BSN4A (GROUP 2)1 XII.

Drug Study Drug Study # 1 Name of Drugs Dosage/ Route/ Timing 200mg/ IVTT/ Q4 Drug Mechanism of Action Produces analgesia by blocking generation of pain impulses. This action is probably caused by inhibition of prostaglandin synthesis; it may also be caused by inhibition of the synthesis or action of other substances that sensitize pain receptors to mechanical or chemical stimulation. It relieves fever by central action in the hypothalamic heatregulating center. Indications Contraindication Adverse Effect Classification: Analgesic Generic Name: Paracetamol Brand Name: Acephen Aceta Actamin Mild pain or fever Paracetamol should not be used in hypersensitivity to the preparation and in severe liver diseases. Skin: Rash, urticaria Hematologic: hemolytic anemia, neutropenia, leucopenia, pancytopenia Hepatic: jaundice, severe liver damage with toxic doses Metabolic: hypoglycemia Nursing Responsibilities Take the temperature before and 1 hour after giving the medication. Provide tepid sponge if fever occurs. Has no significant anti-inflammatory effect Warn patient that high doses or unsupervised chronic use can cause hepatic damage. Excessive ingestion of alcoholic beverages may increase the risk of hepatoxicity Should not be used for selfmedication of marked fever (greater than 39.5C), fever

BSN4A (GROUP 2)2 persisting longer than 3 days, or recurrent fever unless directed by doctor. Inspect the insertion site for phlebitis (inflammation of a vein). Assess IV site for swelling, erythema, tenderness, leakage of fluid, or warmth. If phlebitis is detected, discontinue the infusion and apply warm compress to the venipuncture site. Do not use this injured vein for further infusion.

BSN4A (GROUP 2)3 Drug Study # 2 Name of Drugs Dosage/ Route/ Timing 20mg/ IVTT/ Q8 Drug Mechanism of Action Competitively inhibits the action of histamine at the H2 receptors of the parietal cells of the stomach, inhibiting basal gastric acid secretion and gastric acid secretion that is stimulated by food, insulin, histamine, cholinergic agonists, gastrin and pentagastrin. Indications Contraindication Adverse Effect Nursing Responsibilities Administer IM dose undiluted, deep into large muscle group. Arrange for regular follow-up, including blood tests, to evaluate effects Take drug with meals and at bedtime. Therapy may continue for 4-6 weeks or longer. Inspect the insertion site for phlebitis (inflammation of a vein). Assess IV site for swelling, erythema, tenderness, leakage of fluid, or warmth. If phlebitis is detected, discontinue the

Classification: Histamine-2 (H2) antagonist Generic Name: Ranitidine Brand Name: Zantac

Short-term treatment of GERD Treatment of erosive esophagitis

Contraindicated with allergy to ranitidine, lactation Use cautiously with impaired renal or hepatic function

CNS: Headache, malaise, dizziness, somnolence, insomnia, vertigo CV: Tachycardia, bradycardia Dermatologic: Rash, alopecia GI: Constipation, diarrhea, nausea, vomiting, abdominal pain, hepatitis, increased ALT levels Hematologic: Leukopenia, granulocytopenia, thrombocytopenia, pancytopenia Local: Pain at IM site, local burning or itching at IV site

BSN4A (GROUP 2)4 infusion and apply warm compress to the venipuncture site. Do not use this injured vein for further infusion. Have regular medical follow-up care to evaluate your response Report sore throat, fever, unsual bruising or bleeding, tarry stools, confusion, hallucination, dizziness, severe headache, muscle or joint pain.

BSN4A (GROUP 2)5 Drug Study # 3 Name of Drugs Dosage/ Route/ Timing 570mg/ IVTT/ Q8 Drug Mechanism of Action Bactericidal: Inhibits synthesis of bacterial cell wall, causing cell death Indications Intra-abdominal infections caused by E. Coli, S. Aureus, Bacteroides, Klebsiella Bone and joint infections caused by P. aeruginosa, Klebsiella, Enterobacter, S. Aureus Contraindication Adverse Effect Nursing Responsibilities Assess for history of allergy to cephalosporins and penicillins Arrange for culture and sensitivity before treatment Inspect the insertion site for phlebitis (inflammation of a vein). Assess IV site for swelling, erythema, tenderness, leakage of fluid, or warmth. If phlebitis is detected, discontinue the infusion and apply warm compress to the venipuncture site. Do not use this injured vein for

Classification: Antibiotic Cephalosphorin (third generation) Generic Name: Ceftazidime Brand Name: Ceptaz Fortaz Tazicef Tazidime

Contraindicated with allergy to cephalosphorins or penicillins Use cautiously with renal failure

CNS: Headache, dizzinesss, lethargy, paresthesias

GI: Nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, pseudomembranous colitis, hepatotoxicity GU: Nephrotoxicity Hematologic: Bone Marrow depression--decreased WBC count, decreased platelets, decreased Hct Hypersensitivity: Ranging from rash to fever to anaphylaxis; serum sickness reaction Local: Pain, abscess at injection site;

BSN4A (GROUP 2)6 phlebitis, inflammation at IV site further infusion. Report severe diarrhea, difficulty breathing, unsual tiredness or fatigue, pain at injection site. Patient may experience side effects: Stomach upset or diarrhea.

