VI.

DRUG STUDY (CLIENT-BASED)

Drug Name Indication Action SE/AE Nursing Consideration Patient Teachings

Brand Name: Dolcet For moderate to severe Tramadol and its active CNS & GI - do not exceed - drug is a combination
pain. Short-term use (5 metabolite bind to µ– disturbances. recommended dose. medication to relieve pain,
Generic Name: Tramadol + days or less) for opioids receptors and Nausea, used as directed.
Paracetamol management of acute they are weak inhibitors dizziness, - withdrawal
pain. Onset of of norephinephrine and somnolence. symptoms may occur if - avoid activities that
Date ordered: 06/19/10 analgesia is less than serotonin reuptake. Asthenia, discontinued abruptly. require mental alertness
one hour and faster Acetaminophen may fatigue, hot until drug effects realized.
Classification: than tramadol alone. cause analgesia by flushes, - note drugs to
Narcotic/nonnarcotic inhibiting CNS constipation, prescribe to ensure - do not take with alcohol
analgesic combination drug prostaglandin synthesis, diarrhea, none interact. or OTC agents.
although it has no anti- flatulence, dry
Dose: 1tab inflammatory activity. mouth, pruritus, - assess for history of - do not stop suddenly after
increased seizure, alcohol long-term us; withdrawal
Frequency: PRN sweating, disorder, renal/liver symptoms may occur.
tinnitus abnormalities, reduce
Route: Oral does with dysfunction.
 Drug Name Indication Action SE/AE Nursing Consideration Patient Teachings

Generic Name: For the treatment of bone Interferes with DNA CNS: Headache, - continue therapy for 2 days - if an antacid is
Ciprofloxacin HCl and joint infections and gyrase and dizziness, insomnia, after signs and symptoms of needed take it at
for the treatment of topoisomerase IV. fatigue, somnolence, infection are gone. least 2 hr before or
Date ordered: infections caused by DNA gyrase is an depression, blurred vision after dose.
06/19/10 susceptible gram-negative enzyme needed for - ensure that patient is well
bacteria. replication of CV: Arrhythmias, hydrated. - drink plenty of
Classification: bacterial DNA. hypotension, angina fluids while you are
antibiotic, Topoisomerase IV - give antacids at least 2 hr on this drug.
fluoroquinolone plays a key role in GI: Nausea, vomiting, dry after dosing.
the partitioning of mouth, diarrhea, - inform side effects
Dose: 500mg, 1tab chromosomal DNA abdominal pain - monitor clinical response; if of the drug.
during bacterial cell no improvement is seen or a
Frequency: BID x 1 division. Effective Hematologic: Elevated relapse occurs, repeat culture - report rash, visual
week against both gram- BUN, AST, ALT, serum and sensitivity. changes, severe GI
negative and gram- creatinine and alkaline problems,
Route: Oral positive organisms. phosphatase; decreased - encourage patient to weakness, tremors.
WBC, neutrophil count, complete full course of
Hct therapy.

Other: Fever, rash

 Drug Name Indication Action SE/AE Nursing Consideration Patient Teachings

Brand Name: Acute and long- Inhibits prostaglandin CNS: Headache, - administer drug with food or after - take drug with
Celebrex term treatment of synthesis by dizziness, meals if GI upset occurs. food or meals if GI
signs and inhibiting COX-2, somnolence, upset occurs.
Generic Name: symptoms of thus decreasing insomnia, fatigue, - establish safety measures if CNS,
Celecoxib rheumatoid arthritis inflammation. Does tiredness, dizziness, visual disturbances occur. - take only the
and osteoarthritis. not inhibit COX-1 so tinnitus, prescribed dosage.
Date ordered: Reduction of the it does not affect ophthamologic - if overdose occurs, institute emergency
06/19/10 number of platelet aggregation; effects procedures - gastric lavage, induction of - these side effects
colorectal polyps in renal effects similar emesis, supportive therapy. may occur:
Classification: familial to other NSAIDs. Dermatologic: Rash, dizziness,
NSAID, COX-2 adenomatous Causes fewer GI pruritus, sweating, - provide further comfort measures to drowsiness (avoid
inhibitor polyposis (FAP). complications, such dry mucous reduce pain and to reduce inflammation. driving or the use of
Management of as bleeding and membranes, dangerous
Dose: 20mg, 1 cup acute pain. perforation, stomatitis machinery while
compared with other using this drug).
Frequency: BID x 1 NSAIDs. GI: Nausea,
week abdominal pain, - report sore throat,
dyspepsia, flatulence, fever, rash, itching,
Route: Oral GI bleed weight gain,
swelling in ankles
Other: Peripheral or fingers; changes
edema, anaphylactoid in vision.
reactions to
anaphylactic shock
 Drug Name Indication Action SE/AE Nursing Consideration Patient Teachings

Brand Name: Glucophage Adjunct to diet to Decreases hepatic Endocrine: - monitor urine or serum glucose levels - do not discontinue
lower blood glucose Hypoglycemia, frequently to determine effectiveness of without consulting
Generic Name: Metformin glucose with type production, lactic acidosis drug and dosage. your health care
HCl 2 (non–insulin- intestinal provider.
dependent) absorption of GI: Anorexia, - arrange for transfer to insulin therapy
Date ordered: 06/22/10 diabetes mellitus glucose, and nausea, vomiting, during periods of high stress (infections, - monitor urine or
in patients > 10 increases epigastric surgery, trauma). blood for glucose
Classification: yr; extended peripheral uptake discomfort, and ketones as
antidiabetic, oral; release in patients and utilization of heartburn, - use IV glucose if severe hypoglycemia prescribed.
biguanide > 17 yr. As part glucose. diarrhea occurs as a result of overdose.
of combination - avoid using
Dose: 500mg, 1tab therapy with a Hypersensitivity: alcohol while
sulfonylurea or Allergic skin taking this drug.
Frequency: OD insulin when reactions,
either drug alone eczema, pruritus, - report fever, sore
Route: Oral cannot control erythema, throat, unusual
glucose levels in urticaria bleeding or
patients with type bruising, rash, dark
2 diabetes urine, light-colored
mellitus stools, hypo- or
hyperglycemic
reactions.
 Drug Name Indication Action SE/AE Nursing Consideration Patient Teachings

