MEDICAL MANAGEMENT
Intravenous Fluid (IVF)
MEDICAL DATE BRIEF DESCRIPTION
MANAGEMENT
Plain Lactated Ringer’s February 13 – 14, 2011 An isotonic solution
Solution + Glycin 1L containing sodium,
chloride, potassium,
20-21 gtts./min. calcium and lactate used to
restore vascular volume
and replace fluid and
electrolytes.
Side Drip February 13, 2011 Isotonic solution on initial
5% Dextrose in Water administration but
90cc + 10 mg Isoket provides free water when
dextrose is metabolized
10-11 ugtts./min. expanding intracellular and
extracellular fluid volume.
5% Dextrose in Water + February 15, 2011 Isotonic solution on initial
Lysmix or D5W + 2 amp. administration but
(40 ml Lysmix) 1L provides free water when
dextrose is metabolized
10-11gtts./min. expanding intracellular and
extracellular fluid volume.
INDICATION CLIENT’S REACTION
An alkalinizing solution Consumed with no adverse
that maybe give to treat reaction.
acidosis
Useful in preventing Consumed with no adverse
dehydration, supplied for reaction.
fluid requirements and
carbohydrates for calories
and energy.
Useful in preventing Consumed with no adverse
dehydration, supplied for reaction.
fluid requirements and
carbohydrates for calories
and energy.
Nursing Responsibilities:

Before
 Recheck doctor’s order and compute flow rate.
 Explain purpose of the procedure.
 Recheck blood pressure before administration.
 Monitor urine output and vital signs hourly.

During
 Monitor and regulate IV and its patency.
 Monitor venipuncture site.
 Assess client’s general condition.
 Strictly, monitor and regulate IVF to avoid fluid overload.

After
 Proper disposal of IV bottle after use.
 Assess improvement of patient’s condition.
 Document client’s response.
Oxygen Therapy

MEDICAL DATE BRIEF DESCRIPTION INDICATION CLIENT’S REACTION

MANAGEMENT
OXYGEN THERAPHY February 13, 2011 Is the administration of Provide adequate transport Patient’s Respiratory rate
oxygen at concentration of oxygen in blood when improved from 24cpm to
Via nasal cannula 4 liters greater than that found in decreasing the work of 16cpm
per minute the environmental breathing and reducing
atmosphere. stress in myocardium.

Nursing Responsibilities

Before
 Explain purpose of the procedure.
 Recheck doctor’s order and regulation.
 Position in Semi-Fowlers

During
 Monitor vital signs and record.
 Secure nasal cannula.
 Assess signs of hypoxia.

After
 Assess patient’s general condition.
 Assess client’s nares for irritation and apply lubricants to soothe mucous membrane.
Drugs

E.R. Medications

NAME OF DATE ROUTE OF GENERAL/MECHANI INDICATION/PURP- SIDE CLIENT’S

DRUG ORDERED ADMINISTRAT- -SM OF ACTION OSE EFFECTS/ADVER RESPONSE
(GENERIC ION, DOSAGE -SE REACTION TO
& BRAND AND MEDICATI-
NAME) FREQUENCY ON
Generic February 13, 300 mg. 1 tab. Produces analgesia by  Prevention of EENT:
Name: 2011 stat; 100 mg. 1 blocking prostaglandin thrombosis. Tinnitus, hearing
Aspirin tab. OD synthesis (peripheral  Reduction of risk of loss
(acetylsalicyl action). Drug and other MI in patients with GI:
ic acid) salicylates may prevent previous MI or Nausea, vomiting,
lowering of pain unstable angina. GI distress, occult
Brand threshold that occurs bleeding, dyspepsia,
Name: when prostaglandin GI bleeding
N.A. sensitize pain receptors Hematologic:
to stimulation. Exerts its Prolonged bleeding
Pharmacolo anti-inflammatory effect time,
gic Class: by inhibiting thrombocytopenia
Salicylate prostaglandin synthesis; Hepatic:
also may inhibit Hepatitis
Therapeutic synthesis or action of Skin:
Class: other mediators of Rash, bruising,
Nonopioid inflammatory response. uticaria
analgesic, Relieves fever by acting Other:
anti-pyretic, on hypothalamic heat- Angioedema,
anti- regulating center to cause hypersensitivity
inflammatory peripheral vasodilation, reactions, Reye’s
, antiplatelet which increase peripheral syndrome
drug blood supply and
promotes sweating,
which leads to heat loss
 and to cooling by
evaporation. In low
doses, aspirin also
appears to impede
clotting by blocking
prostaglandin synthesis,
which prevents formation
of platelet aggregating
substance thromboxane
A2.

Nursing Responsibilities:

Before
 Check the expiration date of the drug.
 Check the doctor's order.
 Confirm right dosage and route of administration.
 Make sure the drug is given to the right patient.
 Assess the client's understanding about the drug.
 Explain what the drug is for and its side effects if any.
 Give with food or large amounts of water or milk to minimize GI irritation.

During
 Tell patient to report ototoxicity symptoms, unusual bleeding, and bruising.
 Caution patient to avoid activities that may cause injury. Advise him to use soft toothbrush and electric razor to avoid gum and skin injury.
 Instruct patient to tell all prescribers he’s taking the drug, because it may cause serious interactions with many common medications.
  Tell patient not to take other over the counter preparations containing aspirin.
 Inform patient that he may need to undergo regular blood testing during therapy.

