MEDICAL MANAGEMENT

Doctor’s order Rationale

Admitting orders 3/12/09 2:35 pm
EB 110% TBSA SPT-DPT inv R hand
and L leg
Open Fracture Fx L forearm

 Pls admit patient to burn unit  the patient had major burn injury
under the service of Dr. H. thus, he needed to be properly
Santos(Charity) monitored and taken care of in
the burn unit

 Secure consent for admission  to document that the patient has

and management granted permission for admission
and management

 NPO  to prevent aspiration of vomitus

because Nausea and vomiting
typically occur due to paralytic
ileus resulting from the stress of
injury
 Start Venoclysis c PNSS 1L-
>180 cc/hr.  to replace lost fluids and
electrolytes to prevent
irreversible shock
 for CBC c BT -To determine blood volume and blood
 Na,K type
- to determine serum Na levels(
hyponatremia is usually
present)Serum Na levels vary
in response to fluid
resuscitation
-
 BUN, Crea
 to assess renal function
 to check on the hydration status
 -U/A
 to assess renal function
 to check for any abnormalities in
the urine that can aid in
diagnosing certain diseases
 -ECG-done outside
 to evaluate cardiac function.

 X-ray L forearm AP,L done
outside
 X-ray R hand and forearm
 X-ray L ankle include foot
 -Start Cefazolin 2 g IV LD ANST
(-) then 1 g q8h
 Omeprazole 40 mg/ vial 1 vial
OD per IV
 Tramadol 100 mg/amp 1 amp
q8h for pain
 Refer to Ortho for evaluation
and management
 please insert IFC
 pls. monitor VS q2h
 Monitor UO q 1h
 inform plastic surgeon once
admitted
 Refer
9: 40 pm to OR
Anesthesia post-op order
Electrical current immediately
contracts muscle and cardiac
dysrhythmias and spinal injuries
often result from the muscular
contraction
 to determine the type of fracture
 an anti infective used to prevent
the develepmont of infection and
as a surgical prophylaxis
 a proton pump inhibitor that
blocks final step of gastric acid
secretion to prevent patient from
developing stress ulcer brought
about by the injury
 indicated for moderate to severe
acute pain
 for evaluation and management
of the patient
 to monitor urine output
 to determine irregularities from
the patient’s normal VS
 Check on the stability of the
Patient
 to assess renal function and
hydration status
 for further management
  to PACU
 O2 inhalation via FM @ 6Lpm
 Monitor VS q 15 min until
stable
 Diet-DAT once fully awake
 regulate IVF PNSS q 30 gtts/min
 IVF TF D5LR 1Lx12
Meds:
 Nalbuphine 10 mg amp TIV q
4h x 6 doses
 Ketorolac 30 mg TIV q 6h x 4
doses
 Continue Cefazolin 1g TIV q8h
 Moderate high back rest
 Encourage DBE
 Keep warm and comfortable
 Refer
 6:15 pm-Give Paracetamol 1
amp now IV
 for easy access to experienced
medical team members,
monitoring and support, special
equipment and medications
 For adequate oxygenation
 to determine irregularities from
the patient’s VS
 Check on the stability of the
Patient
 For nutritional needs. Patient can
eat his food preference as
tolerated
 for correct infusion rate
 to prevent phlebitis and
infiltration
 for fluid replacement
 Indicated for Post-op somatic &
visceral pain
 Possesses anti-inflammatory,
analgesic, and anti pyretic
effects
 To prevent infection
 to prevent aspiration
 to clear secretions, help expel
residual anesthetic agents,
mobilize secretions and prevent
alveolar collapse
 to promote relaxation and
comfort
 as an immediate relief for fever
and pain
3/14/09
 Pls give Paracetamol 200 mg IV
PRN basis( T of >38.0)
 IVTF PNSS 1L x8h x3 cycles
 Refer
3/15/09
 IVTF D5LR 1L x8h x 3 cycles
 refer
 3/16/09
 will refer to senior on duty
 Maintain IVF/ IV meds
 Daily wound care
 DAT
 for transfer of service to Ortho.
Please inform
 Refer
3/17/09
 Decrease VS monitoring to q 4h
 IVF D5LR 1L @ 30 gtts/min
 Patient referral ortho to Sr. we’ll
co-manage the patient
 for “E” debridement,irrigation L
forearm
 symptomatic relief of fever and
pain
 for fluid and electrolyte balance
 for fluid and electrolyte balance
 for close monitoring of patient’s
condition
 For the maintenance of
therapeutic effects of IVF and
medications
 To prevent proliferation of
infection-causing
microorganisms in the wound
 for nutritional needs. Patient can
eat his food preference as
tolerated
 For better management
 To determine irregularities in VS
 for correct infusion rate
 to prevent phlebitis and
infiltration
 for better management
  secure consent for procedure  to remove tissue contaminated
by bacteria and foreign bodies
and to remove devitalized
tissues
 for OR on call
 to document that the patient has
 Refer granted permission for admission
and management

