TEACHING/LEARNING May report: Use of multiple medications (prescribed and over-the-counter [OTC]) with interactive effects Discharge plan

DRG projected mean length of inpatient stay: femur 9.0 days; hip/pelvis, 6.7 days; all other, 2.55.0 if hospitalization required considerations: May require temporary assistance with transportation, self-care activities, and homemaker/maintenance tasks May require additional therapy/rehabilitation post discharge, or possible placement in assisted- living/extended-care facility for a period of time Refer to section at end of plan for postdischarge considerations

Arcoxia -acute and chronic treatment of the signs and symptoms of osteoarthritis and rheumatoid arthritis -relief of acute pain How does Arcoxia work? Arcoxia belongs to a group of medicines called cyclooxygenase-2 (COX-2) specific inhibitors (also known as Coxibs). The body produces two similar enzymes called COX-1 and COX-2. COX-1, among other functions, is involved with protecting the stomach, while COX-2 plays a role in joint inflammation and pain. Arcoxia reduces pain and inflammation by blocking COX-2, an enzyme in the body. Arcoxia does not block COX-1, the enzyme involved in protecting the stomach from ulcers. Other anti-inflammatory medicines (NSAIDS) block both COX-1 and COX-2.

Arcoxia relieves pain and inflammation with less risk of stomach ulcers compared to NSAIDS. However taking aspirin with Arcoxia may reverse this benefit (see Before you take Arcoxia, Taking Other Medicines). In clinical studies, the risk of developing ulcers on Arcoxia was lower than with NSAIDs. Some people developed ulcers whether they were taking Arcoxia or placebo in these studies; however the rate was higher on Arcoxia. If any of the following symptoms: shortness of breath, chest pains or ankle swelling appear or worsen, stop your treatment with Arcoxia and consult a doctor, as soon as is practical. If you have kidney, liver or heart disease, your doctor will want to appropriately keep a check on you. If you develop any symptoms that could indicate a severe allergic reaction such as an inability to breathe or a serious skin reaction you must consult a doctor on an urgent basis. Your doctor will want to discuss your treatment from time to time. It is important that you use the lowest dose that controls your pain and you should not take Arcoxia for longer than necessary. This is because the risk of heart attacks and strokes might increase after prolonged treatment, especially with high doses. Arcoxia can increase blood pressure in some people, especially in high doses, and this could increase the risk of heart attacks and strokes. Your doctor will want to check your blood pressure from time to time, to make sure that it is safe to continue treatment. Your doctor may have prescribed Arcoxia for another reason. Ask your doctor if you have any questions about why Arcoxia has been prescribed for you. Arcoxia is not addictive. Before you take Arcoxia Do not take Arcoxia if:
y y y y

you have an allergy to Arcoxia or any of the ingredients listed at the end of this leaflet the packaging is torn or shows signs of tampering the expiry date on the pack has passed. If you take this medicine after the expiry date has passed, it may not work. You have had heart failure, a heart attack, bypass surgery, chest pain (angina), narrow or blocked arteries of the extremities (peripheral arterial disease), a stroke or mini stroke (TIA or transient ischaemic attack).

y y

You have high blood pressure that is not well controlled on blood pressure medication. You are having major surgery and have conditions which increase your risk of coronary artery disease or atherosclerosis such as high blood pressure, diabetes, high cholesterol or smoking. You are having major surgery on you heart or arteries.

If you are not sure whether you should start taking Arcoxia, talk to your doctor. Arcoxia has not been adequately studied in children. Therefore, Arcoxia should not be given to children. Arcoxia works equally well in older and younger adult patients. Adverse experiences may occur at a higher incidence in older patients compared to younger patients. If you are elderly (ie over 65 years of age), your doctor will want to appropriately keep a check on you. No dosage adjustment is necessary for older patients. Before you start to taking Arcoxia tell your doctor if:
y

