Tramadol 25 mg/day, and Therapeutic • Moderate to Should not be This medication may cause • Assess type, location, and

doses may be : moderately administered to patientsdizziness, weakness, intensity of pain before and
increased by 25 Analgesics severe pain who have previously incoordination, nausea or 2-3 hr (peak) after
mg every 3 days(centrally demonstrated vomiting, stomach upset, administration.
to reach 100 acting) hypersensitivity to constipation, headache,
mg/day (25 mg tramadol or in cases of drowsiness, anxiety, • Assess BP & RR before
4 times daily) acute intoxication with irritability, dry mouth, or and periodically during
alcohol, hypnotics, increased sweating. If any of administration. Respiratory
centrally acting these effects persist or depression has not occurred
analgesics, opioids or worsen, inform your doctor. with recommended doses.
psychotropic drugs. Notify your doctor if you
develop any of these serious • Assess bowel function
effects while taking this routinely. Prevention of
medication: chest pain, rapid constipation should be
heart rate, skin rash or instituted with increased
itching, mental confusion, intake of fluids and bulk and
disorientation, seizures, with laxatives to minimize
tingling of the hands or feet, constipating effects.
trouble breathing. In the
unlikely event you have a • Assess previous analgesic
serious allergic reaction to history. Tramadol is not
this drug, seek immediate recommended for patients
medical attention. Symptoms dependent on opioids or who
of a serious allergic reaction have previously received
include: rash, itching, opioids for more than 1 wk;
swelling, severe dizziness, may cause opioid withdrawal
breathing trouble 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.
• Tramadol is considered to
provide more analgesia than
codeine 60 mg but less than
combined aspirin
650mg/codeine 60 mg for
acute postoperative pain.

• Monitor patient for seizures.

May occur within
recommended dose range.
Risk increased with higher
doses and inpatients taking
antidepressants (SSRIs,
tricyclics, or Mao inhibitors),
opioid analgesics, or other
durgs that decrese the
seizure threshold.

• Overdose may cause

respiratory depression and
seizures. Naloxone (Narcan)
may reverse some, but not
all, of the symptoms of
overdose. Treatment should
be symptomatic and
supportive. Maintain
adequate respiratory
exchange.

• Encourage patient to cough

and breathe deeply every 2
hr to prevent atelactasis and
pneumonia.
 The usual cephalosp Cefuroxime for Cefuroxime for
Cefuroxime adult dosage orin Injection USP Injection USP and Side effects from
range for antibiotic and Dextrose Dextrose Injection cephalosporin If you are allergic to penicillin-type
cefuroxime is Injection USP is antibiotics are antibiotics, alert your physician
USP is
750 mg to 1.5 indicated for the generally mild. immediately. Some people who are
grams every 8 treatment of contraindicated in Nevertheless, sensitive to penicillin may also react
hours, usually patients with patients with known diarrhea can be to Ceftin.
for 5 to 10 infections allergy to the troubling for
days. caused by cephalosporin group some people Symptoms such as breathing
susceptible of antibiotics. and in rare difficulty, wheezing, sneezing, hives,
strains of the Solutions containing instances may itching, and skin rash require
designated develop into immediate emergency treatment.
dextrose may be
organisms in colitis.
the following contraindicated in
Life-threatening anaphylactic shock
diseases: patients with Other reactions may produce an inability to breathe
hypersensitivity to that have and cardiovascular collapse and can
1. Lower corn products. occasionally occur within minutes of exposure.
Respiratory been reported
Tract with Ceftin People with kidney or liver disease
Infections, include nausea, may need special medical
including vomiting, supervision when they take Ceftin.
pneumonia, vaginitis, This medicine may also interfere
caused by itching, rash, with certain diabetes tests.
Streptococc stomachache,
us dizziness and Prolonged use of an antibiotic like
pneumonia headache. Ceftin sometimes leads to an
e, overgrowth of fungus or resistant
Haemophilu bacteria known as superinfection. If
s influenzae this occurs, the doctor may need to
Klebsiella have you discontinue Ceftin and
spp., take a different medication.
Staphylococ
cus aureus
Streptococc
us
pyogenes,
and
Escherichia
coli.
 70 to 150 mg organic Vitamin C is Contraindicated in - Always eat full meal
Ascorbic daily. acid recommended those persons who Diarrhea, GI before taking medication
aci antiinfecti for the have shown disturbances.
d ves. prevention and May cause
hypersensitivity to
treatment of acidification of
scurvy. Its any component of the urine;
parenteral this preparation. precipitation of
administration urate, cystine or
is desirable for oxalate stones,
patients with an or drugs in the
acute deficiency urinary tract.
or for those
whose
absorption of
orally ingested
ascorbic acid is
uncertain.

Symptoms of
mild deficiency
may include
faulty bone and
tooth
development,
gingivitis,
bleeding gums,
and loosened
teeth. Febrile
states, chronic
illness, and
infection
(pneumonia,
whooping
cough,
tuberculosis,
diphtheria,
sinusitis,
rheumatic fever,
etc.) increase
Metronidazo •CNS: seizures,
le PO 7.5 mg/kg Anti- Amebicide in • hypersensitivity dizziness, • Administer with food or milk
q6hr (not to infectives, the headache to minimize GI irritation.
exceed Anti- management of • GI: abdominal Tablets may be crushed
4g/day) protozoal amebic pain, anorexia, for patients with difficulty
s dysentery nausea,
diarrhea, dry swallowing.
mouth, furry • Instruct patient to take
tongue, medication exactly as
glossitis, directed evenly spaced
unpleasant times between dose,
taste, vomiting even if feeling better. Do
• Hematologic:
not skip doses or double
leukopenia
• Skin: rashes, up on missed doses. If a
urticaria dose is missed, take as
soon as remembered if
not almost time for next
dose.
•May cause dizziness or
light-headedness.
Caution patient or other
activities requiring
alertness until response
to medication is known.
• Inform patient that
medication may cause an
unpleasant metallic taste.
• Inform patient that
medication may cause
urine to turn dark.
• Advise patient to
consult health care
professional if no
improvement in a few
 DISCHARGE PLAN

MEDICATION:

Ascorbic acid 500mg tablet

-1 Tablet twice a day
-should be taken with food that is when food has entered your stomach. This means 'during' or 'after' however, this must be
straight after otherwise food has travelled on already.

Tramadol 500mg capsule

-1 capsule thrice a day

EXERCISE
Client may perform light exercises such as brisk walking; jogging a few meters and the likes, but exercises must be limited to
what the patient can tolerate so that he will not experience difficulty of breathing. Breathing exercises and chest physiotherapy are
the mainstays for the quick expansion of the lung. Incentive spirometry (eg, TriFlo incentive spirometer) gives the patient the impetus
to expand the lung quickly. Upper limb movements, especially at the shoulder, help restore the movements of the chest wall.

Treatment
Treatment of chest tube thoracostomy includes the continuation in taking medicines prescribed by the physician to improve
his condition.

Health Teaching
Advise the patient to avoid going near people who are smoking, and if possible, wear mask when going out to avoid inhaling
smoke, dusts and other chemicals that may trigger his complication. Remind the client to adhere to drug therapy for long periods of
time even when signs and symptoms are not evident and make some lifestyle changes

Out-patient follow-up
Schedule of follow up check up is on august 19, 2010 in outpatient department, 8 o’clock in the morning until 1 o’clock pm

Diet
Diet as tolerated