acute mi dmii medical management

MEDICAL MANAGEMENT

Intravenous Fluid (IVF)

MEDICAL MANAGEMENT

DATE BRIEF DESCRIPTION INDICATION CLIENT’S REACTION

Plain Lactated Ringer’s Solution + Glycin 1L

20-21 gtts./min.

February 13 – 14, 2011 An isotonic solution containing sodium, chloride, potassium, calcium and lactate used to restore vascular volume and replace fluid and electrolytes.

An alkalinizing solution that maybe give to treat acidosis

Consumed with no adverse reaction.

Side Drip5% Dextrose in Water 90cc + 10 mg Isoket

10-11 ugtts./min.

February 13, 2011 Isotonic solution on initial administration but provides free water when dextrose is metabolized expanding intracellular and extracellular fluid volume.

Useful in preventing dehydration, supplied for fluid requirements and carbohydrates for calories and energy.


5% Dextrose in Water + Lysmix or D5W + 2 amp. (40 ml Lysmix) 1L

10-11gtts./min.

February 15, 2011 Isotonic solution on initial administration but provides free water when dextrose is metabolized expanding intracellular and extracellular fluid volume.

Useful in preventing dehydration, supplied for fluid requirements and carbohydrates for calories and energy.


Nursing Responsibilities:

Before

Recheck doctor’s order and compute flow rate.

Explain purpose of the procedure.

Recheck blood pressure before administration.

Monitor urine output and vital signs hourly.

During

Monitor and regulate IV and its patency.

Monitor venipuncture site.

Assess client’s general condition.

Strictly, monitor and regulate IVF to avoid fluid overload.

After

Proper disposal of IV bottle after use.

Assess improvement of patient’s condition.

Document client’s response.

Oxygen Therapy

MEDICAL MANAGEMENT

DATE BRIEF DESCRIPTION INDICATION CLIENT’S REACTION

OXYGEN THERAPHY

Via nasal cannula 4 liters per minute

February 13, 2011 Is the administration of oxygen at concentration greater than that found in the environmental atmosphere.

Provide adequate transport of oxygen in blood when decreasing the work of breathing and reducing stress in myocardium.

Patient’s Respiratory rate improved from 24cpm to 16cpm

Nursing Responsibilities

Before

Explain purpose of the procedure.

Recheck doctor’s order and regulation.

Position in Semi-Fowlers

During

Monitor vital signs and record.

Secure nasal cannula.

Assess signs of hypoxia.

After

Assess patient’s general condition.

Assess client’s nares for irritation and apply lubricants to soothe mucous membrane.

Drugs

E.R. Medications

NAME OF DRUG

(GENERIC & BRAND

NAME)

DATE ORDERED

ROUTE OF ADMINISTRAT-ION, DOSAGE

AND FREQUENCY

GENERAL/MECHANI-SM OF

ACTION

INDICATION/PURP-OSE

SIDE EFFECTS/ADVER

-SE REACTION

CLIENT’S RESPONSE

TO MEDICATI-

ONGeneric Name:Aspirin (acetylsalicylic acid)

Brand Name:N.A.

Pharmacologic Class:Salicylate

Therapeutic Class:Nonopioid analgesic, anti-pyretic, anti-inflammatory, antiplatelet drug

February 13, 2011

300 mg. 1 tab. stat; 100 mg. 1 tab. OD

Produces analgesia by blocking prostaglandin synthesis (peripheral action). Drug and other salicylates may prevent lowering of pain threshold that occurs when prostaglandin sensitize pain receptors to stimulation. Exerts its anti-inflammatory effect by inhibiting prostaglandin synthesis; also may inhibit synthesis or action of other mediators of inflammatory response. Relieves fever by acting on hypothalamic heat-regulating center to cause peripheral vasodilation, which increase peripheral blood supply and promotes sweating, which leads to heat loss

Prevention of thrombosis.

Reduction of risk of MI in patients with previous MI or unstable angina.

EENT:Tinnitus, hearing lossGI:Nausea, vomiting, GI distress, occult bleeding, dyspepsia, GI bleedingHematologic:Prolonged bleeding time, thrombocytopeniaHepatic:HepatitisSkin:Rash, bruising, uticariaOther:Angioedema, hypersensitivity reactions, Reye’s syndrome

and to cooling by evaporation. In low doses, aspirin also appears to impede clotting by blocking prostaglandin synthesis, which prevents formation of platelet aggregating substance thromboxane A2.


Before

Check the expiration date of the drug.

