Drug NAME Prednisone (Prolix)

CLASSIFICATION Corticosteroid (intermediate acting), Glucocorticoid, Hormone

INDICATION Short-term management of various inflammatory and allergic disorders, such as rheumatoid arthritis, collagen diseases (eg, SLE), dermatologic diseases (eg, pemphigus), status asthmaticus, and autoimmune disorders Hematologic disorders: thrombocytopeni a purpura, erythroblastopen ia

CONTRA INDICATION Contraindicated with infections, especially tuberculosis, fungal infections, amebiasis, vaccinia and varicella, and antibioticresistant infections; lactation.

DOSE,ROUTE FREQUENCY 40-60 mg daily for 3-10 days; give as single or in 2 divided doses PO

ADVERSE RXN Vertigo, headache, paresthesias, insomnia, convulsions, psychosis, cataracts, increased intraocular pressure, glaucoma (long-term therapy) Hypotension, shock, hypertension and CHF secondary to fluid retention, thromboembolism, thrombophlebitis, fat embolism, cardiac arrhythmias Na+ and fluid retention, hypokalemia, hypocalcemia Amenorrhea, irregular menses, growth retardation, decreased carbohydrate tolerance, diabetes mellitus, cushingoid state (long-term effect), increased blood sugar, increased serum cholesterol, decreased T3 and T4 levels, HPA suppression with systemic therapy longer than 5 days Peptic or esophageal ulcer, pancreatitis, abdominal distention, nausea, vomiting, increased appetite, weight gain (long-term therapy) Hypersensitivity or anaphylactoid reactions

NURSING CONSIDERATION - Administer once-a-day doses before 9 AM to mimic normal peak corticosteroid blood levels. Increase dosage when patient is subject to stress. Taper doses when discontinuing highdose or long-term therapy. Do not give live virus vaccines with immunosuppressive doses of corticosteroids.

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Ipratropium Br, Salbutamol/ albuterol sulfate (Ventolin)

Neb q 4 hours (12 am-4am-8am12pm-4pm-8pm)

Antiasthmatic & COPD Preparations

Management of reversible bronchospasm associated with obstructive airway diseases in patients who require more than a single bronchodilator

1.) Patients who is allergic to the Drugs. 2.) Patients with Hypertrop ic obstructiv e cardiomyo pathy 3.) Patients having tachyarryt hmia.

Fine tremor of Skeletal Muscle; Palpitations; Headache, dizziness, nervousness; Dryness of the mouth, throat irritation; urinary retention.

1. Use Cautiously to patients with known sensitivity to atropine, soybeans, soya lecithin, and peanuts. 2. Assess Vital Signs Before drug administration 3. Observe for paradoxical bronchospasm (Wheezing). If Condition occurs, withhold Medication and notify physician or other health care professional immediately. 4. Instruct patient to contact health care professional immediately if shortness of breath is not relieved by medication or is accompanied by diaphoresis, dizziness, palpitations, or chest pain. 5. Advise the patient to rinse mouth with water after using the nebulizer to minimize dry mouth.

ASSESSMENT >Wheezes on both lung fields

NURSING DIAGNOSIS

GOAL

NURSING INTERVENTION >Assessed respiratory movements and use of accessory muscles. >Monitored vital signs especially the RR.

RATIONALE >Use of accessory muscles to breathe

indicates an abnormal increase in work of breathing. >To obtain baseline data.) >Bronchial lung sounds are commonly heard over areas of lung density or consolidation. Crackles are heard when fluid is present. >These determine progression of disease process.) >Hydration helps decrease the viscosity of secretions, facilitating expectorations. >Positioning facilitates chest expansion and respiratory efficiency by reducing pressure of abdominal organs on diaphragm. > Relaxes bronchial and uterine smooth muscle by acting on beta adrenergic receptors. >Chest physiotherapy helps to aid immobilization of secretions. >Discharges from the nebulizer are often foul tasting and smelling. >Fluids are regulated to replace losses and aid immobilization secretions.

EVALUATION

> cough

Ineffective airway clearance related to ineffective cough and retained secretions.

Short Term:

>nasal flaring

After 4 hours of nursing interventions, the client will be able to maintain airway patency.

>Auscutated the lung sounds, noting areas of decreased ventilation and presence of adventitious sounds. >Monitored chest x ray reports. >Encouraged client to increase fluid intake. >Advised the realtives elevate the head of bed at least 30 degrees >Assisted on nebulizer treatment. Nebulization done as per doctors order every 12 hours. >Chest tapping performed after each nebulization. >Instructed the client to have oral care after each nebulization. >Provided supplemental fluids

>restlessness

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Cefexime (Tergecef)

200 mg 1 tab BID for 5 days

3rd generation cephalosporin antibiotic

Acute Bronchitis and Acute Exacerbations of Chronic Bronchitis causedby Streptococcus pneumoniae and Haemophilus influenzae

contraindicated in patients with known allergy to thecephalosporin group of antibiotics.

Diarrhea, loose stools, abdominal pain,dyspepsia, nausea, and vomiting, Headaches,dizziness, seizures

(beta-lactamase positive and negative strains)

assess clients allergy to penicillin or cephalosporin allergy; pregnancyor lactation Arrange for culture and sensitivity tests of infected area beforebeginning drug therapy and during therapy if infection does notresolve Give drug with meals to avoid GI upset Instruct patient complete full course of this drug, even if feeling better before the course of treatment is over This drug is prescribed for this particular infection; warn not to self-treatother infection with this drug Inform that client may experience side effects like stomach upset, lossof appetite, nausea, diarrhea, headache, dizziness

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Give drug with food to prevent GI upset. Gabapentin (neurontin) Anti epileptic Adjunctive therapy in the treatment of partial seizures with and without secondary generalization in adults and children 312 yr with epilepsy Orphan drug use: Treatment of amyotrophic lateral sclerosis Management of postherpetic neuralgia or pain in the area affected by herpes zoster after the disease has been treated Unlabeled uses: Tremors of MS, neuropathic pain, bipolar disorder, migraine prophylaxis 1.) Contraindicated with hypersensitivity to gabapentin. 2.) Use cautiously with pregnancy, lactation.. CNS: Dizziness, insomnia, nervousness, fatigue, somnolence, ataxia, diplopia, tremor Dermatologic: Pruritus, abrasion GI: Dyspepsia, vomiting, nausea, constipation, dry mouth Respiratory: Rhinitis, pharyngitis Other: Weight gain, facial edema, cancer, impotence Take this drug exactly as prescribed; do not discontinue abruptly or change dosage, except on the advice of your health care provider. Inform that client may experience side effects like Dizziness, blurred vision (avoid driving or performing other tasks requiring alertness or visual acuity); GI upset (take drug with food or milk, eat frequent small meals); headache, nervousness, insomnia; fatigue (periodic rest periods may help). Report severe headache, sleepwalking, rash, severe vomiting, chills, fever, difficulty breathing.