DRUG

INDICATION

ACTION

SIDE EFFECTS and ADVERSE REACTION

NURSING CONSIDERATION

GENERIC NAME: Nifedipine BRAND NAME: Procardia CLASSIFICATION: Antianginals, antihypertensives DOSAGE: 30 mg/tab

Management of: 1.Hypetenesion (extended release only) 2.Angina pectoris 3.Vasospastic(Pri nzmetals) angina

Inhibits calcium transport into myocardial and vascular smooth muscle cells, resulting in inhibition of excitationcontraction coupling and subsequent contraction.

SKIN: ischemic injury due to potent vasoconstrictor action and tissue hypoxia. CNS: Anxiety, transient headache. RESPI: dyspnea- shortness of breathe CV: Bradycardia, probably as a reflex result of a rise in blood pressure, arrhythmias. GI: abnormal liver function study, anorexia, constipation, diarrhea, dry mouth, dyspepsia and nausea and vomiting. GU: dysuria, polyuria, sexual dysfunction.

1. Monitor BP and PR before therapy, during dose titration and periodically during therapy. Monitor ECG periodically during prolonged therapy. 2. Monitor I&O ratios and daily weight. Assess for signs of CHF (peripheral edema, rales/cracles, dyspnea, weight gain, jugular venous distension) 3. Adviced the patient to take the medication exactly as directed. 4. Caution the patient to change positions slowly to minimize orthostatic hypotension. 5.Advice the patient to notify health care on duty if irregular heartbeat, dyspnea, swelling of the hands and feet, pronounced dizziness, nausea and constipation, or hypotension occur, or if headache is severe and persistent.

DRUG

INDICATION

ACTION

SIDE EFFECTS and ADVERSE REACTION

NURSING CONSIDERATION
1. Monitor VS, ECG, I & O ratio, cyanosis, neurological status &adverse effects during therapy.

GENERIC NAME: Noradrenaline BRAND NAME: Levophed CLASSIFICATION: Adrenergic agent

For the restoration of blood pressure in certain acute hypotensive states (e.g. phaecochromocytom ectomy, sympathectomy, poliomyelitis, spinal anaesthesia, myocardial infarction, septicaemia, blood transfusion and drug reactions). To restore and maintain an adequate blood pressure after an effective heartbeat and ventilation have been established.

Levophed a sympathomimetic amine acts predominantly on alpha-receptors and on betareceptors in the heart. It therefore causes peripheral vasoconstriction (alphaadrenergic action) m and a positive inotropic effect on the heart and dilation of coronary arteries betaadrenergic action). These actions result in an increase in systemic blood pressure and coronary artery blood flow. In myocardial infarction accompanied by hypotension. Levophed usually increases aortic blood pressure, coronary artery blood flow, and myocardial oxygenation, thereby helping to limit the area of myocardial ischaemia and infarction.

CNS: Head ache, abnormal dreams, anxiety, confusion, Dizziness, drosiness, jitteriness, nervousness, psychiatric disturbances, weakness.

2. Assess for signs of extravasation (eg. Blanching & ENT: Blurred vision, disturbed Coolness of skin over vein) at equilibrium, epistaxis, infusion site. tinnitus. 3. Inform pt. to inform RESPI: Cough dyspneaphysician if using drugs such as shortness of breathe Sodium Bicarbonate, MAOIs, Trycyclics, Oxytocics, AntiCV: arrythnmia CHF, histamine. peripheral edema, bradycardia, chest pain, 4. Advise pt. to notify nurse if hypotension, palpitations, IV site feels cool or painful. syncope, tachycardia. 5.Caution pt. to avoid sudden GI: abnormal liver function position changes to prevent study, anorexia, constipation, Orthostatic Hypotension diarrhea, dry mouth, dyspepsia and nausea and vomiting. GU: dysuria, polyuria, sexual dysfunction.

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INDICATION

ACTION

SIDE EFFECTS and ADVERSE REACTION

NURSING CONSIDERATION

GENERIC NAME: PANTOPRAZOLE SODIUM BRAND NAME: PROTONIX CLASSIFICATION:

1. Erosive esophagitis Binds to an enzyme in the associated with GERD. presence of acidic gastric pH, preventing the final 2. Decrease relapse transport of hydrogen ions rates daytime and into the gastric lumen. nighttime heart burn symptoms on patients with GERD. gastric

CNS: Headache GI: Abdominal pain, diarrhea, Eructation, Flatulence ENDO: hyperglycemia

1. Asses patient routinely for epigastric or abdominal pain and for frank or occult blood in stool, emesis or gastric aspirate. 2. instruct patient that it can be taken with or without food. 3. Instruct patient to take medication as directed for the full course of therapy, even if feeling better. 4. Advice the patient to avoid alcohol, products containing aspirin or NSAIDs, and foods that may cause an GI irritation. 5. Advice the patient to report onset of black, tarry stools, diarrhea, or abdominal pain to health care professional promptly.

