DRUG STUDIES - HTP.docx

7/27/2019 DRUG STUDIES - HTP.docx

1/50

BSN4A (GROUP 2)1

XII. Drug Study

Drug Study # 1

Name of Drugs Dosage/ Route/

Timing

Drug Mechanism of

Action

Indications Contraindication Adverse Effect Nursing

Responsibilities

Classification:

Analgesic

Generic Name:

Paracetamol

Brand Name:

Acephen

AcetaActamin

200mg/ IVTT/ Q4 Produces analgesiaby blocking

generation of painimpulses. This action

is probably causedby inhibition of

prostaglandinsynthesis; it may also

be caused byinhibition of the

synthesis or action of

other substances thatsensitize painreceptors to

mechanical orchemical stimulation.

It relieves fever bycentral action in the

hypothalamic heat-regulating center.

Mild pain or fever Paracetamol shouldnot be used in

hypersensitivity to thepreparation and in

severe liver diseases.

Skin: Rash, urticaria

Hematologic:hemolytic anemia,neutropenia,

leucopenia,pancytopenia

Hepatic:jaundice,severe liver damage

with toxic doses

Metabolic:

hypoglycemia

Take thetemperature beforeand 1 hour after

giving themedication.

Provide tepidsponge if fever

occurs.

Has no significant

anti-inflammatoryeffect

Warn patient that

high doses orunsupervisedchronic use can

cause hepaticdamage. Excessive

ingestion ofalcoholic

beverages mayincrease the risk of

hepatoxicity

Should not be

used for self-

medication ofmarked fever

(greater than39.5C), fever


2/50

BSN4A (GROUP 2)2

persisting longerthan 3 days, or

recurrent feverunless directed by

doctor.

Inspect the

insertion site forphlebitis

(inflammation of avein).

Assess IV site forswelling,

erythema,tenderness,

leakage of fluid, orwarmth.

If phlebitis isdetected,

discontinue theinfusion and apply

warm compress tothe venipuncture

site. Do not usethis injured vein

for furtherinfusion.


3/50

BSN4A (GROUP 2)3

Drug Study # 2


Timing

Drug Mechanism of

Action


Responsibilities

Classification:

Histamine-2 (H2)antagonist

Generic Name:

Ranitidine

Brand Name:

Zantac

20mg/ IVTT/ Q8 Competitively

inhibits the action ofhistamine at the H2

receptors of the

parietal cells of thestomach, inhibitingbasal gastric acid

secretion and gastricacid secretion that is

stimulated by food,

insulin, histamine,cholinergic agonists,

gastrin and

pentagastrin.

Short-term

treatment ofGERD

Treatment of

erosiveesophagitis

Contraindicated

with allergy toranitidine,lactation

Use cautiouslywith impairedrenal or hepatic

function

CNS: Headache,

malaise, dizziness,somnolence,insomnia, vertigo

CV: Tachycardia,bradycardia

Dermatologic: Rash,

alopecia

GI: Constipation,

diarrhea, nausea,

vomiting, abdominalpain, hepatitis,increased ALT levels

Hematologic:

Leukopenia,granulocytopenia,

thrombocytopenia,pancytopenia

Local: Pain at IM

site, local burning or

itching at IV site

Administer IM

dose undiluted,deep into largemuscle group.

Arrange forregular follow-up,including blood

tests, to evaluateeffects

Take drug with

meals and atbedtime. Therapy

may continue for

4-6 weeks orlonger. Inspect theinsertion site for

phlebitis(inflammation of a

vein).

Assess IV site for

swelling,erythema,

tenderness,leakage of fluid,

or warmth.

If phlebitis isdetected,discontinue the


4/50

BSN4A (GROUP 2)4

infusion and applywarm compress to

the venipuncturesite. Do not use

this injured veinfor further

infusion. Have regular

medical follow-upcare to evaluate

your response

Report sore throat,

fever, unsualbruising or

bleeding, tarrystools, confusion,

hallucination,dizziness, severe

headache, muscleor joint pain.


5/50

BSN4A (GROUP 2)5

Drug Study # 3


Timing

Drug Mechanism

of Action


Responsibilities

Classification:

AntibioticCephalosphorin(third generation)

Generic Name:

Ceftazidime

Brand Name:

Ceptaz

FortazTazicef

Tazidime

570mg/ IVTT/ Q8 Bactericidal: Inhibits

synthesis ofbacterial cell wall,causing cell death

Intra-abdominal

infections causedby E. Coli, S.Aureus,

Bacteroides,Klebsiella

Bone and joint

infections causedby P. aeruginosa,

Klebsiella,

Enterobacter, S.Aureus

Contraindicated

with allergy tocephalosphorins orpenicillins

Use cautiouslywith renal failure

CNS: Headache,

dizzinesss, lethargy,paresthesias

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

flatulence,pseudomembranous

colitis, hepatotoxicity

GU: Nephrotoxicity

Hematologic: BoneMarrow depression---decreased WBC

count, decreasedplatelets, decreased

Hct

Hypersensitivity:Ranging from rash to

fever to anaphylaxis;serum sickness

reaction

Local: Pain, abscessat injection site;

Assess for history

of allergy tocephalosporinsand penicillins

Arrange forculture andsensitivity before

treatment

Inspect the

insertion site for

phlebitis(inflammation of a

vein).

Assess IV site forswelling,erythema,

tenderness,leakage of fluid,

or warmth.

If phlebitis is

detected,discontinue the

infusion andapply warm

compress to the

venipuncture site.Do not use thisinjured vein for


6/50

BSN4A (GROUP 2)6

phlebitis,inflammation at IV

site

further infusion.