After
 Watch for signs and symptoms of hypersensitivity and other adverse reactions, especially bleeding tendency. Stay alert for signs and
symptoms of acute toxicity, such as diplopia, ECG abnormalities, generalized seizures, hallucinations, hyperthermia, oliguria, acute renal
failure, incoherent speech, irritability, restlessness, tremor, vertigo, confusion, disorientation, mania, lethargy, laryngeal edema,
anaphylaxis, and coma.
 Monitor elderly patients carefully because they’re at greater risk for salicylate toxicity.
 With prolonged therapy, frequently assess hemoglobin, hematocrit, International Normalized Ratio, and kidney function test results.
 Check salicylate blood levels frequently.
 Evaluate patient for signs and symptoms of ototoxicity (hearing loss, tinnitus, ataxia, and vertigo).
 NAME OF DATE ROUTE OF GENERAL/MECHANI INDICATION/PURP- SIDE CLIENT’S
DRUG ORDERED ADMINISTRAT- -SM OF ACTION OSE EFFECTS/ADVER RESPONSE
(GENERIC ION, DOSAGE -SE REACTION TO
& BRAND AND MEDICATI-
NAME) FREQUENCY ON
Generic February 13, 75 mg. 1 tab. OD Inhibits platelet To reduce CNS:
Name: 2011 aggregation by blocking atherosclerotic events in Depression,
Clopidogrel binding of adenosine patients with recent dizziness, fatigue,
Bisulfate diphosphate myocardial infarction headache
to platelets, thereby (MI) or cerebrovascular CV:
Brand preventing thrombus accident Chest pain,
Name: formation and in those with hypertension
Clopimet established peripheral EENT:
arterial disease or acute Epistaxis, rhinitis
Pharmacolo coronary GI:
gic Class: syndrome Diarrhea, abdominal
Platelet pain, dyspepsia,
aggregation gastritis, GI bleeding
inhibitor Hematologic:
Bleeding,
Therapeutic neutropenia,
Class: thrombotic
Antiplatelet thrombocytopenic
drug purpura
Metabolic:
Hypercholesterolemi
a, gout
Musculoskeletal:
joint pain, back pain
Respiratory:
Cough, dyspnea,
bronchitis,
upper respiratory
tract infection,
 bronchospasm
Skin:
Pruritus, rash,
angioedema
Other:
Hypersensitivity
reactions,
anaphylactic
reactions

Nursing Responsibilities:

Before
 Check the expiration date of the drug.
 Check the doctor's order.
 Confirm right dosage and route of administration.
 Make sure the drug is given to the right patient.
 Assess the client's understanding about the drug.
 Explain what the drug is for and its side effects if any.
 Advise patient to minimize adverse GI effects by eating small, frequent meals or chewing gum.

During
 Tell patient drug may cause headache and dizziness. Caution him to avoid driving and other hazardous activities until he knows how drug
affects concentration and alertness.
 Advise patient to immediately report unusual or acute chest pain, respiratory difficulty, rash, unresolved bleeding, diarrhea, GI distress,
nosebleed, or acute headache.
After
 Monitor hemoglobin and hematocrit periodically.
 Monitor patient for unusual bleeding or bruising; drug significantly increases risk of bleeding.
 Advise patient to contact prescriber before taking over-the-counter products, particularly non-steroidal anti-inflammatory drugs.
NAME OF DATE ROUTE OF GENERAL/MECHANI INDICATION/PURP- SIDE CLIENT’S
DRUG ORDERED ADMINISTRAT- -SM OF ACTION OSE EFFECTS/ADVER RESPONSE
(GENERIC ION, DOSAGE -SE REACTION TO
& BRAND AND MEDICATI-
NAME) FREQUENCY ON
Generic February 13, 1 ml (1 amp.) IVP Interacts with opioid Severe to moderate CNS:
Name: 2011 PRN for chest receptor sites, primarily pain. Confusion, sedation,
Morphine pain in limbic system, dizziness,
sulfate thalamus, and spinal dysphoria, euphoria,
cord. This interaction floating feeling,
Brand alters neurotransmitter hallucinations,
Name: release, altering headache,
Zomorfph perception of and nightmares
tolerance for pain. CV:
Pharmacolo Hypotension,
gic Class: bradycardia
Opioid EENT: blurred
agonist vision, diplopia,
miosis
Therapeutic GI:
Class: Nausea, vomiting,
Opioid constipation, dry
analgesic mouth
Controlled GU:
substance Urinary retention
schedule II Respiratory:
Apnea, respiratory
depression,
respiratory arrest
Skin:
Flushing, itching,
sweating
Other:
Physical or
 psychological drug
dependence, drug
tolerance

Nursing Responsibilities:

Before
 Check the expiration date of the drug.
 Check the doctor's order.
 Confirm right dose and route of administration.
 Make sure the drug is given to the right patient.
 Assess the client's understanding about the drug.
 Explain what the drug is for and its side effects if any.

