Introduction

Anatomy and Physiology

Demographic Data Name: Address: Age: Birth Date: Birth Place: Nationality: Ethnicity: Religion: Chief Complain: Admission Date: Time: Admitting Diagnosis: Principal Diagnosis: Pt. Honey Pooh P1 Victoria, Alicia Isabela 47 y/o August 3, 1965 Alicia, Isabela Filipino Ilocano Roman Catholic Pain when Urinating

July 26, 2012 12:00 pm Staghorn Calculus Nephrolithiasis Staghorn Calculus with Hydronephrosis Right Kidney Nephrolithiasis Left Kidney Cystolithiasis Principal Operation: Nephrolithotomy, Right Other: Cystolithotomy, suprapubic Attending Physician: Dr. Abella Initial Vital Signs: BP: TEMP: PR: RR: 140/80 37oC 76 BPM 20 CPM

Nursing History Present Health History According to the patient, he was diagnosed with kidney stones in 2002. He started drinking buko juice every day because he believed that it would cure his condition. He would drink buko juice 2-3 times a week. In mid-June, he experienced difficulty when urinating but he just ignored it. On July 24,2012, he went to Manango Hospital for a check-up. He was diagnosed with staghorn calculus on the right kidney with nephrolithiasis on the left kidney. He was referred to SIGH and was diagnosed with staghorn calculus w/ hydronephrosis on the right kidney, nephrolithiasis on the left kidney and cystolithiasis. Past Medical History According to the patient, he did not know if he completed his childhood immunization. He couldn't recall how many times he has been hospitalized since he was a kid. He said that he experienced minor illnesses like LBM, cough and colds. Family Health History The patient has no family history of diabetes, hypertension, asthma or other hereditary diseases.

Gordons Function Health Pattern BEFORE HOSPITILIZATION According to the patient, being healthy means that you are free from any diseases. Before hospitalization, the patient likes to eat meat and fish. He also likes to eat salty foods like bagoong. He drinks approximately 4 glasses of water a day and 8 ounces of soft drinks. When he was diagnosed with kidney stones, he started drinking buko juice 3-4 times a week. Before hospitalization, the patient urinated 3-5 times a day with amber color urine. He defecated once a day at noontime. Before hospitalization, the patient woke up at 6AM. He performed his daily activities without the help of others. At 8AM, he would go to work. He considered his work as exercise. The patient usually slept at 9PM. He would take naps at noon. The patient has two children with his ex-wife, and they are living with their grandparents. His ex-wife is currently residing abroad. His relationship with his ex-wife is not good, and he continuously supports his two children financially. Before his confinement, he visited them 2-3 times a month. The patient is a high school graduate. He graduated at School of Our Lady of Atocha. He responds well to the questions being answered. The patient is aware of his condition but did not seek for immediate treatment because of his financial problem. He would still eat salty foods. He's not compliant with his doctor's advice. DURING HOSPITILIZATION According to the patient, he is not healthy anymore because of his condition. He follows all the doctors orders. During hospitalization, he was NPO before his operation. After his operation, he was put on diet as tolerated.

HEALTH PERCEPTIONHEALTH MANAGEMENT PATTERN NUTRITIONALMETABOLIC PATTERN

ELIMINATION PATTERN

ACTIVITY- EXERCISE PATTERN

During hospitalization the patient was hooked to an indwelling catheter and reported no instances of bowel movements. He couldnt perform his ADLs because of his condition.

SLEEP- REST PATTERN

ROLE-RELATIONSHIP PATTERN

The patient couldnt sleep well because of his condition and medication. The patient's SO is his brother. They have a good relationship with each other. His brother takes care of him because the patient cannot ambulate and needs assistance.

COGNITIVEPERCEPTUAL PATTERN

During our interview the patient responds but shows irritability to answer all our queries. The patient is aware of his health condition. He follows what the doctor's orders are. He now understands that health is important.

SELF-PERCEPTIONSELF-CONCEPT PATTERN

SEXUALITYREPRODUCTIVE PATTERN COPING-STRESS TOLERANCE PATTERN

VALUE-BELIEF PATTERN

The patient was circumcised when he was 10 years old. He has 2 children with his exwife. According to the patient, if he has a problem he will just make himself busy, and he will visit his family or hang out with his friends to drink alcoholic beverages. The patient is a Roman Catholic. He was baptized when he was 1-year-old. He believes in Quack doctors.

He didnt have any sexual activity or intercourse during his hospitalization. During hospitalization, the patient sleeps to cope up his stress.

According to the patient, he is praying every night but is not actively going to the church.

1st Physical Assessment Date: August 14, 2012 Time: 1:00PM Vital Signs: BP: 120/80 TEMP: 36.8oC PR: 78 BPM RR: 20 CPM General Appearance: Received pt. lying on bed with ongoing IVF D5LRS @ 800cc regulated 42gtts/min. Mood: responsive, alert, awake Behavior: acting with appropriate behavior

Physical Assessment
AREA ASSESSED METHODS FINDINGS INTERPRETATIO N

1. SKIN COLOR TEXTURE INSPECTION INSPECTION PALPATION TEMPERATURE MOISTURE TURGOR PALPATION Moist PALPATION PALPATION Snacks back to previous state <2 seconds NORMAL NORMAL Light brown skin color Smooth Normally warm Smooth NORMAL NORMAL NORMAL NORMAL

2. HAIR DISTRIBUTION TEXTURE COLOR 3. NAILS COLOR OF THE NAIL BED INSPECTION Pink and Transparent 1-2 seconds Convex NORMAL INSPECTION INSPECTION INSPECTION Evenly distributed Silky Black NORMAL NORMAL NORMAL

PALPATION CAPILLARY REFILL TIME SHAPE 4. EYES/EYEBROW SHAPE SYMMETRY MOVEMENT ABILITY TO BLINK 5. CONJUCTIVA INSPECTION INSPECTION INSPECTION INSPECTION PALPATION

NORMAL NORMAL

Round Equal in size Symmetrical in movement (+) Blink reflex

NORMAL NORMAL NORMAL NORMAL

COLOR PUPIL (PERRLA)

INSPECTION INSPECTION

Pink red Pupils Equal Rounded, Reactive to Light, Accommodatio n

NORMAL NORMAL

6. EXTERNAL AUDITORY CANAL INSPECTION HEARING 7. NOSE SYMMETRY COLOR INSPECTION INSPECTION Symmetrical Same color as the face NORMAL NORMAL Hearing equally NORMAL in both ears

8. LIPS AND MOUTH SYMMETRY COLOR MOISTURE 9. NECK APPEARANCE 10. THORAX CHEST CONTOUR CHEST WALL BREATHING PATTERN INSPECTION INSPECTION INSPECTION Symmetrical Full chest expansion Regular NORMAL NORMAL NORMAL INSPECTION No distention NORMAL INSPECTION INSPECTION INSPECTION Symmetrical Pink Moist NORMAL NORMAL NORMAL

BREATH SOUNDS 11. ABDOMEN GENERAL CONTOUR

AUSCULTATIO N

(-) adventitious breath sound

NORMAL

INSPECTION

(+) surgical incision on Right mid section (11cm)

d/t Nephrolithotomy on the Right

(+) surgical incision 2cm above the umbilicus (+) surgical incision on suprapubic area (5cm)

d/t drainage tube

d/t cystolithothomy

12. UPPER EXTREMITIES SYMMETRY ROM INSPECTION INSPECTION Symmetrical (+) Full range of motion NORMAL NORMAL

13. LOWER EXTREMITIES SIZE SYMMETRY ROM INSPECTION INSPECTION INSPECTION Equal in size Symmetrical (+) Full range of motion NORMAL NORMAL NORMAL

