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DRUG STUDY

Name: SN

Sex: Female

Age: 33 years old

Room #: Ward 6

Physician: Dr. Severo Arnao Jr.

Case Number: 14-66409

Chief Complains:
Diagnosis: Avulsed 4th digit (degloving injury), right foot secondary to vehicular accident

Generic Name: Cefuroxime


Brand Name:
Date Administered: February 17, 2014, February 18, 2014 and February 19, 2014
Classification: Antibiotic
Dosage: 1.5g IVTT q 8 ANST (-)
Illustration:

Action
Bind to bacterial cell wall membrane,
causing cell death; usually
bactericidal.

Indication
Treatment for respiratory tract
infections, skin and skin structure
infections, bone and joint infections,
urinary tract and gynecologic
infection.

Contraindication
Contraindicated in hypersensitivity to
cephalosporins. Serious
hypersensitivity to penicillin.

Nursing Action and Rationale


1. Review the ten rights for drug
administration:
1. Right drug
2. Right patient
3. Right dose
4. Right route
5. Right time and frequency
6. Right documentation

7.
8.
9.

Right history and assessment


Right to refuse
Right drug-drug interaction
and evaluation
10. Right education and
information
2. Before giving drug, ask patient if
he/she is allergic to penicillin or
cephalosporin.
3. Assess for infection (vital signs,
appearance of wound, sputum, urine,
and stool; WBC) at beginning and
during therapy.
4. Advice patient receiving drug I.V.
to report discomfort at I.V. insertion
site.
5. Observe patient for signs and
symptoms of anaphylaxis (rash,
pruritus, laryngeal edema, wheezing).
6. Change sites every 48-72 hours to
prevent phlebitis. Monitor site
frequently for thrombophlebitis (pain,
redness, and swelling).
7. Advise patient to report signs of
superinfection and allergy.

Generic Name: Ketorolac


Brand Name:
Date Administered: February 17, 2014, February 18, 2014 and February 19, 2014
Classification: NSAID and Analgesic
Dosage: 1 ampule IVTT q 8 ANST (-) and 30mg IVTT q 6
Illustration:

Action
Inhibits prostaglandin synthesis, to
produce anti-inflammatory, analgesic,
and antipyretic effects.

Indication
Short-term management of pain (not
to exceed 5 days total for all routes
combined)

Contraindication
Contraindicated in patients with
previously demonstrated
hypersensitivity to Toradol or other
NSAIDs and patients in whom aspirin
or other prostaglandin synthesis
inhibitors induce allergic reactions.

Nursing Action and Rationale


1. Review the ten rights for drug
administration:
1. Right drug
2. Right patient
3. Right dose
4. Right route
5. Right time and frequency
6. Right documentation
7. Right history and assessment
8. Right to refuse
9. Right drug-drug interaction
and evaluation
10. Right education and
information
2. Patients who have asthma, aspirininduced allergy, and nasal polyps are
at increased risk for developing
hypersensitivity reactions. Assess for
rhinitis, asthma, and urticarial.
3. Assess pain (note type, location,

and intensity) prior to and 1-2 hours


following administration.
4. Advise patient to inform health
care professional of medication
regimen prior to treatment or surgery.
5. Do not confuse Toradol with
Torecan or Tramadol.
6. NSAIDs may mask signs and
symptoms of infection because of
their antipyretic and antiinflammatory actions.

Generic Name: Tramadol HCl paracetamol


Brand Name: Dolcet
Date Administered: February 19, 2014
Classification: Analgesic
Dosage: 1 tab TID
Illustration:

Action
The exact site and mechanism of its
analgesic action is not clearly defined.

Indication
Management of moderate to severe
pain.

Contraindication
Patients who have previously
demonstrated hypersensitivity to
Tramadol, Paracetamol and any other
component of Dolcet oropioids.

Nursing Action and Rationale


1. Review the ten rights for drug
administration:
1. Right drug
2. Right patient
3. Right dose
4. Right route
5. Right time and frequency
6. Right documentation
7. Right history and assessment
8. Right to refuse
9. Right drug-drug interaction
and evaluation
10. Right education and
information
2. Assess pain location and type and
give before pain becomes extreme
3. Check for urinary output that may
be cause by urinary retention
4. Assess CNS changes such as
dizziness, drowsiness and

hallucinations
5. Assess for any allergic reaction
6. Encourage to increase oral fluid
intake
7. For better analgesic effect, give
drug before onset of intense pain.
8. Tell patient to take as prescribed
and not to increase dose or dosage
interval unless ordered by prescriber.

