PROTOTYPE DRUG: Ranitidine (Zantac)



Nursing Process Focus:

Patients Receiving Ranitidine (Zantac)

|Assessment |Potential Nursing Diagnoses |

|Prior to administration |Injury, Risk for (falls) related to drowsiness secondary to drug |

|Obtain complete health history including allergies, drug history and |therapy |

|possible drug interactions |Nutrition, Risk for Imbalanced: Less than body requirements related to |

|Assess for presence/history gastroesophageal reflux disease, gastric |adverse effects of drug therapy |

|ulcer |Pain, related to gastric irritation secondary to ineffective response |

|Obtain vital signs |to drug therapy |

|Assess liver and kidney function, pregnancy status and complete blood|Knowledge, Deficient related to drug therapy and side effects |

|count. | |

|Planning: Patient Goals and Expected Outcomes |

|The patient will: |

|Remain free of side effects including abdominal pain, heartburn, jaundice, hematemesis, and respiratory difficulty. |

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

|Remain free of physical injury |

|Maintain balanced nutrition, and weight within expected levels |

|Implementation |

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

|Monitor serum creatinine, AST, ALT alkaline phosphatase and total |Advise patient to: |

|bilirubin. |Report symptoms of liver dysfunction including jaundice, pruritus, |

| |fatigue |

| |Stop smoking while on drug therapy |

| |Abstain from alcohol while taking this medication, as it may potentiate|

| |drowsiness |

|Monitor for bleeding, bruising, including complete blood count. (Drug|Instruct patient to report signs of unusual bleeding such as petechiae |

|may cause thrombocytopenia.) |or excessive bruising |

|Institute safety procedures to protect the patient who experiences |Advise patient not to drive or operate heavy machinery until the |

|dizziness. |response to drug therapy can be evaluated. |

|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 Omeprazole (Prilosec)

|Assessment |Potential Nursing Diagnoses |

|Prior to administration |Injury, Risk for (fall) related to drowsiness secondary to drug therapy|

|Obtain complete health history including allergies, drug history and |Pain, Risk for related to gastric irritation |

|possible drug interactions |Nutrition, Risk for Imblance: less than body requirements related to |

|Assess for presence/history Gastrointestinal distress, |ineffective response to drug therapy |

|gastrointestinal bleeding | |

|Assess alcohol use, complete blood count, renal function, and stool | |

|for occult blood. | |

|Planning: Patient Goals and Expected Outcomes |

|The patient will: |

|Remain free of signs of side effects including headache, dizziness, diarrhea, abdominal pain, hematuria and rash |

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

|Implementation |

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

|Monitor the smoking and food habits of the patient. (Smoking |Advise patient to: |

|increases stomach acid production.) |Abstain from alcohol use while taking this medication |

| |Refrain from spicy foods, caffeine and smoking which may increase |

| |gastric irritation |

|Monitor elimination pattern. (Drug may cause diarrhea.) |Advise patient to keep a food diary to help correlate symptoms with |

| |foods eaten. |

|Periodically monitor urine for the presence of blood and/or protein. |Instruct patient to report change in urine color 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 Diphenoxylate with Atropine (Lomotil)

|Assessment |Potential Nursing Diagnoses |

|Prior to administration: |Fluid volume, Risk for Imbalance: less than body requirements related |

|Obtain complete health history including allergies, drug history and |to fluid loss secondary to diarrhea |

|possible drug interactions |IMpaired skin integrity, Risk for related to diarrhea stools |

|Assess for presence/history of diarrhea, dehydration, electrolyte |Injury, Risk for (falls) related to drowsiness secondary to drug |

|imbalance |therapy |

|Assess sodium level, chloride level, potassium level, stool culture, |Knowledge, Deficient related to drug action and side effects |

|presence of dehydration, vital signs and EKG. | |

|Planning: Patient Goals and Expected Outcomes |

|The patient will: |

|Demonstrate understanding of instructions necessary for drug therapy. |

|Immediately report persistent diarrhea, constipation, abdominal pain, blood in stool, confusion, dizziness or fever. |

|Implementation |

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

|Monitor abdomen for distention and degree and location of abdominal |Advise patient to: |

|pain. (This may be sign of toxic megacolon.) |Record the frequency of stools. Instruct patient to note if any blood |

| |is present. |

| |Report any abdominal pain or abdominal distention to the health care |

| |provider immediately |

|Monitor frequency, volume, characteristics, and consistency of stools.|Instruct patient to: |