During
 Advise patient to inform the nurse on duty at the first sign of pain, because continuous dosing is more effective than p.r.n. dosing.
 Tell patient and caregiver that drug may cause respiratory depression.
 Instruct them to immediately report respiratory rate of 10 bpm or less.
After
 Monitor vital signs. Contact prescriber if respiratory rate is 10 bpm or less.
 Assess pain character, location, and intensity.
 Monitor fluid intake and output.
 Stay alert for urinary retention.
 Monitor bowel elimination pattern.
 If constipation occurs, intervene as appropriate.
 Assess neurologic status. Implement safety measures as needed to prevent injury.
 Evaluate patient for signs and symptoms of physical or psychological dependence. Be watchful for drug hoarding.
ICCU Medications

NAME OF DATE ROUTE OF GENERAL/MECHANI INDICATION/PURP- SIDE CLIENT’S

DRUG ORDERED ADMINISTRAT- -SM OF ACTION OSE EFFECTS/ADVER RESPONSE
(GENERIC ION, DOSAGE -SE REACTION TO
& BRAND AND MEDICATI-
NAME) FREQUENCY ON
Generic February 13, 60 mg ½ tab. bid. Promotes peripheral Treatment and CNS:
Name: 2011 vasodilation and reduces prophylaxis in situations Dizziness, headache,
Isosorbide preload and afterload, likely to provoke acute apprehension,
mononitrate decreasing myocardial angina pectoris. asthenia, syncope
oxygen consumption and CV:
Brand increasing cardiac output. Orthostatic
Name: Also dilates coronary hypotension,
Isorbide 60 arteries, increasing blood tachycardia,
flow and improving paradoxical
Pharmacolo collateral circulation. bradycardia,
gic Class: rebound
Nitrate hypertension
EENT:
Therapeutic Sublingual burning
Class: (with S.L.
Antianginal route)
GI:
Nausea, vomiting,
dry mouth,
abdominal pain
Skin:
Flushing
Nursing Responsibilities:

Before
 Check the expiration date of the drug.
 Check the doctor's order.
 Confirm right dose and route of administration.
 Make sure the drug is given to the right patient.
 Assess the client's understanding about the drug.
 Explain what the drug is for and its side effects if any.

During
 Give oral form 30 minutes before or 1 to 2 hours after a meal. Make sure patient swallows tablets or capsules whole.
 Have patient wet S.L. tablet with saliva before placing it under tongue. To avoid tingling sensation, have him place tablet in buccal pouch.

After
 Monitor ECG and vital signs closely, especially blood pressure.
 NAME OF DATE ROUTE OF GENERAL/MECHANI INDICATION/PURP- SIDE CLIENT’S
DRUG ORDERED ADMINISTRAT- -SM OF ACTION OSE EFFECTS/ADVER RESPONSE
(GENERIC ION, DOSAGE -SE REACTION TO
& BRAND AND MEDICATI-
NAME) FREQUENCY ON
Generic February 13, 50 mg. 1 tab. OD Blocks stimulation of MI CNS:
Name: 2011 beta1 (myocardial) Angina pectoris Fatigue, weakness,
Metoprolol adrenergic receptors, Hypertension anxiety, depression,
succinate usually without affecting dizziness,
beta2 (pulmonary, drowsiness,
Brand vascular, uterine) insomnia,
Name: adrenergic receptor sites. memory loss, mental
Angimet status
changes,
Pharmacolo nervousness,
gic Class: nightmares
Beta- CV:
adrenergic Orthostatic
blocker hypotension,
(selective) peripheral
vasoconstriction,
Therapeutic bradycardia, heart
Class: failure, pulmonary
Antihyperten edema
sive, EENT:
antianginal Blurred vision,
stuffy nose
GI:
Nausea, vomiting,
constipation,
diarrhea,
flatulence, gastric
pain, heartburn,
dry mouth
 GU:
Urinary frequency,
erectile dysfunction,
decreased libido
Hepatic:
Hepatitis
Metabolic:
hyperglycemia,
hypoglycemia
Respiratory:
Wheezing,
bronchospasm
Musculoskeletal:
Back pain, joint pain
Skin:
Rash
Other:
Drug-induced lupus
syndrome

Nursing Responsibilities:

Before
 Check the expiration date of the drug.
 Check the doctor's order.
 Confirm right dose and route of administration.
 Make sure the drug is given to the right patient.
 Assess the client's understanding about the drug.
 Explain what the drug is for and its side effects if any.
  Give metoprolol tartrate with or immediately after meals, because food enhances its absorption.

During
 Tell patient that extended-release tablets are scored and can be divided, but that he should swallow tablets or half-tablets whole and not
crush or chew them.
 Advise patient with heart failure to report signs or symptoms of worsening condition, including weight gain and increasing shortness of
breath.
 Caution patient to avoid driving and other hazardous activities until drug effects are known.
 Instruct patient to notify health care providers (including dentists) that he is taking drug before having surgery.

After
 Measure blood pressure closely when starting therapy and titrating dosage. Once patient stabilizes, measure blood pressure every 3 to 6
months.
 Monitor blood pressure and pulse before I.V. administration. If patient is hypotensive or has bradycardia, consult prescriber before giving
dose.
 Watch for orthostatic hypotension in at-risk patients, particularly the elderly.
 Assess glucose levels in diabetic patient. Be aware that drug may mask signs and symptoms of hypoglycemia.
 Monitor for signs and symptoms of hyperthyroidism. Know that drug may mask these. Reduce dosage gradually in hyperthyroid patients.
 When discontinuing drug, reduce dosage gradually over 1 to 2 weeks.
 NAME OF DATE ROUTE OF GENERAL/MECHANI INDICATION/PURP- SIDE CLIENT’S
DRUG ORDERED ADMINISTRAT- -SM OF ACTION OSE EFFECTS/ADVER RESPONSE
(GENERIC ION, DOSAGE -SE REACTION TO
& BRAND AND MEDICATI-
NAME) FREQUENCY ON
Generic February 13, 20 mg. 1 tab. tid. Trimetazidine is a  Angina pectoris  GI disturbances,
Name: 2011 cellular acting anti-  Vertigo vomiting,
Trimetazidine ischaemic agent. It has 3  Tinnitus nausea.
hydrochloride main properties by which  Hypersensitivity
it acts as a cytoprotective  Pregnancy and
Brand agent. It inhibits the lactation.
Name: anaerobic glycolysis and
Carvidon fatty acid metabolism,
thus allowing only
Pharmacolo aerobic glycolysis. This
gic Class: action helps to restore the
N.A. energy balance in the
cell. It inhibits acidosis
Therapeutic and free radical
Class: accumulation in the cell.
Anti-anginal All these action help the
cell to restore the normal
ionic and metabolic
balance.
Nursing Responsibilities

Before
 Check the expiration date of the drug.
 Check the doctor's order.
 Confirm right dose and route of administration.
 Make sure the drug is given to the right patient.
 Assess the client's understanding about the drug.
 Explain what the drug is for and its side effects if any.
 Give trimetazidine hydrochloride with meals.

