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The world as a whole has been facing different constant changes not only in the
environment but also in peopleǯs lives As changes occur, the more people become in
need to adopt with these changes, thus, and we expose ourselves to illness that could
even lead to unwanted events in our lives
The highlight if the presentation deals with the nursing care presentation with
the nursing care plan of our patient revolving on his priority nursing problems, goals of
care, appropriate nursing intervention and its feedback evaluation
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Age: 54
Civil Status: F
Nationality: Filipino
Ê
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HEADACHE
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One day prior to admission, patient complained of headache,
associated with nape pain and dizziness There was also a noted limitation of
motion of the neck area There was no associated vomiting, blurring of vision
prompted patient to seek consult of his physicianǯs clinic Patient was advised to
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be admitted for further evaluation and management, hence the subsequent
admission
HPN- DX 2002
- DM
- Asthma
- Smoker
HPN on both sides
DM on mother side
CA both sides
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ÃÃÃ c ÃÊ
December 6 2010
Conscious, coherent, ambulatory, NÃCRD
Musculoskeletal disorder
Right extremely
BP: 100/90
PR: 81
RR: 18
Temp: 36 8
!
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PPC, AS
- CLAD
- TPC
!
Ê
SCE,
AP, NARR,
- murmurs
Flabby, nabs, soft
- tenderness
GME
- edema
- cyanosis
PEP
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Convulsion, coherent for 3 spheres
Ê
Can perform RAM
No nystagmus
Ê
Ã
N/A
ÃÃ
PERTL 2-3 mm
ÃÃÃ
Ã
Ã
Ãntact EDMs
ÃÃ
No facial symmetry
Ã
Can swallow
Ã
Can shrug shoulders
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R L
5/5 5/5
5/5 5/5
R L
75 % 100 %
75 % 100 %
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ÃV c
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#
$"%" The Anatomy of the Brain
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The brain is protected by a bony covering called the cranium which, along with
the bones of the face, makes up the skull Ãnside the cranium, the brain is
surrounded by the meninges The meninges are made up of 3 layers of tissue:
&
The largest part of the brain located in the front is called the cerebrum The
cerebrum is responsible for:
îc Movement
îc Body temperature
îc Touch
îc Vision
îc Hearing
îc Vudgment
îc Reasoning
îc Problem solving
îc Emotions
îc Learning
The cerebrum has 2 parts: the right cerebral hemisphere and the left cerebral
hemisphere They are connected at the bottom and have a deep groove running
between them Ãn general, the right cerebral hemisphere controls the left side of
the body, and the left cerebral hemisphere controls the right The right side is
involved with creativity and artistic abilities The left side is important for logic
and rational thinking
The hemispheres of the cerebrum are divided into lobes, or broad regions of the
brain Each lobe is responsible for a variety of bodily functions:
The surface of the cerebrum appears wrinkled and is made up of deep grooves
called sulci and bumps or folds called gyri The outer part of the cerebrum is
called gray matter and contains nerve cells The inner part is called white matter
and contains connections of nerves
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&
The brainstem is located in front of the cerebellum The brainstem is like the
hard-drive of a computer Ãt is the main control panel for the body that passes
messages back and forth between the brain and other parts of the body The
cerebrum, the cerebellum, and the spinal cord are all connected to the
brainstem The brainstem has three main parts, the midbrain, the pons, and the
medulla oblongata
îc Breathing
îc Consciousness
îc Cardiac function
îc Ãnvoluntary muscle movements
îc Swallowing
îc Movement of the eyes and mouth
îc Relaying sensory messages pain, heat, noise, etc
îc Hunger
&
!