Check the doctor's order.

Confirm right dosage and route of administration.

Make sure the drug is given to the right patient.

Assess the client's understanding about the drug.

Explain what the drug is for and its side effects if any.

Give with food or large amounts of water or milk to minimize GI irritation.

During

Tell patient to report ototoxicity symptoms, unusual bleeding, and bruising.

Caution patient to avoid activities that may cause injury. Advise him to use soft toothbrush and electric razor to avoid gum and skin injury.

Instruct patient to tell all prescribers he’s taking the drug, because it may cause serious interactions with many common medications.

Tell patient not to take other over the counter preparations containing aspirin.

Inform patient that he may need to undergo regular blood testing during therapy.

After

Watch for signs and symptoms of hypersensitivity and other adverse reactions, especially bleeding tendency. Stay alert for signs and

symptoms of acute toxicity, such as diplopia, ECG abnormalities, generalized seizures, hallucinations, hyperthermia, oliguria, acute renal

failure, incoherent speech, irritability, restlessness, tremor, vertigo, confusion, disorientation, mania, lethargy, laryngeal edema,

anaphylaxis, and coma.

Monitor elderly patients carefully because they’re at greater risk for salicylate toxicity.

With prolonged therapy, frequently assess hemoglobin, hematocrit, International Normalized Ratio, and kidney function test results.

Check salicylate blood levels frequently.

Evaluate patient for signs and symptoms of ototoxicity (hearing loss, tinnitus, ataxia, and vertigo).

NAME OF DRUG

(GENERIC & BRAND

NAME)

DATE ORDERED


AND FREQUENCY


ACTION

INDICATION/PURP-OSE

SIDE EFFECTS/ADVER

-SE REACTION

CLIENT’S RESPONSE

TO MEDICATI-

ONGeneric Name:Clopidogrel Bisulfate

Brand Name:Clopimet

Pharmacologic Class:Platelet aggregationinhibitor

Therapeutic Class:Antiplatelet drug

February 13, 2011

75 mg. 1 tab. OD Inhibits platelet aggregation by blockingbinding of adenosine diphosphateto platelets, thereby preventing thrombusformation

To reduce atherosclerotic events inpatients with recent myocardial infarction(MI) or cerebrovascular accidentand in those with established peripheralarterial disease or acute coronarysyndrome

CNS:Depression, dizziness, fatigue,headacheCV:Chest pain, hypertensionEENT:Epistaxis, rhinitisGI:Diarrhea, abdominal pain, dyspepsia,gastritis, GI bleedingHematologic: Bleeding, neutropenia,thrombotic thrombocytopenic purpuraMetabolic: Hypercholesterolemia, goutMusculoskeletal: joint pain, back painRespiratory:Cough, dyspnea, bronchitis,upper respiratory tract infection,

bronchospasmSkin:Pruritus, rash, angioedemaOther: Hypersensitivity reactions, anaphylacticreactions


Before



Confirm right dosage and route of administration.




Advise patient to minimize adverse GI effects by eating small, frequent meals or chewing gum.

During

Tell patient drug may cause headache and dizziness. Caution him to avoid driving and other hazardous activities until he knows how drug

affects concentration and alertness.

Advise patient to immediately report unusual or acute chest pain, respiratory difficulty, rash, unresolved bleeding, diarrhea, GI distress,

nosebleed, or acute headache.

After

Monitor hemoglobin and hematocrit periodically.

Monitor patient for unusual bleeding or bruising; drug significantly increases risk of bleeding.

Advise patient to contact prescriber before taking over-the-counter products, particularly non-steroidal anti-inflammatory drugs.

NAME OF DRUG (GENERIC & BRAND NAME)

DATE ORDERED

ROUTE OF ADMINISTRAT-ION, DOSAGE AND FREQUENCY

GENERAL/MECHANI-SM OF ACTION

INDICATION/PURP-OSE

SIDE EFFECTS/ADVER-SE REACTION

CLIENT’S RESPONSE TO MEDICATI-ON

Generic Name:Morphine sulfate

Brand Name:Zomorfph

Pharmacologic Class:Opioid agonist

Therapeutic Class:Opioid analgesicControlled substance schedule II

February 13, 2011

1 ml (1 amp.) IVP PRN for chest pain

Interacts with opioid receptor sites, primarily in limbic system, thalamus, and spinal cord. This interaction alters neurotransmitter release, altering perception of and tolerance for pain.

Severe to moderate pain.