After
 Monitor vital signs and watch for any adverse reactions.
 NAME OF DATE ROUTE OF GENERAL/MECHANI INDICATION/PURP- SIDE CLIENT’S
DRUG ORDERED ADMINISTRAT- -SM OF ACTION OSE EFFECTS/ADVER RESPONSE
(GENERIC ION, DOSAGE -SE REACTION TO
& BRAND AND MEDICATI-
NAME) FREQUENCY ON
Generic February 13, 80 mg. 1 tab. OD Gliclazide is a Type 2 diabetes. Diamicron is
Name: 2011 sulfonylurea which generally well
Gliclazide stimulates insulin tolerated. Nausea,
secretion by the headache, rashes and
Brand pancreas. Its action on gastrointestinal
Name: insulin secretion is disturbances have
Diamicron mainly due to the been reported.
restoration of the early
Pharmacolo phase, resulting in a
gic Class: physiological release of
Sulfonamides insulin. Thus, gliclazide
, urea restores glycemic control
derivatives throughout 24 hrs. It
normalizes fasting and
Therapeutic postprandial blood sugar.
Class: In man, apart from
Anti-diabetic having hypoglycemic
agent effect, gliclazide has
been shown to reduce
platelet
hyperadhesiveness and
hyper-aggregation and to
increase fibrinolytic
activity. Moreover, it has
been demonstrated that
gliclazide possesses
specific antioxidant
properties which is
comparable to vitamin C.
Nursing Responsibilities

Before
 Check the expiration date of the drug.
 Check the doctor's order.
 Confirm right dose and route of administration.
 Make sure the drug is given to the right patient.
 Assess the client's understanding about the drug.
 Explain what the drug is for and its side effects if any.
 Give gliclazide with meals, usually with breakfast or dinner.

During
 Teach patient about diabetes and importance of proper diet, exercise, weight control, and blood glucose monitoring.
 Inform patient that drug may cause diarrhea, nausea, and upset stomach. Advise him to take it with meals to reduce these effects, and tell
him that adverse effects often subside over time.
 Teach patient to recognize and immediately report signs and symptoms of acidosis, such as weakness, fatigue, muscle pain, dyspnea,
abdominal pain, dizziness, light-headedness, and slow or irregular heartbeat.

After
 Monitor blood glucose level closely. If it isn’t controlled after 4 weeks at maximum dosage.
 Monitor kidney and liver function tests, particularly in elderly patients.
 Periodically monitor glucose and glycosylated hemoglobin levels to evaluate drug efficacy.
 NAME OF DATE ROUTE OF GENERAL/MECHANI INDICATION/PURP- SIDE CLIENT’S
DRUG ORDERED ADMINISTRAT- -SM OF ACTION OSE EFFECTS/ADVER RESPONSE
(GENERIC ION, DOSAGE -SE REACTION TO
& BRAND AND MEDICATI-
NAME) FREQUENCY ON
Generic February 13, 20 mg. IVP q 60 Produces osmotic effect, Hypertension CNS:
Name: 2011 with AP which increases water Dizziness, headache,
Furosemide precaution content in colon and vertigo,
enhances peristalsis. weakness, lethargy,
Brand Breakdown paresthesia,
Name: products in colon lead to drowsiness,
Fusem acidification restlessness, light-
of colonic contents, headedness
Pharmacolo softening of feces, and CV:
gic Class: decreased ammonia Hypotension,
Sulfonamide absorption from colon to orthostatic
loop diuretic systemic circulation. hypotension,
These effects reduce tachycardia, volume
Therapeutic blood ammonia level in depletion,
Class: portal system necrotizing angiitis,
Diuretic, encephalopathy. thrombophlebitis,
antihypertens arrhythmias
ive EENT: blurred
vision, xanthopsia,
hearing loss, tinnitus
GI:
Nausea, vomiting,
diarrhea,
constipation,
dyspepsia, oral and
gastric
irritation, cramping,
anorexia, dry
mouth, acute
pancreatitis
GU:
Excessive and
frequent urination,
nocturia, glycosuria,
bladder spasm,
oliguria, interstitial
nephritis
Hematologic:
Anemia, purpura,
leukopenia,
thrombocytopenia,
hemolytic
anemia
Hepatic:
Jaundice
Metabolic:
Hyperglycemia,
hyperuricemia,
dehydration,
hypokalemia,
hypomagnesemia,
hypocalcemia,
hypochloremic
alkalosis
Musculoskeletal:
Muscle pain,muscle
cramps
Skin:
Photosensitivity,
rash, diaphoresis,
urticaria, pruritus,
exfoliative
 dermatitis,
erythema
multiforme
Other:
Fever, transient pain
at I.M. injection
site

Nursing Responsibilities

Before
 Check the expiration date of the drug.
 Check the doctor's order.
 Confirm right dose and route of administration.
 Make sure the drug is given to the right patient.
 Assess the client's understanding about the drug.
 Explain what the drug is for and its side effects if any.
 Instruct patient to take in morning with food (and second dose, if prescribed, in afternoon), to prevent nocturia.
 Be aware that I.V. dose may be given by direct injection over 1 to 2 minutes.

