draft for preterm labor.docx

8/19/2019 Draft for Preterm Labor.docx

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I. INTRODUCTION

PRETERM LABOR

Definition:

• Preterm labor is labor that occurs before the end of week 37 of gestation

• Preterm labor is also defined as presence of uterine contractions of sufficient

frequency and intensity to effect progressive effacement and dilation of the cervix

prior to term gestation (between 20 and 37 wk

• Preterm labor is also defines as regular contractions accompanied by cervical

change occurring at less than 37 weeks! gestation"

• Premature activation of the maternal or fetal hypothalamic#pituitary#adrenal axis ($P%

axis"

•

&xaggerated inflammatory response'infection• ecidual hemorrhage"

• Pathological uterine distention

Risk Factors:

• Previous preterm labor or preterm birth

• Pregnancy with twins) triplets or other multiples

• *ertain problems with the uterus) cervix or placenta

• +moking cigarettes) drinking alcohol or using illicit drugs

• +ome infections) particularly of the amniotic fluid and lower genital tract

• +ome chronic conditions) such as high blood pressure and diabetes• ,eing underweight or overweight before pregnancy) or gaining too little or too

much weight during pregnancy

• +tressful life events) such as the death of a loved one

• %n interval of less than six months since the last pregnancy

Common Sm!toms:

• Persistent) dull) low backache

• -aginal spotting

• .eeling of pelvic pressure or abdominal tightening• /enstrual#like cramping

• ncreased vaginal discharged

• ntestinal cramping

• 1terine contractions

## bserving the characteristics of uterine contractions and cervical change

facilitates the diagnosis of Preterm labor" ften) the diagnosis of preterm labor can be

made only in retrospect as only 24#04 of patients with regular painful contractions

actually proceed to preterm delivery"

Initia" E#a"$ation for Preterm La%or:

• &valuation of maternal clinical status and membrane status

• *omplete blood

• *ell count

• 1rinalysis

• 5roup , ,#hemolytic +treptococcus status


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• .etal status should be ascertained by non#stress test or biophysical profile) and if

not recently done) include evaluation of fetal growth and amniotic fluid"

T&era!e$tic Mana'ement for Preterm La%or:

(For mother :)

• Promote bed rest to relieve pressure of the fetus on cervix

• nstitute - therapy to keep mother well hydrated

• &ncourage mother to stop smoking if mother is smoking

• %dministration of tocolytic agents (beta#sympathomimetic drugs) 6itodrine

hydriochloride) terbutaline

• %dministration of antibiotics more likely if your membranes have ruptured or if the

contractions are caused by infection

(For fetus :)

Adiministration of steroid like bethamethasone to hasten lung maturity of the fetus

If labor cannot be halted which means, membranes are ruptures, cervix is effaced !",

and cervix is dilated for more then #$% cm:

• %rtificial rupture of membrane is not done because of risk for prolapsed cord

• &pisiotomy is needed because of fragile head of infant

II. PATIENT(S PROFILE

ame8 A.P.

%ddress8 San )ose* Enri"e* Ca'aan


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5ender8 Fema"e

%ge8 +, -o

,irthday8 No#em%er +* /0,

/arital +tatus8 Sin'"e

&ducational 9evel8 Co""e'e 1Com!$ter En'ineerin'2

ccupation8 None

6eligion8 Roman Cat&o"ic

ationality8 Fi"i!ino

9ast /enstrual Period8 Marc& 3* +3

&xpected ate of *onfinement8 Decem%er 30* +3

%ge of 5estation8 +4 ,-5 6eeks

.undic $eight8 73 cm

*hief *omplaint8 A%8omina" !ain

ate of %dmission8 Se!tem%er 3,* +3

:ime of %dmission8 +:3, AM

-'+ upon %dmission8

BP: 3- 53

PR: 07

RR: +3

%dmitting iagnosis8 Preterm La%or

%dmitting Physician8 Damaso* C&ristiana C.