Behind the cerebrum at the back of the head is the cerebellum Ãn Latin,
cerebellum means Dzlittle brain However, the cerebellum contains more nerve
cells than both hemispheres combined The cerebellum is primarily a movement
control center, responsible for:
Unlike the cerebrum, the left cerebellum controls the left side of the body,
and the right cerebellum controls the right side of the body
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$"'"
The Motor, Sensory and Association Areas of the
Cerebral Cortex
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" The brain is not a solid organ There are fluid-filled
cavities within the brain called ventricles The ventricles are important in
providing nourishment to the brain The ventricular system produces and
processes cerebrospinal fluid Ȃ a clear, watery substance that flows around the
brain and helps cushion and protect it
Ê
" The brain also contains 12 pairs of cranial nerves each
responsible for specific functions in the body:
"
The pituitary gland is located in the center of the brain and is
about the size of a dime The pituitary gland, often referred to as the Dzmaster
gland, is responsible for a number of functions including producing hormones
for the thyroid and adrenal glands, as well as the hormones responsible for
normal growth and sexual maturation
#"c Ê
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"
Two internal carotid arteries and vertebral arteries and their extensive
system of branches provide the blood supply to the brain The internal carotids
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arise from the bifurcation of the common carotid and supply much of the
anterior circulation of the brain The vertebral arteries branch from the
subclavian arteries, flow back to and upward on either side of the cervical
vertebrae, enters the cranium through the foramen magnum The vertebral
arteries join to become the basilar artery at the level of the brain stem; the
basilar artery divides to form the two branches of the posterior cerebral arteries
The vertebrobasilar arteries supply most of the posterior circulation of the
brain
At the base of the brain surrounding the pituitary gland, a ring of arteries is
formed between the vertebral and internal carotid artery chains This ring is
called the circle of Willis and is formed from the branches of the internal carotid
artery, and anterior and middle cerebral arteries, and anterior and anterior and
posterior communicating arteries Functionally, the posterior portion of the
circulation and the anterior or carotid circulation usually remain separate The
arteries of the circle of Willis can provide collateral circulation if one or more of
the four vessels supplying to become occluded or are ligated
The arterial anastomoses along the circle of Willis are frequent sites of
aneurysms Theses can be formed when the pressure at a weakened arterial wall
causes the artery to balloon out Aneurysms may be congenital or the result of
degenerative changes in the vessel wall associated with atherosclerotic vascular
disease Ãf an artery with an aneurysm bursts or becomes occluded by
vasospasm, an embolus, or a thrombus, the neurons distal to the occlusion are
deprived f their blood supply and the cells die quickly The result is hemorrhagic
stroke cerebrovascular accident or infarction The effects of the occlusion
depend on which vessels are involved and which areas of the brain these vessels
supply
Venous drainage for the brain does not follow the arterial circulation as
in other body structures The veins reach the brainǯs surface, join larger veins,
then cross the subarachnoid space and empty into the dural sinuses, which are
vascular channels lying within the tough Dura mater The network of sinuses
carries venous outflow from the brain and empties into the internal jugular vein,
returning the blood to the heart Cerebral veins and sinuses are unique because,
unlike other veins in the body, they do not have valves to prevent blood from
flowing backward and depend on both gravity and blood pressure
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$"(" The Arterial Blood Supply of the Brain, including the
Circle of Willis, as viewed from ventral surface
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Vc Ã
