DRUG NAME Generic Name:

CLASSIFICA -TION Antibiotic

DOSAGE/ ROUTE Maximum recommended dosage is 6g/day. Adults and pediatric patients weighing 40kg or more: 250-500 mg every 4-6 hr IM or IV. Up to 1g every 4-6 hr in severe infections.

ACTION

INDICATION CONTRAINDICATION Infectious due to penicillinase producing staphylococci; may be used to initiate treatment when a staphylococci infection is suspected Contraindicated with allergies to penicillins, cephalosporins or other allergens

ADVERSE EFFECT CNS: lethargy, hallucinations, seizures GI: glossitis, stomatitis, gastritis, sore mouth furry and black hairy tongue, nausea and vomiting, diarrhea HEMATOLOGIC: anemia, thrombocytopenia , neutropenia, prolonged bleeding time HYPERSENSITIVITY: rash, phlebitis, thrombosis at injection site OTHER:superinfe ction

NURSING INTERVENTION Obtain specimen for culture and sensitivity tests before first dose. To prevent vein irritation, avoid continuous infusions. Change site every 48 hours. Give 1-2 hours before or 2-3 hours after meals to prevent gastric irritation.

PenicillinaseOXACILLIN resistant SODIUM penicillin Brand Name: Bactocill

Bactericidal: inhibits cell wall cell wall of sensitive organisms, causing cell death

DRUG NAME Generic Name: AMINO ACIDS Brand Name: Aminosyn, Freamine - Travasol

CLASSIFICATION Caloric agent Protein Substrate

DOSAGE/ ROUTE Recommended protein dietary allowance are 0.9 g/kg/day for healthy adult, 1.4-2.2 g/kg/day in healthy infants and children Adults: 1-1.5 g/kg/day amino acid injection IV into the peripheral vein, 250-500 ml/day amino acid injection IV mixed with appropriate dextrose, vitamins, and electrolytes as part of a total parenteral nutrition (TPN) solution

ACTION Essential and nonessentials amino acids provides in various combinations to supply calories and proteins and provide a protein building and proteinsparing effect for the body ( a positive nitrogen balance)

INDICATIONS Provide nutrition to patients who are in a negative nitrogen balance when GI tract cannot absorb protein, when protein needs exceed the ability to absorb protein (with burns, trauma, infections); when bowel rest is needed; when tube feeding cannot supply adequate nutrition; when health can be improved or restore by replacing lost amino acids Treatment of hepatic

CONTRAINDICATION Contraindicated with hypersensitivity to any component of the solution; severe electrolyte acid-base imbalance; inborn errors in amino acid metabolism; decreased circulating blood volume; severe renal or hepatic disease; hyperammonenia; bleeding abnormalities.

ADVERSE EFFECT CNS: headache, dizziness, mental confusion, loss of conscious-ness

NURSING INTERVENTION

Assess nutritional status before and frequently during treatment; CV:hyperten-sion, weight the pulmona-ryedema, patient daily to generalized flushing monitor fluid load and Endocrine:hypoglycenia, nutritional status hyperglycemia, fatty acid deficiency, azotemia Monitor vital signs often GI: nausea, vomiting, during infusion abdominal pain, liver impairment, fatty liver Observe infusion site atleast daily Local: pain, infection for infection, phlebitis venous phlebitis; change thrombosis, tissue the dressing sloughing at injection using strict site aseptic technique atleast every 24 hr. Arrange to give D5W or D10W for injection by a peripheral line to avoid hypoglycemia

encephalopathy in patients with cirrhosis or hepatitis Nutritional support of uremic patients when oral nutrition is not feasible or is impractical or insufficient.

rebound if TPN infusion needs to be stopped. Monitor urine glucose, acetone, and specific gravity every 6 hrduring initial infusion period, atleast bid when the infusion stabilized; stop solution at any sign of renal failure Monitor patient for vascular overload or hepatic impairement.

DRUG NAME

CLASSIFICA -TION Aldosterone agonist Potassium sparing diuretic

DOSAGE/ ROUTE Adults: Edema: Initially, 100 mg/day (range 25100mg/day) when given as the sole agent; continue atleast 5 days, then adjust dosage or add another diuretic or both Hypokalemia: 25-100 mg/day PO

ACTION

INDICATION

CONTRAINDICATION Contraindicat ed with allergy to spironolacton e, hyperkalemia, renal disease, anuria, amiloride or triamterene use.

