drug study 39-55

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Medication action Indication Contraindication Side effects Nursing responsibilitiesVitamin K

Brand name:Mephyton

Dose/route: 1 amp IVTT

Freq/timing: q8 (4-12-8)

Classification: A synthetic analog of vitamin K ,blood coagulation modifier

A antihemorrhagic factor that promote hepatic formation of active prothrombin.

To prevent bleeding

Contraindicated to patient hypersensitive to drug or any of its components.

CNS: dizziness, seizurelike movement,rapid and weak pulse

• Asses’ patient’s condition before starting the ther-apy.

• Be alert to ad-verse reaction.

• Monitor PT to de-termine effective-ness.

• Failure to respond to vitamin K may indicate coagula-tion defect.

DRUG STUDY

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Medication action Indication Contraindication Side effects Nursing responsibilities

Aminoleban

Dose/route: 1 sachet 50 g

Freq/timing: q12 (6-6)

classification: A balance and tolerable food supplement to nutritionally support patients with liver disease.

Given to normalize the amino acid, carbohydrates, fats, vitamins and minerals in the plasma

For the treatment of Hepatic Encephalopathy in patient with chronic liver disease.

Patient with abnormal amino acid metabolism (since the infuse amino acids are not adequately metabolized, the patient clinical condition may be worsened.)

Hypersensitivity: rare skin eruptionsGastrointestinal: occasional nausea and vomitingOthers: occasional chills, fever, headache


• Be alert to ad-verse re-action.

• Monitor patient tempera-ture.

• If GI re-action occur monitor patient hydra-tion.

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Medication action Indication Contraindication Side effects Nursing responsibilities

Spironolactone

Brand name;Aldactone

Dose/route:25 mg 1 tab

Freq/timing:Bid (8-6)

Classification: Classified as a potassium-sparing diuretic, a drug that promotes the output of urine (diuretic) while allowing the kidneys to hold onto potassium.

Inhibits the action of aldosterone thereby causing the kidneys to excrete salt and fluid in the urine while retaining potassium.

Removes excess fluid from the body in cirrhosis of the liver, and kidney disease. It can also be used in combination with other drugs to treat for treating diuretic-induced low potassium (hypokalemia).

Contraindicated in patients with hyperkalemia.Use cautiously in patient with impaired kidney function or kidney disease.

Side effects include headache, diarrhea, cramps, drowsiness, rash, nausea, and vomiting.Fluid and electrolytes imbalance (for example, low sodium, low magnesium, and high potassium) may occur, so patients should be monitored carefully

• Asses’ pa-tient’s condi-tion before starting the therapy.

• Be alert to ad-verse reac-tion.

• Give drugs with meals to enhance ab-sorption.

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

• Potassium levels must be closely monitored.

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Medication action Indication Contraindication Side effects Nursing responsibilitiesCiprofloxacin

Brand ne0e: Cipro, Ceproxin

Dose/route:500 mg 1 tab

Freq/timing:Bid (8-6)

Classification:antibiotic

An antibiotic that is used to treat bacterial infections.It stops the multiplication of bacteria by inhibiting the reproduction and repair of their genetic material (DNA).

Used to treat infections of the skin, also frequently used to treat urinary infections caused by bacteria such as E. coli.

Hypersensitivity to ciprofloxacin or other quinolones.

side effects include nausea, vomiting, diarrhea, abdominal pain, rash, headache, and restlessness.

• Asses’ patient’s condi-tion before starting the therapy.

• Be alert to adverse reac-tion.

• If GI reactions occur, monitor patient’s hydra-tion.

• Give oral forms 2 hours before or after meals- food doesn’t affect ab-sorption but may delay peak level.

• Have patient drink plenty of fluids to reduce risk of crystalluria







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Medication action indication Contraindication

Side effects Nursing responsibilities

Metronidazole

Brand ne0e:Flagyl

Dose/route: 500 mg 1 tab

Freq/timing: Tid (8-1-6)

Classification:Antibiotic

An antibiotic effective against anaerobic bacteria and certain parasites.Selectively blocks some of the functions within the bacterial cells and the parasites resulting in their death.

