Mini CP Skin Avulsion Chap11

7/31/2019 Mini CP Skin Avulsion Chap11

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Chapter XI

DRUG STUDY

Drug # 1

Date Ordered: January 26, 2011

Generic Name: Tetanus toxoid

Brand Name: -------------

Classification: Toxoid

Actual Dosage: 0.5 cc IM

Mechanism of Action: Promotes immunity to tetanus by inducing antitoxin production

Indications:

Prevention of tetanus after injury acquired during an accident

Contraindications:

Contraindicated in immunosuppressed patients, in those with immunoglobulin

abnormalities, and in those with severe hypersensitivity or neurologic reactions to

toxoid

Patients with thrombocytopenia or other coagulation disorders that would

contraindicate IM injection unless benefits outweigh risks

Adverse Reactions:

CNS: slight fever, headache, seizures, malaise, encephalopathy

CV: tachycardia, hypotension, flushing

Musculoskeletal: aches, pains


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Skin: erythema, nodule at injection site, urticaria, pruritus

Other: chills, anaphylaxis

Assessment

Obtain medical history, including malignancy or other immune deficiency

Obtain drug history, including high dose immunosuppresants, blood transfusions,

and immune globulin

Determine complete allergy history, including drugs, vaccines, foods, and

environmental allergies

Asses for adverse reactions to previous doses of toxoids or any toxoid

component

Assess for symptoms of moderate to severe acute illness with or without fever

Diagnoses

Ineffective health maintenance r/t non-adherence to medication

Health seeking behavior r/t desire to receive recommended toxoid at appropriate

dosage

Readiness for enhanced immunity status r/t expressed desire in complying

medicine

Planning

Client will adhere to recommended toxoid to prevent tetanus

Client will be free of adverse reactions

Nursing Interventions

Ensure potency of the product by observing properly its storage requirements

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Upon preparation, including reconstitution, administer within time limits stated in

package

Do not mix vaccines in the same syringe

Document in clients record the following data: administration date, route, site

Observe clients for signs and symptoms of adverse reactions to drug

Keep epinephrine readily available for immediate use in case of anaphylactic

reaction

Health Teachings and Nursing Responsibilities

Instruct client to avoid contact with immunocompromised persons

Discuss with the client common side effects of the drug such as soreness at

injection site and fever and instruct client to report to health care providers if

signs of serious reactions are noted

Maintain adequate airway and ventilation and maintain an intravenous line

Monitor client for signs of arrhythmias

Prevent client from having spasms by controlling the environment, avoiding

stress, pain, coughing, or flatus to occur to the patient, avoid touching, turning,

and jarring the bed of the client

Protect the client from injury and provide comfort measures

Evaluation

Client adhered to recommenended dose of toxoid

No adverse reaction occured

Rationale: To prevent tetanus after an injury

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Drug # 2


Generic Name: Ketorolac tromethamine

Brand Name: Toradol

Classification: Nonsteroidal anti-inflammatory drugs

Actual Dosage: 1 amp IVTT

Mechanism of Action: The primary mechanism of action responsible for ketorolac's

anti-inflammatory, antipyretic and analgesic effects is the inhibition of prostaglandin

synthesis by competitive blocking of the enzyme cyclooxygenase (COX). Like most

NSAIDs, ketorolac is a non-selective COX inhibitor

Indications:

Short term management of moderately severe, acute pain for single dose

treatment

Contraindications:

Patients with a previously demonstrated hypersensitivity to ketorolac

Patients with active peptic ulcer disease, recent Gastrointestinal bleeding or

perforation

Patients with complete or partial syndrome of nasal polyps, angioedema,

bronchospastic reactivity or other allergic manifestations to aspirin or other non-

steroidal anti-inflammatory drugs due to possibility of severe anaphylaxis

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Patients with renal dysfunction or with compromised renal, hepatic, and cardiac

function (e.g., heart failure, diuretic use, cirrhosis, dehydration, and renal

insufficiency)

Adverse Reactions:

CNS: drowsiness, sedation, dizziness, headache

CV: edema, palpitations, hypertension, arrythmias

GI: nausea, dyspepsia, GI pain, diarrhea, peptic ulceration, vomiting,

constipation, flatulence, stomatitis

Hematologic: decreased platelet adhesion, purpura, prolonged bleeding time

Skin: pruritus, rash, diaphoresis

Other: pain at injection site

Assessment

Determine medical history. Determine whether there is any history of gastric

upset, gastric bleeding, or liver disease.