y y

you are pregnant or intend to become pregnant Arcoxia is not recommended for use during late pregnancy. If there is a need to consider using Arcoxia during your pregnancy, your doctor will discuss with you the benefits and risks of using it. you are breast-feeding or plan to breast-feed It is not known if Arcoxia passes into breast milk. You and your doctor should discuss whether you should stop breast-feeding or not take Arcoxia. you have or have had any medical conditions, especially the following: history of angina, heart attack or a blocked artery in your heart narrow or blocked arteries of the extremities kidney disease liver disease heart failure high blood pressure you have had an allergic reaction to aspirin or other anti-inflammatory medicines (commonly known as NSAIDs) Symptoms of an allergic reaction may include asthma, pinkish itchy swellings on the skin (hives), runny or blocked nose. you have an infection If you take Arcoxia while you have an infection, it may hide fever and may make you think, mistakenly, that you are better or that your infection is less serious than it might be. you have any allergies to any other medicines or any other substances, such as foods, preservatives or dyes. you have a history of stroke or mini stroke

you have conditions which increase your risk of coronary artery disease or atherosclerosis such as high blood pressure, diabetes, high cholesterol or smoking.

If you have not told your doctor about any of the above, tell them before you take any Arcoxia. Tell your doctor if you are taking any other medicines, including medicines that you buy without a prescription from your pharmacy, supermarket or health food shop. Some medicines and Arcoxia may interfere with each other. These include:
y y y y y y y y

warfarin, a medicine used to prevent blood clots rifampicin, an antibiotic used to treat tuberculosis and other infections water pills (diuretics) ACE inhibitors and angiotensin receptor blockers, medicines used to lower high blood pressure or treat heart failure lithium, a medicine used to treat a certain type of depression birth control pills hormone replacement therapy methotrexate, a medicine used to suppress the immune system

These medicines may be affected by Arcoxia or may affect how well it works. You may need different amounts of your medicine, or you may need to take different medicines. Your doctor or pharmacist has more information on medicines to be careful with or avoid while taking Arcoxia. Arcoxia can be taken with low dose aspirin. If you are currently taking low dose aspirin for the prevention of a heart attack or stroke, you should continue to do so unless specified by your Doctor. Arcoxia cannot replace aspirin for this purpose. How to take Arcoxia Take Arcoxia only when prescribed by your doctor. For osteoarthritis, the recommended dose is 60 mg once a day. For rheumatoid arthritis the recommended dose is 90 mg once a day. For ankylosing spondylitis the recommended dose is 90 mg once a day. For the relief of gout attacks the recommended dose is 120 mg once a day, which should only be used for the acute painful period.

For the relief of chronic musculoskeletal pain the recommended dose is 60 mg once a day. Doses greater than those recommended for each condition have either not demonstrated additional efficacy or have not been studied. Therefore, the daily doses stated above for each condition should not be exceeded. If you have mild liver disease, you should not take more than 60 mg a day. If you have moderate liver disease, you should not take more than 60 mg every other day. Follow all directions given to you by your doctor carefully. They may differ from the information contained in this leaflet. If you do not understand the instructions on the box, ask your doctor or pharmacist for help. Arcoxia comes as tablets. When taking the tablets, swallow them with a glass of water. Do not halve the tablet. Take your Arcoxia at about the same time each day. Taking Arcoxia at the same time each day will have the best effect. It will also help you remember when to take the dose. It does not matter if you take Arcoxia before or after food. Do not use Arcoxia for longer than your doctor says. Your doctor will want to discuss your treatment from time to time. It is important that you use the lowest dose that controls your pain and you should not take Arcoxia for longer than necessary. This is because the risk of heart attacks and strokes might increase after prolonged treatment, especially with high doses. Depending on your condition, you may need to take Arcoxia for a few days or for a longer period. For osteoarthritis and rheumatoid arthritis Arcoxia helps relieve your symptoms but it does not cure it. Continue taking Arcoxia for as long as your doctor prescribes. For the relief of gout attacks or other types of pain, Arcoxia is usually only needed for a few days. If you are not sure how long to take Arcoxia, talk to your doctor.