Laboratory Results July 28,2012 KUB IVP: -scout film showed a lamellate calcified stone in the projection of the Right kidney measuring 4.5 cm. Another rounded calcified stone is also seen in the pelvic cavity measuring 5.0 cm. -subsequent films taken following introduction of 50cc hypoallergenic contrast showed prompt excretion of contrast outlining normal pelvocolyceal structures in the left. There is no contrast excretion noted in the right. -contrast filled bladder showed normal outline of urinary bladder. No irregularities seen. LUNGS -Non-excreting right kidney -large Nephrolithiasis right kidney and Cystolithiasis July 6, 2012 ULTRASOUND REPORT -The right kidney measures 99mm x 60mm - The left kidney measures 97mm x 59m -the parenchyma of both kidneys shows within normal echo pattern. -the pelvocolyceal structures of both kidneys are not dilated. -a Staghorn calculus at the right kidney and a tiny stone measuring 6mm is noted at the left kidney -the UB is UNREMARKABLE -The prostate gland is not enlarged and measures 36mm x 38mm x 39mm (volume 27.9) -the parenchyma appears inhomogeneous. -no calcification noted within the parenchyma IMPRESSION: Staghorn calculus, right Nephrolithiasis, left Prostate gland is unremarkable

July 30, 2012 CHEST PA Both lungs fields are clear Heart is not enlarged Diaphragm and sulci are intact LUNGS Normal chest AUGUST 1, 2012 blood banking

AUGUST 2, 2012 Repeat UTZ after July 6, 2012 (done in another facility) showed moderate dilatation of relvocalyces in the right tiny echogenic stone (0.5cm) are seen in the upper and lower hole. The right kidney is swelled with increased echo pattern (11 x 65 cm) left kidney is unremarkable. UB wall is thickened (2.1 cm) , balloon catheter is noted in place. LUNG -Acute medical renal disease, right with moderate Hydronephrosis and tiny Nephrolithiasis. -Suggestive cystitis July 26, 2012 CLINICAL CHEMISTRY REPORT Kidney Function: BUNCREATININE10.2 116.7

July 26, 2012 HEMATHOLOGY REPORT CBC Hgb Hct WBC DIFFERENTIAL COUNT Segmenters Lymphocytes NORMAL VALUES M: 130-180g/L F: 110-160g/L M: 40-54 F: 37-47 5.10 10 g/L 50-65% 25-35% RESULT 122 36.9 9.8 69.8 23.1

July 30, 2012 CLINICAL CHEMISTRY REPORT GLUCOSE: RANDOM -------90.5 ELECTROLYTES-------------K- 4.50 Na2+ 138.44 July 31, 2012 HEMATHOLOGY REPORT CBC Hgb Hct WBC DIFFERENTIAL COUNT Segmenters Lymphocytes Eosinophils Monocytes Basophils Platelet Count NORMAL VALUES M: 130-180g/L F: 110-160g/L M: 40-54 F: 37-47 5.10 10 g/L 50-65% 25-35% 1-3 % 3-7% 150-450 x 10 g/L RESULT 71 21 22.4 85.1 5.7 9.2 268

August 2,2012 (7:30PM)

HEMATHOLOGY REPORT CBC Hgb Hct WBC DIFFERENTIAL COUNT Segmenters Lymphocytes Eosinophils Monocytes Basophils Platelet Count NORMAL VALUES M: 130-180g/L F: 110-160g/L M: 40-54 F: 37-47 5.10 10 g/L RESULT 51 15.1 16.1 INTERPRETATION

50-65% 25-35% 1-3 % 3-7% 150-450 x 10 g/L

91.1 4.4 4.5 125

August 02,2012 (3AM)

HEMATHOLOGY REPORT CBC Hgb Hct WBC DIFFERENTIAL COUNT Segmenters Lymphocytes Eosinophils Monocytes Basophils Platelet Count NORMAL VALUES M: 130-180g/L F: 110-160g/L M: 40-54 F: 37-47 5.10 10 g/L RESULT 68 20 22.7 INTERPRETATION

50-65% 25-35% 1-3 % 3-7% 150-450 x 10 g/L

82.3 8.2 9.5 149

August 03, 2012 HEMATHOLOGY REPORT CBC Hgb Hct WBC DIFFERENTIAL COUNT Segmenters Lymphocytes Eosinophils Monocytes Basophils Platelet Count NORMAL VALUES M: 130-180g/L F: 110-160g/L M: 40-54 F: 37-47 5.10 10 g/L RESULT 61 18 23.8 INTERPRETATION

50-65% 25-35% 1-3 % 3-7% 150-450 x 10 g/L

85.8 7.1 7.1 152

Chemical Chemistry Report TEST BUN CREATININE

(August 03, 2012) RESULTS 40.5 395.1 INTERPRETATION

NORMAL VALUES M: (9-20mg / dL) F: (7-17mg / dL) M: (71-133 mol / dL) F: (62-106 mol / dL)

August 5,2012 Chemical Chemistry Report TEST FASTING RANDOM 11:25PM K- 3.98 Na - 144.53 HEMATOLOGY REPORT CBC Hgb Hct WBC DIFFERENTIAL COUNT Segmenters Lymphocytes Eosinophils Monocytes Basophils Platelet Count NORMAL VALUES M: 130-180g/L F: 110-160g/L M: 40-54 F: 37-47 5.10 10 g/L RESULT 105 31 13.8 INTERPRETATION (August 05, 2012) RESULTS 128.2 INTERPRETATION

NORMAL VALUES 70-155mg/dL 90-160mg/dL

50-65% 25-35% 1-3 % 3-7% 150-450 x 10 g/L

90.0 5.3 4.7 247

Chemical Chemistry Report TEST K+ CREATININE

(August 08, 2012) RESULTS 3.12 197 INTERPETATION

NORMAL VALUES 3.5-5.1 mmol/L M: (71-133 umol/L) F: (62-106 umol/L)

August 7,2012 HEMATOLOGY REPORT CBC Hgb Hct WBC DIFFERENTIAL NORMAL VALUES M: 130-180g/L F: 110-160g/L M: 40-54 F: 37-47 5.10 10 g/L RESULT 103 30.9 24.9 INTERPRETATION

COUNT Segmenters Lymphocytes Eosinophils Monocytes Basophils Platelet Count

50-65% 25-35% 1-3 % 3-7% 150-450 x 10 g/L

94.5 3.5 2.0 321

Chemical Chemistry Report TEST CREATININE

(August 6, 2012) INTERPRETATION

NORMAL VALUES RESULTS M: (71-133umol/L) 275.4 F: (62-106 umol/L)

(August 10, 2012) HEMATOLOGY REPORT CBC Hgb Hct WBC DIFFERENTIAL COUNT Segmenters Lymphocytes Eosinophils Monocytes Basophils Platelet Count NORMAL VALUES M: 130-180g/L F: 110-160g/L M: 40-54 F: 37-47 5.10 10 g/L RESULT 116 34.6 23.6 INTERPRETATION

50-65% 25-35% 1-3 % 3-7% 150-450 x 10 g/L

79.8 9.3 10.9 336

Chemical Chemistry Report TEST K+ Na

(August 10, 2012) RESULTS 3.31 136.62 INTERPRETATION

NORMAL VALUES 3.5-5.1 mmol/L 135-145 mmol/L

August 09,2012 HEMATOLOGY REPORT CBC Hgb NORMAL VALUES M: 130-180g/L RESULT 100 INTERPRETATION

Hct WBC DIFFERENTIAL COUNT Segmenters Lymphocytes Eosinophils Monocytes Basophils Platelet Count

F: 110-160g/L M: 40-54 F: 37-47 5.10 10 g/L

29.9 29.8

50-65% 25-35% 1-3 % 3-7% 150-450 x 10 g/L

83.2 8.4 8.4 342

August 12,2012 HEMATOLOGY REPORT CBC Hgb Hct WBC DIFFERENTIAL COUNT Segmenters Lymphocytes Eosinophils Monocytes Basophils Platelet Count August 13,2012 KUB /UTZ Both kidneys are visualized Right kidney -normal in size with dilated nelvocalyceal structures pattern is within normal. It measures 9.4 x 6.1 cm Left kidney 10.6x6 cm no hydronephrons on UB small (0.7 cm) an indwelling catheter LUNGS: MODERATE HYDRO NEPHROSIS SIGHT (S/P removed and drain) Suggestive cystitis NORMAL VALUES M: 130-180g/L F: 110-160g/L M: 40-54 F: 37-47 5.10 10 g/L RESULT 136 40.2 26.6 INTERPRETATION

