DIABETES SEPTIC

CARBUNCLE,
WITH SUPPURATION
 INTRODUCTION
 
Description of the Disease/Disorder
Diabetes mellitus is a group of metabolic diseases characterized by increased levels of glucose in the blood (hyperglycemia)
resulting from defects in insulin secretion, insulin action or both. Normally, a certain amount of glucose circulates in the blood. The major
sources of this glucose are absorption of ingested food in GT and formation of glucose by the liver from food substances. Insulin controls
the levels of glucose in the blood by regulating the production and storage of glucose. In DM, the cells may stop responding to insulin or
the pancreas may stop producing insulin entirely leading to hyperglycemia.
Carbuncle is an infection larger than a boil and with several openings for discharge of pus. It is an infection of the subcutaneous tissues
involving the hair follicles and an abscess larger than a boil, usually with one or more openings draining pus onto the skin. It is usually
caused by bacterial infection, most commonly Staphylococcus aureus. The infection is contagious and may spread to other areas of the
body or other people.
Often, the direct cause of a carbuncle cannot be determined. Things that make carbuncle infections more likely include friction
from clothing or shaving, generally poor hygiene and weakening of immunity. For example, persons with diabetes and immune system
diseases are more likely to develop staphylococcal infections.
 
Signs and Symptoms of Diabetes septic carbuncle
• Polyuria
•Polydipsia
•Polyphagia
•Dry skin
•Skin lesions or wounds that are slow to heal
•Recurrent infection
•presence of several skin boils
•infected mass is filled with fluid, pus, and dead tissue
•carbuncle may be the size of a pea or as large as a golf ball
•It may be red and irritated, and might hurt when touched
•It may also grow very fast and have a white or yellow center
•Sometimes, other symptoms may occur, such as fatigue, fever and a general discomfort or sick feeling
•Itching may occur before the carbuncle develops
• Prevalence of the Disease/Disorder (Philippines)
• The prevalence of diagnosed diabetes increased in all age groups. People between 65 and 74 years old had the highest
prevalence, followed by people of 75 years of age or older, people 45 to 64 years of age, and people younger than 45 years of
age. In 2002, the prevalence of diagnosed diabetes among people 65 to 74 years of age (16.8%) was almost 14 times that of
the people younger than 45 years of age (1.2%). However, many people with diabetes were undiagnosed.
• Men are more prone than women to get carbuncles, as those who are elderly, malnourished, obese, or use of corticosteroids.
Carbuncles are also more likely to occur under conditions of poor hygiene, friction by clothing, or moist skin (maceration).
Although the exact incidence of carbuncles is unknown, they are not common.

• Patient Case Introduction

• Patient X, 58 years old who lived in P-5, Baybay Tinagsa Kolambugan Lanao del Norte was admitted on Feb. 22, 2011at
3:06pm in MUMC with a chief complaint of diabetes septic necrotizing mass in the left upper quadrant of her abdomen and
with a pain scale of 7/10, 10 as the highest. She was diagnosed by Dr. I. Pala of diabetes septic carbuncle, upper abdomen
with suppuration.
• Upon assessment, her vital signs were temp. 360C, PR: 106 bpm, RR: 25cpm, BP: 140/80 mmHg, Wt: 48 kg, she was
ambulatory and also has nonproductive cough that occurs a day PTA
 PRESENT ILLNESS REACTIONS TO AND EXPECTATIONS ABOUT
HOSPITALIZATION

 Patient X was admitted on Feb. 22, 2011 @3:06pm in  “ hasol kayo ning magkadiabetes kay daghan kayo ang
MUMC with a chief complaint of diabetes septic akong mga bantayonon”, as verbalized by the patient.
necrotizing mass in the left upper quadrant of her abdomen.  “hasol pod kayo kung magsakit ning akong hubag sa tiyan
 She manifests guarding behavior with a pain scale of 7/10, kay makahunong ko sa akong gtrabaho”, as verbalized by
10 is the highest. the patient.
 Upon admission, she was ambulatory with the v/s of:  ”Dili na ko mkapanilhig ug laba kay sakit akong hubag” as
Temp:360C verbalized by the patient.
PR: 106 bpm  “Patient is widowed and verbalized, “la naman ko bana
RR: 25cpm pero sa akong mga anak ug apo ko naglihok, pero kay
BP: 140/80 mmHg maospital mn ko dili na nako sila mabantayan”.
Wt: 48 kg  “kapoy kayo magmentenar sa ako tambal ug mahal pa jd
paliton”, as verbalized by the patient.
 The patient was worried about her hospitalization due to
financial constraints.