If it is almost time for your next dose, skip the dose you missed and take your next dose when you are meant to. Otherwise, take it as soon as you remember, and then go back to taking your tablet(s) as you would normally. If you are not sure whether to skip the dose, talk to your doctor or pharmacist. Do not take a double dose to make up for the dose that you missed. If you have trouble remembering to take your tablets, ask your pharmacist for some hints. If you take too much Arcoxia (overdose) immediately telephone your doctor or Poisons Centre or go to the emergency department at your nearest hospital, if you think that you or anyone else may have taken too much Arcoxia. Do this even if there are no signs of discomfort or poisoning. While you are using Arcoxia If you become pregnant while taking Arcoxia, tell your doctor immediately. If you get an infection while taking Arcoxia, tell your doctor. Arcoxia may hide fever and may make you think, mistakenly, that you are better or that your infection is less serious than it might be. If you are about to be started on any new medicine, tell your doctor and pharmacist that you are taking Arcoxia. Do not give Arcoxia to anyone else, even if they have the same condition as you. Some self help measures suggested below may help your condition. Talk to your doctor or pharmacist about these measures and for more information.
y

y y y

Exercise - regular exercise can help reduce pain and disability from osteoarthritis by increasing muscle strength and reducing the load on joints, but it is important not to overdo it. Walking is good exercise, however, before starting any exercise, ask your doctor about the best kind of programme for you. Weight - your doctor may suggest losing some weight to help reduce the strain on your joints. Some people may need a dietician's help to lose weight. Hot and cold treatments. Using support devices.

Adverse Effects Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking Arcoxia.

Arcoxia helps most people with osteoarthritis, rheumatoid arthritis, menstrual pain, gout or other types of pain, but it may have unwanted adverse effects in a few people. All medicines can have adverse effects. Sometimes they are serious, most of the time they are not. You may need medical treatment if you get some of the adverse effects. Ask your doctor or pharmacist to answer any questions you may have. Tell your doctor if you notice or have any of the following and they worry you:
y y y y y y y

feeling sick (nausea), vomiting heartburn, indigestion, uncomfortable feeling or pain in the stomach diarrhoea swelling of the legs, ankles or feet high blood pressure dizziness headache

Additionally, the following have been reported:

y y y y y y y y y y y y y

allergic reactions including rash, itching and hives severe skin reactions, which may occur without warning taste alteration wheezing insomnia anxiety drowsiness mouth ulcers diarrhoea severe increase in blood pressure confusion hallucinations platelets decreased

These are usually the mild adverse effects of Arcoxia. If any of the following happen, stop taking Arcoxia and tell your doctor immediately or go to Accident and Emergency at your nearest hospital:
y

y y y y y

swelling of the face, lips, tongue or throat which may cause difficulty in swallowing or breathing (hypersensitivity reactions, anaphylactic/anaphylactoid reactions including shock) abnormal rhythm of the heart (atrial fibrillation) heart failure palpitations serious kidney problems serious liver problems

y y

stomach pain stomach ulcers that may become serious and may bleed, and may occur at any time during use and without warning

Other adverse effects not listed above may also occur in some patients. Tell your doctor if you notice any other effects. Do not be alarmed by this list of possible adverse effects. You may not experience any of them. After using Arcoxia Keep your tablets in the blister pack until it is time to take them. If you take the tablets out of the blister pack they may not keep well. Keep Arcoxia in a cool dry place where the temperature stays below 30 C. Do not store it or any other medicine in the bathroom or near a sink. Do not leave it in the car or on window sills. Heat and dampness can destroy some medicines. Keep it where children cannot reach it. A locked cupboard at least one-and-a-half metres above the ground is a good place to store medicines. If your doctor tells you to stop taking Arcoxia, or the tablets have passed their expiry date, ask your pharmacist what to do with any that are left over.

Clindamycin is a lincosamide antibiotic. It is used to treat infections and anaerobic bacteria. It can be also used to treat some protozoal diseases like malaria and can be useful against some methicillin-resistant Staphylococcus aureus infections. Clindamycin is also common topical treatment for acne. Common brand names are Anerocin, Clindal, Dalacin, Dalacin C, Inprosyn-HP, Klindex, and Zindal. Clindamycin is classified as Lincosamide and Antibiotic. Indication of Clindamycin Treatment of respiratory tract, skin or soft tissue, chronic bone or joint infections; septicemia; intra-abdominal, female genitourinal infections; bacterial vaginosis; endocarditis. Can be used for acne vulgaris. Clindamycin is used for treatment of malaria, otitis media, Pneumocystis carinii pneumonia, and toxoplasmosis. Route and Dosage of Clindamycin IV/IM: ADULTS, ELDERLY: 1.2-1.8 g/day in 2-4 divided doses. CHILDREN: 25-40 mg/kg/day in 3-4 divided doses. Maximum: 4.8 g/day. PO: ADULTS, ELDERLY: 150-450 mg/dose q6-8h. CHILDREN: 10-30 mg/kg/day in 3-4 divided doses. Maximum: 1.8 g/day. Bacterial Vaginosis Intravaginal: ADULTS: One applicatorful at bedtime for 3-7 days or 1 suppository at bedtime for 3 days. PO: ADULTS, ELDERLY: 300 mg 2 times/day for 7 days. Acne Vulgaris Topical: ADULTS: Apply thin layer 2 times/day to affected area. Action of Clindamycin Bacteriostatic. Clindamycin binds to bacterial ribosomal receptor sites. Topically, it decreases fatty acid concentration on skin. It inhibits protein synthesis of bacterial cell wall and prevents outbreak of acne vulgaris. Side Effect and Adverse Reaction of Clindamycin Side Effects of Clindamycin
y y y