CNS:Confusion, sedation, dizziness,dysphoria, euphoria, floating feeling,hallucinations, headache, nightmaresCV:Hypotension, bradycardiaEENT: blurred vision, diplopia, miosisGI:Nausea, vomiting, constipation, drymouthGU:Urinary retentionRespiratory: Apnea, respiratory depression,respiratory arrestSkin:Flushing, itching, sweatingOther:Physical or

psychological drugdependence, drug tolerance


Before



Confirm right dose and route of administration.




During

Advise patient to inform the nurse on duty at the first sign of pain, because continuous dosing is more effective than p.r.n. dosing.

Tell patient and caregiver that drug may cause respiratory depression.

Instruct them to immediately report respiratory rate of 10 bpm or less.

After

Monitor vital signs. Contact prescriber if respiratory rate is 10 bpm or less.

Assess pain character, location, and intensity.

Monitor fluid intake and output.

Stay alert for urinary retention.

Monitor bowel elimination pattern.

If constipation occurs, intervene as appropriate.

Assess neurologic status. Implement safety measures as needed to prevent injury.

Evaluate patient for signs and symptoms of physical or psychological dependence. Be watchful for drug hoarding.

ICCU Medications

NAME OF DRUG

(GENERIC & BRAND

NAME)

DATE ORDERED


AND FREQUENCY


ACTION

INDICATION/PURP-OSE

SIDE EFFECTS/ADVER

-SE REACTION

CLIENT’S RESPONSE

TO MEDICATI-

ONGeneric Name:Isosorbide mononitrate

Brand Name:Isorbide 60

Pharmacologic Class:Nitrate

Therapeutic Class:Antianginal

February 13, 2011

60 mg ½ tab. bid. Promotes peripheral vasodilation and reducespreload and afterload, decreasing myocardial oxygen consumption and increasing cardiac output. Also dilates coronary arteries, increasing blood flow and improving collateral circulation.

Treatment and prophylaxis in situationslikely to provoke acute angina pectoris.

CNS:Dizziness, headache, apprehension,asthenia, syncopeCV:Orthostatic hypotension, tachycardia,paradoxical bradycardia, reboundhypertensionEENT:Sublingual burning (with S.L.route)GI:Nausea, vomiting, dry mouth,abdominal painSkin:Flushing


Before







During

Give oral form 30 minutes before or 1 to 2 hours after a meal. Make sure patient swallows tablets or capsules whole.

Have patient wet S.L. tablet with saliva before placing it under tongue. To avoid tingling sensation, have him place tablet in buccal pouch.

After

Monitor ECG and vital signs closely, especially blood pressure.

NAME OF DRUG

(GENERIC & BRAND

NAME)

DATE ORDERED


AND FREQUENCY


ACTION

INDICATION/PURP-OSE

SIDE EFFECTS/ADVER

-SE REACTION

CLIENT’S RESPONSE

TO MEDICATI-

ONGeneric Name:Metoprolol succinate

Brand Name:Angimet

Pharmacologic Class:Beta-adrenergicblocker (selective)

Therapeutic Class:Antihypertensive,antianginal

February 13, 2011

50 mg. 1 tab. OD Blocks stimulation of beta1 (myocardial)adrenergic receptors, usually without affecting beta2 (pulmonary, vascular, uterine) adrenergic receptor sites.

MIAngina pectorisHypertension

CNS:Fatigue, weakness, anxiety, depression,dizziness, drowsiness, insomnia,memory loss, mental statuschanges, nervousness, nightmaresCV:Orthostatic hypotension, peripheralvasoconstriction, bradycardia, heartfailure, pulmonary edemaEENT:Blurred vision, stuffy noseGI:Nausea, vomiting, constipation, diarrhea,flatulence, gastric pain, heartburn,dry mouth

GU:Urinary frequency, erectile dysfunction,decreased libidoHepatic:HepatitisMetabolic: hyperglycemia, hypoglycemiaRespiratory: Wheezing, bronchospasmMusculoskeletal: Back pain, joint painSkin:RashOther:Drug-induced lupus syndrome


Before







Give metoprolol tartrate with or immediately after meals, because food enhances its absorption.

During

Tell patient that extended-release tablets are scored and can be divided, but that he should swallow tablets or half-tablets whole and not

crush or chew them.

Advise patient with heart failure to report signs or symptoms of worsening condition, including weight gain and increasing shortness of

breath.

Caution patient to avoid driving and other hazardous activities until drug effects are known.

Instruct patient to notify health care providers (including dentists) that he is taking drug before having surgery.

