Drug Study

Hydralazine Brand Name: Apresoline Classification: Antihypertensive Dosage: 5 mg Route: TIV Action Acts directly on vascular smooth muscle to cause vasodilatation, primarily arteriolar, decreasing peripheral resistance, maintains or increases renal and cerebral blood flow. Indication Most commonly in stepped care approach in early malignant hypertension and resistant hypertension. Contraindication Contraindicated with hypersensitivity to hydralazine, tartrazine; CAD, mitral valvular rheumatic heart diseasae. Adverse Reaction CNS: headache, dizziness, tremor CV: angina, flusing, arrhythmia GI: nausea and vomiting, abdominal pain, constipation, diarrhea GU: glumerulonephritis, difficulty in urinating Hematologic: anemia, decrease hematocrit and hemoglobin Hypersensitivity: rash, fever, obstructive jaundice, chills, urticaria Nursing Consideration Monitor BP and HR closely. Check every 5 minutes until it is stabilized at desired level, then every 15 minutes thereafter throughout hypertensive crisis. Monitor I&O when drug is given parenterally and in dose with renal dysfunction Monitor weight, check for edema, and report weight gain to physician. Make position changes slowly and to avoid standing still, hot bath/showers, strenuous exercise, and excessive alcohol intake. Do not breastfeed while taking this drug without consulting the physician.

Mefenamic acid Brand Name: Dolfenal Classification: NSAID Dosage: 500 mg Route: PO Frequency: TID

Action Anti-inflammatory, analgesic, and antipyretic activities related to inhabitation of prostaglandin synthesis; exact mechanisms of action are not known.

Indication Relief of mild to moderate pain

Contraindication Contraindicated with hypersensitivity to mefenamic acid and aspirin allergy

Adverse Reaction
CNS: Headache; dizziness; insomnia. Dermatologic: Rash; urticaria; purpura GI: Diarrhea; vomiting; abdominal pain; GI bleeding; nausea; constipation; GU: Dysuria, renal impairment Hematologic: Decreased hematocrit; bleeding; neutropenia; leukopenia; pancytopenia; eosinophilia; thrombocytopenia. Respiratory: Bronchospasm; laryngeal edema; dyspnea; shortness of breath

Nursing Consideration
Assess patients pain before therapy Monitor for possible drug induced adverse reaction Give prescribed dosage of drug to prevent Overdose or under dose administering of drug may result to trauma and further injury to the patients health. Advice patient to report immediately persistence or failure to relieve pain Stay at the patient bedside during drug intake to insure that the patient take the medicine Give exact dose of drug and administer drug in the appropriate route.

Cefuroxime Brand Name: Zinacef Classification: antibiotic Dosage: 1.5 g Route:TIV

Action Bactericidal: Inhibits synthesis of bacterial cell wall, causing cell death.

Indication Used to treat otitis media, respiratory tract, genitourniary tract, gynecologic, skin, and bone infections. It is also used in the treatment of speticemia, bacterial meningitis, gonorrhea, and other gonococcal infections.

Contraindication Contraindicated with allergy to cephalosporins or penicillin Use cautiously with renal failure, lactation, pregnancy.

Adverse Reaction CNS: Headache; dizziness; lethargic GI: Diarrhea; vomiting; abdominal pain; nausea;hepatoxicity GU: Nephrotoxicity Hematologic: bone marrow depression Hypersensitivity: serum sickness reaction

Nursing Consideration
Do skin test Ask for history of allergies, particularly cephalosporins and penicillins. Assess mouth for white patches on mucous membranes and tongue. Monitor bowel activity and stool consistency carefully. Monitor I&O and renal function reports for nephrotoxicity. Be alert for superinfection: abdominal pain, severe mouth soreness, moderate to severe diarrhea. Discontinue if hypersensitivity reaction occurs.

Ranitidine Brand Name: Zantac Classification: antagonist

Action Inhibits the action of histamine at the H2 receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion.

Indication Treatment and prevention of heartburn, acid indigestion, and sour stomach.

Contraindication Contraindicated with hypersensitivity, Cross-sensitivity may occur; some oral liquids contain alcohol and should be avoided in patients with known intolerance. Use cautiously in renal impairment, geriatric patients, pregnancy or lactation

Adverse Reaction CNS: Confusion, dizziness, drowsiness, hallucinations, headache GI: Altered taste, black tongue, constipation, dark stools, diarrhea, drug-induced hepatitis, nausea GU: Decreased sperm count, impotence Hematologic: Agranulocytosis, Aplastic Anemia, neutropenia, thrombocytopenia

Nursing Consideration Assess patient for epigastric or abdominal pain and occult blood in the stool, emesis, or gastric aspirate.. Inform patient that increased fluid and fiber intake may minimize constipation. Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea; dizziness; or to health care professional promptly. Inform patient that medication may temporarily cause stools and tongue to appear gray black.

