Generic Name Rebamipide

Brand Name Remapride

Classification Antiulcerant; Antacids

Suggested dose PO Gastritis; Peptic ulcer 100 mg 3 times/day.

Mode of Action Rebamipide is a mucosal protective agent and is

postulated to increase gastric blood flow, prostaglandin

biosynthesis and decrease free oxygen radicals.

Drug Interactions None noted.

Indication Treatment for peptic ulcer disease

Prevention of NSAID-induced gastropathy

Contraindication Contraindicated with patients who are hypersensitive to

the drug, lactating, pregnant, and children.

Adverse Reaction Rash, pruritus, constipation, diarrhea, dry mouth, dry lips,

abdominal distention, constipation.

Nursing Responsibilities 1. Ten Rights.

2. Do not give more than three tablets per day of this

medication.

3. Ask the client to take in food which are high in fiber

to prevent constipation.

4. Ask the client to wear lip-balm or place a petroleum

jelly on the lips to prevent it from cracking since the

drug may cause dry lips.

5. Ask the client to increase fluid intake because the

Generic Name Calcium Carbonate

Brand Name TUMS

Classification Calcium-containing Antacids

Suggested dose As Antacid: Chew 2-4 tablets as symptoms occur. Repeat

hourly if symptoms return, or as directed by a physician.

Maximum Daily Dose: 15 tablets equivalent to 7.5 g

calcium carbonate.

As a Calcium Supplement: Chew 2 tablets twice daily with

a meal. Maximum Daily Dose: 4 tablets equivalent to 2 g

calcium carbonate.

Mode of Action Calcium carbonate is an inorganic salt used as an antacid.

It is a basic compound that acts by neutralizing

hydrochloric acid in gastric secretions. Subsequent

increases in pH may inhibit the action of pepsin. An

increase in bicarbonate ions and prostaglandins may also

confer cytoprotective effects. Calcium carbonate may also

be used as a nutritional supplement or to treat

hypocalcemia

Drug Interactions Digoxin: may increase risk for arrhytmiasif hypercalcemia

occurs

Fluroquinolones bisphospanates, throid hormones,

phenytoin tetracyclines: may decrease oral absorption of

these drugs

Date and Time

Cues Needs Nursing Diagnosis

Goal of Care Nursing Interventions Evaluation

N

O

V

E

M

B

E

R

27,

2

0

1

2

Objective:

local pain

noted (pain

scale: 4

mild)

Guarding

noted

Wound

dressing not

soaked with

blood

1 day Post

Dialysis

N

U

T

R

I

T

I

O

N

A

L

-

M

Impaired tissue

integrity related

to open IJ shunt

insertion

®: Tissues were

broken down

upon insertion of

IJ shunt.

Within 5 hours of

nursing

interventions, the

patient:

a) will be able to

demonstrate

willingness for

lifestyle change

such as agreeing

to eat the right

amount of food

and avoid food

which has high

amounts of sugar

to promote

1) Elicit details of injury

and treatment.

®: to know proper interventions to be done.

2) Assess for purulent

drainage.

®: purulent drainage from incision site indicates presence of infection.

3) Assess for elevated

body temperature.

®: elevated temperature is an indication of infection.

4) Assess patient’s level

of discomfort; note

pain.

®: to know how pain affects the client’s rest periods that may delay

GOAL MET

November 27,

2012

8:00 pm

After 8 hours of

care, the patient:

a) Verbalized

understanding

that high blood

sugar level

delays wound

healing

b) Demonstrated

no signs of

infection

3:00pm E

T

A

B

O

L

I

C

P

A

T

T

E

R

N

healing.

b) will verbalize

understanding of

health teachings

on proper wound

care at home

setting.

c) will show no

signs of infection

such as

increased

temperature and

abnormal

amount of

discharges.

d) will show

willingness to

learn cleaning

recovery of tissues.5) Determine client’s

nutritional status.

®: nutritional status may delay recovery.

6) Apply hot and cold

compress just above

the incision site.

®: warmth rushes blood to the affected area to promote healing; cold compress may reduce edema and promote some numbing thereby promoting comfort.

7) Administer analgesics

as prescribed.

