I.W.. Profile

8/8/2019 I.W.. Profile

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Data Collection Student Name: __J. Wilder____Patient Initials: _I.W.___ Admitting diagnosis: Fever / Cyst Draining, uncontrolled diabetes

Coexisting Medical Conditions: HTN, DM, Left knee surgery, open heart surgery

Baseline Data Treatments andEquipment

DiagnosticTests

IV Therapy Medications

VS every q 8 hrsTemp: 98.9 f.pulse: 98resp: 22B/P: 140/84Pulse ox: 98Blood Glucose: 165

List them here

Surgery scheduled toremove cyst. Placed oninsulin sliding scale,Humulin 70/30.

Labs:

CBCEstimated GlomerularFiltration RateBMP

Other:

n/a

Primary:n/a

TPN:n/a

Blood Products:

n/a

Other:n/a

Scheduled/ Routine

Insulin sliding scaleHumulin 70/30Diovan 160Norvasc 5 mgAllopurinol 200 mgValsartan 10 mgZyloprim 300mgDiltiazem 30 mg

PRN:

Tylenol 650 mgMorphine 25 mg

WT212 lbs

Diet: Regular(questionable due to hercoexisting conditionswould suggestmodifications to her diet)

Activity:Bedrest

I & O for past 24

n/a

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Reference:

Date of Admission: 11/29/2010 How many days in hospital: 2 DPatient Initials: I.W. Gender: F Age: 71Adm. DX: Fever / Cyst Draining, uncontrolled diabetesAny hx of Surgery: Open heart surgery, Right knee surgery, hysterectomy

Past Med. History (PMH): HTN, diabetes, open heart surgery,Hyperlipidemia and obesity

The Disease: Diabetes Symptomatology

Pathophysiology: Per Book:

Type 1 DM is a catabolic disorder in which circulating insulin isvery low or absent, plasma glucagon is elevated, and thepancreatic beta cells fail to respond to all insulin-secretorystimuli. Patients need exogenous insulin to reverse thiscatabolic condition, prevent ketosis, decreasehyperglucagonemia, and normalize lipid and protein

metabolism. Type 1 DM is an autoimmune disease. Thepancreas shows lymphocytic infiltration and destruction ofinsulin-secreting cells of the islets of Langerhans, causinginsulin deficiency. Approximately 85% of patients havecirculating islet cell antibodies, and the majority also havedetectable anti-insulin antibodies before receiving insulintherapy. Most islet cell antibodies are directed against glutamicacid decarboxylase (GAD) within pancreatic B cells.

Perry & Potter

Hyperglycemia, Polydipsia, polyuria, polyphagia, glucose in urine, weightloss and fatigue.

Define the Disease: A chronic condition in which the pancreases does

not produce enough insulin thus making the patient hyperglycemic.My Patient: Blood glucose 165 at 0800 then went to 220 at 1100. Decreased healingis a symptom on diabetes which is evidenced by the abscess on the right axilla.

Medical/ Surgical Interventions

Per Book: n/a couldnt find

My Patient: Will be undergoing surgery to remove cyst

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Coexisting Medical Conditions with Definitions Symptomatology

Hypertension: Hypertension is a chronic medicalcondition in which the blood pressure is elevated

Severe headache, fatigue or confusion, vision problems, chest pain, difficultybreathing, irregular heartbeat, blood in urine, pounding in neck, chest or ears.

cyst: an abnormal, closed sac-like structure within a tissue that

contains a liquid, gaseous, or semisolid substance.

inflammation, drainage, fever, elevated wbc, swelling and pain

Are any of the above medical conditions contributing to this patients current admittingdiagnosis? YES/ NO? Why or why not?