Abdominal pain Nausea and Vomiting Diarrhea

y y y y y y y y

Vaginitis and itching Dry scaly skin Phlebitis, thrombophlebitis with IV administration Pain, induration, at the IM injection site Allergic reaction, urticaria, pruritus Headache and dizziness Contact dermatitis Hypersensitivity reaction

Adverse Reactions or Toxic Effects of Clindamycin

y y y

Antibiotic-associated colitis (Severe abdominal pain, tenderness, fever, watery and severe diarrhea) Blood dyscrasias (Leukopenia and thrombocytopenia) Nephrotoxicity (Proteinuria, azotemia, oliguria)

Nursing Consideration for Clients Taking Clindamycin

y y y y y y y y y

Store capsules at room temperature After reconstitution, oral solution is stable for 2 weeks at room temperature. Do not refrigerate oral solution to avoid thickening. Give with 8 oz water. Question patient for history of allergies, particularly to clindamycin, lincomycin, and aspirin. Avoid concurrent use of neuromuscular blocking agents. Monitor bowel activity, stool consistency; report diarrhea promptly due to potential for serious colitis. Assess skin for rash with topical application. Assess for superinfection: severe diaarhea, genital/anal pruritus, increase fever, and change of oral mucosa.

Patient Teaching for Clients Taking Clindamycin

y y y y

y y y

Continue therapy for full length of treatment. Doses should be evenly spaced. Oral doses should be taken with 8 oz water. Caution should be used when applying topical clindamycin concurrently with peeling/abrasive acne agents, soaps, alcohol-containing cosmetics to avoid cumulative effect Do not apply topical preparations near eyes, abraded areas. If accidental contact with eyes, rinse with cool tap water. Do not engage in sexual intercourse during treatment.

Ciprofloxacin is a synthetic chemotherapeutic antibiotic from the fluoroquinolone drug class. It was first patented by Bayer A. G. in 1983 and was approved by the Food and Drug Administration in 1987. Common brand names of Ciprofloxacin are Alcipro, Bacipro, Baxolyn, Baycip, Ciclodin, Cidrolex, Ciflodal, Cifloxin, Ciloxan, Ciprobay, Ciprobiotic, Ciprotor, Flosicron, Floxil, Holdestin, Hyprocel, Iprobac, Iprolan, Proseloc, Proquin, Qinosyn, Xipro, and Zyflox. Ciprofloxacin is classified as a Fluoroquinolone and an Anti-infective. Indication for Ciprofloxacin Ciprofloxacin is used in the treatment of chronic bacterial prostatitis. It is also used in the treatment of skin or skin structure, GI tract, bone or joint, lower respiratory tract, and urinary tract infections. Ciprofloxacin is also used in the treatment of chancroid. Ciprofloxacin is also used in the treatment of infectious diarrhea, uncomplicated gonorrhea, empiric treatment of febrile neutropenia, and acute sinusitis. It can also be

