IX.

DRUG STUDY

DRUG ACTION INDICATION CONTRAINDICATION SIDE EFFECT/ADVERSE NURSING CONSIDERATION

EFFECT

Drug Ordered: Bind with -moderate to -Contraindicated in patients CNS: dizziness, headache, -Reassess patient’s level of pain at
Nalbuphine 5mg opiate receptors severe pain hypersensitive to drug sedation,vertigo,confusion,cryin least 15 to 30minutes after
IV in the CNS, g,delusions,depressions,euphori parenteral administration
altering -Adjunct to a,hallucinations,hostility,nervou - Alert: Drug causes respiratory
Brand Name: perception and balance sness,restlessness, speech depression, which at 10mg is equal
emotional to anesthesia disorders, unusual dreams to respiratory depression produced
Classification: pain. by 10mg morphine.
Opioid analgesic CV: bradycardia, hypertension, - Monitor circulatory and
hypotension, tachycardia respiratory status and bladder and
bowel function.
EENT: blurred vision, dry -Constipation is often severe with
mouth maintenance therapy. Make sure
stool softener or other laxative is
GI: biliary tract spasm, ordered.
constipation, cramps, dyspepsia,
nausea, vomiting

GU: urinary urgency

Respiratory: respiratory
depression, asthma, dyspnea,
pulmonary edema

Skin: burning, clamminess,

diaphoresis, pruritus, urticaria
 DRUG ACTION INDICATION CONTRAINDICATION SIDE NURSING CONSIDERATION
EFFECT/ADVERSE
EFFECT

Drug Ordered: Competitively -Active -Contraindicated in CNS: vertigo, malaise, -Nursing Mothers-Ranitidine is
Ranitidine inhibits action of duodenal and patients hypersensitive to headache secreted into human breast milk and
hydrochloride histamine in the gastric ulcer drug and those with acute may pose a potential risk to the
50 mg IV q8 H2 at receptor poryphyria. EENT: blurred vision infant.
sites of parietal -Maintenance
Brand Name: cells, decreasing therapy for -Use cautiously in patients HEPATIC: jaundice -Instruct patient to take without
Zantac gastric secretion. duodenal or with hepatic regard to meals because absorption
gastric ulcer Other: burning and itching isn’t affected by food.
Classification: -Adjust dosage in patients at injection site,
Anti-ulcerative -Pathologic with impaired renal anaphylaxis, angioedema
(H2 Blocker) hypersecretory function.
condition such
as Zollinger-
Ellison
syndrome (ZES)

-Gastro
esophageal
reflux disease

-Erosive
esophagitis

-Heartburn
 DRUG ACTION INDICATION CONTRAINDICATION SIDE NURSING CONSIDERATION
EFFECT/ADVERS
E EFFECT

Drug Ordered: Prevents bacterial -Low respiratory -Contraindicated in patients -Diarrhea -Before giving drug, ask patient about
Amoxicillin and cell-wall synthesis tract infections hypersensitive to drug or -Nausea, vomiting, allergic reactions to penicillin.
Cluvulanate during replication. -Otitis Media other penicillins and in those abdominal pain, However, a negative history of
Potassium 625 mg Increases -Sinusitis with a history of amoxicillin- gastritis penicillin allergy is no guarantee
tab q6 amoxicillin -skin and Skin related cholestatic jaundice or against an allergic reaction.
effectiveness by in structure infections hepatic dysfunction. -Give drug at least 1 hour before a
Brand Name: activating -Urinary Tract -Contraindicated in patients bacteriostatic antibiotic.
Amoxi-clav betaclamases, infections receiving hemodialysis and -Tell patient to take entire quantity of
which destroy -Serious infections those with creatinine drug exactly as prescribed, even after
Classification: amoxicillin. and community clearance less than feeling better.
Anti-infective acquired 30ml/minute. -Instruct patient to take drug with
pneumonia -Use cautiously in patients food to prevent GI upset. If he’s
-Recurrent or with other drug allergies taking the oral suspension, tell him to
persistent acute (especially to cephalosporins) keep drug refrigerated, to shake it
otitis media caused because of possible cross- well before taking it, and to discard
by Streptococcus sensitivity and in those with remaining drug after 10 days.
Pneumoniae, mononucleosis because of -Tell patient to call prescriber if a
Haemophilus high risk of maculopapular rash occurs because rash is a sign of
Influenzae, or rash. an allergic reaction.
Moraxella -Use cautiously in
Catarrhalis breastfeeding women;it’s
unknown if drug appears in
breast milk.
-Use cautiously in hepatically
impaired patients, and
monitor the hepatic function
of these patients.
 DRUG ACTION INDICATION CONTRAINDICATION SIDE NURSING CONSIDERATION
EFFECT/ADVERSE
EFFECT