Report severe

diarrhea,difficulty

breathing, unsualtiredness or

fatigue, pain atinjection site.

Patient mayexperience side

effects: Stomachupset or diarrhea.


7/50

BSN4A (GROUP 2)7

Drug Study # 4


Timing

Drug Mechanism

of Action


Responsibilities

Classification:

Aminoglycoside

Generic Name:

Amikacin Sulfate

Brand Name:

Amikin

125mg/ IVTT/

Q12

Bactericidal: Inhibits

protein synthesis insusceptible strains ofgram-negative

bacteria, and thefunctional integrity

of bacterial cell

membrane appearsto be disrupted,

causing cell death.

Initial treatment

of staphylococcalinfections whenpenicillin is

contraindicated orinfection may becaused by mixed

organism.

Treatment of

serious infections

such as bacterialsepticemia;

infections of the

respiratory tract,bones, joints,CNS, skin, and

soft tissues

Contraindicated

with allergy to anyaminoglycosides,renal or hepatic

disease,preexistinghearing loss,

myasthenia gravis,parkinsonism.

Use cautiously

with elderlypatients, any

patient with

diminishedhearing, decreasedrenal function,

dehydration,neuromuscular

disorders.

CNS: Ototoxicity,

confusion,disorientation,depression, lethargy,

nystagmus, visualdisturbances,headache, fever,

numbness, tingling,tremor, paresthesias,

muscle twitching,

seizures, muscularweakness,

neuromuscular

blockade, apnea

CV: Palpitations,

hypotension,hypertension

GI:Nausea,

vomiting, anorexia,diarrhea, weight loss,

stomatitis, increasedsalivation,

splenomegaly

Hepatic: Hepatictoxicity,

Inspect the

insertion site forphlebitis(inflammation of a

vein). Assess IV site for

swelling,

erythema,tenderness,

leakage of fluid,

or warmth. If phlebitis is

detected,

discontinue theinfusion and applywarm compress to

the venipuncturesite. Do not use

this injured veinfor further

infusion.

Report pain at

injection site,severe headache,

dizziness, loss of

hearing, changesin urine pattern,difficulty


8/50

BSN4A (GROUP 2)8

hepatomegaly breathing, rash orskin lesions.

Patient mayexperience side

effects: ringing inthe ears,

headache,dizziness

Safety measuresmay need to be

taken if: severenausea, vomiting,

loss of appetite


9/50

BSN4A (GROUP 2)9

Drug Study # 5


Timing

Drug Mechanism

of Action


Responsibilities

Generic name:

Ibuprofen

Brand name:Dolan FP

Classification:Analgesic, NSAID,Propionic Acid

Derivative

200mg/5ml/ PO/

Q6

Produces anti-

inflammatory,analgesic and anti-pyretic effects,

possibly throughinhibition of

prostaglandin

synthesis.

Mild to moderate

pain

With allergy to

ibuprofen salicylates,or other NSAIDS(more common in

patients with rhinitis,asthma, chronicurticaria, nasal

polyps).Contraindicated for

treatment of peri-

operative pain aftercoronary artery

bypass graft.

Blood: Prolonged

bleeding time

CNS: headache,

drowsiness,dizziness, asepticmeningitis

CV: Peripheral

edema

EENT: Visual

disturbances, tinnitus

GI:Epigastricdistress, nausea,

occult blood loss,peptic ulceration

GU: Reversible

renal failure

Hepatic: Elevatedenzymes

Skin: Pruritus, rash,urticaria

Observe patients

with history ofcardiacdecompensation

closely forevidence of fluidretention and

edema.

Do not self-

medicate with

ibuprofen iftaking prescribed

drugs or being

treated for aserious conditionwithout

consultingphysician.

Do not takeaspirin

concurrently withibuprofen.

Notify physicianimmediately of

passage of dark

tarry stools,coffee groundemesis, frankly


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BSN4A (GROUP 2)10

Other:Bronchospasm,

edema

bloody emesis orother GI distress,

as well as bloodor protein in urine

and onset of skinrash, pruritus,

jaundice. Monitor for

therapeuticeffectiveness.


11/50

BSN4A (GROUP 2)11

Drug Study # 6

Name of the Drug Dosage/ Route/

Timing

Mechanism of Action Indication Contraindication Adverse Reaction Nursing

Responsibility

Generic Name:

moxifloxacin

hydrochloride

Trade Name:

Avelox

Classification:

Antibiotic,Flouroquinolone

Dosage:

1 drop

Route:

Optic OU

Timing:

1 drop Q15 for 3

hours as loadingdose, then 1 drop Q1

OU thereafter

Bactericidal; interfereswith DNA replication,

repair, transcription,

and recombination insusceptible gram-

negative and gram-positive bacteria,preventing cell

reproduction andleading to cell death

Management of

infections and

bacterial exacerbationat left eye

Contraindicated withallergy to

fluoroquinolones;

prolonged QT interval,hypokalemia

CNS: headache,dizziness, insomnia,

fatigue, somnolence,

depression,nervousness, anxiety,

paresthesia

CV: Palpitations,

tachycardia,hypertensions,

hypotension,

prolonged QT interval

GI:Nausea, vomiting,

dry mouth, diarrhea,anorexia, gastritis,stomatitis

Hematologic:

Altered PT,eosinophilia,

thrombocytopenia

Respiratory:

Asthma, cough,

dyspnea, pharyngitis,

rhinitis

Others: Fever, rash,

Assess allergy forfluoroquinolones,

prolonged QTinterval,hypokalemia,

hepatic dysfunctioand seizures

Assess for skinstatus,T, orientatio

reflexes, affect; Radventitious sound

P, BP; mucousmembranes, bowe

sounds; ECG, CB

Arrange for culturand sensitivity tes

before beginning

therapy.

