BRAND/GENERIC NAME Metformin (Glucophage + Glucophage XL)

DOSAGE/INDICATION Tablet size (mg) 500,850 1.25 glyburide/250 metformin Renal daily dose (mg) 1,500 (D) Maximum dose (mg) 2,500 Duration of action (h) 10.16

ACTION Produces its antidiabetic effects by facilitating insulins action on peripheral receptor sites. It can be used only in the presence of insulin.

CONTRAINDICATION Contraindicated in patient with renal impairment (serum creatinine level more than 1.4) or these at risk for renal dysfunction (eg. Those with acute myocardial infarction).

SIDE EFFECTS Lactic acidosis is a potential and serious complication of bignaride therapy; the patient must be monitored closely when therapy is initiated or when dosage changes.

NURSING PRECAUTION Should not be administered for two days before any diagnostic testing that may require use of contract agents.

ASSESSMENT

PATHOPHYSIOLOGY DIAGNOSIS The neurochemistry of emesis overlaps with the neurochemistry of motion sickness and vertigo. Acetylcholine, histamine, and dopamine are excitatory neurotransmitters, working centrally on the control of emesis. GABA inhibits central emesis reflexes. Serotonin is involved in central and peripheral control of emesis but has little influence on vertigo. Risk for injury related to altered mobility because of gait disturbances and vertigo.

PLANNING Remains free of any injuries associated with imbalance and or falls.

INTERVENTION

RATIONALE

EVALUATION

1.Assess for History provides vertigo, including basis for history onset, interventions. description of attacks,duration, frequency and any associated ear symptoms. 2.Assess extent of Extent of disability relation disability to activities of indicates risk of saily living. falling. 3.Teach or reinforce vestibula/balance therapy as prescribed. Exercise hasten labyrinthine compensation, which may decrease vertigo and gait disturbances Alleviates acute symptoms of vertigo.

4.Administer or teach administration of antivestibular medications and or vestibular sedation medication, instruct patient about side effects.

5.Encourage patient to sit down when dizzy.

Decreases possibility of falling and injury. Movements aggriviate vertigo.

6.Place pillow on each side of head to restrict movements. 7.Assist patient in identifying aura that suggests an impending attack.

Recognition of aura may trigger the need to take medication before an attack occurs thereby minimizing the severity of effects. Sensation of vertigo decreases and motion decelerates if eyes are kept in a fixed position.

8.Recommend that the patients keep eyes open and stare straight ahead when lying down and expiriencing vertigo.

ASSESSMENT

PATHOPHYSIOLOGY DIAGNOSIS

PLANNING

INTERVENTION

RATIONALE

EVALUATION

Disturbed Sensory Perception (Sensory Overload) related to hearing loss (as evidenced by disorientation to time and place; restlessness; and altered behavior)

Cognitive Orientation as evidenced by not compromised: Identifies significant other(s) Identifies current place Identifies correct season Hearing Compensation Behavior as evidenced by often demonstrated: Positions self to advantage hearing Reminds others to use techniques that advantage hearing Eliminates background noise Uses hearing supportive Devices

1.Provide a consistent physical environment and a daily routine.

Routine eliminates the element of surprise, overstimulation, and further confusion. Familiarity helps reduce confusion.

2.Provide access to familiar objects, when possible. 3.Provide a lowstimulation environment because disorientation may be increased by overstimulation.

A disruption in the quality or quantity of incoming stimuli can affect a persons cognitive status. Sensory overload blocks out meaningful stimuli. Reduces overstimulation and fatigue, which may be contributing factors to confusion.

4.Provide for adequate rest, sleep, and daytime naps.

5.Use a calm and unhurried approach when interacting.

Promotes communication that enhances the persons sense of dignity. The client who has difficulty hearing will be better able to lip read and comprehend speech. Assists the individual to differentiate between own thoughts and reality.

6.Speak to the client in a slow, distinct manner with appropriate volume.

7.Engage patient in concrete here and now activities (that is, ADLs) that focus on something outside the self that is concrete and reality oriented Communication Enhancement: Hearing Deficit 8.Facilitate use of hearing aids, as appropriate.

Hearing can be enhanced if the volume is appropriate and the hearing aid is consistently used.

9.Listen attentively.

Effective listening is essential in a nurseclient relationship. Poor listening skills can undermine trust and block therapeutic communication. Using simple terms and short sentences facilitates understanding and minimizes anxiety.

10. Use simple words and short sentences, as appropriate.

11.Obtain patients attention through touch

Gaining the attention of a client with a hearing impairment is an essential first step toward effective communication. However, the clients personal space should be respected and permission to touch should be obtained.