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8/8/2019 Glenn's Output
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Patients Profile:Name: Anita DevioAge: 66
Diagnosis: Neurotrophic ulcer secondary to bacterial infection; HCVD; CAD; DM type II
Drug Name Indication/Dosage Action AdverseReactions
Contraindications NursingResponsibilities
MetforminHydrochloride /Fortamet
Elderly patients:Dosage should beconservativebecause ofpotential decreasein renal function.
Tablets: 500 mg
Decreaseshepatic glucoseproduction andintestinalabsorption ofglucose and
improves insulinsensitivity(increasesperipheral glucoseuptake and use).
GI: diarrhea,nausea, vomiting,abdominalbloating,flatulence,anorexia, taste
perversion.Hematologic:megaloblasticanemia.Metabolic: lacticacidosis,HYPOGLYCEMIA.
Contraindicated inpatientshypersensitive todrug and in thosewith hepaticdisease or
metabolicacidosis.Contraindicated inpatients with renaldisease and inthose with acreatinineclearance greaterthan or equal to1.5 mg/dl (males)
or greater than orequal to 1.4 mg/dl(females).Contraindicated inpatients with heartfailure requiringpharmacologicintervention and
Before therapybegins and atleast annuallythereafter, assesspatient's renalfunction. If renal
impairment isdetected, adifferentantidiabetic maybe indicated.Give with meals.Maximum dosesmay be bettertolerated if totaldose is divided
into t.i.d. dosingand given withmeals.When switchingpatients fromchlorpropamide tometformin, takecare during the
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patients withconditionspredisposing to
renal dysfunction,CV collapse, MI,hypoxia, andsepticemia.Temporarilywithhold frompatients havingradiologic studiesinvolving use ofcontrast media
containing iodine.Contraindicated inpatients older thanage 80, unlesscreatinineclearanceindicates normalrenal function.Use caution whengiving drug to
elderly,debilitated, ormalnourishedpatients and tothose with adrenalor pituitaryinsufficiencybecause of
first 2 weeks ofmetformin therapybecause the
prolongedretention ofchlorpropamideincreases the riskof hypoglycemiaduring this time.Monitor patient'sglucose levelregularly toevaluate
effectiveness oftherapy. Notifyprescriber ifglucose levelincreases despitetherapy.If patient hasn'tresponded to 4weeks of therapywith maximum
dosage, an oralsulfonylurea canbe added whilekeeping metforminat maximumdosage. If patientstill doesntrespond after
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increased risk ofhypoglycemia.
several months oftherapy with bothdrugs at maximum
dosage, prescribermay stop both andstart insulintherapy.Monitor patientclosely duringtimes of increasedstress, such asinfection, fever,surgery, or
trauma. Insulintherapy may beneeded in thesesituations.Risk of drug-induced lacticacidosis is verylow. Reportedcases haveoccurred primarily
in diabetic patientswith significantrenal insufficiency;in those with othermedical orsurgical problems;and in those withother drug
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regimens. Riskincreases withdegree of renal
impairment andpatient age.Alert: Stop drugimmediately andnotify prescriber ifpatient develops acondition relatedto hypoxemia ordehydrationbecause of risk of
lactic acidosis.Stop drugtemporarily forsurgicalprocedures(except minorprocedures thatdontrestrict intake offood and fluids)
and for patientsundergoingradiologic studiesinvolving use ofcontrast mediacontaining iodine.Don't restart druguntil patient's oral
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intake hasresumed andrenal function has
been deemednormal byprescriber.Monitor patient'shematologicstatus forevidence ofmegaloblasticanemia. Patientswith inadequate
vitamin B12 orcalcium intake orabsorption appearto be predisposedto developingsubnormal vitaminB12 level. Thesepatients shouldhave routinevitamin B12 level
determinationsevery 2 to 3 years.Look alike-soundalike: Don'tconfuseGlucophage withGlucovance.
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Drug Name Indication/Dosage Drug Action Adverse Reaction Contraindication NursingResposibilities
Iberet-FolicAcid / filmtab
Treatment &prevention of Fe-deficiency &concomitant folicacid deficiency w/associateddeficient intake orincreased need
for vit B-complexin nonpregnantadults.