Drug Ordered: First -Peri-op -Contraindicated to patients -Diarrhea -Ask patient if allergic to any drug
Cefazolin 1mg IV q6 gen.cephalospori prevention and allergic to drugs and other especially antibiotic
n that inhibit cell contaminated cephalosporins -Assess for hypersensitivity
Classification: wall synthesis surgery -Use cautiously to patients
Anti-infective promoting allergic to penicillin
osmotic -Infection of -Use cautiously to
instability respiratory and breastfeeding women
usually biliary and GU
bactericidal tracts

DRUG ACTION INDICATION CONTRAINDICATION SIDE NURSING CONSIDERATION

EFFECT/ADVERSE
EFFECT

Drug Ordered: -May inhibit -Moderate to -Contraindicated to patients -Headache, dizziness, -Ask patient if allergic to any drug
Ketorolac 30mg IV q6 prostaglandin severe pain. allergic to drug insomnia -Assess for hypersensitivity
synthesis to -Acute pain
Classification: produce anti-
NSAID inflammatory
analgesic and
anti-pyretic
effect.
 DRUG ACTION INDICATION CONTRAINDICATION SIDE NURSING CONSIDERATION
EFFECT/ADVERSE
EFFECT

Drug Ordered: -Antipyretic: -Common cold, -Contraindicated with allergy CNS: headache -Do not exceed the recommended
Paracetamol IV 1 amp reduces fever by flu, other viral to acetaminophen. CV: Chest pain, dosage.
acting directly on and bacterial dyspnea, myocardial -Avoid using multiple preparations
the hypothalamic infections with -Use cautiously with damage when doses of containing acetaminophen. Carefully
Classification: heat-regulating pain and fever impaired hepatic function, 5-8 g/day are ingested check all OTC products.
Anti-pyretic center to cause chronic alcoholism, daily for several weeks
vasodilation and pregnancy, lactation or when 4 g/day are -Give drug with food if GI upset is
sweating, which ingested for 1 year noted.
helps dissipate GI: hepatic toxicity and
heat. failure, jaundice _discontinue drug if hypersensitivity
GU: Acute kidney reactions occur.
failure, renal tubular
necrosis
Hematologic:Methemog
lobinemia--
cyanosis;hemolytic
anemia—hematuria,
anuria, neutropenia,
leucopenia,
pamncytopenia,
thrombocytopenia,
hypoglycemia
Hypersensitivity: Rash,
fever
 DRUG ACTION INDICATION CONTRAINDICATION SIDE EFFECT/ADVERSE NURSING CONSIDERATION
EFFECT

Drug Ordered: -Thought to -To relieve signs -Contraindicated in CNS: dizziness, headache, -tell patient to report history of
Celecoxib inhibit and symptoms of patients hypersensitive to insomnia allergic reactions to sulfonamides,
200mg BID prostaglandin osteoarthritis drug, sulfonamides, CV: hypertension, peripheral aspirin, or other NSAIDs before
synthesis, -To relieve signs aspirin, or other NSAIDS. edema therapy.
Brand Name: impending and symptoms of -Contraindicated in those EENT: pharyngitis, rhinitis, -Instruct patient to promptly report
Celebrex cyclooxygenase- rheumatoid with severe hepatic sinusitis signs of GI bleeding such as blood in
2 (COX-2), to arthritis impairment and in the GI:abdominal pain, diarrhea, vomit, urine, or stool: or black, tarry
Classification: produce anti- -To relieve signs treatment of perioperative dyspepsia, flatulence, nausea stools.
NSAID inflammatory, and symptomsof pain after coronary artery Metabolic:hyperchloremia -NSAIDS may increase the risk of
analgesic, and ankylosing bypass graft surgery. Musculoskeletal:back pain serious thrombotic events, MI, or
antipyretic spondylitis -Avoid use in the third Respiratory: Upper stroke. The risk may be greater with
effects. -Adjunctive trimester of pregnancy. respiratory tractinfection longer use or in patients with CV
treatment for -Use cautiously in patients Skin:rash, toxic epidermal disease or risk factors for CV
familial with history of ulcers or GI necrolysis, Steven-Johnson disease.
adenomatous bleeding, advanced renal syndrome, erythema -Watch for signs and symptoms of
polyposis to disease, dehydration, multiforme, exfoliative overt and occult bleeding.
reduce the anemia, symptomatic liver dermatitis -Drug can cause fluid retention;
number of disease, hypertension, Other: accidental injury monitor patient with hypertension,
adenomatous edema, heart failure, or edema, or heart failure
colorectal polyps asthma and in poor -Assess patient for CV risk factors
-Acute pain and CYP2c9 metabolizers. before therapy.
primary -Use cautiously in elderly -Before starting drug therapy,
dysmenorrhea or debilitated patients. rehydrate dehydrated patients.
-Drug can be given without regard to
meals, but food may decrease GI
upset.
X. NURSING CARE PLAN

