PROTOTYPE DRUG: Oxytocin (Pitocin, Syntocinon)



Nursing Process Focus:

Patients Receiving Ethinyl Estradiol With Norethindrone (Ortho-Novum)

|Assessment |Potential Nursing Diagnosis |

|Prior to administration: |Anxiety, related to concern about medication failure with resultant |

|Obtain complete health history including allergies, drug history and|pregnancy, imbalances in hormones |

|possible drug interactions |Comfort, impaired, related to side effects of medication |

|Assess for presence/history of pregnancy, thrombophlebitis, CVA, |Health maintenance, ineffective, related to lack of knowledge or |

|breast cancer |understanding of positive health practices (smoking cessation, etc.) |

|Obtain history of smoking |Knowledge, deficient, related to no prior contact with oral contraceptives|

|Obtain vital signs |Nutrition, imbalanced, either less than or more than body requirements, |

| |related to imbalance in hormone make-up of oral contraception |

|Planning: Patient Goals and Expected Outcomes |

|Patient will: |

|Demonstrate compliance with medication regimen |

|Avoid pregnancy |

|Remain free of side effects |

|Demonstrate knowledge of drug therapy and potential side effects |

|Implementation |

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

|Monitor for pregnancy. (Medication must not be administered to woman|Teach patient: |

|who is pregnant. Medication is teratogenic.) |That she must have had negative pregnancy test within 2 weeks prior to |

| |beginning medication |

| |To immediately have pregnancy test if pregnancy is suspected during |

| |therapy |

|Monitor for breast or other estrogen-dependent tumors. (Estrogen in |Teach patient to: |

|medication may cause tumor growth or proliferation.) |Give full medical and family medical history prior to beginning therapy |

| |Report to health care provider immediately if 1st degree relative is |

| |diagnosed with any estrogen-dependent tumor |

|Observe for thrombophlebitis or other thromboembolic disease. |Advise patient of signs of possible thromboembolic event, and to |

|(Estrogen-containing medications predispose a woman to |immediately report: pain in calves, limited movement in legs, dyspnea, |

|thromboembolism.) |sudden severe chest pain, anxiety, fear. |

|Monitor for cardiac disorders. (Medication will lead to worsening of|Advise patient of signs of possible cardiac problems which must be |

|cardiac problems.) |immediately reported: chest pain, dyspnea, edema, tachycardia or |

| |bradycardia, palpitations. |

|Monitor for cerebrovascular disorders. (Medication increases risk |Teach patient: |

|for thrombotic disorders, one of leading causes of CVA.) |To contact all health care providers prior to starting oral contraception |

| |so other medications can be adjusted as needed |

| |Signs of impending migraine headache or seizure, so preventative measures |

| |can be taken |

|Obtain history of cigarette smoking. (Combination of oral |Advise patient to: |

|contraception and smoking greatly increases risk of cardiovascular |Stop smoking prior to beginning treatment with oral contraceptives |

|disease, especially MI Risk increases with age >35 and with number |Attend smoking cessation groups. |

|of cigarettes smoked, e.g., 15 or more/day.) | |

|Monitor mental status. (Side effects such as weight gain may cause |Instruct patient regarding symptoms of depression to report immediately: |

|depression in some women.) |lack of interest in every-day activities, changes in sleeping or eating |

| |habits, stopping previously enjoyable activities, etc. |

|Monitor blood glucose in patients with diabetes. Use with caution in|Advise patient to monitor urine and blood glucose regularly, and contact |

|woman with diabetes or with familial history of diabetes. |health care provider if any abnormalities occur so adjustments in |

|(Combination may upset glycemic control so patient would experience |hypoglycemic medication can be made. |

|either hypo- or hyper-glycemia; adjustments in dose of hypoglycemic | |

|medications may be necessary.) | |

|Monitor for side effects or adverse reactions. (If serious side |Advise patient to: |

