PROTOTYPE DRUG: Interferon alfa 2 (Roferon-A, Intron A)



Nursing Process Focus:

Patients Receiving Hepatitis B Vaccine (Recombinant)

|Assessment |Potential Nursing Diagnoses |

|Prior to administration: |Injury, Risk for related to side effects of medication |

|Assess for possible exposure to HBV. Possible signs/symptoms include: |Knowledge, Deficient related to administration of medication |

|flu-like symptoms, GI symptoms, joint or RUQ pain, jaundice, | |

|clay-colored stool, and/or dark urine. Those exposed to the virus will | |

|need a combination therapy of both the hepatitis B vaccine and the | |

|Hepatitis B Immune Globulin | |

|Obtain blood work for those with possible exposure: HBsAG viral | |

|antigen/antibodies, complete blood count, electrolytes, liver enzymes | |

|(ALT, ALP, AST, GGT, & LDH), bilirubin levels, and prothrombin time. | |

|Assess patient’s drug history/allergy to determine possible sensitivity| |

|to baker’s yeast or previous dose of hepatitis B vaccine. | |

|Planning: Patient Goals and Expected Outcomes |

|The patient will: |

|Complete the series of vaccinations according to recommended immunization schedule |

|Remain free of signs and symptoms of Hepatitis B |

|Implementation |

|Interventions and (Rationales) |Patient Education/Discharge Planning |

|Identify “at risk populations” for Hepatitis. These include |Educate at “risk populations” concerning the availability of |

|People who have more than one sex |immunizations throughout the community; i.e., local health departments |

|partner in 6 months |and clinics. |

|Men who have sex with other men | |

|Sex contacts of infected persons | |

|People who inject illegal drugs | |

|Health care and public safety workers | |

|Household contacts of persons with | |

|chronic HBV | |

|Hemodialysis patients | |

|Monitor for flu-like symptoms. Those who are ill should wait until they|Instruct patient to report any flu-like symptoms, GI upset, changes in |

|recover before getting the vaccine. |urine or stool color before getting vaccine |

|Ensure infants receive the vaccine according to recommended schedule |Instruct infant caregivers of immunization schedule: |

| |within 12 hours of birth |

| |2nd dose: 1-2 months of age |

| |3rd dose: 6 months of age. |

| |The third dose should not be given before 6 months of age because this |

| |could reduce long-term protection. |

|Ensure older children, adolescents or adults receive the vaccine |Instruct patient of immunization schedule: |

|according to recommended immunization schedule. |1st dose: anytime |

| |2nd dose: 1-2 months after first dose |

| |3rd dose: 4-6 months after first dose |

| |If dose is missed, next dose should be received as soon as possible. |

|Monitor for common side effects such as soreness at injection site and |Instruct patient to notify health care provider if fever occurs or |

|fever |soreness at injection site lasts longer than a couple of days. |

|Monitor for possible allergic reactions such as difficulty breathing, |Instruct patient to notify health care provider of any signs or |

|hoarseness or wheezing, hives, paleness, weakness, tachycardia or |symptoms of an allergic reaction |

|dizziness. | |

|Evaluation of Outcome Criteria |

|Evaluate the effectiveness of drug therapy by confirming that the patient goals and expected outcomes have been met (see “Planning”). |

Nursing Process Focus:

Patients Receiving Interferon Alfa 2A (Roferon A, Intron A)

|Assessment |Potential Nursing Diagnoses |

|Prior to administration: |Injury, Risk for related to side effects of medication |

|Assess for presence/history of Cytomegalovirus and any malignancies for |Nutrition Altered, Risk for related to gastrointestinal upset secondary|

|verification of need. |to medication |

|Also check for pancreatitis, hepatic or renal disease, bone marrow |Infection, Risk related to bone marrow suppression secondary to |

|depression, and/or cardiac disease. Interferon may be contraindicated |medication |

|for patients with these disorders. |Knowledge, Deficient related to administration of medication |

|Obtain blood work: complete blood count, electrolytes, and liver enzymes| |

|Obtain weight, and vital signs especially blood pressure | |

|Assess mental alertness | |

|Assess patient’s drug history/allergy to determine possible sensitivity | |

|to interferon alpha or its components | |

|Planning: Patient Goals and Expected Outcomes |

|The patient will: |

|Remain free of fever, chills, sore throat, unusual bleeding, chest pain, palpitations, dizziness, change in mental status |