ADVERSE EFFECT CNS: dizziness, headache, drowsiness, fatigue, ataxia, confusion DERMATOLOGIC: Rash, urticarial GI: impotence, irregular menses, amenorrhea, postmenopausal bleeding HEMATOLOGIC:h yperalemia, hyponatremia, agranulocytosis OTHER:Carcinoge nc in animals, deepening of the voice, hisutism, gynecomastia

NURSING INTERVENTION Mark calendars of edema outpatients as reminders of alternate- day or 3- to 5-day/wk therapy Give daily doses early so that increased urination does not interfere with sleep Measure and record regular weight to monitor mobilization of edema fluid Avoid giving food rich in potassium

Generic Name: Spironolactone Brand name: - Aldctone - Novospiroton

Completitively blocks the effects of aldosterone in the renal tubule, causing loss of sodium and water and retention of potassium

Diagnosis and maintenance of primary hyperaldosternism Adjenctive therapy in edema associated with HF, nephrotic syndrome, hepatic cirrhosis when other therapies are inadequate or inappropriate Treatment of hypokalemia or prevention of hypokalemia in patients who would be at risk if hypokalemiaoccu red

Drug Name Generic name: Diazepam Brand name: Valium

Classificati on Antiepileptic Anxiolytic

Dosage/Rou te Individuals dosage; increase dosage cautiously to avoid adverse effects. Usual dose is 2-20mg IM or IV. Larger doses may be required for some indications (tetanus). Injections may be repeated in 1 hr. >muscle spasm: 510mg IM or IV initially,then 5-10 mg in 34 hr if necessary. >Anxiety: 210 mg IM or IV; repeat in 3-4 hr if

Actions Exact mechanisms of action not understood; acts mainly at the limbic system and reticular formation; may act in spinal cord and at supraspinal spines to produce skeletal muscle relaxation; potentiates the effects of GABA, an inhibitory neurotransmitter; anxiolytic effects occur at doses well below those necessary to cause sedation, ataxia; has little effect on cortical function.

Indications >Management of anxiety disorders or for short-term relief of symptoms of anxiety. >Acute alcohol withdrawal; may be useful in symptomatic relief of acute agitation, tremor, delirium tremens, hallucinosis. >Muscle relaxant >Parenteral: treatment of tetanus >Antiepileptic: adjunct in status epilepticus and severe recurrent convulsive seizures

Contraindicatio ns Contraindicated with hypersensitivity to benzodiazepines; psychoses; acute narrow-angle glaucoma, shock, coma, acute alcoholic intoxication; pregnancy (cleft lip or palate, inguinal hernia, cardiac defects, microcephaly, pyloric stenosis when used in first trimester, neonatal withdrawal syndrome reported in newborns); lactation

Adverse Effects >CNS: transient, mild drowsiness initially; sedation, depression, lethargy, apathy, fatigue, lightheadedness, disorientation, restlessness, confusion, crying >CV: Bradycardia, tachycardia, CV collapse, hypertension and hypotension, palpitations, edema >DEPENDENCE: Drug dependence with withdrawal syndrome when drug is discontinued >DERMATOLOGI C: Urticaria, pruritus, skin rash, dermatitis

Nursing Interventions >Do not administer intra-arterially; may produce arteriospasm, gangrene. >Change from IV to oral therapy as soon as possible >Do not use small veins for IV injection >reduce dose of opioid analgesics with IV diazepam; dose should be reduced by at least one-third or eliminated. >Carefully monitor BP, P, respiration during IV administration >Maintain patients receiving parenteral benxodiazepines in bed for 3 hr; do not permit ambulatory patients to operate a vehicle following an injection.

necessary

>GI: Constipation, diarrhea, dry mouth, salivation, nausea ,anorexia, vomiting, difficulty I swallowing >GU: Incontinence, urinary retention, changes in libido, menstrual irregularities >HEMATOLOGIC: Decreased Hct, blood dyscrasias

Drug Name Generic name: Ranitidine HCl

Classification Dosage/Route Histamine-2 antagonist >Acute duodenal ulcer: 150 mg bid PO for 4-8 wk. Alternatively 300 mg PO once a day at bedtime or 50 mg IM or IV every 6-8 hr or by intermittent IV infusion >Diluted to 100 ml and infused over 15-20 mis.Do not exceed 400 mg/day.

