X.

DRUGSTUDY

X.DRUGSTUDY DRUG

CLASSIFICATIO N

ACTION

INDICATION Adjunct to diet in the treatment of elevated total cholestrol and LDL cholesterol with primary hypercholesterole mia To reduce the risk of coronary disease, mortality, and CV events, including stroke, TIA, MI Treatment of patients with hypertriglyceride mia Short-term tx of active duodenal ulcer Heartburn or GERD Active benign ulcer

ADVERESE EFFECT CNS:Headache,asth enia, sleep disturbances GI: Flatulence, diarrhea, abdominal pain, cramps, constipation, nausea, dyspepsia, heartburn, liver failure Respiratory: Sinusitis, pharyngitis Other: Rhabdomyolysis, acute renal failure, arthralgia, myalgia CNS: Headache, dizziness, asthenia, vertigo, insomnia, apathy, anxiety, paresthesias, dream abnormalities

NURSING RESPONSIBILITIE S
Ensure that patient has tried a cholesterollowering diet regimen for 36 mos. before beginning therapy. Give in the evening; highest rates of cholesterol synthesis are between midnight and 5 AM. Advise patient that this drug cannot be taken during pregnancy; advise patient to use barrier contraceptives. Arrange for regular follow-up during longterm therapy. Consider reducing dose if cholesterol falls below target. Administer before meals. Caution patient to swallow capsules whole, not to open, chew, or crush them. Arrange for further evaluation of patient after 8 wk of therapy

Generic Name: SIMVASTATIN Brand Name: ZOCOR Dosage: 40MG

ANTIHYPERLIPIDIMIC HMG- CoA REDUCTASE INHIBITOR

Inhibits HMG-CoA reductase, the enzyme that catalyzes the first step in the cholesterol synthesis pathway, resulting in a decrease in serum cholesterol, serum LDLs, and either an increase or no change in serum HDLs.

Generic Name: OMEPRAZOLE Brand Name: LOSEC Dosage: 40 mg

Gastric acid-pump ANTI-SECRETORY inhibitor: Suppresses DRUG gastric acid secretion PROTON PUMP by specific inhibition INHIBITOR of the hydrogenpotassium ATPase enzyme system at the

secretory surface of the gastric parietal cells; blocks the final step of acid production

Long term tx of pathologic hypersecretory conditions

Rash, inflammation, alopecia, dry skin GI: Diarrhea, abdominal pain, nausea, vomiting, constipation flatulence, borborygmi, belching, abdominal cramps, pain, distention (initial dose), diarrhea (excessive dose), nausea and vomiting, hypernatremia

for gastro reflux disorders; not intended for maintenance therapy. Administer antacids with omeprazole, if needed. Check stool consistency Monitor electrolyte levels, serum ammonia level Monitor I&0 Monitor patient for any adverse effects, GI reactions, nausea and vomiting, diarrhea Give laxative syrup orally with fruit juice, water or milk to increase palatability increase oral fluid intake to prevent dehydration

Generic Name: LACTULOSE Brand Name: CHRONULAC Dosage: 30 mL

LAXATIVE

drug passes unchanged into the colon where bacteria break it down to organic acids that increases the osmotic pressure in the colon and slightly acidify the colonic contents, resulting in an increase in stool water content, stool softening

Constipation painful anal and rectal conditions, preventions and treatment of portal-systemic encephalophaty (PSE)

Generic Name: CITICOL INE Brand Name:

NEUROTICS

Citicoline activates the biosynthesis of structural phospholipids

Parkinsons disease Head injury Cerebral vascular

Headache Slow or fast heartbeat Nausea or vomiting Low blood pressure such as faintness or dizziness

Citicoline may be taken with or without food. Take it with or between meals.

ZYNAPSE Dosage: 1 gram

in the neuronal membrane, increases cerebral metabolism and increases the level of various neurotransmitt ers, including acetylcholine and dopamine. Citicoline has shown neuroprotectiv e effects in situations of hypoxia and ischemia.

disease Alzheimers disease Cerebral surgery or acute cerebral disturbance Disturbance of consciousness following brain surgery

Diarrhea

The supplement should not be taken in the late afternoon or at night because it can cause difficulty sleeping. Women who are pregnant or trying to become pregnant should consult with their doctor before taking the supplements. Not enough is known about the use of Citicoline during pregnancy and breastfeeding. Stay on the safe side and avoid use. Contact the physician immediately if allergic reaction Citicoline therapy should be started within 24 hours of a stroke. The physician will prescribe the correct dosage and the length

of time it should be taken for a medical condition. Assess patient for history of allergy to amlodipine, impaired hepatic or renal function, sick sinus syndrome, heart block, or CHF. Assess for adverse drug reactions; report irregular heartbeat, swelling of the hands and feet, shortness of breath, pronounced dizziness, and constipation. Monitor BP and cardiac rhythm. Instruct patient to take drug with meals if abdominal discomfort occurs; advise on eating small, frequent meals for N &V.