No

Reference:

NUTRITION CORRELATION TO

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MEDICAL CONDITION

Diet type: Diabetic in order to try to maintain or lower blood sugar

Supplement(s): No

Calorie Count: No

Aspiration Precautions: No

Feed: n/a

Enteral Feeding: n/A

G-Tube

J-Tube

NGT

Feeding Pump/ Hourly Rate: N/a

Continuous Intermittent

DESCRIBE MEDICAL TREATMENTS(Physical Therapy, Respiratory Therapy, Ted hose, SCD, etc)

none

Reference:

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DIAGNOSTIC TESTSTest and Date Completed Results ALL Correlate Results to Medical DX/ or

Medical Condition

Glucose 405 High 60-110 Indicates diabetes

BUN 20 High 7-17

SODIUM 136 NORMAL 137-145

POTASSIUM 4.2 NORMAL 3.6-5.0

CHLORIDE 97 LOW 98-107CO2 21 - LOW 22-30

ANION GAP 23 - HIGH 10-20

CREATININE 1.25 HIGH .6 -1.

CALCIUM 9.5 - NORMAL 8.4-10.2

WBC 19.3 - HIGH 3.5 10 Indicates infection possible related to cyst

RBC 4.53 - NORMAL - 4.00-5.50

HGB 13.6 - NORMAL - 11.4-15.4

HCT 41.2 NORMAL 32.8-45.6

MCV 90.9 - NORMAL 80.0-95.0

MCH 30.1 - NORMAL 26-34

MCHC 33.1 NORMAL 32.0-35.0RDW 14.1 NORMAL 11.5-14.5

PLATELET COUNT 221 NORMAL 150-450

GFR Non African American 42 Abnormal < 60

Reference: chart

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MEDICATION WORKSHEETDrug Action and

TherapeuticDose

Side Effects Contraindications RN parameters

InsulinRegular

Lowers blood glucose by:stimulating glucoseuptake in skeletal muscleand fat, inhibiting hepaticglucose production. Otheractions of insulin:inhibition of lipolysis andproteolysis, enhancedproteinsynthesis. TherapeuticEffects: Control ofhyperglycemia in diabeticpatients.Subcut (Adults andChildren): 0.51unit/kg/day in divideddose

ndo: HYPOGLYCEMIA. Local: lipodystrophy, pruritus, erythema,swelling. Misc: ALLERGIC REACTIONSINCLUDING ANAPHYLAXIS.

Contraindicatedin: Hypoglycemia; Allergyor hypersensitivity to aparticular type of insulin,preservatives, or otheradditives.Use Cautiously in: Stressor infectionmaytemporarily insulinrequirements;Renal/hepatic impairmentmay insulinrequirements; OB: Pregnancy may temporarily insulin requirements.

High Alert: Insulin-relatedmedication errors have resultedin patient harm and death. Clarifyambiguous orders; do not acceptorders using the abbreviation ufor units, (can be misread as azero or the numeral 4; hasresulted in tenfold overdoses).Assess patient periodically forsymptoms of hypoglycemia(anxiety; restlessness; tingling inhands, feet, lips, or tongue; chills;cold sweats; confusion; cool,pale skin; difficulty inconcentration; drowsiness;nightmares or trouble sleeping;excessive hunger; headache;irritability; nausea; nervousness;tachycardia; tremor; weakness;unsteady gait)and hyperglycemia(confusion, drowsiness; flushed,dry skin; fruit-like breath odor;rapid, deep breathing, polyuria;loss of appetite; unusual thirst)during therapy.Monitor bodyweight periodically. Changes inweight may necessitate changesin insulin dose. Lab TestConsiderations: Monitor bloodglucose every 6 hr duringtherapy, more frequently inketoacidosis and times of stress.A1C may be monitered every 36 months to determineeffectiveness. Toxicity andOverdose: Overdose is

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manifested by symptoms ofhypoglycemia. Mildhypoglycemia may be treated byingestion of oral glucose. Severehypoglycemia is a life-threateningemergency; treatment consists ofIV glucose, glucagon, orepinephrine.