%dmitting nstitution8 Ca'aan 9a""e Me8ica" Center


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III. NURSIN ;EALT; ;ISTOR<

;istor of Present I""ness

9ast +eptember 0;) 20


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Fami" ;ea"t& ;istor

%ccording to patient %P) $ypertension runs on her father!s family" ?hile on her mother!s

side) patient %P!s grandfather and grandmother died from *ancer (lung" +he also stated that

her mother has an %nemia"

neco"o'ic ;istor

Patient %P had her first menstrual period when she was


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experiences minor illnesses) such as headache) she =ust ignores it and takes a rest"

A%yaw ko kasi ng laging umiinom ng gamotC) as verbali@ed by the patient"

uring $ospitali@ation8Patient %P said that she feels she is unhealthy now because of her condition"

?hen asked if she adheres to medications given to her and if she finds them useful) she

verbali@ed Ao) iniinom ko lahat kasi para sa mga baby ko yun eh"C

+. N$tritiona"= Meta%o"ic Pattern

,efore $ospitali@ation8Patient %P usually drinks a glass of ,earbrand milk every morning and eats

enough meal consisting of rice) vegetables and some meat for her lunch and dinner"

+he also said that she sometimes takes her midnight snack) especially if they had an

early dinner" +he typically eats at home and her mother cooks her food" %ccording to

patient %P) her favorite foods are pastas" Patient %P is allergic to salty foods such as

bagoong and tuyo& +he usually drinks about one and a half (. E"imination Pattern

,efore $ospitali@ation8

Patient %P regularly defecates once a day" %ccording to her) the usual

characteristic of her stool is yellow to brown in color and soft in consistency" +he

urinates six (D to seven (7 times a day and with a slightly yellow color" Patient %P said

that she doesn!t experience any difficulties when urinating or defecating"

uring $ospitali@ation8

Patient %P defecates once in every three days" ?hen asked about the

characteristics of her stool) she verbali@ed A/aitim yung kulay pero okay lang yung

lambot"C +he doesn!t have any difficulties with her defecation" Patient %P usually urinates

five ( times a day without any difficulties" $er urine is yellowish in color"

7. Acti#it= E?ercise Pattern

,efore $ospitali@ation8?hen asked about her usual activities every day) patient %P verbali@ed ABapag

umaga) nanunuod lang ako ng mga palabas sa :- o kaya nagbabasa ng mga pocket


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book o maga@ine" Bung may gagawin yung mama ko) gaya ng paglalaba) tinutulungan

ko din siya) pero ako yung taga#sampay lang" Bapag hapon natutulog ako o kaya

nanunuod pa din"C +he said that helping her mother in some simple household chores

serves as her exercise" n doing her activities every day) patient %P doesn!t easily get

tired"

uring $ospitali@ation8Patient %P cannot do the things she used to do every day" +he was

recommended to have a complete bed rest without bathroom privileges"

,. S"ee!= Rest Pattern

,efore $ospitali@ation8+he usually goes to bed at around eight (> o!clock in the evening and falls

asleep at around eleven (


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Patient %P has no sensory deficit and responds appropriately to physical and

verbal stimuli" +he responds to questions clearly and follows instructions accordingly"

Patient %P is oriented with time) place and other people"

5. Se"f= Perce!tion @ Se"f= Conce!t Pattern

,efore $ospitali@ation8?hen asked to describe herself) patient %P verbali@ed A/asungit ako" $indi ako

plastic) kung ayaw ko yung tao pinapakita ko na ayaw ko siya" Pero mabait din naman

ako kung alam kong mabait ang isang tao"C +he enumerated her strengths8 her baby

and husband) family" $er weaknesses8 illnesses and problems" Patient %P also stated

the following attitude she does toward herself8 see to it that she eats enough food to be

healthy) and she will do anything to supply her needs and wants"

uring $ospitali@ation8ABahinaan ko ngayon itong sakit ko" %ng pinagkukunan ko na lang ng lakas eh

ang mga babies ko"C) as verbali@ed by the patient"

0. Ro"e @ Re"ations&i! Pattern

,efore hospitali@ation8?hen asked of the hindrances related with accomplishing responsibilities) patient

verbali@e Aahihirapan akong magpakumbaba) ma#pride ako feeling ko ako lagi ang

tama" Bapag may nakasakitan na ako ng loob hindi ko na siya pinapansinC"

uring $ospitali@ation8Patient verbali@ed) Aoong na#hospital ako na#reali@e ko na mahal pala nila ako)

nag#aalala din pala sila sa akin" Parang nag#improve ako sa attitude ko) dati wala akong

pakialam ngayon na#reali@e ko ung mga ginagawa nila sa akinC"