Assessment Subjective: Medyo nahihilo ako as

verbalized by the patient.

Planning

Intervention Independent: Monitor vital signs especially blood pressure. Provide assistive passive range of motion. Provide quiet and restful environment. Instruct patient to have a rest in semifowlers position.

Rationale

Evaluation

Objective: Elevated blood pressure Edema noted on lower extremities V/S taken as follows: T: 36.9 C P: 74bpm R: 24cpm BP: 140/70mmHg

Within 4 hours of nursing intervention, the patient blood pressure will decrease from 140/70mmHg to 120/80mmHg.

To have a baseline data. ROM promotes improved blood circulation It conserves energy/lowers tissue and oxygen damage. To facilitate breathing and sodium tends to be excreted at a faster rate. Antihypertensive drugs help decrease and control blood pressure. To reduce edema that may activate rennin angiotensinaldosterone system.

After 4 hours of nursing intervention patients blood pressure was decreased from 140/70mmHg to 130/70mmHg.

Collaborative: Administer antihypertensive drug as ordered by the physician. Instruct patient to ea t low salt low fat diet as ordered by the dietician

NURSING DIAGNOSIS: Ineffective tissue perfusion related to vasoconstriction of blood vessels as manifested by elevated blood pressure and edema on lower extremities.

Assessment Subjective:

Planning

Intervention
Independent: Monitor vital signs Encourage to do deep breathing exercise Evaluate pain regularly noting characteristics, location, intensity (010 scale). Instruct the client to avoid strenuous exercise and activities Schedule adequate rest periods. Review importance of nutritious diets and adequate fluid intake

Rationale

Evaluation

After 4 hours of Masakit yung tahi nursing intervention ko pag kumikilos the patient pain will ako as verbalized by be relieve or control. the patient Pain scale(0-10): 6

To have a baseline data To reduce tension and promote comfort Provides information about need for or effectiveness of interventions To prevent bleeding of the surgical incision made from the operation Prevents fatigue and conserves energy for healing Provides element necessary for tissue regeneration or healing May relieve pain and enhances circulation

After 4 hours of nursing interventions, the patient pain was relieved or controlled

Objective: Facial grimacing Protective gestures Irritability V/S taken as follows: T: 36.9 C P: 74bpm R: 24cpm BP: 140/70mmHg

Reposition as indicated Collaborative: To relieve pain. Administer Mefenamic acid as ordered. NURSING DIAGNOSIS: Acute pain related to surgical incision as evidenced by pain verbalization and facial grimacing.

Assessment

Planning

Intervention

Rationale

Evaluation

Subjective: Hindi ko pa din masyado maigalaw ang kanang binti at kamay ko as verbalized by the patient. Objective: Inability to ambulate independently. Inability to perform some simple task for herself.

After 4 hours of nursing intervention the client will demonstrates inability to perform some simple task and techniques to meet self-care needs.

Independent: Assess clients psychological status.

Offer assistance as needed with hygiene such as mouth care, bathing and perineal care. Offer choices when possible such as selection of juices, scheduling of bathing, destination during ambulation.

Physical pain experience may be compounded by mental pain that interferes with clients motivation to assume autonomy. Improves selfesteem; increases feeling of well being.

After 4 hours of nursing intervention, the patient was able to perform some simple task to meet selfcare needs.

Allows some autonomy, even though client depends on professional assistance

NURSING DIAGNOSIS: Self care deficit related to decreased strength and endurance as manifested by inability to ambulate independently.

Assessment

Planning

Intervention

Rationale

Evaluation

Subjective: Minamanas yung mga binti ko as verbalized by the client. Objective: Variations in blood pressure Edema noted on lower extremities V/S taken as follows: T: 36.9 C P: 74bpm R: 24cpm BP: 140/70mmHg

After 6 hours of nursing intervention the client will participate in activities that reduce blood pressure or cardiac work load.

Independent: Monitor vital sign especially blood pressure. Observe skin color, moisture, temperature and capillary refill time.

To have a baseline data. Presence of pallor, cool, moist skin and delayed capillary refill time may be due to peripheral vasoconstriction May indicate heart failure, renal or vascular impairment. Help reduce sympathetic stimulation, promotes relaxation. Reduces physical stress and tension that affect blood pressure. Can reduce stressful stimuli and blood pressure.

After 4 hours of nursing intervention, the patient was able to perform some simple task to meet selfcare needs.

Note dependent or general edema. Provide calm, restful surroundings, minimize environmental activity and noise. Maintain activity restriction. Instruct relaxation techniques.

NURSING DIAGNOSIS: Decreased cardiac output related to decreased venous return as manifested by edema and elevated blood pressure.