Humulin70/30

Lower blood glucose by :stimulating glucoseuptake in skeletal muscleand fat, inhibiting hepaticglucose production. Otheractions: inhibition oflipolysis and proteolysis,enhanced protein

synthesis. TherapeuticEffects: Control ofhyperglycemia in diabeticpatients.Dose depends on bloodglucose, response, andmany other factors.

Subcut (Adults andChildren): 0.51unit/kg/day

Endo: HYPOGLYCEMIA. Local: erythema, lipodystrophy, pruritis,swelling. Misc: ALLERGIC REACTIONSINCLUDING ANAPHYLAXIS.

Contraindicatedin: Hypoglycemia; Allergyor hypersensitivity to aparticular type of insulin,preservatives, or otheradditives.Use Cautiously in: Stressand infection (may

temporarily insulinrequirements);Renal/hepatic impairment(may insulinrequirements);

High Alert: Insulin-relatedmedication errors have resultedin patient harm and death. Clarifyambiguous orders; do not acceptorders using the abbreviation ufor units, (can be misread as azero or the numeral 4; hasresulted in tenfold overdoses).

Assess for symptoms ofhypoglycemia (anxiety;restlessness; tingling in hands,feet, lips, or tongue; chills; coldsweats; confusion; cool, paleskin; difficulty in concentration;drowsiness; excessive hunger;headache; irritability; nightmaresor trouble sleeping; nausea;nervousness; tachycardia;tremor; weakness; unsteady

gait) and hyperglycemia(confusion, drowsiness; flushed,dry skin; fruit-like breath odor;rapid, deep breathing, polyuria;loss of appetite; nausea;vomiting; unusual thirst)periodically duringtherapy.Toxicity andOverdose: Overdose ismanifested by symptoms ofhypoglycemia. Mild

hypoglycemia may be treated by7


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ingestion of oral glucose. Severehypoglycemia is a life-threateningemergency; treatment consists ofIV glucose, glucagon, orepinephrine. Toxicity andOverdose: Overdose ismanifested by symptoms ofhypoglycemia. Mildhypoglycemia may be treated byingestion of oral glucose. Severehypoglycemia is a life-threateningemergency; treatment consists ofIV glucose, glucagon, orepinephrine.

Diovan160

Blocks vasoconstrictorand aldosterone-producing effects ofangiotensin II at receptorsites, including vascularsmooth muscle and theadrenalglands. TherapeuticEffects:Lowering of bloodpressure. Slowedprogression of diabeticnephropathy (irbesartanand losartan only).Reduced cardiovasculardeath and hospitalizationsdue to CHF in patientswith CHF (candesartanand valsartan only).Decreased risk ofcardiovascular death inpatients with leftventricular systolicdysfunction who are post-MI (valsartan only).Decreased risk of strokein patients withhypertension and left

CNS: dizziness, anxiety, depression,fatigue, headache, insomnia,weakness.CV: hypotension, chest pain,edema,tachycardia. Derm: rashes. EENT: nasalcongestion, pharyngitis, rhinitis,sinusitis. GI: abdominal pain, diarrhea,drug-induced hepatitis, dyspepsia,nausea, vomiting. GU: impaired renalfunction. F andE hyperkalemia.MS: arthralgia, back pain,myalgia. Misc: ANGIOEDEMA.

Contraindicatedin: Hypersensitivity; OB: Can cause injury or death offetus;Lactation: Discontinue drug or provide formula.Use Cautiously in: CHF(may result in azotemia,oliguria, acute renal failureand/or death); Volume- orsalt-depleted patients orpatients receiving highdoses of diuretics (correctdeficits before initiatingtherapy or initiate at lowerdoses); Black patients(may not be effective);Impaired renal functiondue to primary renaldisease or CHF (mayworsen renal function);Obstructive biliarydisorders (telmisartan) orhepatic impairment(candesartan, losartan, ortelmisartan); Women ofchildbearing potential;