During
 Tell patient that drug may cause serious interactions with many common drugs. Instruct him to tell all prescribers he’s taking it.
 Instruct patient to report signs and symptoms of ototoxicity (hearing loss, ringing in ears, vertigo) and other drug toxicities.
 Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
 Instruct patient to move slowly when rising, to avoid dizziness from sudden blood pressure decrease.
  Encourage patient to discuss need for potassium and magnesium supplements with prescriber.
 Caution patient to avoid alcohol and herbs while taking this drug.
 Inform patient that he’ll undergo regular blood testing during therapy.

After
 Watch for signs and symptoms of ototoxicity.
 Assess for other evidence of drug toxicity (arrhythmias, renal dysfunction, abdominal pain, sore throat, fever).
 Monitor CBC, BUN, and electrolyte, uric acid, and CO2 levels.
 Monitor blood pressure, pulse, fluid intake and output, and weight.
 Assess blood glucose levels in patients with diabetes mellitus.
 Monitor dietary potassium intake.
 Watch for signs and symptoms of hypokalemia.
 NAME OF DATE ROUTE OF GENERAL/MECHANI INDICATION/PURP- SIDE CLIENT’S
DRUG ORDERED ADMINISTRAT- -SM OF ACTION OSE EFFECTS/ADVER RESPONSE
(GENERIC ION, DOSAGE -SE REACTION TO
& BRAND AND MEDICATI-
NAME) FREQUENCY ON
Generic February 13, 30 cc. P.O. h.s. Produces osmotic effect, Constipation GI:
Name: 14, 2011 which increases water Nausea, vomiting,
Lactulose content in colon and diarrhea, intestinal
enhances peristalsis. cramps, abdominal
Brand Breakdown distention,
Name: products in colon lead to flatulence
Rilax acidification Metabolic:
of colonic contents, Hyperglycemia (in
Pharmacolo softening of feces, and diabetic
gic Class: decreased ammonia patients),
Osmotic absorption from colon to hypokalemia,
systemic circulation. hypernatremia
Therapeutic These effects reduce
Class: blood ammonia level in
Laxative portal system
encephalopathy.
Nursing Responsibilities:

Before
 Check the expiration date of the drug.
 Check the doctor's order.
 Confirm right dose and route of administration.
 Make sure the drug is given to the right patient.
 Assess the client's understanding about the drug.
 Explain what the drug is for and its side effects if any.

During
 Instruct patient to dissolve contents of single-use packet in 4 oz of water or juice.
 Suggest that patient dilute syrup with water or juice to mask taste.
 Tell patient drug may cause flatulence and intestinal cramps at first, but these symptoms usually subside.
 Inform patient that excessive use may cause diarrhea and excessive fluid loss.
 Encourage patient to drink adequate fluids and to report signs and symptoms of dehydration.

After
 Watch for adverse GI reactions.
 Check stool consistency and frequency.
 Monitor electrolyte levels, especially in elderly patients.
 Check blood glucose level in diabetic patients.
NAME OF DATE ROUTE OF GENERAL/MECHANI INDICATION/PURP- SIDE CLIENT’S
DRUG ORDERED ADMINISTRAT- SM OF ACTION OSE EFFECTS/ADVER RESPONSE
(GENERIC ION, DOSAGE -SE REACTION TO
& BRAND AND MEDICATI-
NAME) FREQUENCY ON
Generic February 14, 10 mg 1 tab. tid Promotes peripheral Treatment and CNS:
Name: 2011 vasodilation and reduces prophylaxis in situations Dizziness, headache,
Isosorbide preload and afterload, likely to provoke acute apprehension,
dinitrate decreasing angina pectoris. asthenia, syncope
myocardial oxygen CV:
Brand consumption and Orthostatic
Name: increasing cardiac output. hypotension,
Isoket Also dilates tachycardia,
coronary arteries, paradoxical
Pharmacolo increasing blood flow bradycardia,
gic Class: and improving collateral rebound
Nitrate circulation. hypertension
EENT:
Therapeutic Sublingual burning
Class: (with S.L.
Antianginal route)
GI:
Nausea, vomiting,
dry mouth,
abdominal pain
Skin:
Flushing
Nursing Responsibilities:

Before
 Check the expiration date of the drug.
 Check the doctor's order.
 Confirm right dose and route of administration.
 Make sure the drug is given to the right patient.
 Assess the client's understanding about the drug.
 Explain what the drug is for and its side effects if any.

During
 Give oral form 30 minutes before or 1 to 2 hours after a meal. Make sure patient swallows tablets or capsules whole.
 Have patient wet S.L. tablet with saliva before placing it under tongue. To avoid tingling sensation, have him place tablet in buccal pouch.