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Stroke could soon be the most common cause of death worldwide Stroke
is currently the second leading cause of death in the Western world, ranking
after heart disease and before cancer, and causes 10% of deaths worldwide
Geographic disparities in stroke incidence have been observed, including the
existence of a "stroke belt" in the southeastern United States, but causes of these
disparities have not been explained
Family members may have a genetic tendency for stroke or share a lifestyle
that contributes to stroke Higher levels of Von Willebrand factor are more
common amongst people who have had ischemic stroke for the first time The
results of this study found that the only significant genetic factor was the
person's blood type Having had a stroke in the past greatly increases one's risk
of future strokes
Men are 25% more likely to suffer strokes than women, yet 60% of deaths
from stroke occur in women Since women live longer, they are older on average
when they have their strokes and thus more often killed NÃMH 2002 Some risk
factors for stroke apply only to women Primary among these are pregnancy,
childbirth, menopause and the treatment thereof HRT
#"c Ê
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-Trouble speaking or understand speech;
-Visual disturbances;
)*%"
eurologic Deficits of Stroke: Manifestations and ursing
Implications
Ã
ÿ
Homonymous îc Unaware of the -Place objects within intact
hemianopsia loss of persons or objects field of vision
half of the visual field on side of the -Approach the patient
visual loss from side of the intact field
îc Neglect of one side of vision
of the body -Ãnstruct/remind the
îc Difficulty judging patient to turn the head in
distances the direction of visual loss
to compensate for loss of
visual field
-Encourage the use of eye
glasses if available
-when teaching the
patient, do so within the
patientǯs intact visual field
Loss o peripheral îc Difficulty seeing at -Avoid night driving or
vision night other risky activities in the
îc Unaware of darkness
objects or the -Place objects in center of
borders of objects patientǯs intact visual field
-Encourage the use of a
cane or other object to
identify objects in the
periphery of visual field
Diplopia îc Double of vision -Explain to the patient the
location of an object when
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placing it near the patient
-Consistently place patient
care items in the same
location
ë
Hemiparesis îc Weakness of the -Place objects within the
face, arm, and leg patientǯs reach on the non
on the same side affected site
due to a lesion in
the opposite
hemisphere
Hemiplegia îc Paralysis of the -Encourage the patient to
face, arm, and leg provide range-of-motion
on the same side exercises to the affected
due to a lesion in site
the opposite -Provide immobilization as
hemisphere needed on the affected
site
_-Maintain body alignment
in functional position
-exercise unaffected limb
to increase mobility,
strength and use
Ataxia îc Staggering, -Support patient during
unsteady gait the initial ambulation
îc Unable to keep phase
feet together; -Provide supportive device
needs a broad for ambulation walker,
base to stand cane
Ãnstruct the patient not to
walk without assistance or
supporting device
Dysarthria îc Difficulty in -Provide the patient with
forming words alternative methods of
communicating
-Allow the patient
sufficient time to respond
to verbal communication
-Support patient and
family to alleviate
frustration relate to
difficulty communicating
Dysphagia îc Difficulty -Test the patientǯs
swallowing pharyngeal reflexes before
offering food or fluids
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-Assist the patient with
meals
-Place food on the affected
site of the mouth
-Allow ample time to eat
u
Paresthesia occurs îc Numbness and -Ãnstruct the patient to
on the site opposite to tingling of avoid using this extremity
the lesion extremity as the dominant limb due
îc Difficulty with to altered sensation
proprioception -Provide range of motion
to affected areas and apply
corrective devices as
needed
ÿ
Expressive aphasia îc Unable to form -Encourage patient to
words that are repeat sounds of the
understandable; alphabet
may be able to