Generic Name: Tramadol


Brand Name:
Date Administered: February 18, 2014 and February 19, 2014
Classification: Analgesic
Dosage: 50mg 1 cap TID
Illustration:

Action
Unknown. A centrally acting
synthetic analgesic compound not
chemically related to opioids.
Thought to bind to opioid receptors
and inhibit reuptake of norepinephrine
and serotonin.

Indication
Moderate to moderately severe pain.

Contraindication
Contraindicated in patient
hypersensitive to drug or other
opioids, in breastfeeding women, and
in those with acute intoxication from
alcohol, hypnotics, centrally acting
analgesics, opioids or psychotropic
drugs.

Nursing Action and Rationale


1. Review the ten rights for drug
administration:
1. Right drug
2. Right patient
3. Right dose
4. Right route
5. Right time and frequency
6. Right documentation
7. Right history and assessment
8. Right to refuse
9. Right drug-drug interaction
and evaluation
10. Right education and
information
2. Reassess patients level of pain at
least 30 minutes after administration.
3. Monitor bowel and bladder
function.
4. For better analgesic effect, give
drug before onset of intense pain.

5. Monitor patients at risk for


seizures. May occur within
recommended dose range.
6. Tell patient to take drug as
prescribed and not to increase dose or
dosage interval unless ordered by
prescribe.
7. May cause dizziness and
drowsiness. Caution patient to avoid
driving or other activities requiring
alertness until response to medication
is known.
8. Advise patient to change position
slowly to minimize orthostatic
hypotension.
9. Caution patient to avoid concurrent
use of alcohol or other CNS
depressants with this medication.
10. Encourage patient to turn, cough
and breathe deeply every 2 hours to
prevent atelectasis.

Generic Name: Nalbuphine


Brand Name:
Date Administered: February 18, 2014
Classification: Opioid analgesics
Dosage: 5mg slow IVTT now
Illustration:

Action
Binds to opiate receptor in CNS.
Alters the perception of and response
to painful stimuli while producing
generalized CNS depression.

Indication
Moderate to severe pain. Also
provides: analgesia during labor,
Sedation before surgery, Suplement to
balanced anesthesia.

Contraindication
Contraindicated in patients
hypersensitivity to drug. Use
cautiously in elderly and debilitated
patients and in those with head injury,
increased intracranial pressure,
impaired ventilation, MI accompanied
by nausea and vomiting, upcoming
biliary surgery, and hepatic or renal
disease.

Nursing Action and Rationale


1. Review the ten rights for drug
administration:
1. Right drug
2. Right patient
3. Right dose
4. Right route
5. Right time and frequency
6. Right documentation
7. Right history and assessment
8. Right to refuse
9. Right drug-drug interaction
and evaluation
10. Right education and
information
2. Assess vital signs before and
periodically during administration.
3. Assess previous analgesic history.
Antagonistic properties may induce
withdrawal symptoms (vomiting,
restlessness, abdominal cramps, and

increased blood pressure and


temperature) in patients physically
dependent on opioids.
4. Explain therapeutic value of
medication before administration to
enhance the analgesic effect.
5. May cause drowsiness or dizziness.
Advise patient to call for assistance
when ambulating or other activities
requiring alertness until response to
the medication is known.
6. Caution patient to change positions
slowly to minimize orthostatic
hypotension.
7. Encourage patient to turn, cough
and breathe deeply every 2 hours to
prevent atelectasis.

Generic Name: Mefenamic acid


Brand Name:
Date Administered: February 19, 2014
Classification: NSAID
Dosage: 500mg TID RTC P.O.
Illustration:

Action
Mefenamic acid is an NSAID which
is an anthranilic acid derivate. It
exhibits anti-inflammatory, analgesic,
and antipyretic activity by inhibiting
prostaglandin synthesis in body
tissues.

Indication
Relief of moderate pain when therapy
will not exceed 1 week.

Contraindication
Contraindicated with hypersensitivity
to mefenamic acid, aspirin allergy,
and as treatment of preoperative pain
with coronary artery bypass grafting.

Nursing Action and Rationale


1. Review the ten rights for drug
administration:
1. Right drug
2. Right patient
3. Right dose
4. Right route
5. Right time and frequency
6. Right documentation
7. Right history and assessment
8. Right to refuse
9. Right drug-drug interaction
and evaluation
10. Right education and
information
2. Take with food or 8-12 oz water to
avoid GI effects.
3. Informed the patient to tell the
doctor or pharmacist if she has or
experiencing allergies on medicine,
renal, heptic, GI conditions; lactation.
4. If severe diarrhea occurs, reduce
dose or temporarily discontinue drug.

