X.

DRUG STUDY
NAME OF DRUG GENERIC NAME CEFAZOLIN (Cephalosporin) DOSAGE AND ROUTE ACTION INDICATION CONTRAINDICTION ADVERSE REACTION NURSING RESPONSIBILITIES

BRAND NAME: ANCEF

1gm IV every Inhibits bacterial cellwall 8 hours synthesis, thus promoting osmotic instability which eventually leads to bacterial cell death.

Infections caused by staphyloccocus, streptoccocus, E. coli. D. Pneumoniae and other susceptible microorganisms. Respiratory tract infection, genitourinary tract infections, gynecological infections, skin and skin structure infections, pre and post- operative wound and trauma, biliary tract infections, bone and joint infections, perioperative prophylaxis. Treatment of septicemia and endocarditis.

Allergy to penicillins and cephalosporins.

Signs of allergy: skin rash, fever, hematologic disorders: eosinophilia, leukopenia, reversible thrombopenia. Digestive diorders: nausea, vomiting, anorexia, diarrhea.oral thrush. Transient rise in SGOT and SGPT and alkaline phosphatase.

Instruct patient to report sore throat, bruising, bleeding and joint pain, this may indicate blood dyscrasias. Instruct patient to report perineal itching, fever malaise, redness and pain, swelling, drainage, rash, diarrhea and changes in cough, sputum, or furry tongue this may indicate superinfection. Assess patient sensitivity reaction to penicillin or other cephalosporins. Assess patient for sign and symptoms of infection before and during treatment: fever, earache, characteristics of wounds, sputum, urine, stool and WBC>10,000/mm3.

X. DRUG STUDY
NAME OF DRUG DOSAGE AND ROUTE ACTION INDICATION CONTRAINDICTION ADVERSE REACTION NURSING RESPONSIBILITIES

TRAMADOL (Analgesic)

50mg IV PRN Centrally acting for Pain analgesic not chemically related to opioids but binds to mu- opioid receptors and inhibits reuptake of norepinephrine and serotonin.

Moderate to severe pain. Hypersensitivity. Acute intoxication with alcohol, hypnotics, centrally acting analgesics, opioids, or psychotropic agents.

Vasodilation; dizziness/vertigo, headache, somnolence,stimulation, anxiety,confusion,coordi nation disturbances, euphoria, nervousness, sleep disorder,seizures. Pruritus, sweating, rash. Visual disturbances, dry mouth. Nausea, diarrhea, constipation, vomiting, dyspepsia, abdominal pain, anorexia, flatulence. Urinary retention, increased creatinine, proteinuria. Decreased hemoglobin, elevated liver enxymes, asthenia, hypertonia.

Assess for hypersensitivity reactions: pruritus, rash and urticaria. Monitor for CNS changes: dizziness, drowsiness, hallucinations, euphoria, loss of consciousness and pupil reaction. Monitor I and O ratio and chech for decreasing output which may indicate retention. Advise patient to avoid alcohol. Instruct patient to change positions slowly to prevent orthostatic hypotension. Instruct patient to report changes in bowel pattern. Instruct to increase diet bulk and oral fluids and to prevent constipation.

X. DRUG STUDY
NAME OF DRUG DOSAGE AND ROUTE ACTION INDICATION CONTRAINDICTION ADVERSE REACTION NURSING RESPONSIBILITIES

Hypersensitivity.
NALBUPHINE (Muscle Relaxant)

5mg IV every Binds with opiate 4 hours x 4 receptor in the CNS: doses ascending pain pathways in limbic system, thalamus, midbrain, hypothalamus, altering perception of and emotional response to pain. Relieves pain.

Relief of moderate to severe pain; for preoperatively analgesia, supplement to balanced anesthesia, surgical anesthesia, obstetrical anesthesia.

Sedation, drowsiness, sweating, nausea, dry mouth, dizziness and headache, vomiting.

Monitor vital signs after parenteral route. Assess for pain characteristics Check for some reaction (allergic) Instruct patient to change position slowly to prevent orthostatic hypotension and avoid getting up without assistance.

KETOROLAC (Muscle relaxant, Uricosurics, analgesic)

30mg IV every Analgesic, anti 6 hours x 4 inflammatory and anti doses pyretic. Inhibits prostaglandins synthesis by inhibition of cyclooxygenase enzyme, it also inhibits leukotrine synthesis, help stabilize, lysosomal membranes and exert antibradykinin activity.

Short term management of moderate to severe acute post- operative pain.

Active peptic ulcer disease, recent gastrointestinal bleeding or perforation, moderate to severe renal impairment, hypovolemia or dehydration, hypersensitivity to aspirin ASA or NSAIDS, history in asthma.