|effects occur, patient may need to switch to oral contraceptive with|Be aware of edema, unexplained loss of vision, diplopia, intolerance to |

|a different combination or percentage of hormones.) |contact lens, nausea, gall bladder disease, diarrhea or constipation, |

| |abdominal cramps, changes in urinary function, dysmenorrhea, breast |

| |fullness, fatigue, skin rash, acne |

| |Note mid-cycle breakthrough bleeding, vaginal candidiasis, |

| |photosensitivity, changes in urinary patterns, feelings of abdominal |

| |fullness |

|Monitor whether patient understands how/when to take medication. |Advise patient to: |

|(Only with thorough understanding will she be able to take |Use barrier contraceptive during 1st week of initial cycle and for 7 days |

|medication correctly and avoid adverse reactions, or be aware of |after 2 consecutive missed doses |

|physical changes that could be secondary to the medication, and take|Discontinue medication and notify health care provider if bleeding |

|measures to prevent permanent, serious harm.) |resembling menstrual cycle occurs mid-cycle |

| |Be aware of fluid retention (teach to weigh self weekly and record, note |

| |tightening of rings, shoes, etc.) |

| |Decrease salt intake if edema occurs |

| |Contact health care provider if 2 consecutive periods are missed; |

| |pregnancy may have occurred |

| |Follow recommendations for follow-up |

| |Do self breast exams monthly |

| |Have annual PAP smears done. |

| |See health care provider at regular intervals |

|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 Conjugated Estgrogens (Premarin) and Conjugated Estrogens with Medroxyprogesterone (Prempro)

|ASSESSMENT |POTENTIAL NURSING DIAGNOSES |

|Prior to administration: |Body image, disturbed, related to side effects of medication |

|Obtain complete health history including allergies, drug history and |Comfort, impaired, related to effects of medication |

|possible drug intgeractions |Fluid volume, excess, related to edema secondary to medication |

|Assess for presence/history of breast cancer, estrogen dependent |Noncompliance, related to unpleasant side effects, desire for |

|cancer, abnormal genital bleeding, thromboembolic disorders, |pregnancy, lack of knowledge or understanding of proper |

|cardiovascular disorders, smoking history, pregnancy |self-administration |

| |Tissue perfusion, impaired, cardiopulmonary, related to development of |

| |thrombophlebitis, pulmonary embolism, |

| |or cerebral, related to incidence of CVA secondary to medication |

|PLANNING: PATIENT GOALS AND EXPECTED OUTCOMES |

|Patient will: |

|Demonstrate understanding of correct self administration and potential side effects |

|Demonstrate positive body image and self-concept |

|Remain compliance with drug regimen |

|Remain free of symptoms of thrombophlebitis or other clot development |

|Implementation |

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

|Obtain history of cancer in patient or close relative. |Advise patient of importance of complete physical exam prior to |

|(Estrogen-dependent cancer combination of medication and |beginning therapy with conjugated estrogen. |

|estrogen-dependent tumors, either currently or history of, put patient| |

|at much higher risk for developing cancer.) | |

|Monitor for signs of pregnancy. (Can cause serious fetal harm.) |Instruct patient to |

| |Have negative pregnancy test no more than 2 weeks prior to beginning |

| |conjugated estrogen therapy and periodically during treatment |

| |Report immediately if she suspects she is pregnant |

|Monitor for current or past history of thromboembolism. (Estrogen use |Advise patient of importance of complete disclosure of past medical |

|increases chance of thromboembolism occurring.) |history. |

|Monitor for undiagnosed abnormal uterine bleeding. (Can increase |Instruct patient to have complete physical exam prior to beginning |

|bleeding, tumor size, if undiagnosed tumor present.) |therapy. |

|Monitor for cardiovascular/cerebrovascular disorders. (Must be used |Teach patient to: |

|with caution in patients with CAD, hypertension, and cerebrovascular |Have complete physical exam prior to estrogen therapy |