50-65% 25-35% 1-3 % 3-7% 150-450 x 10 g/L

82 10.1 7.9 464

August 06,2012 CHEST AP (SITTING) (OUTSIDE FILM) THERE ARE PATCHY DENSITIES IN THE LUNG FIELDS CARDIAC SHADOW CANNOT BE PROPERLY EVALUATED DIAPHRAGM AND VISUALIZED BY STRUCTURES ARE MARKABLE. REMARKS: PNUEMONIA, AND PULMONARY EDEMA

August 5,2012 TIME 5am 6am 7am 8am 9am 10am 11am Total output: 2507 Total input: 1773 August 6, 2012 TIME 4am 5am 6am 7am 8am 9am 10am 11am August 7, 2012 TIME 1pm 2pm 3pm 4pm 5pm 6pm

URINE OUTPUT IFC 350 450 400 300 350 300 300 CYSTOLYSIS 250 0 15 0 0 0 0

Input: 1,970cc IFC 200 160 110 250 150 150 200 100

IFC 12am 130 160 210 180 130 150 120

August 8, 2012 Total urine output: 700cc TIME 8am IFC 300

9am 10am 12nn 2pm 4pm 8pm 10pm August 9,2012 TIME 12mid 2am 4am 6am 8am 12pm 2pm 4pm 8pm 10pm cystolysis August 13,2012 TIME 2am 10am 12nn (cystolysis) 4pm 6pm 8pm 10pm

200 100 200 300 700 300

IFC 1000cc

1000cc 800 200 700 700 800 30cc

IFC 600cc 700cc 300cc 400cc 100cc 200cc 150cc

Pathophysiology Predisposing Factors - Gender - Race - Age - Sex Etiologic Agent - Proteus - Klebsiella - Pseudomonas Precipitating Factors - Lifestyle - Occupation - Fluid Intake - Geographic Location

Invasion of bacteria Proteus, Klebsiella or Pseudomonas in the urinary tract

Production of enzyme urease that promotes generation of ammonia and hydroxide from urea

Results in alkaline urinary environment and high ammonia concentration, along with abundant phosphate and magnesium in urine

Promotes crystallization of magnesium ammonium phosphate (struvite)

Formation of large, branched stones in the pelvicalical collecting system

Hydronephrosis

Obstruction of urinary flow

Dysuria

Acts as a medium for growth of bacteria

Course in the Ward DATE JULY 26, 2012 DOCTORS ORDER Admit to ROC DAT low salt TPR q4 Request for CBC, BUN, Creatinine PNSS 1L at 42gtts/min Inject Ketorolac 1amp IV now Pen G Na 5m IV q8 ANST Refer

JULY 26, 2012 4pm JULY 27,2012 12nn 4pm JULY 28,2012 6pm JULY 29,2012 6:08 am Acalka 1 tab TID

For UTZ, KUB, prostate Continue Meds and IV fluids

IVF: PNSS 1L

IVF to follow: (40gtts/min) PNSS 1L D5LRS PLNSS For Nephrolithotomy right on call Secure consent NPO now Request: -Hgb -Serum K+ Na -ECG, X-ray view now For Nephrolithotomy Right ASAP (10:50am) Secure consent Notify or Anesthesiologist For BUN Pls. inform Dr. Narciso Reschedule at (8am) NPO midnight Transfer service to Dr. Baquiran Reschedule OR @ 9 am

11am

JULY 30, 2012

1:25pm

2:00pm 6:00pm

7:30pm POST OP ORDER To ward status Post 1st and 2nd procedure Monitor V/S q 15 Once Patient can move to IVF D5LRS 1L x 8 hours x gas meds: -continue

4pm 3-11

-Ketorolac 30mg IV -Morphine Sulfate 0.02% 10cc NSS via epidural catheter 3 doses -WOF morphine sulfate adverse effect -Request CBC 4 hours post BT -give Tramadol IV q8 RTC x 3 doses then PRN severe pain - Post BT CBC after (Dr. Baguien)

-given Tramadol 1 amp (300mg) 1 L D5LRS x 24 hours now as side drip -Transfer Patient in front of AMA station for monitoring -WOF profuse bleeding on operative site -Please transfuse 1 unit of packed RBC properly -O2 inhalation via nasal 3L 60/40mmHg -Fast drip D5 LRS and PNSS replace D5 LRS: PLR 1L once consume -Regulate PNSS to KVO once blood is hooked -Regulate PLRS to 8 hours once done is stable -Give tramadol 50mg IV push now -Transfer 2 units of PRBC -Give Ketorolac 30mg IV q6

August 1,2012 1:15pm -reinsert new IFC -IVF to follow D5 LRS 1L -V.O. Dr. Costales 1:30pm -continue IVF, line 1 D5NM 1L x 12, TF D5LRS 1L line 2 PLRS 1L x KVO 1:55pm - Temp 37.8 C> Paracetamol 300mg IV q 4 RTC the PRN V.O. Dr. Apobra Narciso 4pm - may sit on bed - encourage deep breathing exercise (Dr. Costales)

6:55pm - Clamp Urinary Catheter - On NPO - For suprapubic cystastomy now - Secure consent - Notify or team (Dr. Narciso/Baguiran) 1pm - may give metroclopramide 1pm IV now POST OP ORDER To ward SP cystostomy: -monitor v/s q 15 x 2 hours -resume previews IVF (Left-D5LRS x 8) (Right-PNSS 1L x 8)

MEDS:

- continue present meds - Tramadol 50mg IV q8 RTC x 3 doses PRN for severe pain - Transfuse 1 unit PRBC properly - Request for CBC 4hours BT (Dr. Narciso) - Cystoclysis done with PNSS 1L

August 02, 2012 BP: 160/90 - Catapress 75mg 5L PRN for BP: 140/90 6:55 Start tranexamic acid 1 amp IV q8 (Dr. Costales)

-regulate Cystoclysis to 12 -request CBC -Tranexamic acid (500mg IV q8) -For reinsertion of IFC -Give Tramadol 5omg IV now (Dr. Narciso) -Tramadol 50mg IV for KUB UTZ -Continue present mag + 7:30pm Hgb-51 secure 9:00pm maintain cystoclysis to 35-40 may not reinsert IFC for now (Dr. Costales) - O2 sat 85% > repeat - Increase O2 with 8 LPM - For stat ECG CXR - Give Furosemide 40mg IV now August 3, 2012 1:30 am for STAT BUN, Creatinine -Transfuse PRBC -Give 40mg Furosemide

6am

- (BP: 140/80, PR: 112, RR: 26) 40mg Furosemide IV now -Duavent 1 neb q 10 x 3 doses the 4 hours IV Dopamine drip on side drip with 8-10 uggts 8:28am- IVF to KVO Amlodipine 10mg 1tab OD -Facilitate BT, CO2 12nn -change dress 11:48am -Hold Amlodipine SMS order -Paracetamol shift Pen G to IV q8 ANST August 4, 2012 8:10am-DAT -Repeat CXR -Immune Dopamine drug -Furosemide 40mg -Repeat CXR, PA (10:40am) August 5, 2012 -For cystostophy -NPO -Inform anesthesiology -Creatinine flashing (9:15am) -CBC stat -hypertension treatment -clamp suprapubic catheter for evacuation of bladder hematuria -secure concern -CBC stat -To ICU -VS q15 -O2 at 6 LPM -refer to Dr. Punzalan -NPO -Regulate IV to KVO -Ketorolac 3g IV q6

11:00am

8:35pm

-Continue IV meds -Moderate light back rest -WOF for cyanosis and dyspnea -Hydrocortisone 100mg IV 8hours x 3 doses -Furosemide IV 8 x 2 doses -Regulate IVF 20ggts/min -IVF to follow D5LR x 12 hours -Regulate cystoclysis fluid to 6 hours x 4 bottles PNSS -Continue IV antibiotic -(BP: 140/90,CR: 78bpm) -Request for Na, K and RBC -May start Salbutamol 1 neb to q8 hours -Discontinue if Tachycardia - Discontinue Duavent nebulization

