IV.

Laboratory and Diagnostic Examinations Results DATE August 20, 2011 PROCEDURE Complete Blood Count Hemoglobin 130-170 g/L 64 L g/L Decreased- a low hemoglobin is in Chronic disease (liver, kidney, rheumatoid arthritis, Carcinoid, etc.) Decreased- A low hematocrit and hemoglobin usually indicates decreased production, excessive loss, or destruction of red blood cells. Decreased- The number of red blood cells is inChronic Disease (Liver dysfunction (liver function tests might show abnormalities, kidney dysfunction (chemistry tests and the BUN, creatinine may be abnormal). NORMS RESULT INTERPRETATION AND ANALYSIS

Hematocrit

0.40-0.54 g/L

0.19 g/L

Erythrocyte

2.50-6.50 x 10^12/L

2.21 L x 10^12/L

Increased- May indicate

Leukocytes Neutrophils Lympocytes

4.0-10 x 10^9/L 0.35-0.65 0.20-0.40

12.4 H x 10^9/L 0.75 0.17

infection Increased- Elevated with bacterial infection Decreased- low with diseases such as hepatitis, lymphoma, or AIDS. Decreased- low counts suggest medication interactions, antibody formation or liver disease and blood clotting problems. Decreased- low with liver disease. Increased- Elevated with dehydration, hyperventilation or kidney infection

Platelet

150-500 x 10^9/L

99.00 x 10^9/L

Blood Urea Nitrogen Chloride DATE August 20, 2011 PROCEDURE Chest X-ray

2.14-7.17 mmol/L 98-107 mmol/L

1.09 mmol/L 108.5 mmol/L

RESULT Present supine chest film when compared with the previous done 7-15-11 shows appearance of hazy and nodular infiltrates in the right lower lobe and left upper lobe, suggest a pneumonic process The left costophrenic sulcus appaears blunted, minmal pleural effusion, let not ruled out The rest of the findings are unchanged.

V. Medications, IV infusions, Blood transfusions, Treatments given

GENERIC NAME/ BRAND NAME Generic Name: Metronidazole Dosage: 500 mg IV q 8 Dosage in Adult: 750 mg PO tid for 5-10 days(In amebic dysentery, combine with iodoquinol 650 mg PO tid for 20 days)

CLASSIFICATION Classification: Antiinfectives, Anti-protozoals, Antibiotic, Amebicide

INDICATIONS Acute infection with susceptible anaerobic bacteria Acute intestinal amebiasis

CONTRAINDICATIONS Contraindicated with hypersensitivity to metronidazole Use cautiously with CNS diseases, hepatic disease, candidiasis(moniliasis), blood dyscrasias

SIDE EFFECTS CNS: seizures, dizziness, headache GI: abdominal pain, anorexia, nausea, diarrhea, dry mouth, furry tongue, glossitis, unpleasant taste, vomiting Hematologic: leucopenia Skin: rashes, urticaria

NURSING INTERVENTIONS Administer with food or milk to minimize GI irritation. Tablets may be crushed for patients with difficulty swallowing. Instruct patient to take medication exactly as directed evenly spaced times between dose, even if feeling better. Do not skip doses or double up on missed doses. If a dose is missed, take as soon as remembered if not almost time for next dose. May cause dizziness or light-headedness. Caution patient or other activities requiring alertness until response to medication is known.

Mechanism of Action: Bactericidal: inhibits DNA synthesis in specific( obligate) anaerobes, causing cell death; antiprotozoaltrichomonicidal, amebicidal. Biochemical mechanism of action is not known

Amebic liver abscess

Inform patient that medication may cause an unpleasant metallic taste. Inform patient that medication may cause urine to turn dark. Advise patient to consult health care professional if no improvement in a few days or if signs and symptoms of superinfection (black furry overgrowth on tongue; loose or foul-smelling stools develop).

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NURSING INTERVENTIONS

Generic Name: Omeprazole Dosage: 40 mg IV O.D

Classification: AntiEradication of H. secretory Drug, Proton pylori with pump inhibitor metronidazole Short term treatment of active duodenal cancer Short-term treatment of active benign gastric ulcer

Contraindicated with hypersensitivity to omperazole and its components

CNS: Headache, dizziness, vertigo, apathy,anxiety, aprethesias Dermatologic: Rash, inflammation, Urticaria, pruritus, alopecia, dry skin GI: Diarrhea, abdominal pain, nausea, vomiting, constipation, dry mouth, tongue atrophy Respiratory: URI symptoms, cough, epistaxis

Interventions: Administer before meals. Administer antacids with, if needed. Have regular medical followupvisits. Teaching Points: Advise patient to report if severe headache, worsening symptoms, fever and chills

Mechanism of Action: Gastric acid pump inhibitor: Suppresses gastric secretion by specific inhibition of the hydrogenpotassium ATPase enzyme system at the secretory surface of the gastric parietal cells; blocks final step of acid production

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Generic Name: Lactulose Dosage: Lactulose enema q1 until BM 4x/day Dosage in Adult : RECTALportal-systemic encephalopathy :300 ml lactulose mixed with 700 ml water or physiologic saline as retention enema, retained for 3060 minutes. May be repeated for every 4-6 hour. Start oral drug as soon as feasible and before stopping enemas.