/. Se?$a"it= Re!ro8$cti#e Pattern

,efore $ospitali@ation8

?hen asked if how she views herself as a women) patient verbali@ed

ABomportable naman ako sa sarili ko" .eel ko nasa right age naman na ako para sa mga

desisyon ko"C Patient %P prefers being with girls and feels comfortable with them" +he

sometimes views males as not trustworthy beings and most of them are two#timers" +he

feels satisfied with her partner" Patient %P!s menarche occurred when she was


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na matapang daw ako at madaldal"C +he said that she manages it by having positive

thoughts that she can surpass each problem and thinking of her baby" +ometimes) she

said that she =ust ignores it"

uring $ospitali@ation8

$er situation causes her to be more stressed" +he verbali@ed) A5usto ko

na umuwi" %ng dami kong iniisip) yung mga bills na naiipon) naawa din ako sa

bantay ko"C Patient %P manages it by thinking that her prolonged stay in the

hospital is for her babies so that they will be born in good condition"

.9a"$e= Be"ief Pattern

,efore $ospitali@ation

?hen asked about her motto) Patient %P verbali@ed) A9ife is a gamble) it depends on

how you drive it"C +he values her husband) her baby) her family and friends because she

said without them she is nothing" +he also gives importance to health because it helps

her and her baby live longer" Patient %P doesn!t believe in superstitious beliefs" +he

views 5od as the most powerful person in this world" ,y merely praying and believing)

patient %P shows her faith to 5od" ?hen asked about the reason why she has to show

her faith to 5od she verbali@ed) ABasi siya yung lumikha sa atin"C

uring $ospitali@ation

Patient %P!s condition made her closer to 5od"


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I9. P;


11/31

distributed distributed

:exture nspection +ilky +ilky ormal$&%

+calp nspection ntact ntact ormal

+kull si@e nspection ormocephalic ormocephalic ormal

odules' masses Palpation %bsences of nodules and

masses

%bsence of nodules and

masses

ormal

.%*&

+ymmetry nspection +ymmetrical +ymmetrical ormal

+kin color nspection

+ame as color of

the skin in the

body

+ame as color of

the skin in the

body

ormal

&E&+

&yebrows nspection

+ymmetrically

aligned) equal

movement with

even skin

distribution

+ymmetrically

aligned) equal

movement with

hair evenly

distributed

ormal

&yelashes nspection+lightly curved

upward

+lightly curved

upwardormal

&yelids nspection

*lose

symmetricallyG

skin intact

*lose

symmetricallyG

skin intact

ormal

+&

+ymmetry)

texture and color nspection

+ymmetrical)

smooth and

same as color of

face

+ymmetrical)

smooth and

same as color of

face

ormal

/1:$

9ips

*olor

nspectionPinkish to slightly

brown+lightly brown ormal

+ymmetry nspection +ymmetrical +ymmetrical ormal

:eeth

*olor and

positionnspection

vory'yellowish)

firmly setvory) firmly set ormal

&*B

*olor nspection

+ame as color of

the skin in the

body

+ame as color of

the skin in the

bodyormal

Position nspection /idline /idline ormal/ovement nspection /oves freely /oves freely ormal

6ange of motion nspection .ull range .ull range ormal %,/& Pear# shaped ormal due to


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*ontour nspection.lat) rounded)

scaphoid

increased fetal

si@e

:exture Palpation +mooth +mooth ormal

+kin nspection&ven with other

parts of the body

?ith visible

striae and linea

negrae

ormal due to

hormonal

changes in

response to

pregnancy

&1695*

9evel of

consciousnessnterview

*an follow

instruction and

command

*an follow

instruction and

command

ormal

,ehavior andappearance nterview

/akes eyecontact with the

examiner

/akes eyecontact with the

examiner

ormal

/oodnterview

&xpresses

feelings which

correspond to

situation

&xpresses

feelings which

correspond to

situation

ormal

/ental +tatus

rientationnterview

riented with

time) place and

other people

riented with

timeormal


13/31

9. ANATOM< AND P;


14/31

9I. LABORATOR< EAMINATIONS

*9*%9 /*6+*PE +&*:

+P&*/&8 16&

(+&P:&/,&6 ) 20


15/31

9E/P$*E:&+

&+P$9+ 0"2 0#

,%+P$9+ 0"< 0#<

,E .91 %%9E++

+P&*/&8 %/:* .91

(+&P:&/,&6 07) 20


16/31

%*:1%9

.5+

6/%9

.5+

%%9E++

$&/59, /%++

**&:6%:

<

&+P$9+ "3 20#;0

/*E:&+ 2"D 2#>


17/31

&+P$9+ 0"0 0#2

,%+P$9+ 0"2 0#<

*9*%9 /*6+*PE +&*:

+P&*/&8 16&

(+&P:&/,&6


18/31

" DRU STUD<

. DEAMET;ASONE

*lass8

• *orticosteroid (systemic short#acting corticosteroids

ndications8

• %ttempt to hasten fetal lung maturity

%ction8

• +uppress inflammation and the normal immune response"

• umerous intense metabolic effects"

• +uppress adrenal function at chronic doses of 0"7mg'day"

• $ave negligible mineralocorticoid activity"

Pharmacokinetics8

• %bsorption8 ?ell absorbed after oral administration

• istribution8 *an cross the placenta) and probably enter breast milk

• /etabolism8 /etaboli@ed by the liver

• $alf 9ife8 3#;" hr(plasma)3D#;hr(tissueG adrenal suppression lasts


19/31

• &#adrenal suppression) hyperglycemiaG . and & fluid retention)

hypokalemia) hypokalemic alkalosisG

• $&/%:# thromboembolism )thrombophlebitisG

• /&:%,#weight gainG

• /+# muscle wasting) osteoporosis) aseptic necrosis of =oints) muscle pain"

6oute and osage8

• .our doses of Dmg ) /


20/31

• 1lcerative colitis or regional enteritis

• ndiscriminate chronic use(may lead to iron overload

%dverse 6eactions and &ffects8

• 5#constipation) dark stools) diarrhea) epigastric pain• /+*# staining of teeth(liquid preparation

6oute and osage8

• P (%dults8 prophylactic#200mg'day) therapeutic#200mg 3#; times daily"

*ontrolled#release capsule may be given twice daily"

Patient :eachings8

• :ake missed doses as soon as remembered within


21/31

• /etabolism and &xcretion8 %lmost exclusively metaboli@ed by the liver)

resulting in the conversion to hydroxymida@olam) an active metabolite and 2

other inactive metabolites" /etabolites are excreted in the urine"

• $alf 9ife8


22/31

• -itamins

ndication8

• :reatment and prevention of vitamin * deficiency (scurvy with dietary

supplementation"

• +upplemental therapy in some 5 diseases during long term parenteral

nutrition) or chronic hemodialysis"

• +tates of increased requirements such as8 pregnancy) lactation) stress)

hyperthyroidism) trauma) burns) infancy"

1nlabeled 1ses8

• Prevention of common colds

*ontraindication8

• :artra@ine hypersensitivity

Precautions8

• 6ecurrent kidney stones"

• %void chronic uses in pregnant women"

%dverse 6eactions and +ide &ffects8

• *+8 drowsiness) fatigue) headache) insomnia

• 58 cramp )diarrhea) heartburn) nausea) vomiting

• 518 kidney stones

• &6/8 flushing

• $&/%:8 deep vein thrombosis) hemolysis (in 5DP) sickle cell crisis

6oute and osage8

• P (%19:+8 scurvy#00mg'dayfor at least


23/31

%ction8

• %cts as a *+ depressant at the subcortical level of the *+

• $as an anticholinergic) antihistaminic) and antiemetic property"

Pharmacokinetics8

• %bsorption8 ?ell absorbed following P'/ administration"

• istribution8 1nknown

• /etabolism and &xcretion8 *ompletely metaboli@ed by the liverG eliminated in

the feces via biliary excretion"

• $alf 9ife8 3 hrs"

*ontraindications8

• $ypersensitivity• Pregnancy

Precautions8

• +evere hepatic dysfunction

• 5eriatric patients (dosage reduction recommended

• 9abor(has been used safely


• *+8 drowsiness) agitation) ataxia) di@@iness) headache )weakness

• 6&+P8 whee@ing

• 58 dry mouth) bitter taste) constipation) nausea

• 518 urinary retention

• &6/8 flushing

6oute and osage8

• P (%19:+8 antianxiety) sedative'hypnotic#2#


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4. NALBUP;INE

*lass8

• pioid analgesics

ndications8

• /oderate to severe pain

• %lso provides8 analgesia during labor) sedation before surgery) supplement to

balanced anesthesia"

%ctions8

• ,inds to opiate in the *+

• %lters the perception of and response to painful stimuli while producing

generali@ed *+ depression

• n addition) has a partial antagonist property) which may result in opioid

withdrawal in physically dependent patients"

Pharmacokinetics8

• %bsorption8 ?ell absorbed after / and sub cut administration

• istribution8 probably crosses the placenta) and probably enter breast milk

• /etabolism and &xcretion8 /ostly metaboli@ed by the liverG eliminated in the

feces via biliary excretion" /inimal amounts excreted unchanged by the

kidneys"

