Post on 03-Jun-2018
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VISIONA premier university in historic Cavite
recognized for excellence in the developmentof morally upright and globally competitive
individuals.Republic of the Philippines
CAVITE STATE UNIVERSITY
Don Severino Delas Alas Campus
Indang, Cavite
MISSIONCavite State University shall provide excellent, equitable
and relevant educational opportunities in the arts,science and technology through quality instruction andrelevant research and development activities. It shall
produce professional, skilled and morally uprightindividuals for global competitiveness.
PUEDAN, JENIVIC E. BSN 3-1
Name of Patient (Initial): R.D Date of Admission: July 30, 2013
Age: 16 years old Diagnosis: Dengue Hemorrhagic Fever
Sex: Male Date medication started: July 30 2013
Drug Mechanism of
Action
Indication Contraindication Side effects Nursing responsibilities
Generic: Ranitidine
Brand: Zantac
Classification:
Therapeutic:antiulcer
agents
Pharmacologic:
histamine H2
antagonists
Dosage: Tablet
75,150,300mg;capsules
150-00mg;syrup
15mg/ml;injection
1,25mg/ml
Short-term
treatment of active
duodenal ulcers and
benign gastric ulcers.
Maintenance
therapy for
duodenal and gastric
ulcers after healing
of active ulcers.
Management ofGERD.
Treatment of
heartburn, acid
indigestion, and sour
stomach (OTC use).
Cimetidine,
famotidine,
ranitidine:
Short-term
treatment of active
duodenal ulcers and
benign gastric ulcers.
Maintenance
therapy for
duodenal and gastric
ulcers after healing
of active ulcers.
Management ofGERD.
Treatment of
heartburn, acid
indigestion, and sour
stomach (OTC use).
Cimetidine,
famotidine,
ranitidine:
Hypersensitivity
Some products contain
alcohol and should be
avoided in patients with
known intolerance
Some products contain
aspartame and should be
avoided in patients with
phenylketonuria.
Use Cautiously in:Renal impairment (more
susceptible to adverse CNS
reactions; increased dosage
interval recommended for
cimetidineand nizatidineif
CCr 50 ml/min, and for
famotidineand ranitidineif
CCr
8/12/2019 Ranitidine, Famotidine, Essentiale,Paracetamol, Xyzal, Aeknil
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Route:
PO,IM,IV
Frequency: 0D
Form:
Color:
Management of
gastric
hypersecretory
states (Zollinger-
Ellison syndrome).
Cimetidine,
famotidine,
ranitidine IV:
Prevention and
treatment of stress-
induced upper GI
bleeding in critically
ill patients.
Ranitidine:
Treatment of and
maintenancetherapy for erosive
esophagitis.
Unlabelled Use:
Management of GI
symptoms
associated with the
use of NSAIDs.
Prevention of acid
inactivation of
supplementalpancreatic enzymes
in patients with
pancreatic
insufficiency.
Management of
urticaria.
Management of
gastric
hypersecretory
states (Zollinger-
Ellison syndrome).
Cimetidine,
famotidine,
ranitidine IV:
Prevention and
treatment of stress-
induced upper GI
bleeding in critically
ill patients.
Ranitidine:
Treatment of and
maintenancetherapy for erosive
esophagitis.
Unlabelled Use:
Management of GI
symptoms
associated with the
use of NSAIDs.
Prevention of acid
inactivation of
supplementalpancreatic enzymes
in patients with
pancreatic
insufficiency.
Management of
urticaria.
Hepatic impairment (for
ranitidine)
Acute porphyria (for
ranitidine)
Geri: Geriatric patients
(more susceptible to
adverse CNS reactions;
dosage reduction
recommended)
OB: Lactation: Pregnancy or
lactation.
AGRANULOCYTOSIS,
APLASTIC ANEMIA,
anemia,
neutropenia,
thrombocytopenia.
Local: pain at IM
site. Misc:
hypersensivity
reactions, vasculitis.
24 hr before the test.
-May cause false-negative
results in skin tests using
allergenic extracts.