Obtain drug history, report if a drug-drug interaction is probable

Diagnoses

Risk for injury r/t vertigo

Chronic pain r/t tissue swelling of rheumatoid arthritis

Planning

Client will be free of mild pain in 12-24 hours


Observe client for signs of bleeding such as dark tarry stools, bleeding gums,

petechiae, ecchymosis, purpura

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Monitor for signs ofpain relief, such as anincreased appetite andactivity

Assess pain (note type, location, and intensity) prior to and 1-2 hr following

administration

Ketorolac therapy should always be given initially by the IM or IV route. Oral

therapy should be used only as a continuation of parenteral therapy

Health teachings and Nursing Responsibilities

Instruct client to avoid alcohol and maintain adequate hydration (2-3 L/day of

fluids) unless instructed to restrict fluidintake

Instruct client to avoid taking ketorolac with aspirin or other NSAIDs such as

ibuprofen (Motrin, Advil),naproxen (Aleve,Naprosyn), piroxicam(Feldene)

Advice patient to consult if rash, itching, visual disturbances, tinnitus, weight gain,

edema, black stools, persistent headache, or influenza-like syndromes (chills,

fever, muscle aches, pain) occur

Evaluation

Pain relieved as verbalized by the patient

No side effects experienced

Rationale: To treat moderate to severe pain

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Drug # 3


Generic Name: Cefuroxime

Brand Name: Rezafil

Classification:Antibacterial 2nd generation cephalosporin

Actual Dosage: 750mg IVTT

Mechanism of Action: Cefuroxime is a bactericidal antibiotic, which exerts antibacterial

activity by inhibition of bacterial cell wall synthesis in susceptible species. Cefuroxime

has good stability to several bacterial beta-lactamase enzymes and, consequently, is

active against many penicillin-resistant and amoxicillin-resistant strains of susceptible

species

Indications:

Bone and joint infections caused by S. aureus

Perioperative prophylaxis

Contraindications:

Allergy to cephalosporins or penicillins

Renal failure

Adverse Reactions:

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CNS: Headache, dizziness, lethargy, paresthesias

GI: Nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence,

pseudomembranous colitis, liver toxicity

Hematologic: Bone marrow depression: decreased WBC, decreased platelets,

decreased Hct

GU: Nephrotoxicity

Hypersensitivity: Ranging from rash to fever to anaphylaxis, serum sickness

reaction

Local: Pain, abscess at injection site; phlebitis, inflammation at IV site

Other: Superinfections, disulfiram-like reaction with alcohol

Assessment

Assess for allergy to cephalosporins

Record vital signs and urine output. Report abnormal findings which may include

elevated temperature or decreased urine output

Check laboratory results, especially those that indicate renal and liver function

(blood urea nitrogen, serum creratinine, bilirubin). Use these results for abaseline

values

Diagnoses

Risk for impaired tissue integrity r/t rash

Risk for infection r/t invasive procedure

Ineffective tissue perfusion: renal r/t adverse effects of drug

Noncompliance with drug regimen r/t lack of knowledge relevant to regimen

behavor

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Planning

Clients infection will be controlled and later eliminated


Culture infected area before cephalosporin therapy is started. The organism

causing the infection can be determined by culture, and the antibiotics the

organism is sensitive to are determined by culture and sensitivity

Check for signs and symptoms of superinfection if prolonged used

Administer IV cephalosporins over 30-45 minutes

Monitor vital signs, urine output, and laboratory results. Report abnormal findings Health Teachings and Nursing Responsibilities

