Drug Study Ranitidine Tramadol

I

XII. Drug Study

Mechanism of ActionIndicationContraindicationAdverse ReactionsNursing ResponsibilitiesNursing Implication

Generic Name:

Ranitidine

Brand name:

Zantac

Classification:

Gastointestinal agent; Antisecretory (H2-receptor antagonist)Source:

Nursing 2007 Drug Handbook 27th Edition, Lippincot Williams & WilkinsDosage:

50mg

Frequency:

Q8

Route:

IVTT while on NPOCompetitive inhibition of histamine at H2-receptors of the gastric parietal cells, which inhibits gastric acid secretion, gastric volume, and hydrogen ion concentration are reduced. Does not affect pepsin secretion, pentagastrin-stimulated intrinsic factor secretion, or serum gastrin.Used to prevent ulcer while patient is on NPO.Hypersensitivity to ranitidine or any component of the formulation. Constipation Diarrhea Fatigue Headache Insomnia Muscle pain Nausea Vomiting Agitation Anemia Confusion Depression Easy bruising or bleeding

C - Gastointestinal agent; Antisecretory (H2-receptor antagonist) H - Reduced amount of acid in the stomach that may result to prevented ulcer incidence. E - Every 8 hours while patient is on NPO. C - Instruct client to report any adverse reaction to the physician or nurse. Tell patient that antacids may decrease the absorption of ranitidine. K - Ranitidine can interfere with the metabolism of alcohol. Patients taking ranitidine who drink alcohol may have elevated blood alcohol levels. Inform patient that the medication may cause drowsiness, dizziness, or fatigue (use caution when driving or engaging in tasks requiring alertness). Instruct patient to avoid taking any new medication during therapy without consulting prescriber. Instruct patient to avoid alcohol and follow diet as prescriber recommends.


Generic Name:

Tramadol Brand name:

Ultram Classification:

AnalgesicSource:


50mg

Frequency:

Q6

Route:

IVTT x 6 dosesBinds to -opiate receptors in the CNS causing inhibition of ascending pain pathways, altering the perception of and response to pain; also inhibits the reuptake of norepinephrine and serotonin, which also modifies the ascending pain pathway.Management of pain in the operation site.Hypersensitivity to tramadol, opioids, or any component of the formulation; opioid-dependent patients; acute intoxication with alcohol, hypnotics, centrally-acting analgesics, opioids, or psychotropic drugs

Dizziness Nausea Drowsiness Dry mouth Constipation Headache Sweating Vomiting Itching Rash Visual disturbances VertigoC - Analgesic H - Relief of pain in the operation site.

E - Every 6 hours x 6 doses. May be taken with or without food. C - Instruct client to report any adverse reaction to the physician or nurse. Tell patient that tolerance or drug dependence may result from extended use (withdrawal symptoms have been reported); abrupt discontinuation should be avoided.

K - You should not take Ultram if you have ever been addicted to drugs or alcohol. Should be used only with extreme caution in patients receiving MAO inhibitors Tell patient that driving or operating machinery should be avoided until the effect of drug wears off. Instruct patient to repot cravings to physician immediately. Inform client that medication may cause CNS depression and/or respiratory depression, particularly when combined with other CNS depressants


Generic Name:

Ketorolac

Brand name:

Toradol

Classification:

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)Source:


30mg

Frequency:

Q6

Route:

IVTT x 6 dosesInhibits prostaglandin synthesis by decreasing the activity of the enzyme, cyclooxygenase, which results in decreased formation of prostaglandin precursors, chemicals that cells of the immune system make that cause the redness, fever, and pain of inflammation and that also are believed to be important in the production of non-inflammatory pain.Used for treating inflammation and pain in the operation site.Hypersensitivity to ketorolac, aspirin, other NSAIDs, or any component of the formulation; patients who have developed nasal polyps, angioedema, or bronchospastic reactions to other NSAIDs; active or history of peptic ulcer disease; recent or history of GI bleeding or perforation; patients with advanced renal disease or risk of renal failure; labor and delivery; nursing mothers; prophylaxis before major surgery; suspected or confirmed cerebrovascular bleeding; hemorrhagic diathesis; concurrent ASA or other NSAIDs; epidural or intrathecal administration; concomitant probenecid; pregnancy (3rd trimester Rash Ringing in the ears Headaches Dizziness Drowsiness Abdominal pain Nausea Diarrhea Constipation Heartburn Fluid retentionC - Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) H - Pain as well as inflammation and its signs and symptoms - redness, swelling, fever, and pain are reduced. E - Every 6 hours x 6 doses.

