Puzon, Charlene Anne I.

Group 611A

BSN 4Y1-1

DRUG STUDY
1. Generic name: cimetidine Brand Name: Tagamet Drug Classification: Histamine2 (H2) antagonist Mode of Action: Inhibits the action of histamine at the histamine2 (H2) receptors of the stomach, inhibiting gastric acid secretion and reducing total pepsin output. Indication:

Short-term treatment of active duodenal ulcer Short-term treatment of benign gastric ulcer Treatment of pathologic hypersecretory conditions (Zollinger-Ellison syndrome) Prophylaxis of stress-induced ulcers and acute upper GI bleeding in critical patients Treatment of erosive GERD OTC use: Relief of symptoms of heartburn, acid indigestion, sour stomach

Contraindications:

Contraindicated with allergy to cimetidine. Use cautiously with impaired renal or hepatic function, lactation.

Adverse Reaction:

CNS: Dizziness, somnolence, headache, confusion, hallucinations, peripheral neuropathy; symptoms of brain stem dysfunction (dysarthria, ataxia, diplopia)

CV: Cardiac arrhythmias, cardiac arrest, hypotension (IV use) GI: Diarrhea
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Puzon, Charlene Anne I.

Group 611A

BSN 4Y1-1

Hematologic: Increases in plasma creatinine, serum transaminase Other: Impotence (reversible), gynecomastia (in long-term treatment), rash, vasculitis, pain at IM injection site Nursing Considerations:

Give drug with meals and hs. Decrease doses in renal and liver dysfunction. Administer IM dose undiluted deep into large muscle group. Arrange for regular follow-up, including blood tests to evaluate effects. Take antacids as prescribed, and at recommended times.
1.

Inform your health care provider about your cigarette smoking habits. Cigarette smoking decreases the drugs effectiveness.

2. Generic name: potassium chloride Brand Name: Kalium Durule Drug Class: Electrolytes and minerals Mode of Action: Supplemental potassium in the form of high potassium food or potassium chloride may be able to restore normal potassium levels. Indication: For hypokalemia As prophylaxis during treatment with diuretics To prevent and treat potassium, deficit secondary to diuretics or corticosteroid therapy. Also indicated when potassium, is depleted by severe vomiting, prolonged diuresis and diabetic acidosis.

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Puzon, Charlene Anne I.

Group 611A

BSN 4Y1-1

Adverse Reactions: renal insufficiency hyperkalemia nausea vomiting irritability muscle weakness difficulty swallowing Nursing Considerations: Some patients find it difficult to swallow the large sized KCl tablet. Administer while patient is sitting up or standing (never in recumbent position) to prevent drug-induced esophagus. Follow instructions regarding dilution. Color in some commercial oral solutions fades with exposure to light but drug effectiveness is reportedly not altered. to light but drug effectiveness is reportedly not altered. 3. Generic name: citicoline sodium Brand Name: Zynapse, Somazine, Cholinerve Drug Classification: CNS Stimulant, Peripheral Vasodilators, Cerebral Activators, Neurotropics Mode of Action: It acts by increasing the blood flow and O2 consumption of the brain and involved in the biosynthesis action. In simplest terms, Citicoline promotes brain metabolism. Indication: indicated in CVD in acute recovery phase in severe s/sx of cerebrovascular insufficiency and in-cranial traumatism and their sequellae. Citicoline in CVA, stimulates brain function. Adverse Reaction:

Fleeting and discrete hypotension effect, increased parasympathetic affects, low blood pressure Itching or hives, swelling in face or hands, chest tightness, tingling in mouth and throat. Contraindications:

Any allergy or hypersensitivity to the drug

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Puzon, Charlene Anne I.

Group 611A

BSN 4Y1-1

Hypertonia of the parasympathetic nervous system Use cautiously for pregnancy and lactation Conscious use for patient with renal and hepatic damage Nursing Considerations:

Take Citicoline as prescribed Take Citicoline on time Monitor patients neurologic status Note if there are signs of slurring of speech Note for adverse reactions Titer medication when discontinuing Teach patient on how to take the drug Arrange for regular follow-ups

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Puzon, Charlene Anne I.