speak in single
word responses
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c
verbal cue; holding a
toothbrush, stimulate
brushing of teeth while
saying, Dzà would like you to
brush your teeth now
-Minimize distracting
noises and views when
teaching the patient
-Repeat and reinforce
instructions frequently
G
îc Loss of self control -Support patient during
îc Emotional lability uncontrollable outbursts
îc Decreased -Discuss with the patient
tolerance to and family that the
stressful situations outbursts are due to the
îc Depression disease process
îc Withdrawal -Encourage the patient to
îc Fear, hostility, and participate in group
anger activity
îc Feelings of -Provide stimulation for
isolation the patient
-Control stressful
situations, if possible
-Provide a safe
environment
-Encourage patient to
express feelings and
frustrations related to
disease process
Ê"c
Stroke patients may present to the acute care facility at any point along a
continuum of neurologic involvement A system that uses the time course to
classify patients along this continuum may be used to guide treatment Strokes
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use the time course is commonly classified in the following manner: 1 transient
ischemic attack; 2 reversible ischemic neurologic disease; 3 stroke in
involution; and 4 compensated stroke
The initial diagnostic test for a stroke is a non contrast computed therapy
CT scan performed emergently to determine of the event is ischemic or
hemorrhagic which determines treatment Further diagnostic work up for
ischemic stroke involves attempting to identify the source of thrombi or emboli
A 12-lead electrocardiogram and a carotid ultrasound are standard tests Other
studies may include Cerebral Angiography, transcranial flow studies,
transthoracic or transesophagel echocardiography, magnetic resonance imaging
of the brain and/or neck, xenon CT, and single photon emission CT
ic Carotid phonoangiography
ii c Computerized axial tomographic scan CT or CAT scan
iii c Digital subtraction angiography DSA
iv c Doppler ultrasound test
vc Electroencephalogram EEG
vi c Evoked response test
vii c Magnetic resonance imaging scanning MRÃ
viii c Radionuclide angiography
+
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accurate images of the brain These are used to determine the presence,
location and size of aneurysms and arteriovenous malformations, which
are potential sources for hemorrhagic stroke This test is performed in 40
minutes to one hour, and causes no discomfort
îc
Ȅ Radioactive compounds are injected into
a vein in the arm; the bloodstream then carries them toward the head As
the radioactive compound circulates in the bloodstream, it constantly
emits bursts of radiation Once the radioactive compound reaches the
brain, these bursts of radiation are detected and used to form an image of
the brain This imaging procedure can show areas where the brain has
been deprived of blood flow and is damaged
-
.
+
-
-+
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normal artery, blood flows in a smooth and controlled manner However,
the presence of blockages, such as those caused by atherosclerosis, causes
the blood flow to become turbulent This turbulent blood flow can create
a sound, called a bruit BROO'e, which can be detected and registered by
the microphone The presence of a bruit may indicate a blockage in the
carotid artery and is cause for more tests
îc DSA Ȅ gives an image of the brain's
major blood vessels A thin plastic tube a catheter is inserted into a
major artery of the leg and advanced through the body's major vessels
until it reaches the brain's blood vessels A contrast dye is injected
through the catheter and allowed to circulate in the bloodstream At that
point, an X-ray machine quickly takes a series of pictures of the head and
neck The images track the movement of the contrast dye as it moves
through the brain's blood vessels This imaging technique lets the doctor
identify and localize the source of a blocked blood vessel that caused the
stroke Some people may feel a warm sensation as the contrast medium is
injected into the blood vessels
"c Ã
!
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)*'"
Summary of IH Stroke Scale
Ê
#
1a Level of Alert 0
Consciousness
