DOSAGE/ROUTE/ INDICATIONS FOR USE

TRADE/GENERIC NAME FREQUENCY CLASSIFICATION ACTION OF MEDICATION (PATIENT SPECIFIC)

Zofran ODT/ ondansetron 4mg PO every 4 hours Antinausea, Blocks serotonin, both peripherally on Prevention of postop nausea, vomiting.
PRN nausea Antiemetic vagal nerve terminals, centrally in
chemoreceptor trigger zone.

Lasix/furosemide 20mg 1 tab PO QD Diuretic Produces diuresis, lowers B/P. Treatment of edema associated with
CHF, acute pulmonary edema.

Colace/docusate 100mg PO QD Stool softener Decreases surface film tension by Stool softener for those who need to
mixing liquid with bowel contents. avoid straining during defecation;
constipation associated with hard, dry
stools.

Percocet/ 5/325mg PO three Analgesic Appears to inhibit prostaglandin Relief of mild to moderate pain.
acetaminophen/oxyco- times a day PRN pain synthesis in the CNS and, to a lesser
done 325mg/5mg extent, block pain impulses through
peripheral action.

Cardizem CD/diltiazem 180mg PO PD Antianginal, Decreases heart rate, myocardial Treatment of angina due to coronary
Antiarrhythmic contractility; slows SA, AV conduction; artery spasm, chronic stable angina
decreases total peripheral vascular (effort-associated angina).
resistance by vasodilation.
 NURSING ASSESSMENT
(PATIENT SPECIFIC)

Assess for dehydration if excessive

vomiting occurs. Provide emotional
support. Monitor daily pattern of bowel
activity and stool consistency.

Check vital signs especially B/P for

hypotension before administration.
Assess skin turgor, mucous
membranes for hydration status;
observe for edema. Assess muscle
strength, mental status. Obtain
baseline weight. Initiate I&O
monitoring.

Encourage adequate fluid intake.

Assess bowel sounds for peristalsis.

Assess onset, type, location, duration

of pain. Effect of medication is reduced
if full pain response recurs prior to
next dose. If respirations are 12/min or
less withhold medications, contact
physician. Assess for clinical
improvement and relief of pain.

Assess B/P, apical pulse immediately

before drug is administered. Monitor
pulse rate for bradycardia.
 DOSAGE/ROUTE/ INDICATIONS FOR USE
TRADE/GENERIC NAME FREQUENCY CLASSIFICATION ACTION OF MEDICATION (PATIENT SPECIFIC)

Glynase/glyBURIDE 2.5mg PO QD Hypoglycemic Promotes release of insulin from beta Adjunct to diet, exercise in
cells of pancreas, increases insulin management of stable, mild to
sensitivity at peripheral sites. Lowers moderately severe NIDDM (type 2).
serum glucose level.

Exelon/rivastigmine 4.6mg transdermal Anti-Alzheimer's Slows progression of symptoms of Treatment to mild to moderate
patch QD dementia agent Alzheimer's disease. dementia of the Alzheimer's type.
Treatment of dementia associated with
Parkinson's disease.

Zocor/simvastatin 80mg PO QHS Anti- Decreases LDL, cholesterol, VLDL, Treatment of hyperlipidemia to reduce
hyperlipidemic triglyceride levels; slight increase in elevations in total serum cholesterol.
HDL concentration. Secondary prevention of
cardiovascular events in pts with
hypercholesterolemia.

Prilosec/omeprazole 20mg PO QD Gastric acid Increases gastric pH, reduces gastric Treatment of symptomatic
pump inhibitor acid production. gastroesophageal reflux disease
(GERD) poorly responsive to other
treatment.

Humalog/insulin lispro administer Sub-Q Antidiabetic Controls glucose levels in diabetic Treatment of NIDDM (type 2) when
100units/ml based on sliding scale patients. diet and weight control therapy have
- check BS four times failed to maintain satisfactory serum
daily glucose levels.

Hep-Lock/heparin 5,000 units/ml Sub-Q Anticoagulant Interfers with blood coagulation by Prophylaxis, treatment of
every 8 hours blocking conversion of prothrombin to thromboembolic disorders, including
thrombin and fibrinogen to fibrin. venous thrombosis, pulmonary
embolisy, peripheral arterial embolisy,
atrial fibrillation with embolism.
 NURSING ASSESSMENT
(PATIENT SPECIFIC)

Check serum glucose level. Discuss

lifestyle to determine extent of
learning, emotional needs. Assess for
hypo/hyperglycemia.

Obtain baseline vital signs. Assess

history for peptic ulcer, urinary
obstruction, asthma, COPD. Assess
cognitive, behavioral, functional
deficits. Monitor for nausea, diarrhea,
headache, insomnia.

Monitor serum cholesterol, triglyceride

lab results for therapeutic response.
Monitor hepatic function tests.

