Saint Francis Medical Center College of Nursing

Peoria, Illinois
Date 2/14/2013
Allergies:
MEDICATION/
CLASSIFICATION
USUAL DOSE/SAFE DOSE
Acetaminophen (TYLENOL)
Dose: 650 mg
Freq: Q4H PRN
Route: Oral
OR
Acetaminophen (TYLENOL)
Dose: 650 mg
Freq: Q4H PRN
Route: Rectal
Class: Analgesic, antipyretic
Safe: no more than 4000 mg

Clients Initials GC
DESIRED EFFECT

NURSING IMPLICATIONS

Pain, fever

Adverse Effects
- constipation, N, V,
headache, liver failure,
Stevens-Johnson syndrome

Decreases pain and fever by

inhibiting the synthesis of
prostaglandins in the central
nervous system and work
peripherally to block pain
impulse generation; produces
antipyresis from inhibition of
hypothalamic heat-regulating
center.

Bisacodyl Suppository
Dose: 10 mg
Freq: Daily PRN
Route: Rectal
Class: laxative, stimulant
Safe: 10 mg as single dose

Constipation

Enoxaparin (LOVENOX)
Dose: 40 mg
Freq: Q24H-0700

Prevent DVT
Prevention of deep vein
thrombosis by preventing

8/97
Form No. 691-0019 (7/97)

Student Katelyn Janssen

Stimulates peristalsis by
directly irritating the smooth
muscle of the intestine,
possibly the colonic
intramural plexus; alters
water and electrolyte
secretion producing net
intestinal fluid accumulation
and laxation

Monitor
-Neuro/mental status
- pain relief
- hepatic tests, liver enzymes
- body temp, reduction of
fever Pain
- Blood studies
- I & O ratio
- Allergic reactions
- Do not exceed
recommended dosage
- Toxicity includes s/s of N/V,
abdominal pain
Teaching
- no more than 4000mg in
24hrs
- report s/s of GI hemorrhage,
hepatotoxicity, nephrotoxcitiy
- take with full glass of water
- do not drink alcohol
Adverse Effects
-vertigo, electrolyte fluid
imbalance, mild abdominal
cramps, N/V, rectal burning
Monitor
-pain
-electrolyes
-I&O
-neuro status

Adverse Reactions
- D, N, anemia, bleeding,
thrombocytopenia, liver

EVALUATION OF DESIRED
EFFECT

Saint Francis Medical Center College of Nursing

Peoria, Illinois
Route: Subcutaneous
Class: anticoagulant, low
molecular wt heparin
Safe: subQ; maintenance
1mg/kg subQ q12hrs min of
8days- max dose: 100mg for
first 2 doses only

conversion of fibrinogen to
fibrin and prothrombin to
thrombin by enhancing
inhibitory effects of
antithrombin III

function test, fever, a fib,

heart failure, hemorrhage,
pneumonia
Monitor
- CBC, liver function tests, BP
- CNS status
- bleeding, blood studies
Teaching
- report bleeding
- avoid activities that can
cause injury- use soft bristle
toothbrush

Famotidine (PEPCID)
Dose: 20 mg
Freq: Q12H
Route: Intravenous
Class: Gastric Acid Secretion
Inhibitor, Histamine H2
antagonist
Safe: 20-80mg/day PO

Used for
GERD
Gastric Hypersecretion
Indigestion

Adverse Reactions
- thrombocytopenia,
headache, dizziness,
constipation, dysrhythmias, D

Other uses
Gastritis
GI hemorrhage
Urticaria
Stress ulcer; prophylaxis

Monitor
- epigastric and abdominal
pain and discomfort, GI
sounds, I&Os
- CBC panel, blood counts
- s/s of thrombocytopenia

Decreased abdominal pain;

Ulcer treatment and gastric
pH control

Fentanyl (SUBLIMAZE)
Dose: 25 mcg
Freq: Q2H PRN
Route: Intravenous
OR
Fentanyl (SUBLIMAZE)
Dose: 25 mcg
Freq: Q2H PRN
Route: Subcutaneous
Class: Analgesic, Opioid
Safe: 50 mcg/ml subQ:
OR 25 mcg q15minutes (on

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Form No. 691-0019 (7/97)

Decrease pain
Decreased pain by binding to
opiate receptor sites within
the CNS.