For bacterial infection caused by anaerobic microorganism.

Contraindicated to patient hypersensitive to drug or other nitroimidazole derivatives.

Nausea, diarrhea, and/or metallic taste in the mouth.Hypersensitivity reactions (rash, itch, flushing, fever), headache, dizziness, vomiting, dark urine



• Give drugs with meal to minimize GI distress.

• Inform patient metallic taste dark or red brown urine may occur.

• Advice patient to stand slowly to prevent dizzi-ness.

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Medication action indication Contraindication Side effects Nursing responsibilitiesOmeprazole

Brand ne0e:Prilosec, Zegerid

Dose/route: 20 mg 1 cap

Freq/timing: Bid (8-6)

Classification:Proton pump inhibitors (PPI) that block the production of acid by the stomach

Omeprazole, like other proton-pump inhibitors, blocks the enzyme in the wall of the stomach that produces acid. By blocking the enzyme, the production of acid is decreased, and this allows the stomach and esophagus to heal.

For GI upset

Contraindicated to patient hypersensitive to drug or any of its components.

Most common side effects are diarrhea, nausea, vomiting, headaches, rash and dizziness, weakness, leg cramps, and water retention occur infrequently.

• Asses’ patient’s condition before starting the therapy.

• Be alert to adverse reaction.

• If GI reaction occur monitor patient’s hy-dration

• Give 30 minutes be-fore meals

• Monitor intake and output closely and body weight daily.

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Medication action indication Contraindication Side effects Nursing responsibilitiesFurosemide

Brand ne0e:Furoside, Lasic,

Uritol

Dose/route: 20 mg IVTT

Freq/timing: Post Blood transfusion

Classification:Loop diuretic

Inhibit sodium and chloride reabsorption at proximal and distal tubules and ascending loop of Henle which promote water and sodium excretion

For ascites

Contraindicated to patient hypersensitive to drug or any of its components and in those with anuria.

Common side effects include low blood pressure, dehydration and electrolyte depletion (for example, sodium, potassium). CNS: fever, headache and dizziness are common.

• Asses’ patient’s condi-tion before starting the therapy.


• Monitor weight and pe-ripheral edema

• Advice patient to stand slowly to prevent dizzi-ness.

• Monitor temperature closely.

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NURSING CARE PLAN 1Name of Pt.: Ms. Lee Ver Diagnosis: Liver Cirrhosis Stage III Liver Cirrhosis Secondary to Chronic AlcoholismPriority Number: 1

CUES NURSING DIAGNOSIS

PLANNING INTERVENTIONS RATIONALE EVALUATION

Subjective:“ Galisod gyud ko og ginhawa murag tungod sa gadako nako nga tiyan” as verbalized by the patient.

Objectives:

> Fast and shallow breathing

> Tachypnea RR- 32 cpm

> O2 Sat= 90 %

> restless and

Ineffective breathing pattern related to ascites and restriction of thoracic excursion secondary to ascites and abdominal distention

Short-term Goal:At the end of 2 hours of nursing intervention, the patient will be able to :

o Improve respiratory status.

Long-term Goal:At the end of 8 hours of nursing intervention, the patient will be able to :

Independent:o Auscultate breath

sounds noting crackles, wheezes and rhonchi,

o Elevate head of bed to at least 30 degrees.

o Conserve pa-tient’s strength by providing rest pe-riods and assist-ing activities.

o Change position every 2 hours.

- indicates developing complication

- Reduces abdominal pressure on the diaphragm and permits fuller thoracic excursion and lung expansion.

- Reduces metabolic and oxygen requirements

- Promotes expansion and oxygenation of all

Patient was able to: o Experiences im-

proved respira-tory status

o Reports in-creased strength and sense of well-being.

o Experience ab-sence of cyanosis

o Exhibits enough thoracic excur-sions without shallow respira-tions.