|disease. Any of these conditions predispose woman to thromboembolic |Have routine blood pressure screening; teach that hypertension has no |

|disorders. Cardiovascular side effects are the most serious side |symptoms |

|effects, and include MI, pulmonary embolism, hypertension, CVA.) |Inform female patients that atypical symptoms of a MI may be |

| |experienced: fatigue, dyspnea, nausea, light-headedness, palpitations,|

| |“racing” heart and to report to health care provider immediately if any|

| |of these sensations occur |

|Evaluate breast health. (Use with caution in patient with fibrocystic |Advise patient of importance of complete physical exam prior to |

|breast disease, breast nodules, or abnormal mammograms. Can cause |treatment and periodically during treatment. |

|worsening of condition. If cancer develops, it is essential to have | |

|baseline information with which to make comparisons.) | |

|Monitor for vision changes. (Medication may cause worsened myopia or |Instruct patient to: |

|astigmatism, intolerance of contact lenses.) |Have complete eye exam prior to beginning treatment and periodically |

| |during treatment |

| |Report if decreased vision occurs, or if intolerance to contact lenses |

| |occurs |

|Obtain smoking history. (Smoking increases risk of cardiovascular |Instruct patient to: |

|disease, especially when in combination with estrogens.) |Quit smoking |

| |Attend smoking cessation programs |

|Monitor for diabetes mellitus. (Estrogens may alter blood glucose |Advise diabetic patient to monitor blood glucose frequently and report |

|levels.) |if any consistent changes. |

|Monitor for seizure disorder. (Estrogen-induced fluid retention may |Teach patient to |

|increase incidence of seizures.) |Disclose information if seizure disorder present |

| |Consult health care provider of anti-seizure medication prior to |

| |beginning estrogen therapy |

| |Be extra alert for possibility of seizures occurring |

|Observe for side effects. Side effects are dose dependent, and |Advise patient of common side effects and to be alert to occurrence of |

|include: weight gain, edema, nausea/vomiting, abdominal cramps and |them. |

|bloating, acute pancreatitis, appetite changes, skin eruptions, mental| |

|depression, decreased libido, headache, fatigue, nervousness. | |

|Monitor for GU changes. (Can be caused by estrogens: breakthrough |Advise male patient that he may develop feminine characteristics or |

|bleeding, spotting, changes in amount and/or duration of menstrual |become impotent; teach him these will resolve when treatment completed |

|flow, amenorrhea during and after use, candida vaginitis.) |Advise female patient to report any of GU changes. |

|Evaluate patient’s understanding and proper self-administration. (To |Instruct patient: |

|ensure patient safety) |Regarding dose, form and frequency of medication |

| |To take with food to decrease GI irritation |

| |To take daily dose at HS to decrease occurrence of side effects |

| |That if cyclic therapy ordered, to take medication for 3 weeks and then|

| |omit for 1 week |

| |To document menstruation and any problems that occur |

| |To report immediately if pregnancy suspected |

| |To take lowest effective dose for shortest time period, to decrease |

| |chances of side effects developing |

| |Risks associated with supplemental estrogens |

|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 Medroxyprogesterone (Provera)

|Assessment |Potential Nursing Diagnoses |

|Prior to administration: |Health maintenance, ineffective, related to lack of knowledge or |

|Obtain complete health history including allergies, drug history and |understanding of positive health practices, such as smoking cessation |

|possible drug interactions. |Nausea, related to side effects of medication |

|Assess for presence/history of: |Nutrition, imbalanced, less than or more than body requirements related|

|Pregnancy |to imbalance in hormone make-up |

|Dysfunctional uterine bleeding |Sexual dysfunction, relate to hormonal imbalance |

|Metastatic endometrial or renal cancer |Sleep pattern disturbed, insomnia, related to effects of medication |

|Endometrial hyperplasia |Therapeutic regimen management, ineffective, related to knowledge |