|Demonstrate the ability to self administer IM or SC injection |

|Maintain consumption of balanced diet |

|Implementation |

|Interventions and (Rationales) |Patient Education/Discharge Planning |

|Monitor for leukopenia, neutropenia, thrombocytopenia, anemia, increased|Instruct patient to: |

|liver enzymes (due to possible bone marrow suppression and liver |Comply with all ordered laboratory tests |

|damage). |Immediately report an unusual bleeding and jaundice |

| |Avoid crowds and people with infections |

|Ensure medication is properly administered. |Instruct patient in proper technique for self administration of IM or |

| |SC injection. |

|Monitor vital signs including temperature, pulse respirations and blood |Instruct patient to: |

|pressure. (Loss of vascular tone leading to extravasation of plasma |Monitor blood pressure and pulse everyday and report to health care |

|proteins and fluids into extravasular spaces may cause hypotension and |provider any reading outside normal limits |

|arrhythmias.) |Report any palpitations to health care provider immediately |

|Monitor for common side effects such as muscle aches, fever, weight |Instruct patient to: |

|loss, loss of appetite, nausea and vomiting and arthralgia due to high |Take medication at bedtime to reduce side effects |

|doses of medications. Report to health care provider. |Use frequent mouth care and small frequent feedings to reduce |

| |gastrointestinal disturbances |

|Monitor blood glucose levels. (Blood sugar may increase in patients |Instruct patient to have blood glucose checked at regular intervals. |

|with pancreatitis.) | |

|Monitor for changes in mental status. (May cause depression, confusion,|Instruct patient to notify health care provider of any mental changes. |

|fatigue, visual disturbances, and numbness. Alpha-interferons cause or | |

|aggravate neuropsychiatric disorders. Mechanism of action | |

|undetermined.) | |

|Evaluation of Outcome Criteria |

|Evaluate the effectiveness of drug therapy by confirming that the patient goals and expected outcomes have been met (see “Planning”). |

Nursing Process Focus:

Patients Receiving Cyclosporine (Neoral, Sandimmune)

|Assessment |Potential Nursing Diagnoses |

|Prior to administration |Infection, Risk for related to depressed immune response secondary to |

|Assess for presence/history of organ transplant, grafting, active |medication |

|infection, and pregnancy |Injury, Risk for related to thrombocytopenia secondary to side effects |

|Assess for skin integrity, specifically look for lesions and skin color|of medication |

|Obtain blood work: complete blood count, electrolytes, and liver |Knowledge, Deficient, related to drug action and side effects |

|function | |

|Obtain vital signs especially temperature and blood pressure | |

|Assess patient’s drug history/allergy to determine possible sensitivity| |

|to polyoxyethylated castor oil | |

|Planning: Patient Goals and Expected Outcomes |

|The patient will: |

|Remain free of elevated temperature, unusual bleeding, sore throat, mouth ulcers, fatigue |

|Demonstrate complianewith all laboratory tests needed to monitor this medication |

|Demonstrate understanding of signs and symptoms of side effects related to medication |

|Implementation |

|Interventions and (Rationales) |Patient Education/Discharge Planning |

| Monitor renal function. (May cause nephrotoxicity. 75% of patients |Advise patient to: |

|experience decreased urine flow due to changes physicological in the |Keep good record of urine output |

|kidneys such as microcalcification and interstitial fibrosis.) |Report significant reduction in urine follow to the health care |

| |provider |

|Monitor liver function (due to an increased risk for liver toxicity). |Instruct the patient concerning the importance of regular blood work. |

|Watch for signs and symptoms of infection. (There is an increased risk |Instruct patient: |

|of infection.) |Regarding importance of good, frequent handwashing. |

| |To avoid crowds and anyone who has infection |

|Monitor vital signs especially temperature and blood pressure. (As a |Teach patients to monitor blood pressure and temperature ensuring |

|side effect of this medication especially related to those with kidney |proper use of home equipment and compliance with doctor’s appointments.|

|transplants, hypertension may occur in 10-15% of patients. Increased | |

|temperature may indicate infection.) | |

|Monitor for the following possible side effects: hirsuitism, |Advise patient to: |

|leukopenia, gingival hyperplasia, gynecomastia, sinusitis and |See a dentist on a regular basis. |

|hyperkalemia |Comply with regular laboratory assessments (complete blood count, |

| |electrolytes, and hormones levels) |

|Monitor nutritional status (due to possible weight gain). |Instruct patient in a healthy diet that avoids excessive fats and |

| |sugars. |

|Evaluation of Outcome Criteria |

|Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see “Planning”). |

Nursing Process Focus:

Patients Receiving Prednisone (Meticorten)

|Assessment |Potential Nursing Diagnoses |

|Prior to administration: |Nutrition: more than body requirements, Risk for Imbalanced: related to|

|Obtain complete drug history including allergies, drug history and |weight gain from medication |

|possible drug interactions |Fluid volume, Excess related to fluid retention secondary to medication|

|Assess vital signs |Body image, Disturbed related to physical changes secondary to |

|Assess for history of organ transplant, acute inflammation, diabetes |medication |

|mellitus |Injury, Risk for (infection) related to immunosuppression from |

|Obtain serum electrolytes |medication |

| |Skin Integrity, Risk for Impaired related to tissue fragility secondary|

| |to medication |

|Planning: Patient Goals and Expected Outcomes |

|The patient will: |

|Maintain body weight within normal range |

|Remain free of edema in lower extremities |

|Demonstrate positive body image |

|Maintain intact skin integrity |

|Implementation |

|Interventions and (Rationales) |Patient Education/Discharge Planning |

|Monitor vital signs, especially blood pressure (to determine need for |Inform patient to report to health care provider any signs and |

|possible treatment of fluid and electrolyte disorders and renal |symptoms of fluid retention; e.g. increase in weight by 2 lbs in a 1 |

|insufficiency). |week, swelling of hands and feet, difficulty breathing. |

|Use cautiously in patients with renal insufficiency (due to the drug’s | |

|ability to retain water and sodium and the main excretion of drug is by| |

|the renal system). | |

|Monitor complete blood count. (Capillaries become more permeable |Inform patient concerning the need to for periodic lab testing |

|resulting in vasoconstriction. Red blood cells increase, causing | |

|decrease in white blood cells.) | |

|Obtain medical history of myasthenia gravis (due to the possible |Instruct patient to report any difficulty in breathing to health care |

|adverse effect of exacerbation of respiratory failure). |provider immediately. |

|Monitor blood sugar. (Use cautiously in patients with diabetes mellitus|Instruct patient: |

|due to drug’s effect on blood sugar, causing hyperglycemia. Patients |May increase insulin needs while on this medication |

|may require increased doses of a glucose-lowering drug.) |To increase blood sugar monitoring and to report increased blood sugar |

| |to health care provider. |

|Monitor for signs and symptoms of infection or inflammation. |Instruct patient to: |

|(Medication may mask usual signs of infection. Use cautiously in |Avoid all contact with individuals with infections |

|patients with acute active infections. Contraindicated in patients with|Wash hands frequently and to clean all counters completely after food |

|systemic fungal infection due to the possibility of interaction with |preparation |

|the acute infection and the risk for superinfections.) | |

|Monitor compliance with medication regimen. |Instruct patient: |

| |Take medication exactly as scheduled and to never abruptly stop |

| |medication. |

| |Avoid taking any OTC drugs without checking with the health care |

| |provider. |

|Monitor intake and output (due to drug’s ability to cause water and |Instruct patient to: |

|sodium retention). |Weigh self regularly |

| |Report any sudden weight gain to the health care provider |

|Obtain history of gastrointestinal disorders. |Advise patient to take medication with food to decrease |

|(Use cautiously in patients with active peptic ulcer disease due to |gastrointestinal distress. |

|inhibiting production of cytoprotective mucous and reduction of GI | |

|mucosal blood flow that can lead to gastric ulceration.) | |

|Use extreme care during venipuncture due to capillary fragility. |Advise patient to carry some form of identification stating the |

|(Capillary fragility is due to the suppression of protein synthesis by |medication the patient is taking. |

|the glucocorticoids’ effect.) | |

|Evaluate risk for osteoporosis. (Use cautiously in patients with |Advise patient to consume nutritious low calorie foods and to increase |

|osteoporosis due to drug’s effect to cause suppression of bone |dietary calcium to combat osteoporosis. |

|formation by osteoblasts, hence to worsen symptoms of osteoporosis.) | |

|Evaluation of Outcome Criteria |

|Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see “Planning”). |

Nursing Process Focus:

Patients Receiving Acetaminophen (Tylenol)

|Assessment |Potential Nursing Diagnoses |

|Prior to administration: |Pain related to ineffective response to medication |

|Obtain complete health history including allergies, drug history and |Injury, Risk for hepatic toxicity) related to adverse effects of |

|possible drug interactions. |medication |

|Obtain history of liver disease |Knowledge, Deficient related to drug action and side effects |

|Assess history of pain or fever | |

|Obtain concurrent use of anticoagulants | |

|Obtain intolerance to ASA | |

|Planning: Patient Goals and Expected Outcomes |

|The patient will: |

|Demonstrate an understanding of safe self administration of medication. |

|Demonstrate relief of pain |

|Remain free of evidence of hepatic toxicity |

|Implementation |

|Interventions and (Rationales) |Patient Education/Discharge Planning |

|Monitor for evidence of liver dysfunction (due to acetaminophen |Advise patient to: |

|accumulation, and resulting liver damage). |Abstain from alcohol while taking this medication. |

| |Report signs of liver dysfunction including jaundice, itching, fatigue |

|Monitor renal function tests, and intake and output (due to the ability|Advise patient: |

|of acetaminophen to impair renal function as a result of toxic levels).|Lab tests to assess renal function may be necessary to prevent renal |

| |tubular necrosis. |

| |To notify health care provider if changes in urinary output occurs. |

|Monitor concurrent medication use. (Be alert to all other medications |Advise patient to: |

|that contain acetaminophen especially in combination with narcotic pain|Avoid taking any other OTC medication unless ordered by health care |

|reliever to avoid toxic levels. |provider. |

|Contraindicated for use with warfarin due to the mechanism of |Read directions carefully when using acetaminophen suspension and drops|

|inhibition of warfarin metabolism, which causes warfarin to accumulate |Not to exceed recommended daily dose of medication |

|at high levels.) | |

|Observe for intolerance to ASA for possible cross-hypersensivity to |Instruct patient to report any itching, skin rash, or difficulty |

|acetaminophen. |breathing. |

|Monitor for signs of infection, including complete blood count and |Instruct patient to report signs of infection generalized mild muscular|

|platelet count. (Acetominophen’s effects may mask infection.) |pain and headache. |

|Monitor pain level (to determine effectiveness of drug therapy). |Instruct patient to report changes in pain level to health care |

| |provider. |

|Monitor blood sugar in patients with diabetes mellitus. (Acetaminophen |Advise patient that this medication may cause hypoglycemia. |

|may decrease insulin needs.) | |

|Evaluation of Outcome Criteria |

|Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see “Planning”). |

Nursing Process Focus:

Patients Receiving Diphendrydramine (Benadryl)

|Assessment |Potential Nursing Diagnoses |

|Prior to administration: |Injury, Risk for related to drowsiness and dizziness secondary to |

|Obtain complete health history including allergies, drug history and |effects of medication |

|possible drug interactions |Gas exchange, Risk for Impaired related to respiratory secretions |

|Obtain presence/history of allergic or anaphylactic reactions |Knowledge, Deficient related to drug action and side effects. |

|Obtain vital signs | |

|Obtain history of glaucoma, diabetes mellitus, seizure disorder | |

|Planning: Patient Goals and Expected Outcomes |

|The patient will: |

|Remain free of physical injury |

|Demonstrate knowledge of drug therapy and side effects |

|Remain demonstrate relief of symptoms of allergic reaction |

|Implementation |

|Interventions and (Rationales) |Patient Education/Discharge Planning |

|Monitor vital signs before, during, and after administration (due to |Advise patient: |

|anticholinergic effect on vital signs of decreased BP and increased |That blood pressure may decrease and heart rate increase |

|heart rate). |To report changes in vital signs to health care provider |

| |To monitor blood pressure and pulse |

|Obtain history of narrow angle glaucoma and increased intraocular |Instruct patient to report history of glaucoma to health care provider.|

|pressure. (Drug may worsen condition.) | |

|Obtain history of prostatic hypertrophy and bladder neck obstruction. |Instruct patient to report any urinary obstruction or difficulty in |

|(Both conditions are contraindicated for use with diphenhydramine due |voiding. |

|to exacerbation by anticholinergic effects and muscarinic blockade.) | |

|Monitor for respiratory conditions. (Drug may worsen conditions such as|Instruct patient to: |