Generic Name: Co-amoxiclav


Brand Name:
Date Administered: February 19, 2014
Classification: Antibiotic
Dosage: 1g 1 tab BID P.O.
Illustration:

Action
Binds to the bacterial cell wall,
causing cell death; spectrum of
amoxicillin is broader than penicillin.
Clavulanate resist action of betalactamase, an enzyme produced by
bacteria that is capable of inactivating
some penicillin. Bactericidal action
against susceptible bacteria.

Indication
Treatment of a variety of infections
including: skin to skin structure
infections, Otitis media, sinusitis,
respiratory tract infections,
genitourinary tract infection.

Contraindication
Hypersensitivity to penicillin.
Hypersensitivity to clavulanate.
Suspension and chewable tablets
contain aspartame and should be
avoided in phenylketonurics. History
of amoxicillin/clavulanate-associated
cholestatic jaundice..

Nursing Action and Rationale


1. Review the ten rights for drug
administration:
1. Right drug
2. Right patient
3. Right dose
4. Right route
5. Right time and frequency
6. Right documentation
7. Right history and assessment
8. Right to refuse
9. Right drug-drug interaction
and evaluation
10. Right education and
information
2. Assess for infection (vital signs;
appearance of wound, sputum, urine
and stool; WBC (white blood cells)).
At the beginning of and throughout
the therapy.
3. Observe for signs and symptoms of
anaphylaxis (rash, pruiritus, laryngeal
edema, wheezing). Notify the

physician or other health professional


immediately if these occur.
4. Monitor bowel function. Diarrhea,
abdominal cramping, fever, and
bloody stools should be reported to
health care professional promptly as a
sign of pseudomembranous colitis.
May begin up to several weeks
following cessation of therapy.
5. Do not administer with high fat
meals; clavunate absorption is
decreased.
6. Advise patient to report the signs of
super infection (furry overgrowth on
the tongue, vaginal itching or
discharge, loose or foul smelling
stools) and allergy.
7. Instruct patient to notify health care
professional immediately if diarrhea,
abdominal cramping, fever or bloody
stools occur and not to treat with
antidiarrheal without consulting
health care professionals.
8. Instruct patient to notify health care
professional if symptoms do not
improve or if nausea or diarrhea
persists when drug is administered
with food.

Generic Name: Plain Lactated Ringer


Date Administered: February 17, 2014 and February 18, 2014
Classification: Isotonic crystalloid solution
Dosage: 1 Liter @ 30gtts/minute
Illustration:

Action
Lactated Ringer's solution contains
isotonic concentrations of electrolytes
in water for inj. It is used for
parenteral replacement of
extracellular losses of fluid and
electrolytes.

Indication
As an alkaliniser agent, Replacement
of fluid and electrolytes.

Contraindication
Lactated ringers should not be used in
patients with congestive heart failure
or renal failure.

Nursing Action and Rationale


1. Review the ten rights for drug
administration:
1. Right drug
2. Right patient
3. Right dose
4. Right route
5. Right time and frequency
6. Right documentation
7. Right history and assessment
8. Right to refuse
9. Right drug-drug interaction
and evaluation
10. Right education and
information
2. Do not administer unless solution is
clear and container is undamaged.
3. Discard unused portion.
4. Properly label the IV Fluid
5. Observe aseptic technique when
changing IV fluid

Generic Name: 5% Dextrose Lactated Ringer


Date Administered: February 18, 2014 and February 19, 2014
Classification: Hypertonic solution
Dosage: 1 Liter @ 30gtts/minute
Illustration:

Action
Hypertonic solutions are those that
have an effective osmolarity greater
than the body fluids. This pulls the
fluid into the vascular by osmosis
resulting in an increase vascular
volume. It raises intravascular
osmotic pressure and provides fluid,
electrolytes and calories for energy.

Indication
Treatment for persons needing extra
calories who cannot tolerate fluid
overload. Treatment of shock.

Contraindication
Hypersensitivity to any of the
components.

Nursing Action and Rationale


1. Review the ten rights for drug
administration:
1. Right drug
2. Right patient
3. Right dose
4. Right route
5. Right time and frequency
6. Right documentation
7. Right history and assessment
8. Right to refuse
9. Right drug-drug interaction
and evaluation
10. Right education and
information.
2. Do not administer unless solution is
clear and container is undamaged.
3. Caution must be exercised in the
administration of parenteral fluids,
especially those containing sodium
ions to patients receiving
corticosteroids or corticotrophin.

4. Solution containing acetate should


be used with caution as excess
administration may result in
metabolic alkalosis.
5. Solution containing dextrose
should be used with caution in
patients with known subclinical or
overt diabetes mellitus.
6. Discard unused portion.
7. In very low birth weight infants,
excessive or rapid administration of
dextrose injection may result in
increased serum osmolality and
possible intracerebral hemorrhage.
8. Properly label the IV Fluid
9. Observe aseptic technique when
changing IV fluid