Medical Managemen Hodgskin_s
Transcript of Medical Managemen Hodgskin_s
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Medicalmanagement
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Date/Time Doctors Order Rationale
Dec 06, 2013 Please admit to ICU under the service of
Dr. Gonzales
Secure Consent for admission andmanagement
TPR q shift and record
Diet: DAT
IVF, PNSS 1L x 120cc/hr
For Legality &Documentation
To start hydration
Laboratory:CBC w/ Platelet count, Na, K, CREA,BUN, Hgt, LDH
Cranical CT SCAN w/ contrast ECG
To determine bloodcoagulopathies, Electrolyteimbalance, and Renalfunction
To aid in diagnosing anddetermine possible brainmets
Medications:Neuquinon 1 TAB OD
Diazepam 5mg IV PRNDolcet tab, 1 TAB TID PRNPlasil 1 amp q 8 PRN
Alopurinol 100mg 1 TAB 2x/day
Cardiovascular drug
For frank seizuresFor pain reliefAnti-emeticTo lower uric acid
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Shift procedure to hydrocortisone 100mgIV q 8
5:33pm Start Keppra 500mg tab ODFor cranial MRI w/ gadolinium contrast
Continue present management
AP Updated
Anti-convulsant
7:15pm Cetrizine 10mg 1 TAB now
Continue Meds
Discontinue Alopurinol
for itchiness & allergy
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DIAGNOSTICEXAMS
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Complete Blood Count 12/06/13 1:31pm
Test Name ResultReference
ValuesInterpretation Significance
Hemoglobin 107 gm/L 110-140
Hematocrit0.36 gm/L 0.37-0.47
Indicatesanemia
RBC 4.51 x10^12/1 4-5.5
WBC 7.78 x10^9/1 5.0-10.0
Segmenters0.86 x10^9/1 0.50-0.70
Increase withmalignantdisease
Lymphocytes
0.09 x10^9/1 0.20-0.40
Decrease in
use ofcorticosteroid
Monocytes 0.04 x10^9/1 0-0.05
Basophiles 0.01 x10^9/1 0-0.01
MCV 80.2 n 80-98
MCH23.7pg 26-32
IndicateshypochromicRBCs
MCHC293 g/L 320-360
Indicateshypochromicanemia
Platelet Count Increase in
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DRUG STUDY
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DRUG MECHANISM OFACTION
INDICATION CONTRAINDICATION SIDEEFFECTS
NURSINGINTERVENTION
GENERIC NAME:Ubidecarenone
BRAND NAME:Nequinon
CLASSIFICATION:CardiovascularDrugs
DOSAGE:1 TAB OD
ROUTE:Oral
Inhibits lipidperoxidation by
preventing theproduction of lipidperoxyl radicals
Heart FailureAngina pectoris
Hypersensitivity NauseaGastric
discomforts
Take aftermeals
Instruct patientto report forworseningsymptoms.
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DRUG MECHANISM OFACTION
INDICATION CONTRAINDICATION SIDEEFFECTS
NURSINGINTERVENTION
GENERIC NAME:Diazepam
BRAND NAME:Anxiol
CLASSIFICATION:Benzodiazepines
DOSAGE:5mg IV PRN
ROUTE:IV
Enhances theeffect of the
neurotransmitterGABA by bindingto thebenzodiazepinesite on the GABAleading to CNSdepression
AnxietyPanic
InsommiaSeizures
Respiratorydepression
Sedation Assess patientfor respiratory
depression
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DRUG MECHANISM OFACTION
INDICATION CONTRAINDICATION SIDEEFFECTS
NURSINGINTERVENTION
GENERIC NAME:Tramadol HCl
BRAND NAME:Dolcet
CLASSIFICATION:Analgesics
DOSAGE:1 Tab TID PRN
ROUTE:Oral
Binds to mu opioidreceptors and
inhibits thereuptake ofnorepinephrineand serotonincauses manyeffects similar tothe opioids.
Relief ofmoderate to
moderatelysevere pain
Contraindicated withallergy to tramadol or
opioids
SedationDizziness
HypotensionBradycardia
Explain to thepatient that they
may feel dizzy
Report forseveringsymptoms
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DRUG MECHANISM OFACTION
INDICATION CONTRAINDICATION SIDEEFFECTS
NURSINGINTERVENTION
GENERIC NAME:Metoclopromide
BRAND NAME:Plasil
CLASSIFICATION:Anti-emetics
DOSAGE:1 amp q 8 PRN
ROUTE:
IV
Stimulates motilityof upper GI tract
without stimulatinggastric, biliary orpancreaticsecretions. Andincrease loweresophagealsphincter pressure
Vomitting Hypersensitivity RestlessnessDrowsiness
Fatigue
Monitor BPduring IV
administration
Monitorextrapyramidalreactions.