|asthma.) |Report symptoms of respiratory distress to the health care provider |

| |Increase fluid intake to make expectoration easier |

|Monitor for GI conditions and distress. (Drug interferes with function |Advise patient to take medication with food to reduce gastrointestinal |

|of H1 receptors.) |distress. |

|Obtain history of diabetes mellitus. (Use cautiously in these patients |Advise patient to: |

|due to the possibility of this drug to increase hypoglycemia.) |Monitor blood sugar more frequently |

| |Inform health care provider of any abnormally low blood sugar levels. |

|Monitor neurological status especially for patients with history of |Instruct patients to: |

|seizures. (Use cautiously in these patients due to medication causing |Report aura immediately to health care provider |

|an increase in seizure activity.) |Report increase of seizure activity to health care provider |

|Use cautiously in patients with history of hyperthyroidism, |Advise patient to: |

|cardiovascular disease. (There is an increased risk of thyroid storm, |Report any unusual effects such as increased nervousness, insomnia. |

|and cardiovascular collapse.) |Report changes in vital signs |

|Monitor for side effects such as dry mouth. |Advise patient to suck on hard candy to reduce symptoms of dry mouth. |

|Closely monitor elderly patients (because of an increase incidence of |Advise patient to: |

|dizziness, sedation and hypotension). |Refrain from driving or operating heavy machinery due to sedating |

| |effects |

| |Report feeling of oversedation to the health care provider |

|Discontinue at least 4 days prior to skin tests. (Drug may increase |Inform patient to notify health care provider if they are on any H1 |

|effect to the testing and give a false positive result.) |receptor antagonists. |

|Evaluation of Outcome Criteria |

|Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see “Planning”). |

Nursing Process Focus:

Patients Receiving Fexofenadine (Allegra)

|Assessment |Potential Nursing Diagnoses |

|Prior to administration |Injury, Risk related to drug related drowsiness |

|Obtain complete health history including allergies, drug history an |Knowledge Deficient, related to drug action and side effects |

|possible drug interactions | |

|Assess for presence/history of seasonal allergic rhinitis, allergic | |

|conjunctivitis, urticaria, angioedema | |

|Obtain vital signs | |

|Planning: Patient Goals and Expected Outcomes |

|The patient will: |

|Demonstrate understanding of drug therapy |

|Remain free of physical injury |

|Implementation |

|Interventions and (Rationales) |Patient Education/Discharge Planning |

|Monitor neurological status of elderly patients. (The elderly are more|Advise patient to: |

|prone to syncope, sedation and dizziness due to long acting effects of |Avoid driving or operating heavy machinery until drowsiness is no |

|medication.) |longer a problem |

| |Resort symptoms of over sedation to health care provider |

|Monitor respiratory status prior to therapy (due to anticholinergic |Instruct patient to report any difficulty in breathing to health care |

|effects on respiratory system). |provider |

|Monitor for renal impairment. (Use with caution in these patients due |Advise patient to report changes in urinary pattern or output. |

|to aggravating factors related to muscarinic blockade.) | |

|Observe for allergic conditions, such as seasonal allergic rhinitis, |Instruct patient to report changes in allergic condition to health care|

|allergic conjunctivitis, and urticaria (to monitor effectiveness of |provider. |

|drug therapy). | |

|Monitor vital signs, especially heart rate and respiratory rate. |Advise patient to: |

| |Not take any OTC cold medications without first checking with the |

| |health care providerhealth care provider |

| |Abstain from the use of alcohol while taking this medication |

|Evaluation of Outcome Criteria |

|Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see “Planning”). |

Nursing Process Focus:

Patients Receiving Fluticasone (Flonase)

|Assessment |Potential Nursing Diagnoses |

|Prior to administration |Injury, Risk for related to adverse effects of medication |

|Obtain complete health history including allergies, drug history and |Knowledge, Deficient related to drug action and side effects |

|possible drug interactions | |

|Assess for presence or history of seasonal allergic rhinitis | |

|Obtain vital signs | |

|Planning: Patient Goals and Expected Outcomes |

|The patient will: |

|Remain free of physical injury |

|Demonstrate understanding of drug therapy |

|Demonstrate ability to adminster medication appropriately |

|Implementation |

|Interventions and (Rationales) |Patient Education/Discharge Planning |

|Monitor respiratory function. (Drug worsens respiratory failure, asthma|Instruct patient to immediately report signs of respiratory distress to|

