VISION

A premier university in historic Cavite

recognized for excellence in the development
of morally upright and globally competitive
individuals.



Republic of the Philippines
CAVITE STATE UNIVERSITY
Don Severino Delas Alas Campus
Indang, Cavite
MISSION
Cavite State University shall provide excellent, equitable
and relevant educational opportunities in the arts,
science and technology through quality instruction and
relevant research and development activities. It shall
produce professional, skilled and morally upright
individuals for global competitiveness.


PUEDAN, JENIVIC E. BSN 3-1

Name of Patient (Initial): R.D Date of Admission: July 30, 2013
Age: 16 years old Diagnosis: Dengue Hemorrhagic Fever
Sex: Male Date medication started: July 30 2013
Drug Mechanism of
Action
Indication Contraindication Side effects Nursing responsibilities
Generic: Ranitidine


Brand: Zantac

Classification:
Therapeutic: antiulcer
agents
Pharmacologic:
histamine H
2

antagonists

Dosage: Tablet
75,150,300mg;capsules
150-00mg;syrup
15mg/ml;injection
1,25mg/ml

Short-term
treatment of active
duodenal ulcers and
benign gastric ulcers.
Maintenance
therapy for
duodenal and gastric
ulcers after healing
of active ulcers.
Management of
GERD.
Treatment of
heartburn, acid
indigestion, and sour
stomach (OTC use).
Cimetidine,
famotidine,
ranitidine:
Short-term
treatment of active
duodenal ulcers and
benign gastric ulcers.
Maintenance
therapy for
duodenal and gastric
ulcers after healing
of active ulcers.
Management of
GERD.
Treatment of
heartburn, acid
indigestion, and sour
stomach (OTC use).
Cimetidine,
famotidine,
ranitidine:
Hypersensitivity
Some products contain
alcohol and should be
avoided in patients with
known intolerance
Some products contain
aspartame and should be
avoided in patients with
phenylketonuria.
Use Cautiously in:
Renal impairment (more
susceptible to adverse CNS
reactions; increased dosage
interval recommended for
cimetidine and nizatidine if
CCr 50 ml/min, and for
famotidine and ranitidine if
CCr <50 ml/min
CNS: confusion,
dizziness,
drowsiness,
hallucinations,
headache.
CV: ARRHYTHMIAS.
GI: constipation,
diarrhea, drug-
induced hepatitis
(nizatidine,
cimetidine), nausea.
GU: decreased
sperm count,
erectile dysfunction
(cimetidine).
Endo:
gynecomastia.
Hemat:
-Assess for epigastric or
abdominal pain and frank
or occult blood in the
stool, emesis, or gastric
aspirate.
- Assess geriatric and
debilitated patients
routinely for confusion.
Report promptly.
-Lab Test Considerations:
Monitor CBC with
differential periodically
during therapy.
-Antagonize effects of
pentagastrin and
histamine during gastric
acid secretion testing.
-Avoid administration for

Route:
PO,IM,IV

Frequency: 0D




Form:


Color:

Management of
gastric
hypersecretory
states (Zollinger-
Ellison syndrome).
Cimetidine,
famotidine,
ranitidine IV:
Prevention and
treatment of stress-
induced upper GI
bleeding in critically
ill patients.
Ranitidine:
Treatment of and
maintenance
therapy for erosive
esophagitis.
Unlabelled Use:
Management of GI
symptoms
associated with the
use of NSAIDs.
Prevention of acid
inactivation of
supplemental
pancreatic enzymes
in patients with
pancreatic
insufficiency.
Management of
urticaria.

Management of
gastric
hypersecretory
states (Zollinger-
Ellison syndrome).
Cimetidine,
famotidine,
ranitidine IV:
Prevention and
treatment of stress-
induced upper GI
bleeding in critically
ill patients.
Ranitidine:
Treatment of and
maintenance
therapy for erosive
esophagitis.
Unlabelled Use:
Management of GI
symptoms
associated with the
use of NSAIDs.
Prevention of acid
inactivation of
supplemental
pancreatic enzymes
in patients with
pancreatic
insufficiency.
Management of
urticaria.