used for conjunctival keratitis, keratoconjunctivitis, corneal ulcers, blepharitis, dacrocystitis, blepharoconjunctivitis, and acute meibomianitis. Routes and Dosage of Ciprofloxacin Mild to Moderate Urinary Tract Infections PO: ADULTS, ELDERLY: 250mg every 12 hours. IV: ADULTS, ELDERLY: 200mg every 12 hours. Complicated Urinary Tract, Mild to Moderate Respiratory Tract, Skin or Skin Structure, Bones, Joint Infections, Infectious Diarrhea PO: ADULTS, ELDERLY: 500mg every 12 hours. IV: ADULTS, ELDERLY: 400mg every 12 hours. Severe, Complicated Infections PO: ADULTS, ELDERLY: 750 mg every 12 hours. PO: ADULTS, ELDERLY: 400mg every 12 hours. Prostatitis PO: ADULTS, ELDERLY: 500mg every 12 hours for 28 days. Uncomplicated Bladder Infections PO: ADULTS: 100mg 2 times a day for 3 days. Acute Sinusitis PO: ADULTS, 500mg every 12 hours. Uncomplicated Gonorrhea PO: ADULTS: 250mg as single dose. Usual Dosage for Children PO: 20-30 mg/kg/day in 2 divided doses. Maximum: 1.5 g per day. IV: 20-30 mg/kg/day in 2 divided doses every 12 hours. Maximum: 800mg per day.

Dosage in Renal Impairment Dose and frequency is modified in patients based on severity of infection, degree of renal impairment. Hemodialysis and peritoneal dialysis, 250-500mg every 24 hours after dialysis. Usual Opthalmic Dose Corneal Ulcer: ADULTS, ELDERLY: 2 drops every 15 minutes for 6 hours, then 2 drops ever 30 minutes for remainder of first day; 2 drops every 1 hour for second day; then 2 drops every 4 hours in days 3-14. Conjuctivitis: ADULTS, ELDERLY: 1-2 drops every 2 hours for 2 days, then 2 drops every 4 hours in the next 5 days. Action of Ciprofloxacin Ciprofloxacin inhibits DNA enzyme in susceptible microorganisms. It interferes with bacterial DNA replication. Ciprofloxacin is also bactericidal. Side Effects and Adverse Reactions of Ciprofloxacin Side Effects of Ciprofloxacin
y y y y y y y y y y y y y y y y y y y y y

Nausea Diarrhea Dyspepsia Vomiting Constipation Flatulence Confusion Crystalluria Burning Crusting in the corner of eye Abdominal pain or discomfort Headache Rash Bad taste Redness of the eyelid Confusion Hallucination Hypersensitivity reaction Insomnia Dry mouth Paresthesia

Adverse Reactions of Ciprofloxacin

y y y y y y

Superinfection (especially enterococcal and fungal) Nephropathy Cardiopulmonary arrest Cerebral thrombosis may occur Arthropathy may occur if given to children <18 years. Sensitization may contraindicate later systemic use of Ciprofloxacin

Nursing Considerations for Clients Taking Ciprofloxacin

y y y y y y y y

Question for history of hypersensitivity to Ciprofloxacin or Quinolones. May be given without regards to meals. Preferred dosing time 2 hours after meals. Do not administer antacids within 2 hours of Ciprofloxacin. Encourage cranberry juice or citrus fruits. Evaluate food tolerance. Determine pattern of bowel activity. Check for dizziness, headache, visual difficulties, and tremors. Observe therapeutic response.

Patient Teachings for Clients Taking Ciprofloxacin

y y y y y y y y

Do not skip doses, take full course of therapy. Take with 8 oz water, drink several glasses of water between meals. Eat or drink high sources of ascorbic acid, like cranberry juice or citrus fruits, to prevent crystalluria. Do not take antacids. Shake suspension well before using. Do not chew microcapsules in suspension. Sugarless gum or hard candy may relieve bad taste. Opthalmic: A crystal precipitate may form but usually resolves in 1-7 days.

ASSESSMENT Subjective: Hindi ko maigalaw ung binti ko , as verbalized by the patient Objective: >limited range of motion >slowed movement >limited ability to perform

gross and fine motor > with cast on left leg >Functional Level: 3 Impaired physical mobility related to loss of integrity of bone structures (fracture) INFERENCE: Trauma (Vehicular accident) Fracture of the left leg bleeding from damaged ends of bone and surrounding tissue stimulates inflammatory response increased capillary permeability fluid and cellular

exudation

pain

impaired physical mobility At the end 6hrs. of nurse-patient interaction and

intervention, the patient will: a) Verbalize understanding of the situation and individual treatment regimen and safety measures. b) Participate in ADLs and desired activities c)Maintain position of function and skin integrity as evidenced by absence of decubitus ulcers d) Maintain and increase strength and function of affected part

