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MedicationDoseFrequencyRoutePurpose/actionC- CategoryH - How this category worksW - Why my pt is on itSide effectsT-therapeuticC-commonL -life threateningNursing ImplicationsA - assess before givingW - watch for?IV - drugs - alcohol, dilute, etcOutcomesP - predicted outcomeA - Actual outcome Famotidine (Pepcid)20 mgBIDPer J tubeH2 receptor antagonistBlocks the action of histmamine at the H2 receptors, inhibits gastric acid secretionPt has GERD --- short term tx of GERD and esophagitis d/t GERDT - heartburn & GERD symptoms decreaseC - headache, dizziness, diarrhea, constipationLiver or renal lab valuesDiarrheaP - pt will not have symptoms of GERDA - Goal met, pt was also npo Heparin5000 units Subcutq8hAnticoagulantHeparin inactivates factor Xa, therefore inhibiting thrombus & clot formation by blocking the formation of prothrombin --> thrombin & fibrinogen --> fibrin (which are the final steps in the clotting process)5000 units for prophylaxis of postoperative thromboembolismFor clot prophylaxis t-blood thins outc-bruisingl-hemorrhage, white clot syndrome a-PTT lab valuew-any bruising, internal bleeding (sudden increase in HR then decrease in BP)Subcut-alcohol swab, pinch skin, 45-90 degree anglep-blood clot will not forma-goal met-clot did not form (if pt ambulated it would have helped)Lidocaine injection1 mLNebulizationOnce Local anesthetic, antiarrhythmicBlocks the conduction of sensory nerves, also decreases automaticity of ventricular cellsPt needed the back of his throat numbed so they could insert and NG tube at the bedside despite him not having an esophagusT - pt will not feel the NG tube going downC - burning, stinging, tenderness, swelling, tissue irritationSeizures, anaphylactoid reactionsA - P, BP, LOCW - any seizures or anaphylactoid reactions?P - pt will not feel the NG tube going downA - goal met, pt gagged but did not feel painMetoclopramide HCl (Reglan)10 mgBIDJ tubeAntiemeticTxs N&V, GERD, & heartburn caused by a stomach problem called gastroparesis (when stomach cannot/delays emptying stomach-does not involve a blockage) in diabetes ptsPt has both GERDt-pt does not have heartburnc-tardive dyskinesia (involuntary movements, esp. of the lower face)A- ????w- involuntary movements?Iv- give Reglan IVP over >1 minutep- pt will not c/o GERDa- goal met-pt did not c/o GERDMetoprolol (Lopressor)12.5 mgoralBIDBeta blocker/antihypertensiveBlocks beta-adrenergic receptors of the heart thus decreasing the release of renin & lowering BPPt has HTN, for HR > 110t-pt's BP will decrease to below 120/80c-orthostatic hypotension, heart failure, cardiac dysrhythmias l-bronchospasm, stroke, laryngospasma-HR, BPHold for SBP <100w-HR & BP fluctuations, dizziness when standing r/t orthostatic hypotensionp-pt's BP will stay below 120/80A - goal not met - pts BP at 11:48 was 129/89D5W & 0.45% NaCl w/ KCL 20 mEq1000 mLContinuous IV @ 75 mL/hFluid/electrolyte replenishmentSupplement, D5W gives calories1000 mLPt is on TPN and is on this for extra calories & so K doesn’t decrease?t-electrolytes and fluids will be high enoughc-fluid overloada-intake and output levels, K levelw-fluid overload, hyperkalemiaIv-give lumen 2p-pt will have adequate fluids and Ka-goal met, K was within normal limits and did not pop up on the main pageHydromorphone (Dilaudid) PCA pump6 mgIVContinuous0.1 mg every 6 minutesOpiod analgesicActs at specific mu-opioid receptors in the CNS to produce analgesia, euphoria, sedationFor injection-1-10 mLPt is in pain from esophatectomy t-pain level will decreasec-n/v, dizziness, sedationl-RESPIRATORY DISTRESS, apnea, circulatory depression, respiratory arrest, shock, cardiac arresta-pain level, RESPIRATIONSw-respiratory distressIv-clean port w/ alcohol padp-pt's pain level will decrease from an 8 to agreed upon 3A - goal not met, pts pain was a 6Phenol (sore throat) sprayNo dose/ratePrnAnesthetic Numbs part of mouthPt had his esophagus taken outT - area will become numb for pain reliefC - numbness of cheeks, tongue, or mouthL - allergic reactionA - pain levelW - allergic reactionP - pts pain level