Hepatic impairment (for
ranitidine)
Acute porphyria (for
ranitidine)
Geri: Geriatric patients
(more susceptible to
adverse CNS reactions;
dosage reduction
recommended)
OB: Lactation: Pregnancy or
lactation.
AGRANULOCYTOSIS,
APLASTIC ANEMIA,
anemia,
neutropenia,
thrombocytopenia.
Local: pain at IM
site. Misc:
hypersensivity
reactions, vasculitis.

24 hr before the test.
-May cause false-negative
results in skin tests using
allergenic extracts.
Histamine H
2
antagonists
should be discontinued 24
hr before the test.
-May cause in serum
transaminases and serum
creatinine.
-Serum prolactin
concentration may be
after IV bolus of
cimetidine. May also cause
parathyroid
concentrations.
Nizatidine may cause
alkaline phosphatase
concentrations.
Ranitidine and famotidine
may cause false-positive
results for urine protein;
test with sulfosalicylic
acid. .
- Advise patient to
report onset of black,
tarry stools; fever,
sore throat; diarrhea;
dizziness; rash;
confusion; or
hallucinations to
health car
professional promptly


Drug Mechanism of
Action
Indication Contraindication Side effects Nursing responsibilities
Generic: Famotidine

Brand: Acid Control,
Apo-Famotidine, Gen-
Famotidine,
Maximum Strength
Pepcid, Mylanta AR,
Novo-Famotidine,
Nu-Famotidine,
Pepcid, Pepcid AC,
Pepcid AC Acid
Controller, Pepcid
RPD, Ulcidine

Classification:
HISTAMINE H
2

ANTAGONISTS

Dosage: 300 mg 4
times daily, 5-10
mg/kg q 6 hr.

Route: PO,IM,IV

Frequency: OD



Form:


Color:

Short-term
treatment of active
duodenal ulcers
and benign gastric
ulcers.
Maintenance
therapy for
duodenal and
gastric ulcers after
healing of active
ulcers.
Management of
GERD.
Treatment of
heartburn, acid
indigestion, and
sour stomach (OTC
use).
Cimetidine,
famotidine,
ranitidine:
Management of
gastric
hypersecretory
states (Zollinger-
Ellison syndrome).
Cimetidine,
famotidine,
ranitidine IV:
Prevention and
treatment of stress-
Short-term
treatment of active
duodenal ulcers
and benign gastric
ulcers.
Maintenance
therapy for
duodenal and
gastric ulcers after
healing of active
ulcers.
Management of
GERD.
Treatment of
heartburn, acid
indigestion, and
sour stomach (OTC
use).
Cimetidine,
famotidine,
ranitidine:
Management of
gastric
hypersecretory
states (Zollinger-
Ellison syndrome).
Cimetidine,
famotidine,
ranitidine IV:
Prevention and
treatment of stress-
induced upper GI

Hypersensitivity
Some products contain
alcohol and should be
avoided in patients with
known intolerance
Some products contain
aspartame and should be
avoided in patients with
phenylketonuria.
Use Cautiously in:
Renal impairment (more
susceptible to adverse
CNS reactions; increased
dosage interval
recommended for
cimetidine and nizatidine
if CCr 50 ml/min, and for
famotidine and ranitidine
if CCr <50 ml/min
Hepatic impairment (for
ranitidine)
Acute porphyria (for
ranitidine)
Geri: Geriatric patients
(more susceptible to
adverse CNS reactions;
dosage reduction
recommended)
OB: Lactation: Pregnancy
or lactation.
.

CNS: confusion,
dizziness,
drowsiness,
hallucinations,
headache.
CV: ARRHYTHMIAS.
GI: constipation,
diarrhea, drug-
induced hepatitis
(nizatidine,
cimetidine), nausea.
GU: decreased
sperm count, erectile
dysfunction
(cimetidine).
Endo: gynecomastia.
Hemat:
AGRANULOCYTOSIS,
APLASTIC ANEMIA,
anemia,
neutropenia,
thrombocytopenia.
Local: pain at IM site.
Misc: hypersensivity
reactions, vasculitis.

