If left untreated

bowel/ stomach perforation with acute hemorrhage and pyloric obstruction

 Advice to eat normally with good appetite Instruct to avoid heavily spiced food such as pizza or sausage because it could cause discomfort Teach about the right and healthy eating habits

Generic Name: esomeprazole magnesium Brand Name: Nexium FDA pregnancy risk category: pregnancy category B Drug Class: Antisecretory drug Proton pump inhibitor Available Forms: DR capsules20, 40 mg; DR powder for suspension20mg, 40mg; injection20, 40 mg/vial

Gastric acid-pump inhibitor. Suppresses gastric acid secretion by specific inhibition of the hydrogen-potassium ATPase enzyme system at the secretory surface of the gastric parietal cells; blocks the final step of acid production; is broken down less in the first pass through the liver than the parent compound omeprazole, allowing for increased serum levels Dosages: Duodenal ulcer: 40mg/day PO for 10 days with 1000 mg PO bid amoxicillin and 500mg PO bid clarithromycin

CNS: Headache, dizziness, asthenia, vertigo, insomnia, apathy, anxiety, paresthesias, dream abnormalities Dermatologic: Rash, inflammation, urticaria, pruritus, alopecia, dry skin GI: Diarrhea, abdominal pain, nausea, vomiting, constipation, dry mouth, tongue atrophy, flatulence Respiratory: URI symptoms, sinusitis, cough, epistaxis

-Contraindicated with hypersensitivity to omeprazole, esomeprazole, or other proton pump inhibitor

-Use cautiously with hepatic impairment, pregnancy, lactation

-GERDtreatment of heartburn and other related symptoms

-Erosive esophangitis -As part of combination therapy for the treatment of duodenal ulcer associated with Helicobacter pylori -Reduction in occurrence of gastric ulcers associated with continuous NSAID use in patients at risk (60 years & older, history of gastric ulcers) for developing gastric ulcers

-Treatment of pathological hypersecretory conditions, including Zollinger- Ellison syndrome

-Unlabeled users: non-GERD dyspepsia, Barrett esophagus, stress ulcer prophylaxis

Assessment: History: Hypersensitivity to any proton pump inhibitor, hepatic impairment; pregnancy, lactation Physical: Skin lesions; T; reflexes, affect; urinary output, abdominal examination; respiratory auscultation, LFTs Interventions: -Ensure that the patient swallows capsule whole; do not crush, or chew; patients having difficulty swallowing may open capsule and dispense in tap water. -Obtain baseline liver function tests and monitor periodically during therapy -Maintain supportive treatment as appropriate for underlying problem -Provide additional comfort measures to alleviate discomfort from GI effects and headache -Establish safety precautions if dizziness or other CNS effects occur (use side rails, accompany patient)

Generic Name: clarithromycin

Brand Name: Biaxin FDA pregnancy risk category: pregnancy category C Drug Class: Macrolide antibiotic Available Forms: Tablets250, 500mg; granules for suspension125, 250mg/5 ml; ER tablets500, 1000 mg

Inhibits protein synthesis in susceptible bacteria, causing cell death

Dosages: Duodenal ulcers: 500 mg PO tid plus omeprazole 40 mg PO every AM for 14 days, the omeprazole 20 mg PO every AM for 14 days

CNS:
GI:

Dizziness, headache, vertigo, somnolence, fatigue

Diarrhea, abdominal pain, nausea, dyspepsia, flatulence, vomiting, melena, pseudomembranous colitis, abnormal taste Superinfections, increased PT, decreased WBC count

Other:


-Contraindicated

with hypersensitivity to clarithromycin, erythromycin, or any macrolide antibiotic -Use cautiously with colitis, hepatic, or renal impairment, pregnancy, lactation

-Treatment of URIs caused by Streptococcus pyogenes, Streptococcus pneumonia -Treatment of lower respiratory infections caused by Mycoplasma pneumoniae, S. pneumoniae, Haemopbilus influenza, Moraxella catarrbalis -Treatment of skin and skin structure infections caused by Staphylococcus aureus, S. pyogenes -Treatment of active duodenal ulcer associated with Helicobacter pylori in combination with proton pump inhibitor -Treatment of mild to moderate community- acquired pneumonia -Treatment of acute otitis media, acute maxillary sinusitis due to H. influenza, M. catarrhalis, S.pneumoniae

Assessment: History: Hypersensitivity to clarithromycin, erythromycin, or any macrolide antibiotic; pseudomembranous colitis, hepatic or reanal impairement, lactation, pregnancy Physical: Site of infection; skin color, lesions; orientation, GI output, bowel sounds, liver evaluation; culture and sensitivity tests of infection, urinalysis, LFTs, renal function tests
Interventions: -Culture infection before therapy -Do not crush or cut and ensure that patient does not chew ER tablets -Monitor patient for anticipated response -Administer without regard to meals ; administer with food if GI effects occur