Continue therapy indicated forcondition being

treated.

Instill the misseddose as soon as yo

remember it.However, if it is

almost time for thnext dose, skip themissed dose and


12/50

BSN4A (GROUP 2)12

sweating,photosensitivity,

tendonitis

continue yourregular dosing

schedule. Do notinstill a double do

to make up for amissed one.

How to use:

Wash your handsthoroughly with

soap and water.

Check the droppertip to make sure thit is not chipped o

cracked.

Avoid touching th

dropper tip againsyour eye or anythi

else; eye drops androppers must be

kept clean.

While tilting your

head back, pulldown the lower lid

of your eye withyour index finger

form a pocket.

Hold the dropper(tip down) with thother hand, as clos

to the eye aspossible without

touching it.


13/50

BSN4A (GROUP 2)13

Brace the remainifingers of that han

against your face.

While looking up,gently squeeze thedropper so that a

single drop falls inthe pocket made b

the lower eyelid.Remove your inde

finger from thelower eyelid.

Close your eye fo

to 3 minutes and t

your head down athough looking at

the floor. Try not blink or squeeze

your eyelids.Place a finger on t

tear duct and applgentle pressure.

Wipe any excessliquid from your

face with a tissue.

If you are to usemore than one droin the same eye, w

at least 5 minutesbefore instilling th

next drop.Replace and tighte

the cap on the


14/50

BSN4A (GROUP 2)14

dropper bottle. Donot wipe or rinse t

dropper tip.

Wash your hands remove anymedication.

Health teaching:

Inform the client aSO to report if any

of these symptomare severe or do n

go away:1. red, irritated,

itchy, or teary ey2. blurred vision

3. eye pain4. dry eyes

5.broken bloodvessels in the ey

6. runny nose7. cough;

Report immediateif followingsymptoms occur:

1. sore throat, fevechills and other

signs of infectio2. ear pain or fulln

3. rash

4. hives5. itching6. difficulty


15/50

BSN4A (GROUP 2)15

breathing orswallowing

7. swelling of theface, throat,

tongue, lips, eyehands, feet, ankl

or lower legsStorage:

Keep thismedication in the

container it came tightly closed, and

out of reach ofchildren. Store it a

room temperatureand away from

excess heat andmoisture.


16/50

BSN4A (GROUP 2)16

Drug Study # 7


Timing


Responsibility

Generic Name:

oxacillin sodium

Trade Name:

Oxacillin Sodium

Classification:

Antibiotic,

Penicillinase-resistant penicillin

Dosage:

220mg

Route:

IVTT

ANST(-)

Timing:

Q6

Bactericidal; interfereswith DNA replication,

repair, transcription,

and recombination insusceptible gram-

negative and gram-positive bacteria,preventing cell

reproduction andleading to cell death

Infections due to

penicillinase-

producing

staphylococci; may

be used to initiate

treatment when a

staphylococci

infection is

suspected at both

eyes

Contraindicated withallergies to penicillins,

cephalosporins, or other

allergens.

Use cautiously withrenal disorders

CNS: Lethargy,hallucinations, seizures

GI: Glossitis,stomatitis, gastritis,

sore mouth, furryorblack hair tongue,nausea, vomiting,

diarrhea, abdominalpain, bloody diarrhea,

enterocolitis,

pseudomembranouscolitis, nonspecific

hepatitis

GU: Nephritis-oliguria, proteinuria,

hematuria, casts,azotemia, pyuria

Hematologic:

Anemia,thrombocytopenia,

leukopenia,neutropenia, prolonged

bleeding time(morecommon than with

other penicillinase-resistant penicillins)

Assess if patient iallergy to

penicillins,

cephalosporins, orother allergens; re

disorders

Assess cultureinfection; for skinstatus, lesion; R,

adventitious soundbowel sounds; CB

renal function testserum electrolytes

Hct, urinalysis

Arrange cultureinfection beforetreatment

Continue therapy indicated for

condition beingtreated.

Assess the insertio

site for fluidinfiltration

Inspect the insertisite for phlebitis

(inflammation of avein). Assess IV sfor swelling,


17/50

BSN4A (GROUP 2)17

Hypersensitivity:

Rash,fever,wheezing,anaphylaxis

Local: Pain, phlebitis,

thrombosis at theinjection site

erythema,tenderness, leakag

of fluid, or warmt

If phlebitis isdetected, discontinthe infusion and

apply warmcompress to the

venipuncture site.Do not use this

injured vein forfurther infusion.

Warning: Keepepinephrine, IV

fluids, vasopressobronchodilators,

oxygen, andemergency

equipment readilyavailable in case o

serioushypersensitivity

reaction.

Health teaching:

Teach the clientways to maintain

infusion system, Call for assistan

if the solution

stops dripping the venipunctursite becomes


18/50

BSN4A (GROUP 2)18

swollen

Avoid sudden

twisting orturning

movements of tarm with the

needle orcatheter.

Avoid stretchinor placing tensi

on the tubing.

Try to keep the

tubing fromdangling below

the level of theneedle

Notify nurse ifa)There is a

sudden chanin the flow r

or if thesolution stop

dripping.b)The solution

container isnearly empty

c)There is blooin the IV

tubingd)Discomfort

swelling isexperienced

the IV site


19/50

BSN4A (GROUP 2)19

Teach client thatside effects may b

experienced, suchas: upset stomach

nausea, diarrhea(small frequent

meals), mouth sor(perform frequent

mouth care) andpain at injection s

Report difficultyof breathing, rashe

severe diarrhea,severe pain at

injection site, mousores.