August 6, 2012 6:20am- (+) flatus, (-) BM 3x -may give suppository 8:20am-repeat Creatinine total 9:45am-cystoclysis fluid to follow PNSS x 8 hours -may trans out to regular ward 10:31am -hold Tranexamic acid (Complained of flank pain after Tranexamic acid injection) August 8, 2012 -IVF to follow D5NSS 1L to follow at D5LRS 20gtts/min August 9, 2012 12:50pm -Amlodipine 10mg OD -Multivitamin 1 cap OD -repeat CBC now -verbal order by Dr. Costales -Decrease IVF rate to 15gtts/min -Prepare gloves and dressing kit

7:00pm

August 9, 2012 7:50pm -Drain removed transfused 2 units PRBC after typing and cross matching

August 10, 2012 7:20pm -Clear U.O. -No complains -No DOB -Hold Cefuroxime -Tergecef 200mg 1 tab 2x a day PO -Doxycycline 100mg 1 capsule PO BID -IVF to (12 hours) -Full diet -Repeat CBC, Na K+

10:40pm August 11, 2012

11:00AM

11:30PM August 12, 2012

-Remove IFC - May drink distilled water only -Continue meds -Clean the dressing -D5LRS x 1L KVO -Repeat CBC tomorrow AM -Tergecef 200mg 10g BID -Levofloxacin 500mg IV q8 hours -Ranitidine 500mg IV -Doxycycline via 1 bolus 100mg -Mefenamic acid 1 cup QID -Kalium durule 1 tab TID -Amlodopine OD -D/C Tergecef. Doxycycline, Ranitidine -Levofloxacin 500mg 1 tab OD -Kalium durule 1 tab OD -Multivitamin 1 cap OD -Amlodipine 1 tab OD -Meropenem 500mg IV q8 hours -MFA 500mg PRN for pain -IVF to 10 hours -change dressing q shift -for BOC -BUN, Creatinine -D/C kalium durule -CXR RA tomorrow

August 13, 2012

August 13, 2012

August 13, 2012 9:16 - Unclamp suprapubic catheter -Relaxed UTZ, KUN -(+) soft dressing/cystoclysis change dressing -May remove suprapubic catheter if OK -Continue meds -D5LR 1 L x KVO

August 14, 2012

Nursing Care Plan August 14, 2012 ASSESSMENT S: masakit ang sugat ko kapag gumagalaw ako as verbalized by the patient with a pain scale of 7/ 10. C: sharp pain O: after surgery L: right side D: for a few seconds S: 7/10 P: pain arrives only when the patient moves A: none O: (+) facial grimace irrritability DIAGNOSIS Acute pain r/t to tissue trauma secondary to surgical incision. PLANNING After 30 minutes to 1 hour of nursing intervention the patients pain scale of 7/ 10 will decrease to 2/ 10 as manifested by: (-) facial grimace INTERVENTION Monitor V/S Provide comfort measures such as touch and nurses presence Instruct patient to socialize with others Encourage adequate rest periods Administer analgesic as order by the physician RATIONALE For baseline data To promote nonpharmacological pain management. To distract attention from pain. To conserve O2 demand To relieve pain. EVALUATION After 45 minutes of nursing intervention the patient pain scale of 7/10 decreased to 2/10. Goal met.

August 14, 2012 ASSESSMENT Subjective: mainit ang pakiramdam ko as verbalized by the pt.

DIAGNOSIS Hyperthermia r/t infection

PLANNING After 15-30 min. of nursing. Intervention the patient temperature will decrease from 38.0oC to 36.5-37.5oC

INTERVENTION Established rapport Monitor V/S Performed TSB Promote cooling by means of undressing Encourage to increase fluid intake Administer medications as prescribed by the physician

RATIONALE To gain trust For baseline data Heat loss by evaporation To prevent dehydration

EVALUATION After 30 min. of nursing intervention the patient, the temperature decreased from 38.0oC to 37.7oC

Objective: Warm to touch V/S: Temp: 38.0o C PR: 76 BPM RR: 20 BPM BP: 140/80 mmHg

August 14, 2012 ASSESSMENT S: O: (+) lesion at RLQ (+) redness Wet dressing because of the leakage of urine BP: TEMP: PR: RR:

DIAGNOSIS Risk for infection r/t inadequate primary defenses (broken skin)

PLANNING After 30 minutes 1 hour, identify interventions to prevent / reduce risk of infection

INTERVENTION - Established rapport Note signs and sepsis

RATIONALE - To gain trust First line defense against HAIs To limit exposure thus reducing cross contamination To reduce infection

Demonstrate/instruct to do proper hand washing Offer masks and tissue to client / visitors who are coughing / sneezing Change surgical/other wound dressing as indicated, using proper technique for changing / disposing of contaminated materials Use gloves when doing/ caring for open lesion Provide regular urinary catheter and perineal care

EVALUATION After 30mins. 1 hour of nursing intervention the patient was able to identify interventions to prevent /reduce risk for infection

To minimize transmission of viral disease.

Reduces risk ascending

To prevent the possibility of developing a UTI

DRUG STUDY Drug Name Generic Name: Ranitidine Brand Name: Zantac Action Inhibits the action of histamine at the H2 receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion; has some antibacterial action against H. pylori Indications Treatment and prevention of heartburn, acid indigestion, and sour stomach. Prophylaxis of GI hemorrhage from stress ulceration Contraindications Hypersensitivity, Crosssensitivity may occur; some oral liquids contain alcohol and should be avoided in patients with known intolerance Side Effects CNS: Headache, malaise, dizziness, somnolence, insomnia, vertigo CV: Tachycardia, bradycardia GI: Constipation, diarrhea, nausea and vomiting, abdominal pain, hepatitis Nursing Considerations Instruct patient not to take new medication without consulting physician Instruct patient to take as directed and do not increase dose Allow 1 hour between any other antacid and ranitidine Avoid excessive alcohol Assess patient for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate Nurse should know that it may cause falsepositive results for urine protein; test with sulfosalicylic acid Inform patient that it may cause drowsiness or

dizziness Inform patient that increased fluid and fiber intake may minimize constipation Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea; dizziness; rash; confusion; or hallucinations to health car professional promptly Inform patient that medication may temporarily cause stools and tongue to appear gray black. Instruct patients to monitor for and report occurrence of druginduced adverse reaction.

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NSG. CONSIDERATION Before - Assess for contraindications. - Assess body weight, skin color, V/S, urinalysis, serum electrolytes, X-rays, CBC. - Arrange for increased dosage when patient is subject to unusual stress. - Do not give live vaccines with immunosuppressive doses of hydrocortisone. - Observe the 15 rights of drug administration. During - Give daily before 9am to mimic normal peak diurnal corticosteroid levels. - Space multiple doses evenly throughout the day. - Use minimal doses for minimal duration to minimize adverse

Generic Name: Hydrocortisone

Enters target cells and binds to cytoplasmic receptor; initiates many complex reactions that are Classification: Adrenal Cortical steroid responsible for its antiinflammatory, Corticosteroid immunosuppressive Glucocorticoid (glucocorticoid), and saltretaining Therapeutic Class: (mineralocorticoid) Hormone actions. Some actions maybe undesirable, depending on drug use

-Replacement therapy in adrenal cortical insufficiency -Allergic states Severe or incapacitating allergic conditions -Hematologic disorders -Ulcerative colitis

-Allergy to any component of the drug -Fungal infections -Amebiasis -Hepatitis B -Vaccinia or varicella -Antibiotic -Resistant infections -Immunosuppression