PREVIOUS ILLNESS REACTIONS ABOUT TREATMENT AND DIAGNOSTIC

PROCEDURES

 Patient X was admitted the year 2003and was diagnosed  “nagpaospital ko kay para maayo akong gibati” as
with DM. verbalized by patient.
 Patient undergone several Laboratory tests and was  “ngano diay ni mihubag ug duro ako samad? Maulian ra kaha
diagnosed with Diabetes Mellitus. ning akong hubag?”’ as verbalized by the patient
 Patient claims that she feels uncomfortable whenever her
body is exposed during examinations and treatments.
 Nursing History Clinical Inspection Observation on On-going Appraisal Observation on Other Sources
Normal Patterns of Functioning First day of Duty 2nd day of Duty Laboratory Exam Result
(Before Admission)
PATTERNS OF FUNCTIONING
RESPIRATION  Nonproductive cough  Dyspnea noted CXR result reveals :
 Patient X stated that she noted  Nonproductive cough  Streak densities
did not experience feeling  Use of accessory muscle  RR as of 8 am: 23cpm L-upper lobe
out of breath. noted  RR as of 12 nn: 24cpm  Cardiac shadow is w/in
 “sauna magubo ko pero  RR as of 8 am: 25cpm  Crackles noted upon normal size and
wala plema” as verbalized  RR as of 12 nn: 26cpm auscultation configuration
by patient.  SOB  Tracheal shadow is in
 Patient does not use  Crackles noted upon midline
tobacco and is not auscultation  Bone and other chest
practicing breathing structures are
exercise. unremarkable
 Has nonproductive cough Impression:
occurred a day PTA  PTB minimal most
probably inactive in L-
upper lobe

CIRCULATION
 Wound noted at LUQ  Wound noted at LUQ  Random blood sugar is
 Patient pointed that her
with purplish with purplish above 500mg/dL
lower extremities feels  WBC: 1.2x103/mm3
colder time to time while discoloration with pus discoloration with pus
 RBC: 4.5x106/uL
her back feels warmer  Pale skin noted  BP as of 8am: 130/80  Hgb: 14.0g/dL
sometimes.  BP as of 8am: 140/80 mmHg  Hct: 45%
 Patient claimed that she mmHg  BP as of 12nn: 150/80  Platelet: 350,000/mm3
does not feel her heart  BP as of 12nn: 150/90 mmHg
pound nor skip beats. mmHg  PR as of 8am: 104 bpm
 PR as of 8am: 106bpm  PR as of 12nn: 98bpm
 PR as of 12nn: 102bpm  Temp: 36.8 C
 Temp: 36.8 C  Capillary refill test more
 Capillary refill test more than 3 sec.
than 3sec.
 FOOD AND FLUID INTAKE
 Patient eats 3meals/day  On Diabetic diet  On Diabetic diet
with 2in between snacks.  Served and consumed  Served and consumed diet
Meal usually contains diet  Drink aprrox. 5 cup of
large amount of rice and  Weighs 52kg and stands water from 7am-3pm
either fish, vegetable, or 5’3” tall. Body build is  Had eaten ½ cup rice, ½
meat. skinny and appears pale. cup tinolang isda, 5 cups
 Patient is fond of eating  Drink aprrox. 6 cup of of water.
sweets and fatty foods water from 7am-3pm
PTA.  Had eaten ½ cup rice, ½
 Drinks 4-7 glasses of cup tinolang isda,
water a day
 Seasonings include magic
sarap, salt, vetsin, and
etc.

ELIMINATION
 Patient voids 3-6 times a  Had not defecated from  Not defecated but Had  Creatinine is 1.01 mg/dL
day usually during bed 7am-3pm voided 3 times from 7am-  BUN is 12mg/dL
time.  Had voided 4 times from 3pm shift with estimated U/A
 Frequency of bowel 7am-3pm shift with 1200ml in amount with Appearance: Cloudy
movement is every other estimated 900ml in cloudy white urine Color: Amber
day without timing. amount with light yellow Odor: Aromatic
 Experienced difficulty in in color pH: 7.5
eliminating bowel. Glucose: +2
WBC: 2
RBC: <2
REST AND SLEEP
 Patient usually sleeps 6-7  Not able to take proper  Had slept 8hours last night
hours a day. Goes to bed at sleep since hospitalization from 10pm-6am.
10pm and wakes up around due to environmental  Had utilized 2 pillows. One
4-5 am. factors. is under her head and the
 Patient watches TV before  Patient is lying on bed and other is in between her
going to bed. appears drowsy and thigh.
 Experienced difficulty yawning  She had her 1hr nap at 1-
sleeping when wound is in 2pm
pain.
 EXERCISE
 Owns a sari2x store which she  Can perform active ROM
manages alone.  Patient is ambulatory with assistance
 Fond of watching TV and eating when from bed to comfort room about 20
nothing to do. steps.
 Movement is slow and steps are
small.
PAIN/DISCOMFORT
 Patient claimed that she experienced  Patient described the pain as 7 on a 0-  Complaint of pain at the carbuncle on her
pain from headache years before. 10 scale L-upper abdomen with a pain scale of
Reports discomfort from the wound at  Guarding behavior noted 5/10.
her abdomen 2 weeks before admission.  Patient often covers the area of the  Still manifest guarding behavior around
 Resorts to medicine to relieve pain. wound. wound.
Medicines include Cephalexin and  Pain scale reduce at 4/10 after 2hrs of
Mefenamic acid. pharmacologic mngt.
REGULATORY MECHANISM
 “normal man nang hilantanon ta” as  RR as of 8am: 25cpm  RR as of 8am: 23cpm
verbalized by the patient.  RR as of 12nn: 26cpm  RR as of 12nn: 24cpm
 Patient claim that she had not  BP as of 8am: 140/80 mmHg  BP: 130/80 mmHg
experienced seizures but sometimes felt  BP as of 12nn: 150/90 mmHg  BP as of 12nn: 150/80 mmHg
dizzy.  PR as of 8am: 106bpm  PR as of 8am: 104bpm
 Patient had her menopause at the age of  PR as of 12nn: 102bpm  PR as of 12nn: 98bpm
45.  Temp: 36.8 C  Temp: 37 C
 Skin appears pale  Skin appears pale
 Diaphoretic
 Dry mucous membrane noted with
cracked lips