 for preparation of an operating

procedure

March 18, 2009

 IVFTF D5LR TL for 8 hrs x 3  For fluid replacement

cycles
 To prepare patient for the surgical
 Maintain on NPO procedure
 To monitor fluid status
 I&O monitoring q 4

 Refer

March 20, 2009

 For blood replacement
 Please transfuse 2U PRBC
properly typed and cross
matched
 Still for BT  To evaluate BT outcome

 Repeat H&H p BT

 Refer  For adequate oxygenation

 Addendum:
Start O2 @3 lmp
 TSB c/o relatives  To decrease body temp via
evaporation
 Continue monitoring q 4hours
 To determine irregularities in VS
ORTHO

 For COD today

 To prevent proliferation of
infection causing microorganism
 For transfusion of 2U PRBC in the wound
properly typed
 For blood replacement
 To avoid blood agglutination

March 22, 2009

 COD done  To prevent proliferation of

infection causing microorganism
in the wound
 Cont. IVF/ IV meds
 For the maintenance of
therapeutic effects of IVF and
 Daily wound care medications

 To prevent proliferation of
 Repeat H&H infection causing microorganism
in the wound
 Transfer pt. to ortho penthouse
 To evaluate BT outcome

 For better management

March 23, 2009

 Transfer pt. to ortho ward under  For better management

the service of DR. Geromilla

9:30am

 Pls. facilitate BT 4U PRBC once  For blood replacement

available

 Start FeSO4 1 tab TID  For Iron supplementation

 For COD today  To prevent proliferation of
infection causing microorganism
in the wound
 Refer accdgly.

March 24, 2009

9:30
 For tissue repair
 High protein diet
 For Iron supplementation
 Green leafy veg. to diet
 For the maintenance of
 Cont. IV meds
therapeutic effects of medications

 For fluid replacement and

 IVF to FF: PNSS 1L x KVO
hydration status

 For blood replacement

 Facilitate BT pls.
 To prevent proliferation of
 Wound care pls.
infection causing microorganism
in the wound
 Refer to rehab for bedside
 To prepare the patient for
conditioning
ambulation
March 25, 2009

 Pls. facilitate transfusion of 1U  To increase O2 carrying capacity

of PRBC in symptomatic anemia

 To prevent Anaphylactic shock

 BT precautions pls.
 symptomatic relief of fever and
 Paracetamol 300 mg IV RTC for pain
T > 38°C
 Refer
March 26, 2009
7:00 am

 For COD today  To prevent proliferation of

infection causing microorganism
in the wound
 For H&H
 To evaluate BT outcome
 d/c IFC: WOF bladder distention
 To assess urinary retention
 Continue IVF/IV meds
 For the maintenance of
therapeutic effects of IVF and
 IVF to FF: PNSS 1L x KVO medications

