Drug Study

Brand and Generic Name

Action Uses/ Indication Contraindication Side effects Nursing Consideration

Tramadol( Dolotral, Milador)

Centrally acting analgesic not chemically related to opioids but binds to mu-opioid receptors and inhibits reuptake of norepinephrine and serotonin

Used for moderate to severe pain

Hypersensitivity, acute intoxication with alcohol, hypnotics, centrally acting analgesics

Vasodilation, dizziness/ vertigo, headache, stimulation, anxiety, confusion and sleep disorder

-Assess patient pain( location and types)-Assess for hypersensitivity reaction: rash and pruritus-Monitor for possible drug induced adverse reaction CNS;stimulation dizziness,vertigo,headache,CV:vasodilationGI:nausea

Azyth (Azythromycin)

Binds to the P site of 50s bacterial ribosomal subunits thereby inhibiting protein synthesis.Treatment of infection in skin and soft tissues.

Treatment of infection of respiratory tract , skin and skin structure,and sexually transmitted disease cause by susceptible organisms

Hypersensitivityto azithromycin or or any macrolide antibiotic

Hypersensitivity reaction such as: skin redness with or without itching photosensitivity, joint pains

Assess for sign symptoms of infection :fever drainage,sore throat increased WBC count positive specimen culture

Band Name and Generic Name

Action Uses/ indication Contraindication Side effects Nursing consideration

Cefradine(drug maker’s Biotech cefradine)

Inhibits mucopeptide synthesis in bacterial cell wall

Infection caused by susceptible strains of staphylococci, streptopneumonia and E-coli

Patients with history of shock, hypersensitivity to any ingredients and to cephem-type antibiotics

GI disturbances hypersensitivity reactions.

-hypersensitivity to drugs-monitor for positive response to antibiotic therapy-monitor for signs of infections

Losartan (bepzar,lifezar)

Selectively blocks the binding at angoitensin II to receptor sites in many tissues especially the vascular smooth muscles and adrenal glands. This prevents the vasoconstricting and aldestosterone secreting of angoitensin II on these tissue

Treatment of hypertension ,in heart failure and myocardial infarction,

Pregnancy, breast feeding, hypokalemia

Dizziness, dose-related orthostatic hypotension.impaired renal function and rarely ,rash,angioedema and raised alanine.

-assess BP , Monitor for possible drug reaction-assess patient’s and family knowledge of drug therapy

Ferrous SulfateBrotesol,feosol Spansule,Fer-in-sol

Provides elemental iron, an essential component in formation of hemoglobin in red blood cell development.

Prevention and treatment of iron-deficiency anemia

Hypersensitivity to any ingredients,hemosiderosis, hemolytic anemia.

Alteration and abdominal pain with nausea, vomiting diarrhea or constipation.

Obtain baseline assessment of iron deficiency before starting therapy -evaluate hemoglobin, hematocrit and reticulocyte count during therapy.-monitor for adverse reaction.-increase-assess diet nutrion

GORDONS 11 TYPOLOGY OF FUNCTIONAL HEALTH PATTERNS

BEFORE HOSPITALIZATION DURING HOSPITALIZATIONA.)HEALTH MANAGEMENT PATTERNS

® what is your past illnesses?®what do you do whenever you got sick?®how do you maintain your good health?®how often do you go to the doctor to have medical check-up?

“asthma at UTI”“umiinom lang ng gamot”“kumakain lang ng mga gulay at prutas”“pumupunta ako sa center , tuwing nakakaramdam lang ako ng sakit”

B.)SELF-PERCEPTION PATTERN ®how do you describe yourself? ®your moods? ®how many times do you take a bath in a day? ®how many times do you brush your teeth in a day?

“malakas, abala sa mga gawaing bahay”“madaldal, palatawa at palabiro”“dalawang beses sa isang araw”

“hindi na ako nagtotoothbrush, wala na akong ngipin, mumog- mumog lang”

“ito nakahiga lang, walang silbi”“naging maiinitin ang ulo”“hindi na ako nakakaligo,punas-punas lang”

“mga isang beses lang”

C.) NUTRITIONAL-METABOLIC PATTERN ®what are the foods you usually eat?

®how many times do you ate in a day? ®how many times do you drink water in a day?

“kanin,gulay at mga fruits”

“tatlong beses sa isang araw”“mga apat –anim na beses sa isang araw”

“kung ano lang ang nirarasyon ditto tulad ng kanin, pansit at tinapay”“ganun pa din, tatlong beses pa din”“mga apat –anim na beses”

D.)ELIMINATION PATTERN ®how many times do you defecate in a day? ®any discomfort? ®how many times do you urinate in a day? ®how many times do you change your pampers in a day? ®any discomfort?