After
 Monitor ECG and vital signs closely, especially blood pressure.
 NAME OF DATE ROUTE OF GENERAL/MECHAN INDICATION/PURP- SIDE CLIENT’S
DRUG ORDERED ADMINISTRA- -ISM OF ACTION OSE EFFECTS/ADVE- RESPONSE
(GENERIC & TION, RSE REACTION TO
BRAND DOSAGE AND MEDICATI-
NAME) FREQUENCY ON
Generic Name: February 13, 40 mg 1 tab OD Inhibits hepatic enzyme Coronary artery CNS:
Simvastatin 14, 2011 @ h.s. HMG-CoA reductase, disease; Headache, asthenia
interrupting cholesterol hyperlipidemia. GI:
Brand Name: synthesis Nausea, vomiting,
Buztin and low-density diarrhea,
lipoprotein (LDL) constipation,
Pharmacologic consumption. Net effect abdominal pain or
Class: is total cholesterol and cramps,
HMG-CoA serum triglyceride flatulence,
reductase reductions. dyspepsia
inhibitor Musculoskeletal:
Myalgia,
Therapeutic rhabdomyolysis
Class: Respiratory:
Antihyperlipide Upper respiratory
mic infection
Nursing Responsibilities:

Before
 Check the expiration date of the drug.
 Check the doctor's order.
 Confirm right dose and route of administration.
 Make sure the drug is given to the right patient.
 Assess the client's understanding about the drug.
 Explain what the drug is for and its side effects if any.

During
 Advise patient to take with evening meal, but not with large amounts of grapefruit juice.
 Tell patient drug may take up to 4 weeks to be effective.

After
 Watch closely for myositis and other adverse musculoskeletal reactions. Know that drug may cause rhabdomyolysis.
 Monitor CBC, and lipid levels.
NAME OF DATE ROUTE OF GENERAL/MECHANI INDICATION/PURP- SIDE CLIENT’S
DRUG ORDERED ADMINISTRAT- -SM OF ACTION OSE EFFECTS/ADVER RESPONSE
(GENERIC ION, DOSAGE -SE REACTION TO
& BRAND AND MEDICATI-
NAME) FREQUENCY ON
Generic February 13, 2 ml (1 amp.) IVP Blocks dopamine Nausea and vomiting. CNS:
Name: 14, 2011 stat then q 80 receptors by disrupting Drowsiness,
Metoclopram CNS chemoreceptor restlessness, anxiety,
ide trigger zone, increasing depression,
hydrochloride peristalsis and promoting irritability, fatigue,
Brand gastric emptying. lassitude,
Name: insomnia, tardive
Metsil dyskinesia,
parkinsonian-like
Pharmacolo reactions,
gic Class: extrapyramidal
Dopamine reactions, akathisia,
antagonist dystonia
CV:
Therapeutic Hypertension,
Class: hypotension,
Antiemetic, arrhythmias
GI GI:
stimulant Nausea,
constipation,
diarrhea, dry
mouth
GU:
Gynecomastia
Nursing Responsibilities:

Before
 Check the expiration date of the drug.
 Check the doctor's order.
 Confirm right dose and route of administration.
 Make sure the drug is given to the right patient.
 Assess the client's understanding about the drug.
 Explain what the drug is for and its side effects if any.

During
 Tell patient to take 30 minutes before meals.
 Instruct patient to report involuntary movements of face, eyes, or limbs.
 Caution patient to avoid driving and other hazardous activities until drug’s effects are known.
 As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs,
tests, and behaviors mentioned above.
After
 Monitor blood pressure during I.V. administration.
 Stay alert for depression and other adverse CNS effects.
 Watch for extrapyramidal reactions, which usually occur within first 24 to 48 hours of therapy. To reverse these symptoms, give
diphenhydramine 50 mg I.M. or benztropine 1 to 2 mg I.M., as prescribed.
 In diabetic patient, stay alert for gastric stasis. Insulin dosage may need to be adjusted.
NAME OF DATE ROUTE OF GENERAL/MECHANI INDICATION/PURP- SIDE CLIENT’S
DRUG ORDERED ADMINISTRAT- -SM OF ACTION OSE EFFECTS/ADVER RESPONSE
(GENERIC ION, DOSAGE -SE REACTION TO
& BRAND AND MEDICATI-
NAME) FREQUENCY ON
Generic February 14, 4,000 IU IVP OD Inhibits thrombus and  To treat acute ST- CNS: Dizziness,
Name: 2011 clot formation by segment–elevation headache, insomnia,
Enoxaparin blocking factor Xa and MI (STEMI). confusion,
sodium factor IIa. This inhibition cerebrovascular
accelerates formation  Prevention of accident
Brand of antithrombin III- ischemic CV:
Name: thrombin complex complications of Edema, chest pain,
Lovenox (a coagulation inhibitor), unstable angina or atrial fibrillation,
thereby deactivating non-Qwave heart failure
Pharmacolo thrombin and preventing myocardial GI:
gic Class: conversion of fibrinogen infarction. Nausea, vomiting,
Low- to fibrin. constipation
molecularwei GU:
ght Urinary retention
heparin Hematologic:
Anemia, bleeding
Therapeutic tendency,
Class: thrombocytopenia,
Anticoagulan hemorrhage
t Metabolic:
Hyperkalemia
Skin:
Bruising, pruritus,
rash, urticaria
Other:
Fever; pain,
 irritation, or
erythema at injection
site
Nursing Responsibilities:

Before
 Check the expiration date of the drug.
 Check the doctor's order.
 Confirm right dose and route of administration.
 Make sure the drug is given to the right patient.
 Assess the client's understanding about the drug.
 Explain what the drug is for and its side effects if any.

During
 Instruct patient to promptly report irregular heartbeat, unusual bleeding or bruising, rash, or hives.
 Teach patient safety measures to avoid bruising or bleeding.