Teaching
- drug must be continued for
prescribed time in prescribed
method
- report bleeding, bruising
- no smoking
- increase bulk and fluid
Adverse Effects
- site reaction, pruritius,
abdominal pain, constipation,
D, N, V, confusion,
nervousness, dizziness,
headache,anxiety,
depression, hallucinations,
urinary retention, dyspnea,
Upper Resp Infection, fatigue,
apnea, resp depression,
cough, chest pain
Monitor

Saint Francis Medical Center College of Nursing

Peoria, Illinois
demand)

- HAVE NARCAN AVAILABLE

- HR, RR, BP, s/s of resp
depression
- monitor pain levels
- CNS/Mental status

Glucose (GLUTOSE)
Dose: 15 g
Freq: PRN
Route: Oral
Class: Antidote, hypoglycemia
Safe: 10-20 g single dose,
repeat in 10 minutes if
necessary

Increase blood glucose

Hydralazine (APRESOLINE)
Dose: 10 mg
Freq: Q4H PRN
Route: Intravenous
Class: Peripheral Vasodilator

Lower blood pressure

Safe: PO: 0.75-7.5mg/kg/day

in 4 doses; max up to
200mg/day); Parenteral:
usual dose is 1.7-

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Dextrose, a monosaccharide,
is a source of calories and
fluid for patients unable to
obtain an adequate oral
intake; may decrease body
protein and nitrogen losses;
promotes glycogen
deposition in the liver. When
used in the treatment of
hyperkalemia (combined with
insulin), dextrose stimulates
the uptake of potassium by
cells, especially in muscle
tissue, lowering serum
potassium.

Acts directly on vascular

smooth muscle to cause
vasodilation, primarily
arteriolar; maintains or
increases renal and cerebral
blood flow; lowers BP

Teaching
- report use of MAO inhibitor
within last 14 days prior to
therapy
- avoid activities until effects
known
- report absence of pain relief
or constipation
- report s/s of resp
depression, hypoventilation
- do not stop drug suddenly
- do not use OTC drugs
- avoid alcohol or other CNS
depressants
Adverse Effects
-edema, dehydration, venous
thrombosis, mental
confusion, unconsciousness,
polyuria, diarrhea, nausea,
vein irritation, pain
Monitor
-neuro/mental status
-pain
-I&O
-skin turgor

Adverse Effects
- chest pain, palpitations,
tachycardia, D, N, V,
headache, agranulocytosis,
heaptoxicitiy, leucopenia
Monitor
- reduction in S and D BP,
monitor BP frequently
- CBC with diff at baseline and

Saint Francis Medical Center College of Nursing

Peoria, Illinois
3.5mg/kg/day in divided
doses q4-6hrs

during therapy
- body wt, I&Os,
- Temp, RR, bowel sounds,
voiding pattern
- kidney function tests,
urinalysis
- LOC, reflexes, lymph node
palpation
Teaching
- report chest pain,
palpitations, dyspnea, s/s of
tachyarrhythmia, neuropathy,
hypoTN, agranulocytosis,
heapatoxicity
- take exactly as prescribed
- take with food

Hydrocodone-acetaminophen
(NORCO)
Dose: 1 Tab
Freq: Q6H PRN
Route: Oral
Class: Analgesic combination,
Opioid
SafeL 5-10 mg qid

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Decrease pain
Hydrocodone, as with other
narcotic (opiate) analgesics,
blocks pain perception in the
cerebral cortex by binding to
specific receptor molecules
(opiate receptors) within the
neuronal membranes of
synapses. This binding
results in a decreased
synaptic chemical
transmission throughout the
CNS thus inhibiting the flow
of pain sensations into the
higher centers. Mu and kappa
are the two subtypes of the
opiate receptor which
hydrocodone binds to cause
analgesia.
Acetaminophen inhibits the
synthesis of prostaglandins in
the CNS and peripherally
blocks pain impulse
generation; produces
antipyresis from inhibition of
hypothalamic heat-regulating
center.

Adverse Effects:
-hypotension, bradycardia,
cardiac arrest, dizziness,
drowsiness, mood changes,
rash, urinary retention,
abdominal pain, constipation,
heartburn, nausea
Monitor
-BP, pulse
-neuro/mental status
-I&O
-pain
-bowel sounds

Saint Francis Medical Center College of Nursing

Peoria, Illinois
Insulin (HUMULIN R, NOVOLIN
R)
Dose: 2-12 Units
Freq: Q6H
Route: Subcutaneous
Mild Sliding Scale
Class: Insulin, short-acting
Safe: 0.5-1.2 units/kg/day in
divided doses

Decrease blood glucose

Labetalol (NORMODYNE,
TRANDATE)
Dose: 20 mg
Freq: Q4H PRN
Route: Intravenous
Class: alpha- and betaadrenergic blocker,
antihypertensive