Generic Name: AMLODIPINE Brand Name: NORVAS C Dosage: 250 mg

CALCIUM CHANNEL BLOCKER

Inhibits calcium ions from entering the slow channels or select voltage sensitive areas of vascular smooth muscle and myocardium during depolarization

Treatment of essential hypertension and angina

CNS: Dizziness, Lightheadedness, Fatigue, Lethargy CV: Peripheral edema, Arhythmias Dermatologic: Flushing, rash GI: Nausea, Abdominal discomfort

Generic Name: METOPROLOL Brand Name: LOPRESS OR Dosage: 100mg

Competitively blocks ANTIbeta-adrenergic HYPERTENSIVE receptors in the heart BETA- SELECTIVE and juxtaglomerular ADRENERGIC apparatus, BLOCKER decreasing the influence of the sympathetic nervous system on these tissues and the excitability of the heart, decreasing cardiac output and the release of renin, and lowering BP; acts in the CNS to reduce sympathetic outflow and vasoconstrictor tone.

Hypertension Prevention of reinfarction in MI Treatment of angina pectoris Treatment of stable, symptomatic CHF of ischemic, hypertensive, or cardiomyopathic origin

CNS: Dizziness, vertigo, tinnitus CV: CHF, cardiac arrhythmias, peripheral vascular insufficiency, claudication, CVA, pulmonary edema, hypotension Dermatologic: Rash, pruritus, sweating, dry skin GI: Gastric pain, flatulence, constipation, diarrhea, nausea, GU: Impotence, decreased libido, Respiratory: Bronchospasm, dyspnea, cough, bronchial obstruction

Take apical pulse and BP before administering drug. Report to physician significant changes in rate, rhythm, or quality of pulse or variations in BP prior to administration. Monitor BP, HR, and ECG carefully during IV administration. Expect maximal effect on BP after 1 wk of therapy. Observe hypertensive patients with CHF closely for impending heart failure: Dyspnea on exertion, orthopnea, night cough, edema, distended neck veins. Monitor I&O, daily weight; auscultate daily for pulmonary rales. Monitor patients with thyrotoxicosis closely

Since drug masks signs of hyperthyroidism.

Generic Name: KALIUM DURULE Brand Name:

ELECTROLYTE

Replace potassium and maintain potassium level

To prevent hypokalemia, prophylaxis during treatment w/ diuretics

Dosage:

Arrhythmias, Heart block, Hypotension Cardiac arrest Hyperkalemia Respiratory paralysis Nausea and vomiting , abdominal pain

Make sure the powder are completely dissolve before giving Monitor renal function. after surgery, dont give drug until urine flow is established tell patient to take drug with or after meals with full glass of water of fruit juice to lessen GI distress

XII.NURSING CARE PLAN FOR CVA ACTUAL

CUES SUBJECTIVE: namamanhid yung kanang bahagi ng katawan ko, pero nagagalaw ko naman xha medyo mhirap lng ako. OBJECTIVE: >Limited range of motion (client cant fully extend his right arm and hold up his right shoulder) >Slowed movement >Right body weakness >Right facial asymmetry NURSING DIAGNOSIS INFERENCE GOAL/OBJECTIVE CVA Disruption on cerebral blood flow Nerve cells in the brain die bec. Of lack O2 consumption impaires transmission of information to the muscle cut off of blood supply body weakness/ paralysis inability to perform ADLs impaired physical Short term: After 8 hrs of nursing intervention, client will be able to participate in therapeutic regimen Expected outcome: Verbalize understanding of the situation Verbalization of understanding the therapy Able to participate in the interventions rendered by the nurse Long term: After 3 days of nursing intervention, client will be able to physical mobility Expected outcome: Demonstrate resumption of activities Participate in ADLs Maintain or muscle control NURSING INTERVENTION Independent: > establish rapport >monitor vital signs >observe affected side for color, edema, or other signs of compromised circulation. >determine readiness to engage in activities/ exercise >assist patient in active/passive ROM exercise to all extremities. Encourage exercises such as quadriceps/gluteal exercise, squeezing rubber bsll, extension of fingers and legs/feet. >provide rest periods between care activities, limit duration of procedures. >avoid doing things for patient that patient can do for self, but provide assistance as necessary. RATIONALE EVALUATION After 3 days of nursing intervention, the patient able maintain/ gained minimal strength function of affected body part *Partially Met

Impaired physical mobility related to hemiparesis as evidence by limited body movement secondary to CVA probably infarct
Impaired physical mobility r/t neuromuscular damage involvement (Right body weakness) as evidenced by motor control

Vital signs BP 160/ 90 PR 64 RR 19

>To promote cooperation >to have a baseline data >edematous tissue is more easily traumatized and heals more slowly. >to assess expected level of participation >minimizes muscle atrophy, promotes circulation, helps prevent contractures. >continual stimulation/activity can increase ICP. >these patients may become fearful and dpendent, and although assistance is helpful in preventing frustration, it is important for patient to do as much as possible for self to maintain self-esttem and promote recovery. >reduces risk of tissue

Temp

mobility
Reference: Understanding Pathophysiology, Huether

>change position at least every 2 hours(supine,sidelyiong) and possibly more often if placed on affected side.