After

Measure blood pressure closely when starting therapy and titrating dosage. Once patient stabilizes, measure blood pressure every 3 to 6

months.

Monitor blood pressure and pulse before I.V. administration. If patient is hypotensive or has bradycardia, consult prescriber before giving

dose.

Watch for orthostatic hypotension in at-risk patients, particularly the elderly.

Assess glucose levels in diabetic patient. Be aware that drug may mask signs and symptoms of hypoglycemia.

Monitor for signs and symptoms of hyperthyroidism. Know that drug may mask these. Reduce dosage gradually in hyperthyroid patients.

When discontinuing drug, reduce dosage gradually over 1 to 2 weeks.

NAME OF DRUG

(GENERIC & BRAND

NAME)

DATE ORDERED


AND FREQUENCY


ACTION

INDICATION/PURP-OSE

SIDE EFFECTS/ADVER

-SE REACTION

CLIENT’S RESPONSE

TO MEDICATI-

ONGeneric Name:Trimetazidine hydrochloride

Brand Name:Carvidon

Pharmacologic Class:N.A.

Therapeutic Class:Anti-anginal

February 13, 2011

20 mg. 1 tab. tid. Trimetazidine is a cellular acting anti-ischaemic agent. It has 3 main properties by which it acts as a cytoprotective agent. It inhibits the anaerobic glycolysis and fatty acid metabolism, thus allowing only aerobic glycolysis. This action helps to restore the energy balance in the cell. It inhibits acidosis and free radical accumulation in the cell. All these action help the cell to restore the normal ionic and metabolic balance.

Angina pectoris Vertigo Tinnitus

GI disturbances, vomiting, nausea.

Hypersensitivity Pregnancy and

lactation.


Before







Give trimetazidine hydrochloride with meals.

After

Monitor vital signs and watch for any adverse reactions.

NAME OF DRUG

(GENERIC & BRAND

NAME)

DATE ORDERED


AND FREQUENCY


ACTION

INDICATION/PURP-OSE

SIDE EFFECTS/ADVER

-SE REACTION

CLIENT’S RESPONSE

TO MEDICATI-

ONGeneric Name:Gliclazide

Brand Name:Diamicron

Pharmacologic Class:Sulfonamides, urea derivatives

Therapeutic Class:Anti-diabetic agent

February 13, 2011

80 mg. 1 tab. OD Gliclazide is a sulfonylurea which stimulates insulin secretion by the pancreas. Its action on insulin secretion is mainly due to the restoration of the early phase, resulting in a physiological release of insulin. Thus, gliclazide restores glycemic control throughout 24 hrs. It normalizes fasting and postprandial blood sugar.In man, apart from having hypoglycemic effect, gliclazide has been shown to reduce platelet hyperadhesiveness and hyper-aggregation and to increase fibrinolytic activity. Moreover, it has been demonstrated that gliclazide possesses specific antioxidant properties which is comparable to vitamin C.

Type 2 diabetes. Diamicron is generally well tolerated. Nausea, headache, rashes and gastrointestinal disturbances have been reported.


Before







Give gliclazide with meals, usually with breakfast or dinner.

During

Teach patient about diabetes and importance of proper diet, exercise, weight control, and blood glucose monitoring.

Inform patient that drug may cause diarrhea, nausea, and upset stomach. Advise him to take it with meals to reduce these effects, and tell

him that adverse effects often subside over time.

Teach patient to recognize and immediately report signs and symptoms of acidosis, such as weakness, fatigue, muscle pain, dyspnea,

abdominal pain, dizziness, light-headedness, and slow or irregular heartbeat.

After

Monitor blood glucose level closely. If it isn’t controlled after 4 weeks at maximum dosage.

Monitor kidney and liver function tests, particularly in elderly patients.

Periodically monitor glucose and glycosylated hemoglobin levels to evaluate drug efficacy.

NAME OF DRUG

(GENERIC & BRAND

NAME)

DATE ORDERED


AND FREQUENCY


ACTION

INDICATION/PURP-OSE

SIDE EFFECTS/ADVER

-SE REACTION

CLIENT’S RESPONSE

TO MEDICATI-

ONGeneric Name:Furosemide

Brand Name:Fusem

Pharmacologic Class:Sulfonamideloop diuretic

Therapeutic Class:Diuretic, antihypertensive

February 13, 2011

20 mg. IVP q 60 with AP precaution

Produces osmotic effect, which increases water content in colon and enhances peristalsis. Breakdownproducts in colon lead to acidificationof colonic contents, softening of feces, and decreased ammonia absorption from colon to systemic circulation. These effects reduceblood ammonia level in portal system encephalopathy.

