IX.

MEDICATIONS, INFUSIONS, TREATMENTS GIVEN

Generic/ Dosage/ Classification Indication Contra- Side Effects Nsg. Responsibilities

Trade Name Frequency indication
 Paracetamo - Mild to - nonnarcotic / - Fever - - Body as a Whole: - Monitor for S&S of:
l Moderate Pain, nonopioid reduction. Hypersensitivit Negligible with hepatotoxicity, even with
Fever analgesic, y to recommended moderate acetaminophen
Adult: PO 325– antipyretic; - acetaminophen dosage; rash. doses, especially in
650 mg q4–6h Temporary or phenacetin; individuals with poor nutrition
(max: 4 g/d) PR relief of use with - Acute poisoning: or who have ingested alcohol
650 mg q4–6h mild to alcohol. Anorexia, nausea, over prolonged periods;
(max: 4 g/d) moderate vomiting, dizziness, poisoning, usually from
pain. lethargy, diaphoresis, accidental ingestion or suicide
Child: PO 10–15 chills, epigastric or attempts; potential abuse from
mg/kg q4–6h PR - Generally abdominal pain, psychological dependence
2–5 y, 120 mg as diarrhea; (withdrawal has been
q4–6h (max: substitute associated with restless and
720 mg/d); 6–12 for aspirin - onset of excited responses).
y, 325 mg q4–6h when the hepatotoxicity—
(max: 2.6 g/d) latter is not elevation of serum
tolerated or transaminases (ALT,
Neonate: PO is AST) and bilirubin;
10–15 mg/kg contraindic hypoglycemia,
q6–8h ated hepatic coma, acute
renal failure (rare).

- Chronic ingestion:
Neutropenia,
pancytopenia,

25
 leukopenia,
thrombocytopenic
purpura,
hepatotoxicity in
alcoholics, renal
damage.
 Ofloxacin - Uncomplicated - antibiotic, - - - CNS: Headache, - Assessment & Drug Effects
Gonorrhea quinolone Chlamydia Hypersensitivit dizziness, insomnia,
Adult: PO 400 trachomatis y to ofloxacin hallucinations. - Lab tests: Do C&S tests
mg for 1 dose infection, or other prior to initial dose. Treatment
quinolone - GI: Nausea, may be implemented pending
- Urinary Tract, - antibacterial vomiting, diarrhea, results.
Respiratory uncomplica agents; GI discomfort.
Tract, and Skin ted - Determine history of
and Skin gonorrhea, - tendon pain; - Urogenital: hypersensitivity reactions to
Structure Pruritus, pain, quinolones or other drugs
Infections - prostatitis, - sunlight (UV) irritation, burning, before therapy is started.
Adult: PO 200– respiratory exposure; vaginitis, vaginal
400 mg q12h x tract discharge, - Withhold ofloxacin and
7–10 d IV 400 infections, - QT dysmenorrhea, notify physician at first sign
mg q12h x 7 d prolongation; menorrhagia, dysuria, of tendon pain, a skin rash, or
- skin and urinary frequency. other allergic reaction.
skin - viral
- Prostatitis
structure infection; - Monitor for seizures,
Adult: PO 300 - Skin: Pruritus, rash.
infections, pregnancy especially in patients with
mg b.i.d. x 6 wk
(category C). known or suspected CNS
-Other: Cartilage
- urinary disorders. Discontinue
- Superficial erosion.
tract Cautious Use ofloxacin and notify physician
Ocular
infections immediately if seizure occurs.
Infections - Renal
26
Adult:
Ophthalmic due to disease; - Assess for signs and
Instill 1–2 drops susceptible symptoms of superinfection
q2–4h for first 2 bacteria, - patients with (see Appendix F).
d, then q.i.d. for a history of
up to 5 - epilepsy, Patient & Family Education
additional d superficial psychosis, or
ocular increased - Drink fluids liberally unless
- Otitis Media infections, intracranial contraindicated.
with Perforation pressure,
- pelvic cerebrovascula - Be aware that dizziness or
Adult: Otic 10
inflammato r disease, CNS light-headedness may occur;
drops (0.5 mL)
ry disease. disorders such use appropriate caution.
q12h for 14 d
Child ( 1 y): as seizures,
- Otic: epilepsy, - Avoid excessive sunlight or
Otic 5 drops
otitis myasthenia artificial ultraviolet light
(0.25 mL) q12h
externa, gravis; because of the possibility of
for 14 d
otitis media phototoxicity.
with - GI disease,
- Otitis Externa
perforated colitis,
Adult: Otic 10
tympanic dehydration;
drops (0.5 mL)
membranes
q12h for 7 d
. - syphilis;
Child (6 mo–13
y): Otic 5 drops
Unlabeled - atrial
(0.25 mL) q12h
Uses fibrillation;
for 7 d
- EENT -acute MI;
- Renal infections, CVA;
Impairment
27
 Clcr 20–
50mL/min: dose - - children and
should be given Helicobacte adolescents
q24h; <20 r pylori <18 y (except
mL/min: ½ the infections, for otic
dose q24h Salmonella preparation).
gastroenteri
- Hepatic tis.
Impairment
Severe
impairment: 400
mg qd
 Tramadol - Pain - analgesic; - - - CNS: Drowsiness, Assessment & Drug Effects
Adult: PO 50– narcotic (opiate) Manageme Hypersensitivit dizziness, vertigo,
100 mg q4–6h agonist; nt of y to tramadol fatigue, headache, - Assess for level of pain
prn (max: 400 moderate to or other opioid somnolence, relief and administer prn dose
mg/d), may start moderately analgesics; restlessness, as needed but not to exceed
with 25 mg/d if severe pain. euphoria, confusion, the recommended total daily
not well - patients on anxiety, coordination dose.
tolerated, and MAO disturbance, sleep
increase by 25 inhibitors; disturbances, - Monitor vital signs and
mg q3d up to seizures. assess for orthostatic
200 mg/d - patients hypotension or signs of CNS
Geriatric: PO acutely - CV: Palpitations, depression.
50–100 mg q4– intoxicated vasodilation.
6h prn (max: with alcohol, - Discontinue drug and notify
300 mg/d), may hypnotics, - GI: Nausea, physician if S&S of
start with 25 centrally acting constipation, hypersensitivity occur.
mg/d if not well analgesics, vomiting,
28
tolerated, and xerostomia,
increase by 25 opioids, or dyspepsia, diarrhea, - Assess bowel and bladder
mg q3d up to psychotropic abdominal pain, function; report urinary
200 mg/d drugs; anorexia, flatulence. frequency or retention.