Generic Name: amoxicillin trihydrate Brand Name: Amoxil, Amoxil Pediatric Drops, Apo-Amoxi (CAN), DisperMox, Gen-Amoxicillin (CAN), Moxatag, Novamoxin (CAN), Nu-Amoxi (CAN), Trimox FDA pregnancy risk category: pregnancy category B Drug Class: Antibiotic (penicillinampicillin type) Available Forms: Chewable tablets125, 200, 250, 400 mg; tablets500, 875 mg; capsules250, 500 mg; powder for oral suspension50mg/mL; 125mg/5mL,200mg/5mL, 250mg/5mL


Bactericidal: Dosages: URIs,

Inhibits synthesis of cell wall of sensitive organisms, causing cell death

GU infections, skin and soft tissue infections: Mild to moderate250 mg PO every 8 hr500 mg PO every 12 hr, severe infection500 mg every 8 hr or 875 mg every 12 hr

CNS: Lethargy, hallucinations, seizures GI: Glossitis, stomatitis, gastritis, sore mouth, furry tongue, black hairy tongue, nausea, vomiting, diarrhea, abdominal pain, bloody diarrhea, enterocolitis, pseudomembranous colitis, non specific hepatitis GU: Nephritis Hematologic: Anemia, thrombocytopenia, leucopenia, neutropenia, prolonged bleeding time Hypersensitivity: rash, fever, wheezing, anaphylaxis Other: Superinfectionsoral and rectal moniliasis, vaginitis


-Contraindicated -Use

with allergies to penicillins, cephalosporins, or other allergies cautiously with renal disorders, lactation

-Infections due to susceptible strains of Haemophilus influenza, Escherichia coli, Proteus mirabilis, Neisseria gonorrhoeae, Strptococcus pneumonia, Enterococcus faecalis, streptococci, nonpenicillinase-producing staphylococci -Helicobacter pylori infection in combination with other agents -Postexposure prophylaxis against Bacillus antbracis -Unlabeled use: Chlamydia trochomatis in pregnancy, mild to moderate otitis media in children

Assessment: History: Allergies to penicillins, cephalosporins, or other allergens; renal disorders; lactation Physical: Culture infected area; skin color, lesion; R, adventitious sounds; bowel sounds; CBC, LFTs, renal function tests, serum electrolytes, Hct, urinalysis Interventions: -Culture infected area prior to treatment; reculture area if response is not as expected -Give in oral preparations only; amoxicillin is not affected by food -Continue therapy for at least 2 days after signs of infection disappeared; continuation for full 10 days is recommended -Use corticosteroids or antihistamines for skin reactions

Patient: Mr. C Age: 19 years old

Subjective: Sumasakit dito ko (referring to abdomen) parang may naninigas sa loob. as verbalize by the patient Objective: -Pain scale of 6 for abdominal pains -Exhibits grimace upon palpitation of the abdomen -Show some signs of irritability -Restlessness

v/s taken as follows: BP= 120/80 RR= 24 PR= 74 bpm T=37.0

Acute pain related to abdominal cramps secondary to dyspepsia

Inference: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage (International Association for the Study of Pain); sudden or slow onset of any intensity from mild to severe with an anticipated or predictable end and a duration of less than 6 months

Short Term Goal: After series of nursing interventions, the patient will be able to: -Verbalize reduction of pain or relief of pain in the abdomen -Feel and palpate abdomen without facial grimace and moaning -Recite and demonstrate some non-pharmacologic ways to lessen pain

Long Term Goal: After 3 days of nursing intervention, the patient will be able to experience gradual reduction or relief of pain from a pain scale of 6 to at least 3

Independent: - Provide comfort measures such as use of pillows under extremities Rationale: To promote relief and wellness. - Encourage and assist client to do deep breathing exercises. Rationale: Deep breathing exercises contribute to relief of pain - Teach client and significant other about the nonpharmacologic ways to lessen the pain.

Rationale: To maximize opportunities for self-control over pain manifestations. - Instruct client to report any improvement/exacerbation in pain experience. - Encourage verbalization of feelings about the pain.
Rationale: Only the client can judge the level and distress of pain; pain management should be a team approach thatincludes the client. - Physical Examination: Periodic auscultation of the abdomen for bowel sounds Inspection and Palpation for masses and tenderness.

Administer medications, particularly analgesics, as prescribed. - Assist with laboratory/diagnostic studies as indicated. (e.g., abdominal X-ray Rationale: Necessary for management of underlying and possible complications

Short Term Goal: After series of nursing interventions, the patient was able to: -Verbalize reduction of pain or relief of pain in the abdomen -Feel and palpate abdomen without facial grimace and moaning -Recite and demonstrate some non-pharmacologic ways to lessen pain

Long Term Goal: After 3 days of nursing intervention, the patient was able to experience gradual reduction or relief of pain from a pain scale of 6 to at least 3 O GOAL MET O GOAL PARTIALLY MET O GOAL UNMET