20/50

BSN4A (GROUP 2)20

Drug Study # 8


Timing


Responsibility

Generic Name:

sodium

hyaluronate

ophthalmic

Trade Name:

Lubristil

Classification:

Eye Lubricant

Dosage:

1 drop

Route:Optic OU

Timing:

Q6

Sodium hyaluronatemoistens and

lubricates the surface

of your eye. Itprovides a stable

coating on the surfaceof the eye

thus allowing, for its

lubricating andhydrating properties, a

very low resistance

to movement such asblinking and assuring

protection during thehealing

processes of cornealepithelium.

It is indicated for use

in all cases of eye

discomfort, in

particular to help

relieve irritation or

dryness due to poor

quality or amount

of tears (lachrymal

film) caused by

environmental factors

such as dust, glare,

pollen, air pollution

and use of computer

monitors. It will also

protect the eyesurface during the

healing processes

following abrasions.

Hypersensitivityor allergic to any

ingredients of the drug

The use of the productmay occasionally

cause intolerance (mild

burning orirritation). If this

occurs discontinue useand consult your

doctor.

Assess if patient h

allergic reaction to

sodium hyaluronaor to any other eye

drops.

If the vision

becomes blurred

after using the dro

tell the patient and

SO to avoid

activities that requ

clear vision until

they can see clearlagain.

How to use:

Instil 1-2 drops fo

times a day in the

conjunctival sac

(inside the lower

eyelid).

Avoid touching th

eye or any surface

with the tip of the

container. If the d


21/50

BSN4A (GROUP 2)21

of medication is n

retained for any

reason, another dr

should be instilled

Leave an interval

at least 10 minute

before the

instillation of

another eye drop.

Instructions to SO

1. Wash your hands

2. Open a single uni

dose by twisting and

pulling off the cap

3. Carefully pull dow

the lower eyelid to

form a space betwee

the eye and the eyel

4. Gently squeeze a

drop into the eye bu

do not touch the ey

with the tip

5. Close the eye for

seconds then open

your eyes and blink

few times


22/50

BSN4A (GROUP 2)22

6. Repeat these

instructions for the

other eye if required

7. Wash your hands


23/50

BSN4A (GROUP 2)23

Drug Study # 9


Timing


Responsibility

Generic Name:

tropicamide

ophthalmic

Trade Name:

Mydriacyl

Classification:

MydriaticsCycloplegics

Dosage:

1 drop

Route:Optic OD

Timing:

Q6

Blocks acetylcholineresulting in relaxation

of cholinergically

innervated irissphincter muscle.

Adrenergicinnervation to radialmuscle is therefore

unopposed and pupilbecomes dilated.

This medication is

used to widen (dilate)

the pupil of the eye in

preparation for certaineye examinations. It

belongs to a class of

drugs known as

anticholinergics.

Tropicamide works

by relaxing certain

eye muscles; also

used to treat swelling

in different parts of

the eye.

Hypersensitivity;Known or suspected

angle-closure glaucoma,

presence of a shallowanterior chamber unless

gonioscopic observationof the chamber angle is

possible

Cautions

Hypertension,hyperthyroidism,diabetes mellitus,

cardiac disorders

Remove contactlenses beforeinstilling drops

Possibility ofundiagnosed

glaucoma should beconsidered

Risk of potentiallydangerous CNS

disturbances in Peds

May cause increasedIOP

0.5% solutionincapable of

producing

Increased IOP

Transient stinging

Dry mouth

Blurred vision

Photophobia with orwithout corneal

staining

Tachycardia

Headache

Parasympatheticstimulation

Allergic reactions

Assess for historyallergies to

tropicamide and a

other allergiesAssess for medica

history of glaucom(open-angle), high

blood pressure,hyperthyroidism

How to use:

To apply eye dropwash your hands

first.

To avoidcontamination, donot touch the

dropper tip or let itouch your eye or

any other surface.

Tilt the head backlook upward, and

pull down the loweyelid to make a

pouch.

Hold the dropper

directly over youreye and place 1 ordrops into the pou


24/50

BSN4A (GROUP 2)24

satisfactorycycloplegia

usually 15 to 20minutes before an

eye examination oas directed by the

doctor.

Look downward agently close your

eyes for 1 to 2minutes.

Place one finger athe corner of youreye (near the nose

and apply gentlepressure for 2 to 3

minutes. This willprevent the

medication fromdraining out and

being absorbed byyour body. Try no

to blink and do norub your eye.

Repeat these stepsfor your other eyeso directed.

Do not rinse the

dropper. Replace tdropper cap after

each use.

If you are using

another kind of eymedication (e.g.,

drops or ointment


25/50

BSN4A (GROUP 2)25

wait at least 5 to 1minutes before

applying othermedications. Use

eye drops before eointments to allow

the drops to enter

eye.Wash your hands

after using this

medication. If givthis medication to

child, do not let thmedication get int

the child's mouth.Also wash the

child's hands aftergiving this

medication.

Health teaching:

After you apply thdrug, your vision

may becometemporarily blurre

Do not drive, usemachinery, or do

any activity thatrequires clear visiuntil you are sure

you can perform

such activitiessafely.


26/50

BSN4A (GROUP 2)26

This medication mmake your eyes

more sensitive tolight. Protect your

eyes in bright lighUse dark sunglass

when outdoors.

Eye stinging,temporary blurr

vision, dry mouor eye sensitivit

to light may occIf any of these

effects persist orworsen, report

promptly.