Group 611A

BSN 4Y1-1

FDAR
Focus Deficient knowledge related to unfamiliarity with information resources Data Ano po ba yung hypertension? As verbalized by the patient Agitated expression Action Determine clients ability and readiness to learn and cooperate Provide information relevant only to the situation to prevent overload. Provide positive reinforcement. Do health teaching about the disease and the medications that the patients needs to comply. Action Vital signs taken and recorded. Assess NGT placement before feeding and giving of medications. Administered feeding and medications with strict aspiration Response The patient was able to attain all the information discussed and was cooperative to comply with all the medications needed by the patient.

Focus Risk for aspiration

Data Patient diagnosed with CVD with right sided weakness on blenderized feeding via N GT, with NGT clumped for feeding intact and in place.

Response No aspiration noted.

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Puzon, Charlene Anne I.

Group 611A

BSN 4Y1-1

precaution. Placed on high back rest for 30 minutes, after feeding as tolerated. Focus Impaired bed mobility Data (+) General body weakness Tremors noted on left arm and hands Inability to perform gross/fine motor skills (+) Paralysis of left side of the body functional level scale: 4 (does not participate in activity) Action Determine diagnosis that contributes to immobility Assess nutritional status and S/O others report of energy level. Determine degree of immobility in relation to functional level scale Assist or have significant other reposition client on a regular schedule (turn to side every 2 hours) as ordered by the physician Provides safety measures (side rails up, using pillows to support body part) Encourage patients S/Os involvement in decision making as much as possible. Response After the rotation and nursing intervention the patient will: a. Maintain position and function and skin integrity as evidenced by absence of contractures, foot drop, decubitus and so forth. b. S/O will demonstrate techniques/ behaviors that will enable safe repositioning

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Puzon, Charlene Anne I.

Group 611A

BSN 4Y1-1

Nursing Care Plan

Assessment Objective Data: Pressure ulcer stage 2 at the sacral or bottom area Nursing Diagnosis Impaired Skin Integrity r/ t pressure ulcer secondary to prolonged immobility and unrelieved pressure Planning After 6-8 hours of nursing interventions the client will: Have reduced risk of furthe r impairm ent of skin integrity Patients caregiver s will demonst rate understa nding & skill in care of woun d Intervention 1. Increase frequency of turning ( turning every 2 hours. Position the client to stay off the ulcer site. 2. Use seat cushions and assess sacral ulcers daily. 3. Follow body substance precautions; use clean gloves and clean dressing for wound care. Practicing proper hand washing before and after wound Rationale 1. To disperse pressure over time or decreasing the tissue load. Evaluation Goal was met. After 6hrs of nursing intervention the client had reduced risk of further impairment of th skin integrity and Patients caregivers demonstrated understandin g and caring of wound was demonstrated as well.

2. To prevent further occurrence of pressure ulcer. 3. To reduce risk of infection.

4. To prevent
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Puzon, Charlene Anne I.

Group 611A

BSN 4Y1-1

care. 4. Ensure adequate dietary intake. Review dieticians recommendati ons. 5. Prevent the ulcer from being exposed to urine and feces. Use indwelling catheter, bowl containment systems, and topical creams or dressings. Assessment Subjective: Simula nung na i-stroke sya., na bedridden na siya as verbalized by the relative of the patient. Objective: Nursing Diagnosis Self care deficit : hygiene, dressing and grooming, feeding and toileting related to Neuromuscular impairment Planning After the rotation and nursing interventions. The patient should: a. meet all therapeutic self care demands in a complete absence of self care agency

malnutrition and delayed healing.

5. To prevent contamination/sp read of infection.

Intervention 1. Provide enteric nutrition VIA NG Tube feeding. High fowlers for at least 15 minutes

Rationale 1. To meet patients need for an adequate nutritional intake. 2. To

Evaluation

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Puzon, Charlene Anne I.