PERSONAL HYGIENE
 Patient claimed that she usually takes a  Skin appears pale  Skin appears pale
bath every other day at 9am.  Hair appears white and grayish  Had already a well trimmed nails
 Patient brush her teeth sometimes.  Nails and mouth appears pale  Had a wound dress newly
 All of her teeth are artificial.  Dry mucous membrane noted with changed-7:30am
 Had an ingrown before at her right big cracked lips  Without dentures
toe.  Dentures are removed
 Usually waits for skin problems to be
gone by itself.
 COMMUNICATION AND SPECIAL SENSES  Dentures are removed.
 Patient claims that she’s having difficulty seeing,  Leans forward to hear voices and  Had difficulty hearing
speaking, and hearing. has difficulty seeing. especially when talked in a
 Used eyeglasses to read and see distant objects.  Uses glasses to see clearly. moderate tone.
 Communicates well when she is  Uses glasses to see clearly.
able to hear properly.  Words are not so clear due
 Answers heard questions properly. to absence of teeth
 Words are not so clear due to dentures.
absence of teeth dentures.
COPING WITH STRESS
 Patient talks to family and relatives to release stress.  Patient answers our questions  Patient answers our
 Usually asks for advice from her son. appropriately questions appropriately
 Patient said that she usually cries when upset and  Patient is in good mood as evidenced by  She positively interact with
then talks to her son about it. positive social interaction with others other people
 Patien t appears lethargic.

RELIGIOUS LIFE
 Patient is member of UCCP and go to church every  No religious medals worn  No religious medals worn
Sunday.  No pictures or objects related to  No pictures or objects
 Past member of CWL religion noted related to religion noted
 Reads the bible when she had time
 Has an interruption in her
religious life during hospitalization
SOCIAL/OCCUPATIONAL LIFE
 “sa tindahan ra ko cge pundo” as verbalized by  Patient would entertain visitors  Patient positively interacts
client.  Patient continuously update his son, to other patients in the room,
 Mother of 1 son and grandmother of 2 kids. who is at work, through text SO, and health care
 Stays with son, daughter-in-law, and 2 providers.
grandchildren
 “gatuo ko na dli mayo manudlay basta gadaot or
gasakit” as verbalized by the patient.
 RECREATION/DIVERSION
 Goes to vacation when there is time and  Often chats with SO and  Often chats with SO and other
money other patient patient
 Went to wedding at Cagayan de Oro  Tends to have some naps
city when there’s nothing more
 Watches TV as preparation to sleep to do.

HEALTH SUPERVISION
 “wala na nako namaintenar akong tambal  Follows prescribed  Follows what the physician had
sukad atong 2005 kay namatay akong pharmacologic regimen instructed her like maintaining
bana ug wala nako kwarta”, as verbalized proper hygiene and diet.
by the patient.
 Does not strictly monitor her blood
glucose level at home
 Does not take her Humulin R religiously
due to cost of the drug
 DIAGNOSTIC TEST

Interpretation/Significa
Lab Test/Exam Normal Values Results Date nce
02-22-11
Random Blood Sugar < 200 mg/dL Above 500 mg/dL/ Hyperglycemia, Diabetes

CBC

02-22-11 Leukocytosis, acute

 WBC 5,000-10,000/mm3 12 x103/mm3
infection
02-22-11
 RBC 4.2-5.4 x 106/uL 4.5x106/uL Within Normal Limit

02-22-11
 Hgb 12.0-16.0 14.0g/dL Within Normal Limit

02-22-11
 Hct 37-47% 45% Within Normal Limit

02-22-11
 Platelet 150,000-400,000/mm3 350,000/mm3 Within Normal Limit

U/A

1.01 mg/dL 02-22-11

Creatinine 0.5-1.5 mg/dL Within Normal Limit
02-22-11
12mg/dL 02-22-11
BUN 10-20mg/dL Within Normal Limit
02-22
 ANATOMY AND PHYSIOLOGY