®: to reduce pain due to incision.

8) Promote optimum

nutrition by advising

the patient to eat right

amounts of food.

c) Understood

that pressure

might cause

bleeding to the

affected area.

d) Understood

that BP taking

should be done

at the left upper

arm to reduce

pressure on the

right where the

IJ shunt is

inserted.

techniques by

participating

during the

teaching

process.

®: to facilitate healing.9) Encourage adequate

periods of rest and

sleep.

®: to limit metabolic demands, maximize energy available for healing, and meet comfort needs.

10) Promote early

mobility.

®: to promote blood circulation.

11) Assist with exercises.

®: to prevent excessive tissue pressure; to prevent bed sore from prolonged bed rest.

12) Instruct client to note

changes in her

condition such as

changes in pain

characteristics and

unusual physical

discomfort.

®: promotes early intervention; reduces potential for complications.

13) Instruct client to avoid

eating sweet food/food

which may alter blood

sugar level.

®: increased blood sugar delays wound healing.

14) Check wound

dressing for signs of

active bleeding; note

amount of secretions.

®: secretions may be due to infection; active bleeding may indicate opening of incision.

15) Teach client of proper

care of area; minimize

paper.

®: adding pressure to

the area might cause bleeding.

16) Instruct the patient to

finish all prescribed

antibiotics.

®: to minimize or prevent bacterial growth.

17) Teach client of the

early signs of infection

such as fever and

abnormal secretions;

instruct to tell

physician if these

signs are felt.

®: early detected infections are easier to cure.

PHYSICAL ASSESSMENT

General Survey

Received patient lying on bed awake and responsive with Hep-lock on right cephalic

vein and a right IJ shunt.

She appears appropriate to the stated chronological age. Client has good body

symmetry with no deformity; appears restless. Body fat is evenly distributed. Limbs and trunk

appear proportional to the body’s height. Body odor and halitosis not noted.

Client appears clean and neatly dressed. Clothing of choice was appropriate for the

weather. Client is not irritable. When she is asked, it she answers immediately.

Vital Signs (November 27, 2012)

BP: 150/90 mmHg RR: 24 cpm

PR: 74 bpm Temp: 36.9 °C

Skin, Hair and Nails

Client’s skin is uniformly light brown in color. No areas of increased vascularity,

ecchymosis, or bleeding noted. No lesions noted upon inspection. The skin is moist with a

minimum of perspiration. No tenderness noted. Skin is smooth, even and firm. Good skin turgor

noted as evidenced by skin retraction in less than 3 second when pinched at the anterior chest,

under the clavicle, and the abdomen. Edema not noted. Rashes noted on both of her arms.

Hair is originally black but has mixture of white hair and evenly distributed. The scalp is

pale white in color. There are no signs of infestation or lesions. Seborrhea not noted. Hair is

thin, and wavy. Hair is shiny and resilient when traction was applied, hair won’t come out in

clumps in hands.

Nails are clean and well trimmed with light pink nail beds. Capillary refill is two seconds.

The nail surface is smooth and slightly rounded. The angle of the nail base is approximately 160

degrees. Surrounding tissues were intact; no lesions or lacerations were observed.

Head, Neck and Regional Lymphatics

The head is normocephalic and proportional to body size. The skull is smooth,

nontender, and without masses or depressions. The scalp is shiny, intact, and without lesions or

masses. The facial features and movements are symmetrical. The shape of the face is round.

No edema, disproportionate structures, or involuntary movements noted. The patient

experienced no discomfort with movement. The temporomandibular joint articulate smoothly

and without crepitus. The patient was able to raise her eyebrows, close her eyes, frown and

smile.

The muscles of the neck are symmetrical with the head in a central position. The client is

able to move the head through a full range of motion without complaint of discomfort or

noticeable limitation. The muscles are symmetrical without palpable masses or spasms.

Regional Lymphatics

No enlargement, masses, or tenderness noted on palpation. Lymph nodes are not

palpable. There were no abnormalities in her thyroid gland both anteriorly and posteriorly.

