DRUG NAME Tramadol 50 mg IV now then q8

SPECIFIC ACTION

MECHANISM OF ACTION

INDICATION Moderate to moderately severe pain

CONTRAINDICATION

ADVERSE REACTION

NURSING RESPONSIBILITIES Assess bowel function routinely. Prevention of constipation should be instituted with increased intake of fluids and bulk and with laxatives to minimize constipating effects.

Analgesics (centrally acting)

Binds to mu-opioid receptors. Inhibits reuptake of serotonin and norepinephrine in the CNS.

Hypersensitivity to the drug

CNS: seizure. Feeling nervous and anxious

Acute intoxication of alcohol , hypnotics, narcotics, opoid

RESPI: respiratory depression GI: Nausea, vomiting, diarrhea, Upset stomach RESPI: cough, epistaxis. Shallow breathing

Assess previous analgesic history. Tramadol is not recommended for patients dependent on opioids or who have previously received opioids for more than 1 wk; may cause opioid withdrawal symptoms.

Prolonged use may lead to physical and psychological dependence and tolerance, although these may be milder than with opioids. This

should not prevent patient from receiving adequate analgesia. Most patients who receive tramadol for pain d not develop psychological dependence. If tolerance develops, changing to an opioid agonist may be required to relieve pain.

Omeprazo le 40 mg IV now then OD

Proton pump inhibitor

Gastric-acid pump inhibitor: Suppresses gastric acid secretion by specific inhibition of the hydrogenpotassiumATPase enzyme system at the secretory surface of the gastric mucosa

Short term treatment for duodenal ulcer. Short term treatment of active benign gastric ulcer. Eradication of H.Pylori. first line of treatment in heartburn or symptoms of GERD

Contraindicated with hypersensitivity to Omeprazole or its components

CNS: Headache, dizziness, asthenia,vertigo, insomnia,apathy, Anxiety, parasthesia, GI: Nausea, vomiting constipation, dry mouth, tongue, atrophy. RESPI: cough, epistaxis DERM: Inflammation,

Assesment: assess for history or allergy to the drug.

Administer before meals

Administer antacids if needed

Have a regular follow up medical visits

Report severe

rash Urticaria

headache , worsening of symptoms, fever, chills.

Clonidine 75mg tab now then q6 PRN

(Central Alpha Agonists) Antihypertensive

Acts in the brain to lower blood pressure. It works by relaxing blood vessels so blood can flow more easily.

This medication is used alone or with other medications to treat high blood pressure (hypertensio n). Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems.

Hypersensitivity, Disorders of Cardiac Pacemaker Activity and Conduction.

CNS: drowsiness, depression, nervousness, nightmares CV: bradycardia,

Review if the patient intake alcohol prior to administration.

Observe route of administration

Pregnancy and Lactation

hypotension GI: dry mouth, constipation, nausea, vomiting GU: impotence, DERM: rash, sweating F& E: sodium retention METAB: weight gain, MISC: withdrawal phenomenon

(sublingual)

Be sure to teach the patient the following about this medication

Take clonidine at the same time each day, even if feeling well. Allroutes of clonidine should be gradually discontinued over 2-4 daysto prevent rebound

hypertension, Advise patient to avoid driving or other activities requiring alertness until response to medication isknown, Caution patient to avoid sudden changes in position todecrease orthostatic hypotension.Instru ct patient on proper application of transdermal system. Donot cut or trim unit. Transdermal system can remain in place duringbathing or swimming

Lactulose

Laxative,

The drug passes unchanged into

Treatment of

Contraindicated

GI: Transient

DRUG-DRUG

30 cc ODHS

Ammonia reduction drug

the colon where bacteria break it down to organic acids that increase the osmotic pressure in the colon and slightly acidify the colonic contents, resulting in an increase in stool water content, stool softening, laxative action. This also results in migration of blood ammonia into the colon contents with subsequent trapping and expulsion of feces.

constipation.

with allergy to lactulose, low-

flatulence, distention, intestinal cramps, belching, Do not administer other laxatives with lactulose.

Prevention and treatment of portalsystemic encephalopathy

galactose diet.

Use cautiously with diabetes, pregnancy, and lactation.

diarrhea, nausea. DRUG-FOOD May be taken with fruit juice or milk to increase palatability

History Allergy to lactulose, lowgalactose diet.

diabetes, pregnancy, and lactation.

Physical Abdominal examination, bowel sounds, serum electrolytes, serum ammonia levels.

Do not freeze

laxative form. Ask patient to report diarrhea, severe belching, abdominal fullness. CoAmoxicla v 1.2 g IV then q12 Antibacterial Amoxicillin + Clavulanic Acid Inhibits bacterial cell wall synthesis preventing spread of infection Against susceptible bacteria causing infections of the middle ear, ear, throat infections, laryngitis, bronchitis, sinusitis, and pneumonia. Severe kidney disease that requires dialysis, history of liver problems (such as cholestatic jaundice) that occurred with It is also used in treating urinary tract infections, skin infections, and gonorrhea previous use of amoxicillin/clavula nic acid. GI: Diarrhea, nausea, vomiting, or stomach/abdomin al pain may occur during the first few days as your body adjusts to the medication Prior to administration encourage the patient to verbalize to their doctor, pharmacist medical history especially of: liver disease, kidney disease, a certain type of viral infection (infectious mononucleosis).Ki dney function declines as you grow older. Take the medication with full stomach

Celemin Hepa IV BID

Amino acid with electrolytes

Adequate protein supply during hepatic insufficiency

Parenteral

nutrition

for pre, peri, and post operative support

Prophylaxis

and

therapy for protein deficiency

or oral

Inadequate impossible feeding

Hyper natrem ia Hepati c renali mpair ment Water intoxic ation

Nausea Vomitinh Diarrhea Constipation Stomch ache Gi upset Water intoxication hypernatremia

Assessed fluid and electrlytes balance Monitor intake and output Check laboratory results especiall sodium level.

G.I. Tract disease / disorders : short gut syndrome, inflammatory disease, pancreatitis, peritonitis, ulcerative fistula, colitis, bowel tumors,

chronic diarrhoea & vomiting etc.

Cancer and related cachexia

Burns Trauma Hypermetabolism during stress

Sepsis Immunocompromised patient, HIV infection

Prolonged unconsciousness, head injury, poisoning

Moriamin forte 1cap OD

Multivitamins and minerals

Supplies necessary vitamin and mineral supplement to the tissues distributing to different organs of the body ;

For protein deficiency, nutritional imbalance, hypovitaminosis prevention and treatment, rapid fatigability, stress, compromise immune system.

hypervitaminosis

CNS: nausea GI:, diarrhea, vomiting, constipation,stom achache, loss of appetite DERM: peeling skin OTHERS: overdose

Instruct client not to use more than one vitamin supplement, instruct to use regularly for maximum benefits. In case of overdose seek for immediate medical attention , dont use with milk products.