 For fluid replacement and

hydration status

March 27, 2009

 H&H noted  To evaluate BT outcome

 For transfusion of 2U PRBC  For blood replacement

properly typed & cross
matched
 For the maintenance of
 Cont. IVF/IV meds therapeutic effects of IVF and
medications

 IVF to FF: PNSS 1L x KVO  For fluid replacement and

hydration status

 For COD tom.  To prevent proliferation of

infection causing microorganism
 Refer in the wound

March 29, 2009 6:30 am

 For COD tomorrow  to prevent infection and to keep

the wound from moisture that is
a good medium for bacterial
proliferation
 Cont IVF/ IV meds
 for the maintenance of
 therapeutic effects of IVF and
 Encourage wheelchair medications

 for ambulation without

 IVF to ff: PNSS 1L x KVO overexertion of the patient’s
energy

 Still for referral for total body  for fluid replacement and
casting hydration status
 Refer
 to prevent further injuries and
March 30, 2009 9:05 damage

 Still for BT of 2 “U” PRBC

properly typed and
crossmatched
 to replace lost blood products
 IVF: PNSS 1L x KVO

 for fluid replacement and

 Cont. oral meds hydration status

 Refer  for the maintenance of

therapeutic effects of oral
April 01, 2009 medications
 Still for transfusion of 1 “U”
PRBC properly typed and
crossmatched
 to replace lost blood products; to
 Cont IVF/ IV meds prevent blood reaction

 for the maintenance of

 IVF: PNSS 1L x KVO therapeutic effects of IVF and
medications

 For COD today  for fluid replacement and

hydration status
2 pm
 For COD today  to prevent proliferation of
infection-causing bacteria in the
wound
 For referral for total body
casting  to prevent proliferation of
infection-causing bacteria in the
April 07, 2009 wound
  NPO p pm
 to prevent further injuries and
damage
 Start D5LR 1L x 8 on NPO

 to prevent aspiration once the

Meds patient is called for surgical
 Nalbuphine IV 500 mg procedure

April 08, 2009  for fluid replacement and

 Maintain on NPO nutritional needs of the patient
while on NPO
 For CBC today
 Refer
 Relief of moderate to severe
pain.

April 09, 2009

 to prevent aspiration once the is
 Still for BT called for surgical procedure
 to determine blood
 IVF to ff: PNSS 1L x KVO abnormalities in its components,
and volume

 Start Fe SO4 1 tab PO

 For H&H

 Cont. wound care  to replace lost blood products

 Refer  for fluid replacement and

hydration status
April 10, 2009 9:20 am
 for iron supplementation
 Still for CBG
 to evaluate BT outcome
 Cont IVF/ IV meds
 to prevent wound contamination
 For COD today and infection

 Refer accordingly

April 11,2009
 to determine blood glucose
levels
 Cont. FeSO4 1 tab
 for the maintenance of
 IVF to ff: PNSS 1L x KVO therapeutic effects of IVF and
medications
 Cont. wound care
 to prevent proliferation of
 Refer infection-causing bacteria in the
wound
April 12, 2009
 Facilitate transfusion of 1 “U”
PRBC properly typed and
crossmatched  for iron supplementation

 Facilitate CBC c APC  for fluid replacement and

hydration
 Refer
 to prevent wound contamination
April 14, 2009 and infection

 NPO p mn

 to replace lost blood products

 Start D5LR 1L x 8 once on NPO

 to determine blood
 Cont. meds abnormalities in its components,
and volume
 Refer

April 15, 2009

 Maintain on NPO  to prevent aspiration once the

patient is called for surgical
procedure
 For emergency debridement
 for fluid replacement and
nutritional needs of the patient
while on NPO
 Fixator & ex H x L
 for the maintenance of
therapeutic effects of oral
medications
 For COD today

 Refer
9:30 pm  to prevent aspiration once the
 DAT then NPO p mn patient is called for surgical
procedure