Evaluate for therapeutic response

(relief of GI symptoms). Question if GI
discomfort, nausea, diarrhea occurs.

Check serum glucose level. Assess for

hypo/hyperglycemia. Discuss lifestyle
to determine extent of learning,
emotional needs.

Cross-check dose with co-worker.

Monitor aPTT diligently. Assess Hct,
platelet count, urine and stool for
occult blood. Assess for decrease in
B/P, increase in pulse rate,
abdominal/back pain, severe headache
(signs of hemorrhage).
 NURSING DIAGNOSIS
Impaired Gas exchange related to
bronchial COPD as evidenced by
abnormal shallow breathing, pale
skin color, confusion, and
irritability
PATIENT GOALS
Patient will demonstrate adequate
cardiac output as evidenced by
blood pressure and pulse rate and
rhythm within normal parameters
for 30 days
Patient will be able to tolerate
activity without symptoms of
dyspnea, syncope, or chest pain
within 30 days
Patient to remain free of side
effects from analgesics and the
medications used to achieve
adequate cardiac output x 2wks
NURSING INTERVENTIONS
Nurse to monitor for symptoms of
heart failure and decreased
cardiac output, including B/P,
diminished quality of peripheral
pulses, cool skin and extremities,
increased respiratory and heart
rate, and the presence of edema.
Observe for chest pain or
discomfort, noting location,
radiation, severity, quality, and
duration. Nurse also to observe for
nausea, indigestion, and
diaphoresis and also to note
precipitating and relieving factors.
Nurse to check blood pressure,
pulse, and condition before
administering cardiac medications
such as ACE inhibitors, digoxin,
calcium channel blockers, and
beta blockers. Nurse to notify MD
of low heart rate or B/P before
holding medications.
RATIONALE
As these symptoms of heart failure
progress, cardiac output declines.
If patient develops pulmonary
edema, there will be coarse
crackles on inspiration and severe
dyspnea.
Chest pain and discomfort is
generally indicative of an
inadequate blood supply to the
heart, which can compromise
cardiac output.
It is important that the nurse
evaluate how well the client is
tolerating current medications
before administering cardiac
medications, do not hold
medications without physician
input.
 EVALUATION

Goal currently met, patient

currently shows no signs of
decreased cardiac output. VSS.
Peripheral pulses are equal and
strong, lungs CTA, and no signs of
edema observed.

Patient has episodes of dyspnea

with moderate exertion that is
relieved with rest and c/o
"tightness in back". Pain relieved
with current medication regime
that includes Ultram 50mg PO q4
hours PRN. No c/o dizziness or
chest pain.

Goal in progress, patient currently

had 4 day episode of constipation
and stool softerners were provided
as ordered with good effect. Nurse
currently monitoring bowel
function and patient cautioned not
to strain when defecating. No
other side effects observed.
 NURSING DIAGNOSIS PATIENT GOALS NURSING INTERVENTIONS RATIONALE

Acute pain related to tissue injury
from recent CABGx2 and aortic
valve replacement as evidenced
by patient verbalizing pain and
observing self-protective behavior
when ambulating OOB
Patient will learn to use pain rating
scale to identify current pain
intensity and to accurately
verbalize pain or discomfort within
1 week
Nurse to perform a comprehensive
assessment of pain q shift to
include location, characteristics,
onset, duration, frequency, quality,
intensity, and precipitating factors
of pain.
Pain is a subjective experience and
must be described by the patient
in order to plan effective
treatment.

Patient will report that pain Nurse to provide patient with Each patient has a right to expect
management regime relieves pain optimal pain relief with perscribed maximum pain relief. Medications
to satisfactory level with analgesics. ordered on a PRN basis should be
acceptable and manageable side offered to the patient at the
effects immediately after interval when the next dose is
administration of analgesics available.

Patient to perform activities of Patient to be medicated before an Turning and ambulation activities
recovery with reported acceptable activity to increase participation will be enhanced if pain is
level of pain during the next 30 controlled and tolerable
days

Nurse will evaluate the The analgesic dose may not be

effectiveness of the pain control
measures used through ongoing
assessment of patient's pain
experience
adequate enough or may be
causing intolerable or dangerous
side effects. Ongoing evaluation
will assist in making necessary
adjustments for effective pain
management.
 EVALUATION

Goal met. Patient currently able to

verbailze pain using the 0 to 10
numerical pain rating scale.

Goal currently in progress, patient

reports adequate pain relief after
the administration of Ultram 50mg
PO q 4hrs PRN.

Patient is able to tolerate physical

therapy twice daily with the help
of analgesics. Patient also
verbalizes the importance of
therapy and the on-going need for
recovery.

Goal currently met, patient's pain

is assessed q shift to identify new
pain intensity and to evaluate
effectiveness of last dose and to
assess for any side effects that
may develop.