Classification: Ammo nia reduction drug , Laxative Mechanism of Action: The drug passes unchanged into the colon where bacteria break it down to organic colon slightly acidify the colonic contents, resulting in an increase stool water content, stool softening, laxative action. This also results in migration of blood ammonia into the contents with subsequent trapping and expulsion in the feces.

Treatment of constipation Prevention and treatment of portal-systemic encephalopathy

Contraindicated with allergy to lactulose, low lactulose- diet Use cautiously with diabetic patient

GI: Transient flatulence, diarrhea, intestinal cramps, nausea, belching OTHER: Acid-base imbalances, electrolyte imbalance

Interventions Administer retention enema using a rectal balloon catheter. Do not use cleansing enema containing soapsuds or other alkaline drugs that counteract the effects of lactulose Do not use other laxative while using lactulose Monitor serum ammonia levels Monitor with longterm potential of electrolyte imbalances Teaching Points Do not use other laxatives. For laxative use, do not use continuously for more than 1 week unless directed by your healthcare

provider Make sure you have ready access to bathroom, bowel movements will increase in two or three per day You may experience side effects: abdominal fullness, flatulence, belching Report diarrhea, severe belching and abdominal fullness occurs.

GENERIC NAME/ BRAND NAME

CLASSIFICATION

INDICATIONS

CONTRAINDICATIONS

SIDE EFFECTS

NURSING INTERVENTIONS

Generic Name: Lactulose Dosage: Lactulose enema q1 until BM 4x/day Dosage in Adult : RECTALportal-systemic encephalopathy :300 ml lactulose mixed with 700 ml water or physiologic saline as retention enema, retained for 3060 minutes. May be repeated for every 4-6 hour. Start oral drug as soon as feasible and before stopping enemas.

Classification: Ammo nia reduction drug , Laxative Mechanism of Action: The drug passes unchanged into the colon where bacteria break it down to organic colon slightly acidify the colonic contents, resulting in an increase stool water content, stool softening, laxative action. This also results in migration of blood ammonia into the contents with subsequent trapping and expulsion in the feces.

Treatment of constipation Prevention and treatment of portal-systemic encephalopathy

Contraindicated with allergy to lactulose, low lactulose- diet Use cautiously with diabetic patient

GI: Transient flatulence, diarrhea, intestinal cramps, nausea, belching OTHER: Acid-base imbalances, electrolyte imbalance

Interventions Administer retention enema using a rectal balloon catheter. Do not use cleansing enema containing soapsuds or other alkaline drugs that counteract the effects of lactulose Do not use other laxative while using lactulose Monitor serum ammonia levels Monitor with longterm potential of electrolyte imbalances Teaching Points Do not use other laxatives. For laxative use, do not use continuously for more than 1 week unless directed by your healthcare

provider Make sure you have ready access to bathroom, bowel movements will increase in two or three per day You may experience side effects: abdominal fullness, flatulence, belching Report diarrhea, severe belching and abdominal fullness occurs.

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NURSING INTERVENTIONS

Generic Name: Albuterol sulfate Salbutamol Dosage: Salbutamol nebule every 8 hours( Inhalatio n) Dosage in Adult :INHALATIONeach actuation of aerosol dispenser delivers 90 mcg albuterol; 2 inhalations every 4-6 hours some patients may require only 1 inhalation in every 4 hours; more frequent administration or larger number of inhalations not recommended.

Classification: Antasth matic Beta-2 selective adrenergic agonist Mechanism of Action: In low doses, acts as relatively selectively at beta adrenergic receptors to cause bronchodilation and vasodilation; at higher doses, beta2 receptors tocause typical sympathomimetic cardiac effects.

Relief and prevention of bronchospasm in patients with reversible obstructive airway disease or COPD. Inhalation: treatment of acute attacks of bronchospasm. >Unlabeled use: Adjunct in treating serious hyperkalemia in dialysis patient, seems to lower potassium concentrations when inhaled by patients on hemodialysis.

Contraindicated with hypersensitivity to albuterol; tachyarrhythmias. Tachycardia, cause by digitalis intoxication; unstatbe vasomotor system disorder; hypertension coronary insufficiency, CAD, history of CVA, COPD patients with degenerative heart disease. >Use cautiously with DM; hyperthyroidism; history of seizure disorders, psychoneurotic individuals

CNS: restlessness, apprehension, anxiety, fear, CNS stimulation, hyperkinesias, insomnia, tremor, drowsiness, irritability, weakness, vertigo, headache CV: Cardiac arrhythmias, tachycardia, palpitations, PVCs(rare), anginal pain. Dermatologic: sweating, pallor, flushing GI: nausea, vomiting, heart burn, unusual or bad taste in mouth. GU: Increased incidence of leiomyomasof uterus when given in higher than human doses in

Use minimal doses for minimal periods, drug tolerance can occur with prolong use. Maintain a Beta adrenergic blocker(Cardio selective Beta blocker, such as Atenolol, shoud be use with respiratory distress) on standby in case cardiac arrhythmias occur. Prepare solution for inhalation by diluting 0.5 ml, 0.5% solution with 2.5 ml normal saline, deliver over 5 -15 minutes by nebulization. Do not exceed recommended dosage, administer pressurized inhalation drug forms during 2nd half of inspiration, because the airways are open wider and the aerosol distribution is more extensive.

preclinical studies Respiratory: respiratory difficulties, pulmonary edema, coughing, broncospasm, paradoxical airway resistance with repeated, excessive use of inhalation preparation.