ischemia/injury. Affected side has poorer circulation and reduced sensation and is more predisposed to skin breakdown/decubitus. >to prevent occurrence of injury

>provide for safety measures including fall prevention. Instruct to use side rails, roller pads for position changes and pillows. >involve patient and significant others in care assisting them to learn ways of managing problems of immobility

>to promote wellness

>to facilitate recuperation

>provide restful environment

>for patients wellness

Dependent: >administer medication as per doctors order Collaborative: >provide egg-crate mattress as indicated. >consult with physical/occupational therapist regarding active, resistive

>promotes even weight distribution,decreasing pressure on bony points and helping to prevent skin breakdown/decubitus formation. >individualized

exercises and patient ambulation.

program can be developed to meet particular needs/deal with deficits in balance, coordination strength.

XII. NURSING CARE PLAN ACTUAL ASSESSMENT NURSING DIAGNOSIS INFERENCE OBJECTIVES

Diagnosis: CVA probable Infarct Left MCA, HPN 2

NURSING INTERVENTION

RATIONALE

EVALUATION

Subjective: Nangangalay ang kanang kamay at paa ko as verbalized by the patient.

Ineffective cerebral tissue perfusion related to interruption of blood flow.

Vasospasm

STG:

Independent: - Monitor vital signs -This will serve as baseline data of the patient.

Vascular effects

After 4 hours of nursing intervention, the patient will be able to display a

After 4 hours of nursing intervention, the patient was able to participate in activities of daily living and has Decreased BP as

Objectives: Elevated blood pressure BP: 160/90

Blood pressure

Vasoconstriction

decrease in the blood pressure and will be able to participate in activities of daily living. Long term goal:After 6 days of nursing intervention the client is able to have a normative BP. Expected outcome: >demonstrate stable vital signs and absence of signs in increase ICP. >display no further deterioration/recu rrence of deficits.

-Observe for the neurological conditions of the patient. Monitor the patients Level of consciousness >assess for nuchal rigidity, twitching, increased restlessness, irritability, onset of seizure activity.

- Alteration in the patients neurological condition may indicate Intra Cranial Pressure, which may affect the clients LO and sensation. >indicative of meningeal irritation. Seizures may reflect increased ICP/cerebral injury, requiring further evaluation and intervention. >reduces arterial pressure by promoting venous drainage and may improve cerebral circulation/perfusio n.

evidenced by BP=130/90

Poor cerebral perfusion - Restless/ Irritable - Difficulty in swallowing - Slurred speech

>position with head slightly elevated aand in neutral position -Provide calm, restful surrounding and minimize environmental activity or noise.

After 67 days of nursing intervention the client displays a normative BP.

-Maintain activity restrictions

-Help reduce sympathetic stimulation and promotes relaxation. -Reduce physical stress and tension that affect blood pressure and course of hypertension. Conserves energy and decreases the bodys Oxygen demand -Can reduce stressful stimuli; produce calming effect, thereby reduce blood pressure.

-Instruct in relaxation technique.

COLLABORATIVE: - Implement dietary sodium, fat, and cholesterol restriction as indicated. -Administer antihypertensive and hyperlipidemic drugs as ordered by the physician ( Simvastatin, Metoprolol)

- These restrictions can help manage fluid retention and with associated hypertensive response, which affects cerebral

tissue perfusion -Helps in lowering down blood pressure

NURSING CARE PLAN POTENTIAL

CUES Subjective:

Objective: >with Nasogastric tube

NURSING DIAGNOSIS Risk for aspiration related to insertion of nasogastric tube

INFERENCE CVA Blockage of blood circulation in the brain Probably affect brainstem Damage of cranial nerves Inability to control vital activities such as swallowing and digestion NGT insertion Risk for aspiration
Reference: Understanding Pathophysiology, Huether

GOAL/OBJECTIVE After 4 hours of nursing intervention, the patient and significant others will understand the importance of health teaching.

NURSING RATIONALE INTERVENTION Independent: >Establish rapport >to promote cooperation >Monitor level of >A decreased consciousness.. level of consciousness is a prime risk factor for aspiration > Check placement >A displaced of NGT before tube may feeding. erroneously deliver tube feeding into the >Assess airway pulmonary status >Aspiration of for clinical small amounts evidence of can occur without aspiration. coughing or Auscultate breath sudden onset of sounds for respiratory development of distress, crackles and/or especially in rhonchi. patients with > Position patients decreased levels who have a of consciousness. decreased level of > This protects consciousness on the airway. their sides. Proper positioning can decrease the risk of aspiration. Comatose patients need frequent turning

EVALUATION after 4 hours of nursing intervention., the patient and the significant others understand the importance of health teaching.

>Feed in upright position and maintain for 1 hour after eating when possible to reduce aspiration risk >Feed slowly, stop for signs of choking and notify nurse ASAP. Dependent: > Keep suction setup available and use as per doctors order

to facilitate drainage of secretions. > Upright position facilitates the gravitational flow of food or fluid through the alimentary tract. >Slower feedings will reduce the risk of aspiration

>This is necessary to maintain a patent airway.