Marie Louise E.

Ordoño
13 – Hematinics
Group 52
DRUG STUDY
GENTAMICIN
Brand Name: Garamycin, Garamycin Ophthalmic, Genoptic
Generic Name: Gentamicin sulfate
Therapeutic Action: Broad-spectrum aminoglycoside antibiotic derived from
Micromonospora purpurea. Action is usually bacteriocidal.
Indication: Parenteral use restricted to treatment of serious infections of GI,
respiratory, and urinary tracts, CNS, bone, skin, and soft tissue
(including burns) when other less toxic antimicrobial agents are
ineffective or are contraindicated. Has been used in combination
with other antibiotics. Also used topically for primary and
secondary skin infections and for superficial infections of external
eye and its adnexa.
Contraindications: History of hypersensitivity to or toxic reaction with any
aminoglycoside antibiotic. Safe use during pregnancy
(category C) or lactation is not established
Drug-Drug Interactions:
• increased ototoxic, nephrotoxic.
• increased neuromuscular blockade and muscular paralysis with
anesthetics
• potential inactivation of both drugs if mixed with beta-lactam-type
antibiotics
• increased bactericidal effect with penicillins
Adverse Effect:
• Special Senses: Ototoxicity (vestibular disturbances, impaired
hearing), optic neuritis.
• CNS: neuromuscular blockade: skeletal muscle weakness, apnea,
respiratory paralysis (high doses); arachnoiditis (intrathecal use).
 • CV: hypotension or hypertension. GI: Nausea, vomiting, transient
increase in AST, ALT, and serum LDH and bilirubin;
hepatomegaly, splenomegaly.
• Hematologic: Increased or decreased reticulocyte counts;
granulocytopenia, thrombocytopenia (fever, bleeding tendency),
thrombocytopenic purpura, anemia.
• Body as a Whole: Hypersensitivity (rash, pruritus, urticaria,
exfoliative dermatitis, eosinophilia, burning sensation of skin,
drug fever, joint pains, laryngeal edema, anaphylaxis).
• Urogenital: Nephrotoxicity: proteinuria, tubular necrosis, cells or
casts in urine, hematuria, rising BUN, nonprotein nitrogen, serum
creatinine; decreased creatinine clearance.
• Other: Local irritation and pain following IM use;
thrombophlebitis, abscess, superinfections, syndrome of
hypocalcemia (tetany, weakness, hypokalemia, hypomagnesemia).
Teaching Points:
• Apply ophthalmic preparations by tilting head back; place
medications into conjunctival sac and close eye; apply light
pressure on lacrimal sac for 1 minute. Cleanse area before applying
dermatologic preparations; area may be covered if necessary.
• May experience these side effects: ringing in the ears, headache,
dizziness, nausea, vomiting, loss of appetite, burning, blurring of
vision with ophthalmic preparations
• Report pain at injection site, severe headache, dizziness, loss of
hearing, changes in urine pattern, difficulty breathing, rash or skin
lesions, itching or irritation
PENICILLIN G
Brand Name: Pfizerpen
Generic Name: Penicillin G potassium
Therapeutic Action: Bactericidal: inhibits synthesis of cell wall of sensitive
organisms, causing cell death.
Indications:
 • Treatment of severe infections caused by sensitive organisms
• Treatment of Syphilis, gonococcal infections
• Unlabeled Use: Treatment of Lyme Disease
Contraindications:
• Contraindicated with allergy to penicillins, cephalosporins, other
allergens
• Use cautiously with renal disease, pregnancy, lactation.