Histamine H2
antagonists
should be discontinued 24
hr before the test.
-May cause in serum
transaminases and serum
creatinine.
-Serum prolactin
concentration may be
after IV bolus of
cimetidine. May also cause
parathyroid
concentrations.
Nizatidinemay cause
alkaline phosphatase
concentrations.
Ranitidineandfamotidine
may cause false-positive
results for urine protein;
test with sulfosalicylic
acid. .
-Advise patient to
report onset of black,tarry stools; fever,
sore throat; diarrhea;
dizziness; rash;
confusion; or
hallucinations to
health car
professional promptly
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Drug Mechanism of
Action
Indication Contraindication Side effects Nursing responsibilities
Generic: Famotidine
Brand: Acid Control,
Apo-Famotidine, Gen-
Famotidine,
Maximum Strength
Pepcid, Mylanta AR,
Novo-Famotidine,
Nu-Famotidine,
Pepcid, Pepcid AC,
Pepcid AC Acid
Controller, Pepcid
RPD, Ulcidine
Classification:
HISTAMINE H2
ANTAGONISTS
Dosage: 300 mg 4
times daily, 5-10
mg/kg q 6 hr.
Route: PO,IM,IV
Frequency: OD
Form:
Color:
Short-term
treatment of active
duodenal ulcers
and benign gastric
ulcers.
Maintenance
therapy for
duodenal and
gastric ulcers after
healing of active
ulcers.
Management of
GERD.Treatment of
heartburn, acid
indigestion, and
sour stomach (OTC
use).
Cimetidine,
famotidine,
ranitidine:
Management of
gastrichypersecretory
states (Zollinger-
Ellison syndrome).
Cimetidine,
famotidine,
ranitidine IV:
Prevention and
treatment of stress-
Short-term
treatment of active
duodenal ulcers
and benign gastric
ulcers.
Maintenance
therapy for
duodenal and
gastric ulcers after
healing of active
ulcers.
Management of
GERD.
Treatment ofheartburn, acid
indigestion, and
sour stomach (OTC
use).
Cimetidine,
famotidine,
ranitidine:
Management of
gastric
hypersecretorystates (Zollinger-
Ellison syndrome).
Cimetidine,
famotidine,
ranitidine IV:
Prevention and
treatment of stress-
induced upper GI
Hypersensitivity
Some products contain
alcohol and should be
avoided in patients with
known intolerance
Some products contain
aspartame and should be
avoided in patients with
phenylketonuria.
Use Cautiously in:
Renal impairment (more
susceptible to adverse
CNS reactions; increaseddosage interval
recommended for
cimetidineand nizatidine
if CCr 50 ml/min, and for
famotidineand ranitidine
if CCr
8/12/2019 Ranitidine, Famotidine, Essentiale,Paracetamol, Xyzal, Aeknil
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induced upper GI
bleeding in critically
ill patients.
Ranitidine:
Treatment of and
maintenance
therapy for erosive
esophagitis.
Unlabelled Use:
Management of GI
symptoms
associated with the
use of NSAIDs.
Prevention of acid
inactivation of
supplementalpancreatic enzymes
in patients with
pancreatic
insufficiency.
Management of
urticaria.
bleeding in critically
ill patients.
Ranitidine:
Treatment of and
maintenance
therapy for erosive
esophagitis.
Unlabelled Use:
Management of GI
symptoms
associated with the
use of NSAIDs.
Prevention of acid
inactivation of
supplemental
pancreatic enzymesin patients with
pancreatic
insufficiency.
Management of
urticaria.
or other activities
requiring alertness until
response to the drug is
known.
-Advise patient to avoid
alcohol, products
containing aspirin or
NSAIDs, and foods that
may cause an increase in
GI irritation.
Inform patient that
increased fluid and fiber
intake and exercise may
minimize constipation.
-Advise patient to report
onset of black, tarrystools; fever; sore throat;
diarrhea; dizziness; rash;
confusion; or
hallucinations to health
care professional
promptly. .