After
 Monitor CBC and platelet counts.
 Watch for signs and symptoms of bleeding or bruising.
 Monitor fluid intake and output.
 Watch for fluid retention and edema.
NAME OF DATE ROUTE OF GENERAL/MECHANI INDICATION/PURP- SIDE CLIENT’S
DRUG ORDERED ADMINISTRAT- -SM OF ACTION OSE EFFECTS/ADVER RESPONSE
(GENERIC ION, DOSAGE -SE REACTION TO
& BRAND AND MEDICATI-
NAME) FREQUENCY ON
Generic February 14, 40 ml. (2 amps.) n.a. Nutritional supplement n.a.
Name: 2011 for incorporation for lactating women,
n.a. to IVF children, also for
patients with acute and
Brand chronic liver disease
Name: such as liver cirrhosis,
Lysmix fatty liver, hepatic
encephalopathy.
Pharmacolo
gic Class:
Parenteral
Nutrition

Therapeutic
Class:
Multivitamin
s
Nursing Responsibilities:

Before
 Check the expiration date of the drug.
 Check the doctor's order.
 Confirm right dose and route of administration.
 Make sure the drug is given to the right patient.
 Assess the client's understanding about the drug.
 Explain what the drug is for and its side effects if any.
NAME OF DATE ROUTE OF GENERAL/MECHANI INDICATION/PURP- SIDE CLIENT’S
DRUG ORDERED ADMINISTRAT- -SM OF ACTION OSE EFFECTS/ADVER RESPONSE
(GENERIC ION, DOSAGE -SE REACTION TO
& BRAND AND MEDICATI-
NAME) FREQUENCY ON
Generic February 14, 50 mg 1 tab. bid. Vildagliptin is a For people with type 2 Hypoglycemia,
Name: 2011 dipeptidylpeptidase-4 diabetes whose blood delayed gastric
Vildagliptin (DPP-4) inhibitor that sugar is not sufficiently emptying, nausea
improves glycemic controlled by other and vomiting. Flu-
Brand control by preventing antidiabetic medicines. like symptoms,
Name: DPP-4 from inactivating It can be added to headache and
Galvus the incretin hormones treatment with dizziness may occur.
glucagon-like peptide-1 metformin; a
Pharmacolo and glucose-dependent sulphonylurea, for Potentially Fatal:
gic Class: insulinotropic example gliclazide; or Stevens-Johnson
dipeptidyl polypeptide, thus another type of syndrome.
peptidase-4 prolonging incretin antidiabetic medicine
(DPP-4) activity in response to known as a
inhibitor ingestion of nutrients. thiazolidinedione, for
This increases insulin example pioglitazone or
Therapeutic sensitivity, decreases rosiglitazone.
Class: glucagon secretion and
Anti- improves β-cell function.
hyperglycemi
c
Nursing Responsibilities:

Before
 Check the expiration date of the drug.
 Check the doctor's order.
 Confirm right dose and route of administration.
 Make sure the drug is given to the right patient.
 Assess the client's understanding about the drug.
 Explain what the drug is for and its side effects if any.
NAME OF DATE ROUTE OF GENERAL/MECHANI INDICATION/PURP- SIDE CLIENT’S
DRUG ORDERED ADMINISTRAT- -SM OF ACTION OSE EFFECTS/ADVER RESPONSE
(GENERIC ION, DOSAGE -SE REACTION TO
& BRAND AND MEDICATI-
NAME) FREQUENCY ON
Generic February 14, 50 mg 1 tab. bid. Increases insulin Concurrent use with GI:
Name: 2011 sensitivity by decreasing insulin in type 2 Diarrhea, nausea,
Metformin glucose production and diabetes mellitus. vomiting, abdominal
hydrochloride absorption in liver and bloating
intestines and enhancing Metabolic:
Brand glucose uptake and Lactic acidosis
Name: utilization. Other:
Glycon Unpleasant metallic
taste, decreased
Pharmacolo vitamin B12 level
gic Class:
Dimethylbigu
anide

Therapeutic
Class:
Antidiabetic
Nursing Responsibilities:

Before
 Check the expiration date of the drug.
 Check the doctor's order.
 Confirm right dose and route of administration.
 Make sure the drug is given to the right patient.
 Assess the client's understanding about the drug.
 Explain what the drug is for and its side effects if any.