- Renal - substance - Body as a Whole: - Use seizure precautions for

Impairment abuse; Sweating, patients who have a history of
Clcr <30 anaphylactic reaction seizures or who are
mL/min: - patients on (even with first dose), concurrently using drugs that
decrease to 50– obstetric withdrawal syndrome lower the seizure threshold.
100 mg q12h preoperative (anxiety, sweating,
medication; nausea, tremors, - Monitor ambulation and take
- Hepatic diarrhea, appropriate safety
- abrupt precautions.
Impairment piloerection, panic
discontinuation
Cirrhosis: attacks, paresthesia,
; Patient & Family Education
decrease to 50– hallucinations) with
100 mg q12h abrupt
- alcohol - Exercise caution with
discontinuation.
intoxication; potentially hazardous
activities until response to
- pregnancy - Skin: Rash.
drug is known.
(category C);
- Special Senses: - Understand potential adverse
- lactation; Visual disturbances. effects and report problems
with bowel and bladder
- children <16 - Urogenital: Urinary function, CNS impairment,
y. retention/frequency, and any other bothersome
menopausal adverse effects to physician.
Cautious Use symptoms.

29
Debilitated
patients;

- chronic
respiratory
disorders;

- respiratory
depression;

- older adults;

- liver disease;

- renal
impairment;

- myxedema,
hypothyroidis
m, or hyp

- oadrenalism;

- GI disease;

- acute
abdominal
conditions;

30
 - increased ICP
or head injury,
increased
intracranial
pressure;

- history of
seizures;