CNS: Vertigo, headache, paresthesias, insomnia, seizures, psychosis CV: Hypotension, shock, HPN and heart failure secondary to fluid retention, thromboembolism, thrombophlebitis, fat embolism, cardiac arrhythmias Dermatologic: Thin, fragile skin, petechiae, ecchymosis, purpura, striae, subcutaneous fat atrophy EENT: Cataracts, glaucoma, increased IOP Endocrine: Amenorrhea, irregular menstruation, growth retardation, decreased carbohydrate tolerance and DM, cushingoid state, HPA suppression

systemic, hyperglycemia GI: Peptic or esophageal ulcer, pancreatitis, abdominal distention, nausea, vomiting, increased appetite and weight gain Hematologic: Na and fluid retention, hypocalcemia, increased blood sugar, increased serum cholesterol, decreased T3and T4levels Hypersensitivity: Anaphylactoid or hypersensitivity reactions Musculoskeletal: Muscle weakness, steroid myopathy and loss of muscle mass, osteoporosis, spontaneous fractures Other: Immunosuppression, aggravation or masking of infections, impaired wound healing

effects. - Do not give IM injections if patient has thrombocytopenic purpura. - Taper doses when discontinuing high-dose or long-term therapy. After - Monitor client for at least 30minutes. - Educate client on the side effects of the medication and what to expect. - Instruct client to report pain at injection site. - Instruct client to take drug exactly as prescribed. - Dispose of used materials properly. - Document that drug has been given

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NSG. CONSIDERATION Assessment: History: hepatic and renal impairment, lactation, pregnancy. Physical: Skin Status, culture of affected area. Oral Drug: Give oral drug with food to decrease GI upset and enhance absorption. Discontinue if hypersensitivity occurred. Parenteral Drug: Report severe diarrhea, difficulty of breathing, unusual tiredness or fatigue, pain at injection site

Generic Name: Cefuroxime

Bactericidal: inhibits synthesis of bacterial cell wall, causing cell death.

Acute bacterial maxillary Contraindicated with sinusitis caused by allergy to cephalosporins streptococcus pyrogens. and penicillins. Lower respiratory infections caused by streptococcus pneumonia, H. influenza

Classification: antibiotic Cephalosporin Dosage: 250 mg PO bid Route: oral

CNS: headache, dizziness, lethargy, paresthiasis. GI: nausea and vomiting, Use cautiously with renal diarrhea, anorexia, failure, lactation, abdominal pain, pregnancy flatulence. HEMATOLOGIC: bone marrow depression (WBC, decreased platelets, decrease hematocrit.) HYPERSENSITIVITY: Ranging rush to fever to anaphylaxis: serum sickness reaction.

DRUG NAME Generic name: METOCLOPRAMIDE (reclomide) Classification: gastrointestinal stimulant Pregnancy category: B Brand name: Clopra, Emex, Maxeran, Maxolon, Reglan Dosage:

ACTION Dopamine antagonist that acts by increasing sensitivity to acetylcholine; results increase motility of the upper GI tract and relaxation of pyloric sphincter and duodenal bulb

INDICATION For the treatment of gastro esophageal reflux disease (GERD)

CONTRAINDICATION SIDE EFFECTS -Metoclopramide should not be used whenever stimulation of gastrointestinal motility might be dangerous, e.g., in the presence of gastrointestinal hemorrhage, mechanical obstruction, or perforation. -Metoclopramide is contraindicated in patients with pheochromocytoma because the drug may cause a hypertensive crisis, probably due to release of catecholamines from the tumor. Such hypertensive crises may be controlled by phentolamine. -Metoclopramide is contraindicated in patients with known sensitivity or intolerance to the drug. -Metoclopramide should not be used in epileptics or patients receiving other drugs, which are likely to cause extrapyramidal

Side effect: change in mood (depression), constipation, diarrhea, drowsiness, fatigue, involuntary Note reasons for therapy movements of the limbs or eyes, restlessness Assess abdomen bowel Adverse effect: sounds, distention, N&V Depression (with suicidal ideation), seizures, agranulocytosis, hypotension

NURSING CONSIDERATION Inject IV slowly over 1-2 minutes to prevent transient feelings of anxiety

reactions, since the frequency and severity of seizures or extrapyramidal reactions may be increased.

DRUG NAME Generic name: Catapres

ACTION

INDICATION Step 2-drug in stepped-care approach to treatment of hypertension, either alone or with diuretic or other antihypertensive agents. Epidural administration as adjunct therapy for severe pain

CONTRAINDICATION SIDE EFFECTS Pregnancy (category C), lactation. Use of clonidine patch in polyarteritis nodosa, scleroderma, SLE

Centrally acting anti adrenergic derivative. Stimulates alpha2Classification: adrenergic receptors cardiovascular agent; centralin CNS to inhibit acting anti-hypertensive; analgesic sympathetic vasomotor centers. Brand name: Central actions CLONIDINEHYDROCHLORIDE reduce plasma concentrations of norepinephrine. It Dosage: decreases systolic and PO 75 mcg 1 tab SL PRN for BP diastolic BP and heart >140 rate. Orthostatic effects tend to be mild and occur infrequently. Also inhibits renin release from kidneys

NURSING CONSIDERATION Side effects: Monitor BP closely. Dizziness, Determine positional lightheadedness, changes (supine, drowsiness, dry mouth, sitting, standing). or constipation may With epidural occur. administration, frequently monitor BP Adverse effect: and HR. Hypotension is CV: a common side effect Hypotension that may require (epidural), postural intervention. hypotension (mild), Monitor BP closely peripheral edema, ECG whenever a drug is changes, tachycardia, added to or withdrawn bradycardia, flushing, from therapeutic rapid increase in BP regimen. with abrupt Monitor I&O during withdrawal. period of dosage GI: Dry mouth, adjustment. constipation, Report change in I&O abdominal pain, ratio or change in pseudo-obstruction voiding pattern. of large bowel, altered Determine weight taste, nausea, vomiting, daily. Patients not hepatitis, receiving a concomitant hyperbilirubinemia, diuretic agent may gain weight gain (sodium weight, particularly retention). during first 3 or 4 d CNS: of therapy, because of Drowsiness, sedation, marked sodium and dizziness, headache, water retention.

fatigue, weakness, sluggishness, dyspnea, vivid dreams, nightmares, insomnia, behavior changes, agitation, hallucination, nervousness, restlessness, anxiety, mental depression. Skin: Rash, pruritus, thinning of hair, exacerbation of psoriasis; with transdermal patch: hyperpigmentation, recurrent herpes simplex, skin irritation, contact dermatitis, mild erythema. Special Senses: Dry eyes. Urogenital: Impotence, loss of libido

Supervise closely patients with history of mental depression, as they may be subject to further depressive episodes

DRUG NAME Generic name: Furosemide Classification: ELECTROLYTIC AND WATER BALANCE AGENT; LOOP DIURETIC Brand name: Lasix Dosage:

ACTION A potent loop diuretic that inhibit sodium and chloride reabsorption at the proximal and distal tubules and the ascending loop of Henle

INDICATION Acute pulmonary edema, Edema, hypertension Treatment of edema associated with CHF, cirrhosis of liver, and kidney disease, including nephrotic syndrome. May be used for management of hypertension, alone or in combination with other antihypertensive agents, and for treatment of hypercalcemia. Has been used concomitantly with mannitol for treatment of severe cerebral edema, particularly in meningitis.

CONTRAINDICATION SIDE EFFECTS Contraindicated to patients hypersensitivity to drug and In those with anuria Use cautiously in patients with hepatic cirrhosis Use furosemide during pregnancy only if potential benefits to mother clearly out weight risks to fetus

NURSING CONSIDERATION Side effects: Observe 10 Rs in giving CNS: medication. vertigo, headache, Monitor weight, blood dizziness, paresthesia, pressure, and pulse rate weakness, restlessness, routinely with long-term fever. use and during rapid CV: diuresis. orthostatic, hypotension; Furosemide can lead to thrombophlebitis with IV profound and electrolyte administration depletion. EENT: transient Monitor fluid intake and deafness, blurred vision output and electrolyte, GI: abdominal BUN, and carbon discomfort and pain, dioxide level frequently. diarrhea, anorexia, Watch for signs nausea, vomiting, of hypokalemia such as constipation muscle weakness and Hepatic: Hepatic cramps Dysfunction Advise patient to Metabolic: volume immediately report depletion and ringing ears, severe dehydration, abdominal pain, or soar asymptomatic throat and fever which hyperuricemia, impaired may indicate furosemide glucose intolerance, toxicity hypokalemia, hypochloremic alkalosis, fluids and electrolyte imbalance Musculoskeletal: muscle spasm

Skin: dermatitis, purpura, photosensitivity, transient pain at IV injection site Adverse effect: Furosemide may induce fluid and electrolyte abnormalities. Patients should be monitored for hydration status and electrolyte imbalances (especially potassium, calcium and sodium). Other potential adverse effects include ototoxicity (especially in cats with high dose IV therapy), gastrointestinal disturbances, hematologic effects (anemia, leukopenia), weakness and restlessness.