Hypertension CNS:Dizziness, headache, vertigo,weakness, lethargy, paresthesia, drowsiness,restlessness, light-headednessCV:Hypotension, orthostatic hypotension,tachycardia, volume depletion,necrotizing angiitis, thrombophlebitis,arrhythmiasEENT: blurred vision, xanthopsia,hearing loss, tinnitusGI:Nausea, vomiting, diarrhea, constipation,dyspepsia, oral and gastricirritation, cramping, anorexia, drymouth, acute

pancreatitisGU:Excessive and frequent urination,nocturia, glycosuria, bladder spasm,oliguria, interstitial nephritisHematologic: Anemia, purpura, leukopenia,thrombocytopenia, hemolyticanemiaHepatic:JaundiceMetabolic: Hyperglycemia, hyperuricemia,dehydration, hypokalemia, hypomagnesemia,hypocalcemia, hypochloremicalkalosisMusculoskeletal: Muscle pain,musclecrampsSkin: Photosensitivity, rash, diaphoresis,urticaria, pruritus, exfoliative dermatitis,

erythema multiformeOther:Fever, transient pain at I.M. injectionsite


Before







Instruct patient to take in morning with food (and second dose, if prescribed, in afternoon), to prevent nocturia.

Be aware that I.V. dose may be given by direct injection over 1 to 2 minutes.

During

Tell patient that drug may cause serious interactions with many common drugs. Instruct him to tell all prescribers he’s taking it.

Instruct patient to report signs and symptoms of ototoxicity (hearing loss, ringing in ears, vertigo) and other drug toxicities.

Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.

Instruct patient to move slowly when rising, to avoid dizziness from sudden blood pressure decrease.

Encourage patient to discuss need for potassium and magnesium supplements with prescriber.

Caution patient to avoid alcohol and herbs while taking this drug.

Inform patient that he’ll undergo regular blood testing during therapy.

After

Watch for signs and symptoms of ototoxicity.

Assess for other evidence of drug toxicity (arrhythmias, renal dysfunction, abdominal pain, sore throat, fever).

Monitor CBC, BUN, and electrolyte, uric acid, and CO2 levels.

Monitor blood pressure, pulse, fluid intake and output, and weight.

Assess blood glucose levels in patients with diabetes mellitus.

Monitor dietary potassium intake.

Watch for signs and symptoms of hypokalemia.

NAME OF DRUG

(GENERIC & BRAND

NAME)

DATE ORDERED


AND FREQUENCY


ACTION

INDICATION/PURP-OSE

SIDE EFFECTS/ADVER

-SE REACTION

CLIENT’S RESPONSE

TO MEDICATI-

ONGeneric Name:Lactulose

Brand Name:Rilax

Pharmacologic Class:Osmotic

Therapeutic Class:Laxative

February 13, 14, 2011

30 cc. P.O. h.s. Produces osmotic effect, which increases water content in colon and enhances peristalsis. Breakdownproducts in colon lead to acidificationof colonic contents, softening of feces, and decreased ammonia absorption from colon to systemic circulation. These effects reduceblood ammonia level in portal system encephalopathy.

Constipation GI:Nausea, vomiting, diarrhea, intestinalcramps, abdominal distention,flatulenceMetabolic: Hyperglycemia (in diabeticpatients), hypokalemia, hypernatremia


Before







During

Instruct patient to dissolve contents of single-use packet in 4 oz of water or juice.

Suggest that patient dilute syrup with water or juice to mask taste.

Tell patient drug may cause flatulence and intestinal cramps at first, but these symptoms usually subside.

Inform patient that excessive use may cause diarrhea and excessive fluid loss.

Encourage patient to drink adequate fluids and to report signs and symptoms of dehydration.

After

Watch for adverse GI reactions.

Check stool consistency and frequency.

Monitor electrolyte levels, especially in elderly patients.

Check blood glucose level in diabetic patients.


DATE ORDERED


GENERAL/MECHANISM OF ACTION

INDICATION/PURP-OSE



Generic Name:Isosorbide dinitrate

Brand Name:Isoket

Pharmacologic Class:Nitrate

Therapeutic Class: Antianginal

February 14, 2011

10 mg 1 tab. tid Promotes peripheral vasodilation and reduces preload and afterload, decreasingmyocardial oxygen consumption and increasing cardiac output. Also dilatescoronary arteries, increasing blood flow and improving collateral circulation.

