ACTION INDICATIONS Chemical effect: Moderate to severe pain Binds with opioid receptors in Adjunct to Balanced anesthesia CNS,

altering pain reception and response to pain by unknown mechanism Therapeutic effect: Relieves pain and enhances anesthesia

Generic name: Nalbuphine Hydrochloride Brand name: Nubaine Classification: Analgesic, Adjunct to Anesthesia Dosage: 5 mg IV CONTRAINDICATIONS ADVERSE EFFECTS Contraindicated in patients CNS: confusion, crying, hypersensitive to drug or sulfites delusions, depression, dizziness, present in some preparations of euphoria, hallucinations, drug. headache, hostility, nervousness, restlessness, Use cautiously in substance sedation, speech difficulty, abusers and in those with unusual dreams, vertigo emotional instability, head injury, increased ICP, impaired CV: bradycardia, HPN, ventilation, MI accompanied by hypotension, tachycardia n/v, upcoming biliary surgery, and EENT: blurred vision hepatic or renal disease GI: bitter taste, constipation, cramps, dry mouth, dyspepsia, N/V GU: urinary urgency Respiratory: pulmonary edema, respiratory depression Skin: burning itching; sweaty, clammy feeling; urticaria

NURSING RESPONSIBILITIES -Assess patient s pain or anesthetic requirement before starting therapy and regularly thereafter monitor drug effectiveness -Monitor patient closely for respiratory depression. -Monitor patient for s/sx of constipation -Be alert for adverse reactions and drug interactions. -For patients receiving long-term therapy, start with 25% of usual dose -Give stool softener or other laxative to prevent constipation. Encourage patient to drink fluids and eat fiber. -If patient s respirations are shallow or rate is below 12 breathes /minute, withhold dose and notify physician -Warn ambulatory patient about getting out of bed or walking -Instruct outpatient to avoid hazardous activities until the drug s CNS effects are known.

ACTION Chemical effect: Ampicillin inhibits cell-wall synthesis during microorganism multiplication; sulbactam inactivates bacterial betalactamase, the enzyme that inactivates ampicillin and provides bacterial resistance to it. Therapeutic effect: Kills susceptible bacteria

INDICATIONS Intra-abdominal, gynecologic, and skinto-skin structure infections caused by susceptible grampositive, gramnegative, and betalactamase-producing strains

Generic name: Ampicillin Sulbactam Brand name: Unasyn Classification: Antibiotic Dosages: 1.5 g SIVP after negative skin test CONTRAINDICATIONS ADVERSE EFFECTS Contraindicated in patients C.V.: thrombophlebitis, vein hypersensitive to other irritation penicillins. GI: diarrhea, glossitis, nausea, Use cautiously in patients stomatitis, vomiting with other drug allergies, especially to Hematologic: agrunulocytosis, cephalosporins (possible anemia, eosiniphilia, cross-sensitivity), and in leucopenia, those with mononucleosis thrombocytopenia, (high risk of maculopapular thrombocytopenic purpura rash) Other: hypersensitivity In pregnant and reactions (anaphylaxis, breastfeeding women, use erythematous maculopapular cautiously. In children rash, urticaria), overgrowth of younger than age 1, safety nonsusceptible organism, pain of drug hasn t been at injection site established. In children age 1 and older, dug can be used I.V. for skin and skinstructure infections. Children shouldn t receive the drug I.M.

y y y y y y

y y y

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NURSING RESPONSIBILITIES Obtain history of patient s infection before therapy, and observe throughout therapy to determine improvement. Ask patient about previous allergic reaction to penicillin Obtain specimen for culture and sensitivity tests before giving first dose. Be alert for allergic reactions and drug interaction. Monitor patient for hydrations status if adverse GI reactions occur. Assess patient and family s knowledge of drug therapy. When giving I.M. injection, reconstitute with sterile water for injection or with 0.5% or 2% lidocaine hydrochloride. Add 3.2 ml to a 1.5-g vial to yield 375 mg/ml In patients with renal impairment, reduce dosage. Give drug at least 1 hr before bacteriostatic antibiotics Stop drug immediately if anaphylaxis occurs. Notify prescriber and give immediate treatment, such as epinephrine, corticosteroid, antihistamines; and other resuscitative measurements. Tell patient to call prescriber if rash (most common), fever, or chills develop. Advise women taking hormonal contraceptive to use barrier form of contraceptive during drug therapy.

Generic name: NICARDIPINE Brand name: Cardene Classification: Antianginal, Antihypertensive, Calcium channel blockers Dosage: 20-40 mg three times daily ACTION  Nicardipine relaxes (widens) your blood vessels, which makes it easier for the heart to pump and reduces its workload.  Nicardipine is used to treat hypertension (high blood pressure) and angina (chest pain). INDICATION  Chronic stable angina. CONTRAINDICATIONS  Advanced aortic stenosis.  Hypersensitivity to nicardipine or any component ADVERSE EFFECTS  Increased angina  Hypotension  Flushing  Headache  pedal edema  asthenia  dizziness  tachycardia  somnolence  GI upset  insomnia.  to assess adequacy of blood pressure response, measure blood pressure 8 hours after dosing  ampuls must be diluted before use;  do not crush sustained release product NURSING RESPONSIBILITIES  Monitor closely for orthostasis

NUSING CARE PLAN

RATIONALE -To prevent skin

EVALUATION Goal met. At the end of the shift the patient was able to ambulate

-Encouraged verbalization of feelings -Encouraged ambulation

-Promotes comfort

-for faster recovery -Promotes well-being and maximizes energy consumption -Enhances commitment to plan -to relieve pain

O: y y y y v/s: y y y y Restless Slowed movement Difficulty turning Needs assistance when moving T- 36 C P- 91 bpm R- 38 cpm Bp- 130/80 mmHg -Encouraged adequate intake of fluids/nutritious food -Involved SO in care

-administered medication as ordered