DRUG NAME Generic name: Duavent Classification: Antiasthmatic & COPD Preparations Brand name: duavent Dosage:

ACTION

INDICATION

CONTRAINDICATION SIDE EFFECTS Hypertrophic obstructive cardiomyopathy or tachyarrhythmia. Hyper sensitivity to atropine and its derivatives

Treatment of obstructive Management of airway diseases; reversible bronchospasm bronchodilator associated to obstructive airway disease Patient with chronic obstructive pulmonary disease on a regular inhaled bronchospasm and who required a second bronchodilator

NURSING CONSIDERATION Adverse effect: Drugs should be given Headache, pain, influenza, only if the potential chest pain, nausea. benefit justifies the Bronchitis, dyspnea, potential risk to the coughing, pneumonia, fetus. bronchospasm pharyngitis, Position patient on high sinusitis, rhinitis, edema, backrest position. fatigue, hypertension, Do back tapping after dizziness, nervousness, you nebulize the patient. paresthesia, tremor, Do not give a food dyspepsia, vomiting, immediately it can cause arrhythmia, palpitation, vomiting tachycardia, arthralgia, angina, increased sputum, taste perversion and UTI/dysuria, allergic-type reactions.

DRUG NAME Generic name: Tranexamic Acid Classification: Anti-fibrinolytic, antihemorrhagic Brand name: Hemostan, Fibrinon, Cyklokapron, Lysteda, Transamin Dosage:

ACTION Tranexamic acid is a synthetic derivative of the amino acid lysine. It exerts its antifibrinolytic effect through the reversible blockade of lysine-binding sites on plasminogen molecules. Anti-fibrinolytic drug inhibits endometrial plasminogen activator and thus prevents fibrinolysis and the breakdown of blood clots. The plasminogenplasmin enzyme system is known to cause coagulation defects through lytic activity on fibrinogen, fibrin and other clotting factors. By inhibiting the action of plasmin (fibrinolysin) the anti-fibrinolytic agents reduce excessive breakdown of fibrin and effect physiological hemostasis.

INDICATION Tranexamic acid is used for the prompt and effective control of hemorrhage in various surgical and clinical areas: Treating heavy menstrual bleeding Hemorrhage following dental and/or oral surgery in patients with hemophilia Management of hemophilic patients (those having Factor VIII or Factor IX deficiency) who have oral mucosal bleeding, or are undergoing tooth extraction or other oral surgical procedures. Surgical: General surgical cases but most especially operative procedures on the prostate, uterus, thyroid, lungs, heart, ovaries, adrenals, kidneys, brain, tonsils, lymph nodes and soft tissues. Obstetrical and

CONTRAINDICATION SIDE EFFECTS Allergic reaction to the drug or hypersensitivity Presence of blood clots (e.g. in the leg, lung, eye, brain), have a history of blood clots, or are at risk for blood clots Current administration of factor IX complex concentrates or antiinhibitor coagulant concentrates

NURSING CONSIDERATIONS Side effect Unusual change in Back pain; headache; bleeding pattern should joint pain; muscle pain, be immediately reported spasms, or cramps; nasal to the physician. or sinus congestion; For women who are stomach pain; tiredness taking Tranexamic acid to control heavy Adverse effect bleeding, the medication Diarrhea, nausea, should only be taken vomiting, disturbances in during the menstrual color vision, giddiness, period. hypotension (after rapid Tranexamic Acid should IV injection), be used with extreme thromboembolic events. caution in CHILDREN younger than 18 years old; safety and effectiveness in these children have not been confirmed. The medication can be taken with or without meals. Swallow Tranexamic Acid whole with plenty of liquids. Do not break, crush, or chew before swallowing. If you miss a dose of Tranexamic Acid, take it when you remember, then take your next dose

gynecological: abortion, post-partum hemorrhage and menometrorrahgia Medical: epistaxis, hemoptysis, hematuria, peptic ulcer with hemorrhage and blood dyscrasias with hemorrhage Effective in promoting hemostasis in traumatic injuries. Preventing hemorrhage after orthopedic surgeries.

at least 6 hours later. Do not take 2 doses at once. Inform the client that he/she should inform the physician immediately if the following severe side effects occur: Severe allergic reactions such as rash, hives, itching, dyspnea, tightness in the chest, swelling of the mouth, face, lips or tongue Calf pain, swelling or tenderness Chest pain Confusion Coughing up blood Decreased urination Severe or persistent headache Severe or persistent body malaise Shortness of breath Slurred speech

Slurred speech Vision changes

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NSG. CONSIDERATION

Generic Name: Paracetamol Brand Name: Classification: Analgesic, Anti pyretics Dose: 1amp Frequency: for PRN meds q 4-6 hours Route: oral

Indicated in conditions like Ear pain, Headache, Malaise, Migraine, mild to moderate pain, Pain, Post-vaccine reaction, Short bowel syndrome, Toothache.

Paracetamol exhibits analgesic action by peripheral blockage pain impulse generation. It produces antipyresis by inhibiting the hypothalamic heatregulating center. Its weak anti-inflammatory activity is related to inhibition of prostaglandin synthesis in the CNS

Contraindicated in conditions like hypersensitivity

Nausea, allergic reaction, If sensitivity reaction skin rashes, acute renal occurs, discontinue use tubular, necrosis. of paracetamol Potentially fatal: Liver damage If pain persist more than 10 days and arthritic and rheumatic condition affecting children, immediately consult physician.

DRUG NAME Generic name: Kalium durule Classification: electrolytic and water balance agent; replacement solution Brand name: Potassium Chloride Dosage:

ACTION Principal intracellular cation; essential for maintenance of intracellular isotonicity, transmission of nerve impulses, contraction of cardiac, skeletal, and smooth muscles, maintenance of normal kidney function, and for enzyme activity. Plays a prominent role in both formation and correction of imbalances in acid base metabolism

INDICATION To prevent and treat potassium deficit secondary to diuretic or corticosteroid therapy. Also indicated when potassium is depleted by severe vomiting, diarrhea; intestinal drainage, fistulas, or malabsorption; prolonged diuresis, diabetic acidosis. Effective in the treatment of hypokalemic alkalosis (chloride, not the gluconate).

CONTRAINDICATION SIDE EFFECTS Severe renal impairment; severe hemolytic reactions; untreated Addisons disease; crush syndrome; early postoperative oliguria (except during GI drainage); dynamic ileus; acute dehydration; heat cramps, hyperkalemia, patients receiving potassium-sparing diuretics, digitalis intoxication with AV conduction disturbance. GI: Nausea, vomiting, diarrhea, abdominal distension. Body Whole: Pain, mental confusion, irritability, listlessness, paresthesias of extremities, muscle weakness and heaviness of limbs, difficulty in swallowing, flaccid paralysis. Urogenital: Oliguria, anuria. Hematologic: Hyperkalemia. Respiratory: Respiratory distress.

NURSING CONSIDERATION Monitor I&O ratio and pattern in patients receiving the parenteral drug. If oliguria occurs, stop infusion promptly and notify physician. Lab test: Frequent serum electrolytes are warranted. Monitor for and report signs of GI ulceration (esophageal or epigastric pain or hematemesis).

DRUG NAME Generic name: Amlodipine Classification: Calcium-channel blocker Brand name: Norvasc Dosage:

ACTION Inhibits calcium ions from entering the slow channels or select voltage sensitive areas of vascular smooth muscle and myocardium during depolarization

INDICATION For the treatment of hypertension, chronic stable angina and confirmed or suspected vasospastic angina.