Assess blood pressure (lying,sitting, standing) and pulseperiodically during therapy. Notifyhealth care professional ofsignificant changes.Monitorfrequency of prescription refills todetermine adherence.Assesspatient for signs of angioedema(dyspnea, facial swelling). Mayrarely cause angioedema.TestConsiderations: Monitor renalfunction and electrolyte levelsperiodically. Serum potassium,BUN, and serum creatinine maybe .May cause AST, ALT, andserum bilirubin (candesartan andolmesartan only).May cause uric acid, slight in hemoglobinand hematocrit, neutropenia, andthrombocytopenia.Emphasize theimportance of continuing to takeas directed, even if feeling well.Take missed doses as soon asremembered if not almost timefor next dose; do not doubledoses. Instruct patient to takemedication at the same time

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ventricular hypertrophy(effect may be less inblack patients) (losartanonly).PO (Adults): Hypertension80 mg or 160 mg oncedaily initially in patientswho are not volume-depleted; may be to 320mg once daily; CHF40mg twice daily, may betitrated up to target doseof 160 mg twice daily astolerated; Post-MI20mg twice daily (may beinitiated 12 hr after MI);dose may be titrated up totarget dose of 160 mgtwice daily, as tolerated.

each day. Warn patient not todiscontinue therapy unlessdirected by health careprofessional.Caution patient toavoid salt substitutes containingpotassium or food containinghigh levels of potassium orsodium unless directed by healthcare professional. See AppendixM.Caution patient to avoidsudden changes in position todecrease orthostatichypotension. Use of alcohol,standing for long periods,exercising, and hot weather mayincrease orthostatichypotension.May causedizziness. Caution patient toavoid driving or other activitiesrequiring alertness until responseto medication is known.Advisepatient to consult health careprofessional before taking anyOTC or herbal cough, cold, orallergy remedies or othermedications.Instruct patient tonotify health care professional ifswelling of face, eyes, lips, ortongue occurs, or if difficultyswallowing or breathingoccurs.Emphasize theimportance of follow-up exams toevaluate effectiveness ofmedication.Hypertension: Encourage patient to comply withadditional interventions forhypertension (weight reduction,low-sodium diet, discontinuationof smoking, moderation ofalcohol consumption, regularexercise, stress management)

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Medication controls but dose notcure hypertension.Instruct patientand family on proper techniquefor monitoring blood pressure.Advise them to check bloodpressure at least weekly and toreport significant changes .

Norvasc5 mg

Inhibits the transport ofcalcium into myocardialand vascular smoothmuscle cells, resulting ininhibition of excitation-contraction coupling andsubsequentcontraction. TherapeuticEffects: Systemic

vasodilation resulting indecreased bloodpressure. Coronaryvasodilation resulting indecreased frequency andseverity of attacks ofangina.PO (GeriatricPatients): AntihypertensiveInitiate therapy at 2.5mg/day, as

required/tolerated (up to10 mg/day); antianginalinitiate therapy at 5mg/day, asrequired/tolerated (up to10 mg/day).

CNS: headache, dizziness,fatigue. CV: peripheral edema, angina,bradycardia, hypotension,palpitations. GI: gingival hyperplasia,nausea. Derm: flushing.

Contraindicatedin: Hypersensitivity;Systolic blood pressure


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to contact health careprofessional if heart rate is


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anginal attacks.Advise patient tocontact health care professionalif chest pain does not improve orworsens after therapy, if it occurswith diaphoresis, if shortness ofbreath occurs, or if severe,persistent headacheoccurs.Caution patient to discussexercise restrictions with healthcare professional beforeexertion.Hypertension: Encourage patient to comply with otherinterventions for hypertension(weight reduction, low-sodiumdiet, smoking cessation,moderation of alcoholconsumption, regular exercise,and stress management).Medication controls but does notcure hypertension.Instruct patientand family in proper technique formonitoring blood pressure.Advise patient to take bloodpressure weekly and to reportsignificant changes to health careprofessional .