Determine diagnosis that

contributes to immobility. > note situations such as fractures > determine the degree of immobility in relation to suggested scale > determine presence of complications related to immobility (pneumonia, elimination problems,decubitus) > Assist client reposition self on a regular schedule

Support affected body part using pillows. > Encourage adequate intake of fluids/nutritious foods RATIONALE To identify contributing factors > cause it may restrict movement

> to assess functional mobility > to assess presence of complications > to promote optimum level of function and prevent complications > to maintain position and function and reduce risk of pressure ulcers. > It promote wellbeing and maximizes energy production

BACTIDOL Contents Hexetidine Indications Minor sore throat; halitosis; general oral hygiene; improves appearance of mouth tissues; protects tooth surfaces against formation of decay acids. Dosage Hold 15-20 mL in the mouth. Swish & gargle for 30 sec in the morning & evening. Use full strength. Special Precautions Caution use in childn 6 yr. Do not swallow. Adverse Drug Reactions Transient numbness & alteration in taste may occur.View ADR Monitoring Form MIMS Class Mouth/Throat Preparations ATC Classification A01AB12 - Hexetidine ; Belongs to the class of local antiinfective and antiseptic preparations. Used in the treatment of diseases of the mouth.

Brand Name: Bactidol Generic Name:Hexetidine Indications: Minor sore throat; halitosis, general oral hygiene, Improves appearance of mouth tissue, protects toothe surfaces afaints formation of decay acids. Drug Classification: Oral antiseptic Mechanism of action: Protection against oral bacterial and fungal infection to give fast relief from sore throat and mouth ulcers. First, bactidol quicly reduces bacteria in the affected areas to help relieve and prevent soreness, then hexetidine contains adheres to affected areas for extended period of time, giving long lasting protection. Dosage: mouthful should be held in the mouth, swished and gargled for 30sec in the morning and evening. Use full strength. Special Precaution: Children <6y/o Pregnancy Risk Category: B Adverse reaction: No available data Contraindication: Lesions and ulcerations of oral/buccal mucosa. Form: Aqueous solution: 30ml, 60ml, 150ml/

Nursing Responsibilities: Instruct patient not to swallow the medication. Caution the patient that the solution may be too harsh to taste. Assess for any lesions in the mouth of the patient.

What is this medicine? PIPERACILLIN; TAZOBACTAM (pi PER a sil in; ta zoe BAK tam) is a penicillin antibiotic. It is used to treat certain kinds of bacterial infections. It will not work for colds, flu, or other viral infections. This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions. What should I tell my health care provider before I take this medicine? They need to know if you have any of these conditions:
y y y y y y

bleeding problems kidney disease salt restricted diet an unusual or allergic reaction to piperacillin, tazobactam, other penicillin or cephalosporin antibiotics, imipenem, foods, dyes, or preservatives pregnant or trying to get pregnant breast-feeding

How should I use this medicine? This medicine is for infusion into a vein. It is usually given by a health care professional in a hospital or clinic setting. If you get this medicine at home, you will be taught how to prepare and give this medicine. Use exactly as directed. Take your medicine at regular intervals. Do not take your medicine more often than directed. It is important that you put your used needles and syringes in a special sharps container. Do not put them in a trash can. If you do not have a sharps container, call your pharmacist or healthcare provider to get one. Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed. Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once. NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose? If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses. What may interact with this medicine?
y y y y y y

aspirin and aspirin-like drugs certain antibiotics given by injection medicines that treat or prevent blood clots like warfarin, heparin, enoxaparin, and dalteparin methotrexate probenecid vecuronium used for sleep during surgery

