IX.

DRUG STUDY

LOSARTAN
DRUG NAME LOSARTAN 100mg 1tab OD ACTIONS * SA: Cardiovascular agent; angiotensin II receptor antagonist; antihypertensive * MA: Angiotensin II receptor antagonist acts as a potent vasoconstrictor and primary vasoactive hormone of the renin-angiotensinaldosterone system INDICATIONS * hypertension * * * * ADVERSE REACTIONS dizziness, insomnia, headache diarrhea, dyspepsia muscle cramps, myalgia, back or leg pain nasal congestion, cough, upper respiratory infection CONTRAINDICATIONS * hypersensitivity to Losartan; pregnancy; lactation NURSING RESPONSIBILITIES * monitor BP * monitor drug effectiveness * notify physician for signs of hypotension * provide comfort and safety precautions

SODIUM BICARBONATE
DRUG NAME SODIUM BICARBONATE 2tabs TID ACTIONS * SA: gastrointestinal agent; antacid; fluid and electrolyte balance agent * MA: short acting, potent systemic antacid. Rapidly neutralizes gastric acid to form NaCl, CO 2 and H2O. After absorption of NaHCO3, plasma alkali reserve is increased and excess Na and HCO3 ions are excreted in the urine, thus rendering urine less acid. INDICATIONS * Systemic alkalinized to correct metabolic acidosis to minimize uric acid crystallization associated with uricosuric agents, to increase the solubility of sulfonamides and to enhance renal excretion of barbiturate and salicylate overdose ADVERSE REACTIONS * GI: belching, gastric distention, flatulence * Metabolic: metabolic alkalosis, electrolyte imbalance, sodium overload, hypocalcemia, hypokalemia, milkalkali syndrome, DHN CONTRAINDICATIONS * Prolonged therapy to NaHCO3; patient losing chloride; heart disease, hypertension, renal insufficiency; peptic ulcer, pregnancy (Category C) NURSING RESPONSIBILITIES * Take BP before administering drug * Observe for or report of improvement or reversal of metabolic acidosis * Do not take antacids longer than two weeks except under advice and supervision of physician * Instruct on adequate fluid intake

CAPTOPRIL
DRUG NAME CAPTOPRIL 25mg SL 1tab q6 for BP 140/90 ACTIONS * SA: cardiovascular agent; angiotensin converting enzyme inhibitor; anti hypertensive * MA: Lowers BP by specific inhibition of the ACE. This interrupts conversion sequences initiated by renin that lead to formation of angiotensin II, a potent endogenous vasoconstrictor. INDICATIONS * Hypertension in conjunction with digitalis and diuretics in CHF, diabetic neuropathy * ADVERSE REACTIONS Slight increase in heart rate, first dose hypotension, dizziness, fainting Altered taste sensation, weight loss Cough Macula-papul;ar rash, urticaria Azotemia, impaired renal function, nephrotic syndrome CONTRAINDICATIONS * Pregnancy (category D); lactation * Safe use in children not established NURSING RESPONSIBILITIES * Monitor heart rate * Monitor BP * Encourage to have adequate rest and sleep * Assess skin for rashes * Report to physician the onset of unexplained fever, unusual fatigue, sore mouth or throat, easy bruising or bleeding

* * * *

CO-AMOXICLAV
DRUG NAME CO-AMOXICLAV (Potassium clavunate and Amoxicillin) 1gm q12 ANST (-) ACTIONS * SA: anti infective; Beta-lactam antibiotic; aminopenicillin * MA: Used alone, clavulanic acid antibacterial activity is weak. In combination, it inhibits enzyme (beta-lactamase) degradation of amoxicillin and by synergism extends both spectrum of activity and bactericidal effect of amoxicillin against many strains of betalactamase-producing bacteria resistant to amoxicillin alone. INDICATIONS * Infevtions caused by susceptible betalactamase-producing organisms; lower respiratory tract infections, acute bacterial sinusitis, CAP. Otitis media, sinusitis, skin and skin structure infections and UTI ADVERSE REACTIONS * GI: diarrhea, nausea and vomiting * Skin: rash, urticaria * Others: candidal vaginitis; moderate increases in serum, ALT, AST; glomerulonephritis; agranulocytosis (rare) CONTRAINDICATIONS * Combination shares toxic potential of ampicillin * Hypersensitivity too penicillins, infectious mononucleosis * Pregnancy (category B) lactation NURSING RESPONSIBILITIES * Determine previous hypersensitivity reactions to penicillins, cephalosporins and other allergens prior to therapy * Lab tests: baseline C&S tests prior to initiation of therapy; start drug pending results * Monitor for S&S of an urticarial rash (usually occurringwithin a few days after start of drug) suggestive of a hypersensitivity reaction) If it occurs, look for other signs of hypersensitivity (fever, wheezing, generalized itching, dyspnea) and report to physician immediately