Actions Competitively inhibits the action of histamine at the H2 receptors of the parietal cells of the stomach, inhibiting basal gastric acid secretion and gastric acid secretion that is stimulated by food, insulin, histamine, cholinergic agonists, gastrin and pentagastrin.

Indications >Short-term treatment of active duodenal ulcer >Maintenance therapy for duodenal ulcer at reduced dosage >Short-term treatment and maintenance therapy of active, benign gastric ulcer >short-term treatment of GERD >treatment of erosive esophagitis

Contraindications >Contraindicated with allergy to ranitidine, lactation.

Adverse Effects >CNS: headache, malaise, dizziness, somnolence, insomnia, vertigo >CV: tachycardia, bradycardia, PVCs

Nursing Interventions >Administer oral drug with meal and at bedtme.

Brand name: Zantac

>Decrease doses in renal and liver >DERMATOLOGIC: failure. >Provide >GI: concurrent constipation,diarrhea, antacid hepatitis, abdominal therapy to pain relieve pain. >GU: gynecomastia
>HEMATOLOGIC: leucopenia, granulocytopenia, thrombocytopenia, pancytopenia >LOCAL: Pain at IM site, local burning or itching at IV site >OTHER: arthralgias

>Administer IM dose undiluted, deep into large muscle group. >Arrange for regular followup, including blood tests, to evacuate effects.

Drug Name

Classificatio n >Amebicide >Antibacteria l >Antibiotic >Antiprotozo al

Dosage/Route

Actions

Indications

Contraindicatio ns Contraindicated with hypersensitivity to metronidazole; pregnancy (do not use for trichomoniasis in 1st trimester).

Adverse Effects

Nursing Intervention s Avoid use unless needed. Metronidazole may be carcinogenic. >Administer oral doses with food. >Apply topically (MetroGel) after cleansing the area. Advise patient that cosmetics may be used over the area after application. >Reduce dosage in hepatic disease.

Generic name: Metronidazol e Brand name: Protostat, Vandazole

ORAL

Bactericidal: Inhibits DNA >amebiasis: 750 synthesis in mg PO tid for 5-10 specific days. anaerobes, causing cell >antibioticdeath; associated antiprotozoalpseudomembrano trichomonacida us colitis: 1-2 l, amebicidal: g/day PO in 3-4 Biochemical divided doses for mechanism of 7-10 days. actions is not known. >giardiasis:250 mg PO tid for 7 days. IV Anaerobic bacterial infection: 15 mg/kg IV infused over 1 hr; then 7.5 mg/kg infused over 1 hr every 6 hr for 710 days, not to exceed 4 g/day.

>Acute infection with susceptible anaerobic bacteria >Acute intestinal amebiasis >Amebic liver abscess >trichomonias is >bacterial vaginosis >Preoperative, intraoperative, postoperative prophylaxis for patients undergoing colorectal surgery >Topical application:

>CNS: headache, dizziness, ataxia, vertigo, incoordination, insomnia, seizures, peripheral neuropathy, fatigue >GI: unpleasant metallic taste, anorexia, nausea, vomiting, diarrhea, GI upset, cramps >GU: dysuria, incontinence,darkeni ng of the urine >LOCAL: thrombophlebitis (IV); redness, burning, dryness, amd skin irritation on topical medication >OTHER: severe, disulfiram-like interaction with alcochol, candidiasis (superinfection)

Treatment of inflammatory papules, pustules, and erythema of rosacea

Assessment Subjective: ------

Diagnosis Activity Intolerance related to involuntary muscle contractions as manifested by restlessness, neck rigidity, reflex spasm, and spasm of the jaw.

Planning After 8 hours of nursing intervention the patients relatives will verbalize understanding of situation and individual treatment regimen and safety measures. After 2 weeks of nursing intervention an improvement in patients condition will be seen as manifested by decreased involuntary movements, and increased ability to recognize his condition and be able to prevent secondary side effects such as falls or injury.