-Instruct patient to take
medication as directed
for the full course of
therapy, even if feeling
better. Take missed
doses as soon as
remembered but not if
almost time for next
dose. Do not double
doses.
-Advise patients taking
OTC preparations not to
take the maximum dose
continuously for more
than 2 wk without
consulting health care
professional.
-Notify health care
professional if difficulty
swallowing occurs or
abdominal pain persists..
-Inform patient that
smoking interferes with
the action of histamine
antagonists.
-Encourage patient to
quit smoking or at least
not to smoke after last
dose of the day.
-May cause drowsiness
or dizziness. Caution
patient to avoid driving




induced upper GI
bleeding in critically
ill patients.
Ranitidine:
Treatment of and
maintenance
therapy for erosive
esophagitis.
Unlabelled Use:
Management of GI
symptoms
associated with the
use of NSAIDs.
Prevention of acid
inactivation of
supplemental
pancreatic enzymes
in patients with
pancreatic
insufficiency.
Management of
urticaria.

bleeding in critically
ill patients.
Ranitidine:
Treatment of and
maintenance
therapy for erosive
esophagitis.
Unlabelled Use:
Management of GI
symptoms
associated with the
use of NSAIDs.
Prevention of acid
inactivation of
supplemental
pancreatic enzymes
in patients with
pancreatic
insufficiency.
Management of
urticaria.

or other activities
requiring alertness until
response to the drug is
known.
-Advise patient to avoid
alcohol, products
containing aspirin or
NSAIDs, and foods that
may cause an increase in
GI irritation.
Inform patient that
increased fluid and fiber
intake and exercise may
minimize constipation.
-Advise patient to report
onset of black, tarry
stools; fever; sore throat;
diarrhea; dizziness; rash;
confusion; or
hallucinations to health
care professional
promptly. .





Drug Mechanism of Action Indication Contraindication Side effects Nursing responsibilities
Generic: Essentiale
Forte

Brand:

Classification: A05BA -
Liver therapy ; Used in
liver therapy.

Dosage: 2 cap tid.

Route:

Frequency:



Form:


Color: Brown

Among the
pharmacodynamic
properties reported were
hepatoprotective effects
found in numerous
experimental models in
acute liver damage
(induced by ethanol,
alkyl alcohol, carbon
tetrachloride,
paracetamol and
galactosamine).
Furthermore, it was also
seen to inhibit steatosis
and fibrosis in chronic
liver damage models
(induced by ethanol,
thioacetamide and
organic solvents). Its
suggested principal
actions have been
through accelerated
membrane regeneration
and stabilization,
inhibited lipid
peroxidation and
inhibited collagen
synthesis.
Nutritional support
in the management
of damaged liver
due to chronic liver
disease, liver
cirrhosis, fatty liver
& intoxication by
hepatotoxic
substances.

Hypersensitivity to soya
bean prep.
Occasionally,
stomach complaints,
soft stool, diarrhea.


Drug Mechanism of
Action
Indication Contraindication Side effets Nursing
responsibilities
Generic: Paracetamol
, Acetaminophen


Brand: Biogesic,
Panadol, Tylenol

Classification:
Non-narcotic
analgesic, Antipyretic

Dosage: 500-1,000
mg

Route: Oral, IV

Frequency: 4-6 hrs



Form:


Color: Brown

- Decreases fever
by a hypothalamic
effect leading to
sweating and
vasodilation
-Inhibits pyrogen
effect on the
hypothalamic-
heat-regulating
centers
-Inhibits CNS
prostaglandin
synthesis with
minimal effects on
peripheral
prostaglandin
synthesis
-Does not cause
ulceration of the
GI tract and causes
no anticoagulant
action.

Symptomatic treatment
of mild to
moderate pain &/or fever.
Nephrotoxicity.
Renal Insufficiency
Anemia

Occasionally, skin rashes
& hypersensitivity
reactions. Renal damage
(long-term use).
Hematological reactions
including
thrombocytopenia,
leukopenia &
methemoglobinemia
resulting to cyanosis.
Minimal GI upset.
1. Methemoglobinemia
2. Hemolytic Anemia
3. Neutropenia
4. Thrombocytopenia
5. Pancytopenia
6. Leukopenia
7. Urticaria
8. CNS stimulation
9. Hypoglycemic coma
10. Jaundice
11. Glissitis
12. Drowsiness
13. Liver Damage

1. Do not exceed
4gm/24hr. in
adults and
75mg/kg/day in
children.
2. Do not take for
>5days for pain in
children, 10 days
for pain in adults,
or more than 3
days for fever in
adults.
3. Extended-Release
tablets are not to
be chewed.
4. Monitor CBC, liver
and renal
functions.
5. Assess for fecal
occult blood and
nephritis.
6. Avoid using OTC
drugs with
Acetaminophen.
7. Take with food or
milk to minimize GI
upset.
8. Report N&V.
cyanosis, shortness
of breath and
abdominal pain as
these are signs of
toxicity.








