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Drug

Tranexamic acid

Classification
anti-fibrinolytics

Indication
It is also used in people with other high-risk bleeding conditions to control bleeding at such times as after surgery or an injury, during heavy nosebleeds, or during heavy menstrual bleeding.

Contraindication Adverse Recation


Nausea, vomiting, diarrhea, or dizziness chest/jaw/left arm pain, sudden shortness of breath, coughing up blood, fainting, pain/swelling/warmth in the groin/calf, swelling/weakness/redness in the arms/legs, confusion, slurred speech, weakness on one side of the body, vision changes, change in the amount of urine including.

Nursing Responsibility
o o o Assess allergy to lactulose, lowgalactose diet. Use cautionlly with diabetes pregnancy and lactation . Give laxative syrup orally with fruit juice, water and milk to increase palatability. o o Monitor serum ammonia level. Carefully monitor blood glucose level in diabetic patients. o Do not use laxative for more than 1 week unless prescribed by the doctor.

Inderal (propanolol) 10 mg TID

Antianginal Antiarrhythmia Antihypertensive Beta adrenergic blockers

Hyper tensive alon or with drug, especially with diuretic Angina pectories caused with coronary atherosclerosis Idiopathic hypertrophic subaortic stenosis to

Allergy to beta blocking agent, sinus bradycardia, second or third heart block, cardiogenic shock, heart failure, bronchial asthma, bronchospasm COPD,

Pharingitis , erythematous rash, fever, sore throat, laryngospasm, vertigo, emotional depression, sleep disturbance, disorientation, bradcardia, heart failure, cardiac arrhythmia, pruritis, blurred vision, eye

o o o

Don't discontinue this medication abruptly. Take the drug with meal. If the patient have diabetes, the normal sign of hypoglycemia is tachycardia may be blocked by this drug, so

manage associated stress pregnancy.ect.. induced angina, palpitation and syncope. Cardiac arrhythmia. (Vitamin B12) 1 mg OD vitamin Vitaminb12 deficiency due to malabsorption (pernicious anemia), GI pathology, folic acid deficiency, tapworm Allergy to cobalt vitamin b12 Cautionly used with pregnancy and lactation

irritation, conjactivitis, gastric pain, bronchospasm. o

monitor your blood or urine glucose carefully, eat regular meal .

Omeprazole 20 mg OD

Antisecretory drug Proton pump inhibiors

Short term treatment of active duodenal ulcer First line in treatment of heart burn or symptoms of GERD

Allergy to this medication Pregnancy and lactation, use cautionly.

Sever and swift optic nerve atrophy Pulmonary edema, heart failure, peripheral vascular thrombosis urticaria , mild transint diarrhea , hypocalemia. Headache dizziness, vertigo, insomnia, apathy, anxiety, rash. Urticaria , constipation, tongue atrophy, coup, epistaxis.

o o

Monitor serum potassium. Report swelling of ankle leg cramps fatigue, difficulty in breathing.

Furosemide (Lasix) 40 mg OD

(Loop diuretic)

IV: edema associated with heart failure , chirosis and renal failure. Iv : acute pulmonary edema

Allergy to fursemide, Dizziness, orthostatic sulfamide. Use cautionly with gaut , diabetes mellitus. hypotension , weakness, muscle spasm, fluids and electrolyte imbalance, blurred vision, urinary bladder spasm, nocturia,

Administer before meal. caution patient to swallow capsule whole ,not to open, chew or to crush them. o Report severe headache, worsening of symptoms fever or chills. o Obtain baseline of vital signs o o especially BP and HR, diabetes mellitus. o Administer with food to prevent gastric upset, reduce dosage ''' if given with other

polyuria.

antihypertensive medication o Give early in the day so the increased urination will not disturb sleep. o Measures and records weight to monitor fluids change. o Report sudden loss or gain in a day, swelling in your ankles or fingers, dizziness, numbness fatigue, muscle weakness.

Folic acid 5 mg OD

Vitamin supplement)

Treatment of megablastic anemia due to spure , nutritional deficiency, pregnancy ,infancy, childhood.

Allergy to folic acid preparations, pernicious, a plastic, normocystic anemia. Cautionly use during lactation.

Hyper sensitivity.