Intervention -Monitor vital signs every 2 hours.

Rationale -To note changes and possible signs of complication, improvement and serves as baseline data -To maintain position of function and reduce the risk of pressure ulcers

Evaluation After 8 hours of nursing intervention the patients relative was able to understand the situation and provide safety measures. After 2 weeks of rendering nursing intervention: *the patient's condition had improved *the patient had been able to demonstrate coping behaviors in preventing secondary side effects of the present condition.

Objectives: Vital Signs BP: 100/60mmHg BT: 36C PR: 74BPM RR: 24CPM >Inability to performed ADL > Limited range of motion >uncoordinated jerky movements >limited ability to perform gross motor skill

-Reposition the patient every 2 hours as needed to prevent contractures and pressure sores. -Provide therapeutic environment, placing the patient in a quiet room with a dim light and with a large proximity with other rooms. -Provide safety measures (raise side rails) as indicated in patient situation

-To avoid extrinsic stimulants that will trigger the involuntary muscle contractions of the patient.

-To avoid secondary injuries.

Nursing care plan1

Assessment SUBJECTIVE: Yung Amino Acids lang po na nireseta ni doctora yung pagakain nya and hindi po sya nakakalunok ng pagakain as verbalized by the wife of the patient. OBJECTIVE: (+) trismus or spasm of the jaw (+) TPN of Amino Acids (+) Dysphagia

Diagnosis Altered Nutrition less than body requirement related to Cranial Nerve V impairment as manifested by trismus or spasm of the jaw, difficulty in swallowing and muscle stiffness.

Planning SHORT TERM After 1 week the patient will be able to: -Increase/ Improve body weight. -have normal level of Fluids and Electrolytes. LONG TERM -After 1 month the patient will be able to perform ADL, independently. -After 3 months the patient will able to establish stable nutritional status such as normal body weight.

Intervention -Infuse and maintain TPN of Amino Acid that serves as the clients only source of nutrition. -After the recovery of the patient (2-5 weeks), administer oxygen as ordered by the physician.

Rationale -To support the failing nutritional status of the client and to provide reserve energy requirement. -For the patient to have increased and stable nutritional status by administering osteurized food via NGT insertion. -To serve as the baseline data and to know the nutritional improvement of the client.

Evaluation After 1 week of intervention the client manifests an increase level of body weight for at least 2lbs. Level of Fluid and Electrolytes normalized within a week. After 1 month of rendering care and supporting the client, he shown an improvement in terms of performing ADL independently. After 3 months, the patient established a stable nutritional status.

-Assess and monitor body weight before and after the interventions applied to the client.

Nursing Care Plan 2

Assessment Subjective: Nahihirapan siya huminga as verbalized by the patients wife Objective: Use of accessory muscles Altered RR Difficulty of Breathing Nasal Flaring Irritability Restlessness

Diagnosis Ineffective Breathing pattern related to spasm as evidenced by increase respiratory rate, DOB and nasal flaring

Planning

Intervention

Rationale

Evaluation STG: After an hour of Nursing Intervention Patients DOB was relieved LTG: After 2 weeks of Nursing intervention patient was able to: Demonstrate coping behaviors

STG: STG: STG: After an hour of 1. Administer 1. For management of Nursing Intervention oxygen at underlying Patients DOB lowest pulmonary will be concentration condition, relieved as indicated respiratory distress and prescribed or cyanosis. LTG: respiratory 2. That may restrict or After 2 weeks of medication. limit respiratory Nursing intervention 2. Assess for pain effort. patient will have a: and 3. To promote lung Demonstrate discomfort. expansion. coping 3. Elevate Head 4. To evaluate behaviors of bed as presence or appropriate. character of breathe 4. Auscultate sounds and chest. Secretions. LTG: LTG: 1. Encourage slower or deeper respiration 2. Encourage adequate rest periods between activities. 3. Refer for upper and lower 1. To assist client in taking control of the situation. 2. To limit fatigue. 3. To maximize clients level of functioning. 4. To maximize respiratory effort.

extremity endurance and strength training slowly. 4. Stress importance of good posture and effective use of accessory muscle.