Take the complete course of medication

Avoid alcohol 3 days after because severe reactions often occurs

Observe the 12 rights when administering the drug

Have vitamin K available in case hypoprothrombinemia occurs

Observe for adverse reactions and discontinue if hypersensitivity occurs

Do not mix with aminoglycosides

Evaluation

Infection has ceased; decreased white blood cell count

No side effects occured

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Rationale: To treat the existing acute infection

Drug # 4


Generic Name: Ranitidine

Brand Name: Zantac

Classification: Histamine2 Antagonist


Mechanism of Action: Competitively inhibits the action of

histamine at the H2 receptors of the parietal cells of the stomach, inhibiting basal gastric

acid secretions and gastric acid secretion that is stimulated by food, insulin, histamine,

cholinergic agonist, gastrin, and pentagastrin

Indications:

Treatment of heartburn, sour stomach

Contraindications:

Contraindicated with allergy to ranitidine

Use cautiously with impaired renal or hepatic function

Adverse Reactions:

CNS: headache, dizziness, insomnia, vertigo

Hepatic: jaundice

EENT: blurred vision

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CV: tachycardia, bradycardia

GI: constipation, diarrhea, nausea, vomiting, abdominal pain

Local: pain at site, local burning or itching at IV site

Other: burning and itching at injection site, anaphylaxis, angioedema

Assessment

Evaluate clients pain, including type, duration, severity, and frequency

Evaluate gastrointestinal complaints

Check mental status

Check clients renal function

Assess for fluid and electrolyte imbalances, including intake and output

Obtain drug history; report drug-drug interactions

Diagnoses

Acute pain r/t excess gastric secretion

Planning

Client will no longer experience abdominal pain after drug therapy


Check the doctors order to protect self from illegal actions

Observe 12 rights before administration for an effective treatment regimen

Be alert to prevent metabolic acidosis

Consider laboratory results; may increase creatinine and ALT levels; may

decrease white blood cell count


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Encouraged patient to avoid cigarette smoking because this increase gastric acid

secretion and worsen disease

Advise patient to report abdominal pain and blood in stools and emesis

Assess patient for abdominal pain. Note presence of blood in emesis, stool, or

gastric aspirate

Provide concurrent antacid therapy to relieve pain

Observe and report presence of severe diarrhea and rash since it may indicate

hypersensitivity reaction to the drug

Assess for liver and kidney functions and evaluate the complete blood count for

possible anemia

Evaluation

Client is free of pain

No presence of side effects seen

Rationale: To prevent gastrointestinal distress

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Drug # 5


Generic name: Nalbuphine Hydrochloride

Brand name: Nubain

Classification: Opioid agonist-antagonist analgesic


Mechanism of Action: Nalbuphine acts as an agonist at specific opioid receptors in the

CNS to produce analgesia and sedation. It inhibits the ascending pain pathways,

altering the perception of and response to pain by binding to opiate receptors in the

CNS but also acts to cause hallucinations and is an antagonist at mu receptors.

Indications:

Relief to moderate to severe pain

Preoperative analgesia, as a supplement to surgical anesthesia

Prevention and treatment of intrathecal morphine-induced pruritus after CS

Contraindications:

Hypersensitivity to nalbuphine, sulfites

Use cautiously with emotionally unstable patients or those with history of opioid

abuse, bronchial asthma, COPD, respiratory depression, anoxia, acute MI

Adverse Reactions:

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CNS: sedation, clamminess, sweating, headache, nervousness, restlessness,

depression, crying, confusion, faintness, unusual dreams, hallucinations,

dizziness, vertigo, floating feeling, feeling of heaviness, numbness, tingling,

flushing, warmth, blurred vision

GI: Nausea, vomiting, cramps, dyspepsia, bitter taste dry mouth

GU: urinary urgency

Respiratory : respiratory depression, dyspnea, asthma

Assessment

Obtain a drug history from client. Report if a drug-drug interaction is probable

Assess for hypersensitivity to nalbuphine, sulfites, emotional instability or history

of opioid abuse, bronchial asthma, COPD, respiratory depression, anoxia,

increased ICP, and MI

Note baseline vital signs for future comparison

Assess type of pain, duration, and location before giving the drug

Diagnoses

Acute pain r/t trauma

Planning

Clients intensity of pain will be lessened


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Monitor vital signs. Note any changes in respiration

Check bowel sounds and date of last bowel movement to identify constipation.