alert, drowsy, etc Drowsy 1
Stupotous 2
Coma 3
incorrect 2
Ãncorrect 2
Bilateral Hemianopia 3
Minor 1
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Partial 2
Complete 3
No movement 4
No movement 4
No movement 4
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6b Motor leg-Right No drift 0
elevate extremity
to 30ͼ and score Drift 1
drift movement
Canǯt resist gravity 2
No movement 4
Mute 3
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Ãntubated or Other
Physical Barrier
The level of stroke severity as measured by the NÃH stroke scale scoring system:
/ = no stroke
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VÃ c Ã
Ãn an ischemic brain attack, there is disruption of the cerebral blood flow due
to obstruction of blood vessel This disruption in blood flow initiates a complex
series of cellular metabolic events referred to as the ischemic cascade
The ischemic cascade begins when cerebral blood flow falls less than 25
ml/100 g/min at this point, neurons can no longer maintain anaerobic
respiration The mitochondria must then switch to anaerobic respiration, which
generates large amounts of lactic acid, causing a change in pH level This switch
to the less efficient anaerobic respiration also renders the neuron incapable of
producing sufficient quantities of adenosine triphosphate ATP to fuel the
depolarization process Thus membrane pumps that maintain electrolyte
balances begin to fail and the cells cease to function
Early in the cascade, an area of low cerebral blood flow, referred to as
penumbra region, exists around the area of infarction The
is
ischemic brain tissue that can be salvaged with timely intervention The ischemic
cascade threatens cells in the penumbra because membrane depolarization of
the cell walls leads to an increase in intracellar calcium and the release of
glutamate The penumbra area can be revitalized with the administration of
tissue plaminogen activator t-PA, and the influx of calcium can be limited with
the use of cacium channel blocker The influx of calcium and release of
glutamate, if continued, activate a number of damaging pathways that result in
the destruction of the cell membrane, the release of more calcium and glutamate,
vasoconstriction, and the generation of free radicals These processes enlarge
the area of infarction into the penumbra, extending the stroke
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ccc
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0*% Pathophysiology of the Cerebrovacular Accident èrocess
contributing to ischemic brain iinjury. Courtesy of ational Stroke
Association, Englewood, Colorado
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VÃÃ c #
"c Ê
#
Ê
/0
'/%/
Ã
117 g/L 123-152 g/ L Lower
0 36 0 37-0 42 % Slightly lower
#Ê
11 9 5 0-10 0 x 10 Higher
g/L
Ê
0 22 0 20-0 40 Normal
0 07 0 02-0 08 Normal
0 01 0 01-0 03 Normal
#
0 01 0-0 02 Normal
0 69 0 40-0 60 Higher
#Ê
4 98 4 5-5 5x10/2 L Normal
Ê
73 88-96 Lower
Ê
23 5 27-33 pg Lower
ÊÊ
321 330-360 g/L Lower
14 3 12 7-22 7 % Normal
0-20 mm/hr
#"c
Ê
88 2mmol/L
135 mmol/L
4 3 mmol/L
Ê
1 12 mmol/L
Ê
92 mmol/L
Ê"c Ê
Ê
Ê
5 0 mmol/L
0 32 mmol/L
Ê
1 9 mmol/L
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Ê
3 66 mmol/L
"c Ê
1
'/%/
Ã
Cortical cerebral atrophy
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Ê
-
"
1
'/%/
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VÃÃÃ c Ê
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#
Osmitrol
2
75 mg prn
Ê
Diagnostic agent; osmotic diuretic, urinary irrigant
Ã
îc Prevention and treatment of oliguric phase of
renal disease
îc Reduction of intracranial pressure and
treatment of cerebral edema; of elevated ÃOP
when the pressure cannot be lowered by
other means
îc Promotion of the urinary excretion of toxic
substances
îc Diagnostic use: measurement of GFR
îc Ãrrigant in transurethral prostatic resection or
other transurethral precedures
Elevates the osmolarity of the glomerular filtrate,
thereby hindering the reabsorption of water and
leading to a loss of water, sodium, chloride used for
diagnosis of glumerular filtration rate; creates an
osmotic gradient in the eye between plasma and
oclular fluids, thereby reducing ÃOP; creates an
osmotic effect, leading to decreased swelling in
posttransurethral prostatic resection
!
!