Gastrointestinal ulceration, bleeding and perforation, post operative, bleeding, acute renal failure, anaphylactic and anaphylactoid reactions, liver failure. Hypertension, pruritus rash, GI disturbances, nausea, dyspepsia, diarrhea, purpura, headache, drowsiness edema and injection site pain.

Assess for hypersensitivity reaction. Advice patient to report persistence or worsening of pain. Check for swelling or itching.

IX. NURSING CARE PLAN CUES Subjective: nasakit ken nautot pay laeng ta sakak manang as verbalized by the patient. NURSING DIAGNOSIS Pain related to injury to the soft tissue secondary to direct trauma (vehicular accident) as evidenced by cues presented. SCIENTIFIC OBJECTIVES BACKGROUND Unpleasant sensory - Perform appropriate and emotional and accurate care in experience arising conjunction of the from actual or patient. potential tissue damaged( - To provide necessary International health teachings Association for the essential for the study of Pain); patient fast recovery sudden or slow onset and discharge, of any intensity from prevention of possible mild to severe with complication an anticipated or predictable end and a duration of less than - Assess patient overall six months. health status INTERVENTION - Maintain immobilization of affected part by means of bed rest, cast, splint or traction. - Elevate and support injured extremity RATIONALE - Relieves pain and prevents bone displacement/ extension of tissue injury - Promote venous return, decreases edema and may reduce pain - Can increase discomfort by enhancing heat production in the drying cast. - Helps alleviate anxiety. Patient may feel need to relieve the accident experience - Maintain strength/ mobility of unaffected muscle and facilitate resolution of inflammation in injured tissues - Improve general circulation, reduces areas of local pressure and muscle fatigue NURSING RESPONSIBILITIES After series of nursing interventions goals partially met as evident of the patient decrease in pain scale of 8/10 to 3/10 and positive verbal report of the patient during evaluation.

Objective: - Reports of pain with pain scale of 8/10. - Facial mask of pain - Guarding behavior - Irritable - Minimal movement -

- Avoid use of plastic sheet/ pillows under limbs in cast - Encourage patient discuss problem related to injury

- Perform and supervise active/ passive ROM exercise.

- Provide alternative comfort measure such as position changes.

Nurses Pocket Guide: Diagnoses, interventions and Rationales 9th edition. Marilyn E. Doenges Mary Frances Moorh ouse Alice C. Geissler Murr

CUES Subjective: haan ko pay unay maigaraw toy sakak manang as verbalized by the patient.

Objective: - Decrease muscle strength/contr ol. - Reluctance to attempt movement

NURSING DIAGNOSIS Impaired physical mobility related to neuromuscular skeletal impairment due to direct trauma(vehicular accident) as evidenced by cues presented.

- Limited ROM - Inability to move purposefully

SCIENTIFIC BACKGROUND impaired skin integrity defined as alteration in the epidermis and/or dermis. The skin is subject to injury from a variety of external and internal factors. Extremes of heat and cold; pressure, shearing, and other mechanical forces; allergens; chemicals; radiation; and excretions and secretions such as those from an ostomy or a draining wound are all potentially damaging conditions and substances that exist in the external environment. Internal factors include emaciation, drugs, altered circulation and impaired oxygen transport, altered metabolic state, and infections.

OBJECTIVES/PLANNING After 2 days of nursing intervention, the patient will a) Verbalize understanding of the situation and individual treatment regimen and safety measures. b)Participate in ADLs and desired activities c) Maintain position of function and skin integrity as evidenced by absence of decubitus ulcers d.)Maintain a n d increase strength and function of affected part.

INTERVENTION - Assess degree of immobility produce by injury/ treatment and note patients perception of immobility. -

- Instruct patient in/assist with active/passive ROM exercises of affected and unaffected extremities.

- Encourage use of isometric exercises starting with the unaffected limb.

- Monitor blood pressure (BP) with resumption of activity. Note reports of dizziness.

- Reposition periodically and encourage coughing/deepbreathing exercises

NURSING RESPONSIBILITIES Patient may be restricted by Goal unmet as self-view/self-perception evident of the out of proportion with patient difficulty actual physical limitations, in initiating requiring movement and information/interventions to cant maintain promote progress toward strength and wellness. function of the affected area. Increases blood flow to muscles and bone to improve muscle tone, maintain joint mobility; prevent contractures/atrophy and calcium resorption from disuse Isometrics contract muscles without bending joints or moving limbs and help maintain muscle strength and mass Postural hypotension is a common problem following prolonged bed rest and may require specific interventions (e.g., tilt table with gradual elevation to upright position). Prevents/reduces incidence of skin and respiratory complications (e.g., decubitus, atelectasis, pneumonia).

RATIONALE