 IVF to ff: PNSS 1L x KVO  to remove tissue contaminated

c bacteria and foreign bodies
 Refer and to remove devitalized
tissues
April 16, 2009
 For CBC c APC total  attached to bone fragments to
stabilize them

 Maintain in NPO
 to prevent proliferation of
infection-causing bacteria in
the wound

 to prevent aspiration once the

patient is called for surgical
procedure

 for fluid replacement and

hydration status

 to determine blood
abnormalities in its
components, and volume

 to prevent aspiration once the

patient is called for surgical
procedure
 PATIENT’S PROFILE

BIOGRAPHICAL DATA:

Name: M.D.M.
Age: 25 yrs old
Sex: Male
Civil status: Single
Address: Towerville 2, Hector block 38 lot 6 , San Jose del Monte,
Bulacan
Religion: Roman Catholic
Nationality: Filipino

ADMISSION DATA:

Admission date: March 12, 2009

Admission time: 3:00 pm
Attending physician: Dr. Tamayo
Admitting diagnosis: Electrical Burn
Chief complaint: difficulty of flexing due to pain

HISTORY OF PAST AND PRESENT ILLNESS

History of present illness

• Few hours prior to admission patient fell while tapping on an

electric post thus sustaining injury

Past Medical History

• No known past medical illnesses

Family History

• No known hereditary diseases

Personal history
• High school graduate
• Unemployed
 • No allergies to foods

PHYSICAL ASSESSMENT

Admission(March 12,2009)

VITAL SIGNS
PR=75 bpm
RR=21 cpm
TEMP=37.3 °C

PHYSICAL ASSESSMENT

Skin

 Skin color – deep brown

 Skin turgor – slowly goes back to its previous state
 Skin warm to touch
 Visible skin lesions

Hair

 Evenly distributed hair

 Thick hair
 No infestations

Nails

 Fingernail plate shape- convex curvature

 Texture- smooth
 Bed- highly vascular and pink
 Tissues- intact epidermis
 Capillary refill test- return to its normal color

Skull and Face

 Rounded
 Smooth skull contour
 Absence of nodules
  Symmetric facial movements

Eyes

 Eyebrows evenly distributed and symmetrically aligned

 Eyelashes equally distributed
 Eyelids- skin intact, no discharge, no discoloration
 Pupils- black in color, equal in size. Round

Ears

 Auricles- color same as facial skin

 Symmetrical, aligned with outer canthus

Nose

 Symmetric and straight

 No discharge
 No tender or lesions

Mouth

 Outer: soft, moist, smooth

 Inner: pink color, moist, smooth

Thorax and Lungs

 Symmetric
 Spine is aligned
 Skin intact
 No lesions
 Full and symmetric chest expansion

Abdomen
 No lesions
 flat

Extremities

 No edema
 Skin lesions
 Right forearm amputated
  With external fixator on left arm
 With elastic bandage of the left lower leg due to2nd degree
burn

LABORATORY TEST RESULTS

HEMATOLOGY
HEMATOLOGY
Components Result Normal Values Interpretation
WBC 16.3 4.5 – 11X103/cu Increase in value may indicate that
mm the patient has an acute bacterial
infection or infectious disease, or he
is in inflammatory state
Hemoglobin 14.9 M: 14.0 – 17.0 Normal
gm/dL Decreased level would suggest anemia,
F: 12.0 – 14.0 acute blood loss, and severe hemorrhage
gm/dL while elevated value may indicate
NB: 18.7 – 20.1 dehydration and polycythemia vera
gm/dL
Hematocrit 43.3% M: 40 – 50% Normal
F: 38 – 48% Values decreases in anemia and
NB: 49 – 58% increases in dehydration and
polycythemia

DIFFERENTIAL COUNT
Neutrophil 76% 45 – Increase in value may be due to presence of
65% acute bacterial infection, inflammation, stress
or drug reaction
Lymphocyte 18% 25 – Decreased level may suggest that the patient
s 40% has an aplastic anemia, leukemia,
immunodeficiency
Monocytes 3% 2 – 6% Normal
Values increases in viral infection, parasitic disease,
collagen and hemolytic disorder
Values decreases when patient is taking corticosteroid,
or suffers in RA and HIV infection
Eosinophil 3% 2 – 4% Normal
Values increases during allergic reaction, parasitic
infestation and eosinophilic leukemia, and decreases
 in patient with endocrine disorders, and during stress
Platelet 204 150 – Normal
450,00 Thrombocytopenia is associated with anemias.
0/mm3 Thrombocytosis (elevated platelet count) occurs in
polycythemia vera.