Vitamins &Minerals (Pre &PostNatal) / Antianemics
Allergic reactions,
GI effects,
hyperbilirubinemia,
acneform vulgaris
deterioration or
acneform
exanthema
eruption, brightyellow urine
discoloration,
flushing, dizziness
or faintness,
peripheral sensory
neuropathies,
stone formation,
crystalluria &
oxalosis, black
discoloration of
stool
Thalassemia,sideroblasticanemia,hemochromatosis& hemosiderosis.
Can be givenbefore or aftermeals.
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multiforme,exfoliativedermatitis
Other: accidentalinjury.
anemia,symptomatic liverdisease,
hypertension,edema, heartfailure, or asthmaand in poorCYP2C9metabolizers.Use cautiously inelderly ordebilitatedpatients.
alcoholism, olderage, and pooroverall health.
Alert: NSAIDsmay increase therisk of seriousthrombotic events,MI, or stroke. Therisk may begreater with longeruse or in patientswith CV diseaseor risk factors for
CV disease.Although drugmay be used withlow aspirindosages, thecombination mayincrease risk of GIbleeding.Watch for signsand symptoms of
overt and occultbleeding.Drug can causefluid retention;monitor patientwith hypertension,edema, or heartfailure.
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Assess patient forCV risk factorsbefore therapy.
Drug may behepatotoxic; watchfor signs andsymptoms of livertoxicity.Before startingdrug therapy,rehydratedehydratedpatient.
Drug can be givenwithout regard tomeals, but foodmay decrease GIupset.Look alike-soundalike: Don'tconfuse Celebrexwith Cerebyx orCelexa.
8/8/2019 Glenn's Output
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Drug Name Indication/Dosage Drug Action Adverse
Reaction
Contraindication Nursing
ResponsibilitiesTelmisartan /Micardis
Treatment ofessential hypertension. 40mg 1tab OD
Angiotensin IIAntagonists
Headache,upper resp tractinfection,dizziness,fatigue.
Pregnancy &lactation, biliaryobstructivedisorders, severehepaticimpairment.
Monitor forhypotensionfollowing initiationof drug. Placepatient in supineposition ifhypotensionoccurs andadminister IV
normal saline ifneeded, asordered.Most of theantihypertensiveeffect occurswithin 2 weeks.Maximal bloodpressurereduction is
generally reachedafter 4 weeks.Diuretic may beadded if bloodpressure is notcontrolled by drugalone.
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Drug Name Indication/Dosage Drug Action Adverse Reaction Contraindication Nursing
ResponsibilitiesSultamicillin /Sultamicillin
Urinary tractinfectionsAdult: 375-750mg TID.
Inhibits bacterialprotein synthesisby binding to the50S subunit of theribosome
Diarrhoea, nausea,
vomitting, rashes,
pruritus, blood
dyscrasias,
superinfections,
dizziness,
dyspnoea.
Potentially
Fatal: Anaphylaxis.
Hypersensitivity to
drug or other
penicillin
Obtain specimenfor culture andsensitivity testsbefore giving firstdose. Therapymay beginpending resultsMonitor renal,hepatic, and
hematopoeticfunctions duringprolongedtherapy, asordered.Observe patientfor signs ofsuperinfection.
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Drug Name Indication/Dosage Drug Action Adverse Reaction Contraindication NursingResponsibilities
AmpicillinSulbactam
Intra-abdominal,gynecologic and skinstructure infections due
to susceptible strains
Adult:POSusceptible infections 0.25-0.5 g6 hrly.
Anaminopenicillinthat inhibits cell-
wall synthesisduringmicroorganismmultiplication.Sulbactaminhactivatesbacterial beta-lactamase,whichinactivates
ampicillin,causingbacterialresistance to it
GI upset, nausea,
vomiting, diarrhoea;
blood dyscrasias;
urticaria, exfoliativedermatitis, rash;
fever, seizures;
interstitial nephritis.
Potentially
Fatal: Anaphylactic
shock;
pseudomembranous
colitis;
neuromuscularhypersensitivity;
electrolyte
imbalance.
Hypersensitivity
to drug or other
penicillins;
infectiousmononucleosis.