> Goals partially met.

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moderately anxious

> Rales

> cyanotic

> restless and moderately anxious

o Be free of cyanosis and other signs and symptoms of hypoxia.

o Teach client to do deep breath-ing.

Collaborative:o Provide supple-

mental O2 inhala-tion with flow rate of 2L/mins as prescribed.

areas of the lungs.- To facilitate lung expansion

- Maybe necessary to treat/ prevent hypoxia.

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Subjective: “nabantayan nako gadako ako tiyan” as verbalized by the patient.

Objectives:

> shifting dullness of the abdomen (ascites)

> weight gain - from 45 kg. to 49 kg.

> abdominal girth - from 28 inches to 33.2 inches

Fluid volume excess related to ascites secondary to impaired liver function


o Stabilize fluid vol-ume as evi-denced by balanced I and O, and vital signs within client’s nor-mal limits.

Long-term

Independent:o Restrict sodium

and fluid intake

o Explain rationale for sodium and fluid restriction

o Record intake and output every one to eight hours de-pending on re-sponse to inter-ventions and on patient acuity.

o Measure and record abdominal girth and weight daily.

- Minimizes formation of ascites and edema

- promotes patient’s understanding of restriction and cooperation with it.

- Indicates effectiveness of treatment and adequacy of fluid intake.

- Monitors changes in ascites formation and fluid accumulation.

Patient was able to: o Consume diet

low in sodium and within pre-scribed fluid re-striction.

o Take diuretics, potassium, and protein supple-ments as indi-cated without experiencing side effects.

o Exhibit increase urine output.

o Identifies ratio-nale for sodium and fluid restric-tions

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> change in electrolytes Na = 150. 52 mEq/L K+ = 3.06 mEq/L

Goal:At the end of 4 days of nursing intervention, the patient will be able to :

o Restore normal fluid volume and electrolyte balance (Na & K+).

Collaborative:

o Administer diuret-ics, potassium and protein supple-ments as pre-scribed.

- Promotes excretion of fluid through the kidneys and maintenance of normal fluid and electrolyte balance.


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Subjective:“Naana ang sakyanan saubos? Gusto na ko mo kaon og pan ” as verbalized by the patient.

Objectives:

> BUN: 48.1 mg/dl

> incoherent speech> GCS: 12 (E – 3; V- 3; M- 6)


> lethargic

> Deterioration of handwriting

Disturb thought process related to deterioration of liver function and increase of BUN level.


Understand the importance of safety measure in doing ADLs.

Long-term Goal:At the end of 4 days of nursing intervention, the patient will be able to : Manifest stable

cognitive status and maintain safety

Independent:o Give frequent

small feedings of carbohy-drates

Protect from infection

Provide close monitoring to patient

Collaborative:o Administer lax-

atives e.g. lac-tulose as pre-scribed

- Promotes consumption of adequate carbohydrates for energy requirements and spares protein from breakdown for energy- minimizes risk for further increase in metabolic requirements- ensure patient’s safety

- Reduces ammonia level.

Patient was able to: o Follow and par-

ticipate in con-versation appro-priately

Demonstrate ADLs with safety measure


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Subjective:“ Paminaw nako nagniwang ko og gadako ako tiyan” as verbalized by the patient.

Objectives:

> was fed via NGT on Sept. 10-16, 2010.

>decreased appetite due to abdominal discomfort

> currently on soft diet

Imbalanced nutrition: Less than body requirements related to abdominal distention and discomfort


o Verbalize un-derstanding of causative fac-tors such as decreased ap-petite.

o Understanding of necessary interventions.

Long-term Goal:At the end of 4 days of nursing intervention, the patient will be able to :

Independent:o Assess dietary

intake and nutri-tional status, and daily weight measurements.

o Provide diet high in carbohydrates with protein in-take consistent with liver func-tion.

o Assist patient in identifying low sodium foods

o Elevate the head of bed during meals.