Allopurinol 200mg

Inhibits the production ofuric acid by inhibiting theaction of xanthineoxidase.TherapeuticEffects: Lowering ofserum uric acid levels.Management of GoutPO (Adults and Children>10 yr): Initially100mg/day; increase atweekly intervals based onserum uric acid (not toexceed 800 mg/day).Doses >300 mg/day

CV: hypotension, flushing, hypertension,bradycardia, and heart failure (reportedwith IVadministration). CNS: drowsiness. GI: diarrhea, hepatitis, nausea,vomiting. GU: renal failure,hematuria. Derm: rash (discontinue drugat first sign of rash),urticaria. Hemat: bone marrowdepression. Misc: hypersensitivityreactions.

Use Cautiously in: Acuteattacks of gout; Renalinsufficiency (dosereduction required if CCr


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should be given in divideddoses; Maintenance dose100200 mg 23 timesdaily. Doses of 300 mgmay be given as a singledaily dose.Management ofSecondary Hyperuricemia

PO (Adults and Children>10 yr): 600800 mg/dayin 23 divided dosesstarting 12 days beforechemotherapy orradiation.

a mild reaction has subsided, ata lower dose (50 mg/day withvery gradual titration). If skin rashrecurs, discontinuepermanently .Gout: Monitor forjoint pain and swelling. Additionof colchicine or NSAIDs may benecessary for acute attacks.

Prophylactic doses of colchicineor an NSAID should beadministered concurrently duringthe first 36 mo of therapybecause of an increasedfrequency of acute attacks ofgouty arthritis during earlytherapy.Lab TestConsiderations: Serum and urineuric acid levels usually begin to 23 days after initiation of oral

therapy.Monitor blood glucose inpatients receiving oralhypoglycemic agents. May causehypoglycemia.Monitorhematologic, renal, and liverfunction tests before andperiodically during therapy,especially during the first fewmonths. May cause serumalkaline phosphatase, bilirubin,AST, and ALT levels. CBC andplatelets may indicate bonemarrow depression. BUN,serum creatinine, and CCr mayindicate nephrotoxicity. Theseare usually reversed withdiscontinuation of therapy.Instruct patient to takeallopurinol as directed. Takemissed doses as soon asremembered. If dosing scheduleis once daily, do not take if

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remembered the next day. Ifdosing schedule is more thanonce a day, take up to 300 mgfor the next dose.Instruct patientto continue taking allopurinolalong with an NSAID orcolchicine during an acute attackof gout. Allopurinol helps prevent,

but does not relieve, acute goutattacks.Alkaline diet may beordered. Urinary acidification withlarge doses of vitamin C or otheracids may increase kidney stoneformation (see Appendix M).Advise patient of need forincreased fluid intake.Mayoccasionally cause drowsiness.Caution patient to avoid drivingor other activities requiring

alertness until response to drugis known.Instruct patient to reportskin rash, blood in urine, orinfluenza symptoms (chills, fever,muscle aches and pains, nausea,or vomiting) to health careprofessional immediately; skinrash may indicatehypersensitivity.Advise patientthat large amounts of alcoholincrease uric acid concentrations

and may decrease theeffectiveness ofallopurinol.Emphasize theimportance of follow-up exams tomonitor effectiveness and sideeffects.

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Valsartan10 mg

Blocks vasoconstrictorand aldosterone-producing effects ofangiotensin II at receptorsites, including vascularsmooth muscle and theadrenal glands. Reducedcardiovascular death and

hospitalizations due toCHF in patients with CHF(candesartan andvalsartan only).Decreased risk ofcardiovascular death inpatients with leftventricular systolicdysfunction who are post-MI (valsartan only).Hypertension80 mg or

160 mg once daily initiallyin patients who are notvolume-depleted; may be to 320 mg oncedaily; CHF40 mg twicedaily, may be titrated upto target dose of 160 mgtwice daily astolerated; Post-MI20mg twice daily (may beinitiated 12 hr after MI);

dose may be titrated up totarget dose of 160 mgtwice daily, as tolerated.