C - Instruct client to report any adverse reaction to the physician or nurse. Tell patient that adverse reactions can occur with overuse.K - Do not drink alcohol while taking ketorolac. Alcohol can increase the risk of stomach bleeding caused by ketorolac. Instruct client to avoid alcohol and maintain adequate hydration (2-3 L/day of fluids) unless instructed to restrict fluid intake. Monitor for signs of pain relief, such as an increased appetite and activity Instruct client to avoid taking ketorolac with aspirin or other NSAIDs such as ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), piroxicam (Feldene), etc.


Generic Name:

Ampicillin Brand name:

Omnipen, Polycillin, PrincipenClassification:

Antibiotic (penicillins)Source:


500mg

Frequency:

Q6

Route:

IVTT Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin binding proteins (PBPs); which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.Used for treating bacterial infection.Hypersensitivity to ampicillin, any component of the formulation, or other penicillins Nausea Vomiting Loss of appetite Diarrhea Abdominal pain Rash Itching Headache Confusion DizzinessC - Antibiotic H - Pain as well as inflammation and its signs and symptoms - redness, swelling, fever, and pain are reduced. E - Every 6 hours

C - Instruct client to report any adverse reaction to the physician or nurse. Tell patient that Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. K - Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Tell patient that medication may cause nausea or vomiting (small, frequent meals, frequent mouth care, sucking lozenges, or chewing gum may help); or diarrhea (buttermilk, boiled milk, or yogurt may help). Instruct client to maintain adequate hydration (2-3 L/day of fluids) unless instructed to restrict fluid intake.


Generic Name:

ParacetamolClassification:

Analgesic and Antipyretic

Source: Nursing 2007 Drug Handbook 27th Edition, Lippincot Williams & WilkinsDosage:

500mg

Frequency:

PRN

Route:

IVTTReduces fever by acting on the hypothalamus to cause vasodilatation & sweating.Used for the relief of fever, headaches, and other and pains regarding surgical wound.Contraindicated with allergy to acetaminophen or any component.Use cautiously with impaired hepatic function, chronis alcoholism, and pregnancy lactation. Chest pain Dyspnea Rash

Fever

Acute kidney failure

Jaundice

Acute kidney failure

Hepatic toxicity and failureC - Analgesic and Antipyretic H - Relief of fever, headaches, and other minor aches and pains. E - as necessary or when temperature is more than 37.80C C- Instruct client to report any adverse reaction like allergies to the physician or nurse. Warn patient that high doses or unsupervised long term use can cause liver damage. K - Do not exceed the recommended dosage. Not to use for marked fever (temperature higher than 39.50C). Fever persisting longer than 3 days.

Warn patient that acute overdoses (above 1000 mg per single dose and above 4000 mg per day for adults, above 2000 mg per day if drinking alcohol) of paracetamol can cause potentially fatal liver damage and, in rare individuals, a normal dose can do the same; the risk is heightened by alcohol .

XIII. Health Teaching Plan

MedicationExerciseTreatmentHygieneOutpatientDiet

Ranitidine

C - Gastointestinal agent; Antisecretory (H2-receptor antagonist) H - Reduced amount of acid in the stomach that may result to prevented ulcer incidence. E - Every 8 hours while patient is on NPO.

C - Instruct client to report any adverse reaction to the physician or nurse. Tell patient that antacids may decrease the absorption of ranitidine.

K - Ranitidine can interfere with the metabolism of alcohol. Patients taking ranitidine who drink alcohol may have elevated blood alcohol levels.Tramadol C - Analgesic H - Relief of pain in the operation site.

E - Every 6 hours x 6 doses. May be taken with or without food. C - Instruct client to report any adverse reaction to the physician or nurse. Tell patient that tolerance or drug dependence may result from extended use (withdrawal symptoms have been reported); abrupt discontinuation should be avoided.

K - You should not take Ultram if you have ever been addicted to drugs or alcohol. Should be used only with extreme caution in patients receiving MAO inhibitors

Ketorolac

C - Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) H - Pain as well as inflammation and its signs and symptoms - redness, swelling, fever, and pain are reduced. E - Every 6 hours x 6 doses.

C - Instruct client to report any adverse reaction to the physician or nurse. Tell patient that adverse reactions can occur with overuse.