Obtain specimenfor culture andsensitivity tests
before giving firstdose. Therapymay beginpending results.Observe patientclosely. With largedoses andprolongedtherapy, bacterialor fungal
superinfectionmay occurspecially inimmunosupressedpatients.Dosage should bedecreased inpatients with
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impaired renalfunction
Drug Name Indication/Dosage Drug Action AdverseReaction
Contraindication NursingResponsibilities
Clindamycin
/ Abanxl
For the treatmentofliverabscess, actinomycosis
, staphylococcal bone &joint infections, thecarrier stateofdiphtheria,gasgangrene, variousgynecological infectionsincluding bacterialvaginosis, endometritis,pelvic inflammatorydisease,pharyngitis, pn
eumonia, septicemia &skin infections.
Usual dose: 150-300
mg every 6 hr. Severe
infections 450 mg
every 6 hr.
Inhibits bacterial proteinsynthesis by binding tothe 50S subunit of the
ribosome
Abdominalpain.Pseudomembra
nous colitis,esophagitis,nausea,vomiting,diarrhea, skinrashes &pruritus.
Hypersensitivityto clindamycin orlincomycin.
Obtainspecimen forculture and
sensitivity testsbefore givingfirst dose.Therapy maybegin pendingresultsMonitor renal,hepatic, andhematopoeticfunctions during
prolongedtherapy, asordered.Observe patientfor signs ofsuperinfection.
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Drug Name Indication/Dosage Drug Action Adverse Reaction Contraindication NursingResponsibilities
Amlodipine /Norvasc
Chronic stableangina,vasospastic
angina(Prinzmetal's orvariant angina)Adults: Initially, 5to 10 mg P.O.daily. Mostpatients need 10mg daily.
Inhibits calciumion influx acrosscardiac and
smooth-musclecells, dilatescoronary arteriesand arterioles,and decreasesblood pressureand myocardialoxygen demand.
CNS: headache,somnolence,fatigue, dizziness,
light-headedness,paresthesia.CV: edema,flushing,palpitations.GI: nausea,abdominal pain.GU: sexualdifficulties.Musculoskeletal:
muscle pain.Respiratory:dyspnea.Skin: rash,pruritus.
Contraindicated inpatientshypersensitive to
drug.Use cautiously inpatients receivingother peripheralvasodilators,especially thosewith severe aorticstenosis, and inthose with heartfailure. Because
drug ismetabolized bythe liver, usecautiously and inreduced dosage inpatients withsevere hepaticdisease.
Alert: Monitorpatient carefully.Some patients,
especially thosewith severeobstructivecoronary arterydisease, havedevelopedincreasedfrequency,duration, orseverity of angina
or acute MI afterinitiation ofcalcium channelblocker therapy orat time of dosageincrease.Monitor bloodpressure
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frequently duringinitiation oftherapy. Because
drug-inducedvasodilation has agradual onset,acute hypotensionis rare.Notify prescriber ifsigns of heartfailure occur, suchas swelling ofhands and feet or
shortness ofbreath.Alert: Abruptwithdrawal of drugmay increasefrequency andduration of chestpain. Taper dosegradually undermedical
supervision.Look alike-soundalike: Don'tconfuseamlodipine withamiloride.
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Problem Justification
Noncompliance to therapeutic regimen
related to inadequate knowledge andfinancial constraints
This problem is given top priority due to
the fact that if this problem is resolved,then it would eliminate the need andthe presence of the other problems
Infection related to open woundsecondary to diabetes mellitus
This problem is ranked second even ifit is an actual problem because withoutclearing the first problem, problemssuch as these will continue to arise.The correction of the first problem will
reduce or eliminate the emergence ofthis problem
Skin integrity related to extremes ofage
This problem is ranked last because itis not life threatening and that the clienthas expressed the least concern for it.
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Cues NursingDiagnosis
Analysis Goal/Objectives Intervention Rationale Evaluation
Subjective:Umiinom akodati ng niresetasakin ng doctorna Neoblocpara sapresyon kopero di na akoumiinom pag dinaman
sumasakit angulo ko
minsan di narin akogumagamit nginsulin kasiminsan wala rinnaman kasikaming pambili
Objective:o Behavioralcharacteristics:
Evidence ofdevelopment of
Noncompliance totherapeuticregimenrelated toinadequateknowledgeand financialconstraints
Degree ofcompliance mayrange fromdisregardingevery aspect oftherecommendations following thetherapeuticplans. There are
many reasonswhy somepeople complyand others donot:Factorsinfluencingcompliance-Degree oflifestyle change
necessary-over-all cost ofprescribedtherapyReference:Fundamentalsof nursing byKozier, 5th
Goal:After 8 hours
nursingintervention, theclient will be ableto comply with thetreatmentregimen
Objectives:
Afternursingmanagement, the clientwill be ableto verbalizeaccurateconditionandunderstandin
g oftreatmentprocedure
Listento/activelisten toclientschiefcomplaints,comments.