9. Report paleness,
weakness and
heart beat skips
10. Report abdominal
pain, jaundice, dark
urine, itchiness or
clay-colored stools.
11. Phenmacetin may
cause urine to
become dark
brown or wine-
colored.
12. Report pain that
persists for more
than 3-5 days
13. Avoid alcohol.
14. This drug is not for
regular use with
any form of liver
disease.








Drug Mechanism of Action Indication Contraindication Side effects Nursing responsibilities
Generic:
Levocetirizine
dihydrohloride

Brand: Xyzal


Classification:
Antihistamine

Dosage: tablet
5mg; oral
solution
2.5mg/5ml

Route: Oral

Frequency: BID

Form:


Color:
Potent Histamine (H1)
receptor antagonist;
inhibits histamine
relesase and
eosinophil chemotaxis
during
inflammation,reducing
swelling and
inflammatory
response.
-Relief from
symptoms of
seasonal and
perennial allergic
rhinitis in adults
and children 6
mos nd older.
-Treatment of
uncomplicated
skin effects in
chronic idiopathic
urtiuria in patients
2 yr and older.
-Hypersensitivity to
levocetirizine, any
of its components,
or cetirizine; end-
stage renal disease;
renl impairement in
children .
-Use cautiously
with pregnancy and
with use of CNS
depressants.
CNS: Somnolence,
asthenia
GI: Dry mouth
RESPI:
Nasopharyngitis,cough,p
haryngitis,epistaxis
Other: fatigue, fever
-Administer once each day, in the
evening.
-Alert patient to possible alterations
in mental alertness while taking this
rug.
-Encourage use of humidifiers and
adequate intake of fluids to help
prevent severe dryness of mucous
membranes.
-Provide skin care for urticuria.








Drug Mechanism of Action Indication Contraindication Side effects Nursing responsibilities
Generic:
Paracetamol

Brand: Aeknil


Classification:
Analgesic (Opiod)

Dosage: 2-3 ml

Route: IV

Frequency: Q4

Form:


Color:
Paracetamol produces
analgesia by raising
the threshold of the
pain center in the
brain n by obstructing
impulses at the pain-
mediating
chemoreceptors. The
drug produces
antipyretics by an
action on the
hypothalamus; heat
dissipation is
increased as a result
of vasodilation an
increased peripheral
blood flow.

-pyrexia of
unknown
origin,fever and
pain associated
with common
childhood
disorders
,tonsillitis, upper
respiratory tract
infection post
immunization
reactions.
-Prevention of
febrile convulsion,
headache, cold,
sinusitis,musle
pain,arthritis and
toothache.


-Liver damage
-skin rashes
-blood disorders and
swollen pancreas.

-Use liquid form of children and
patients who have difficulty
swallowing.
-In children, dont exceed five dose
in 24 hrs
-Advise patient that drug is only for
short term use and to consult the
physician if giving to children for
longer than 5 days.
- Advise patient that many over the
counter products contains
acetaminophen; be aware of this
when calculating total daily dose.
-Warn patient that high doses or
unsupervised long term can cause
liver damage.