• $alf 9ife8 hrs"

*ontraindications8

• $ypersensitivity to nalbuphine or bisulfites

• Patients who are physically dependenton opioid and have not been detoxified

(may precipitate withdrawal

Precautions8

• $ead trauma

• ncreased intracranial pressure

• +evere renal )hepatic) or pulmonary disease

• $ypothyroidism

• %drenal insufficiency

• %lcoholism

• 5eriatric or debilitated patients (dosage reduction suggested

• 1ndiagnosed abdominal pain

• Prostatic hyperthrophy

• Patients who have recently received opioid agonists

• Pregnancy (has been used during labor but may cause respiratory

depression in the newborn



25/31

• *+8 di@@iness) headache) sedation) confusion) dysphoria) euphoria) floating

feeling) hallucinations) unusual dreams

• &&:8 blurred vision) diploplia) miosis (high doses

• 6&+P8 respiratory depression

• *-8 hypertension orthostatic hypotension) palpitations

• 58 dry mouth) nausea) vomiting) constipation• 518 urinary urgency

• &6/8 clammy feeling) sweating

• /+*8 physical dependence) psychologicaldependence) tolerance"

Patient :eachings8

• nstruct patient on how and when to ask for pain medication"

• /ay cause drowsiness or di@@iness

•

*aution patient to change position slowly to minimi@e orthostatichypotension

• nform patient that frequent mouth rinses) good oral hygiene) and sugarless

gum or candy may help decrease dry mouth"

5. CEFUROIME SODIUM

*lass8

• %ntibiotic) cephalosporin (2nd generation

ndication8

• .or the treatment of many different types of bacterial infections such as

bronchitis) sinusitis) tonsillitis) ear infections) skin infections) gonorrhea) and

urinary tract infections"

%ction8

• nterferes with bacterial cell#wall synthesis and division by binding to cell wall)

causing cell to die" %ctive against gram#negative and gram#positive bacteria)

with expanded activity against gram#negative bacteria" &xhibits minimal

immunosuppressant activity"

Pharmacokinetics8

•

%bsorption8 higher absorption in the proximal region of the 5 tract• istribution8 *rosses placenta) enters breast milk

• /etabolism %nd &xcretion8 $epatic) 1rine

*ontraindications8


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• *ontraindicated with allergy to cephalosphorine and penicillin

•

Precautions8

• ?ith renal failure) lactation) pregnancy

%dverse reactions and +ide effects8

• *+8 $eadache) di@@iness) lethargy) paresthesias

• 58 ausea) vomiting) diarrhea) anorexia) abdominal pain) flatulence) pseudo

membranous colitis)hepatotoxicity

• 518 ephrotoxicity

• $&/%8 ,one marrow depression (decreased ?,*) platelets and $*:

6oute and osage8

• - 0 mg

Patient :eachings8

• :ake full course of therapy even if you are feeling better"

• nstruct patient that it should not be used to self# treat other problems

• +wallow the drug whole" o not crush them

• :ake the drug with food

0. MULTI9ITAMINS PLUS AMINO ACID

*lass8

• ietary rugs' -itamins

ndication8

• :reating or preventing low levels of vitamins) folic acid) and amino acids in

the body" t may also be used for other conditions as determined by the

doctor"

*ontraindication8

• %llergic to any ingredient in multivitamins with amino acid

• f you have high blood levels of arginine

Precautions8

• Pregnant women) either an excess or deficiency can cause birth defects"



27/31

• +evere allergic reactions (rash) hives) itching) difficulty breathing) tightness) in

the chest swelling of the mouth) face) lips) or tongue"

6oute and osage8

• P) take /ultivitamins with .olic %cid'%mino %cids with a full glass of

water (> o@'2;0 m9"

Patient :eachings8

• o not take large doses of vitamins while you use /ultivitamins with .olic

%cid'%mino %cids unless your doctor tells you to"

• /ultivitamins with .olic %cid'%mino %cids has folic acid in it" ,efore you

start any medicine check the label to see if it has folic acid in it too" f itdoes not or if you are not sure) check with your doctor or pharmacist"

• f you miss a dose of /ultivitamins with .olic %cid'%mino %cids) take it as

soon as possible" f it is almost time for your next dose) skip the missed

dose and go back to your regular dosing schedule" o not take 2 doses at

once"

• :ake /ultivitamins with .olic %cid'%mino %cids by mouth with or without

food" f stomach upset occurs) take with food to reduce stomach irritation"

