NURSING CARE PLANS ACTUAL Assessment Subjective: masakit ang kamay ko as verbalized by the patient.

Objective: Pain scale: 7/10 Facial grimace Guarding movements Diagnosis Acute pain related to post surgical procedure (CTS release) as evidenced by pain scale of 7/10, facial grimace and guarding movements. Planning After 2 hours of nursing intervention patient will be able to establish reduction of pain from 7/10 to 5/10, absence of facial grimace and guarding movements Intervention 1. Observe and document location and severity (0-10 scale) of pain. Rationale Assist in differentiating cause of pain and provides info about the disease progression, resolution, development of complications and effectiveness of intervention. Evaluation After 2 hours of nursing intervention patient was able to establish reduction of pain from 10/10 to 5/10, absence of facial grimace and guarding movements

2. Promote activities that helps further recovery of the surgical site such as : Cold and warm compress if not contraindicated Frequent elevation e.g

It will help patient to relax and regained body strength.

placing hand over the pillow when lying on bed 3. Provide divisional activities such as watching tv, and listening to relaxing music 4. Maintain frequent contact and make time to interact with the patient.

Helps the patient to redirects its attention may enhance coping.

5. Administer analgesics as indicated -

Helpful in alleviating anxiety and refocusing attention which can relieve pain. Relief of pain and facilitates cooperation with other therapeutic interventions.

Assessment Subjective: hirap ako igalaw ang kamay ko as verbalized by the patient. Objective: Limited range of motion Slowed movements Limited ability to perform gross fine motor skills.

Diagnosis Impaired physical mobility related to limited range of motion and reluctance to attempt movement.

Planning After 3 hours of nursing intervention patient will verbalize understanding of situation and individual treatment regimen and safety measures.

Intervention 1. Immobilize the hand of the patient. 2. Do wound care on the hand of the patient.

Rationale To prevent from having further injuries. To prevent from infection.

Evaluation After 3 hours of nursing intervention patient was able verbalized understanding of situation and individual treatment regimen and safety measures

3. Wrist splint in slight extension. 4. Corticosteroid injection (e.g. dexamethazone). 5. Monitor level of pain, numbness, paresthesias and functioning.

To relieve pressure aggravated by wrist flexion. To relieve inflammation.

To determine progression of disease.

DRUG STUDY Drug Generic name: Digoxin Brand name: Lanoxin Classification: Cardiac antidysrhytthmic Available forms: Capsules: 0.05mg, 0.1 mg, 0.2mg. Elixir: 0.05mg/ml Injection: 0.05 mg/ml, 0.1 mg/ml (pediatric), 0.25 mg/ml Tablets: 0.125mg, 0.25mg Action Inhibits sodiumpotassium- activated adenosine triphosphatase, promoting movement of calcium from extracellular to intracellular cytoplasm and strengthening myocardial contraction. Indications Heart failure, , atrial fibrillation. Contraindications Contraindicated in patients hypersensitive to drug and in those with digitalis induced toxicity, ventricular fibrillation, or ventricular tachycardia unless caused by heart failure. Adverse reaction CNS: fatigue, generalized muscle weakness, agitation, hallucinations, headache, malaise, dizziness, vertigo. CV: arrhythmias EENT: yellow green halos around visual images, blurred vision, light flashes, photophobia, diplopia. GI: anorexia diarrhea. Nursing consideration Drug-induced arrhythmias may increase the severity of heart failure and hypotension. Patients with hypothyroidism are extremely sensitive to cardiac glycosides and may need lower doses.

Drug Generic name: Pregabalin Brand name: lyrica Classification: Anticonvulsant Available forms: Capsule: 25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 225mg 300mg

Action Drug may contribute to analgesic and anticonvulsant effects by binding to sites in CNS

Indications Post herpetic neuralgia

Contraindications Contraindicated in patients hypersensitive to pregabalin or any of its components. Use cautiously in patients with new York heart association class III or class IV heart failure

Adverse reaction CNS: abnormal gait, abnormal thinking, amnesia, anxiety. CV: edema EENT: blurred or abnormal vision, conjunctivitis, diplopia. GI: abdominal pain, constipation, dry mouth, flatulence.

Nursing consideration Monitor patients weight and fluid status especially if he has heart failure. Check for changes in vision. Dont stop drug abruptly. Instead, taper it gradually over at least 1 week.

Drug Generic name: irbesartan Brand name: aproval Classification: Angiotensin II receptor antagonist Dosage: 150mg

Action Produces antihypertensive effect by competitive antagonist activity at the angiotensin II receptor.

