DRUGS STUDY

Generic Name: Celecoxib Classification: NSAID Dosage, Route, Frequency: Mechanism of Action: This drug acts by inhibiting prostaglandin synthesis, impeding cyclooxygenase-2 (COX-2) to produce anti-inflammatory, analgesic and antipyretic effects. Desired Effect: This drug was given to our patient to relieve pain Nursing Responsibilities: 1. Assess patient to report history of allergic reactions to sulfonamides, aspirin, or other NSAID before therapy. Rationale: To prevent drug-to-drug interaction because patients with a history of anaphylactic reactions to sulfonamides, aspirin, or other NSAID maybe allergic to this drug. 2. Instruct patient to promptly report signs of GI bleeding such as blood in vomitous, urine, or stool or black tarry stool. Rationale: 3. Instruct patient to immediately report rash, unexplained weight gain or swelling. Rationale: Because drug can cause fluid retention. 4. Instruct patient to take drug with food if stomach upset occurs. Rationale: Drug can be given without regard to meals, but food may decrease GI upset. 5. Instruct patient to stop therapy and notify prescriber immediately if he experiences signs and symptoms of liver toxicity, including nausea, fatigue, lethargy, itching, yellowing of skin or eyes, right upper quadrant tenderness and flu like syndrome. Rationale: Because drug may be hepatotoxic. Watch for signs and symptoms of liver toxicity to give prompt treatment. 6. Instruct patient that it may take several days before he feels consistent pain relief. Rationale: 7. Instruct patient to avoid alcohol and cigarette while taking the drug.

Rationale: Because the drug could cause GI irritation or bleeding. 8. In patient with hypertension, monitor blood pressure regularly. Rationale: Because the drug decreases the effect of anti-hypertensive drugs.

Generic Name: Tramadol Hydrochloride Brand Name: Ultram Classification: Analgesics Dosage, Route, Frequency: Mechanism of Action: A centrally acting synthetic analgesic compound not chemically related to opiates. Thought to bind to opoid receptors and inhibit re-uptake of norepinephrine and serotonin. Desired Effect: This drug was given to our patient to relieve the pain brought about by the disease process. Nursing Responsibilities: 1. Assess type, location and intensity of pain before and after 2-3 hours (peak) after administration. Rationale: This is necessary in order to determine improvements after drug administration. 2. Assess blood pressure and RR before and periodically during administration. Rationale: So as to determine the possibility of respiratory depression and hypotension as an effect of the drug. 3. Assess bowel function routinely. Rationale: In order to determine the presence of constipating effect of the drug. 4. Advice client to increase intake of fluids and bulk. Rationale: This is necessary to prevent the constipating effect of the drug. 5. Monitor patient for seizures. Rationale: Drug may reduce seizure threshold.

6. Caution patient to avoid activities requiring alertness until response to medication is known. Rationale: In order to prevent injury since dizziness and drowsiness may occur. 7. Advice patient to change positions slowly. Rationale: In order to prevent orthostatic hypotension.

Generic Name: Cephalexin Monohydrate Classification: First Generation Cephalosporin Dosage, Route, Frequency: Mechanism of Action: First generation cephalosporin has a bactericidal effect. It inhibits cell wall synthesis thus promoting osmotic instability. Desired Effect: This drug was given to our patient to treat infection caused by Escherichia coli and other coliform bacteria, group A beta-emolytic streptococci, klebsiella species, proteus mirabilis, streptococcus pneumoniae and staphylococci. Nursing Responsibilities: 1. Instruct patient to use the drug cautiously in patients hypersensitive to penicillin. Rationale: Because of the possibility of cross-sensitivity with other beta-lactam antibiotics. 2. Instruct patient to take the drug exactly as prescribed, even after he feels better. Rationale: To avoid antibiotic resistance. 3. Instruct patient to take drug with food or milk. Rationale: To lessen GI discomfort. 4. Assess bowel function routinely. Rationale: In order to determine the presence of diarheal effect of the drug. 5. Advice client to increase oral fluid intake. Rationale: This is necessary to prevent the dehydration due to the diarrhea effect of the drug.

6. Caution patient to avoid activities requiring alertness until response to medication is known. Rationale: In order to prevent injury since dizziness and drowsiness may occur. 7. Instruct patient to notify Physician if rash or signs and symptoms of super infection occur. Rationale: To give prompt treatment.

Generic Name: Cefazolin Sodium Classification: First Generation Cephalosporin Dosage, Route, Frequency: 1 gm IV 1 hour prior to OR Mechanism of Action: First generation cephalosporin has a bactericidal effect. It inhibits cell wall synthesis thus promoting osmotic instability. Desired Effect: This drug was given to our patient as a perioperative prevention in contaminated surgery. Nursing Responsibilities: 1. Instruct patient to take the drug exactly as prescribed, even after he feels better. Rationale: To avoid antibiotic resistance. 2. Instruct patient to take drug with food or milk. Rationale: To lessen GI discomfort. 3. Obtain specimen for culture and sensitivity tests before giving first dose. Therapy may begin while awaiting results. Rationale: To know the specific causative agent that causes the infection. 4. If creatinine clearance falls below 55ml/min, adjust dosage. Rationale: 5. Assess bowel function routinely. Rationale: In order to determine the presence of diarheal effect of the drug.

6. Advice client to increase oral fluid intake.

Rationale: This is necessary to prevent the dehydration due to the diarrhea effect of the drug. 7. Caution patient to avoid activities requiring alertness until response to medication is known. Rationale: In order to prevent injury since dizziness and drowsiness may occur. 8. Instruct patient to notify Physician if rash or signs and symptoms of super infection oocur such as recurring fever, chills and malaise. Rationale: To give prompt treatment

Generic Name: Fentanyl Classification: Opioid agonist Dosage, route, frequency: Mechanism of Action: This drug acts by binding with opiate receptors in the CNS, altering perception of and emotional response to pain. Desired Effect: This drug was given to our patient for post operative pain, restlssness, tachypnea and emergence delirium. Nursing Responsibilities: 1. Instruct patient to request drug before pain becomes intense Rationale: 2. For post-op patient encouraged patient to turn, cough and breathe deeply. Rationale: To prevent lung problems. 3. Instruct patient to avoid hazardous activities until CNS effects subside. Rationale: Because the drug has CNS adverse reaction. 4. Caution patient to avoid activities requiring alertness until response to medication is known. Rationale: In order to prevent injury since dizziness and drowsiness may occur 5. Instruct patient to take drug with food or milk. Rationale: To lessen GI discomfort.