CLONIDINE
DRUG NAME CLONIDINE 75mcg 1tab BID ACTIONS * SA: antihypertensive; centrally acting * MA: Stimulates alpha-adrenergic receptors of the CNS, resulting in inhibition of the sympathetic vasomotor centers and decreased nerve impulses INDICATIONS * Alone or with a diuretic or other antihypertensives to treat mild to moderate hypertension * * * * * ADVERSE REACTIONS Dry mouth Drowsiness Dizziness Sedation Constipation CONTRAINDICATIONS * Obstetric, post partum or perioperative pain NURSING RESPONSIBILITIES * Identify reasons for therapy, onset, type of symptoms and previous reasons * Monitor BP closely; >BP decreases 3060 minutes after administration and may persist for 8 hours >note any fluctuations

KETOSTERIL
DRUG NAME KETOSTERIL 600mg 2tabs TID ACTIONS * SA: genitourinary drug * MA: increases absorption of calcium levels, which decreases phosphate INDICATIONS * Treatment of patient with renal lithiasis, phosphate calculi * Uric acid lithiasis and calcium lithiasis ADVERSE REACTIONS * Hypercalcemia, dry mouth or throat, anorexia, nausea, vomiting, hypokalemia, electrolyte imbalance, orthostatic hypotension or high glucose levels CONTRAINDICATIONS * Hypercalcemia, disturbed amino acid metabolism NURSING RESPONSIBILITIES * Monitor Ca levels and ensure sufficient supply of calories * Monitor I&O * Monitor fluid consumption and offer instruction * Assess findings of hypokalemia and hyperkalemia * Monitor pulse and BP; caution client about rising too abruptly to avoid orthostatic hypotension

SODIUM CHLORIDE
DRUG NAME SODIUM CHLORIDE 1tab TID ACTIONS * SA: electrolyte supplement. * MA: It works by supplying a source of sodium for the body. INDICATIONS * Preventing or treating sodium loss due to excessive sweating or dehydration. It may also be used for other conditions as determined by your doctor. ADVERSE CONTRAINDICATIONS REACTIONS * Severe allergic * allergic to reactions (rash; any ingredient in hives; itching; Sodium Chloride difficulty breathing; * have high tightness in the chest; blood sodium levels swelling of the mouth, face, lips, or tongue); nausea; stomach pain; swelling in the hands, ankles, feet, or legs; vomiting. NURSING RESPONSIBILITIES * monitor Na levels * take as recommended * check for any adverse reactions

VIII. NURSING CARE PLAN

ALTERED TISSUE PERFUSION

CUES/CLUES Objectives: * pale and weak in appearance * with slightly pale conjunctiva * with pale lips * with pale nailbeds; with capillary refill time of 3-4 seconds * with slightly dry skin * Hgb = 7.1 gm/dL NURSING DIAGNOSIS * Altered tissue perfusion related to decreased oxygen carrying capacity of the blood NURSING GOAL * At the end of nursing interventions, the patient with the help of the SO will be able to demonstrate ways and techniques on how to improve arterial circulation INTERVENTIONS * Assessed vital signs * Monitored blood pressure RATIONALE * For baseline data * Because it also indicates that the oxygenated blood were properly supplied to the tissues * To monitor any development * To promote relaxation * To promote relaxation * Relaxation technique * To improve proper circulation of blood in the body * To avoid exerting too much energy * To normalize the Hgb level faster EVALUATION * Seen doing some passive exercise like flexion and extension of extremities * Seen SO assisting patient when ambulating

* Monitored capillary refill * Encouraged rest after meal * Provided quiet and restful environment * Encouraged to do deep breathing exercise * Encouraged to change positions at least every 2 hours * Encouraged on passive exercises and minimal ambulation * Stressed the importance of blood transfusion