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DRUG MECHANISM OFACTION
INDICATION CONTRAINDICATION SIDEEFFECTS
NURSINGINTERVENTION
GENERIC NAME:Allopurinol
BRAND NAME:Zyloprim
CLASSIFICATION:
DOSAGE:100mg TAB, BID
ROUTE:
Oral
Prevents theproduction of uric
acid by blockingthe activity of theenzyme thatconvert purines touric acid
Management ofpatients with
leukemia,lymphoma andmalignancies whoare receivingcancer therapywhich causeselevations ofserum and urinaryuric acid levels
Drug allergy Skin rash anditching
nausea,diarrhea
Administer drug
after meals
Promoteincreased fluidintake
Check urinealkalinity
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DRUG MECHANISM OFACTION
INDICATION CONTRAINDICATION SIDEEFFECTS
NURSINGINTERVENTION
GENERIC NAME:Prednisone
BRAND NAME:
CLASSIFICATION:NSAIDs
DOSAGE:10mg 1 TAB BID
ROUTE:Oral
Prevents therelease of
substances in thebody that causeinflammation andsuppresses theimmune system.
Allergic disordersSkin conditions
Ulcerative colitisArthritisLuposPsoriasisBreathingdisorders
Drug allergyFungal infection
preset
Increasedappetite
Gradual weightgain
Insomia
Take drug withfood
Do not crushchew or break adelayed releasetablet. Swallowit whole.
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DRUG MECHANISM OFACTION
INDICATION CONTRAINDICATION SIDEEFFECTS
NURSINGINTERVENTION
GENERIC NAME:Omeprazole
BRAND NAME:Prilosec
CLASSIFICATION:Protonn pumpinhibitors
DOSAGE:40mg 1 TAB OD
ROUTE:Oral
Block theproduction of acid
by the stomach
GERDAcid induced
inflammationPrevention ofUGIB
Allergies to PPIs Stomach painNausea
vomitingDiarrhea
Administerbefore meals
Report ifworsening ofsymptoms
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DRUG MECHANISM OFACTION
INDICATION CONTRAINDICATION SIDEEFFECTS
NURSINGINTERVENTION
GENERIC NAME:Ascorbic Acid
BRAND NAME:Cecon
CLASSIFICATION:Vitamin
DOSAGE:1 TAB OD
ROUTE:Oral
Water solublevitamin essential
for synthesis admaintenance ofcollagen andintercellularground substanceof body tissuecells, bloodvessels, cartilage,bones teeth skinand tendons
Prophylaxis andtreatment of
scurvy
Use of sodiumascorbate in patients
on sodium restriction
Patients receivingdigitalis
Yellow acidicurine
Take drug withmeal
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DRUG MECHANISM OFACTION
INDICATION CONTRAINDICATION SIDEEFFECTS
NURSINGINTERVENTION
GENERIC NAME:FeSO4
BRAND NAME:
CLASSIFICATION:Iron Prep
DOSAGE:325mg 1 TAB TID
ROUTE:Oral
Elevates serumiron concentration
which then helpsto form high ortrapped inreticuloendothelialcells for storageand eventualconversion to ausable form of iron
Prevention of IDADietary
supplement ofIrom
HypersensitivitySevere hypotension
ConstipationDizziness
Hypotension
Take drug withmeals or with
orange juice
Increase oralfluid intake
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DRUG MECHANISM OFACTION
INDICATION CONTRAINDICATION SIDEEFFECTS
NURSINGINTERVENTION
GENERIC NAME:Leviteracetam
BRAND NAME:Keppra
CLASSIFICATION:Anticonvulsant
DOSAGE:500mg TAB OD
ROUTE:OP
Provides an anti-epileptic effect
Used to treatpartial onset of
seizures
Treats tonic-clonic
Hypersensitivity SomnolenceHostility
Nervousness
Give drug withfood
Establish safetyprecautions
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DRUG MECHANISM OFACTION
INDICATION CONTRAINDICATION SIDEEFFECTS
NURSINGINTERVENTION
GENERIC NAME:Cetrizine HCl
BRAND NAME:Zyrtec
CLASSIFICATION:Anti-histamine
DOSAGE:10mg 1 TAB
ROUTE:OP
Inhibit histaminerelease andeosinophilchemotaxis duringinflammationleading to reducedswelling anddecreasedinflammatoryresponse
Allergies &pruritus
Hypersensitivity DrowsinessSedationDizziness
Take this drugwithout regardto meals
Explain topatient, thatdrowsiness mayoccur.
Limit activityafter taking thedrug