CONTRAINDICATION SIDE EFFECTS Allergy to amlodipine Hepatic or renal impairment Sick sinus syndrome Heart block Sick sinus syndrome Lactation Side effect CNS: Dizziness Lightheadedness Fatigue Lethargy CV: Peripheral edema Arhythmias Dermatologic: Flushing, rash GI: Nausea Abdominal discomfort

NURSING CONSIDERATION Assess patient for history of allergy to amlodipine, impaired hepatic or renal function, sick sinus syndrome, heart block, or CHF. Assess for adverse drug reactions; report irregular heartbeat, swelling of the hands and feet, shortness of breath, pronounced dizziness, and constipation. Monitor BP and cardiac rhythm. Instruct patient to take drug with meals if abdominal discomfort occurs; advise on eating small, frequent meals for nausea and vomiting.

DRUG NAME Generic name: Meropenem Classification: Carbapenem antibiotic Brand name: Merrem Dosage:

ACTION Inhibiting the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls by binding to one or more of the penicillin-binding proteins (PBPs), thus inhibiting cell wall biosynthesis resulting to bacterial lysis.

INDICATION Susceptible intraabdominal infections caused by viridans group streptococci, E. coli, K. pneumoniae, P. aeruginosa, B. fragilis, B. thetaiotaomicron, and Peptostreptococcus. Bacterial meningitis caused by S. pnuemoniae, H. influenza, N. meningtidis in patients over 3 months only

CONTRAINDICATION SIDE EFFECTS Hypersensitivity to any component of this product or to other drugs in the same class; anaphylactic reactions to beta-lactams.

NURSING CONSIDERATION Diarrhea, nausea, Assessment vomiting, abdominal History: Allergy to pain; headache; cephaosporins, constipation; rash, penicillins, beta lactans, pruritus, uticaria; apnea; renal failure, CNS phlebitis, disorders, seizures, renal thrombophlebitis, or hepatic impairment, swelling and pain at pregnancy, lactation. injection site; Physical: Orientation, disturbances in LFTs affect, skin color, (may cause increases in lesions, culture site of serum transaminases, infection, R, adventious alkaline phosphatase, sounds, bowel sounds, lactic dehydrogenase). abdominal exam, renal Rarely: erythema and liver function tests multiforme; eosinophilia, Interventions thrombocytopenia, Culture infected area leucopenia, neutropenia; and arrange for seizures and CNS effects sensitivity tests before reported in patients with beginning therapy underlying CNS disorders or renal impairment.

DRUG NAME Generic name: Morphine Sulfate Classification: Opioid analgesic Brand name: Astramorph, Depodur Dosage:

ACTION An opiod agonist that binds with opiod receptors in the CNS. It alters the perception of and emotional response to pain; it produces generalized CNS depression.

INDICATION Relief of severe acute or chronic pain, analgesia during labor. Drug of choice for pain due to MI, dyspnea from pulmonary edema not resulting from chemical respiratory irritant.

CONTRAINDICATION SIDE EFFECTS Acute or severe asthma, GI obstruction, paralytic ileus, hepatic and renal dysfunction, hypersensitivity, intracranial pressure and suspected head injuries, severe respiratory depression. Side effects: Rash, itching, anaphylaxis, confusion Euphoria, dizziness, constipation Bradycardia, orthostatic hypotension Respiratory depression

NURSING CONSIDERATION Perform strict documentation and inventory assessment of narcotic Assess pain and vital signs (especially respiration) before and after the dose If given IV push, watch for respiratory depression, hypotension, and vascular collapse Advice patient to avoid alcohol, tasks that require alertness, motor skills until response to drug is established

DRUG NAME Generic name: Multivitamin Classification: Multivitamins and minerals Brand name: Dosage:

ACTION Prevention of deficiency or replacement in patients whose nutritional status is questionable

INDICATION Promotes normal biochemical reactions, strengthens the immune system, supports normal growth and development and helps prevent growth retardation in children and young adult.

CONTRAINDICATION SIDE EFFECTS Should be avoided in patients with known alcohol intolerance; Hypersensitivity to preservatives, colorants or additives including tartrazine, saccharine, and aspartame (oral forms) Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue). Upset stomach; Headache; or unusual or unpleasant taste in your mouth.

NURSING CONSIDERATION Assess patient for signs of nutritional deficiency prior to and throughout the day Instruct to notify side effects of medication to physician Encourage to comply on medication Encourage patient to comply with physicians recommendation. Explain that the best source of vitamins is a well balanced diet with foods from the 4 basic food groups Advise patients not to refer to chewable multivitamins for children as candy

DRUG NAME Generic name: Mefenamic acid Classification: Central nervous system agent; analgesic; NSAID; antipyretic Brand name: Ponstan, Ponstel Dosage:

ACTION Anthranilic acid derivative. Like ibuprofen inhibit sprostaglandin synthesis and affects platelet function. No evidence that it is superior to aspirin.

INDICATION This medication is a nonsteroidal antiinflammatory drug (NSAID), prescribed for dysmenorrhea and other pain. It decreases inflammation and uterine contractions.

CONTRAINDICATION SIDE EFFECTS Hypersensitivity to drug; GI inflammation, or ulceration. Safety in children <14 y, during pregnancy (category C), or lactation is not established.

NURSING CONSIDERATION Adverse effects Discontinue drug CNS: Drowsiness, promptly if diarrhea, insomnia, dizziness, dark stools, nervousness, confusion, hematemesis, headache. ecchymoses, epistaxis, or GI: Severe diarrhea, rash occur and do not use ulceration, and bleeding; again. Contact physician. nausea, vomiting, Notify physician if abdominal cramps, persistent GI discomfort, flatus, constipation, sore throat, fever, or hepatic toxicity. malaise occur. Hematologic: Prolonged Do not drive or engage prothrombin time, severe in potentially hazardous autoimmune hemolytic activities until response anemia (long-term use), to drug is known. It may leukopenia, eosinophilia, cause dizziness and agranulocytosis, drowsiness. thrombocytopenic Monitor blood purpura, megaloblastic glucose for loss of anemia, pancytopenia, glycemic control if bone marrow hypoplasia. diabetic. Urogenital: Do not breast feed while Nephrotoxicity, dysuria, taking this drug without albuminuria, hematuria, consulting physician. elevation of BUN. Skin: Urticaria, rash, facial edema. Spec Senses: Eye irritation, loss of color vision (reversible), blurred vision, ear pain.

Body Whole: Perspiration. CV: Palpitation. Respiratory: Dyspnea; acute exacerbation of asthma; bronchoconstriction (in patients sensitive to aspirin).

DRUG NAME Generic name: Doxycycline Hyclate Classification: Antibiotic; tetracycline prototype: Tetracycline Brand name: Vibramycin Dosage:

ACTION Semisynthetic broad spectrum tetracycline antibiotic derived from oxytetracycline. More completely absorbed with effective blood levels maintained for longer periods and excreted more slowly than most other tetracyclines. Thus it requires smaller and less frequent dosing.

INDICATION Treating bacterial infections, such as: Certain types of pneumonia Chlamydia Rocky Mountain spotted fever, Typhus fever, Tick fever, Syphilis (when unable to take penicillin) Some respiratory or urinary tract infections (UTIs) Treating acne Preventing malaria Treating anthrax infections Treating rosacea Treating periodontitis (gum disease).

CONTRAINDICATION SIDE EFFECTS The drug is contraindicated in persons who have shown hypersensitivity to any of the tetracyclines.

NURSING CONSIDERATION Adverse effects Take capsule or tablet Spec forms with a full glass Senses: Interference (240 mL) of water to with color vision. ensure passage into GI: Anorexia, nausea, stomach and prevent vomiting, diarrhea, esophageal ulceration. enterocolitis; esophageal Avoid taking capsule or irritation (oral capsule tablet within 1 h of lying and tablet) down or retiring. Skin: Rashes, Avoid exposure to direct photosensitivity reaction sunlight and ultraviolet Other: Thrombophlebitis light during and for 4 or (IV use), superinfections. 5 d after therapy is terminated to reduce risk of phototoxic reaction. Phototoxic reaction appears like exaggerated sunburn. Sunscreens provide little protection. Do not breast feed while taking this drug.