ASSESSMENT NURSING SCIENTIFIC GOAL INTERVENTION RATIONALE EVALUATION

DIAGNOSIS EXPLANATION

Subjective: Acute pain r/t LTCS Within the shift, INDEPENDENT:

tissue trauma 2° ↓ the patient will: Goal met as evidenced by:
“Nasakit atuy to LTCS Tissue trauma -Monitor/document -Variation of appearance &
sugat atuy tiyan ↓ -Report pain is characteristics of pain behavior of patients in pain may -patient verbalized relief
ko” as verbalized Stimulation of the relieved / noting verbal reports, present a challenge in assessment from pain
by the patient nociceptors controlled nonverbal cues
↓ -Obtain full description of -Pain is subjective experienced and -VS
Release of chemical -Verbalized non- pain for patient including must be described by patients T -37.1
Objective: mediators pharmacologic location, intensity, provides baseline for comparison PR-78
-Grimacing ↓ methods that duration, characteristics to aid in determining effectiveness RR-20
-Irritable Transmission of the provide relief -Instruct patient to report of therapy, sol’n progression of
-Guarding chemical mediators pain immediately problem -Patient verbalized and
behavior on ↓ -Demonstrate demonstrated non-
abdomen Interpretation of the use of relaxation -Assist client to explore -Delay in reporting pain hinders pharmacologic methods
-Restless hypothalamus skills and methods for pain relief/may require increased that provides relief from
-VS ↓ diversional alleviation/control of dosage of medication to achieve pain
T -37.3 Sensitization and activities pain: relief
PR-86 pain perception a. provide comfort -to promote non-pharmacological
RR-24 measures, quiet pain management
BP-120/80 environment
b. Instruct/encourage use -To distract attention and reduce
of relaxation techniques tension enhances sense of control
such as deep breathing and may improve coping abilities
exercises, guided -To maintain acceptable level of
imagery, and music pain

COLLABORATIVE: -With antipyretic and analgesic

-Administer Nalbuphine effects
5mg IV as prescribed by
the physician
ASSESSMENT NURSING SCIENTIFIC GOAL INTERVENTION RATIONALE EVALUATION
DIAGNOSIS EXPLANATION

“Napudut Hyperthermia Surgical incision -Within 1 hour INDEPENDENT Goals met as evidenced
riknak” as r/t infection ↓ the patient’s -To obtain an accurate core by:
verbalized secondary to Entry of temperature -Take axillary temperature
LTCS microorganism will decrease temperature of 1 to 4 -patient’s temperature
Objective: ↓ from 38°C to hours -For baseline data from 38°C to 37.2°C
-flushed skin Infection normal range
-warm to touch ↓ -Assess vital signs -To lower body temperature -Patient maintained
-VS stimulation of the -Within the normal body
T- 38 hypothalamus shift, the -Apply tepid sponge temperature
RR-18 ↓ patient will bath especially in axilla -To promote comfort
PR-78 Thermo-regulatory maintain and groin
BP-100/70 set point temperature
↓ within normal -Remove blankets -To prevent dehydration
Increase range -Remove all wet or
temperature constrictive clothing

-Encourage patient to -To decrease body temperature

increase fluid intake

COLLABORATIVE

-Administer
Paracetamol 1amp RTC
as ordered by the
physician
ASSESSMENT NURSING SCIENTIFIC GOAL INTERVENTION RATIONALE EVALUATION
DIAGNOSIS EXPLANATION

“Nasakit daytoy Sleep LTCS Within the INDEPENDENT

sugat ko, madi deprivation r/t ↓ shift, the
ak makaturog” pain 2° to Tissue trauma patient will: -asses -to identify appropriate Goal met as evide3nce
as verbalized LTCS ↓ -have an causative/contributing intervention by:
Stimulation of the adequate rest factor
OBJECTIVE: nociceptors -Patient relieve from
-Restlessness ↓ -identify -observe for physical -Helps identify appropriate pain
-Irritablity Release of appropriate signs like yawning & option
-Pain rated as chemical interventions to determine interventions -Patient able to sleep &
8/10 mediators promote sleep client has tried had adequate rest
-VS ↓
T -37 Transmission of -Instruct in relaxation -To decrease tension prepare
PR-86 the chemical technique for sleep/rest
RR-20 mediators
BP-130/80 ↓
Interpretation of -Provide calm, quiet -Promote rest & sleep
the hypothalamus environment & manage
↓ controllable sleep-
Sensitization and disrupting factors (
pain perception noise, light, room temp)
↓
Sleep deprivation COLLABORATIVE

-Administer nalbuphine -Relieves pain

5mg IV as order by
physician