CNS: dizziness, anxiety, depression,fatigue, headache, insomnia,weakness.CV: hypotension, chest pain,edema,tachycardia. Derm: rashes. EENT: nasalcongestion, pharyngitis, rhinitis,sinusitis. GI: abdominal pain, diarrhea,drug-induced hepatitis, dyspepsia,

nausea, vomiting. GU: impaired renalfunction. F andE hyperkalemia.MS: arthralgia, back pain,myalgia. Misc: ANGIOEDEMA.

Use Cautiously in: CHF(may result in azotemia,oliguria, acute renal failureand/or death); Volume- orsalt-depleted patients orpatients receiving highdoses of diuretics (correctdeficits before initiating

therapy or initiate at lowerdoses); Black patients(may not be effective);Impaired renal functiondue to primary renaldisease or CHF (mayworsen renal function);Obstructive biliarydisorders (telmisartan) orhepatic impairment(candesartan, losartan, or

telmisartan); Women ofchildbearing potential;

Assess blood pressure (lying,sitting, standing) and pulseperiodically during therapy. Notifyhealth care professional ofsignificant changes. Assesspatient for signs of angioedema(dyspnea, facial swelling). Mayrarely cause

angioedema.CHF: Monitor dailyweight and assess patientroutinely for resolution of fluidoverload (peripheral edema,rales/crackles, dyspnea, weightgain, jugular venousdistention)Lab TestConsiderations: Monitor renalfunction and electrolyte levelsperiodically. Serum potassium,BUN, and serum creatinine may

be .May cause AST, ALT, andserum bilirubin (candesartan andolmesartan only).May cause uric acid, slight in hemoglobinand hematocrit, neutropenia, andthrombocytopenia. Correctvolume depletion, if possible,prior to initiation of therapy.PO: May be administered withoutregard to meal Emphasize theimportance of continuing to take

as directed, even if feeling well.Take missed doses as soon asremembered if not almost timefor next dose; do not doubledoses. Instruct patient to takemedication at the same timeeach day. Warn patient not todiscontinue therapy unlessdirected by health careprofessional. aution patient toavoid salt substitutes containing

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potassium or food containinghigh levels of potassium orsodium unless directed by healthcare professional. See AppendixM. Caution patient to avoidsudden changes in position todecrease orthostatichypotension. Use of alcohol,

standing for long periods,exercising, and hot weather mayincrease orthostatic hypotension.Advise patient to consult healthcare professional before takingany OTC or herbal cough, cold,or allergy remedies or othermedications. Instruct patient tonotify health care professional ifswelling of face, eyes, lips, ortongue occurs, or if difficulty

swallowing or breathing occurs.Emphasize the importance offollow-up exams to evaluateeffectiveness of medication.Hypertension: Encourage patientto comply with additionalinterventions for hypertension(weight reduction, low-sodiumdiet, discontinuation of smoking,moderation of alcoholconsumption, regular exercise,

stress management) Medicationcontrols but dose not curehypertension. Instruct patient andfamily on proper technique formonitoring blood pressure.Advise them to check bloodpressure at least weekly and toreport significant changes .

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Zyloprim300mg

Inhibits the production ofuric acid by inhibiting theaction of xanthineoxidase.TherapeuticEffects: Lowering ofserum uric acid levels.PO (Adults and Children>10 yr): Initially100

mg/day; increase atweekly intervals based onserum uric acid (not toexceed 800 mg/day).Doses >300 mg/dayshould be given in divideddoses; Maintenance dose100200 mg 23 timesdaily. Doses of 300 mgmay be given as a singledaily dose.

CV: hypotension, flushing, hypertension,bradycardia, and heart failure (reportedwith IVadministration). CNS: drowsiness. GI: diarrhea, hepatitis, nausea,vomiting. GU: renal failure,hematuria. Derm: rash (discontinue drugat first sign of rash),

urticaria. Hemat: bone marrowdepression. Misc: hypersensitivityreactions.