Drug-Drug Interaction:
• Decrease effectiveness of Penicillin G with Tetracyclines
• Inactivation of parenteral aminoglycosides
Adverse effect:
• CNS: Lethargy, hallucinations, seizures
• GI: Glossitis, stomatitis, gastritis, sore mouth, furry tongue, black
“hairy” tongue, nausea, vomiting, diarrhea, abdominal pain, bloody
diarrhea, enterocolitis, pseudo membranous colitis, non specific
hepatitis
• GU: Nephritis oliguria, proteinuria, hematuria, casts, azotemia,
pyuria
• Hematologic: Anemia, thrombocytopenia, leukopenia, neutropenia,
prolonged bleeding time
• Hypersensitivity Reactions: Rasb, fever, wheezing, anaphylaxis
• Local: Pain, phlebitis, thrombosis at injection site, Jarish-
Herxheimer reaction when use to treat syphilis
• Other: Superinfections; sodium overload, leading to CHF
Teaching Points:
• This Drug must be given by injection for severe infection
• May experience this side effects: Upset stomach, nausea, vomiting,
sore mouth, diarrhea, pain or discomfort at the injection site.
• Report unusual bleeding, sore throat, rash, hives, fever, severe
diarrhea, difficulty breathing.
LIDOCIANE
Brand Name:
 • Anestacon®
• Burnamycin
• Solarcaine® Aloe Extra Burn Relief
• Topicaine®
• Xylocaine®
• Zilactin-L®
Generic Name: Lidocaine Hydrochloride
Therapeutic Action:
• Type 1 antiarrhythmic: Decrease diastolic depolarization,
decreasing automacity of ventricular cells;increases ventricular
fibrillation threshold
• Local anesthetic: Blocks the generation and conduction of action
potentials in sensory nerves by reducing sodium permeability
Indications:
• As antiarrhythmic: management of acute ventricular arrhythmias
during cardiac surgery and MI
• As anesthetic: infiltration anesthesia, peripheral and sympathetic
nerve blocks, central nerve block, spinal and caudal anesthesia.
Contraindication:
• Contraindicated with allergy to lidocaine or amide-type local
anesthetics, CHF, cardiogenic shock, second or third degree heart
block
• Use cautiously with hepatic or renal desease. inflammation or
sepsis in the region of injection, labor and delivery, lactation.
Drug to Drug Interaction: Increased lidocaine levels with beta blockers,
cimetidine, ranitidine, prolonged apnea with
succinycholine
Adverse Effects:
• Antirrjythmic with systemic administration:
- CNS: Dizziness or light-headedness, fatigue, drowsiness,
unconsciousness, tremors, twitching vision changes; may progress
to seizures.
 - CV: Cardiac arrhythmias, cardiac arrest, vasodilation,
hypotention
- GI: Nausea, vomiting
- HYPERSENSITIVY: Rash, anaphylactoid reactions
- RESPIRATORY: Respiratory depression, respiratory arrest
- OTHER: malignant hyperthermia, fever, local injection site
reaction.
• Injectable Local anesthetic for epidural or caudal anesthesia:
- CNS: headache, backache, septic meningitis, persistent sensory,
motor, or autonomic deficit of lower spinal segments, sometimes
with incomplete recovery.
- CV: Hypotention due to symphatetic block
- DERMATOLOGIC: Urticaria, pruritus, erythema, edema
- GU: Urinary retention, urinary or fecal incontinence.
• Topical local anesthetic:
- DERMATOLOGIC: Contact dermatitis, urticaria, cutaneous
lesions
- HYPERSENSITIVITY: Anaphylactoid reactions
- LOCAL: Burning, stinging, tenderness, swelling, tissue irritation,
tissue sloughing and necrosis
Teaching Points:
• Dosage is changed frequently in response to cardiac rhythm, on
monitor
• Oral lidocaine can cause numbness of the tongue, cheeks, and
throat. Do not eat or drink for 1 hour after using oral lidocaine to
prevent biting the inside of your mouth or tongue and choking.
• May experience these side effects: Drowsiness, dizziness,
numbness, double vision; nausea, vomiting; stinging, burning,
local irritation
• Report difficulty speaking, thick tongue, numbness, tingling,
difficulty breathing, pain or numbness at IV site, swelling or pain
at site of local anesthetic use.