“isang beses sa isang araw”“wala naman”“ mga tatlo o apat na beses sa isang araw”

“wala naman”

“isang beses lang din”“wala”“ngayon, naka pampers kasi ako”“mga dalawang beses”

“wala naman”E.)ACTIVITY- EXERCISE PATTERN ®what are the things you usually do?

®hobbies?

“nag aalaga ng mga apo ko, gumagawa ng mga gawaing bahay at naglalabada”“nanunuod ng T.V, nag-aalaga ng mga apo”

“ito nakahiga lang, pautos utos lang, nahihirapan na akong gumalaw-galaw”“ditto nakikinig ng music sa cellphone ng anak ko”

®exercise? “Tumatakbo-takbo” “dito paunat unat lang”

F.)SLEEP-REST PATTERN ®usual no. of hours of sleep and rest @ night? ®at day time? ®how do you relax yourself?

“siyam na oras” “hindi ako natutulog sa hapon”“nanunod lang ng t.v”

“walong oras”

“Mga dalawang oras”“nakahiga lang dito”

G.)ROLE- RELATIONSHIP PATTERN ®do you have close family ties? ®how do you bond with each other?

®who do you talk most often?

®how do you bond with your neighborhood?

“oo”“kumakain ng sama-sama, nagkwekwentuhan at nagtatawanan””yung mga anak ko at mga kapitbahay ko”

“super bonding kami, puro tawanan, kwentuhan”

“oo”“wala na eh”

“yung anak kong ngababantay sa akin, mga pasyente din dito at mga bantay nila”“wala na eh”

H.)COPING-STRESS PATTERN ®what are things that made you angry? ®what do you do whenever you got angry?

®how do you feel towards the death of your son- in law? ®have you accepted about the death?

®how do you handle this?

”kapag nag aaway ang mga apo ko”“nagsesermon, nilalabas ang galit, salita ng salita”“malungkot, hindi ako makapaniwala”

“hindi pa”

“kapag iniiwanan nila ako dito sa hospital”“wala lang, hindi kumikibo”

“malungkot, masama ang loob”

“hindi pa masyado, nalulungkot ako kasi namatay ang manugang ko at hanggang ngayon di pa nahuhuli ang pumatay”“nagdadasal, pinapasa diyos ko na lang”

I.)VALUE BELIEF PATTERN ®are you religious? “oo” “oo”

DIAGNOSIS RANKImpaired physical mobility 1Impaired skin integrity 2Knowledge deficit 3Risk for infection 4anxiety 5

Nursing Care Plan

Assessment Nursing diagnosis Planning Intervention Rationale Evaluation Subjective:“mas gusto ko magpasemento na lang kaysa magpaopera ng binti ko”

Objective:-facial grimace-poor eye contact-restlessness-unmotivated to learn-economic status

Knowledge deficit r/t difficulty understanding disease process and its effect on own self care

After the 8 hour shift the px will;a.)express understanding of disease process, medication regimen and treatment planb.)px will make informed choices when addressing health care problems and self care deficitsc.)px will demonstrate ability to effectively implement chosen health strategy

1. consider old px life experience when developing teaching plan

2.provide quiet, calm environment for learning.

3.limit length of each teaching’s session.

4.ask if the px wants to learn new or additional information. If not discuss why.

5. set aside time during each session for answering questions and clarifying information.

-new information is easier to assimilate if it is built on existing knowledge.

-to enable px to process information w/o distraction from background noise or stress.

-to avoid information overload

-open discussion helps to identify barriers to learning and determine

-older px may need affirmation that knowledge she possesses is current and correct. Discussion may also stimulate exchange of ideas and further learning.

After the 8 hour shift the px was;a.)expressed understanding of disease process, medication regimen and treatment planb.)px was informed choices when addressing health care problems and self care deficitsc.)px was demonstrate ability to effectively implement chosen health strategy

Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation Subjective:“ no verbal cues”

Objective:-(+) open fracture@ the left lower femur-(+)skeletal traction@ the left tibia-(+)open gun shot wound @ the left lower femur-(+) edema @ the wounded site-(+) immobility-decreased hemoglobin:95m/L-Decreased hematocrit:0.25-V/S taken:T-36.9 CPR-81 bpmRR-21 cpmBP-110/70 mmHg

Risk for infection r/t open fracture as manifested by open gunshot wound @ the left femur

At the end of 2 weeks of nursing intervention there will be:

a.)reduce risk of infection

b.)px will maintain good personal hygiene

c.)results of laboratory studies won’t indicate infection

1.wash hands before and after providing care

2.monitor WBC count, as ordered and promptly report abnormal values.

3.instruct client in proper personal hygiene

4.follow facility’s infection control policy

5.use aseptic technique when performing invasive procedures.