Mean 90.2 80 – Normal

Corpuscular 100 Decreased level is associated with microcytic anemia
Volume µm3 like iron deficiency anemia
(MCV) Values increases in macrocytic anemias like aplastic,
hemolytic and pernicious
Mean 31.0 27 – 31 Normal
Corpuscular pg It is decreased in hypochromic anemias, and increased
Hemoglobin in hyperchromic anemias.
(MCH)
Mean 34.4% 32 – Normal
Corpuscular 36% It is diminished (hypochromic) in microcytic anemias,
Hemoglobin and normal (normochromic) in macrocytic
Concentrati anemias (due to larger cell size, though the
on (MCHC) hemoglobin amount or MCH is high, the
concentration remains normal). MCHC is elevated
in hereditary spherocytosis.
Red Blood 13.0 11.6 - Normal
Cell 14.6 % Vitamin B12 deficiency produces a macrocytic
Distribution (large cell) anemia with a normal RDW. However,
Width iron deficiency anemia initially presents with a varied
(RDW) size distribution of red blood cells, and as such shows
an increased RDW. And in the case of a mixed iron and
B12 deficiency we will have a mix of both large cells
and small cells hence the RDW will usually be
elevated.
 CHEMISTRY
Test Result Normal Interpretation
Values
Sodium 137.5 135 – 148 Normal
mEq/L Value increases in increased intake, either
orally or parentally of sodium
Decrease in value is associated with burns,
Addison’s disease, sodium-losing nephropathy,
vomiting, diarrhea, fistulas, tube drainage,
ascites, renal insufficiency with acidosis
Potassium 4.21 3.50 – Normal
5.30 Blood levels of potassium may be higher than
mEq/L normal when patient is suffering from diabetic
ketosis, renal failure, and Addison’s disease.
Value decreases when patient is taking
Thiazide diuretics and steroid therapy, or also
may suggest cushing’s syndrome, cirrhosis
with ascites, hyperaldosteronism, malignant
hypertension, poor dietary habits, chronic
diarrhea, diaphoresis, renal tubular necrosis,
malabsorption syndrome, vomiting

March 12, 2009

CHEMISTRY
Test Result Normal Resul Unit Normal Interpretation
Values t Values
Conv
ersio
n
Creatinine 100 53- 1.13 m 0.5 – 1.3 Normal
115,000 g/d Values increases in
mmol/L L skeletal muscle
necrosis/atrophy,
starvation,
hyperthyroidism,
kidney disease,
March 20, 2009
HEMATOLOGY
Componen Result Normal Values Interpretation
ts
Hemoglobi 6.0 M: 13 – 18 Decrease level suggest anemia and may
n gm/dL also be associated with blood loss
F: 12 – 16 (traumatic injury, surgery, bleeding),
gm/dL nutritional deficiency, bone marrow
problems, immunosuppression
Hematocri 17.6 M: 42 – 52% A low hematocrit is referred to as being
t % F: 35 – 47% anemic. Some of the more common
reasons are loss of blood (traumatic
injury, surgery, bleeding colon cancer),
nutritional deficiency (iron, vitamin B12,
folate), bone marrow problems
(replacement of bone marrow by cancer,
suppression by chemotherapy drugs,
kidney failure), and abnormal
hematocrit (sickle cell anemia).