Eyes

She could only see clearly the things near to her. She mentioned that she has reading

eyeglasses but upon assessment she didn’t wear such. The eyelids appear symmetrical with no

dropping, infections, or tumors. The client can raise both eyelids symmetrically. Eyebrows are

present bilaterally and are evenly distributed. There’s no enlargement, swelling, or redness, no

large amount of exudates, and minimal tearing. Skin is intact with no noted scaling and flakiness

of skin. Eyelashes are evenly distributed and curled slightly outward. No swelling, enlargement,

or redness noted in her lacrimal apparatus. Conjunctiva was pink and moist without foreign

bodies.

Both eyes move smoothly and symmetrically in each of the six fields of gaze and

converge on the held object as it moves toward the nose. Sclera is white with some small,

superficial vessels and without exudates, lesions or foreign bodies. The pupils are deep black,

round, and equal diameter, ranging from two to six mm. Lenses are transparent in color.

Ears, Nose, Mouth, and Throat

She was able to hear the ticking sound from our watch in both ears. Auricles are smooth,

symmetrical, and no discoloration noted. Her pinna has no noted deformities, lesions, nodules

and inflammations. Pinna recoils after it is being folded; it is firm and non-tender. Minimal

cerumen in her ear canal was observed. The ears are physically symmetrical and are both

located in line with the outer canthus of her eyes. Upon palpation, no pain or tenderness noted.

She was able to repeat a sentence when it was softly said behind her ears, which reveals that

she does not have any hearing problems.

Nose is located symmetrically in the midline of the face and is without swelling, bleeding,

lesions, or masses. Nasal flaring not noted. The nasal mucosa is pink without swelling or

polyps. Both left and right nares were patent, with no discharges. The septum is at the midline

and without perforation, lesions, or bleeding. There is no evidence of swelling around the nose

and eyes. Client experienced no discomfort/tenderness during palpation or percussion.

Halitosis not noted. Her breath smells fresh. The lips are pink without lipstick. The lips

are moist. The tongue is in the midline of the mouth. The tongue moves freely.. Wharton’s ducts

are patent and without inflammation or lesions. Client has 30 teeth, white and smooth edges, in

proper alignment and with no caries noted. The hard and soft palates are concave and pink.

Client was asked to speak “yes,” the soft palate and the uvula rose symmetrically. The

uvula is midline. The throat is pink and vascular and without swelling, exudates, and lesions.

Tonsils are not inflamed. There were no swellings or lesions.

Breast and Regional Nodes

The patient refused to be assessed.

Thorax and Lungs

Patient has a regular and normal breathing pattern with a respiratory rate of 24cpm upon

assessment. She has quiet and rhythmic respirations. The thorax rises and falls in unison in the

respiratory cycle. There is no paradoxical movement. No adventitious breath sounds noted on

both left and right lung fields during auscultation. Crepitus not noted. Tactile Fremitus on both

lungs are symmetrical. Trachea is at midline.

Heart and Peripheral Vasculature

Murmurs not noted. Point of maximum impulse and beat is auscultated at the 5 th

intercostal space midclavicular line. Patient has a cardiac rate of 78bpm, normal. Pulses have

regular rhythm. Her pulse rate upon assessment was 74bpm and could be easily felt at her

carotid pulse.

Abdominal assessment

Surgical wound incision noted at her right upper quadrant due to open cholecystectomy

done. Pain is felt with a pain scale of 4/10, moderate. Opsite dressing noted with no

abnormalities and bleeding noted, and it was dry and intact. Umbilicus is medially located and

shows no sign of inflammation/ abnormal discharges. Bowel sounds of 11 per minute were

heard upon auscultation. The abdomen rises with inspirations and falls with expiration.

Musculoskeletal System

She was able to exhibit strong hand grip on both arms. Client was able to extend both

arms. Upper and lower extremities were proportional in length. No hand tremors noted.

Female Genitalia

The patient refused to be assessed.

Ateneo de Davao University

College of Nursing

SY 2012 - 2013

2nd Semester

DRUG STUDY

PHYSICAL ASSESSMENT

NCP

Submitted to;

Leonardo Molina, RN MN

Submitted by:

Toni Anne Virocel

BSN – 3A

GROUP 2