Seek immediate

medical attentiowhen a very

serious allergicoccurs which

includes: rash,

itching/swelling(especially of th

face/tongue/thro, severe dizzines

trouble breathin

Storage:

Store at roomtemperature betwe

68-77 degrees F (2

BSN4A (GROUP 2)27


27/50

BSN4A (GROUP 2)27

25 degrees C) awafrom light. Do not

refrigerate or storehigh temperatures

Keep containertightly closed. Ke

all medicines awa

from children andpets.

Do not flushmedications downthe toilet or pour

them into a drainunless instructed t

do so. Properlydiscard this produ

when it is expiredno longer needed.

BSN4A (GROUP 2)28


28/50

BSN4A (GROUP 2)28

Drug Study # 10


Timing


Responsibility

Generic Name:

vitamin K

Trade Name:Phytomenadione

Classification:

Hemostatic

Antihemorrhagic

Dosage:

10 mg x 2 doses

Route:IVTT

Timing:

Q24

An antihemorrhagicactor that promotes

hepatic formation of

active prothrombin.

This medication is a

haemostatic agent,

prescribed for blood

clotting and boneformation; and used

to treat and to prevent

vitamin K deficiency.

It is also used as an

antidote to warfarin.

Prothrombine time

result with Activity

of 52.7%

Hypersensitivity Anaphylaxis,

difficulty inbreathing,

cyanosis,pain,

swelling,

vein inflammation atthe injection site,

increased sweating,

dizziness,

low blood pressure

rapid and weak

pulse, diaphoresis,

flushing,

erythema,

Assess for allergicreactions to vitam

k before

Asses for medicalhistory, especially

blood disorders,kidney disease, liv

disease.

Avoid excessdosage.

Do not giveWarfarin(Coumadin)

interacts withVITAMIN K at th

same time

Monitor PT to

determine dosage

effectiveness as

ordered.If severe bleeding

occurs, dont dela

other measures, su

as fresh frozen

plasma or whole

blood.Inspect the inserti

site for phlebitis

BSN4A (GROUP 2)29


29/50

BSN4A (GROUP 2)29

(inflammation of avein).

Assess IV site forswelling, erythem

tenderness, leakagof fluid, or warmt

If phlebitis is

detected, discontinthe infusion andapply warm

compress to thevenipuncture site.

Do not use thisinjured vein for

further infusion.

Alert: watch for

signs of flushing,

weakness,

tachycardia andhypotension; may

progress to shock

Storage:

Store in a cool, drplace, away from

direct heat and lig

Wrap infusion

container withaluminum foil.

BSN4A (GROUP 2)30


30/50

BSN4A (GROUP 2)30

XIII. Health Teaching Plan

Medication Exercise Treatment Hygiene Outpatient Teaching Diet

1.) Paracetamol

Classification:

- Analgesic

How do you know its

effective:

- Relief from signs andsymptoms of fever and

pain

Exact time:

- 200mg/ IVTT/ Q4

Client teaching:

- Paracetamol should not

be used inhypersensitivity to the

preparation and in severeliver diseases.

- Take the temperaturebefore and 1 hour after

giving the medication.-Provide tepid sponge if

fever occurs.- Has no significant anti-

inflammatory effect.- Warn patient that high

doses or unsupervisedchronic use can cause

Do ROM on extremities(may be active or active-

passive) such as:

Shoulder> Flexion

> Extension

> Hyperextension

> Abduction

> Adduction (anteriorand posterior)

> Horizontal flexion

> Horizontalextension

> Circumduction

> External rotation

> Internal rotation Elbow

> Flexion

> Extension

> Rotation forSupination

> Rotation forpronation

Wrist

> Flexion

> Extension

> Hyperextension

> Circumduction> Radial Flexion

Antibiotics to reducethe inflammation

process

Mydriatic orCycloplegic agents to

help relax papillarymuscles thus dilates

the pupils

Take medicationregiously and as

prescribed by the

physician.

Vital signs arecontinuouslymonitored.

STAT Intravitreal andIntracameral tap andinjection of antibiotics

is the proposedoperations which leads

to the evisceration ofabscess both eyes

Laboratory Test:

Eye examinations byusing a special eyemicroscope, known as

Maintain proper hygieneby:

taking a bath daily, or

have a sitz bath(protect the eye)

changing clothesdaily,

observe good dentalhygiene, properly

brushing teeth two tothree times a day

every after meals,

do mouth garglebefore meals

practice proper

grooming, andcutting of nails at leastonce a week.

do hand washing toprevent spread ofinfection

avoid scratching,rubbing and touching

the infected eye withbare hands

use alcohol-based

hand rub when soapand water is notavailable

Maintain a properdiet and take the

medications

prescribed to you asyour doctor directs.

Follow up with yourphysician on a

regular basis tomonitor progress of

the disease and theneeded interventions

After surgery, followtreatment regimen

and maintenance ofthe newly operated

eye to prevent furtherinjury

Consult doctor ifsevere eye

discomfort or othersign and symptoms is

experienced.

Consult the doctorfor any adverse

effects of drugs ortreatment.

Follow doctors maygo home instructions

Follow the drug

Encourage fluidintake of 8-10

glasses a day of

water to avoiddehydration and

have a good skinturgor.

Give diet as tolerated

by the patient.

Increase caloricintake due toincrease metabolic

process

Eat morecarbohydrates such

as rich, cereals,corns, root crops

Eat a protein rich

diet such as chicken,

meat, and pork

Eat salmon, tuna and

other fish products

that are rich in

omega-3 fatty acid

which help to

improve dry eyes

Eat more fruits

which are rich in Vit.

