (anything not documented is considered undone)

Generic Name: Metronidazole Brand Name: Flagyl Pharmacologic Classification: Anti-infectives, Antiprotozoal, Antibiotic Dose, Route and frequency: 500mg IV every 8 hours ANST (-) Date ordered: July 2, 2011 Mechanism of action: Inhibit DNA synthesis in specific (obligate) anaerobes causing cell death Desired Effect: It is given to our patient to treat infection. Nursing Responsibilities Verify doctors order Rationale To confirm order of drug administration and prevent incorrect administration as to dosage, route and time To prevent allergic reactions To boost immune system For the patient not to worry of its occurrence To prevent double administration of drug and for legal purposes (anything not documented is considered undone)

Perform skin test prior to drug administration Encourage patient to increase intake of foods rich in Vit C Inform patient that medication may cause urine to turn dark Document

Generic Name: Regular Insulin Brand Name: Humulin R Pharmacologic Classification: Anti-diabetic Dose, Route and frequency: Subcutaneous Regular Insulin scale to following RBS: 150 199 mg/dl 200-249 mg/dl 250-299 mg/dl 300- 349 mg/dl >350 mg/dl Date ordered: July 2, 2011 Mechanism of action: Insulin promotes the storage of bodys fuels, facilitating the transport of metabolites and ions (potassium) through cell membranes and stimulating the synthesis of glycogen from glucose, of fats from lipids, and proteins from amino acids. Desired Effect: It is given to our patient to decrease the glucose level. Nursing Responsibilities Verify doctors order Rationale To confirm order of drug administration and prevent incorrect administration as to dosage, route and time Monitor patients glucose level regularly To adjust the dosage to be administered based on before administering. the sliding scale of the RBS. Give maintenance doses SC, rotating injection To decrease incidence of lipodystrophy sites regularly Teach the patient on how to inject insulin. In order for the patient to be knowledgeable in self administration of insulin, and to promote independence. Explain to patient that this medication controls To avoid misunderstanding. hyperglycemia but does not cure diabetes. Therapy is long term Document To prevent double administration of drug and for legal purposes (anything not documented is considered undone) 2 units 4 units 6 units 8 units 10 units

Generic Name: Nalbuphine Brand Name: Nubain Pharmacologic Classification: Opioid agonist- antagonist, analgesic Dose, Route and frequency: 1 amp SIVP now/given 9:45 AM/ then every 4 hours PRN for severe pain Date ordered: July 3, 2011 Mechanism of action: Acts as an agonist at specific opioid receptor in the CNS to produce analgesia and sedation. Desired Effect: It is given to our patient to decrease severe pain. Nursing Responsibilities Verify doctors order Rationale To confirm order of drug administration and prevent incorrect administration as to dosage, route and time To prevent discomfort to the patient. To minimize orthostatic hypotension To prevent atelectasis To attend needs immediately To prevent double administration of drug and for legal purposes (anything not documented is considered undone)

Administer slowly Caution patient to change position slowly Encourage patient to turn, cough, and breathe deeply every 2 hr Instruct patient to report if pain occurs Document

Generic Name: Glimepiride Brand Name: Amaryl Pharmacologic Classification: Anti diabetic; Sulfonylurea (2nd gen) Dose, Route and frequency: 2mg 1 tab BID Date ordered: July 4, 2011 Mechanism of action: Stimulates insulin release from functioning beta cells in the pancreas; may improve binding between insulin and insulin receptors or increase the number of insulin receptors. Binds to specific receptors on -cells, resulting in closure of potassium ATP channels. As a result, calcium channels open, leading to an increase in cytoplastic calcium that stimulates insulin release. Desired Effect: It is given to our patient to lower blood glucose level.

Nursing Responsibilities Verify doctors order

Monitor serum glucose levels. Emphasized that the drug should be taken 20 30 minutes before a meal Instruct patient to take medication at same time each day. Document

Rationale To confirm order of drug administration and prevent incorrect administration as to dosage, route and time To determine effectiveness of drug and dosage being used. For adequate control of blood glucose levels In order to prevent alteration of the effectiveness of the drug. To prevent double administration of drug and for legal purposes (anything not documented is considered undone)

Generic Name: Metformin Brand Name: Fortamet Pharmacologic Classification: anti- diabetic Dose, Route and frequency: 500 mg 1 tab BID Date ordered: July 4, 2011 Mechanism of action: Metformin works by inhibiting the production and release of glucose from the liver, which means that lesser insulin is needed to transport blood sugar into the cells. Metformin appears to function as insulin sensitizers and require the presence of insulin for their effects. Desired Effect: It is given to the patient to lower his glucose level.

Nursing Responsibilities Verify doctors order

Rationale To confirm order of drug administration and prevent incorrect administration as to dosage, route and time Encourage patient to follow prescribed diet, To prevent hyperglycemic or hypoglycemic medication. episodes. Advise patient to report the occurrence of To be able to alert physician immediately as these diarrhea, nausea, vomiting and stomach pain or are side effects of the drug. fullness to heath care provider. Document To prevent double administration of drug and for legal purposes (anything not documented is considered undone) Generic Name: Insulin detemir Brand Name: Levemir Pharmacologic Classification: Antidiabetic Dose, Route and frequency: 10 units SQ at 6 PM OD

Date ordered: July 6, 2011 Mechanism of action: Insulin promotes the storage of bodys fuels, facilitating the transport of metabolites and ions (potassium) through cell membranes and stimulating the synthesis of glycogen from glucose, of fats from lipids, and proteins from amino acids. Desired Effect: It is given to our patient as a treatment for diabetes that requires basal insulin for control of hyperglycemia. Nursing Responsibilities Verify doctors order Rationale To confirm order of drug administration and prevent incorrect administration as to dosage, route and time To determine effectiveness of drug and dosage

Monitor serum glucose levels. Monitor body weight periodically.

Changes in weight may necessitate changes in insulin dose. Emphasize the importance of compliance with This is to facilitate effectiveness of the drug nutritional guidelines as directed by health care provider. Document To prevent double administration of drug and for legal purposes (anything not documented is considered undone) Generic Name: Clindamycin Brand Name: Cleocin Pharmacologic Classification: Anti-infectives Dose, Route and frequency: 300mg IV every 6 hours Date ordered: July 11, 2011 Mechanism of action: Inhibits protein synthesis in susceptible bacteria causing cell death. Desired Effect: It is given to the patient as a prophylaxis for infection since the patient has a non- healing wound. Nursing Responsibilities Verify doctors order Rationale To confirm order of drug administration and prevent incorrect administration as to dosage, route and time To boost immune system

Encourage patient to increase intake of foods rich in Vit. C

Document

To prevent double administration of drug and for legal purposes (anything not documented is considered undone)