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DRUG Tranexamic Acid (Hemostan) Classification: Anti-fibrinolytic, antihemorrhagic

MECHANISM OF ACTION

INDICATION Hemorrhage following dental and/or oral surgery in patients with hemophilia Surgical: General surgical cases but most especially operative procedures on the prostate, uterus, thyroid, lungs, heart, ovaries, adrenals, kidneys, brain, tonsils, lymph nodes and soft tissues. Medical: epistaxis, hemoptysis, hematuria, peptic ulcer with hemorrhage and blood dyscrasias with hemorrhage Effective in promoting hemostasis in traumatic injuries.

CONTRAINDICATION Allergic reaction to the drug or hypersensitivity Presence of blood clots (eg, in the leg, lung, eye, brain), have a history of blood clots, or are at risk for blood clots Current administration of factor IX complex concentrates or antiinhibitor coagulant concentrates

ADVERSE EFFECT

Tranexamic acid is a synthetic derivative of the amino acid lysine. It exerts its antifibrinolytic effect through the reversible blockade of lysine-binding sites on plasminogen molecules. Antifibrinolytic drug inhibits endometrial plasminogen activator and thus prevents fibrinolysis and the breakdown of blood clots. The plasminogen-plasmin enzyme system is known to cause coagulation defects through lytic activity on fibrinogen, fibrin and other clotting factors. By inhibiting the action of plasmin (finronolysin) the antifibrinolytic agents reduce excessive breakdown of fibrin and effect physiological hemostasis.

NURSING RESPONSIBILITY Severe allergic 1. Unusual change reactions such as in bleeding rash, hives, itching, pattern should dyspnea, tightness be immediately in the chest, reported to the swelling of the physician. mouth, face, lips 2. The medication or tongue can be taken Calf pain, swelling with or without or tenderness meals. Chest pain 3. Swallow Confusion Tranexamic Acid Coughing up blood whole with Decreased plenty of liquids. urination Do not break, Severe or crush, or chew persistent before headache swallowing. Severe or 4. Inform the client persistent body that he/she malaise should inform Shortness of the physician breath immediately if Slurred speech the following Slurred speech severe side Vision changes effects occur.

DRUG Diclofenac K (Cataflam) 50mg/tab Po TID After meals Classification: Antiinflammatory, NSAID

MECHANISM OF ACTION Diclofenac has potent anti-inflammatory, analgesic and antipyretic actions. It inhibits the enzyme, cyclooxygenase, thus resulting in reduced synthesis of prostaglandin precursors..

INDICATION Acute or long-term treatment of mild to moderate pain, including dysmenorrhea Rheumatoid arthritis Osteoarthritis Ankylosing spondylitis Treatment of actinic keratosis in conjunction with sun avoidance Ophthalmic: Postoperative inflammation from cataract extraction

CONTRAINDICATION Active peptic ulcer; hypersensitivity to diclofenac or other NSAIDs. Treatment of perioperative pain in CABG surgery. 3rd trimester of pregnancy. Topical: Not to be applied onto damaged or nonintact skin.

ADVERSE EFFECT GI disturbances; headache, dizziness, rash; GI bleeding, peptic ulceration; abnormalities of kidney function. Pain and tissue damage at Inj site (IM); local irritation (rectal); transient burning and stinging (ophthalmic).

NURSING RESPONSIBILITY Take drug with food or meals if GI upset occurs. Take only the prescribed dosage. You may experience these side effects: Dizziness, drowsiness (avoid driving or using dangerous machinery while using this drug). Report sore throat, fever, rash, itching, weight gain, swelling in ankles or fingers, changes in vision; black, tarry stools.

Assessment Subjective: medyo nahihirapan akong matulog as verbalized by the patient. Objective: Irritability Inability to concentrate Restlessness Slowed reaction Unable to move because it triggers pain.

Diagnosis Sleep deprivation related discomforts

Planning SHORT TERM: After 1-2 hours of nsg intervention, the patient will be able to verbalize understanding of sleep disorder. LONG TERM: After 6-8 of nsg intervention, the patient will be able to identify appropriate intervention like listening musics and reading books to promote sleep.

Intervention: Determine clients usual sleep pattern and expectations. Suggest abtaining from daytime naps.

Intervention -to provide comparative baseline. -because they impair ability to sleep at night. To reduce stimulation so client can relax.

Evaluation SHORT TERM: After 1-2 hours of nsg intervention, the patient was able to verbalized understanding of sleep disorder.

Recommend quiet activities, such as reading/listening to music. Instruct in relaxation techniques, music therapy, meditation etc. Provide calm, quiet environment

LONG TERM: After 1 week of nsg intervention, the patient was be able To decrease tension to identify and prepare for sleep appropriated or rest. intervention to promote sleep. -Goal was met. To reduce need for redosing during prime sleep hours.

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