|attacks.) |the health care provider. |

|Monitor for concurrent use of systemic corticosteroids. (Can lead to |Instruct patient to completely disclose all other medications he/she is|

|suppression of adrenal function.) |taking. |

|Monitor for signs of infections. (Use with caution in patients with: |Instruct patient to report signs of infection to the health care |

|tuberculosis, untreated fungal, bacterial or viral infections due to |provider. |

|possible development of superinfection; ocular herpes simplex due to | |

|worsening of symptoms due to immune suppression.) | |

|Monitor for signs and symptoms of hypercorticism such as acne and |Advise patient to inform health care provider if any weight gain, |

|hyperpigmentation (due to adrenal insufficiency). |severe skin conditions occur, hyperactivity. |

|Provide humidification (to decrease crusting and drying of nasal |Instruct patient: |

|passages). |To report irritation of nasal passages to health care provider |

| |To wash cap and nosepiece with warm water after each use |

| |That transient burning of the nasal passages as well as sneezing are |

| |common side effects |

|Observe for proper use of medication. |Instruct patient: |

| |In proper technique for use of nasal inhaler |

| |To shake inhaler prior to use |

| |That medication will be most effective if nasal passages are clear |

| |before use |

| |To use only prescribed amount to avoid systemic side effects |

| |That this medication does not provide immediate symptom relief |

|Evaluation of Outcome Criteria |

|Evaluate the effectiveness of drug therapy by confirming the patient goals and expected outcomes have been met (see “Planning”). |

Nursing Process Focus

Patients Receiving Oxymetazoline (Afrin)

|Assessment |Potential Nursing Diagnoses |

|Prior to administration: |Injury, Risk for (nosebleed) related to adverse effects of medication|

|Obtain complete health history including allergies, drug history and |Tissue Perfusion, Risk for Ineffective related to adverse effects of |

|possible drug interactions |medication |

|Assess for presence or history of nasal congestion due to allergic |Knowledge, Deficient related to drug action, side effects, and |

|conditions, nasal surgery, middle ear infections (treatment and |administration |

|prevention) | |

|Planning: Patient Goals and Expected Outcomes |

|The patient will: |

|Demonstrate an ability to use a nasal inhaler. |

|Remain free of physical injury |

|Maintain effective tissue perfusion |

|Demonstrate knowledge of drug therapy |

|Implementation |

|Interventions and (Rationales) |Patient Education/Discharge Planning |

|Evaluate pupil size and respiratory status before administration. |Inform patient: |

|(Drug stimulates alpha1-adrenergic receptors that may cause |That pupil constriction and respiratory depression may occur |

|constricted pupils and respiratory depression.) |To immediately report respiratory distress to the health care |

| |provider |

|Obtain history of diabetes mellitus (Use cautiously in these patients|Instruct patient: |

|due to possible interaction of drug with glucose-lower agents.) |To monitor their glucose levels frequently when on this medication |

| |To notify their health care provider for any abnormalities in their |

| |results. |

| |May need increased doses of glucose-lowering agents |

|Monitor compliance with medication regimen. (Rebound congestion will |Instruct patient: |

|occur if medication is used for longer than 5 days due to prolonged |Not to use medication longer than 5 days. |

|use, patient must use more and larger doses of drug.) |To notify health care provider if rebound congestion occurs |

| |In proper technique for administering nose drops |

| |To wash hands before and after using nose drops |

| |To rinse dropper in hot water after each use |

|Obtain history hyperthyroidism (Use cautiously in patients with |Instruct patient to report nervousness, shaking, tremors, fever, |

|hyperthyroidism due to central nervous system stimulation by drug’s |rapid heart beat and breathing to the health care provider. |

|effect that possibility would cause an exacerbation of the disease | |

|process.) | |

|Monitor vital signs, especially pulse and respiration. (Drug has |Advise patient to: |

|cardiovascular effects by stimulation of alpha1-adrenergic |Use only the prescribed amount |

|receptors.) |Monitor blood pressure at same time daily and record. |

| |Report any abnormal results to health care provider. |

|Evaluation of Outcome Criteria |

|Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see “Planning”). |

Nursing Process Focus:

Patients Receiving Epinephrine (Adrenalin)

|Assessment |Potential Nursing Diagnoses |

|Prior to administration: |Tissue perfusion, Risk for Ineffective related to cardiovascular |

|Obtain complete health history including allergies, drug history and |effects of medication |

|possible drug interactions |Sleep pattern, Disturbed, related to CNS effects of medication |

|Assess for presence/history of Anaphylactic shock, asthma, |Nutrition Impaired: less than body requirements related to anorexia |

|cardiopulmonary resuscitation |secondary to medication |

|simple glaucoma, ventricular |Knowledge Deficient, related to drug action and side effects |

|fibrillation, croup, septic shock, | |

|wheezing | |

|Obtain vital signs | |

|Planning: Patient Goals and Expected Outcomes |

|The patient will: |

|Demonstrate understanding of the risks and benefits of drug therapy. |

|Maintain adequate tissue perfusion |

|Maintain adequate sleep |

|Demonstrate maintenance of weight within normal range |

|Implementation |

|Interventions and (Rationales) |Patient Education/Discharge Planning |

|Monitor vital signs and lung sounds, including croup and wheezing (to |Instruct patient to report changes in respiratory status to the |

|determine effectiveness of drug therapy). |health care provider. |

|Monitor blood glucose. (Use with caution in patients with diabetes |Advise patient to monitor blood glucose frequently during treatment. |

|mellitus due to epinephrine’s effect of increasing hyperglycemia.) | |

|Obtain history of closed angle glaucoma. (Drug dilates the pupil, which|Instruct patient to immediately report vision changes to the health |

|may lead to worsening of condition.) |care provider. |

|Use with caution in patients with hyperthyroidism (due to exacerbation |Instruct the patient to notify the health care provider if they |

|of thyroid crisis). |experience; increased heart rate, fever, nervousness, tremors. |

|Monitoring cardiovascular status (Cardiac arrhythmias may occur and may|Advise patient that cardiac monitoring will occur while receiving |

|lead to ventricular fibrillation. Hypertensive crisis may occur.) |this medication. |

| | |

|Monitor neurological status. (Drug may cause cerebral hemorrhage.) |Instruct patient to immediately report the first signs of severe |

| |headache. |

|Evaluation of Outcome Criteria |

|Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see “Planning”). |

Nursing Process Focus:

Patients Receiving Celecoxib

|Assessment |Potential Nursing Diagnoses |

|Prior to administration: |Injury, Risk for (Gastrointestinal bleeding) related to adverse effects|

|Obtain complete health history including allergies, drug history and |of the medication |

|possible drug interactions. |Mobility, Impaired physical related to joint disease |

|Assess for presence/history |Knowledge Deficient, related to drug action and side effects |

|Rheumatoid arthritis | |

|Osteoarthritis | |

|Congestive heart failure | |

|Hypertension | |

|Renal disease | |

|Pregnancy | |

|assess renal function tests, e.g. BUN, creatinine levels | |

|Planning: Patient Goals and Expected Outcomes |

|The patient will: |

|Avoid evidence of gastrointestinal bleeding |

|Demonstrate compliance with lifestyle modifications necessary for successful medication therapy. |

|Demonstrate knowledge of drug action and side effects of drug |

|Implementation |

|Interventions and (Rationales) |Patient Education/Discharge Planning |

|Monitor for congestive heart failure, fluid retention, hypertension, |Advise patient to: |

|and renal disease. (Use cautiously in these patients, as drug may cause|Report any difficulty breathing to the health care provider immediately|

|increased edema and fluid retention.) |Report to the health care provider immediately, any blood in the stool,|

|Monitor vital signs (especially pulse and blood pressure) for baseline |any swelling or skin rash or any yellow coloration to the eyes or skin |

|information and to monitor the drug’s possible effect of COX 1 | |

|inhibition on renal vasodilation. | |

|Monitor intake and output (due to possible drug interactions that may |Instruct patient to report changes in urinary output to the health care|

|decrease function of reabsorption of water at the loop of Henle). |provider. |

|Monitor for gastrointestinal distress such as nausea, diarrhea, |Advise patient to take medication with food if gastrointestinal |

|abdominal pain, or flatulence. |distress is a problem. |

|Monitor liver function, complete blood count, BUN, serum creatinine, |Instruct patient to keep all appointments for laboratory tests. |

|and serum electrolytes. | |

|Monitor lithium levels in patients who are taking lithium. (Celecoxib |Encourage patients to comply with lithium serum levels lab tests as |

|may alter established lithium levels.) |ordered by health care provider. |

|Evaluation of Outcome Criteria |

|Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see “Planning”). |

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