:
ÃV infusion only; individualized concentration and rate of administration
Dosage is 50-200g/day Adjust dosage to maintain urine flow of 30-50 ml/hr
îc èrevention of oliguria: 50-100 g ÃV as a 5% -25% solution
îc Treatment of oliguria: 50-100 g ÃV of a 15%-25% solution
îc 6eduction of intracranial pressure and cerebral edema: 1 5-2g/kg ÃV as
a 15%-25% solution over 30-60 minutes Evidence of reduced
pressure should be seen in 15 minutes
îc 6eduction of IOè: infuse 1 5-2 g/kg as a 25% solution, 20% solution Or
15% solution over 30 minutes Ãf used preoperatively, use 60-90
c
c
minutes before surgery for maximal effect
îc Adjunctive therapy to promote dieresis in intoxications: maximum of
200 g ÃV of mannitol with other fluids and electrolytes
îc Measurement of glumerular filtration rate: dilute 100 ml of a 20%
solution with 108 ml of sodium chloride injection Ãnfuse this 280 ml of
702% solution ÃV at rate of 20 ml/ min collect urine with a catheter for
the specified time for measurement of mannitol in mg/min draw blood
at the start and at the end of the time for measurement of mannitol in
mg/ml plasma
îc Test dose of mannitol for patients with inadequate renal function: 0 2
g/kg ÃV about 50 ml of 25% solution, 75 ml of a 20% solution in 3-5
minutes to produce urine flow of 30-50 ml/hour Ãf urine flow does not
increase, repeat dose Ãf no response to second dose, reevaluate patient
situation
îc {rologic irrigation: use prepared 5g/ 100ml distilled water solution;
irrigate as needed
Ê
Dizziness, headache, blurred vision, ,,
Ê
îc
Pulmonary congestion, active intracranial bleeding,
dehydration, renal disease, heart failure, pregnancy,
lactation
îc
Skin color, lesions, edema, hydration, orientation,
muscle strength , reflexes, pupils, pulses, BP,
perfusion; Respiratory pattern, adventitious sounds,
urinary output patterns, serum electrolytes,
urinalysis , renal function tests
c
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Ã
¦ : Do not give electrolyte free mannitol with blood Ãf blood must be
given, add at least 20 mEq of sodium chloride to each liter of mannitol
solution
îc Do not exposesolutions to low temperatures; crystallization may occur
Ãf crystals are seen, warm the bottle in a hot water bath, then cool to
body tempearature before administering
îc Make sure the infusion set contains a filter if giving concentrated
mannitol
îc Monitor serum electrolyte periodically with prolonged therapy
îc *ou may experience these side effects: Ãncreased urination; GÃ upset
eat frequent small meals; dry mouth suck sugarless lozenges;
headache, blurred vision use caution when moving for assistance
îc Report difficulty of breathing, pain in the ÃV site, chest pain
#"c
#
Ultral, Ultral ER
2
50 mg PO q 6h
Ê
Analgesic centrally acting
Opoid Analgesic
Ã
îc relief of moderate to moderately severe pain
îc relief of moderate to severe chronic pain
in adults who need RTC Treatment for
extended periods ER tablets
îc Unlabelled uses: Premature ejaculation;
restless leg syndrome
Binds to mu-opiod receptors and inhibits the
reuptake of norepinephrine and serotonin; causes
many effects similar to opoids- dizziness,
somnolence, nausea, constipation - but does not
have the respiratory depressant effects
!
!
îc èatients who require rapid analgesic effect: 50-100mg PO every 4-6 hr;
do not exceed 400 mg/day
c
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îc èatients with moderate to moderately severe chronic pain: Ãnitiate at 25
mg /day in the morning, and titrate in 25-mg increments every 3 days
to reach 100 mg/day Then increase every 3 days to reach 200 mg/day
After titration, 50-100mg every 4-6 hours; do not exceed 400 mg/day
Alternatively, 100-mg ER tablet once daily, titrated by 100-mg
increments every 5 days; do not exceed 300 mg/day
-
Ê
Sedation, dizziness or vertigo, headache, confusion,
dreaming, sweating, anxiety, seizures
Ê
Ê
îc
Hypersensitivity to tramadol; pregnancy; acute
intoxication with alcohol, opoids, psychotropic
drugs or other centrally acting analgesics; lactation;
seizures; concomitant use of CNS depressants or
MAOÃs; renal ore hepatic impairment; past or
present history of opoid addiction
c
c
îc
Skin color, texture, lesions; orientation, reflexes,
bilateral grip strength, affect; Pulmonary
auscultation, BP; bowel sounds, normal output;
LFTs, renal function tests
Ã
Ê"c Ê
#
Celebex
2
100 mg PO bid
Ê
Analgesic nonopoid
NSAÃD
Specific COX-2 enzyme inhibitor
Ã
îc acute and long term treatment of Signs and
symptoms of rheumatoid arthritis and
osteoarthritis
îc reduction of the number of colorectal polyps
in familial adenomatous polyposis FAP
îc management acute pain
îc treatment of primary dysmenorrhea
îc relief of signs and symptoms of ankylosing
spondylitis
îc Relief of signs and symptoms of juvenile
rheumatoid arthritis
Analgesic and anti-inflammatory activities related to
inhibition of the COX-2 enzyme, which is activated Ã
inflammation to cause the signs and symptoms
associated with inflammation; does not affect the
COX-1 enzyme, which protects the lining of the GÃ
tract and has blood clotting and renal functions
!