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Drug Mechanism of Action Indication Contraindication Side effects Nursing responsibilities
Generic: Essentiale
Forte
Brand:
Classification: A05BA -
Liver therapy ; Used in
liver therapy.
Dosage: 2 cap tid.
Route:
Frequency:
Form:
Color: Brown
Among the
pharmacodynamic
properties reported were
hepatoprotective effects
found in numerous
experimental models in
acute liver damage
(induced by ethanol,
alkyl alcohol, carbon
tetrachloride,
paracetamol and
galactosamine).
Furthermore, it was also
seen to inhibit steatosis
and fibrosis in chronicliver damage models
(induced by ethanol,
thioacetamide and
organic solvents). Its
suggested principal
actions have been
through accelerated
membrane regeneration
and stabilization,
inhibited lipidperoxidation and
inhibited collagen
synthesis.
Nutritional support
in the management
of damaged liver
due to chronicliver
disease,liver
cirrhosis,fatty liver
& intoxication by
hepatotoxic
substances.
Hypersensitivity to soya
bean prep.
Occasionally,
stomach complaints,
soft stool, diarrhea.
http://www.mims.com/Philippines/diagnoses/info/1396?q=liver%20diseasehttp://www.mims.com/Philippines/diagnoses/info/1396?q=liver%20diseasehttp://www.mims.com/Philippines/diagnoses/info/490?q=liver%20cirrhosishttp://www.mims.com/Philippines/diagnoses/info/490?q=liver%20cirrhosishttp://www.mims.com/Philippines/diagnoses/info/490?q=liver%20cirrhosishttp://www.mims.com/Philippines/diagnoses/info/490?q=liver%20cirrhosishttp://www.mims.com/Philippines/diagnoses/info/1396?q=liver%20diseasehttp://www.mims.com/Philippines/diagnoses/info/1396?q=liver%20disease8/12/2019 Ranitidine, Famotidine, Essentiale,Paracetamol, Xyzal, Aeknil
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Drug Mechanism of
Action
Indication Contraindication Side effets Nursing
responsibilities
Generic: Paracetamol
, Acetaminophen
Brand: Biogesic,
Panadol, Tylenol
Classification:
Non-narcotic
analgesic, Antipyretic
Dosage: 500-1,000
mg
Route: Oral, IV
Frequency: 4-6 hrs
Form:
Color: Brown
- Decreases fever
by a hypothalamic
effect leading to
sweating andvasodilation
-Inhibits pyrogen
effect on the
hypothalamic-
heat-regulating
centers
-Inhibits CNS
prostaglandinsynthesis with
minimal effects on
peripheral
prostaglandin
synthesis
-Does not cause
ulceration of the
GI tract and causes
no anticoagulant
action.
Symptomatic treatment
of mild to
moderatepain &/orfever.
Nephrotoxicity.
Renal Insufficiency
Anemia
Occasionally, skin rashes
& hypersensitivity
reactions. Renal damage
(long-term use).Hematological reactions
including
thrombocytopenia,
leukopenia &
methemoglobinemia
resulting to cyanosis.
Minimal GI upset.
1. Methemoglobinemia
2. Hemolytic Anemia3. Neutropenia
4. Thrombocytopenia
5. Pancytopenia
6. Leukopenia
7. Urticaria
8. CNS stimulation
9. Hypoglycemic coma
10. Jaundice
11.Glissitis
12.Drowsiness
13.Liver Damage
1. Do not exceed
4gm/24hr. in
adults and
75mg/kg/day inchildren.
2. Do not take for
>5days for pain in
children, 10 days
for pain in adults,
or more than 3
days for fever in
adults.
3. Extended-Release
tablets are not tobe chewed.
4. Monitor CBC, liver
and renal
functions.
5. Assess for fecal
occult blood and
nephritis.
6. Avoid using OTC
drugs with
Acetaminophen.
7. Take with food ormilk to minimize GI
upset.