Decreased peristalsis may result in constipation. A mild laxative may be

necessary

Determine urine output. Report if urine output is


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Drug # 6


Generic name: Diphenhydramine Hydrochloride

Brand name: Benadryl

Classification: Antihistamine


Mechanism of Action: Competes with histamine1 for H1 receptor sites on effector cells.

Prevents, but doesnt reverse, histamine-mediated responses, particularly the effects of

histamine on the smooth muscles of the bronchial tubes, GI tract, and blood vessels.

Structurally related to local anesthetics, it provides local anesthesia by preventing

initiation and transmission of nerve impulses. Also suppresses cough reflex by a direct

effect on the medulla.

Indications:

Sedation

Pre-operative medications

Contraindications:

Hypersensitivity to drug

Use cautiously in patients with asthma, COPD, hyperthyroidism, hypertension

Adverse Reactions:

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CNS: drowsiness, sedation, headache, nervousness, restlessness, confusion,

insomnia, dizziness, vertigo, incoordination, fatigue, tremors, seizures

CV: palpitations, tachycardia, hypotension

EENT: blurred vision, nasal congestion, tinnitus

GI: nausea, vomiting, diarrhea, dry mouth, constipation, epigastric distress,

anorexia

GU: dysuria, urine retention, urine frequency

Hematologic: hemolytic anemia, thrombocytopenia, agranulocytosis

Respiratory : thickening of bronchial secretions

Skin: urticaria, photosensitivity, rash

Other: anaphylactic shock

Assessment

Obtain a drug history from client. Report if a drug-drug interaction is probable

Determine baseline vital signs for future comparison

Assess signs and symptoms of urinary dysfunction

Note complete blood count during drug therapy

Assess cardiac and respiratory status

Diagnoses

Ineffective airway clearance r/t nasal congestion

Risk for imbalanced fluid volume r/t excessive sweating and loss of fluids

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Sleep deprivation r/t frequent coughing

Planning

Client will sleep 6-8 hours per night

Client will not experience nasal congestion


Observe 12 rights of drug administration


Avoid alcohol and other central nervous system depressants

Tell the client to take the medication with food to decrease GI upset

Instruct client not to use alcohol. Respiratory depression can occur

Discontinue if hypersensitivity occurs

Observe for adverse reactions since side effects may be experienced

Avoid performing tasks that require alertness

Evaluation

Aided in sleep

Allergic reactions are relieved

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Rationale: To aid in sedating patient before operation and prevent any allergic

reactions

Drug # 7


Generic name: Gentamicin Sulfate

Brand name: Gentamycin

Classification: Antibiotics; Aminoglyscoside


Mechanism of Action: Inhibits protein synthesis by binding directly to 30S ribosomal

subunits; bactericidal

Indications:

Serious infections caused by sensitive strains of Pseudomonas aeruginosa,

Escherichia coli, Proteus Klebsiella, or Straphylococcus

To treat bacterial infection after surgery

Contraindications:

Contraindicated to patients hypersensitive to drug or other aminoglycosides

Use cautiously in patients with impaired renal function or neuromuscular disorder

Adverse Reactions:

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CNS: dizziness, fever, headache, lethargy, encephalopathy, confusion, seizure,

numbness, peripheral neuropathy, vertigo, ataxia, tingling

CV: hypotension

GI: nausea and vomiting

GU: nephrotoxicity, possible increase in urinary excretion of casts

Hematologic: eosinophilia, anemia, leukopenic, thrombocytopenia,

agranulocytosis

Musculoskeletal: muscle twitching, myasthenia gravis-like sybdrome

Skin: rash, urticaria, pruritus, injection site pain

Other: anaphylaxis

Assessment

Determine baseline vital signs for future comparison and urine output.