Indications Hypertension

Contraindications Contraindicated in patients hypersensitive to drug or its component. Use cautiously in patients with impaired renal function renal heart failure or renal artery stenosis and in breastfeeding as possible.

Adverse reaction CNS: fatigue, anxiety, dizziness, headache. CV: chest pain, edema, tachycardia. GI: Nausea and vomiting, diarrhea. GU: UTI Musculoskeletal: musculoskeletal trauma or pain. Respiratory: URTI, cough.

Nursing consideration Drug may be given with diuretic or other antihypertensive. Symptomatic hypotension may occur in volume or salt depleted patients Dizziness and orthostatic hypotension may occur more frequently in patients with type 2 diabetes and renal disease.

Drug Generic name: Warfarin sodium Brand name: coumadin Classification: oral anticoagulant available forms: injections: 2 mg/ml (powder) tablets:1 mg, 2mg, 2.5mg, 3mg, 4mg, 5mg, 6mg, 7mg, 10mg

Action Oral anticoagulant that inhibits the synthesis of clotting factors, thus preventing blood clot formation.

Indications Rheumatic heart disease with heart valve damage, prosthetic heart valve damage.

Contraindications Anticoagulation is contraindicated in any localized or general physical condition or personal circumstance in which the hazard of hemorrhage might be greater than the potential clinical benefits of anticoagulation, such as: pregnancy

Adverse reaction CNS: headache fever GI: anorexia nausea and vomiting. GU: hematuria, excessive menstrual bleeding Hematologic: hemorrhage Skin: dermatitis, necrosis alopecia. Other: enhance uric acid excretion

Nursing consideration Draw blood to establish baseline coagulation parameters before therapy With hold drug and all call prescriber at once in the event of fever or rash Elderly patients and patients with renal or hepatic failure especially dose who are sensitive to drug

Drug Generic name:

Action

Indications

Trimetazidine
Brand name:

Vastarel
Classification:

Anti-angina
Dosage:

0-60 mg/day in divided doses. Extended release 35 mg twice daily.

The coupling of glycolysis with glucose oxidation is improved and ATP production is further increased, while cell acidosis andCa2+ overload are limited. The increase in total glucose utilization has been evidenced by studies using 18FDG positron emission tomography (PET

-acute angina attacks - prevent situation that may cause anginal attacks

Contraindications Lactation

Adverse reaction

Nursing consideration

- Nausea and vomiting, headache, edema

1. Check for doctors order 2. Monitor blood pressureand pulse rate before and after givingthe meds. 3. Notify prescribing signsof heart failure such asswelling of hands and feet or SOB. 4. Advise patient of thesideeffects of the drug

Drug Generic name: ISOSORBIDE DINITRATE Brand name: Isoket Classification: anti anginal drug Dosage: Capsule: 40mg Tablets: 5mg 10mg

Action Isosorbide dinitrate is a smooth muscle relaxant. It is particularly effective on vascular and bronchial smooth muscle. Its systemic cardiovascular effects are mainly due to a decrease in venous return

Indications unresponsive left ventricular failure secondary to acute MI, severe or unstable angina pectoris

Contraindications Allergic reactions to organic nitrates are extremely rare, but they do occur. Isosorbide dinitrate is contraindicated in patients who are allergic to isosorbide dinitrate or any of its other ingredients.

Adverse reaction Nervous system disorders: headache, dizziness, somnolence. Cardiac disorders: tachycardia, angina pectoris aggravated. Vascular disorders: orthostatic hypotension, collapse (sometimes accompanied by bradyarrhythmia and syncope). Gastrointestinal disorders: nausea, vomiting, heartburn.

Nursing consideration Monitor BP and heart rate. Assess location, duration, intensity, and precipitating factors of anginal pain

Drug

Action

Indications

Contraindications

Adverse reaction

Nursing consideration

Generic name: Mefenamic Acid Brand name: Ponstan, Ponstel Classification: central nervous system agent; analgesic; nsaid; antipyretic Dosage: Tablet: 250mg 500mg

Aspirin-like drug that has analgesic, antipyretic, & antiinflammatory activities

Relief of pain rheumatic pain

Pregnancy & lactation, hypersensitivity, active ulceration or chronic inflammation of either upper or lower GIT, blood disorders, poor platelet function, kidney or liver impairment, children < 14 yrs

Upset stomach, nausea, heartburn, dizziness, drowsiness, diarrhea, and headache

assess pt.s pain before therapy monitor for possible drug induced adverse reactions > advice pt. not to take drug for more than 7 days advice pt. to report immediately persistence or failure to relieve pain