VII.

The Patient and his Care 4/27/2013 Medical Management #1 D5IMB 500cc 500cc @34 ugtts/min Clients Response to Treatment The patient responded normally.

General Description D5 IMB is a hypertonic solution,which makes the cell shrink. It is composed of water and carbohydrates as source of energy and both cations and anions D5 0.3NaCl is a hypertonic solution owing to the higher than normal amount of Na and Cl ions. It pulls fluid and electrolytes from the intracellular and interstitial compartments into the intravascular compartments Oxygen therapy is the administration of oxygen as a medical intervention.

Indication / Purpose It is used to supply the necessary nutrients to the patient.

Date April 27, 2013

#2 D5 0.3 NaCL 500cc 500cc @35 ugtts/min

To compensate cellular dehydration and corrects moderate fliud loss, prevents alkalosis provides calorie and NaCl

April 27, 2013

The treatment resulted to a good skin turgor and capillary refill and decreased risk for deficient fluid volume.

Oxygen Therapy via nasal canula prn

Salbutamol Nebulization

Adrenergic bronchodilators are medicines that are breathed in through the mouth to open up the bronchial tubes (air passages) in the lungs.

Oxygen is essential for cell metabolism, and in turn, tissue oxygenation is essential for all normal physiological functions. Salbutamol is typically used to treat bronchospasm (due to either allergen asthma or exercise-induced), as well as chronic obstructive pulmonary disease

April 27, 2013

The therapy resulted to improved oxygenation level of the patient

April 27, 2013

The treatment resulted to quick relief on respiration and thinning of mucus.

4/28/2013 Medical Management #4 D5IMB 500cc 500cc @25 ugtts/min

General Description D5 IMB is a hypertonic solution,which makes the cell shrink. It is composed of water and carbohydrates as source of energy and both cations and anions D5 0.3NaCl is a hypertonic solution owing to the higher than normal amount of Na and Cl ions. It pulls fluid and electrolytes from the intracellular and interstitial compartments into the intravascular compartments Oxygen therapy is the administration of oxygen as a medical intervention.

Indication / Purpose It is used to supply the necessary nutrients to the patient.

Date April 28, 2013

Clients Response to Treatment The patient responded normally.

#3 D5 0.3 NaCL 500cc 500cc @35 ugtts/min

To compensate cellular dehydration and corrects moderate fliud loss, prevents alkalosis provides calorie and NaCl

April 28, 2013

The treatment resulted to a good skin turgor and capillary refill and decreased risk for deficient fluid volume.

Oxygen Therapy via nasal canula prn

Salbutamol Nebulization

Adrenergic bronchodilators are medicines that are breathed in through the mouth to open up the bronchial tubes (air passages) in the lungs.

Oxygen is essential for cell metabolism, and in turn, tissue oxygenation is essential for all normal physiological functions. Salbutamol is typically used to treat bronchospasm (due to either allergen asthma or exercise-induced), as well as chronic obstructive pulmonary disease

April 28, 2013

The therapy resulted to improved oxygenation level of the patient

April 28, 2013

The treatment resulted to quick relief on respiration and thinning of mucus.

4/29/2013 Medical Management #4 D5IMB 500cc 500cc @25 ugtts/min

General Description D5 IMB is a hypertonic solution,which makes the cell shrink. It is composed of water and carbohydrates as source of energy and both cations and anions D5 0.3NaCl is a hypertonic solution owing to the higher than normal amount of Na and Cl ions. It pulls fluid and electrolytes from the intracellular and interstitial compartments into the intravascular compartments Oxygen therapy is the administration of oxygen as a medical intervention.

Indication / Purpose It is used to supply the necessary nutrients to the patient.

Date April 29, 2013

Clients Response to Treatment The patient responded normally.

#5 D5 0.3 NaCL 500cc 500cc @30 ugtts/min

To compensate cellular dehydration and corrects moderate fliud loss, prevents alkalosis provides calorie and NaCl

April 29, 2013

The treatment resulted to a good skin turgor and capillary refill and decreased risk for deficient fluid volume.

Oxygen Therapy via nasal canula prn

Salbutamol Nebulization

Adrenergic bronchodilators are medicines that are breathed in through the mouth to open up the bronchial tubes (air passages) in the lungs.

Oxygen is essential for cell metabolism, and in turn, tissue oxygenation is essential for all normal physiological functions. Salbutamol is typically used to treat bronchospasm (due to either allergen asthma or exercise-induced), as well as chronic obstructive pulmonary disease

April 29, 2013

The therapy resulted to improved oxygenation level of the patient

April 29, 2013

The treatment resulted to quick relief on respiration and thinning of mucus.

4/30/2013 Medical Management #6 D5IMB 500cc @35 ugtts/min

General Description D5 IMB is a hypertonic solution,which makes the cell shrink. It is composed of water and carbohydrates as source of energy and both cations and anions D5 0.3NaCl is a hypertonic solution owing to the higher than normal amount of Na and Cl ions. It pulls fluid and electrolytes from the intracellular and interstitial compartments into the intravascular compartments Adrenergic bronchodilators are medicines that are breathed in through the mouth to open up the bronchial tubes (air passages) in the lungs.