FURACIN
Brand Name: Furacin
Generic Name: Nitrofurazone
Therapeutic Action: Asynthetic topical antibacterial agent unrelated to the
antibiotics and sulphonamides, with a broad spectrum of
action.
Indications: Indicated in bacterial skin infections including pyodermas, infected
dermatoses and infections of cuts, wounds, burns and ulcers due to
susceptible organisms. Furacin is also of value in other conditions
such as treatment of skin graft donor sites and otitis externa.
Contraindications: Contra-indicated in patients with known sensitivity to
nitrofurazone.
Adverse Effect:
• Itching
• Rash
• Swelling
• Abdominal pain
• Allergic reaction
• Changes in appetite
• Diarrhea
• Difficulty seeing and dizziness
• Abnormal bleeding
• An irregular heartbeat
• Backache
• Breast tenderness
• Constipation
• Dry mouth or increased thirst
Teaching points:
•
FLAMAZINE
Brand Name: Flamazine
Generic Name: Silver Sulfadiazine
Therapeutic Action: An antibiotic that is active against a wide range of bacteria
and it is commonly used to treat and prevent infections at
the site of burns.Silver sulfadiazine has also been used in
other skin conditions, such as leg ulcers or pressure sores,
where infection may prevent healing and for the prevention
of infection in skin grafting.
Indications: Allergy to any sulphonamide medicine
• Decreased kidney function
• Decreased liver function
• Lack of the enzyme G6PD in the blood (G6PD deficiency)
Contraindications:
• Babies less than one month old (neonates)
• Heavily weeping (exudative) leg or pressure ulcers
• Premature infants
• Term or near term pregnancy
• This medicine should not be used if you are allergic to one or any
of its ingredients. Please inform your doctor or pharmacist if you
have previously experienced such an allergy. If you feel you have
experienced an allergic reaction, stop using this medicine and
inform your doctor or pharmacist immediately.
• This medicine should not be used in pregnancy unless your doctor
considers it essential. It should not be used in the weeks prior to
child birth. Seek medical advice from your doctor.
• This medicine should be used with caution by breastfeeding
mothers, and only if the expected benefit to the mother is greater
than any possible risk to the baby. Seek medical advice from your
doctor.
Drug-Drug Interaction: may interact with,
• antidiabetes medications
• cimetidine
• enzymatic debriding agents
• phenytoin
 Adverse Effect:
• Itching (pruritus)
• Burning sensation
• Rash
• Allergy to active ingredients (hypersensitivity)
• Decrease in the number of white blood cells in the blood
(leucopenia)
• blistering, peeling, or loosening of skin
• bloody or cloudy urine
• chills or fever
• cough
• decreased amount of urine or less frequent urination
• increased sensitivity of skin to sunlight, especially for patients with
burns on large areas
• intense itching of burn wounds
• pain at site of application
• painful or difficult urination
• red skin lesions, often with a purple centre
• shortness of breath
• sore throat
• sores, ulcers, or white spots on lips or in mouth
• swollen glands
• unusual bleeding or bruising
• unusual tiredness or weakness
Teaching Points:
• teach patient that virus transmission can occur during treatment. $$ Tell
patient that there may be some discomfort with application.
• Teach patient that therapy should begin as soon as signs and symptoms
appear. Tell patient to notify prescriber if adverse reactions occur.
FIND MEANING IN WHAT YOU ARE DOING,
refuse to fail
WOUND ASSESSMENT: Instructions for Use
General Guidelines
Fill out the attached rating sheet to assess a wound after reading the definitions and methods of assessment
described below. Evaluate once a week and whenever a change occurs in the wound. Rate according to each item
by picking the response that best describes the wound and entering that number in the column for the appropriate
date.
Specific Instructions
1. Size: Use ruler to measure the longest and widest aspect of the wound surface in centimeters; always measure
length from head to toe.
2. Depth: Measure in centimeters (cm)
3. Edges: Use this guide:
Indistinct, diffuse = unable to clearly distinguish wound outline.
Attached = even or flush with wound base, no sides or walls present; flat.