6. ensure adequate nutritional intake

-hand washing is the single best way to avoid spreading of pathogens

-decreased production of WBC indicates infection

-to reduce risk for infection

-to minimize risk of nosocomial infection

-to minimize risk of inducing pathogens

-To promote healing

At the end of 2 weeks of nursing intervention there was:

a.)reduced risk of infection

b.)px was maintained good personal hygiene

c.)results of laboratory studies won’t indicate infection

Assessment Nursing diagnosis Planning Intervention Rationale Evaluation Subjective ;Nahihirapan akong gumalaw galaw”

Objective:-Facial grimace-presence of skeletal traction-limited range of motion-limited ability to perform gross motor skills-difficulty in turning-V/S taken:T-36.9 CPR-81 bpmRR-21 cpmBP-110/70 mmHg

Impaired physical mobility r/t musculoskeletal impairment

After the nursing intervention there will be:a.)regain/maintain mobility at the highest possible level

b.)maintain position of function

c.)increase strength/functions of affected and compensatory body parts

d.)demonstrate techniques that enable resumption of activities

1.observe px’s functional ability: document and report any changes using functional level scale

2.ensure comfort measures by padding extremities prone to skin break down.

3.implement ROM exercises every shift

4.promote progressive mobilization to maximum within limits of px’s tolerance for pain

5.instruct the px and family members in ROM exercises, transfers, skin inspection and ability regimen

6.encourage px to discuss feelings and concerns about altered state of mobility

-Changes may indicate progressively decline or improvement

-this measures prevent skin breakdown

-This prevents joint contracture and muscle atrophy-maintain muscle tone and prevents complication of immobility

-to reduce anxiety and promote compliance

-to control minimize effects on immobility.

After the nursing intervention there was:

a.)regained/maintained mobility at the highest possible level

b.)maintained position of function

c.)increased strength/functions of affected and compensatory body parts

d.)demonstration techniques that enable resumption of activities

Assessment Nursing diagnosis Planning Intervention Rationale EvaluationSubjective:“ no verbal cues”

Objective:-(+) open fracture@ the left lower femur-(+)skeletal traction@ the left tibia-(+)open gun shot wound @ the left lower femur-(+) edema @ the wounded site-(+) immobility-decreased hemoglobin:95m/L-V/S taken:T-36.9 CPR-81 bpmRR-21 cpmBP-110/70 mmHg

Impaired skin integrity r/t open fracture @ the lower femur as manifested by open gun shot wound @ the left lower femur

At the end of 2 weeks of nursing intervention:

a.) patient will exhibit in evidence of skin breakdown

b.) Patient will regain skin integrity

c.) Patient will demonstrate skill in care of wound

d.) Patient will perform skin care routine

1. inspects skin every shift-describe and document skin condition and report changes.

2. assists with general hygiene and comfort measures

3. Administer pain medication and monitor its effectiveness.

4. use of foam mattress, red cradle or other devices

5.maintain infection control standards

6.change position at least every 2 hours

7.instruct patient and family members in skin care regimen

-this provides evidence of effectiveness of skin care regimen

-to promote comfort and sense of well being.

-patient needs pain relief to maintain health

- to avoid potential for infection

-to reduce risk of spreading disease

- reduce pressure and promoteCirculation

-to encourage compliance

At the end of 2 weeks of nursing intervention:

a.) patient was exhibit in evidenced of skin breakdownb.)Patient was regained skin integrityc.)Patient was demonstrated skill in care of wound

d.)Patient was perform skin care routine

Assessment Nursing diagnosis Planning Intervention Rationale EvaluationSubjective;“nalulungkot ako kasi namatay ang manugang ko at hanggang ngayon di pa nahuhuli ang pumatay”

Objective:-poor eye contact-tearfulness-facial tension-facial blushing-restlessness-feelings if anger-V/S taken:T-36.9 CPR-81 bpmRR-21 cpmBP-110/70 mmHg

Anxiety r/t situational crises and hospitalization

After of 8 hour nursing intervention the patient will able:

a.) appear relaxed and report anxiety reduced to a manageable level

b.) verbalize awareness of feelings of anxiety

1. spend time with patient convey a willingness to listen, offer verbal reassurance

2. give px clear, concise explanation of anything about to occur. avoid information overload: an anxious px cant assimilate many details.3.listen attentively: allow px to express feelings verbally

4. Identify and reduce many environmental stressors as possible.

5.include px in decisions related to care when feasible.

-specific amount of uninterrupted non-care related time spent with anxious px build trust

-Anxiety may impair px’s cognitive abilities

-This may allow px to identify anxious behaviors and discover some of anxiety

-Anxiety often results from lack of trust on the environment

-anxious px may mistrust own abilities: involvement in decision making may reduce anxious behaviors.

After of 8 hour nursing intervention the patient was:

a.)appeared relaxed and report anxiety reduced to a manageable level

b.)verbalize awareness of feelings of anxiety

6.support family members in coping with px’s anxious behavior

7.allow extra visiting periods with family if this seems to allay anxiety.

-involving family members in process of reassuranc4 and explanation allays

- this allows px and family to support each other according to their abilities and at their own race.