DECREASED CARDIAC OUTPUT

CUES/CLUES Objectives: * BP=180/100mmHg * PR=68bpm * Pale in appearance * With pale nailbeds; with capillary refill time of 3-4 seconds NURSING DIAGNOSIS * Decreased cardiac output related to peripheral vasoconstriction NURSING GOAL * At the end of nursing interventions, the patient with the help of the SO will be able to demonstrate ways and techniques on how to improve circulation INTERVENTIONS * Assessed general condition * Monitored BP and RR * Encouraged on adequate fluid intake * Encouraged on intake of Vitamin C rich foods such as dalandan * Instructed to avoid strenuous activities * Placed on a comfortable position * Turned from side to side at least every two hours * Provided adequate rest and sleep RATIONALE * To serve as baseline data * To serve as baseline data * For proper hydration * Helps improve circulation * To avoid further increase in BP * To provide comfort measure * To improve circulation * To provide comfort EVALUATION * BP=140/100mmHg * PR=72bpm * Seen patient drinking ample amount of pineapple juice

ALTERATION IN COMFORT
CUES/CLUES S: Ang sakit ng ulo ko. as verbalized O: * With complaint of headache * RR = 30 bpm * Irritable at times * Easy fatigability * Pain scale: 8/10 NURSING DIAGNOSIS * Alteration in comfort; headache r/t dilation of cerebral blood vessel secondary to disease condition NURSING GOAL * At the end of the nursing interventions, the patient with the help of the S.O. will be able to demonstrate ways and techniques on how to lessen pain felt INTERVENTIONS * Assessed contributing factors * Encouraged on verbalization of feelings * Encouraged and demonstrated relaxation technique such as deep breathing exercise * Provided therapeutic touch such as massage * Provided diversional activity through therapeutic communication and talking to S.O. * Assisted in a comfortable position * Assisted on frequent turn side to side at least every two hours * Provided adequate rest and sleep RATIONALE * For further assessment * To promote trusting relation * To promote relaxation EVALUATION * Pain scale: 4/10 * Seen comfortably sleeping on bed

* To promote relaxation and ease of feeling * To divert pain felt on some activities

* For comfort measures * To assume a comfortable position * For comfort measure

ACTIVITY INTOLERANCE
CUES/CLUES Objectives: * Pale and weak in appearance * With body weakness * With limited ROM * With slowed movement * Needs assistance NURSING DIAGNOSIS * Activity Intolerance related to body weakness and decreased muscle strength NURSING GOAL * At the end of nursing interventions, patient will demonstrate gradual coping with activities within his capacity INTERVENTIONS * Assessed activity intolerance * Provided adequate rest and sleep * Assisted on assuming a comfortable position * Provided safety measures including fall prevention like side rails or pillows * Encouraged SO to massage or exercise the extremities * Assisted upon moving such as: a. turning from side to side b. flexion and extension of upper and lower extremities RATIONALE * To indicate limited or impaired activity intolerance * To minimize fatigue and improve activity tolerance * To determine the patients capacity * To promote optimal level of function and to provide comfort * To promote safety * To help prevent muscle atrophy and maintain muscle strength and joint function * To prevent onset of complications * To facilitate blood circulation in the body EVALUATION * Seen patient changing positions with minimal assistance from SO * Seen patient with a support pillow on the side * Seen patient sleeping

RISK FOR INJURY

CUES/CLUES S: Nahihilo ako as verbalized O: * * * * With complaint of dizziness BP: 110/70 mmHg With limited range of motion With slight body weakness NURSING DIAGNOSIS * Risk for injury r/t episodes of dizziness NURSING GOAL * At the end of the nursing interventions, the patient with the help of the S.O. will be able to demonstrate ways and techniques on how to prevent occurrence of injury INTERVENTIONS * Assessed general condition * Monitored vital signs especially BP * Supported the patient with pillows * Removed all sharp objects that can harm the patient * Instructed S.O. not to leave patient alone unattended * Instructed not to move abruptly RATIONALE * To serve as baseline data * Alteration in vital signs may occur; to note for changes * To prevent patient from falling * This would prevent patient from acquiring injury * To have someone who will assist and monitor the patient * To prevent patient from falling EVALUATION * Seen patient supported with pillow * Seen S.O. always on patients bedside