March 26, 2009

HEMATOLOGY
Componen Result Normal Values Interpretation
ts
Hemoglobi 8.5 M: 13 – 18 Decreased level would suggest anemia,
n gm/dL acute blood loss, and hemodilution
F: 12 – 16
gm/dL
Hematocri 24.9 M: 42 – 52% Values decreases in anemia
t % F: 35 – 47%

March 31, 2009

CROSSMATCHING RESULT
Blood Typing Result Interpretation
ABO “O” Individuals with type O blood can receive blood
from donors of only type O, so as to prevent
hemolytic transfusion reaction.
RH (+) Individual who inherited the D antigen. This is to
prevent Rh incompatibility reaction.
Blood Component
PRBC Extraction Date: March 28, To increase oxygen carrying
2009 capacity in symptomatic anemia
Expiration Date: April 1, patients
2009
April 7, 2009
CROSSMATCHING RESULT
Blood Typing Result Interpretation
ABO “O” Individuals with type O blood can receive blood
from donors of only type O, so as to prevent
hemolytic transfusion reaction.
RH (+) Individual who inherited the D antigen. This is to
prevent Rh incompatibility reaction.
Blood Component
PRBC Extraction Date: April 5, To increase oxygen carrying
2009 capacity in symptomatic anemia
Expiration Date: May 10, patients
2009
Generic Name: cefazolin sodium
Brand Name: Ancef, Kefzol
Classification: First generation cephalosporin (anti-infective)
MECHANISM DOSAGE/ INDICATION ADVERSE CONTRAINDICATI NURSING
OF ACTION FREQUEN REACTION ON CONSIDERATIO
CY N
Interferes with Cefazolin 1 Treatment Drug induce fever, Hypersensitivity to Monitor CBC,
bacterial cell gm TIV q variety of GI side effects, cephalosporins Prothrombin time,
wall synthesis, 8h infections due skin rashes, Kidney and liver
causing cell to to susceptible eosinophilia, function test
rupture and organism: allergic nephritis, result
die. Respiratory anaphylactic
tract, GIT, GUT, reaction, Watch for signs
OTIC, bone, hematological and symptoms of
skin soft changes, superinfection
tissues, post-op headache, and other serious
infection, dizziness, malaise, adverse reaction
bacteremia, shock, cytopenia,
septicemia, thrombocytopenia Tell patient to
endocaditis, , alteration of report reduce
surgical bacterial flora. urinary output,
prophylaxis persistent
diarrhea, bruising
and bleeding

Instruct the
patient to take
the drug exactly
as prescribed and
to complete full
course of drug
therapy even
when he feels
better.