DRUG NAME Generic name: Dopamine Hydrochloride

ACTION

INDICATION To correct hemodynamic imbalance in shock syndrome due to MI (cardiogenic shock), trauma, endotoxic septicemia (septic shock), open heart surgery, and CHF. Treat shock and correct hemodynamic imbalances To improve perfusion to vital organs To increase cardiac output To correct hypotension

CONTRAINDICATION SIDE EFFECTS Pheochromocytoma; uncorrected tachyarrhythmias; ventricular fibrillation; allergy to corn/corn products (dextrose solutions). Adverse Reactions: CNS: headache CV: ectopic beats, tachycardia, angina, palpitations, hypotension GI: nausea, vomiting Metabolic: azotemia, hyperglycemia Respiratory: dyspnea, asthmatic episodes Skin: necrosis and tissue sloughing with extravasation, piloerection Other: anaphylactic reactions

Naturally occurring neurotransmitter and immediate precursor of Classification: norepinephrine. Major AUTONOMIC cardiovascular effects NERVOUS SYSTEM produced by direct AGENT; ALPHA- AND action on alpha- and BETA-ADRENERGIC beta-adrenergic AGONIST receptors and on (SYMPATHOMIMETIC) specific dopaminergic receptors in mesenteric Brand name: and renal vascular beds. Docard Dosage:

NURSING CONSIDERATION Monitor blood pressure, pulse, & heart rate Monitor urine output Assess for blanching Monitor pulmonary artery catheter

DRUG NAME Generic name: Bisacodyl Classification: Stimulant laxatives Brand name: Dulcolax Dosage:

ACTION It acts directly on the bowels, stimulating the bowel muscles to cause a bowel movement

INDICATION Short-term relief of constipation. Constipation, either chronic or of recent onset, whenever a stimulant laxative is required. Bowel clearance before surgery or radiological investigation.

CONTRAINDICATION SIDE EFFECTS Patients with ileus, intestinal obstruction, acute abdominal conditions including appendicitis, acute inflammatory bowel diseases, and severe abdominal pain associated with nausea and vomiting which may be indicative of the aforementioned severe conditions. Severe dehydration and inpatients with known hypersensitivity to Bisacodyl or any other component of the product. IS Anaphylactic reactions, angioneurotic edema and other hypersensitivity. GI vomiting, Abdominal discomfort, abdominal pain, abdominal cramps, nausea and diarrhea.

NURSING CONSIDERATION Evaluate periodically patients need for continued use of drug; bisacodyl usually produces 1 or 2 soft-formed stools daily. Monitor patients receiving concomitant anticoagulants. Indiscriminate use of laxatives results in decreased absorption of vitamin K. Add high-fiber foods slowly to regular diet to avoid gas and diarrhea. Adequate fluid intake includes at least 68 glasses per day. Do not breast feed while taking this drug without consulting physician.

DRUG NAME Generic name: Potassium Citrate Classification: Antiurolithic Brand name: Acalka Dosage:

ACTION The aim of the treatment is to restore the level of the urinary citrate and to increase the pH of urine to 6-7, and to this end, the dosage pattern are: In patients with slight hypocitraturia start the treatment with a dose of 30mEq (3 tabs/day, divided into 3 takings daily.

INDICATION Treatment of patients with renal lithiasis and hypocitraturia, chronic formers of calcium oxalate, phosphate calculi. Uric acid lithiasis alone or accompanied by calcium lithiasis

CONTRAINDICATION SIDE EFFECTS Renal insufficiency Persistent alkaline urinary infections Obstruction of the urinary tract Hyperpotassemia Adrenal insufficiency Respiratory or metabolic alkalosis Active peptic ulcer Intestinal obstruction Patients submitted to anticholinergic therapy Patients with slow gastric emptying. Adverse effect Slight gastrointestinal disorders may appear which can be palliated by means of the joint administration of food.

NURSING CONSIDERATION The tablets must not be masticated or diluted. The active component of Acalka is contained with a porous wax matrix. As this was matrix is insoluble, it can be eliminated in visible form in the feces. The active component, however, has been released in the gastrointestinal tract. Must not be administered to patients receiving potassium-sparing diuretics (triamterene, spirolactone, or amyloride). It is advisable to carry out an evaluation of electrolytes (Na-K-Cl) and CO2, creatinine and hemogram every 4 hrs. It is recommended that the patients in treatment with Acalka follow a diet w/o salt and increase the intake of fluids.

DRUG NAME Generic name: Tramadol Classification: Analgesic (centrally acting) opiod analgesic Brand name: Ultram Dosage:

ACTION A centrally acting analgesic not related chemically to opiates. In contrast to morphine, tramadol does not cause release of histamine, and relieves pain.

INDICATION Treating moderate to moderately severe pain. This prescription is only approved for use in adults 16 and older.

CONTRAINDICATION SIDE EFFECTS Hypersensitivity to tramadol. In acute intoxication with alcohol, hypnotics, centrally acting analgesics, opiates, or psychotropic drugs Side effect Dizziness, headache, CNS stimulation, ataxia, sedation/somnolence, constipation, nausea

NURSING CONSIDERATION List reasons for therapy, location, onset, triggers, characteristics of signs and symptoms. Use a pain-rating scale to rate pain. Assess for history of drug addiction allergy to opiates or codeine, seizures, may increase the risk of convulsion. Monitor vital sign, input and output, renal and LFTs.

DRUG NAME Generic name: Ketorolac Classification: Antipyretic, non-opiod analgesics, NSAID Brand name: Acular LS, Acular PF. Dosage:

ACTION Anti inflammatory and analgesics activity; inhibits prostaglandins and leukotriene synthesis.

INDICATION Short term management of pain (up to 5 days) Ophthalmic: relief of ocular itching due to seasonal conjunctivitis and relief of postoperative inflammation after cataract surgery.

CONTRAINDICATION SIDE EFFECTS Contraindicated with significant renal impairment, during labor and delivery, active peptic ulcer disease, recent GI and perforation. Side effect Headache, somnolence, rash fatigue, nausea and vomiting

NURSING CONSIDERATION Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess for rhinitis, asthma, and urticaria. Assess pain (note type, location, and intensity) prior to and 1-2 hour following administration. Caution patient to avoid concurrent use of alcohol, aspirin, NSAIDs, acetaminophen, or other OTC medications without consulting health care professional. Advise patient to consult if rash, itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headche, or influenzalike syndromes (chills, fever, muscles aches, pain) occur

DRUG NAME Generic name: Penicillin G Benzathine

ACTION

INDICATION Severe infections caused by sensitive organisms (streptococci)- URTI caused by sensitive streptococci- Treatment of syphilis, bejel, congenital syphilis, pinta, yaws- Prophylaxis of rheumatic fever and chorea

CONTRAINDICATION SIDE EFFECTS A previous hypersensitivity reaction to any penicillin is a contraindication. Allergies to penicillins, cephalosporins, or other allergens CNS: Lethargy, hallucinations, seizures GI: Glossitis, stomatitis, gastritis, sore mouth, furry tongue, black hairy tongue, nausea, vomiting, diarrhea, abdominal pain, bloody diarrhea, enterocolitis, pseudomembranous colitis, non specific hepatitis GU: Nephritis Hematologic: Anemia, thrombocytopenia, leukopenia, neutropenia, prolonged bleeding time Hypersensitivity: Rash, fever, wheezing, anaphylaxis Local: Pain, phlebitis, thrombosis at injection site, JarischHerxheimer reaction when used to treat syphilis Other: Superinfections, sodium overload leading to heart failure

Interferes with bacterial cell wall synthesis during active Classification: multiplication, causing Penicillin cell wall death and Therapeutic Class resultant bactericidal Anti-infective, Antibiotic activity against susceptible bacteria. Brand name: Penadur Dosage:

NURSING CONSIDERATION Drug is not for IV use. Do not inject or mix with other IV solutions. Give IM injection in upper outer quadrant of the buttock.- Avoid contact with the needle.Withdraw needle as quickly as possible to avoid discomfort.- Stay with patient throughout whole duration of administration. After Monitor client for at least 30minutes. Arrange for regular follow-up, including blood tests, to evaluate effects Instruct to report difficulty breathing, rashes, severe pain at injection site, mouth sores, unusual bleeding or bruising Instruct to take medication as directed for the full course of therapy, even if

feeling better. Do proper documentation