K - Do not drink alcohol while taking ketorolac. Alcohol can increase the risk of stomach bleeding caused by ketorolac

Ampicillin

C - Antibiotic H - Pain as well as inflammation and its signs and symptoms - redness, swelling, fever, and pain are reduced. E - Every 6 hours

C - Instruct client to report any adverse reaction to the physician or nurse. Tell patient that Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. K - Do not take the medication in larger amounts, or take it for longer than recommended by your doctor.ParacetamolC - Analgesic and Antipyretic H - Relief of fever, headaches, and other minor aches and pains. E - as necessary or when temperature is more than 37.80C

C- Instruct client to report any adverse reaction like allergies to the physician or nurse. Warn patient that high doses or unsupervised long term use can cause liver damage. K - Do not exceed the recommended dosage. Not to use for marked fever (temperature higher than 39.50C). Fever persisting longer than 3 days.The extended period of bed rest after a hysterectomy can weaken the muscles in the lower back and stomach. Following exercises should be held for five to 10 seconds and repeated 10 times on a daily basis.

The chin tuck can be performed while sitting in a chair or on the side of your bed. Keep your arms relaxed and by your side. Look straight ahead and pull your chin as though you are attempting to create a double chin.

The upper back and shoulder stretch is done while lying in bed or on a mat. Bring your hands over your head and rest with your palms up. Press your arms back into the bed.

The pelvic tilt can also be achieved in a lying-down position. You can place your hands on your stomach or put one hand under your lower back and keep the remaining hand on your stomach. Lightly tighten your buttocks and stomach muscles to pull your lower back down. You will notice your pelvis or hip bones roll backward.

You will have to get on your hands and knees to carry out the stomach-strengthening movement. Start by taking a deep breath. As you slowly exhale, keep the rest of your body still while tightening your stomach muscles.

Exercise as soon as the doctor authorizes it. Moderate exercise will improve immune defenses and antioxidant levels.Pain relievers prescribed by the doctorIndwelling catheter

Make sure you have enough sanitary pads for vaginal bleeding and discharge. You may have some discharge and bloody drainage for several days after your hysterectomy.Keep sanitary environment one that would not allow microorganisms to multiply and cause infection.

Provide catheter care: Keep the catheter coiled by the clients side to prevent the tubing to hang in a loop that allow the urine to sit in the tubing; maintain external cleanliness around the catheter. Keep the drainage bag off the floor to prevent microorganisms from moving up from outside the bag and into the catheter; change catheter every 2 weeks to prevent infection.Maintain good oral hygiene

Provide good perineal care. Change off perineal pad at least twice a day. Wiping from front to back.

Instruct patient to have follow up check up consultation and regular check ups.Instruct patient to follow good compliance to medication

Instruct patient to limit her movement at the beginning or if her doctor authorizes it take some short walks to keep her blood circulating and prevent blood clots from forming in her legs.

Avoid all lifting after the surgery and during the post hysterectomy period (ask for assistance).

Instruct patient avoid climbing stairs or driving a car during this recuperation period (ask family and friends for help).

Tell patient to avoid drinking alcoholic beverages for a few weeks (especially while taking medication).

Instruct patient to avoid aspirin and dairy foods during the post hysterectomy time because dairy products will not help you with constipation. The pain medicine you will be taking during the post hysterectomy time will tend to make you constipated. Instruct patient to change the dressing over her incision once a day or sooner if it gets dirty or wet.

Keep the wound area clean by washing it with mild soap and water. Tell patient that she may remove her wound dressings (bandages) and take showers if sutures (stitches), staples, or glue were used to close her skin. Instruct her not to soak in a bathtub or hot tub, or go swimming, until her doctor tells her it is okay.

If tape strips (Steri-Strips) were used to close her incision, cover them with plastic wrap before showering for the first week. Do not try to wash off the Steri-Strips or glue. They should fall off in about a week. If they are still there after 10 days, she can remove them, unless her doctor tells her not to.

Try eating smaller meals than normal and have healthy snacks in between .Eat healthy, because the patients body needs nutrients to heal (even if she doesnt feel like it). Eat cold-water fish as well as turkey, chicken, organic bread, soups, salads, vegetables and broths. Take the best daily multiple premium vitamins recommend and vitamin C as well. These vitamins will help improve sleep, will make less susceptibility to colds, flus and viruses less, will increase energy levels and provide the patient with sharper and clearer mind. Instruct patient to drink filtered water. And since most of life is "consumption and elimination", the patient needs to consume 8-10 glasses of water daily to adequately "flush" her system of toxins which would otherwise build up and cause some level of discomfort or illness.

Taking omega-3 and fatty acids should be taken daily because it has shown that it reduces inflammation, reduces the risk of strokes and heart attacks, help lower cholesterol and thin the blood.

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Drug Study Ranitidine Tramadol