Treatment and prophylaxis in situations likely to provoke acute angina pectoris.

CNS:Dizziness, headache, apprehension,asthenia, syncopeCV:Orthostatic hypotension, tachycardia,paradoxical bradycardia, reboundhypertensionEENT:Sublingual burning (with S.L.route)GI:Nausea, vomiting, dry mouth,abdominal painSkin:Flushing


Before







During

Give oral form 30 minutes before or 1 to 2 hours after a meal. Make sure patient swallows tablets or capsules whole.

Have patient wet S.L. tablet with saliva before placing it under tongue. To avoid tingling sensation, have him place tablet in buccal pouch.

After

Monitor ECG and vital signs closely, especially blood pressure.

NAME OF DRUG

(GENERIC & BRAND NAME)

DATE ORDERED

ROUTE OF ADMINISTRA-

TION, DOSAGE AND FREQUENCY

GENERAL/MECHAN-ISM OF

ACTION

INDICATION/PURP-OSE

SIDE EFFECTS/ADVE-RSE REACTION

CLIENT’S RESPONSE

TO MEDICATI-

ONGeneric Name:Simvastatin

Brand Name:Buztin

Pharmacologic Class:HMG-CoAreductase inhibitor

Therapeutic Class: Antihyperlipidemic

February 13, 14, 2011

40 mg 1 tab OD @ h.s.

Inhibits hepatic enzyme HMG-CoA reductase, interrupting cholesterol synthesisand low-density lipoprotein (LDL)consumption. Net effect is total cholesterol and serum triglyceride reductions.

Coronary artery disease; hyperlipidemia.

CNS:Headache, astheniaGI:Nausea, vomiting, diarrhea, constipation,abdominal pain or cramps,flatulence, dyspepsiaMusculoskeletal: Myalgia, rhabdomyolysisRespiratory:Upper respiratory infection


Before







During

Advise patient to take with evening meal, but not with large amounts of grapefruit juice.

Tell patient drug may take up to 4 weeks to be effective.

After

Watch closely for myositis and other adverse musculoskeletal reactions. Know that drug may cause rhabdomyolysis.

Monitor CBC, and lipid levels.


DATE ORDERED



INDICATION/PURP-OSE



Generic Name:MetoclopramidehydrochlorideBrand Name:Metsil

Pharmacologic Class:Dopamineantagonist

Therapeutic Class:Antiemetic, GIstimulant

February 13, 14, 2011

2 ml (1 amp.) IVP stat then q 80

Blocks dopamine receptors by disruptingCNS chemoreceptor trigger zone, increasing peristalsis and promoting gastric emptying.

Nausea and vomiting. CNS:Drowsiness, restlessness, anxiety,depression, irritability, fatigue, lassitude,insomnia, tardive dyskinesia,parkinsonian-like reactions, extrapyramidalreactions, akathisia, dystoniaCV:Hypertension, hypotension,arrhythmiasGI:Nausea, constipation, diarrhea, drymouthGU:Gynecomastia


Before







During

Tell patient to take 30 minutes before meals.

Instruct patient to report involuntary movements of face, eyes, or limbs.

Caution patient to avoid driving and other hazardous activities until drug’s effects are known.

As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs,

tests, and behaviors mentioned above.

After

Monitor blood pressure during I.V. administration.

Stay alert for depression and other adverse CNS effects.

Watch for extrapyramidal reactions, which usually occur within first 24 to 48 hours of therapy. To reverse these symptoms, give

diphenhydramine 50 mg I.M. or benztropine 1 to 2 mg I.M., as prescribed.

In diabetic patient, stay alert for gastric stasis. Insulin dosage may need to be adjusted.


DATE ORDERED



INDICATION/PURP-OSE



Generic Name:Enoxaparin sodium

Brand Name:Lovenox

Pharmacologic Class:Low-molecularweightheparin

Therapeutic Class:Anticoagulant

February 14, 2011

4,000 IU IVP OD Inhibits thrombus and clot formation by blocking factor Xa and factor IIa. This inhibition accelerates formationof antithrombin III-thrombin complex(a coagulation inhibitor), thereby deactivating thrombin and preventing conversion of fibrinogen to fibrin.

To treat acute ST-segment–elevation MI (STEMI).

Prevention of ischemic complications of unstable angina or non-Qwave myocardial infarction.