Indication / Purpose It is used to supply the necessary nutrients to the patient.

Date April 30, 2013

Clients Response to Treatment The patient responded normally.

#7 D5 0.3 NaCL 500cc @25 ugtts/min

To compensate cellular dehydration and corrects moderate fliud loss, prevents alkalosis provides calorie and NaCl

April 30, 2013

The treatment resulted to a good skin turgor and capillary refill and decreased risk for deficient fluid volume.

Salbutamol Nebulization

Salbutamol is typically used to treat bronchospasm (due to either allergen asthma or exercise-induced), as well as chronic obstructive pulmonary disease

April 30, 2013

The treatment resulted to quick relief on respiration and thinning of mucus.

5/01/2013 Medical Management #8 D5 0.3 NaCL 500cc @25 ugtts/min #9 D5 0.3 NaCL 500cc @25 ugtts/min

General Description D5 0.3NaCl is a hypertonic solution owing to the higher than normal amount of Na and Cl ions. It pulls fluid and electrolytes from the intracellular and interstitial compartments into the intravascular compartments

Indication / Purpose To compensate cellular dehydration and corrects moderate fliud loss, prevents alkalosis provides calorie and NaCl

Date May 01, 2013

Clients Response to Treatment The treatment resulted to a good skin turgor and capillary refill and decreased risk for deficient fluid volume.

5/02/2013 Medical Management #11 D5IMB 500cc 500cc @30 ugtts/min

General Description

Indication / Purpose It is used to supply the necessary nutrients to the patient.

Date May 02, 2013

D5 IMB is a hypertonic solution,which makes the cell shrink. It is composed of water and carbohydrates as source of energy and both cations and anions #10 D5 0.3 NaCL 500cc D5 0.3NaCl is a hypertonic @30 ugtts/min solution owing to the higher than normal amount of Na and Cl ions. It pulls fluid and electrolytes from the intracellular and interstitial compartments into the intravascular compartments NURSING RESPONSIBILITIES:

Clients Response to Treatment The patient responded normally.

To compensate cellular dehydration and corrects moderate fliud loss, prevents alkalosis provides calorie and NaCl

May 02, 2013

The treatment resulted to a good skin turgor and capillary refill and decreased risk for deficient fluid volume.

Before: 1. Verify the doctors order indicating the type of solution, the amount to be administered, the rate of flow of the infusion and any allergies. 2. Explain the procedure and prepare the client. 3. Prepare the equipments needed. 4. Wash hands thoroughly. 5. Obtain IV solution and check for the sediments and any crack or leak from the container. 6. Check also for the expiration date. 7. Check fluid discoloration or defect. If noted, dispose the defected tubing and get another. 8. Assess clients vital signs for baseline data, skin turgor, bleeding tendencies, disease, or injury to the extremities, status of vein to determine the appropriate puncture site. During: 1. Explain the importance and purpose of IVF. 2. Place the patient in a comfortable position to facilitate easyinsertion of the IV line. 3. Use the smallest gauge needle possible.

4. Maintain aseptic technique throughout the procedure. 5. Follow proper procedures in infusing IV solution. 6. Watch out for fluid overload. 7. Secure the needle properly after insertions. Always check the needle of the IV, if it is in the vein:- Bring the IV bottle lower than the patient arm.- Pinch the IV tubing.- Observe the backflow of the blood in the distal portion of the IV tubing. 8. Avoid or remove air from the tubing as it may cause embolism. After: 1. Check for swelling around the site for IV infiltration. Assess for anysigns of edema or bulging of vein if it is not properly inserted. 2. Regulate IVF as ordered. Apply a medication label on the solution if a medication is added. 3. Observe for the reaction of the patient to the solution given. 4. Document related data. 5. Chart the procedure including time, name, dosage and the patient response to the administration. 6. Properly dispose used materials after insertion Diet Type of Diet SFF c SAP (Small Frequent Feeding with Strict Aspiration Precaution) Clients Response The patient responded normally.

General Description The patient is fed frequently in small amounts with strict aspiration precaution

Indication or Purpose It was ordered to help maintain the nutritional status and energy of the patient. Strict aspiration precaution is also instructed since the patient is at high risk of aspiration.