|Thrombophlebitis or thromboembolic |deficit or planned failure of therapy |

|disease | |

|Breast cancer | |

|Decreased liver or kidney function | |

|Depression | |

|Epilepsy | |

|Asthma | |

|Migraine headache | |

|Cardiac disorders | |

|PLANNING: PATIENT GOALS AND EXPECTED OUTCOMES |

|Patient will: |

|Follow medication regime exactly as recommended |

|Remain free of sleep disturbances |

|Remain free of side effects or adverse reactions |

|Demonstrate understanding of side effects and adverse reactions to report |

|Maintain usual sexual function |

|Maintain nutrition at expected level |

|Demonstrate understanding of appropriate lifestyle changes |

|Implementation |

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

|Monitor for pregnancy. (Medication must not be administered to woman |Instruct patient that she must have negative pregnancy test within 2 |

|who is pregnant; will cause serious fetal damage.) |weeks prior to beginning medication. |

|Monitor for seizure disorder. (Fluid retention secondary to medication|Advise patient: |

|may increase seizure activity. Use with caution in women with seizure |Of importance of consulting health care provider who ordered |

|disorders.) |anticonvulsants before beginning this medication |

| |Regarding life-style changes that may decrease chances of triggering |

| |seizure activity |

|Monitor for hypercalcemia. (Medication may cause increased serum |Advise patient to: |

|calcium levels, especially if in conjunction with a low daily fluid |Have regular lab studies performed |

|intake.) |Increase fluids as way to decrease chance of hypercalcemia occurring |

| |Note signs of hypercalcemia and report immediately: deep bone and |

| |flank pain, anorexia, nausea/vomiting, thirst, constipation, lethargy, |

| |psychoses) |

|Monitor mental status. (Use with caution in women with history of |Advise patient and caregivers regarding symptoms of depression to note |

|depression. Medication may cause nervousness, insomnia, worsening of |and report: changes in eating and sleeping habits, disinterest in |

|depression.) |every-day activities, failure to perform ADLs, etc. |

|Evaluate patient’s knowledge level. (Informed patient will comply more|Instruct patient: |

|fully with |How and when to take medication, and importance of taking exactly as |

|administration regime, and be more aware of and alert to adverse |ordered if being used for contraception |

|reactions.) |Proper self-administration if being taken as cancer therapy |

| |Regarding symptoms of hypercalcemia |

|Monitor for side effects: amenorrhea, nausea, jaundice, dizziness, |Instruct patient to: |

|headache, signs of pulmonary embolism (sudden severe chest pain and |Monitor for side effects and to report to health care provider if they |

|dyspnea), edema, weight gain. Report immediately |occur |

| |Monitor for edema or weight gain by weighing self weekly and recording;|

| |noting if rings or shoes become tight |

|Observe foreskin changes caused by reactions to medication. |Instruct patient: |

| |To monitor for pruritis, urticaria, acne, rash, hirsutism, alopecia |

| |That these changes are temporary and will improve upon discontinuation |

| |of this medication |

|Evaluation of Outcome Criteria |

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

Nursing Process Focus:

Patients Receiving Oxytocin

|Assessment |Potential Nursing Diagnosis |

|Prior to administration: |Comfort, Impaired related to strong uterine contractions |

|Obtain complete health history including complete past and present |Excessive fluid volume |

|gynecological and obstetric history |Injury, Risk for to fetus related to effect of drug on uterine |

|Obtain drug history to determine possible drug interactions and |contractions |

|allergies | |

|Obtain vital signs | |

|Asses fetal monitoring | |

|Planning: Patient Goals and Expected Outcomes |

|Patient will |

|Demonstrate increase in force and frequency of uterine contractions and/or let down of milk for breastfeeding. |

|Demonstrate understanding of the drug’s action by accurately describing drug side effects and precautions. |

|Demonstrate need to report effects such as listlessness, headache, confusion, anuria, hypotension, nausea, vomiting, and weight gain. |

|Implementation |

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

|Administer IV medication through infusion device (To maintain accurate|Inform patient regarding the need for equipment. |