During
 Instruct patient to take metformin tablet at breakfast and dinner if taking drug twice a day. Instruct him to take E.R. tablets once daily with
evening meal and to swallow them whole without crushing or chewing.
 Teach patient about diabetes and importance of proper diet, exercise, weight control, and blood glucose monitoring.
 Inform patient that drug may cause diarrhea, nausea, and upset stomach. Advise him to take it with meals to reduce these effects, and tell
him that adverse effects often subside over time.
 Teach patient to recognize and immediately report signs and symptoms of acidosis, such as weakness, fatigue, muscle pain, dyspnea,
abdominal pain, dizziness, light-headedness, and slow or irregular heartbeat.
 Advise patient to report changes in health status (such as infection, persistent vomiting and diarrhea, or need for surgery). These may
warrant dosage decrease or drug withdrawal.
After
 Monitor blood glucose level closely. If it isn’t controlled after 4 weeks at maximum dosage, oral sulfonylurea may be added.
 Monitor kidney and liver function tests, particularly in elderly patients.
 Assess hematologic parameters and vitamin B12 levels at start of therapy and periodically thereafter.
 Watch for signs and symptoms of lactic acidosis. Stop drug if acidosis occurs. To aid differential diagnosis, check electrolyte, ketone,
glucose, blood pH, lactate, and metformin blood levels.
 Periodically monitor glucose and glycosylated hemoglobin levels to evaluate drug efficacy.
 NAME OF DATE ROUTE OF GENERAL/MECHANI INDICATION/PURP- SIDE CLIENT’S
DRUG ORDERED ADMINISTRAT- -SM OF ACTION OSE EFFECTS/ADVER RESPONSE
(GENERIC ION, DOSAGE -SE REACTION TO
& BRAND AND MEDICATI-
NAME) FREQUENCY ON
Generic February 14, 600 mg. IVP q 80 Resistance to many  Adult Formulation: Infections and
Name: 2011 antibiotics is caused by For short-term Infestations:
Co- bacterial enzymes treatment of Common:
amoxiclav which destroy the bacterial infections Mucocutaneous
at the following
antibiotic before it can candidiasis.
Brand sites when caused
act on the pathogen. Blood and
Name: by co-amoxiclav-
Augmentin The clavulanate in co- sensitive organisms: Lymphatic
IV amoxiclav anticipates Upper respiratory System
this defense tract infections Disorders: Rare:
Pharmacolo mechanism by (including ear, nose Reversible
gic Class: blocking the β- and throat) eg, leukopenia
Penicillin lactamase enzymes, recurrent tonsillitis, (including
thus rendering the sinusitis and otitis neutropenia) and
Therapeutic organisms sensitive to media. thrombocytopenia.
Class: amoxicillin's rapid Very Rare:
Bactericidal  Lower respiratory
bactericidal effect at Reversible
tract infections eg,
concentrations readily agranulocytosis
acute exacerbations
attainable in the of chronic and hemolytic
body.Clavulanate by bronchitis, lobar and anemia,
itself has little bronchopneumonia. prolongation of
antibacterial activity; bleeding time and
however, in association prothrombin time.
with amoxicillin as co- Immune System
amoxiclav, it produces Disorders: Very
an antibiotic agent of Rare:
broad spectrum with Angioneurotic
wide application in edema,
hospital and general anaphylaxis, serum
practice. sickness-like
syndrome,
hypersensitivity
vasculitis.
CNS Disorders:
Uncommon:
Dizziness,
headache. Very
Rare: Convulsions.
Convulsions may
occur in patients
with impaired
renal function or in
those receiving
high doses.
Vascular
Disorders: Rare:
Thrombophlebitis
at the site of
injection.
GI Disorders:
Common:
Diarrhea.
Uncommon:
Nausea, vomiting,
indigestion. Very
Rare: Antibiotic-
associated colitis
(including
pseudomembranou
s colitis and
hemorrhagic
colitis) are less
likely to occur
after parenteral
administration.
Hepatobiliary
Disorders:
Uncommon: A
moderate rise in
AST and/or ALT
has been noted in
patients treated
with β-lactam class
antibiotics, but the
significance of
these findings is
unknown. Very
Rare: Hepatitis and
cholestatic
jaundice. These
events have been
noted with other
penicillins and
cephalosporins.
Hepatic events
have been reported
predominantly in
males and elderly
patients and may
be associated with
prolonged
treatment.
Signs and
symptoms usually
occur during or
shortly after
treatment but in
some cases may
not become
apparent until
several weeks after
treatment has
ceased. These are
usually reversible.
Hepatic events
may be severe and
in extremely rare
circumstances,
deaths have been
reported. These
have almost
always occurred in
patients with
serious underlying
disease or taking
concomitant
medications
known to have the
potential for
hepatic effects.
Skin and
Subcutaneous
Tissue Disorders:
Uncommon: Skin
rash, pruritus,
urticaria. Rare:
Erythema
multiforme. Very
rare: Stevens-
Johnson syndrome,
toxic epidermal
necrolysis, bullous
exfoliative-
dermatitis, acute
generalized
exanthemous
pustulosis
(AGEP).
If any
hypersensitivity
dermatitis reaction
occurs, treatment
should be
discontinued.
Renal and
Urinary
Disorders: Very
rare: Interstitial
 nephritis,
crystalluria

Nursing Responsibilities:

Before
 Check the expiration date of the drug.
 Check the doctor's order.
 Confirm right dose and route of administration.
 Make sure the drug is given to the right patient.
 Assess the client's understanding about the drug.
 Explain what the drug is for and its side effects if any.
 Perform ANST to confirm patient’s sensitivity to the drug.

During
 Instruct patient to immediately report signs and symptoms of hypersensitivity reactions, such as rash, fever, or chills.
 Tell patient he may take drug with or without food.
 Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.

After
 Monitor for signs and symptoms of hypersensitivity reaction.
  Monitor patient’s temperature and watch for other signs and symptoms of super infection (especially oral or rectal candidiasis).

Diet

TYPE OF DIET DATE PURPOSE

Diabetic diet February 13, 2011 To keep blood sugar levels normal.

Nursing Responsibilities

Before
 Check the doctor’s order.
 Assess clients and S.O’s knowledge and understanding of the diet.

During
 Assess client’s ability to swallow.

After
 Constant monitoring of blood glucose level.
BIBLIOGRAPHY

Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, Eleventh Edition, Suzanne C.

Smeltzer et. al., copyright 2008

2010 Nursing Spectrum Drug Handbook, 5th ed, Patricia Dwyer Schull, copyright 2009

Jones & Bartlett Learning 2011 Nurse’s Drug Handbook, Tenth Edition, copyright 2010

http://www.mims.com/Page.aspx?
menuid=mng&name=Isoket+IV+amp&brief=true&h=isoket&CTRY=PH&searchstring=isoket*#
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