CNS: Dizziness, headache, insomnia,confusion, cerebrovascular accidentCV:Edema, chest pain, atrial fibrillation,heart failureGI:Nausea, vomiting, constipationGU:Urinary retentionHematologic: Anemia, bleeding tendency,thrombocytopenia, hemorrhageMetabolic: HyperkalemiaSkin:Bruising, pruritus, rash, urticariaOther:Fever; pain, irritation, or

erythema at injection site


Before







During

Instruct patient to promptly report irregular heartbeat, unusual bleeding or bruising, rash, or hives.

Teach patient safety measures to avoid bruising or bleeding.

After

Monitor CBC and platelet counts.

Watch for signs and symptoms of bleeding or bruising.

Monitor fluid intake and output.

Watch for fluid retention and edema.


DATE ORDERED



INDICATION/PURP-OSE



Generic Name:n.a.

Brand Name:Lysmix

Pharmacologic Class:Parenteral Nutrition

Therapeutic Class:Multivitamins

February 14, 2011

40 ml. (2 amps.) for incorporation to IVF

n.a. Nutritional supplement for lactating women, children, also for patients with acute and chronic liver disease such as liver cirrhosis, fatty liver, hepatic encephalopathy.

n.a.


Before








DATE ORDERED



INDICATION/PURP-OSE



Generic Name:Vildagliptin

Brand Name:Galvus

Pharmacologic Class:dipeptidyl peptidase-4 (DPP-4) inhibitor

Therapeutic Class:Anti-hyperglycemic

February 14, 2011

50 mg 1 tab. bid. Vildagliptin is a dipeptidylpeptidase-4 (DPP-4) inhibitor that improves glycemic control by preventing DPP-4 from inactivating the incretin hormones glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide, thus prolonging incretin activity in response to ingestion of nutrients. This increases insulin sensitivity, decreases glucagon secretion and improves β-cell function.

For people with type 2 diabetes whose blood sugar is not sufficiently controlled by other antidiabetic medicines. It can be added to treatment with metformin; a sulphonylurea, for example gliclazide; or another type of antidiabetic medicine known as a thiazolidinedione, for example pioglitazone or rosiglitazone.

Hypoglycemia, delayed gastric emptying, nausea and vomiting. Flu-like symptoms, headache and dizziness may occur.

Potentially Fatal: Stevens-Johnson syndrome.


Before Check the expiration date of the drug. Check the doctor's order. Confirm right dose and route of administration. Make sure the drug is given to the right patient. Assess the client's understanding about the drug. Explain what the drug is for and its side effects if any.


DATE ORDERED



INDICATION/PURP-OSE



Generic Name:Metformin hydrochloride

Brand Name:Glycon

Pharmacologic Class:Dimethylbiguanide

Therapeutic Class:Antidiabetic

February 14, 2011

50 mg 1 tab. bid. Increases insulin sensitivity by decreasingglucose production and absorption in liver and intestines and enhancing glucose uptake and utilization.

Concurrent use with insulin in type 2 diabetes mellitus.

GI:Diarrhea, nausea, vomiting, abdominalbloatingMetabolic:Lactic acidosisOther:Unpleasant metallic taste, decreasedvitamin B12 level


Before







During

Instruct patient to take metformin tablet at breakfast and dinner if taking drug twice a day. Instruct him to take E.R. tablets once daily with

evening meal and to swallow them whole without crushing or chewing.

Teach patient about diabetes and importance of proper diet, exercise, weight control, and blood glucose monitoring.

Inform patient that drug may cause diarrhea, nausea, and upset stomach. Advise him to take it with meals to reduce these effects, and tell

him that adverse effects often subside over time.

Teach patient to recognize and immediately report signs and symptoms of acidosis, such as weakness, fatigue, muscle pain, dyspnea,

abdominal pain, dizziness, light-headedness, and slow or irregular heartbeat.

Advise patient to report changes in health status (such as infection, persistent vomiting and diarrhea, or need for surgery). These may

warrant dosage decrease or drug withdrawal.

After

Monitor blood glucose level closely. If it isn’t controlled after 4 weeks at maximum dosage, oral sulfonylurea may be added.

Monitor kidney and liver function tests, particularly in elderly patients.

Assess hematologic parameters and vitamin B12 levels at start of therapy and periodically thereafter.

Watch for signs and symptoms of lactic acidosis. Stop drug if acidosis occurs. To aid differential diagnosis, check electrolyte, ketone,

glucose, blood pH, lactate, and metformin blood levels.

Periodically monitor glucose and glycosylated hemoglobin levels to evaluate drug efficacy.