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hepatic damage.Excessive ingestion of

alcoholic beverages mayincrease the risk of

hepatoxicity.- Should not be used for

self-medication of

marked fever (greaterthan 39.5C), fever

persisting longer than 3

days, or recurrent feverunless directed by

doctor.- Inspect the insertion

site for phlebitis(inflammation of a vein).

- Assess IV site forswelling, erythema,

tenderness, leakage of

fluid, or warmth.

2.) Ranitidine

Classification:

- Histamine-2 (H2)

antagonist

How do you know if its

effective:

- Competitively inhibits

the action of histamine atthe H2 receptors of the

(abduction)

> Ulnar Flexion

(adduction)

Hands and Fingers

> Flexion

> Extension

> Hyperextension

> Abduction> Adduction

Thumb

> Flexion

> Extension

> Abduction

> Adduction

> Opposition

Circumduction

Deep breathingexercises regularly-used

to improve pulmonarygas exchange or tomaintain respiratory

function

Position client insupine or sitting

positionIntruct patient to

inhale air through thenose and hold breath(3-5 sec) and exhale

through the mouth

intermittentlybypurse-lip

a slit lamp. To makethe ulcer easier to see,

he or she will put adrop containing the

dye fluorescein intoyour eye.

Complete-blood count

reveals presence ofinflammation anddisease process. A

white blood cell countmay reveals

leukocytosis

CornealScraping/Woundculture and sensitivity

testing may be done toidentify the infecting

organism

Corneal topography isanother painlessinvestigation which

maps the surface of

the cornea rather likean ordinance survey

map, showing thegradient at each spot

and thereforehighlighting

asymmetries, such asare found in the

dystrophic conditions

apply lotion to preventdryness of skin

clean environmentalways

regimen exactly asprescribed

Always to have asupply of medicine

on hand

Eye Care1.Apply cool

compresses to the

affected eye.2.Do not touch or rub

your eye with yourfingers.

3.Limit spread ofinfection by

washing your handsoften and drying

them with a clean

towel.4.Wear eye

protection when

exposed to small

particles that canenter your eye.

5.Try to avoiddangerous activities

where people mightbe hit in the eye bya sharp object such

as a stick or

fingernail.6.If you have dry

C to help body fight

infection.

Eat more foods rich

in vit. A and

carotenoids, found in

leafy green

vegetables andyellow vegetables

such as pumpkin and

squash as well as

brightly colored

fruits such as

oranges or papayas.

Increasing intake of

these fruits and

vegetables helps

treat and prevent

vitamin A

deficiency; vitamin

A supplementation

will probably also be

required for treating

existing disease.

Eat vegetables and

fiber-rich foods to

prevent constipation,

and promote good

health.

Consume dairy

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parietal cells of thestomach, inhibiting basal

gastric acid secretion andgastric acid secretion that

is stimulated by food,insulin, histamine,

cholinergic agonists,

gastrin and pentagastrin

Exact time:

- 20mg/ IVTT/ Q8

Client teaching:

- Contraindicated with

allergy to ranitidine,lactation.

- Use cautiously withimpaired renal or hepatic

function.

- Take drug with mealsand at bedtime. Therapymay continue for 4-6

weeks or longer. Inspectthe insertion site for

phlebitis (inflammationof a vein).


tenderness, leakage offluid, or warmth.

- Have regular medical

follow-up care toevaluate your response.

technique. Repeat forprocedure for 3 times

Instruct patient toinhale air through the

nose, hold breath for3-5 sec, then cough

out or by a huff

sound

Provide comfortmeasures (e.g back rub,change of position) to

promote bloodcirculation.

Monitor patients abilityto ambulate, provide a

safe environment, andassist patient in

activities of daily living

Resume usual activitiesgradually

It is best to start

exercising slowly anddo more as you get

stronger

Do have some warm upbefore going to workand cool down after

work. Slowly start to domore each day.

Maintain a regular astolerated (e.g. morning

walk, stretching, deep

Non-Pharmacotherapyincludes the following:

Conduct passive to

activeROM

Deep breathing andcoughing exercise

Positioning

Post-Operative General

Instructions:

For 12 hours

following surgery

avoid strenuous andheavy activities. You

may wish to start

eating lighter, with

liquids and

progressing to your

regular diet as

tolerated by your

stomach.

Unless directed by

your surgeon, do not

remove your eye patch

except when applying

eyes or if youreyelids do not close

completely, useartificial teardrops

to keep your eyeslubricated.

7.If an eye is red and

irritated, do notcontinue touse over-the-

counter eye drops.Have an

ophthalmologistexamine the eyes to

make certain thatthere is not a

serious problem.

products as indicated

Limit refined

products, like sugar,

white breads, and

white rice

If nausea and

vomiting occurs,give small frequent

feedings with rest

period in between, or

give crackers.

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( )

- Report sore throat,fever, unsual bruising or

bleeding, tarry stools,confusion, hallucination,

dizziness, severeheadache, muscle or joint

pain.

3.) Ceftazidime

Classification:

- Antibiotic

Cephalosporin (thirdgeneration)

How do you know if its

effective:

- Bactericidal: the

bacteria is lessen or

treated-Lessens or no signs andsymptoms of infection

Exact time:

-570mg/ IVTT/ Q8

Client teaching:

-Before using

ceftriaxone, tell yourdoctor or pharmacist if

you are allergic to it; or

to other cephalosporins;or to penicillins; or if

breathingexercises).Exercising

makes the heartstronger, lowers blood

pressure, and helps keepyou healthy

Take a rest or nap to

balance the bodiesactivities and to recovermore

Avoid lifting heavyobjects or excessive

activities.