Not attached = sides or walls are present; floor or base of wound is deeper than edge.
Rolled under, thickened = soft to firm and flexible to touch
Hyperkeratosis = callous-like tissue formation around wound and at edges
Fibrotic, scarred = hard, rigid to touch
4. Undermining: Assess by inserting a cotton-tipped applicator under the wound edge; advance it as far as it will
go without using undue force; raise the tip of the applicator so it may be seen or felt on the surface of the skin;
mark the surface with a pen; measure the distance from the mark on the skin to the edge of the wound. Continue
process around the wound.
5. Necrotic Tissue Type and Amount: Pick the type of necrotic tissue that is predominant in the wound
according to color, consistency adherence, and amount using this guide:
White/gray non-viable = may appear prior to wound opening; skin surface is white or gray.
Non-adherent yellow slough = thin, mucinous substance; scattered throughout wound bed; easily seperated
from wound tissue.
Loosely adherent yellow slough = thick, stringy clumps of debris; attached to wound tissue.
Adherent, soft black eschar = soggy tissue; strongly attached to tissue in center or base of wound.
Firmly adherent, hard black = firm, crusty tissue; strongly attached to wound base and edges (like a hard
scab).
Indicate % of wound involved next to number in item column for the appropriate date.
6. Exudate Type and Amount: Some dressings interact with wound drainage to produce a gel or trap liquid.
Before assesing exudate type, gently cleanse wound with normal saline or water. Pick the exudate type that is
predominant in the wound according to color and consistency, using this guide:
Bloody = thin, bright red
Serosanguineous = thin, watery, pale red to pink
Serous = thin, water, clear*
Purulent = thin or thick, opaque tan to yellow*
Foul purulent = thick, opaque yellow to green with offensive odor*
Use this guide and indicate none, scant, small, moderate or large for amount next to number in column under
appropriate date.
None = wound tissues dry
Scant = wound tissues moist; no measurable exudate
Small = wound tissues wet; moisture evenly distributed in wound; drainage involved < 25% of dressing
Moderate = wound tissues saturated; drainage may or may not be evenly distributed in wound; drainage involved >
25% to < 75% of dressing
Large = wound tissues bathed in fluid; drainage freely expressed; may or may not be evenly distributed in wound;
drainage involves > 75% of dressing
7. Skin Color Surrounding Wound: Assess tissues within 4 cm of wound edge. Dark-skinned persons show the
colors "bright red" and "dark red" as a deepening of normal ethnic skin color or a purple hue. As healing occurs in
dark-skinned persons, the new skin is pink and may never darken. *Redness can be a sign of infection.
8. Peripheral Tissue Edema: Assess tissues within a 4 cm of wound edge. Non-pitting edema appears as skin
that is shiny and taut. Identify pitting edema by firmly pressing a finger down into the tissues and waiting for 5
seconds; on release of pressure, tissues fail to resume previous position and an indentation appears. Crepitus is
accumulation of air or gas in tissues. *Edema can be a sign of infection.
9. Induration: Assess tissues within 4 cm of wound edge. Induration is abnormal firmness of tissues with margins.
Assess by gently pinching the tissues. Induration results in an inability to pinch the tissues. *Induration can be a
sign of infection.
10. Granulation Tissue: Granulation tissue is the growth of small blood vessels and connective tissue to fill in full-
thickness wounds. Tissue is healthy when bright, beefy red, shiny, and granular with a velvety appearance. Poor
vascular supply appears as pale pink or blanched to dull, dusky red color.
11. Infection: A wound or tissue infection is present when the signs and symptoms are present. Pus is always an
indication of infection. In the absence of pus or purulent drainage four of the following signs and symptoms must be
present: heat, fever of 101F, swelling or induration, tenderness/pain, serous drainage, or redness of skin. To
indicate infection the appropriate asterisked areas on the form must also be marked.