Group 611A

BSN 4Y1-1

(+) NGT insertion Patient is unable to: [HYGIENE] Access and prepare bath supplies Wash body Control washing mediums [DRESSING AND GROOMING] Obtain articles for clothing Put on clothes Maintain appearance at an acceptable level [FEEDING] Prepare/obtain food for ingestion Handle utensils Bring food to mouth Chew and swallow up food Pick up food

b. ABSENCE OF S&S OF NUTRITIONAL DEFICIT. [Adequate nutritional intake] c. GOOD SKIN TURGOR, NORMAL URINE OUTPUT, ABSENCE OF EDEMA, HYPER AND HYPOVOLEMIA [Fluid and Electrolyte balance] d. ABSENCE OF DECUBITUS ULCERS AND FOUL ODORS IN BETWEEN LINENS/CLOTHI NG AND SKIN [Clean, Intact skin and mucus membrane] e. ABSENCE OF ABDOMINAL AND BLADDER DISTENTION, RECTAL

after feeding. 2. Careful I/O Monitoring and apply necessary dietary restriction s 3. . 4. Change position at least ONCE every two hours or more often when needed. 5. Provide padding for the elbows, needs, ankles and other areas for possible skin abrasion.

establish careful assessmen t on patients fluid and electrolyte balance. 3. To prevent decubitus ulceration s.

4. To protect the patients skin integrity maintaini ng his first line of defense against sickness and infection. 5. To prevent soiling of bed sheets,
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Puzon, Charlene Anne I.

Group 611A

BSN 4Y1-1

[TOILETING] Go to the toilet

FULLNESS AND PRESSURE, PAIN IN DEFECATION [ Meeting toileting demands ]

6. An adult diaper should be WORN at all times. Change the diaper as soon as patient defecated.

7. Promote an Environme nt conducive to rest and recovery. Decrease stimuli and Metabolic demand of the body.

clothes and linens providing maximum comfort and prevention of skin irritation if feces remain in contact with the patients skin for a long time. 6. To conserve energy promoting rest and recovery.

7. This is to improve circulation , reducing the risk of atheromat

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Puzon, Charlene Anne I.

Group 611A

BSN 4Y1-1

8. Passive ROM Exercises Early morning once a day, 10 times targeting both upper and lower extremities . 9. Lastly, Do health teaching when S/O is at the optimum level to receive informatio n.

ous formation. 8. 10. To educate the S/O what factors have contribute d to the clients illness and educating them to decrease, if not totally eliminate those contributo ry factors to prevent recurrence of the disease and promote change for a healthy lifestyle.

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Puzon, Charlene Anne I.

Group 611A

BSN 4Y1-1

Nursing Diagnosis Subjective: Fluid Volume Namamaga ang Excess related mga binti at paa to sodium ko as retention as verbalized by manifested by the patient. presence of edema in both Objective: lower - Presence of extremities. edema in both lower Extremities. Vital signs: BP- 150/90 PR- 95 RR- 22 T- 37.3 C

Assessment

Planning After 8 hours of nursing interventions, patient will verbalize understanding of the measures to prevent and lessen fluid volume excess.

Intervention - Establish rapport

Rationale - To assess precipitating & causative factors. - To obtain baseline data. - To obtain baseline data

Evaluation After 8 hours of nursing interventions, patient verbalized understanding of measures to prevent and lessen fluid volume excess.

- Monitor and record vital signs. - Compare current weight gain with admission or previous stated weight. - Discuss the following measures to prevent and lessen fluid volume excess: a) Advise patient to elevate feet when sitting down. b) Instruct patient regarding restricting fluid intake.

- This prevent and lessen fluid accumulation in lower extremities - Intake of fluid up to 500ml is equivalent to 0.5 kg. Increase in weight due to fluid retention. Therefore limiting is
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Puzon, Charlene Anne I.

Group 611A

BSN 4Y1-1

necessary to avoid fluid retention.

c) Instruct patient regarding the restricting dietary sodium intake. d) Administer diuretics (Furosemide) to relieve excess fluid volume as prescribed by the physician. e) Encouraged compliance to Dialysis treatment as indicated.

- Sodium intake produces a feeling of thirst. This causes increase in the intake of fluid. - Diuretics enhances the excretion of both sodium and chloride in the urine so that water follows and also excreted thus fluid overload is prevented.

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