will decrease from giving this sprayA - did not giveSodium chloride 0.9%20 mL/hIVContinuousFluidsIsotonic fluids to hydrate patientPt is NPO-fluids help to keep pt hydratedT - pt's urine will not be concentratedC - fluid overloadA - for any edemaW - edemaIV - give continuousP - pt will stay hydrated, will not have pitting edemaA - goal met, pt did not have edema Diphenhydramine (Benadryl)25 mg oral or 12.5 mg IVQ6h PRNAntihistamine, cough suppressant, anti motion-sicknessBlocks histamine effects at h1-receptor sites, has sedative effects10-50 mL for injectionPt is also taking dilaudid which may cause people to become itchy t-pt's itching/inflammation will decreasec-drowsiness, sedation, dizziness, epigastric distress, thickening of bronchial secretionsl-anaphylactic shock, 2 anemias, leukpenia, agranulocytosis, pancytopenia.a-give with food if GI upset occurs, where pt is itching atw-if itching decreasesIv-clean w alcohol swab beforep-pt's itching will decrease to pt not itching anymorea-did not giveEye lubricant (Duratears)OintmentNo dosePRN for dry eyesRelieves dry, irritated eyesKeeps eyes moist helping to protect them from infectionPt stated he had dry eyes at homeT - eye moisture will increaseC - tempoarily blurred visionC - eye pain, change in visionA - eye statusM - for any change in visionP - pt will not c/o dry eyes and will voice a need when he feels the need to take DuratearsA - not givenHydromorphone (Dilaudid) 0.5 mg IV or 1 mg IVQ3h PRNOpiod analgesicActs at specific mu-opioid receptors in the CNS to produce analgesia, euphoria, sedationFor injection-1-10 mLPt had a bone marrow biopsy yesterdayt-pain level will decreasec-n/v, dizziness, sedationl-RESPIRATORY DISTRESS, apnea, circulatory depression, respiratory arrest, shock, cardiac arresta-pain level, RESPIRATIONSw-respiratory distressIv-clean port w/ alcohol padp-pt's pain level will decrease to the goal of 3A - goal not met, pts pain went to a 6 from an 8Naloxone (Narcan)0.1, 0.2 or 0.4 mg Q15m PRNFor RR <10/min & if pt in unarousableStop PCA, give O2, & call house officerIVOpioid antagonistReverses the effects of opioids (including respiratory depression, sedation, hypotension)0.1-0.2 mg IV for postop opioid depressionPt in on dilaudid pca (opioid)?t-pt's will become arousalable & RR will increase to 12-18 c-n/v, sweating, increase HR & BP, hypotension, tremulousnesst-fibrillation, pulmonary edema, acute opioid abstinence syndromea-respirations, pt's state of conditionw-pt's respirations & if is arousableIv-p-pt's respirations will increase to 12-18 & pt will become arousablea-not givenOndansetron (Zofran)0.4 mgQ4h prnIvAntiemeticBlocks receptor sites which are associated w n/v in the chemoreceptor trigger zoneAll of pt's meds may cuase nauseat- nausea will decrease to an acceptable levelc- headache, dizziness, diarrhea, myalgial- prolonged QT intervala-nausea & vomiting levelw-if pt vomitedIv- give slowly, clean hub beforehandsp-pt's nausea will decreasea-did not administer Oxycodone (Roxicodone)5 or mgOralQ3h PRNOpioid analgesicActs as agonist at specific opioid receptors in the CNS to produce analgesia, euphoria, & sedationPt has many co-morbidities on top of cancer & recently had his esophagus taken outt-pt's pain level will decrease to an acceptable level decided upon by the pt & RN c-dizziness, sedatoin, n/v, sweatingl-shock, cardiac arrest, respiratory arrest, bronchospasma-pt's pain level, RESPIRATIONSw-RESPIRATIONS!!!!!! ?p-pt's pain level will decrease to an agreed upon level bw the RN & pta-not givenPromethazine (Phenergan)12.5 mg IV Q6h prnFor nauseaAntiemeticBlocks histamine-1 receptors, diminishing the effects of histamine on cells25-50 mg iv, 12.5-50 poAn indication is postop pain or postop sedation, n/vt-n/v will decreasec-dizziness, drowsiness, urinary frequency, epigastric distress, thickening of bronchial secretionsl-agranulocytosis, pancytopeniaa- if pt vomittedw-n/v decrease, IV siteIv-Phenergan = irritant.. IVP admin REQUIRES dilution w/ 10 mL saline, p-pt's n/v will decreasea-did not administer ................
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