12. Discomfort: Assess severity of pain on a scale of 0 to 5 with 0 being no pain and 5 being the most discomfort
or pain. Also, assess when the patient has pain and place the appropriate number and letter in the column under
the appropriate date.
13. Wound Status: Check previous assessment and indicate whether there is improvement, no change or whether
the wound is deteriorating. Treatment should be attempted for at least two weeks before changing therapy.
14. Stage: Pressure ulcers only will be staged.
Stage I: Nonblanchable erythema of intact skin, the heralding lesion of skin ulceration. In individuals with darker
skin, discoloration of the skin, warmth, edema, induration or hardness may also be indicators.
Stage II: Partial thickness skin loss involving epidermis, dermis, or both. The ulcer is superficial and presents
clinically as an abrasion, blister, or shallow crater.
Stage III: Full thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to,
but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without undermining of
adjacent tissue.
Stage IV: Full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or
supporting structures (e.g., tendon, joint capsule). Undermining and sinus tracts also may be associated with Stage
IV pressure ulcers.
15. Dressing order, order changes, extra changes. The DRESSING ORDER should include everything
regarding the treatment of the wound, such as cleansing solution; brand of dressing; whether duoderm has a
border or not; wheter it is a rope or guaze; size of dressing; frequency of dressing changes; if packing is required
and with what; if it is wet to dry. the dressing order is to written in the box on the first page. DRESSING ORDER
CHANGES also, go on the first page and should include all the same information as for a dressing order. EXTRA
CHANGES other than the routine dressing changes should be noted on the blank lines on second page. These notes
should include the date and reason for the change.
* Indicates infection
Cleaning an Open Wound
Once bleeding has been controlled, the open wound should be cleaned with mild soap and water (see illustration).
Liquid soaps do a great job, and there is no need for fancy antibacterial soaps. Be sure to rinse the entire depth of
the cut, and rinse the soap from the surface thoroughly.
Water sometimes has a tendency to sting. Saline solution (0.9% salt solution) can be a little easier on tender skin.
Bottled water can do double duty in a first aid kit that's tight on space or weight (you can wash with it or drink it),
but saline solution is better for cleaning wounds and eyes.
Keeping a wound clean is as important as cleaning it the first time. If it seems a wound has become contaminated
or dirty after it was been cleaned and dressed, remove the dressing and clean it again. Keeping a wound clean is
the best way to avoid infection.
Cleaning an open wound can sometimes cause bleeding to return. The bleeding will be minor and should be easily
stopped with direct pressure using a sterile - or at least clean - dressing. Once the bleeding has been stopped, it's
time to dress the wound.
Dressing an Open Wound
Don't dress a wound without first cleaning it as well as possible. Do not dress a wound with visible contamination. If
you can't get it clean, leave it open and seek medical attention.
Once the wound is clean and not bleeding, dab a bit of antiseptic ointment on it to keep out the germs. Cover the
wound lightly with an adhesive dressing. If body hair gets in the way of an adhesive dressing, you may wrap the
extremity loosely with a wide roller gauze. Always change dressings every 12 hours.
For lacerations and incisions, pull the edges of the wound together and use butterfly enclosures to hold them.
Avulsions with a flap of skin can be closed and butterfly enclosures applied as well. Apply antiseptic ointment over
butterfly enclosures and cover with a bandage as above. Superficial wounds, those that are not deep enough to see
subcutaneous (fatty) tissue, do not need butterfly enclosures.
If a wound resumes bleeding at any point, follow the steps to control bleeding. If bleeding doesn't stop, you may
need to seek medical attention. If at any point the victim gets pale, dizzy, or weak, call 911 and treat for shock.
How Long Do I Have to Get Stitches?
If stitches are necessary, you will need to keep the wound closed with butterfly enclosures until you can get to an
emergency room or urgent care clinic. Remember always, keep it closed and keep it clean.
How much time you have depends on a number of factors. If the wound has a high likelihood of contamination, then
you have about six (6) hours to get stitches before the wound will become too contaminated to stitch. Some
wounds are not generally stitched because of severe contamination, human or animal bites are good examples.