/. NIFEDIPINE

*lass8

• %nti anginal

• %nti hypertensive

• *alcium channel blocker

ndications8

• %ngina pectoris due to coronary artery spasm

• *hronic stable angina

• &6 preparation only" :reatment of hypertension"

• :reatment of interstitial cystitis"

1nlabeled 1ses8

• %nal fissures) urethral stones topical use to improve wound healing"

%ctions8

• nhibits the movement of calcium ions across the membranes of cardiac and

arterial muscle cellsG inhibition of transmembrane calcium flow results in the

depression of impulse formation in speciali@ed cardiac pacemaker cells) in

slowing of the velocity of conduction of the cardiac impulse) in the depression

of myocardial contractility) and in the dilation of coronary arteries and


28/31

arterioles and peripheralarteriolesG these effects lead to decreased cardiac

energy consumption) and increased delivery of oxygen to myocardial cells"

Pharmacokinetics8

• %bsorption8 issolved nifedipine was found to enter the systemic circulation

completely along the intestine) being absorbed from =e=unum to colon"

• istribution8 Probably crosses the placenta) and probably enter breast milk

• /etabolism and &xcretion8 hepaticG excreted in feces and urine

*ontraindication8

• ?ith allergy to nifedipine

1se cautiously in8

• 9actation

• Pregnancy

• heart failure

• aortic stenosis


• *+8 i@@iness) light headedness) head ache) asthenia) fatigue)

nervousness) sleep disturbances) blurred vision) weakness) tremor) mood

changes

• *-8 peripheral edema) angina) hypotension) arrhythmias)

• &6/8 .lushing) rash) dermatitis) pruritus) urticarial

• 5"" ausea) diarrhea) constipation)cramps) flatulence) hepatic in=ury

• :$&68 nasal congestion) cough) fever) chills) shortness of breath)

muscle cramps) =oint stiffness) sexual difficulties

6oute and osage8

• P /aintenance range)


29/31

ndications8

• :emporary reduction of fever) temporary relief of minor aches and pains

caused by common cold and influen@a) headache) sore throat) toothache

(patients 2 year and older) backache) menstrual cramps) minorarthritispain) and muscle aches"

1nlabeled use8

• Prophylaxis in children and patients at risk for sei@ures who are receiving

P: vaccination to reduce incidence of fever and pain

%ctions8

• 6educes fever by acting directly on the hypothalamic heat regulating center

to cause vasodilation and sweating and sweating which helps dissipate heat"

Pharmacokinetics8

• %bsorption8 %cetaminophen is rapidly and almost completely absorbed from

the gastrointestinal tract" %fter oral administration of immediate or extended#

release acetaminophen preparations in therapeutic doses) peak plasma or

serum concentrations occur within < to 2 hours) respectively"• istribution8 *rosses the placenta) and probably enter breast milk

• /etabolism and &xcretion8 hepatic) excreted in the urine

• *ontraindicated n8 %llergy to acetaminophen

1se *autiously n8

• mpaired hepatic function) chronic alcoholism) pregnancy) lactation


• *+8 head ache

• *-8 chest pain) dyspnea) myocardial damage when doses of #>g' day are

ingested daily for several weeks or when dosageof ;g'day are ingested for <

year

• 58 hepatic toxicity and failure) =aundice

• 518 %cute renal failure) renal tubular necrosis

• $&/%8 cyanosis) hemolytic anemia#hematuria) anuria) neutropenia)

leukopenia) pancytopenia) thrombocytopenia) hypoglycemia

• $EP&6+&+:-:E8 6ash) fever

6oute and osage8

• P or rectal suppositories ( adults and children older than


30/31

• ,y suppositories) 32#D0 mg every;#D hr" P) or hr"

Patient teachings8

• o not exceed 3F00 mg'day

• o not take longer than


31/31

• iabetes) coronary insufficiency) *P patientswho have developed

degenerative heart disease) hyperthyroidism) history os sei@ure disorders)

psychoneurotic individuals) hypertension


• *+8 restlessness) apprehension) anxiety) fear) *+ stimulation)

hyperkinesia) insomnia) tremor) drowsiness) irritability) weakness) vertigo)

headache sei@ure"

• *-8cardiac arrhythmias palpitations) angina pain) changes in ,P and &*5

• 58 nausea) vomiting) heartburn) unusual or bad taste in mouth

• 6&+P8 respiratory difficulties) pulmonary edema) coughing) bronchospasm

• :$&68 pallor) sweating) flushing) muscle cramps

6oute and osage8

• P adults#

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