Assess allergy for folic acid preparation, pernicious, aplastic, normocytic anemias,lactation.

Test using schilling test and serum vitamin b12 level to rule out pernicious anemia. Therapy may mask signs of pernicious anemia while the neurological deterioration.

Nursing Diagnosis
Nutritional imbalance ,less than body requirement related to taking medication ( ENTERCAVIR ) that induce Pancytopenia and also related to anorexia .

Goal

Nursing Intervention
In collaboration with dietitian, determine number of calories

Rational
Required to provide adequate nutrition and realistic (according to body structure and height) weight gain.

Outcome Criteria
Vital signs, blood pressure, and laboratory serum studies are within normal limits. Client is able to verbalize importance of adequate nutrition. Patient demonstrate asteady weight gain Patient verbalize rlieving from constipation Constipation Patient

Client will exhibit no signs or symptoms of malnutrition by the time of discharge from treatment (e.g., electrolytes and blood Subjective data: counts will be within The patient has verbalized " normal limits, a steady I eat less and I usually weight gain will be didnt feel very hungry" demonstrated, Patient relative verbalize" constipation will be that patient didn't eat corrected, client will sufficient food" exhibit increased energy in participation Objective data in activities) . HGB: 7.4, WBC 2.9 PLT: 75, MCV: 72.2, MCH: 23.8M, RBC: 3.11, HCT: 22.5 all blood cells are less that indicate anemia. Loss of weight Lack of interest in food.

To prevent constipation, ensure that diet includes foods high in fiber content. Encourage client to increase fluid consumption and physical exercise to promote normal bowel functioning.

Depressed clients are particularly vulnerable to constipation because of psychomotor retardation.

Keep strict documentation of intake, output, and calorie count.

This information is necessary to make an accurate nutritional assessment and maintain client safety.

Pale conjunctiva and mucous membranes. Poor muscle tone. Electrolyte imbalances(sodium). Weakness. Constipation.

Weigh client daily.

Weight loss or gain is important assessment information. Client is more likely to eat foods that he or she particularly enjoys. Large amounts of food may be objectionable, or even intolerable, to the client. To replace blood cells and correct pancytopenia.

demonstrate increased energy and participation in activities.

Determine clients likes and dislikes, and collaborate with dietitian to provide favorite food

Ensure that client receives small, frequent feedings, including a bedtime snack, rather than three larger meals. Administer vitamin and mineral supplements and stool softeners or bulk extenders, Transfuse 2 PRBC according doctor order. If appropriate, ask family members or significant others to bring in special foods that client particularly enjoys.

Stay with client during meals Monitor laboratory values, and report significant changes to physician

To assist as needed and to offer support and encouragement.

Explain the importance of adequate nutrition and fluid intake. .

Client may have inadequate or inaccurate knowledge regarding the contribution of good nutrition to overall wellness.

Potential care plan


Nursing Diagnosis
Risk for infection related to low immunity with the patient and poor nutritional status. Manifested by: Objective data: HGB: 7.4 , WBC: 2.9, PLT: 75, MCV: 72.2FL, MCH: 23.8, RBC 3.11, HCT: 22.5 all blood cells are less that indicate anemia. Loss of weight that indicate poor nutrition. She have diabetes mellitus . She have low immunity because her disease. The patient in hospital that increase possibility for infection.

Goal
Client will exhibit no signs or symptoms of infection by the time of discharge from treatment (e.g., electrolytes and blood counts will be within normal limits, nutritional balance will be demonstrated, vital sign will be within normal level) .

Nursing Intervention
Assess the nutritional status of the patient and try to improve nutritional status of the patient. Give isolation room for the patient as doctor order. Explain to the relative to not come in contact with the patient if any of them ill. Give iron supplement for the patient as doctor order. Do any intrusive procedure in aseptic way .

Rational

Outcome Criteria

Because person can The patient acquire infection and demonstrate good prolong on it if there is nutritional status. low nutritional status. Patient have low immunity and can catch infection Because patient is having low immunity The patient verbalizes the importance of the isolation procedure. The patient develop no signs and symptoms of infection. This will make the nutritional status is much better To prevent infection. The patient laboratory values and vital signs stay with the normal level.

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