Wounds with less chance of contamination may be stitched as long as eight (8) hours after the injury. Depending on
the wound, scarring can be minimized as long as 24 hours after the injury, but the longer you wait, the less likely
that stitches will be possible.
For wounds that have other complications like numbness or decreased movement, seek medical attention
immediately.
Complications of Open Wounds
Infection is the most common complication of an open wound. If you experience any of the following symptoms
after sustaining an open wound, consult a doctor:
• Tenderness or inflammation around the wound
• Fever
• Swelling around the wound
• Numbness around the wound
• Red streaks around the wound
What is Tetanus?
Tetanus is a serious infection that can lead to spasms in the jaw - commonly called Lockjaw - and possibly
death. It is easily blocked with a simple vaccination. If you haven't had at least three tetanus vaccinations
with the last being within ten (10) years, it's time to get a tetanus shot.
 1.) To cleanse a wound, wash your hands thoroughly with soap and water. Use a mild soap like Ivory or any
other mild soap you may have, just try to keep this kind of soap in your house at all times because you
never know when you may need it. Never try to touch a wound with dirty hands use some sanitary wipes
what ever you can to clean your hands that is so important to prevent infection.

2.) Wash inside and around the wound to remove bacteria and other pieces of objects and dirt that may be
inside the effected area that could cause an infection.

3.) Rinse the wound thoroughly by flushing with clean water, preferably running tap water but, if that's not
possible use the water you have.

4.) Blot the wound dry with a sterile gauze pad or a clean cloth you should try to use a white cloth or towel,
because colors have dye which may effect the wound.

5.) Apply a dry sterile bandage or clean dressing and secure it firmly in place making sure you're covering
the whole area, the bandages and dressing should be changed everyday before you reapply the bandages,
clean the would with mild soap and water first pat dry than apply new bandages.

6.) You should see a Physician right away if the wound get infected if not, it should heal on it's own
provided it's not a deep puncture wound that may need stitches or further treatment.

A Guide to Wound Dressing

Dressing Your Wound

Healthy skin is a natural barrier to prevent infection. A break in your skin makes it possible for germs to enter your
body and cause infection. Covering your wound will help to keep it clean and prevent infection.
Changing Your Dressing
Your wound care nurse will show you how to properly care for your wound, including dressing changes.

1. Gather the supplies you will need for your dressing change:
- Wound Cleanser
- Dressing
- Trash Bag
- Tape
- Hand Washing Supplies
- Disposable Gloves
2. Wash your hands with soap and water before and after dressing changes.
3. Wear gloves during dressing care.
4. Carefully remove your dressing. Place old dressing in a small sealable bag before disposal.
5. Clean your wound.
6. Look at your wound carefully. Notice any foul odors, change in color or amount of drainage, redness or
swelling around the wound or spreading away from the wound. Report any of these to your physician.
7. Put on a new dressing as directed by your wound care physician.
When To Change Your Dressing
1. When the dressing gets dirty or wet
2. As directed by the wound center staff
Helping Your Wound To Heal
1. Keep the outside of your dressing clean and dry. If it becomes soiled or wet, change it as soon as possible.
2. Keep your body clean. Bathe daily with soap and water. Do dressing changes after each bath or shower.
3. Eat a well balanced diet to help your body heal. Follow special dietary or fluid restrictions that your doctor
has ordered.
 4. Carefully examine your wound every time you remove your dressing. Immediately report any changes to
your physician.
You Should Call Your Physician Immediately If You Experience:
• Increased pain at the wound site
• Redness or swelling around the wound or spreading away from the wound
• Foul odor coming from the wound
• Change in color or amount of drainage from the wound
• Fever and chills
• Nausea or vomiting
Any wound that has not started to heal in two weeks or completely healed in six weeks may benefit from a
specialized wound healing center. Ask your regular physician if a referral to a wound healing center might be the
right option for you.