As appropriate
review all other
significant life
threatening
reactions and
interactions
especially those
related to the
drugs, test and
behaviors
Generic Name: omeprazole
Brand Name: Omepron
Classification: Proton Pump inhibitor
Generic Name: Nalbuphine HCl
Brand Name: Nubain [amp]
MECHANISM OF DOSAGE/ INDICATIO ADVERSE CONTRAINDICATI NURSING
ACTION
MECHANISM DOSAGE/ FREQUEN
INDICATIONN REACTION ON CONSIDERATION
NURSING
OF ACTION FREQUEN CY ADVERSE CONTRAINDICATI CONSIDERATION
Binds to opiate receptors
CY Nalbuphine Relief of REACTION
Sedation. ON Patients who are Abrupt discontinuation
in the CNS, causing
Thought to be Omeprazol10 mg IV
Duodenal moderate
ulcer, Infrequentl Hypersensitivity
Headache, hypersensitive toto after sustained
Consider dosageuse
inhibition of ascending push q 4 to severe y nalbuphine HCl or
a gastric
pain e 40 mg/
pathways, altering gastric ulcer, rarely rash, drug or its adjustment >10
(generally days)
in those
pump hours x6 pain. Pre- pruritis,
sweating, components.
any component, mayhepatic
cause withdrawal
the perception of vial
and reflux with failure
inhibitor in pain;1 vial OD doses op
esophagitis, GI upsets,
dizziness, including sulfites; symptoms. Mixed
response to
that it blocks
produces per IV
generalized associated analgesia,parasthesia,
vertigo, pregnancy agonist-antagonist:
Avoid activities that
the
CNS final step
depression as a dizziness;
duodenal gastric somnolence, (prolonged use or Incidence
require of
mental
of acid ulcers, supplemen dry mouth; high dosages at
insomnia,ver psychomimetic
alertness effect is
until drug
production by t to
gastroduodenal tigo,headache, term) lower than with
effects’ realized; may
inhibiting the erosion, balanced diarrhea,allergic pentazocine;
cause dizziness may
H+/K+ ATP- anesthesia,
Helicobacter reactions.
constipation, precipitate withdrawal
ase system of surgical flatulence,
pylori- associated in narcotic-dependent
For short term use
the secretory anesthesia,
peptic ulcer increased patients.
only, drug inhibits total
surface of the disease, for obstet liver gastric secretion. Side
gastric ric the enzyme,mal
dyspepsia(in effects of prolonged
parietal cell. relief of analgesia aise,hyperse therapy and
symptomsduring
in nsitivity suppression of acid
labor
patient with & reaction secretion alter
epigastricrelief of bacterial colonization
pain
pain/discomfort and lead to
following
with or without hypochlorhydria which
MI. Post-op
heartburn),Zollin may cause an
ger-Ellisonsomatic & increased risk for
syndromevisceral gastric tumors
pain.
Classification: Anaesthetics - Local & General, Analgesics (Opioid)

Generic Name: Ketorolac tromethamine

Brand Name: Apo-Ketorolac
Classification: Non-steroidal anti-inflammatory drug
MECHANISM DOSAGE/ INDICATION ADVERSE CONTRAINDICATI NURSING
OF ACTION FREQUEN REACTION ON CONSIDERATIO
CY N
Possesses Ketorolac As a single or Systemic use: Hypersensitivity to 1. Use as a part
anti- 30 mg q 6 multiple dose Headache, dizziness, the drug or allergic of a regular
inflammatory, hours x 4 regimen on a drowsiness, diarrhea, symptoms; Active analgesic
analgesic, doses regular or as nausea, peptic ulcer rather than on
and anti needed dyspepsia/indigestio disease; those at an as needed
pyretic schedule for n, epigastric pain, risk for renal failure basis
effects the edema
management 2. Do not mix
of moderate IV/IM in a small
to severe pain volume(i.e, a
that requires syringe) with
analgesia at morphine
the opioid sulfate,
level meperidine,
HCL,
promethazine
HCL, or
hydroxyzine
HCL; will
precipitate
from solution
Generic Name: tramadol hydrochloride
Brand Name: Ultram
Classification: Non-steroidal anti-inflammatory drug
MECHANISM DOSAGE/ INDICATION ADVERSE CONTRAINDICATI NURSING
OF ACTION FREQUENC REACTION ON CONSIDERATIO
Y N
Inhibits re Tramado For moderate Seizures, Acute intoxication assess patient’s
uptake of l 100 to severe hypersensitivity with alcohol, response to
serotonin and mg/amp acute or reactions, analgesics, drug 30 mins.
norepinephrin 1 amp chronic pain respiratory hypnotics or after
e in the CNS q8h for e.g. cancer or depression; CV, CNS, psycho tropics, dministration
pain post op pain musculoskeletal and patients receiving
urogenital disorder, MAOI’s , severe Monitor
nausea, vomiting, respiratory respiratory
abdominal depression, status, withhold
distention,anorexia, cerebral pathology drug and
dependence, contact
prescriber if
respiration
becomes
shallow or
slower than 12
cpm