|dosing) | |

|Monitor fetal heart rate. (Increase in force and frequency of uterine|Instruct patient about the purpose and importance of fetal monitoring. |

|contractions may cause fetal distress.) | |

|Monitor maternal status including BP, pulse, and frequency, duration |Instruct patient about the importance of monitoring maternal status. |

|and intensity of contractions and pain. (Initial administration of | |

|mediation may cause a drop in blood pressure. High doses may increase | |

|duration and intensity of contractions and increase pain level) | |

|Monitor fluid balance. (Prolonged IV infusion may cause water |Instruct patient to report symptoms of water intoxication including |

|intoxication.) |drowsiness, listlessness, headache, confusion, anuria, or weight gain. |

|Monitor for post partum/post abortion hemorrhage. |Instruct patient: |

| |About the importance of being monitored frequently after delivery or |

| |after abortion |

| |To report severe vaginal bleeding or increase in lochia |

|Evaluation 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 Testosterone Base (Andro and Others)

|Assessment |Potential Nursing Diagnosis |

|Prior to administration: |Body image, disturbed, related to lack of normal sexual development, |

|Obtain complete health history including allergies, drug history and |impotence, decreased sperm count, growth retardation, gynecomastia, |

|possible drug interactions. |virilism in females |

|Assess for presence/history of hypogonadism, secondary sex |Coping, ineffective, related to delayed sexual development and |

|characteristics, increased or decreased libido, low sperm count, |inability to accept this |

|impotence |Family processes, interrupted, related to male’s inability to function |

|Monitor history of cardiovascular disease |sexually and/or inability to impregnate partner |

| |Identity, disturbed personal, related to lack of secondary sex |

| |characteristics expected in pubertal boy |

| |Sexual dysfunction, related to lack of normal |

| |amounts of androgen |

|Planning: Patient Goals and Expected Outcomes |

|Patient will: |

|Experience improvement of underlying condition for which testosterone ordered, without worsening of underlying condition, with few side effects|

|and no adverse reactions |

|Demonstrate understanding of how/why he/she is taking medication and desired effects |

|Demonstrate improved body image as effectiveness of medication is established |

|Experience return of usual sexual function |

|Implementation |

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

|Monitor for prostatic or male breast cancer. (Testosterone will worsen|Instruct patient to: |

|either condition.) |Have complete medical exam including PSA tests prior to taking |

| |testosterone and periodically during therapy |

| |Note and report any symptoms of altered urinary function: retention, |

| |hesitancy, nocturia, hesitancy, frequency, dribbling |

|Monitor for serious renal disease. (Edema caused by testosterone and |Instruct patient to: |

|added stress placed on the kidneys.) |Have renal function tests, BUN, creatinine performed prior to |

| |testosterone therapy and periodically during therapy |

| |Report immediately any symptoms of kidney dysfunction: decreased |

| |urination, edema, uremic frost, confusion, etc. |

|Monitor for decreased cardiac function. (Edema caused by testosterone |Instruct patient to: |

|stresses the heart.) |Have cardiac function tests performed prior to and periodically during |

| |therapy |

| |Immediately report symptoms of decreased cardiac function: general |

| |weakness, fatigue, dyspnea, and edema |

|Monitor serum cholesterol levels. (Elevated cholesterol levels |Instruct patient: |

|secondary to testosterone administration may increase patient’s risk |To have cholesterol levels measured prior to and periodically during |

|of cardiovascular disease.) |therapy |

| |Regarding lifestyle modifications which may lower risk of |

| |hypercholesterolemia: low fat diet, increased exercise, decrease |

| |consumption of red meat, butter, fried foods, etc. |

|If patient is female, monitor for pregnancy or lactation. |Instruct patient: |

|(Testosterone crosses into breast milk and may cause damage to infant,|To have negative pregnancy test within 2 weeks before initiating |