Avoid overexertion and

have time for rest andleisure

eye drops as directed.

In rare instances, a

surgical dressing may

be placed. Do not

remove your eye

dressing and do not

begin your eye dropsuntil after your first

post-operative

appointment.

You may take pain

reliever as needed

every 4 hours for pain.

Continue your regular

medications as

directed by your

physician including

any eyedrops

prescribed for the

other eye.

Your first post-

operative appointment

will be the day

following surgery. At

this time your eye will

be examined. Your

post-operative care

schedule and

medications will be

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you have any otherallergies.

- Contraindicated withallergy to

cephalosphorins orpenicillins

- Use cautiously with

renal failure- Arrange for culture andsensitivity before

treatment- Inspect the insertion

site for phlebitis(inflammation of a vein).


tenderness, leakage offluid, or warmth.

- If phlebitis is detected,

discontinue the infusionand apply warmcompress to the

venipuncture site.- Report severe diarrhea,

difficulty breathing,unsual tiredness or

fatigue, pain at injectionsite.

- May experience sideeffects: Stomach upset or

diarrhea

4.) Amikacin Sulfate

reviewed.

Post- Operative

Limitations (for 4

weeks):

You may bath orshower if indicated by

the doctor; protect the

eye from soapy water

by patching it

securely. Always turn

your back against the

shower spray.

Always wear your eye

patch while sleeping.

Avoid sleeping on theside of your operated

eye.

Do not bend at the

waist to pick up

objects on the floor. If

you must, squat or

bend at the knees and

use your hand to

stabilize yourself.

Do not lift heavy

objects

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Classification:

- Aminoglycoside

How do you know its

effective:

- Bactericidal: the

bacteria is lessen ortreated-Lessens or no signs and

symptoms of infection

Exact time:

- 125mg/ IVTT/ Q12

Client teaching:

- Contraindicated withallergy to any

aminoglycosides, renal

or hepatic disease,preexisting hearing loss,myasthenia gravis,

parkinsonism.- Use cautiously with

elderly patients, anypatient with diminished

hearing, decreased renalfunction, dehydration,

neuromuscular disorders.- Inspect the insertion

site for phlebitis

(inflammation of a vein).- Assess IV site for

Avoid straining your

bowel

Avoid coughing and

sneezing as much as

possible.

Do not submerge your

eye under water

Post-Operative Eye

Care:

Wash your hands

before caring for the

eye.

If the lids are sticky

or itchy in the

morning, they may be

gently cleaned with a

cotton ball moistened

with sterile water.

Wipe from your nose

toward you ear, in one

direction only. Be

careful not to rub or

put pressure on the

eye.

The operated eyeshould be protected at

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swelling, erythema,tenderness, leakage of

fluid, or warmth.- If phlebitis is detected,

discontinue the infusionand apply warm

compress to the

venipuncture site. Do notuse this injured vein forfurther infusion.

- Report pain at injectionsite, severe headache,

dizziness, loss ofhearing, changes in urine

pattern, difficultybreathing, rash or skin

lesions.- Patient may experience

side effects: ringing in

the ears, headache,dizziness- Safety measures may

need to be taken if:severe nausea, vomiting,

loss of appetite

5.) Ibuprofen

Classification:

- Analgesic, NSAID,

Propionic Acid

Derivative

all times by either

glasses (prescription

or sunglasses) or the

polycarbonate

goggles. When the

glasses are removed

for showering, gentlytape the metal shield

over the eye. A soft

eye patch may also be

used under the

shield/goggles if

desired.

Give medications

properly as indicated.

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How do you know its

effective:

- Relief from signs andsymptoms of pain and

fever

Exact time:

- 200mg/5ml/ PO/ Q6

Client teaching:

-With allergy toibuprofen salicylates, or

other NSAIDS (morecommon in patients with

rhinitis, asthma, chronicurticaria, nasal polyps).

Contraindicated fortreatment of peri-

operative pain after

coronary artery bypassgraft.- Observe patients with

history of cardiacdecompensation closely

for evidence of fluidretention and edema.

- Do not self-medicatewith ibuprofen if taking

prescribed drugs or beingtreated for a serious

condition without

consulting physician.- Do not take aspirin

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concurrently withibuprofen.

- Notify physicianimmediately of passage

of dark tarry stools,coffee ground emesis,

frankly bloody emesis or

other GI distress, as wellas blood or protein inurine and onset of skin

rash, pruritus, jaundice.- Monitor for therapeutic

effectiveness.

6.) Moxifloxacin

Hydrochloride

Classification:

- Antibiotic,

Flouroquinolone

How do you know its

effective:

- Bactericidal: the

bacteria is lessen ortreated

-Lessens or no signs andsymptoms of infection

Exact time:

- 1 drop/Optic OU/1 drop

Q15 for 3 hours asloading dose, then 1 drop

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Q1 OU thereafter

Client teaching:

- Contraindicated with

allergy tofluoroquinolones;

prolonged QT interval,

hypokalemia.- Arrange for culture andsensitivity test before

beginning therapy.- Continue therapy as

indicated for conditionbeing treated.

- Instill the missed doseas soon as you remember

it. However, if it isalmost time for the next

dose, skip the missed

dose and continue yourregular dosing schedule.Do not instill a double

dose to make up for amissed one.