Inform patient
that drug can
cause physical
and
psychological
dependence.
Generic Name: Paracetamol
Brand Name: Aeknil
Classification: Analgesics (Non-Opioid) & Antipyretics
 MECHANISM DOSAGE/ INDICATION ADVERSE CONTRAINDICATIO NURSING
OF ACTION FREQUENC REACTION N CONSIDERATION
Y
Paracetamol is Paracetamo Pyrexia of Skin Nephropathy. 1. Never take more
rapidly and l 300 mg Iv unknown origin eruption, than 2 tablets
prn for (of 500mg each
almost temp. and for hematologic day) at any one
completely >380C symptomatic al toxicity time and no
more than 4
absorbed from Paracetamo relief of fever e.g., times in 1 day.
the GIT. l 1 amp IV and pain thrombocyto
Following oral prn basis associated with penia and 2. Paracetamol
for temp may be taken
administration, >37.80C common leucopenia, with or without
peak plasma childhood methemoglo food.
levels are disorders, binaem-ia 3. If you need pain
attained in 10 tonsillitis, upper which can relief fast, take it
min to 1 hr and respiratory result in on an empty
stomach as food
the half-life is tract infections, cyanosis, may slow down
75 min to 3 hrs. post- and on long- the absorption
of paracetamol.
Distribution of immunization term use,
paracetamol to reactions, after renal 4. Do not double a
most body tonsillectomy damage can dose under any
circumstances.
tissues and and other result.
fluids is both conditions 5. Do not take
paracetamol of
rapid and where patient is you have liver or
uniform. unable to take kidney problem.
Approximately oral
6. Do not take this
85% of a dose medications but medicine with
of paracetamol where other products
that contain
is excreted in paracetamol paracetamol.
the urine within can be
24 hrs after administered 7. Avoid alcohol

administration. with advantage.

For prevention
Generic Name: ferrous sulfate
Brand Name: Apo ferrous sulfate
Classification: Anti Anemic Iron
MECHANISM OF DOSAGE/ INDICATION ADVERSE CONTRAINDICATI NURSING
ACTION FREQUEN REACTION ON CONSIDERATI
CY ON
Iron is absorbed Ferrous Prophylaxis GI irritation and Hemosiderosis, Eggs, milk,
from the sulfate 1 and blackening of stool, hemochromatosis, coffee or tea
duodenum and tab OD treatment of constipation, peptic ulcer, consumed with
upper jejunum by iron nausea and regional enteritis, a meal or 1
anactive deficiency anorexia, diarrhea ulcerative colitis. hour after may
mechanism and iron Hemolytic anemia, significantly
through the deficiency pyridoxine inhibit the
mucosal cells anemia; responsive anemia, absorption of
where it dietary liver cirrhosis dietary iron
combines with supplement
the protein for iron Ingestion of
transferring and calcium and
is stored in the iron
body as supplements
hemosiderin or with food can
aggregated decrease
ferritin w/c is absorption by
found in the 1/3
reticuloendothelia
l cells of the liver, Note any GI
spleenand bone bleeding, tarry
marrow stools or bright
blood in stool or
vomitus

Note any
complaints of
fatigue, pallor.
Poor skin turgor
or change in
mental status

Take with meals

Date: 4/17/09

Subjective:
> “ Masakit tong mga sugat ko” as verbalized by the patient.”
Pain scale of 8 out of 10.

Objective:
> V.A.S.

>guarding behaviors
>restless
>narrowed focus

Date: 4/17/09

Subjective:
“Nadamay lang naman ako eh, tapos ganito na nangyari”, as verbalized by the patient.
Objective:
> amputated R arm
> Negative feelings about body/self,
>fear of rejection
>Focus on past appearance, abilities;

Date:4/17/09

Subjective:
“Eto nga eh putol na yung kamay ko, tas ung kabila sunog din.”as verbalized by the patient.

Objective:
>absence of viable tissue on L arm
> c multiple lesions on extremities and trunk
> presence of fluid exudates on injured areas

PDAGDAG NLNG N2 SA P.A OR SA S & S

HYPOTENSIVE UNG PATIENT THROUGHOUT OUR SHIFT