Endocrine system (Pancreas) Integumentary system

 
 
Figure 1. Illustration of the Organ System ___Endocrine System: Pancreas___
And Integumentary system
  
 

Physiology of the Organ System

In physiology, the endocrine system is a system of glands, each of which secretes a type of hormone into the bloodstream to regulate the body. The endocrine
system is an information signal system like the nervous system. Hormones are substances (chemical mediators) released from endocrine tissue into the bloodstream
that attach to target tissue and allow communication among cells. Hormones regulate many functions of an organism, including mood, growth and development,
tissue function, and metabolism. The field of study that deals with disorders of endocrine glands is endocrinology, a branch of internal medicine.
The endocrine system is made up of a series of glands that produce chemicals called hormones. A number of glands that signal each other in sequence is usually
referred to as an axis, for example, the hypothalamic-pituitary-adrenal axis. Typical endocrine glands are the pituitary, thyroid, and adrenal glands. Features of
endocrine glands are, in general, their ductless nature, their vascularity, and usually the presence of intracellular vacuoles or granules storing their hormones. In
contrast, exocrine glands, such as salivary glands, sweat glands, and glands within the gastrointestinal tract, tend to be much less vascular and have ducts or a hollow
lumen.
 
This study primariyly focus on the physiology of the pancreas which includes the following:
•Produces Insulin (Primarily) by β Islet cells which is responsible in the Intake of glucose, glycogenesis and glycolysis in liver and muscle from blood and intake of
lipids and synthesis of triglycerides in adipocytes Other anabolic effects.
• 
•Secretes Glucagon (Also Primarily) by α Islet cells which is responsible in glycogenolysis and gluconeogenesis in liver for the increase of blood glucose level
• 
•Secretes Somatostatin δ Islet cells that Inhibit release of insulin[4] and of glucagon. It is responsible also for the suppression of the exocrine secretory action of
pancreas.
• 
•Secretes Pancreatic polypeptide by PP cells which Self regulate the pancreas secretion activities and effect the hepatic glycogen levels.
The integumentary system (From Latin integumentum, from integere 'to cover'; from in- + tegere 'to cover'[1]) is the organ system that protects the body from
damage, comprising the skin and its appendages[2][3] (including hair, scales, feathers, and nails). The integumentary system has a variety of functions; it may serve to
waterproof, cushion, and protect the deeper tissues, excrete wastes, and regulate temperature, and is the attachment site for sensory receptors to detect pain,
sensation, pressure, and temperature. In humans the integumentary system also provides vitamin D synthesis.

The integumentary system has multiple roles in homeostasis. All body systems work in an interconnected manner to maintain the internal conditions essential to
the function of the body. The skin has an important job of protecting the body and acts as the body’s first line of defense against infection, temperature change,and
other challenges to homeostasis.
Functions include:
•Protect the body’s internal living tissues and organs
•Protect against invasion by infectious organisms
•Protect the body from dehydration
•Protect the body against abrupt changes in temperature, maintain homeostasis
•Help excrete waste materials through perspiration
•Act as a receptor for touch, pressure, pain, heat, and cold (see Somatosensory system)
•Protect the body against sunburns
•Generate vitamin D through exposure to ultraviolet light
•Store water, fat, glucose, and vitamin D
 PATHOPHYSIOLOGY (Diagram – Client based)
Precipitating Factor
Predisposing Factor
-Sedentary lifestyle (lack of excersise)
Age (58 y/o)
Diet (high fat, fond of eating sweet food)
Hereditary (both of her parents had diabetes)

Decreased sensitivity of cell to Decreased production of

Polyphagia insulin insulin by pancreas

Cellular starvation Decreased peripheral glucose Decreased insulin secretion

uptake (into cell)

Decreased utilization of glucose by cell

Osmotic Diuresis Hyperglycemia Blood viscosity Increase BP

Polyuria Slower blood circulation

Cellular DHN
Increased risk for Delayed wound
Polydipsia infection healing

Staphylococcal Infection Increased risk for wound

infection

Furuncle

Failure to wall off a furuncle

Invasion of neighboring tissue

Carbuncle
 PATHOPHYSIOLOGY (Diagram – Book based)
Lack of insulin

·Decreased utilization of glucose by muscle, Increased breakdown of fat

fat and liver
·Increased production of glucose by liver
Increased fatty acids
Hyperglycemia
Acetone breath
Increased ketone bodies
Poor appetite
Blurred vision Polyuria
Nausea
Nausea Acidosis
Dehydration
Vomiting
Increasingly rapid respiration
Polydipsia Abdominal pain

Long-Term Complications

Macrovascular Microvascular Complication Diabetic retinopathy

Complication
Diabetic neuropathies
CAD
Cerebro-vascular Nephropathy
disease
Peripheral vascular Peripheral neuropathies
disease
Foot and Leg Problems