FOCUS ASSESSMENT:
Name of Patient (Initial): R.D Date of Admission: July 30, 2013
Age: 16 years old Diagnosis: Dengue Hemorrhagic Fever
Sex: Male Date medication started: July 30 2013

Vital Signs







LABORATORY RESULTS
DATE: 08-01-13/ 7:20 PM
RESULT. Normal Value
Hematocrit 0.42 % 41-50 %
Hemoglobin 147 g/dl 13.5 - 16.5g/dl
Platelet count 86,000 x10 9/L
100,000 x10 9/L as of 08-
02-13
150,000-450,000
x10 9/L
APTT 40.0 sec 25-38 seconds
System Findings
General Good Hygiene, (-) fever, pallor
Musculoskeletal
(-) Muscle and Joint pain
(-) Back pain
Skin Dry
Mouth Dry lips
Upper and Lower Extremities (+) rashes
Date: 08-01-13 08-02-13
Time: 8AM 12PM 8AM 12PM
T 36.4 36.7 36.5 36.0
PR 71 74 20 25
RR 24 24 73 74
BP 110/80 110/60 110/60 100/60

Assessment Nursing Diagnosis Scientific
Rationale
Planning Intervention Rationale Evaluation
Objective data:


Pallor
Weakness
Decreased
hematocrit
(0.42%)
Decreased
hemoglobin (
Decreased
platelet count
(100,00 x10
9/L)
Decreased
capillary time
of 3-4 sec.
Rashes in
upper and
lower
extremities


Ineffective tissue
perfusion related
to decreased
hemoglobin
concentration in
blood,
hematocrit , and
platelet count
secondary to DHF
stage 2.
DHF

Viral infection

Decreased CBC
&platelet count

Decreased level
of hemoglobin
and hematocrit

Decreased
blood
oxygenation

Pallor and
muscle
weakness

Ineffective
tissue
perfusion
After 4hours of
nursing
intervention and
with the help of
Medical
Management the
patient will
demonstrate
behaviors to
improve circulation
and increased
perfusion as
appropriate.
Monitored Vital
signs of the
patient.
Assessed
patients
condition.
Performed
blanch test
Positioned
patient in semi
fowlers.
Encouraged quite
and restful
atmosphere.
Instructed the
patient to avoid
tiring activities.
Encouraged light
ambulation.
Encourage use of
relaxation
techniques.
Administered
medication as
ordered by the
doctor.
Encourage
patient to take
iron supplements
and eat foods
rich in iron.
To obtain baseline
data.

To assess
contributing factors.

To determine
adequate perfusion
To promote
circulation.

To promote comfort
and decrease tissue
O2 demand.
To decrease cardiac
workload.

To enhance venous
return.
To decrease tension
and anxiety.

To treat underlying
cause.


To help elevate
hemoglobin and
hematocrit levels.


After 8 hours of
nursing intervention
the patient shall
have demonstrated
behaviors to
improve circulation
and to increased
perfusion as
appropriate as
evidenced by the
result of platelet
count from 86,000
to 100,000.


Number 2: Risk for bleeding
Assessment Nursing Diagnosis Scientific
Rationale
Planning Intervention Rationale Evaluation
Objective data:
Rashes on the
upper and
lower
extremities
Restlessness
(-)bleeding
and
abdominal
pain
Platelet count
of 86,000 x10
9/L as of 08-
01-13
Vs as
followed.
T-36.7
PR-74
RR-24
BP-110/60

Risk for bleeding
related to altered
clotting factor
secondary to DHF
stage 2.
It is a mosquito
born viral disease
cause Aedis
Aegypti . This
infectious disease
is manifested by a
sudden onset
of fever, with severe
headache; muscle
and joint pains
severe pain gives it
the name break
bone fever or bone
crusher.
After 2 hours of
nursing
intervention and
with the help of
Medical
management the
patient will be able
to demonstrate
behaviors that
reduce the risk for
bleeding and will
be free of signs of
active bleeding.
Monitored
Vital Signs of
the patient.

Assessed for
signs and
symptoms of
G.I bleeding.
Check for
secretions.


Instructed the
patient to
avoid eating
dark color
foods.
Assessed skin
color and
moisture, urine
output, level of
consciousness.
Reviewed
laboratory data
such as CBC
and PC.


Serve as
baseline for
more effective
nursing action.
The G.I tract
(esophagus
and rectum) is the
most usual source
of bleeding of its
mucosal Fragility


It can affect
the color of his
stool.


Changes in
these signs
may be
indicative of
blood loss.
To determine if
there is
abnormal of
patients blood
count.
Goal Met.
After 8 hours of
nursing
intervention the
patient was able to
demonstrate
behavior that
reduced the risk
for bleeding.