8. Report N&V.
cyanosis, shortness
of breath and
abdominal pain as
these are signs of
toxicity.
http://www.mims.com/Philippines/diagnoses/info/1692?q=painhttp://www.mims.com/Philippines/diagnoses/info/849?q=feverhttp://www.mims.com/Philippines/diagnoses/info/849?q=feverhttp://www.mims.com/Philippines/diagnoses/info/1692?q=pain8/12/2019 Ranitidine, Famotidine, Essentiale,Paracetamol, Xyzal, Aeknil
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9. Report paleness,
weakness and
heart beat skips
10.Report abdominal
pain, jaundice, dark
urine, itchiness or
clay-colored stools.
11.Phenmacetin may
cause urine to
become dark
brown or wine-
colored.
12.Report pain that
persists for more
than 3-5 days
13.Avoid alcohol.14.This drug is not for
regular use with
any form of liver
disease.
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Drug Mechanism of Action Indication Contraindication Side effects Nursing responsibilities
Generic:
Levocetirizine
dihydrohloride
Brand: Xyzal
Classification:
Antihistamine
Dosage: tablet
5mg; oral
solution
2.5mg/5ml
Route: Oral
Frequency: BID
Form:
Color:
Potent Histamine (H1)
receptor antagonist;
inhibits histamine
relesase and
eosinophil chemotaxis
during
inflammation,reducing
swelling and
inflammatory
response.
-Relief from
symptoms of
seasonal and
perennial allergic
rhinitis in adults
and children 6
mos nd older.
-Treatment of
uncomplicated
skin effects in
chronic idiopathic
urtiuria in patients
2 yr and older.
-Hypersensitivity to
levocetirizine, any
of its components,
or cetirizine; end-
stage renal disease;
renl impairement in
children .
-Use cautiously
with pregnancy and
with use of CNS
depressants.
CNS: Somnolence,
asthenia
GI: Dry mouth
RESPI:
Nasopharyngitis,cough,p
haryngitis,epistaxis
Other: fatigue, fever
-Administer once each day, in the
evening.
-Alert patient to possible alterations
in mental alertness while taking this
rug.
-Encourage use of humidifiers and
adequate intake of fluids to help
prevent severe dryness of mucous
membranes.
-Provide skin care for urticuria.
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Drug Mechanism of Action Indication Contraindication Side effects Nursing responsibilities
Generic:
Paracetamol
Brand: Aeknil
Classification:
Analgesic (Opiod)
Dosage: 2-3 ml
Route: IV
Frequency: Q4
Form:
Color:
Paracetamol produces
analgesia by raising
the threshold of the
pain center in the
brain n by obstructing
impulses at the pain-
mediating
chemoreceptors. The
drug produces
antipyretics by an
action on the
hypothalamus; heat
dissipation is
increased as a result
of vasodilation anincreased peripheral
blood flow.
-pyrexia of
unknown
origin,fever and
pain associated
with common
childhood
disorders
,tonsillitis, upper
respiratory tract
infection post
immunization
reactions.
-Prevention of
febrile convulsion,headache, cold,
sinusitis,musle
pain,arthritis and
toothache.
-Liver damage
-skin rashes
-blood disorders and
swollen pancreas.
-Use liquid form of children and
patients who have difficulty
swallowing.
-In children, dont exceed five dose
in 24 hrs
-Advise patient that drug is only for
short term use and to consult the
physician if giving to children for
longer than 5 days.
- Advise patient that many over the
counter products contains
acetaminophen; be aware of thiswhen calculating total daily dose.
-Warn patient that high doses or
unsupervised long term can cause
liver damage.