| |Report worsening of diarrhea to health care provider |

| |Report occurrence of bloody stools to health care provider |

| |Increase fluid intake and to drink electrolyte enriched fluids. |

|Offer ice, gum or sour candy. May swab lips with a glycerine-based |Advise patient to suck on sour candy or chew gum to relieve sensations |

|emollient. (The medication may cause dry mucous membranes.) |of dry mouth. |

|Initiate safety measures to prevent falls. (The medication may cause |Advise patient to: |

|drowsiness.) |Not drive or operate heavy machinery due to drowsiness. |

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

|Monitor electrolyte levels. |Advise patient to keep all laboratory appointments. |

|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 Prochlorperazine (Compazine)

|Assessment |Potential Nursing Diagnoses |

|Prior to administration: |Injury, Risk for (fall) related to dizziness secondary to drug |

|Obtain complete health history including allergies, drug history and |therapy |

|possible drug interactions |Fluid volume, Risk for Imbalance: deficit related to ineffective |

|Assess for presence/history severe |response to drug therapy |

|nausea, vomiting |Nutrition, Risk for Imbalanced: less than body requirements related |

|Obtain vital signs |to nausea and vomiting |

|Assess for presence of dehydration, sodium level, chloride level, |Knowledge, Deficient, related to drug therapy and side effects |

|potassium level, and temperature. | |

|Planning: Patient Goals and Expected Outcomes |

|The patient will: |

|Demonstrate understanding of need for drug therapy and will comply with all instruction given |

|Remain free of drug side effects including rash, blurred vision, jaundice, tremor and changes in vision. |

|Maintain adequate fluid balance |

|Maintain adequate nutrition |

|Remain free of physical injury |

|Implementation |

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

|Monitor neurological status (Seizure threshold is decreased. May need |Advise patient with a seizure disorder that there is an increased |

|to increase seizure medication.) |risk for seizures with this medication. |

|Monitor intake and output (to evaluate drug effectiveness), |Advise patient: |

| |To report continue nausea and vomiting |

| |That medication may cause urine to appear reddish brown |

|Monitor elimination pattern. (Medication may cause urinary retention.) |Instruct patient to report difficult urination to health care |

| |provider. |

|Institute safety procedures to prevent patient falls or injuries. |Advise patient to avoid driving or operating heavy machinery due to |

| |sedating effects of medication. |

|Monitor changes in skin integrity. (Medication may cause gray–blue |Advise patient: |

|discoloration of skin.) |To protect skin from direct sunlight and to use sunscreen |

| |That medication may cause sun exposed skin to turn gray blue |

|Evaluation of Outcome Criteria |

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

Nursing Process Focus:

Patients Receiving Sibutramine (Meridia)

|Assessment |Potential Nursing Diagnoses |

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

|Obtain complete health history including allergies, drug history and |ineffective response to drug therapy |

|possible drug interactions |Tissue perfusion, Risk for Ineffective related to adverse effects of |

|Assess for presence/history obesity, desire to lose weight |drug therapy |

|Assess weight, blood pressure, pulse, EKG, liver function and kidney |Gas exchange, Risk for Impaired related to respiratory difficulty |

|function |secondary to adverse effects of drug therapy |

| |Injury, Risk for (anaphylaxis) related to adverse effects of drug |

| |therapy |

| |Knowledge, Deficient related to drug action and side effects |

|Planning: Patient Goals and Expected Outcomes |

|The patient will: |

|Remain free of adverse reaction to drug including severe headache, fever, muscle aches, tachycardia, rash, nausea, vomiting, profuse sweating, |

|tremor, irritability and respiratory difficulty. |

|Demonstrate weight loss within expected range |

|Maintain adequate tissue perfusion |

|Demonstrate knowledge of drug action and side effects |

|Implementation |

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

|Obtain medication history for concurrent use of SSRIs. (Medication may |Instruct patient to immediately report the development of any rash, |

|cause serotonin syndrome.) |fever or difficulty breathing. |

|Monitor weight pattern (to evaluate effectiveness of drug therapy). |Advise patient to: |

| |Keep weight record |

| |Report weight increase to health care provider |

|Monitor intake and output (to evaluate compliance with treatment |Encourage patient to: |

|regimen.) |Remain compliant with prescribed dietary and lifestyle modifications |

| |Take medication as prescribed by the health care provider |

|Monitor liver function, bilirubin, alkaline phosphatase and lipid |Advise patient to keep all laboratory appointments. |

|profile. (There is an increased risk of liver dysfunction.) | |

|Monitor patients with narrow angle glaucoma for increased intraocular |Advise patient to report any vision changes to the health care |

|pressure (Medication may worsen condition.) |provider immediately. |

|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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