!
c
c
Crosses placenta; may enter breast milk
Bile, urine
Use cautiously with impaired hearing, hepatic and
CV condition
Ê
îc
Renal impairment, impaired hearing, allergies
hepatic and CV conditions, lactation and pregnancy
îc
Skin color and lesions; orientation, reflexes,
ophthalmologic and audiometric evaluation,
c
c
peripheral sensation; Pulmonary edema,
Respiratory, adventitious sounds; liver evaluation;
CBC, LFTǯs, renal function tests; serum electrolytes
Ã
# !
#
-
Be aware that the patient maybe at increased risk for
CV events, GÃ Bleeding; monitor accordingly
îc Administer drug with food or after meals if GÃ upset occurs
îc Establish safety measures if CNS or visual disturbances occur
îc Arrange for periodic ophthalmologic examination during long term
therapy
Ãf overdose occurs, institute emergency procedures-gastric lavage,
induction of emesis, supportive therapy
îc Provide further comfort measures to reduce pain e g positioning,
environmental control and t reduce inflammation e g warmth,
positioning, and rest
Ê
îc Take only the prescribed dosage, do not increase dosage
îc *ou may experience these side effects: Dizziness, drowsiness avoid
driving or the use of dangerous machinery while taking this drug
îc Report sore throat, fever, rash, itching, swelling in ankles or fingers;
changes in vision
"c
#
Benicar
2
20 mg/ day PO as a once-daily dose
Ê
Angiotensin ÃÃ receptor antagonist
Antihypertensive
Ã
Treatment of hypertension, alone or in combination
with other hypertensives
Selectively blocks the binding Angiotensin ÃÃ to
specific tissue receptors found in the vascular
smooth muscle and adrenal gland; this action blocks
the vasoconstricting effect of the renin-angiotensin
system as well as the release of aldosterone leading
to decreased BP; may prevent the vessel remodeling
associated with the development of atherosclerosis
!
!
c
c
îc History Hypersensitivity to any component of the drug,
pregnancy, lactation, hepatic or renal impairment
hypovolemia, salt depletion
c
c
with volume expansion
îc Monitor patient closely in any situation that may lead to decreased in
BP secondary to reduction in fluid volume- excessive perspiration,
dehydration, vomiting, diarrhea; excessive hypotension can occur
Ê
îc Take drug without regard of meals Do not stop taking this drug
without consulting your health care provider
îc Use barrier method of birth control while using this drug; if you
become pregnant or desire to become pregnant, consult your health
care provider
îc Take special precautions to maintain your fluid intake and safety
precautions in any situations that night cause a loss of fluid volume-
excessive perspiration, dehydration, vomiting, diarrhea; excessive
hypotension can occur
îc *ou may experience these side effects: Dizziness avoid driving a car or
perform hazardous activitie0; headache medications may be available
to help nausea, vomiting diarrhea proper nutrition is important,
consult dietician o maintain nutrition; symptoms of the upper
respiratory tract and cough do not self medicate, consult your health
care provider if this becomes uncomfortable
îc Report fever, chills, dizziness, pregnancy, and swelling
c
c