Diabetes Furuncles complicate to

carbuncle
 TOP 10 PRIORITY NURSING DIAGNOSIS
1. Acute pain related to an abscess of subcutaneous tissue
involving hair follicles.
2. Ineffective tissue perfusion related to blood
hyperviscosity.
3. Impaired skin integrity related to presence of wound.
4. Anxiety related to change in health status.
5. Risk for fluid volume deficit related to polyuria.
6. Risk for injury related to biochemical disturbance
7. Self-care deficit (Bathing) related to decreased motivation
8. Impaired dentition related to ineffective oral hygiene
9. Deficient knowledge about diabetes self-care skills related
to inaccurate/ incomplete information presented
10. Disturbed sleep pattern related to environmental factors.
 Nursing Care Plan
Student’s Name: __________________ Area of Assignment: Special Area, MUMC Date: __________________________
1.Nursing Diagnosis No__1_: _Acute pain related to subcutaneous tissue involving hair follicles.(PE format)

Cues/Evidences Outcome Criteria Nursing Intervention Rationale Evaluation

Subjective: At the end of 2 hours Independent: After 2 hours nursing
“hasol pod kayo  To assess
nursing intervention, the  Perform comprehensive intervention, the patient
kung magsakit ning
etiology/precipitating
akong hubag sa tiyan patient will: assessment of pain to include had:
kay makahunong ko contributory factors.
 report pain is location, severity (0to10 or  Reported decrease of
sa akong gtrabaho”,
 To evaluate patient’s
as verbalized by the relieved faces scale), and precipitating pain scale from 7 to
patient. response to pain.
 verbalize method or aggravating factors. 4/10, 10 is the
Objective:  To assist patient to
that provide relief  Perform pain assessment each highest.- goal met
> pain scale of 7/10, explore methods for
 demonstrate use of time pain occurs.  Verbalized methods
10 is the highest alleviation/control of
relaxation skills  Teach and encourage patient that provide pain
> manifest guarding pain.
and diversional relaxation techniques and relief like listening to
 To maintain
behavior especially
activities as diversional activities like acceptable level of radio.-goal met
in her left upper pain.
indicated for DBE, TV/radio, socialization  Demonstrated DBE
abdomen
individual situation with others to alleviate pain.-
> grimace
Dependent: partially met
> autonomic
 Administer centrally-acting
responses:
analgesic,Tramadol (Ultram)
PR: 106 bpm
RR: 22cpm 50 mg cap 1 TID po as orders
BP: 140/90 mmHg
by the physician.
diaphoresis
Collaborative:
(optional depending on the
problem)
 Nursing Care Plan
Student’s Name: __________________ Area of Assignment: Special Area, MUMC Date: __________________________
1.Nursing Diagnosis No__2_: _Ineffective tissue perfusion (Peripheral) related to blood hyperviscosity (PE format)

Cues/Evidences Outcome Criteria Nursing Intervention Rationale Evaluation

Subjective: At the end of 8hrs Independent: After 8hrs nursing
 To assess
Objective: nursing intervention, the  note presence of conditions intervention, the patient
contributing factor
 SOB noted patient will: that can affect multiple had:
 Note degree of
 Capillary refill  Verbalize systems (DM)  Verbalized
impairment
test >3sec. understanding of  investigate reports of pain out understanding of
 RR as of 8 am:  To note degree of
condition to of proportion to degree of condition to
25cpm
involvement
 RR as of 12 nn: therapeutic injury therapeutic regimen-
26cpm  To note degree of
regimen  assess lower extremities partially met
 Cold, clammy
impairment
skin noted  Demonstrate noting skin texture, presence  Demonstrated
 Enhances venous
behavior/ lifestyle of edema, and non-healing behavior/ lifestyle
return
changes to imorive wound. changes to improve
 To maximize tissue
circulation (dietary  Measure capillary refill circulation (dietary
perfusion
program, exercise)  Encourage ambulation program, exercise)-
 Elevate legs partially met
Dependent:
Collaborative:
(optional depending on the
problem)
 Nursing Care Plan
Student’s Name: __________________ Area of Assignment: Special Area, MUMC Date: __________________________
1.Nursing Diagnosis No__3_: __ Impaired skin integrity related to lesions and inflammatory response____________( (PE format)

Cues/Evidences Outcome Criteria Nursing Intervention Rationale Evaluation

Subjective: At the end of 8hrs Independent: After 8hrs nursing
 To assess
Objective: nursing intervention, the  Identify underlying intervention, the patient
causative/contributin
 Presence of patient will: condition/pathology involved had:
g factors
carbuncle with  Demonstrate (diabetes mellitus)  Demonstrated proper
 To assess extent of
pus in left proper wound care  Note odors emitted from the wound care- goal met
injury
upper abdomen  Identify ways to skin/ area of injury.  Identify ways to
 To determine impact
 Disruption of prevent infection  Inspect skin in daily basis, prevent infection –
of condition
skin surface describing lesions and changes goal met
 To assist body’s
(epidermis) observed.
natural process of
 Disruption of  Keep the area clean/dry,
repair.
skin layer carefully dress wounds
 To prevent further
(dermis)  Teach and Encourage patient
complication
to maintain proper hygiene
 To promote wound
and wound care
healing and prevent
Dependent:
further infection.
 Administer
antibiotic,Cefuroxime (Ceftin)
750 mg IVTT q80 ANST, as
ordered.
Collaborative:
(optional depending on the
problem)
 DOCTOR’S ORDER
Date Order (Medications) Rationale/Significance/ Nursing Responsibility
2/22/11  Cefuroxime 750 mg IVTT q80 ANST Used to treat skin and skin structure infections.