- Identifies deficits in nutritional intake and adequacy of nutritional state.

- Provides calories for energy, sparing protein for healing

- Reduces edema and ascites formation

- Reduces discomfort from abdominal distention and decreases sense of fullness produce by pressure

Patient was able to:o Identifies foods

high in carbo-hydrates and within protein requirements.

o Reports im-prove appetite.

o Identifies foods and fluids that are nutritious and permitted on diet.


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> weight gain - from 45 kg. to 49 kg. ( due to ascites)

o Be free of signs of mal-nutrition such as emaciation.

o Encourage pa-tient to eat meals and supplemen-tary feeding.

of abdominal contents and ascites in the stomach.

- Encouragement is essential for the patient with abdominal discomfort

NURSING CARE PLAN 5Name of Pt.: Ms. Lee Ver Diagnosis: Liver Cirrhosis Stage III Liver Cirrhosis Secondary to Chronic Alcoholism

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Priority Number: 5



Subjective:“ Dili ko makasugakod kung maglihok-lihok ko”, as verbalized by the patient.

Objectives:

> weak

> drowsy

> body malaise

> restless

> anxious

Activity intolerance related to fatigue, lethargy and malaise secondary to impaired liver function


o Report de-crease in fatigue and reports in-crease abil-ity to partic-ipate in ac-tivities.

Independent:o Assess level of

activity tolerance and degree of fa-tigue, lethargy and malaise when performing routine ADLs.

o Assist with activi-ties and hygiene when fatigued

o Encourage rest when fatigued or when abdominal pain or discom-fort occurs.

o Assist with selec-tion and pacing of desired activi-ties and exercise.

o Provide diet high in carbohydrates with protein in-take consistent

- Provides baseline for further assessment and criteria for assessment of effectiveness of interventions.

- Promotes exercise and hygiene within patient’s level of tolerance.

- Conserves energy and protects liver

- Stimulates patient interest in selected activities.

- Provides calories

Patient was able to:o Exhibit increase

interest in activ-ities and events.

o Participate in activities and gradually in-creases exer-cise within physical limits.

o Plan activities to allow ample periods of rest.

o Take vitamins as prescribed.


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with liver func-tion.

Collaborative:o Administer sup-

plemental vita-mins (A, B com-plex, C, K)

for energy and protein for healing

- Provides additional nutrients

NURSING CARE PLAN 6

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Name of Pt.: Ms. Lee Ver Diagnosis: Liver Cirrhosis Stage III Liver Cirrhosis Secondary to Chronic AlcoholismPriority Number: 6



Subjective:“Mahadlok ko og tindog basin matumba ko” as verbalized by the patient.

Objectives:


Lab results> Prothombin Time : 35.0 seconds

> Prothombin

Activity : 31.42 %

> Jaundice Bilirubin :16.14

High risk for injury related to altered clotting mechanisms secondary to impaired liver function


o Understand the impor-tance of pre-cautions in reducing the risk of injury.

Independent:o Record vital

signs at frequent intervals de-pending on pa-tient’s acuity (ev-ery 1-4 hrs).

o Provide safe en-vironment (side rails up).

o Replace sharp objects (knifes, forks, etc.) with safer items.

o Observe each stool for color, consistency and amount.

o Administer medi-cations carefully,

- Provides baseline and evidence of hypovolemia and hemorrhagic shock.

- Minimizes falls and injury if falls occur.

- Avoid cuts and bleeding.

- Permits detection of bleeding in gastrointestinal tract.

- Reduces risk of side effects secondary to

Patient was able to:o Exhibit the pre-

cautions to pre-vent injury

o Use measures to prevent trauma.

o Takes all medi-cations as pre-scribed.


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mg/dl monitor for side effects

Collaborative:

o Administer Vita-min K as pre-scribed.

damage liver’s inability to detoxify (metabolize) medications normally.

- Promotes clotting by providing fat-soluble vitamin necessary for clotting.

drug study 39-55

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