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine. What should I watch for while using this medicine? Tell your doctor or healthcare professional if your symptoms do not start to get better or if they get worse. Your doctor will monitor your condition and blood work as needed. Do not treat diarrhea with over the counter products. Contact your doctor if you have diarrhea that lasts more than 2 days or if it is severe and watery. This medicine can interfere with some urine glucose tests. If you use such tests, talk with your health care professional. GENERIC NAME: PIPERACILLIN/TAZOBACTAM SODIUM - INJECTION (pih-PERuh-SIL-in/tay-zoh-BACK-tam) BRAND NAME(S): Zosyn USES: This medication is used to treat a wide variety of bacterial infections. This medication is a combination of 2 drugs. Piperacillin is a penicillin-type antibiotic that works by stopping the growth of bacteria. Tazobactam is an enzyme inhibitor (betalactamase inhibitor) that helps the piperacillin work better. HOW TO USE: This medication is given by injection into a vein as directed by your doctor, usually every 6 hours. It should be injected slowly over at least 30 minutes. The dosage is based on your medical condition, age, weight, and response to treatment.If you are giving this medication to yourself at home, learn all preparation and usage

instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.Antibiotics work best when the amount of medicine in your body is kept at a constant level. Therefore, use this drug at evenly spaced intervals.Continue to use this medication until the full prescribed amount is finished, even if symptoms disappear after a few days. Stopping the medication too early may allow bacteria to continue to grow, which may result in a return of the infection.Tell your doctor if your condition persists or worsens. SIDE EFFECTS: Swelling, redness, pain, or soreness at the injection site may occur. Dizziness, trouble sleeping, nausea, vomiting, diarrhea, or headache may also occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: muscle cramps/spasms, swelling of the arms/legs/hands/feet, easy bruising/bleeding, chest pain, confusion, new signs of infection (e.g., fever, persistent sore throat), severe abdominal/stomach pain, slow/fast/irregular heartbeat, persistent nausea/vomiting, seizures, extreme tiredness, dark/cloudy urine, change in the amount of urine, yellowing eyes/skin.This medication may rarely cause a severe intestinal condition (Clostridium difficile-associated diarrhea) due to a type of resistant bacteria. This condition may occur during treatment or weeks to months after treatment has stopped. Do not use anti-diarrhea products or narcotic pain medications if you have any of the following symptoms because these products may make them worse. Tell your doctor immediately if you develop: persistent diarrhea, abdominal or stomach pain/cramping, blood/mucus in your stool.Use of this medication for prolonged or repeated periods may result in oral thrush or a new vaginal yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Independent 1. Assess degree of immobilityproduced by injury/treatmentand note patientsperception of immobility 2. Reposition periodically andencourage coughing/deepbreathing exercises. 3. Encourage increased fluidintake to 2000 3000 mL/day(within cardiac tolerance),including acid/ash juices. 4. Encourage participation indiversional/recreationalactivities. 5. Maintain stimulating limited environment, e.g., radio, TV,newspapers, personalpossessions/pictures, clock,calendar, visits fromfamily/friends. Instructpatient in/assist withactive/passive ROMexercises of affected andunaffected extremities. 6. Encourage use of isometricexercises starting with theunaffected limb. 7. Provide footboard, wristsplints, trochanter/hand rollsas appropriate. 8. Place in supine positionperiodically if possible, whentraction is used to stabilizelower limb fractures. 9. Instruct in/encourage use of trapeze and post positionfor lower limb fractures.

10. Assist with/encourage self-care activities (e.g., bathing,shaving). 11. Provide/assist with mobilityby means of wheelchair,walker, crutches, canes assoon as possible. Instruct insafe use of mobility aids. 12. Monitor blood pressure (BP)with resumption of activity.Note reports of dizziness. Collaborative 13. Consult withphysical/occupationaltherapist and/or rehabilitation specialist

PARACETAMOL To relieve mild to moderate pain due to things such as headache, muscle and joint pain, backache and period pains. It is also used to bring down a high temperature. For this reason, paracetamol can be given to children after vaccinations to prevent postimmunisation pyrexia (high temperature). Paracetamol is

often included in cough, cold and flu remedies NURSING CONSIDERATIONS: Assessment & Drug Effects Monitor for S&S of: hepatotoxicity, even with moderate acetaminophen doses, especially in individuals with poor nutrition. Patient & Family Education Do not take other medications (e.g., cold preparations) containing acetaminophen without medical advice; overdosing and chronic use can cause liver damage and other toxic effects. Do not self-medicate children for pain more than 5 d without consulting a physician. Do not use for fever persisting longer than 3 d, fever over 39.5 C (103 F), or recurrent fever.

 Do not give children more than 5 doses in 24 h unless prescribed by physician.