NAME OF DRUG

(GENERIC & BRAND

NAME)

DATE ORDERED


AND FREQUENCY


ACTION

INDICATION/PURP-OSE

SIDE EFFECTS/ADVER

-SE REACTION

CLIENT’S RESPONSE

TO MEDICATI-

ONGeneric Name:Co-amoxiclav

Brand Name:Augmentin IV

Pharmacologic Class:Penicillin

Therapeutic Class:Bactericidal

February 14, 2011

600 mg. IVP q 80 Resistance to many antibiotics is caused by bacterial enzymes which destroy the antibiotic before it can act on the pathogen. The clavulanate in co-amoxiclav anticipates this defense mechanism by blocking the β-lactamase enzymes, thus rendering the organisms sensitive to amoxicillin's rapid bactericidal effect at concentrations readily attainable in the body.Clavulanate by itself has little antibacterial activity; however, in association with amoxicillin as co-amoxiclav, it produces an antibiotic agent of

Adult Formulation: For short-term treatment of bacterial infections at the following sites when caused by co-amoxiclav-sensitive organisms: Upper respiratory tract infections (including ear, nose and throat) eg, recurrent tonsillitis, sinusitis and otitis media.

Lower respiratory tract infections eg, acute exacerbations of chronic bronchitis, lobar and bronchopneumonia.

Infections and Infestations: Common: Mucocutaneous candidiasis.Blood and Lymphatic System Disorders: Rare: Reversible leukopenia (including neutropenia) and thrombocytopenia. Very Rare: Reversible agranulocytosis and hemolytic anemia, prolongation of bleeding time and prothrombin time.Immune System Disorders: Very Rare:

broad spectrum with wide application in hospital and general practice.

Angioneurotic edema, anaphylaxis, serum sickness-like syndrome, hypersensitivity vasculitis.CNS Disorders: Uncommon: Dizziness, headache. Very Rare: Convulsions. Convulsions may occur in patients with impaired renal function or in those receiving high doses.Vascular Disorders: Rare: Thrombophlebitis at the site of injection.GI Disorders: Common: Diarrhea. Uncommon: Nausea, vomiting, indigestion. Very Rare: Antibiotic-associated colitis

(including pseudomembranous colitis and hemorrhagic colitis) are less likely to occur after parenteral administration.Hepatobiliary Disorders: Uncommon: A moderate rise in AST and/or ALT has been noted in patients treated with β-lactam class antibiotics, but the significance of these findings is unknown. Very Rare: Hepatitis and cholestatic jaundice. These events have been noted with other penicillins and cephalosporins.Hepatic events have been reported predominantly in males and elderly

patients and may be associated with prolonged treatment.Signs and symptoms usually occur during or shortly after treatment but in some cases may not become apparent until several weeks after treatment has ceased. These are usually reversible. Hepatic events may be severe and in extremely rare circumstances, deaths have been reported. These have almost always occurred in patients with serious underlying disease or taking concomitant medications known to have the potential for

hepatic effects.Skin and Subcutaneous Tissue Disorders: Uncommon: Skin rash, pruritus, urticaria. Rare: Erythema multiforme. Very rare: Stevens-Johnson syndrome, toxic epidermal necrolysis, bullous exfoliative-dermatitis, acute generalized exanthemous pustulosis (AGEP).If any hypersensitivity dermatitis reaction occurs, treatment should be discontinued.Renal and Urinary Disorders: Very rare: Interstitial nephritis, crystalluria


Before







Perform ANST to confirm patient’s sensitivity to the drug.

During

Instruct patient to immediately report signs and symptoms of hypersensitivity reactions, such as rash, fever, or chills.

Tell patient he may take drug with or without food.

Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.

After

Monitor for signs and symptoms of hypersensitivity reaction.

Monitor patient’s temperature and watch for other signs and symptoms of super infection (especially oral or rectal candidiasis).

Diet

TYPE OF DIET DATE PURPOSEDiabetic diet February 13, 2011 To keep blood sugar levels normal.


Before

Check the doctor’s order.

Assess clients and S.O’s knowledge and understanding of the diet.

During

Assess client’s ability to swallow.

After

Constant monitoring of blood glucose level.

BIBLIOGRAPHY

Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, Eleventh Edition, Suzanne C.

Smeltzer et. al., copyright 2008

2010 Nursing Spectrum Drug Handbook, 5th ed, Patricia Dwyer Schull, copyright 2009

Jones & Bartlett Learning 2011 Nurse’s Drug Handbook, Tenth Edition, copyright 2010

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