- patients >75
y.
 Ampicillin - Systemic - antibiotic; - Treatment - - Body as a Whole: Assessment & Drug Effects
+ Infections aminopenicillin of Hypersensitivit Hypersensitivity
Sulbactam Adult/Child (> infections y to (rash, itching, - Determine previous
40 kg): IV/IM due to penicillins; anaphylactoid hypersensitivity reactions to
1.5–3 g q6h susceptible reaction), fatigue, penicillins, cephalosporins,
(max: 4 g organisms - malaise, headache, and other allergens prior to
sulbactam/d) in skin and mononucleosis chills, edema. therapy.
Child ( 1 y): IV skin .
300 mg/kg/d structures, - GI: Diarrhea, - Lab tests: Baseline C&S
(200 mg/kg Cautious Use nausea, vomiting, tests prior to initiation of
ampicillin and - abdominal distention, therapy; start drug pending
100 mg/kg intraabdom - candidiasis. results.
sulbactam) inal Hypersensitivit
divided q6h infections, y to - Hematologic: - Report promptly
and cephalosporins Neutropenia, unexplained bleeding (e.g.,
- Renal ; thrombocytopenia. epistaxis, purpura,
Impairment - ecchymoses).

31
 Clcr >30 gynecologi - Urogenital:
mL/min: give c - GI disorders; Dysuria. - Monitor patient carefully
q6–8h; 15–29 infections. during the first 30 min after
mL/min: give - Renal disease - CNS: Seizures. initiation of IV therapy for
q12h; 5–14 or impairment; signs of hypersensitivity and
mL/min: give - Other: Local pain at anaphylactoid reaction (see
q24h - pregnancy injection site; Appendix F). Serious
Dialysis: Give (category B) or thrombophlebitis. anaphylactoid reactions
dose after lactation. require immediate use of
dialysis emergency drugs and airway
management.

- Observe for and report

symptoms of superinfections
(see Appendix F). Withhold
drug and notify physician.

- Monitor I&O ratio and

pattern. Report dysuria, urine
retention, and hematuria.

Patient & Family Education

- Report chills, wheezing,

pruritus (itching), respiratory
distress, or palpitations to
physician immediately.

Treatment/ Classification Indication Contraindication Nursing

32
 Infusion Responsibilities
Plain Normal Saline Isotonic *Hypovolemia *CHF *Do not connect flexible
Solution (PNSS) *Heat-related plastic containers of
emergencies intravenous solutions in
*Freshwater drowning series, i.e., do not
*Diabetic piggyback connections.
ketoacidosis(DKA) Such use could result
in air embolism due to
residual air being
drawn from one
container before
administration of the
fluid from a secondary
container is completed.
*Pressurizing
intravenous solutions
contained
in flexible plastic
containers to increase
flow
rates can result in air
embolism if the residual
air in the container is not
fully evacuated prior
to administration.
*Use of a vented
intravenous
administration
set with the vent in the
33
 open position could
result in air embolism.
Vented intravenous
administration sets with
the vent in the open
position should not be
used with flexible
plastic contain.
Dextrose 5% in H2O Hypotonic dextrose *IV access for *Trauma * Since the tonicity is
(D5W) solution; Crystalloid emergency drug *Hypovolemia, low, avoid using in head
solution administration Hypotension injury patients.
*Dilution of drugs to be *When Dilantin * Use sterile technique
given IVPB (phenytoin) will be in venipuncture and
*Provides free water for given equipment assembly,
intravenous KVO *Patients at risk for with all venipunctures
*Provides a modest increased I.C.P. * Do not administer
sugar source for cellular * Patients who have an quantity in excess of that
metabolism acute neurological required to keep vein
dysfunction. open or administer
* Hypovolemic states. appropriate dose of
* Patients at risk for medication.
third-space fluid shifts. * Do not use solution if
* Elevated blood outdated, cloudy or the
glucose concentrations. seal is not intact, as with
all IV solutions.
* Monitor E.C.G.
continuously.
* Monitor blood
pressure, pulse rate and
34
 respiratory rate
frequently.
Plain Lactated Ringers Isotonic * This medication is an * Renal failure * Never stop hypertonic
Solution (PLR) intravenous (IV) * Liver dysfunction solutions abruptly.
solution used to supply * Diabetes Mellitus * Don’t give
water * Lactic acidosis concentrated solutions
andelectrolytes (e.g., * Alkalosis I.M. or
calcium, potassium, subcutaneously.
sodium, chloride) * Check vital signs
without calories frequently. Report
(dextrose), to the body. adverse reactions.
It is also used as a * Monitor fluid intake
mixing solution (diluent) and output and weight
for other IV carefully. Watch closely
medications. for signs and symptoms
of fluid overload.
* Monitor patient for
signs of mental
confusion