|including masculinization of female infant.) |testosterone therapy and monthly during therapy |

| |Regarding the importance of reliable birth control during testosterone |

| |therapy |

|Monitor for hypercalcemia. (Hypercalcemia in patient with metastatic |Instruct patient: |

|breast cancer usually indicates bone metastasis.) |To have lab studies performed prior to and during therapy |

| |About symptoms of increased serum calcium and to report immediately if |

| |the following occurs: deep bone and flank pain, anorexia, |

| |nausea/vomiting, thirst, constipation, lethargy, psychoses |

|Evaluate bone growth in children and adolescents. (Premature |Advise patient and caregivers that bone age determinations should be |

|epiphyseal closing may occur, leading to growth retardation.) |done every 6 months. |

|Monitor fluid intake. (Increased fluids will increase urine production|Advise patient: |

|and decrease chance of stone formation.) |To consume 3,000-4,000cc fluid daily |

| |That urinary output will increase, and not to be alarmed |

| |Non-liquids that can be consumed to increase fluid intake: gelatin, |

| |popsicles, ice cream, etc. |

|Monitor for diabetes mellitus. (Testosterone therapy may change |Instruct patient to: |

|glucose tolerance.) |Monitor blood sugar daily and notify health care provider if changes |

| |occur |

| |Make needed adjustments in hypoglycemic medications and diet |

|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 Sildenafil (Viagra)

|Assessment |Potential Nursing Diagnosis |

|Prior to administration: |Body image, Disturbed related to impaired sexual function |

|Obtain complete health history including hematologic disorders, |Sexual dysfunction related to known or unknown cause |

|cardiac, kidney or liver disease, and anatomic deformities |Sensory perception, disturbed, visual related to disease process. |

|Obtain drug history, specifically organic nitrates and | |

|nitroglycerin, to determine possible drug interactions and | |

|allergies | |

|Planning: Patient Goals and Expected Outcomes |

|Patient will: |

|Report more positive body image during drug therapy |

|Report normal sexual function |

|Demonstrate understanding of the drug’s action by accurately describing side effects and precautions, and importance of follow-up care |

|Implementation |

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

|Monitor cardiovascular status. (Patient who has 1st attack of |Instruct patient and/or caregiver to: |

|angina during time he is taking sildenafil should not receive any |Carry identification stating he is taking Sildenafil, so he will not be |

|nitrate products. |given nitrates |

| |Recognize the importance of EKG monitoring periodically during therapy |

| |Have vital signs, including BP, |

| |checked routinely during therapy with slidenafil |

| |Recognize CV risk factors and modify: smoking, high fat/high cholesterol |

| |diet, lack of exercise, obesity, Type A personality, high stress lifestyle |

|Monitor sexual response to include: |Instruct patient and/or caregiver to: |

|*Frequency, firmness, maintenance of erections; |Keep diary R/T use of sildenafil, sexual response, any cardiovascular |

|*Frequency of orgasms |symptoms that may occur |

|*Frequency, satisfaction and enjoyment of sexual activity; |Report any changes to health care provider |

|*Satisfaction with sexual relationship |Seek emergency care if erection lasts longer that 4 hours. |

|Monitor diet. (High fat meals can delay absorption of sildenafil |Instruct patient and/or caregiver to: |

|and delay onset of action by 1 hour. Taking sildenafil with |Avoid administration of Sildenafil with meals, especially high-fat meals |

|grapefruit juice may lead to increased serum sildenafil levels, |Avoid grapefruit juice when administering Sildenafil |

|leading to adverse effects.) | |

|Monitor patient knowledge and understanding. |Instruct patient and/or caregiver that: |

| |Sildenafil should not be taken more than once in a 24 hour period |

| |Optimum time to take Sildenafil is 1 hour prior to sexual activity, but |

| |that it can be taken for up to 4 hours prior |

| |Sildenafil will not produce erection unless he is sexually stimulated |

| |This medication should not to share medication with anyone else |

|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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