Developtherapeutic
nurse-clientrelationship.
Helps toidentifyclientsthinkingabout thetreatmentregimen
Developstrust,
provideatmosphere in whichclient/SOcan freelyexpressviews/concerns.
The clientwas able tocomply withthe agreedtreatmentregimen
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complications/exacerbation of
symptoms Behavior
indicative offailure toadhere
Failure toprogress
Failure tokeepappointment
s The client is
jobless andno source ofincome.
DefiningCharacteristics:
Therapeuticeffect not
achieved ormaintained
edition pp.254-255
Afternursingmanagement, the clientwill be ableto identifyfactors thatinterfere hismedication
regime
Identifyfactors thatinterferewith takingmedications or lead tolack ofadherence( e.g.,depression
, activealcoholuse, lowliteracy,lack ofsupport,lack ofbelief in
Adherenceassessment is most
successfulwhenconductedin apositive,nonjudgmentalatmosphere
Forgetfulness is themostcommonreasongiven fornotcomplyingwith thetreatment
plan.
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Afternursingmanagement, the clientwill be able
to verbalizecommitmentto mutuallyagreed upongoals andtreatmentplan
Afternursingmanagementthe nurse willbe able to
treatmentefficacy.)
Determinewhomanagesthemedicationregimenand
whetherindividualknowswhat themedications are andwhy aretheyprescribed
Exploreclientinvolvement in or lackof mutualgoalsetting.
Helps thepatient orSO/s toknow theimportanceofmedication
.
Client willbe morelikely tofollow-through ongoals heparticipated in
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assist theclient inidentifying
communityresourcesand referthem tomedical/charitableinstitutions
Reviewtreatmentstrategies.Identifywhichinterventions in theplan ofcare are
mostimportantin meetingtherapeuticgoals andwhich areleastamenabletocompliance
Involvefamily andfriends inhealthplanningconferences.
developing.
Setsprioritiesandencourages problemsolvingareas ofconflict
Familymembersneed tounderstandthat care isplanned tofocus on
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Refer the
client to ayhealthcareorganizations, socialworkers, oranycharitableinstitutions(PGH,DSWD,
PCSO.)
what ismostimportant
to thepatient.Thisenablesthe patientto maintaina sense ofautonomy.
Neighborh
oodcenters,communitycenters,andoutpatientclinics areequippedto assistpatients in
modifyinglifestylehabits.
Clientswho live inpovertyand have
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loweducational levels are
at greaterrisk forinjury anddisease.Assistingthem insuchinstitutionswillmotivate
them tocomply.(Fundamentals of nursing,Potter, p.824)
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NURSINGDIAGNOSIS
GOAL OFCARE
OBJECTIVESOF CARE
INTERVENTIONMEASURES
RESOURCES EVALUATION
MATERIAL MANPOWER
Noncompliance totherapeuticregimen related toinadequateknowledge andfinancialconstraints
After 4 days ofnursing
intervention,the client will
follow histreatmentregimen
1.to be able toknow the effectsof diabetesmellitus typeII
2. To be able toknow the
importance oftakingmedications
3. To be able toidentify the uses
of eachmedication
4. be able to takemedications ontime prescribed
Collaborative1.Openly have aconversation with theclient regarding DM typeII and let her read aboutit in pamphlets and lether voice out herconcerns about the topic.
CollaborativeDiscuss to the patient
the effects of themedications regardingDM type II and theadverse effects that willshow once themedications are nottaken
CollaborativeDiscuss to the client the
medications that she willtake and its effect on thebody
Independent/DependentAdminister medicationsprior to activity as
pen, smallnotebook,pamphlets
Time andeffort of thestudent nurse,the patient andher relatives.
It will beevaluatedthroughweighing,measuring ofabdominal girthand monitoringintake andoutput.
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by the clientsphysician.
needed- Explain the importanceof strict compliance to
proper medication