 Tramadol 50 mg cap 1 TID po Relieves pain associated to painful carbuncle.

 Humulin R 10 “U” SQ now Used as antidiabetic that lower blood glucose by stimulating glucose uptake in
skeletal muscle and fat, inhibiting hepatic glucose production.

 Start Amikacin (Cinmik) 250 mg q80 IVTT ANST Used as anti-infective to treat bacterial infection commonly caused by S. aureus.

 Metronidazole (Flagyl) 500 mg tab TID po Treatment of the following anaerobic infections: Intra-abdominal infections (may
be used with a cephalosporin)

 Start PNSS 1L @30m gtts/min Used as route to IVTT medications.

 TPR q40 To monitor pt’s v/s

 Diabetic diet To manage diabetes mellitus

 CXR PA view To view patient respiratory organs for possible lung consolidation

 ECG 12 leads To monitor cardiac electrical activity

 Please sched for debridement & drainage tomorrow pm To surgically intervene carbuncle

2/23/11  Humulin R 10 “U” SQ now Used as antidiabetics that lower blood glucose by stimulating glucose uptake in
skeletal muscle and fat, inhibiting hepatic glucose production.

 Captopril 25 g 1 tab q80 po for Used to manage hypertension.

BP > 140/90 mmHg
 PNSS 1L @30m gtts/min Used as route to IVTT medications.

2/24/11  Humulin R 10 “U” SQ now Used as antidiabetics that lower blood glucose by stimulating glucose uptake in
skeletal muscle and fat, inhibiting hepatic glucose production.

 PNSS 1L @30m gtts/min Used as route to IVTT medications.