Lower blood pressure

Safe: PO: 100 mg bid; may

increase to 200 mg bid after 2
days; may continue to
increase q1-3 days; max 400
mg bid
- IV 20 mg (0.25 mg/kg)
slowly over 2 min

Metoclopramide (REGLAN)
Dose: 10 mg
Freq: Q6H
Route: Intravenous
Class: antiemetic, dopamine
antagonist
Safe: PO: 10-15mg up to

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Insulin acts via specific

membrane-bound receptors
on target tissues to regulate
metabolism of carbohydrate,
protein, and fats. Target
organs for insulin include the
liver, skeletal muscle, and
adipose tissue.

Competitively blocks alpha 1and beta 1- and beta 2adrenergic receptors, and has
some sympathomimetic
activity at beta 2-receptors.
Alpha- and beta-blocking
actions contribute to the BPlowering effect; beta
blockade prevents the reflex
tachycardia seen with most
alpha-blocking drugs and
decreases plasma renin
activity

Second line antiemetic if

Zofran is not enough
Prevention of nausea,
vomiting, anorexia, fullness
by enhancing response to
acetylcholine of tissue in
upper GI tract, which causes

Adverse Effects
-tacycardia, palpation,
fatigue, headache, mental
confusion, hypoglycemia,
nausea, blurred vision
Monitor
-neuro/mental status, glucose
level, pulse, BP
Adverse Effects
- hypoTN, N, dizziness, nasal
congestion, fatigue, heart
failure, hyperkalemia,
hepatotoxicity, bronchospasm
Monitor
- BP
- hepatic function tests
- exacerbation of angina
pectoris
Teaching
- take drug with meals
- do not stop drug unless
instructed to
- report difficulty breathing,
night cough, confusion,
swelling of extremities, slow
HR, sore throat
- diabetic patients: drug may
mask usual symptoms of
hypoglycemiamonitor
glucose carefully
- avoid activity until effects
known
Adverse Reaction
- fluid retention, N, V,
headache, fatigue,
neuroleptic malignant
syndrome, tardive dyskinesia
Monitor
-CNS/Mental status

Saint Francis Medical Center College of Nursing

Peoria, Illinois
4x/day; IV/IM: 10-20mg slowly
over 1-2mins

Ondansetron (ZOFRAN)
Dose: 4 mg
Freq: Q12H PRN
Route: Intravenous
Class: Antiemetic, Serotonin
Receptor Antagonist, 5-HT3
Safe: N/V: 4mg IV

contraction of gastric muscle

Reduce nausea
Prevents nausea, vomiting by
blocking serotonin
peripherally, centrally, and in
the small intestine

- hydration level, BP
- signs of extrapyramidal side
effects, parkinsonian-like
syndromes
Teaching
- avoid driving
- avoid alcohol
- report s/s of tardive
dyskinesa, extrapyramidal
effects. Or parkisonaian
symptoms
- take oral formulations 30
mins before meals and at
bedtime, or single dose prior
to provoking situation
- avoid concomitant MAO
inhibitors, tricyclic
antidepressants, or
sympathomimetic amine
therapy
Adverse Reactions
- D, constipation, headache,
dizziness, drowsiness,
fatigue, EPS, fever, hypoxia,
urinary retention,
anayphylaxis
Monitor
-CNS/Mental status
- absence of N or V
- hypersensitivity reaction
- EPS
- ECG

Total Parenteral Nutrition

Ordered Infusion Rate: 100
mL/hr
Infused over: 24 hours
Dispensed Volume: 2,400 mL
Freq: Continuous

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Support nutritional needs

Teaching
- report D, constipation, rash
or changes in RR
- avoid concomitant use of
apomorphine due to risk of
sig hypoTN and loss of
consciousness
Adverse Effects:
- Fluid overload, hypercapnia,
hyperglycemia,
hyper-/hypokalemia,
hyper-/hypophosphatemia,
metabolic bone disease,

Saint Francis Medical Center College of Nursing

Peoria, Illinois
Route: Intravenous
Class: Nutritional
suplementation

nonanion gap metabolic

acidosis, refeeding syndrome,
BUN increase
Monitor:
- Sodium
-Potassium
-Chloride
-Glucose
-S/s of infection at line site

Reference
Lexi-Comp Online. (n.d.). Lexi-drugs. Retrieved from http://online.lexi.com.libproxy.osfhealthcare.org/lco/action/home

8/97
Form No. 691-0019 (7/97)