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FOCUS ASSESSMENT:
Name of Patient (Initial): R.D Date of Admission: July 30, 2013
Age: 16 years old Diagnosis: Dengue Hemorrhagic Fever
Sex: Male Date medication started: July 30 2013
Vital Signs
LABORATORY RESULTS
DATE: 08-01-13/ 7:20 PM
RESULT. Normal Value
Hematocrit 0.42 % 41-50 %
Hemoglobin 147 g/dl 13.5 - 16.5g/dl
Platelet count 86,000 x10 9/L
100,000 x10 9/L as of 08-
02-13
150,000-450,000
x10 9/L
APTT 40.0 sec 25-38 seconds
System Findings
General Good Hygiene, (-) fever, pallor
Musculoskeletal(-) Muscle and Joint pain
(-) Back pain
Skin Dry
Mouth Dry lips
Upper and Lower Extremities (+) rashes
Date: 08-01-13 08-02-13
Time: 8AM 12PM 8AM 12PM
T 36.4 36.7 36.5 36.0
PR 71 74 20 25
RR 24 24 73 74
BP 110/80 110/60 110/60 100/60
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Assessment Nursing Diagnosis Scientific
Rationale
Planning Intervention Rationale Evaluation
Objective data:
Pallor
Weakness
Decreased
hematocrit
(0.42%)
Decreased
hemoglobin (
Decreased
platelet count
(100,00 x10
9/L) Decreased
capillary time
of 3-4 sec.
Rashes in
upper and
lower
extremities
Ineffective tissue
perfusion related
to decreased
hemoglobin
concentration in
blood,
hematocrit , and
platelet count
secondary to DHF
stage 2.
DHF
Viral infection
Decreased CBC
&platelet count
Decreased level
of hemoglobin
and hematocrit
Decreased
blood
oxygenation
Pallor and
muscle
weakness
Ineffective
tissue
perfusion
After 4hours of
nursing
intervention and
with the help of
Medical
Management the
patient will
demonstrate
behaviors to
improve circulation
and increased
perfusion as
appropriate.
Monitored Vital
signs of the
patient.
Assessed
patients
condition.
Performed
blanch test
Positioned
patient in semi
fowlers.
Encouraged quite
and restful
atmosphere. Instructed the
patient to avoid
tiring activities.
Encouraged light
ambulation.
Encourage use of
relaxation
techniques.
Administered
medication asordered by the
doctor.
Encourage
patient to take
iron supplements
and eat foods
rich in iron.
To obtain baseline
data.
To assess
contributing factors.
To determine
adequate perfusion
To promote
circulation.
To promote comfort
and decrease tissue
O2 demand. To decrease cardiac
workload.
To enhance venous
return.
To decrease tension
and anxiety.
To treat underlying
cause.
To help elevate
hemoglobin and
hematocrit levels.
After 8 hours of
nursing intervention
the patient shall
have demonstrated
behaviors to
improve circulation
and to increased
perfusion as
appropriate as
evidenced by the
result of platelet
count from 86,000
to 100,000.
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Number 2: Risk for bleeding
Assessment Nursing Diagnosis Scientific
Rationale
Planning Intervention Rationale Evaluation
Objective data:
Rashes on the
upper and
lower
extremities
Restlessness
(-)bleeding
and
abdominal
pain
Platelet count
of 86,000 x109/L as of 08-
01-13
Vs as
followed.
T-36.7
PR-74
RR-24
BP-110/60
Risk for bleeding
related to altered
clotting factor
secondary to DHF
stage 2.
It is a mosquito
born viral disease
cause Aedis
Aegypti . This
infectious disease
is manifested by a
sudden onset
of fever, with severe
headache; muscle
and joint pains
severe pain gives it
the name breakbone fever or bone
crusher.
After 2 hours of
nursing
intervention and
with the help of
Medical
management the
patient will be able
to demonstrate
behaviors that
reduce the risk for
bleeding and will
be free of signs ofactive bleeding.
Monitored
Vital Signs of
the patient.
Assessed for
signs and
symptoms of
G.I bleeding.
Check for
secretions.
Instructed the
patient to
avoid eating
dark color
foods.
Assessed skin
color and
moisture, urine
output, level of
consciousness. Reviewed
laboratory data
such as CBC
and PC.
Serve as
baseline for
more effective
nursing action.
The G.I tract
(esophagus
and rectum) is the
most usual source
of bleeding of its
mucosal Fragility
It can affect
the color of his
stool.
Changes in
these signs
may be
indicative of
blood loss. To determine if
there is
abnormal of
patients blood
count.
Goal Met.
After 8 hours of
nursing
intervention the
patient was able to
demonstrate
behavior that
reduced the risk
for bleeding.