 DRUG STUDY
Generic
Name Adverse
Pharmaco- Pharmaco- Contra-
Brand Classification Indication Effects/ Side Nursing Responsibilities
dynamics kinetics indication
Name Effects
Dosage
Cefuroxime Second- Probenecid- decrease Absorption: Tx. of : Hyper- CNS: seizures  Assess for infection
(Ceftin) 750 generation excretion and well-absorbed  Resp. sensitivity to (high doses) (v/s, appearance of
mg IVTT cephalosporin increases blood following oral tract cephalosporins GI: wound, sputum, urine
q80 ANST levels. If alcohol is administration infection Serious pseudomembra and stool, WBC) at
ingested within 48- .  Skin and hypersensitivit nous colitis, beginning and during
72 hours of Distribution: skin y to diarrhea, therapy.
cefotetan, a widely structure penicillins. jaundice,  Before initiating a
disulfram-like distributed. infections n/v,cramps. therapy, obtain hx to
reaction may occur. Penetration to  Bone and Derm: rashes, determine previous use
Cefotetan- may CSF is poor, joint urticaria of and reactions to
increase effects of but adequate infection Hemat: penicillin or
anticoagulants and for cefuroxime  UTI and bleeding, blood cephalosporin.
icrease risk of to treat gynecolo dyscrasias,  Obtain specimen for
bleeding with meningitis. gic hemolytic C&S before initiating
antiplatelet agents, Crosses infections anemia therapy.
thrombolytic agents, placenta and  Meningiti Local: pain at  Observe pt. for s/sx of
NSAIDs or valproic enter breast s IM site, anaphylaxis (rash,
acid. milk in lower  Otitis phlebitis at IV pruritus, laryngeal
Risk of bleeding concentration. media site. edema, wheezing)
with cefotetan may Metabolism Misc: allergic  Assess for renal
be increased with & excretion: reactions dysfunction and adjust
garlic, ginger, excreted including dose accordingly.
ginkgo. primarily anaphylaxis
unchanged by and serum
the kidneys. sickness,
superinfection
 DRUG STUDY
Generic Name Adverse
Classificatio Pharmaco- Pharmaco- Contra-
Brand Name Indication Effects/ Side Nursing Responsibilities
n dynamics kinetics indication
Dosage Effects
Tramadol Analgesics Increase risk of Absorption: 75% Moderate to Hypersensitivity. CNS: seizures,  Assess type, location,
(Ultram) 50 mg (centrally- CNS depression absorbed after moderately Cross-sensitivity dizziness, and intensity of pain
cap 1 TID po acting) when used oral severe pain with opioids headache, before & 2-3hr(peak)
concurrently with administration. may occur. somnolence, after administration.
other CNS Distribution: Patients who are anxiety, CNS  Assess BP and RR before
depressants crosses placenta; acutely stimulation, and periodically during
including alcohol, enters breast milk intoxicated with confusion, administration.
antihistamines, Metabolism & alcohol, euphoria, Respiratory depression
sedatives, opioid excretion: mostly sedatives, malaise, has not occurred with
analgesics, metabolized by centrally-acting nervousness, recommended doses.
anesthetic or the liver; one analgesics, sleep disorder,  Assess bowel function
psychotropic metabolite has opioid weakness. routinely. Prevention of
agents. analgesic analgesics or EENT: visual constipation should be
Increase risk of activity; 30% is psychotropic disturbances instituted with increase
seizures with high excreted agents. CV: intake of fluids and bulk
doses of penicillin, unchanged in Patients who are vasodilation with laxatives to
cephalosporin, urine. physically GI: minimize constipation
phenothiazines, or dependent on constipation, effect.
antidepressants. opiod analgesics nausea,  Monitor patient for
(may precipitate abd.pain, seizures. May occur with
withdrawal). anorexia, recommended dose
Not diarrhea, range.
recommended dyspepsia, dry  Overdose may cause
for use during mouth, respiratory depression
pregnancy and flatulence, and seizures. Naloxone
lactation. vomiting. (Narcan) may reverse
Derm: pruritus, some but not all of the sx
sweating of overdose.
Neuro:
hypertonia
Misc: physical
&
psychological
dependence,
tolerance
 DRUG STUDY
Generic
Adverse
Name Pharmaco- Pharma- Contra-
Classification Indication Effects/ Side Nursing Responsibilities
Brand Name dynamics cokinetics indication
Effects
Dosage
Regular Antidiabetics, Glucose Absorption: Tx. of DM, Hypoglycemia Derm: urticaria  Assess patient for signs
insulin hormones lowering effects rapidly absorb can be used Allergy or Endo: and symptoms of
(Humulin R) may be decrease from to treat DKA hypersensitivity hypoglycemia, hypoglycemia (anxiety,
10 “U” SQ by subcutaneous to a particular rebound restlessness, mood
now corticosteroids, administration type of insulin, hyperglycemia changes, tingling in
danazol, site. preservatives or (Somogyi effect) excessive huger,
diazoxide, Distribution: other additives. Local: headache, irritability,
diuretics, Widely Use cautiously lipodystrophy, nausea, nervousness,
sympathomimeti distributed in: Itching, Rednes, rapid pulse, shakiness)
c agents, Metabolism &  Stress Swelling and hyperglycemia
estrogens, excretion:  Pregnancy Misc: allergic (confusion, drowsiness,
progestins. Metabolized by reactions flushed dry skin, fruit-
Blood glucose liver, spleen,  Infection including like breath odor, rapid
lowering effect kidneys, and anaphylaxis deep breathing
and risk of muscle. frequent urination, loss
hypoglycemia of appetite, unusual
may be increase thirst)
by oral  Monitor body wt.
antidiabetic periodically during
agents, ACE therapy.
inhibitors, MAO  Overdose is manifested
inhibitors, by hypoglycemia. Mild
propoxyphene, hypoglycemia nay be
sulfonamides. treated by ingestion of
Beta blockers oral glucose. Severe
and reserpine hypoglycemia as a life-
may block some threatening emergency;
signs of and tx consists of IV
delay recovery glucagon.
from
hypoglycemia.
 DRUG STUDY
Generic
Adverse
Name Classifica- Pharmaco- Pharmaco- Contra-
Indication Effects/ Side Nursing Responsibilities
Brand Name tion dynamics kinetics indication
Effects
Dosage
Amikacin Antiinfectiv Inactivated by Absorption: Tx of serious Hypersensitivit EENT:  Assess for infection