Use Cautiously in: Acuteattacks of gout; Renalinsufficiency (dosereduction required if CCr


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especially during the first fewmonths. May cause serumalkaline phosphatase, bilirubin,AST, and ALT levels. CBC andplatelets may indicate bonemarrow depression. BUN,serum creatinine, and CCr mayindicate nephrotoxicity. These

are usually reversed withdiscontinuation oftherapy .PO: May beadministered after milk or mealsto minimize gastric irritation; givewith plenty of fluid. May becrushed and given with fluid ormixed with food for patients whohave difficulty swallowing.Instruct patient to take allopurinolas directed. Take missed doses

as soon as remembered. Ifdosing schedule is once daily, donot take if remembered the nextday. If dosing schedule is morethan once a day, take up to 300mg for the next dose.Instructpatient to continue takingallopurinol along with an NSAIDor colchicine during an acuteattack of gout. Allopurinol helpsprevent, but does not relieve,

acute gout attacks. Alkaline dietmay be ordered. Urinaryacidification with large doses ofvitamin C or other acids mayincrease kidney stone formation(see Appendix M). Advise patientof need for increased fluid intake.May occasionally causedrowsiness. Caution patient toavoid driving or other activitiesrequiring alertness until response

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to drug is known. Instruct patientto report skin rash, blood in urine,or influenza symptoms (chills,fever, muscle aches and pains,nausea, or vomiting) to healthcare professional immediately;skin rash may indicatehypersensitivity. Advise patient

that large amounts of alcoholincrease uric acid concentrationsand may decrease theeffectiveness of allopurinol.Emphasize the importance offollow-up exams to monitoreffectiveness and side effects.

Diltiazem30 mg

Inhibits transport ofcalcium into myocardialand vascular smoothmuscle cells, resulting ininhibition of excitation-contraction coupling andsubsequentcontraction. TherapeuticEffects: Systemicvasodilation resulting indecreased bloodpressure. Coronaryvasodilation resulting indecreased frequency andseverity of attacks ofangina. Reduction ofventricular rate in atrialfibrillation or flutter.PO (Adults): 30120 mg34 times daily or 60120mg twice daily as SRcapsules or 180240 mgonce daily as CD or XRcapsules or LA tablets (up

Sick sinus syndrome; 2nd- or 3rd-degreeAV block (unless an artificial pacemaker isin place); Systolic blood pressure


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to 360 mg/day). Arrhythmias: Monitor ECGcontinuously duringadministration. Reportbradycardia or prolongedhypotension promptly.Emergency equipment andmedication should be available.Monitor blood pressure and pulse

before and frequently duringadministration. Lab TestConsiderations: Total serumcalcium concentrations are notaffected by calcium channelblockers. Monitor serumpotassium periodically.Hypokalemia the risk ofarrhythmias and should becorrected. Monitor renal andhepatic functions periodically

during long-term therapy. Maycause in hepatic enzymes afterseveral days of therapy, whichreturn to normal ondiscontinuation of therapy .PO: May be administered withoutregard to meals. May beadministered with meals if GIirritation becomes a problem. Donot open, crush, break, or chewsustained-release capsules or

tablets Empty tablets that appearin stool are not significant. Crushand mix diltiazem with food orfluids for patients having difficultyswallowing . Advise patient totake medication as directed atthe same time each day, even iffeeling well. Take missed dosesas soon as possible unlessalmost time for next dose; do notdouble doses. May need to be

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discontinued gradually. Advisepatient to avoid large amounts(68 glasses of grapefruitjuice/day) during therapy. Instructpatient on correct technique formonitoring pulse. Instruct patientto contact health careprofessional if heart rate is


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professional .

Reference: DavisDrug2010

INTRAVENOUS THERAPYIV Therapy n/a Correlate to Medical Conditions

IV Solution n/a

Hourly rate n/a

IV Site location and condition n/a

IV Solution n/a

Hourly rate n/a

IV Site and condition n/a

IV Solution n/a

Hourly rate n/a

IV Site and condition n/a

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