-Inform the client andSO to report if any of

these symptoms aresevere or do not go

away:red, irritated, itchy, or

teary eyes

blurred visioneye pain

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dry eyesbroken blood vessels in

the eyesrunny nose

cough;- Report immediately if

following symptoms

occur:sore throat, fever, chillsand other signs of

infectionear pain or fullness

rashhives

itchingdifficulty breathing or

swallowing

7.) Oxacillin Sodium

Classification:

- Antibiotic,

Penicillinase-resistantpenicillin

How do you know its

effective:

- Bactericidal: the

bacteria is lessen ortreated

-Lessens or no signs and

symptoms of infection

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Exact time:

- 220mg/ IVTT,ANST(-

)/Q6

Client teaching:

- Assess if patient is

allergy to penicillins,

cephalosporins, or otherallergens; renal disorders- Assess culture

infection; for skin status,lesion; R, adventitious

sounds; bowel sounds;CBC, renal function

tests, serum electrolytes,Hct, urinalysis

- Arrange cultureinfection before

treatment

- Continue therapy asindicated for condition

being treated.

- Assess the insertion sitefor fluid infiltration

- Inspect the insertionsite for phlebitis

(inflammation of a vein).Assess IV site for


fluid, or warmth.

- If phlebitis is detected,discontinue the infusion

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and apply warmcompress to the

venipuncture site. Do notuse this injured vein for

further infusion.- Teach client that side

effects may be

experienced, such as:upset stomach, nausea,diarrhea (small frequent

meals), mouth sores(perform frequent mouth

care) and pain atinjection site.

- Report difficultyof breathing, rashes,

severe diarrhea, severepain at injection site,

mouth sores.

8.) Sodium

Hyaluronate

Classification:

- Eye Lubricant

How do you know its

effective:

- Moistens and lubricatesthe surface of your eye

Exact time:- 1 drop/ Optic OU/ Q6

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Client teaching:

- Assess if patient hasallergic reaction to

sodium hyaluronate or toany other eye drops.

- If the vision becomes

blurred after using thedrops, tell the patient andSO to avoid activities

that require clear visionuntil they can see clearly

again.-Instructions to SO:

1. Wash your hands2. Open a single unit

dose by twisting andpulling off the cap

3. Carefully pull down

the lower eyelid to forma space between the eyeand the eyelid

4. Gently squeeze a dropinto the eye but do not

touch the eye with the tip5. Close the eye for 30

seconds then open youreyes and blink a few

times6. Repeat these

instructions for the other

eye if required.7. Wash your hands

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9.) Tropicamide

Classification:

-

Mydriatics/Cycloplegics

How do you know its

effective:- Pupils dilation andabscess comes out

Exact time:

- 1 drop/ Optic OD/ Q6

Client teaching:

- Assess for history of

allergies to tropicamideand any other allergies

- Assess for medical

history of glaucoma(open-angle), high bloodpressure,

hyperthyroidism- After you apply this

drug, your vision maybecome temporarily

blurred. Do not drive,use machinery, or do any

activity that requiresclear vision until you are

sure you can perform

such activities safely.- This medication may

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make your eyes moresensitive to light. Protect

your eyes in bright light.Use dark sunglasses

when outdoors.- Eye stinging, temporary

blurred vision, dry

mouth, or eye sensitivityto light may occur. If anyof these effects persist or

worsen, report promptly.- Seek immediate

medical attention when avery serious allergic

occurs which includes:rash, itching/swelling

(especially of theface/tongue/throat),

severe dizziness, trouble

breathing.- Do not flushmedications down the

toilet or pour them into adrain unless instructed to

do so. Properly discardthis product when it is

expired or no longerneeded.

10.) Vitamin K

Classification:

- Hemostatic/Antihemorrhagic

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How do you know its

effective:

- An antihemorrhagic

actor that promoteshepatic formation of

active prothrombin

Exact time:

- 10 mg x 2

doses/IVTT/Q24

Client teaching:

- Assess for allergic

reactions to vitamin kbefore

- Asses for medicalhistory, especially of

blood disorders, kidney

disease, liver disease.- Avoid excess dosage.- Do not give Warfarin

(Coumadin) interactswith VITAMIN K at the

same time- Monitor PT to

determine dosageeffectiveness as ordered.

- If severe bleedingoccurs, dont delay other

measures, such as fresh

frozen plasma or wholeblood.

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- Inspect the insertionsite for phlebitis

(inflammation of a vein).- Assess IV site for


fluid, or warmth.- If phlebitis is detected,

discontinue the infusionand apply warm

compress to thevenipuncture site. Do not

use this injured vein forfurther infusion.

-Alert: watch for signs offlushing, weakness,

tachycardia andhypotension; may

progress to shock.

How to use ophthalmic

medications

1. To apply eye drops,

wash your handsfirst.

2. To avoidcontamination, do

not touch the dropper

tip or let it touchyour eye or any other

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surface.

3. Tilt the head back,

look upward, andpull down the lower

eyelid to make apouch.

4. Hold the dropperdirectly over your

eye and place 1 or 2drops into the pouch,

usually 15 to 20minutes before an

eye examination oras directed by the

doctor.

5. Look downward and

gently close youreyes for 1 to 2

minutes.6. Place one finger at

the corner of your

eye (near the nose)

and apply gentlepressure for 2 to 3

minutes. This willprevent the

medication fromdraining out and

being absorbed byyour body. Try not to

blink and do not rub

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your eye.

7. Repeat these steps

for your other eye ifso directed.

8. Do not rinse the

dropper. Replace the

dropper cap after

each use.

9. If you are usinganother kind of eye

medication (e.g.,drops or ointments),wait at least 5 to 10

minutes before

applying othermedications. Use eye

drops before eyeointments to allow

the drops to enter theeye.

10.Wash your hands

after using this

medication. If givingthis medication to a

child, do not let themedication get into

the child's mouth.Also wash the child's

hands after givingthis medication.

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