Brand Name: Lyrica Management of Binds with high CNS: Dizziness, - do not administer this drug after a fatty or - do not stop taking
acute pain affinity to the somnolence, large meal, absorption can be affected. this drug suddenly;
Generic Name: Pregabalin associated with alpha2-delta site neuropathy, dosage should be
diabetic (subunit of ataxia, confusion, - provide safety measures if dizziness, adjusted to avoid
Date ordered: 06/22/10 peripheral voltage-gated Ca euphoria, somnolence, changes in thinking occur. adverse effects.
neuropathy. channels) in CNS incoordination,
Classification: analgesic, Management of tissues. Binding vision - monitor weight gain and fluid retention. - do nor perform
antiepileptic, calcium post anesthetic may be involved abnormalities, activities that
channel modulator neuralgia. in pregabalin’s tremors, thinking require mental
Adjunct therapy antinociceptive abnormalities alertness
Dose: 75mg, 1tab for adults with and antiseizure
partial onset of effects GI: Dry mouth, - avoid alcohol and
Frequency: HS seizures. constipation, CNS depressants as
Management for flatulence these may
Route: Oral fibromyalgia potentiate sedation
Other: Peripheral and impairment of
edema, weight motor skills
gain,
hypoglycemia,
back pain, chest
pain, infection,
creatinine kinase
elevations, loss of
fertility (male)
IX. NURSING CARE PLAN

A.

NURSING GOALS AND

CUES/NEEDS NURSING INTERVENTIONS RATIONALE EVALUATION
DIAGNOSIS OBJECTIVES

Subjective: Acute Pain After 30 minutes Independent: Goal met as

related to left to 1 hour of manifested by:
“Ang sakit ng sugat ko sa dislocated knee effective nursing - determine factors in client’s lifestyle that - this may cause
paa”, as verbalized by the joint and fracture interventions, the can affect responses to analgesics or certain chosen - client’s
patient. with sever tissue client will be able choice of interventions for pain interventions to verbalization of
damage to: management become ineffective pain relief and pain
Objective: scale reduced from
- verbalize relief - provide comfort measures (touch, - to promote 4/10 to 2/10
- facial expression of pain with a repositioning), quiet environment and nonpharmacological
of pain pain scale calm activities pain management,
- patient is irritable reduced from this can reduce pain
and restless 4/10 to 2/10 sensation
- pain scale of 4/10

- encourage relaxation techniques such as - to distract attention

focused breathing, CD’s or tapes and and reduce tension
encourage diversional activities like radio and pain sensation
and socialization with others

Dependent:

- administer analgesics like Dolcet as - Dolcet cause

ordered analgesia by
inhibiting CNS
prostaglandin
synthesis so without
the chemical
mediator
prostaglandin, there
would be no pain
 NURSING GOALS AND NURSING
CUES/NEEDS RATIONALE EVALUATION
DIAGNOSIS OBJECTIVES INTERVENTIONS

Subjective: Impaired Skin After 4 days to 1 Independent: Goal met as

Integrity related week of effective manifested by:
“Madami dami pa din to trauma: severe nursing - ascertain attitudes - identifies areas to be addressed in teaching
akong sugat, medyo left leg injury and interventions, the of individual/SO(s) plan and potential referral needs - timely healing of
nangangati na nga eh”, as tissue damage client will be able about condition skin lesions
verbalized by the patient. to: (cultural values,
stigma). Note
Objective: - display timely misconceptions.
healing of skin
- (+) disruption of lesions - photograph - to document status/provide visual baseline
skin surface lesions and for future comparisons and monitor progress
- (+) destruction of remeasure, as of wound healing
skin layers appropriate

- note presence of - skin is a particularly important avenue of

compromised communication for this population and,
vision, hearing or when compromised, may affect responses
speech

- keep the area - to assist body’s natural process of repair

clean/dry

- remove wet or - moisture potentiates skin breakdown

wrinkled linens
promptly
 NURSING GOALS AND NURSING
CUES/NEEDS RATIONALE EVALUATION
DIAGNOSIS OBJECTIVES INTERVENTIONS
 Risk for infection After 2 hours of Independent: After 2 hours of
Objective: related to nursing nursing intervention
inadequate intervention the - establish rapport - to gain trust and cooperation of the patient the patient will be
- wounds are primary defense patient will gain able to gain
not fully as manifested by knowledge in - teach patient to - hand washing reduces the risks for infection knowledge in
healed delicate skin infection control wash hands often, infection control as
as evidenced by especially before evidenced by his
discussing the toileting, before discussion in
wound care meals and before and wound care.
after administering Therefore, the goal
self-care was met

- discuss to patients - to impart to the patient when the wound

the following signs of become infected and when to sought medical
infection - redness, care
swelling, increased
pain, or purulent
drainage on the site
and fever

- demonstrate and - to know if the patient understands the

allow return principle of proper wound care
demonstration of
wound care