2.Pathologic PROTON PUMP hypersecretory INHIBITOR condition. DOSAGE: IV

DRUG

INDICATION

ACTION

SIDE EFFECTS ADVERSE REACTION

NURSING CONSIDERATION

GENERIC NAME: metformin hydrochloride BRAND NAME: Glucophage, Glucophage Riomet XR,

Management of type 2 diabetes mellitus; may be used with diet, insulin, or sulfonylurea oral hypoglycemic.

1. Decreases hepatic Endocrine:Hypoglycemia, lactic glucose production. GI: Anorexia, nausea, vomiting, 2. Decreases intestinal epigastric, discomfort, glucose absorption. heartburn, diarrhea 3.Increases to insulin

CLASSIFICATION: Antidiabetic DOSAGE: IV

1. Observe the patient for signs and symptoms of hypoglycemic reactions ( abdominal pain, sweating, hunger, weakness, dizziness, headache, tremor, tachycardia, anxiety) when combined sensitivity Hypersensitivity: Allergic skin with oral sulfonylureas. reactions, eczema, pruritus, 2. Instruct the patient to take metformin erythema, urticaria at the same time each day, exactly as directed. 3. Explain to patient that metformin to helps control hyperglycemia but does not cure diabetes. Therapy usually long term. 4. Encourage patient to follow prescribed diet, medication and exercise regimen to prevent hyperglycemic or hypoglycemic episode. 5. Review signs of hypoglycemia and hyperglycemia with patient. If hypoglycemia occurs, advice the patient to take a glass of orange juice or 2-3 tsp of sugar, honey or corn syrup dissolve in water and notify the health care on duty. 6. Inform patient that metformin may cause an unpleasant or metallic taste that usually resolves spontaneously.

7. Advice the patient to carry a form of sugar ( sugar packets, candy) and identification descripting disease process and medication regimen at all times.

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INDICATION

ACTION

SIDE EFFECTS and ADVERSE REACTION

NURSING CONSIDERATION

GENERIC NAME: Itraconazole BRAND NAME: Sporanox CLASSIFICATION: Antifungals (systemic)

IV,PO: 1.Histoplasmosis 2.Blastomycosis 3.Aspergillosis 4.Onychomycosis of the fingernail and toenail caused by tinea unguium in noimmunocomprimiss ed patients( oral capsule only)

Inhibits enzymes necessary for integrity of the fungal cell membrane.

CNS: Dizziness, drowsiness, fatigue, headache, malaise EENT: tinnitus CV: CHF, edema, hypertension GI: Hepatoxicity, nausea, abdominal pain, anorexia, diarrhea, flatulence, vomiting GU: albuminuria, decrease libido, impotence DERM: toxic epidermal necrosis, pruritus, rash ENDO: adrenal insufficiency

1.Assess patient for signs and symptoms of infection ( v/s, lung sounds, sputum, oral and pharyngeal mucosa, nail beds) before and periodically during the therapy. 2.Do not interchange capsules and oral solution. 3.CAPSULES: administer with a full meal to minimize nausea and vomiting and to increase absorption. 4.DO NOT administer with antacids or other medications that may increase gastric PH; may decrease absorption of itraconazole. 5. Instruct the patient to take medication as prescribed.

DIAGNOSIS: Revised diagnosis (18 January 2014) pulmonary embolism, hypoxic ischemic encephalopathy, s/p (17 January 2014) s/p ORIF plate removal; clavicle (l) s/p CVP insertion basic vein (R) DATE AND TIME 20 January 2014 1500H 1600H Endorsement. Received patient lying on bed asleep, unconscious. With the Glasgow-coma scale of 3. With the intravenous fluid of D5NSS 1L to run for 12 hours regulated at 27-28 ugtts, D5 W 500cc + 4mg Levophed x 15 ucg/min. at 112 ugtts/min via infusion pump. NURSES NOTES

With endotracheal tube attached to the mechanical ventilator. With Nasogastic tube inserted at left nares for drainage. With foley catheter attached to the urinebag draining to a dark yellow colored urine. Still NPO Capillary refill of less than 3 minutes. With Central Venous Pressure monitoring hooked at basilica vein (R) With pulse Oximeter on right hand. 1615H Establish rapport to the wife of patient. Vital signs are taken every 15 minutes interval and are as follows: BP: 80/60mmhg PR: 113BPM T:35.8 O2Sat: 97%

1630H 1645H

Hooked Dobutamine Drip

+ 2 ampule, chloramine started at 1630H with 7-8 ugtts/min via infusion pump

Assisted the staff nurse for suction. With minimal secretion in ET. Observed for CVP monitoring. Done with the staff nurse.

1653 1700H

Dobutamine Drip

+ 2 ampule, chloramine was changed with 20ugtts/min.

Vital signs are rechecked and endorsed to the NOD. Interview was done with the wife. According to the wife, patient was undergone ORIF last March 2012, patient is in good condition when he subjected himself to the operation in January 17 for removal of ORIF. But after 4 hours of staying in recovery room the patient was collapse.

1800H 1830

DINNER BREAK Vital signs are rechecked and endorsed to the NOD. Chart reading Vital signs was plotted to the chart.

2100

Endorsed sleeping on bed with the latest vital signs of: BP: 60/40mmhg PR: 119 T: 36.3 O2SAT: 97%