Date April 27, 2013

NURSING RESPONSIBILITIES: Before: Check the Doctors Order. Explain the Indication and purpose of the diet to the patients SO. Explain the Importance of Right Nutrition to the patient / SO. Check the clients choice of food. During: Encourage the patients SO to feed nutritious foods to the patient. After: Recommend the Patients SO to perform Oral Hygiene on patient every after meal

Drugs
Generic Name / Brand Name Acetaminophen / Paracetamol 90mg Date: April 27/ April 28, 2013 prn Mechanism of Action Reduces fever by inhibiting the formulation and release of prostaglandins in the CNS and by inhibition endogenous pyrogens at the hypothalamic thermoregulator center. Classification >acetaminophen combination >analgesic >antipyretic Side Effect Stimulation, drowsiness, nausea, vomiting, abdominal pain, hepatotoxicity. Rare: Hypersensitivity reaction (rashes and shortness of breath). Very Rare: Blood disorders resulting in readiness to bruise or bleed (e.g. thrombocytopenia) or low numbers of white blood cells (leucopenia). Palpitations, chest pain, tremors, headache, dizziness, nervousness. Nursing Consideration >do not take more than 4g in 24hour period >report s/sx of GI hemorrhage, hepatotoxicity, or nephrotoxicity >take with full glass of water

Albuterol Sulfate / Salbutamol neb. Q8 Date: April 27, 2013 Ampicillin 250mg Q8 Date: April 27May03, 2013

Increases cyclic adenosine monophosphate (cyclic AMP) levels resulting in bronchial smooth muscle relaxation and inhibition of release of immediate hypersensitivity mediators from mast cells. Works by inhibiting bacterial cell wall synthesis through binding to one or more penicillin bind proteins of actively dividing cells.

>Beta-2 Adrenergic Agonist >Bronchodilator >Symphatomim etic

>Antibiotic >Penicillin, Aminopenicillin

Glossitis, stomatitis, nausea, vomiting, laryngeal stridor, high fever

>report need for increased frequency or amounts of drug to provide symptomatic relief. >secure mouthpiece for proper inhalation of the drug >pat back of patient after administration with cupped hands. >report incidence of diarrhea >report development of late skin rash >take with full glass of water 1 hr before or 2hr after meal.

Cefotaxime Sodium 250mg Q8 Date: April 27May03, 2013 Acetaminophen / Aeknil (Paracetamol)

Inhibits bacterial cell wall synthesis in a wide range of gram-positive and gramnegative microorganisms.

>3rd generation cephalosporin >antibiotic

Nausea, vomiting, fever.

>report s/sx of serum-sickness like reactions (rash, urticaria, arthralgia, fever, malaise, enlarged lymph nodes)

Reduces fever by inhibiting the formulation and release of prostaglandins in the CNS and

>acetaminophen combination >analgesic

Stimulation, drowsiness, nausea, vomiting, abdominal pain, hepatotoxicity.

>do not take more than 4g in 24hour period >report s/sx of GI hemorrhage,

90mg IV prn Date: April 28/ April 29/ April 30/ May 02, 2013 Diazepam 1.7mg IV prn

by inhibition endogenous pyrogens at the hypothalamic thermoregulator center.

>antipyretic

hepatotoxicity, or nephrotoxicity >take with full glass of water

Reduces neuronal depolarization resulting in decreased action potentials. Enhances action of gamma-

>antianxiety >anticonvulsant >benzodiazepin e

Hypotension, ataxia, sedation, somnolence, respiratory depression, fatigue.

>always keep an eye on the patient after administration of drug. >avoid abrupt discontinuation of drug to prevent withdrawal symptoms.

Date: May 01, 2013

amino butyric acid (GABA) by tightly binding to A-type GABA receptors, thus opening the membrane channels and allowing the entry of chloride ions.

Zinc sulfate monohydrate / E-zinc 0.5ml OD Date: April 29May 02, 2013 Ambroxol Hydrochloride / Ambroxol drops 0.5ml Date: April 29May 02, 2013

E-Zinc contains zinc. Zinc helps the body's natural defense against damaging free radicals (antioxidant effect) and helps bosot immune function.

>Vitamins and minerals (pediatric) >electrolytes

Nausea, vomiting

>take with meals to reduce GI discomfort >take 1hour before or 2hr after meal

It stimulates synthesis and release of surfactant by type II pneumocytes. Surfactant acts as an anti-glue factor by reducing the adhesion of mucus to the bronchial wall, in improving its transport and in providing protection against infection and irritating agents Reduces fever by inhibiting the formulation and release of

>mucolytic agent

GI discomfort, dizziness, allergic reactions

Acetaminophen / Paracetamol

>acetaminophen combination

Stimulation, drowsiness, nausea, vomiting, abdominal pain,

>avoid excess dosage >monitor s/sx of aspiration of excess secretions and bronchospasm >monitor ABG, pulmonary functions and pulse oximeter as indicated. >report difficulty with clearing the airway or respiratory distress >do not give 5 doses within 24 hours unless prescribed by

Drops 1ml Date: May 02, 2013

prostaglandins in the CNS and by inhibition endogenous pyrogens at the hypothalamic thermoregulator center.

>analgesic >antipyretic

hepatotoxicity.

physician >monitor s/sx of hepatotoxicity >avoid taking medications containing acetaminophen unless advised to avoid overdosing. >do not self medicate children >do not use for fever longer than 3days, fever over 39.5 C or recurrent fever.