Obtain a medical history related to renal or hearing disorders. Large doses of

aminoglycosides could cause nephrotoxicity or ototoxicity

Assess laboratory results to determine renal and liver functions. Aminoglycosides

may increase serum potassium and magnesium levels

Diagnoses

Risk for infection r/t invasion of bacteria

Risk for impaired tissue integrity r/t side effect of rash

Risk for ineffective tissue perfusion: renal r/t an aminoglycoside adverse effect of

nephrotoxicity

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Planning

Clients infection will be controlled and later eliminated


Observe 12 rights of drug administration

Send sample from infected area to laboratory for culture and sensitivity

Monitor intake and output. Report immediately if urine output is decreased or less

than 600 cc per day

Check for hearing loss

Evaluate laboratory results and compare with baseline values

Monitor vital signs. Note if body temperature is decreased

Administer over 30-60 minutes

Monitor for signs and symptoms of superinfection


Encourage client to increase fluid intake unless restricted

Instruct client never to take leftover antibiotics

Instruct patient to report adverse reactions promptly report adverse reactions,

such as dizziness, vertigo, tingling or muscle twitching

Advise patient to notify prescriber if a rash develops or if signs and symptoms of

superinfection occur

Tell patient to report discomfort at I.V. injection site

Evaluation

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Infection has ceased; white blood cell count went back to its normal range

No side effects had occurred

Rationale: To treat bacterial infection

Drug # 8


Generic name: Celecoxib

Brand name: Celebrex

Classification: Non-steroidal anti-inflammatory drugs

Actual Dosage: 200mg PO

Mechanism of Action: Thought to inhibit prostaglandin synthesis, primarily via

inhibition of cyclooxygenase-2 (COX-2), thereby producing anti-inflammatory, analgesic,

and antipyretic effect

Indications:

Moderately to severely acute pain

Contraindications:

Contraindicated to patients hypersensitive to drug, sulfonamides, aspirin, or other

NSAIDs

With severe hepatic impairment

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Use cautiously on patients with history of ulcers or GI bleeding, advanced renal

disease, dehydration, anemia, symptomatic liver disease, hypertension, edema,

heart failure, or asthma

Adverse Reactions:

CNS: dizziness, headache, insomnia

CV: peripheral edema

EENT: pharyngitis, rhinitis, sinusitis

GI: nausea, abdominal pain, diarrhea, dyspepsia, flatulence

Metabolic: hyperchloremia

Musculoskeletal: back pain

Respiratory: upper respiratory tract infection

Skin: rash

Other: accidental injury

Assessment

Determine medical history. Determine whether there is any history of gastric

upset, gastric bleeding, or liver disease.

Obtain drug history, report if a drug-drug interaction is probable

Diagnoses

Risk for injury r/t vertigo

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Planning

Client will be free of pain


Observe client for signs of bleeding such as dark tarry stools, bleeding gums,

petechiae, ecchymosis, purpura

Monitor for signs ofpain relief, such as anincreased appetite andactivity

Assess pain (note type, location, and intensity) prior to and 1-2 hr following

administration

Health teachings and Nursing Responsibilities

Instruct client to avoid alcohol and maintain adequate hydration (2-3 L/day of

fluids) unless instructed to restrict fluidintake

Do not take with antacids

Advise patient to consult if rash, itching, visual disturbances, tinnitus, weight gain,

edema, black stools, persistent headache, or influenza-like syndromes (chills,

fever, muscle aches, pain) occur

Instruct client to take drug with food, at mealtime, or with plenty of fluids to

prevent GI disturbances

Avoid driving or engaging in tasks requiring alertness until response to drug is

known

Evaluation

Pain relieved as verbalized by the patient

No side effects experienced

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Rationale: To treat moderate to severe pain

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Mini CP Skin Avulsion Chap11