GENERIC/TRADE CLASSIFICATION NAME Classification: Generic Name:

INDICATION Symptomatic

CONTRAINDICATION Contraindicated in

SIDE EFFECTS CNS: Headache

NURSING RESPONSIBILITIES Interventions

Paracetamol Dosage: 500 mg/tab, 1 tab every 4 for T 37.5 Dosage in Adult: 1000mg T.I.D to Q.I.D. Do not exceed 4 g/day

Analgesic Antipyretic Mechanism of Action: Antipyretic; reduces fever by acting on the hypothalamic heatregulating center to cause vasodilation and sweating, which helps dissipate heat.

relief of pain and fever Fever, Relief of mild to moderate pain like headaches, muscular aches and pain, toothache, colds, earache, fever due to tonsillectomy, inoculations, and vaccinations

patients hypersensitive to drug. Use cautiously in patients with long term alcohol use because therapeutic doses cause hepatotoxicity in these patients.

CV:chest pain, dyspnea, myocardial damage when doses 5-8 g/dy are ingested daily for several weeks or when dose of 4g are ingested foe 1 year GI: Hepatotoxicity and failure, jaundice GU: Acute renal failure and renal tubular necrosis Hematologic: hemolytic anemia, neutropenia, leucopenia, pancytopenia. Hepatic: Jaundice Metabolic: Hypoglycemia Skin: rash, urticaria.

Do not exceed recommended dossage Reduce dosage with hepatic impairment Avoid using multiple preparations containing acetaminophen. Carefully check all OTC drugs Give drug with food if GI upsets Discontinue drug if hypersensitivity occurs Treatment overdose: Monitor serum level regularly. Nacetylecysteine should be available as a specific antidote, basic life support measures may be necessary. Teaching Points Do not exceed recommended dossage; do not take for longer than 10 days

Advise patient or caregiver that many over the counter products contain acetaminophen; be aware of this when calculating total daily dose. Warn patient that high doses or unsupervised long term use can cause liver damage.

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Generic Name: Co-amoxiclav Dosage: Per 1.2 g vialCoamoxiclav:Amox icillin 1g &clavulanicacid 200 mg

Classification: Bacteri cidal Mechanism of Action: Bactericidal- Coamoxiclav is a broadspectrum antibiotic that kills a wide variety of bacteria that cause a wide variety of commonly-occuring infections. It is usually reserved for treating infections caused by bacteria that are resistant to amoxicillin. Inhibits enzymes involved information of peptidoglycan layer of bacterial cell wall No effect on human cell walls. Bactericidal; only works on dividing bacteria Well absorbed enterally. Clavulanic acid inhibits bacterial -lactamase

Lower resp tract infections, otitis media, sinusitis, skin & soft tissue infections, UTI, pre& postsurgical procedures, bone & joint, O & G infections. Bacterial infections of the lower respiratory tract (lungs, airways) eg bronchitis, pneumonia.

History of penicillin hypersensitivity. Superinfections involving Pseudomonas or candida.

Allergic reactionsitching, rashes, fever angioneuroticoede ma- anaphylaxis (1 in 50,000to 100,000) Cross-allergy with other penicillins Partial crossallergy with cephalosporins (10%)Hepatitis, cholestatic jaundice Erythema multiforme (including Stevens-Johnson) Toxic epidermal necrolysis; exfoliative dermatitis Diarrhea, vomiting Rashes Neutropenia Anemia

Hepatic impairment may cause cholestatic jaundice up to 6 weeks after cessation May cause maculo papular rashes - almost always in presence of glandular fever People receiving high doses of this medicine, particularly by injection, should make sure they drink plenty of fluid to reduce the risk of crystals forming in the urine. If in hospital, this fluid may be given via a drip. Broad-spectrum antibiotics can sometimes cause inflammation of the bowel (colitis). For this reason, if you get diarrhoea either during or after taking this medicine, particularly if it becomes severe or persistent, or contains blood or mucus, you should consult your

doctor immediately. Co-amoxiclav can rarely cause cholestatic jaundice either during or following treatment. For this reason, the duration of treatment should not exceed 14 days without review by your doctor. Consult your doctor if you experience any yellowing of the eyes or skin while taking this medicine, or in the few weeks after finishing treatment. This side effect is more common in people above the age of 65 years and in men. People with impaired liver function should have their liver function monitored while receiving treatment with this medicine.