(Cinmik) 250 es penicillin and well-absorbed gramnegative y. ototoxicity (v/s, appearance of
mg q80 IVTT Aminoglyco cephalosporin when after IM bacillary Most parenteral (cochlear and wound, sputum, urine
ANST -sides co administered to administration. infection and products vestibular) and stool, WBC) at
patients with renal IV infections contain GU: beginning and during
insufficiency. administration caused by bisulfites and nephrotoxcity therapy.
Possible respiratory results in staphylococci, should be F&E: hypo-  Obtain specimen for
paralysis after complete when penicillin avoided in magnesemia C&S before initiating
inhalation bioavailability. or other less patient with MS: muscle therapy.
anesthetics or Some toxic drugs are known paralysis (high  Evaluate CN VIII by
neuromuscular absorption contraindicated intolerance. parenteral audiometry before and
blocking agents. follow . Products doses) throughout therapy.
Increased incidence administration containing Misc:  Monitor I&O and daily
of ototoxicity with by other routes. benzyl alcohol hypersensitivit wt. to assess hydration
loop diuretics. Distribution: should be y reactions. and renal function.
Increased incidence Widely avoided in  Assess pt for
f nephrotoxicity distributed neonates. superinfection(ever,
with other throughout Cross- URTI, vaginal
nephrotoxic agents. extracellular sensitivity itchiness/ discharge,
fluid; crosses among increasing malaise,
placenta; small aminoglycosid diarrhea). Report to
amt. enter in es may occur. physician or other
breast milk. health care
Poor professional.
penetration into  Monitor neurologic
CSF. status. Before
Metabolism & administering oral
excretion: medication, assess pt’s
excretion is ability to swallow.
>90% renal
 Generic DRUG STUDY
Name Adverse
Classifica- Pharmaco Contra-
Brand Pharmacokinetics Indication Effects/ Side Nursing Responsibilities
tion -dynamics indication
Name Effects
Dosage
Metronidaz Anti- Cimetidine may Absorption: 80% Tx of the Hypersensitivi CNS:  Assess patient for
ole infectives decrease the absorbed after oral following ty. seizures, infection (vital signs;
(Flagyl) Antiproto metabolism of administration. anaerobic Hypersensitivi dizziness, appearance of wound,
500 mg tab zoals metronidazole. Minimal absorption infections: ty to parabens headache sputum, urine, and
TID po Antiulcer Phenobarbital after topical or intra- (topical only). EENT: stool; WBC) at
agents and rifampin vaginal application. abdominal Patients tearing beginning of and
increases Distribution: infections receiving (topical only) throughout therapy.
metabolism and Widely into most (maybe used corticosteroids GI:  Obtain specimen for
may decrease tissues fluids, with a or predisposed abdominal C&S before initiating
effectiveness. including CSF. cephalosporin to edema nausea, therapy. First dose
Metronidazole Crosses the placenta ), diarrhea, dry may be given before
increases the and enters fetal Gynecologic mouth, furry receiving results.
effects of circulation rapidly; infections, tongue,  Monitor neurologic
pheytoin, enters breast milk in skin and skin vomiting status during and
lithium, and concentrations equal structure Derm: rashes, after IV infusions.
warfarin.Disulfir to plasma levels. infections, urticaria, Inform physician if
am-like reaction Metabolism & lower mild dryness, numbness,
may occur with Excretion: Partially respiratory skin paresthesia,
alcohol metabolized by the tract irritation, weakness, ataxia, or
ingestion. May liver (30-60%), infections, transient seizure occur.
cause acute partially excreted bone and joint redness  Monitor intake and
psychosis and unchanged in the infections, Hemat: output and daily
confusion with urine, 6-15% CNS leucopenia weight, especially for
disulfiram. eliminated in the infections, Local: patients on sodium
Increased risk of feces. septicemia, phlebitis at restriction. Each
leucopenia with endocarditis IV site 500mg of Flagyl IV
fluorouracil or Neuro: for dilution contains 5
azarthioprine. peripheral mEq of sodium; each
neurpathy 500mg of Flagyl RTU
contains14 mEq of
sodium.
 DRUG STUDY
Generic Name
Adverse Effects/
Brand Name Classification Pharmacodynamics Pharmacokinetics Indication Contraindication Nursing Responsibilities
Side Effects
Dosage
Antihypertensi Excessive Absorption: At  Reduction Hypersensitivity CNS: dizziness,  Monitor blood pressure and
Captopril 25 g 1
ves hypotension may least 75% of risk of Cross-sensitivity fatigue, pulse frequently during
tab q80 po for occur with concurrent following oral death or among ACE headache, initial dose adjustment and
BP > 140/90 use of diuretics, other administration developmen inhibitors may insomnia, periodically during therapy.
mmHg antihypertensive, (decreased to 30- t of CHF occur weakness Notify health care
nitrates, 55% by food) following Resp: cough, professional of significant
phenothiazines, acute Distribution: All MI. Slowed eosinophilic, changes
ingestion of alcohol ACE inhibitors progression pneumonitis  Monitor frequency of
and during surgery or cross the placenta. of left CV: hypotension, prescription refills to
general anesthesia. Metabolism & ventricular angina pectoris, determine adherence
Hyperkalemia may Excretion: dysfunction tachycardia  Assess urine protein prior to
result from metabolized by the into overt GI: taste and periodically during
concurrent use of liver to inactive heart disturbances, therapy for up to 1 year in
potassium compounds, 50% failure. anorexia, patients with renal
supplements, excreted unchanged  Decreased diarrhea, impairment or those
potassium-sparing by the kidneys progression hepatoxicity receiving > 150 mg/day of
diuretics, of diabetic (rare), nausea captopril. If excessive or
indomethacin, salt nephropath GU: proteinuria, increase proteinuria occurs,
substitutes, or y impotence, renal re-evaluate ACE inhibitor
cyclosporine. failure therapy.
Derm: rashes  Monitor weight and assess
Hemat: patient routinely for
agranulocytosis, resolution of fluid overflow
neutropenia