X. PROBLEM IDENTIFICATION AND PRIORITIZATION

NURSING DIAGNOSIS PRIORITY RATIONALE

Acute Pain related to inflammation and High Priority This is an actual problem that needs to be resolved
presence of a chest tube as manifested by immediately or be attended urgently. The resolution of
facial grimace upon position changing, this problem will also resolve the clients impaired gas

35
 pain scale of 8/10, guarding behavior,
reported unilateral chest pain aggravated
by coughing, moving, and breathing,
decreased breath sounds on affected area
of the lungs.
Risk for Ineffective Breathing Pattern
related to decreased lung expansion.
Impaired Gas Exchange related to altered
oxygen supply secondary to ventilation-
perfusion mismatch, presence of lung
secretions, as manifested by tachypnea,
difficulty of breathing.
XI. NURSING CARE PLAN
NURSING ANALYSIS
DIAGNOSIS/
CUES
exchange as this will let client to easily practice deep
breathing exercise. Pain is a 5th vital sign and so this is
of high priority. This also of short term goal. Also pain
is something that triggers anxiety and mood changes.
As health care providers we want to allay fears and
anxiety especially it’s the patient’s first time to be
confined in hospital.
Low Priority This is not an actual problem.
Low Priority This is an actual problem that is related to airway.
Breathing exercises could be learnt by patient but with
difficulty still because of pain felt by the client upon
breathing especially deep breathing. This problem will
easily be modified if pain is not present upon deep
breathing. This also does not pose a life threat as
patient can sort to oxygen therapy.
GOAL/ NURSING RATIONALE EVALUATION
INTERVENTION
OBJECTIVES
36
Acute Pain related to Pain affects the GOAL: After 1 hr of
inflammation and entire body. It can nursing
presence of a chest increase heart rate After 1 hr of nursing intervention, the
tube as manifested and blood pressure intervention, the client’s
by facial grimace alter mood and client’s subjective subjective
upon position cause stress and perception of pain will perception of
changing, pain scale anxiety. Until the decrease as pain decreases,
of 8/10, guarding pain is managed, it documented by pain as documented
behavior, reported will be difficult to scale. Objective by pain scale.
unilateral chest pain proceed with other indicators, such as Objective
aggravated by lower priority grimacing, will be indicators, such
coughing, moving, nursing absent or diminished. as grimacing,
and breathing, interventions. For OBJECTIVES: were diminished.
decreased breath example, a patient
sounds on affected recently had knee After nursing GOAL MET
area of the lungs. surgery and is interventions, client
cleared to start will be able to:
ambulating. He is
Report pain is
also being At frequent intervals, These
relieved and/or
discharged soon assess patient’s degree of assessments
controlled.
and needs to discomfort using patient’s monitor trend of
understand care verbal and non-verbal pain and help
instructions. But his cues. Devise a pain scale determine
knee is still causing with a patient with 0 effectiveness of
him a great deal of having no pain at all and subsequent pain
pain. He is not 10 having worst pain. interventions.
interested in trying
to walk, he doesn't
want to hear his Follow prescribed
Medicate with analgesics This action
37
instructions, he just pharmacological as prescribed. Use also provide pain
wants to stop regimen. pain scale to evaluate and relief and
hurting. Everything document medication determine
else comes to a halt effectiveness. effectiveness of
until that pain the analgesia
reaches a
manageable level. Verbalize methods .
Encourage patient to
that provide relief. request analgesic before Prolonged
pain becomes severe or stimulation of
alternatively, administer at pain receptors
scheduled intervals. results in
increased
sensitivity to
painful stimuli
and increases
amount of drug to
relieve pain
Pre-medicate patient 30
minutes before initiating
coughing, repositioning.
This medication
provides comfort
to client prior to
coughing and
Demonstrate use of repositioning.
Teach patient to splint
relaxation skills and
affected side when
activities that reduce
coughing, moving, or
level of pain This action
repositioning, and lauging.
perceived. reduces

38
 discomfort.

Facilitate coordination
among health care
providers to provide rest
periods in between care Relaxation
activities. decreases oxygen
demand and
reduces level of
pain.

Stabilize chest tube. Tape

chest tube securely to
thorax.

Position tube to ensure These actions

there are no dependent reduce pull or
loops drag on latex
connector tubing,
prevent
discomfort and
help facilitate
drainage and
appropriate
functioning.

39