BSN4A (GROUP 2)7 Drug Study # 4 Name of Drugs Dosage/ Route/ Timing 125mg/ IVTT/ Q12 Drug Mechanism of Action Bactericidal: Inhibits protein synthesis in susceptible strains of gram-negative bacteria, and the functional integrity of bacterial cell membrane appears to be disrupted, causing cell death. Indications Initial treatment of staphylococcal infections when penicillin is contraindicated or infection may be caused by mixed organism. Treatment of serious infections such as bacterial septicemia; infections of the respiratory tract, bones, joints, CNS, skin, and soft tissues Contraindication Adverse Effect Nursing Responsibilities

Classification: Aminoglycoside Generic Name: Amikacin Sulfate Brand Name: Amikin

Contraindicated with allergy to any aminoglycosides, renal or hepatic disease, preexisting hearing loss, myasthenia gravis, parkinsonism. Use cautiously with elderly patients, any patient with diminished hearing, decreased renal function, dehydration, neuromuscular disorders.

Inspect the insertion site for phlebitis (inflammation of a vein). Assess IV site for swelling, erythema, tenderness, leakage of fluid, or warmth. If phlebitis is detected, discontinue the infusion and apply CV: Palpitations, warm compress to hypotension, the venipuncture hypertension site. Do not use this injured vein GI: Nausea, for further vomiting, anorexia, infusion. diarrhea, weight loss, Report pain at stomatitis, increased injection site, salivation, severe headache, splenomegaly dizziness, loss of hearing, changes Hepatic: Hepatic in urine pattern, toxicity, difficulty CNS: Ototoxicity, confusion, disorientation, depression, lethargy, nystagmus, visual disturbances, headache, fever, numbness, tingling, tremor, paresthesias, muscle twitching, seizures, muscular weakness, neuromuscular blockade, apnea

BSN4A (GROUP 2)8 hepatomegaly breathing, rash or skin lesions. Patient may experience side effects: ringing in the ears, headache, dizziness Safety measures may need to be taken if: severe nausea, vomiting, loss of appetite

BSN4A (GROUP 2)9 Drug Study # 5 Name of Drugs Dosage/ Route/ Timing 200mg/5ml/ PO/ Q6 Drug Mechanism of Action Produces antiinflammatory, analgesic and antipyretic effects, possibly through inhibition of prostaglandin synthesis. Indications Contraindication Adverse Effect Nursing Responsibilities Observe patients with history of cardiac decompensation closely for evidence of fluid retention and edema. Do not selfmedicate with ibuprofen if taking prescribed drugs or being treated for a serious condition without consulting physician. Do not take aspirin concurrently with ibuprofen. Notify physician immediately of passage of dark tarry stools, coffee ground emesis, frankly

Generic name: Ibuprofen Brand name: Dolan FP Classification: Analgesic, NSAID, Propionic Acid Derivative

Mild to moderate pain

With allergy to ibuprofen salicylates, or other NSAIDS (more common in patients with rhinitis, asthma, chronic urticaria, nasal polyps). Contraindicated for treatment of perioperative pain after coronary artery bypass graft.

Blood: Prolonged bleeding time CNS: headache, drowsiness, dizziness, aseptic meningitis CV: Peripheral edema EENT: Visual disturbances, tinnitus GI:Epigastric distress, nausea, occult blood loss, peptic ulceration GU: Reversible renal failure Hepatic: Elevated enzymes Skin: Pruritus, rash, urticaria

BSN4A (GROUP 2)10 Other: Bronchospasm, edema bloody emesis or other GI distress, as well as blood or protein in urine and onset of skin rash, pruritus, jaundice. Monitor for therapeutic effectiveness.

BSN4A (GROUP 2)11 Drug Study # 6 Name of the Drug Generic Name: moxifloxacin hydrochloride Trade Name: Avelox Classification: Antibiotic, Flouroquinolone Dosage/ Route/ Timing Dosage: 1 drop Route: Optic OU Timing: 1 drop Q15 for 3 hours as loading dose, then 1 drop Q1 OU thereafter Mechanism of Action Indication Contraindication Contraindicated with allergy to fluoroquinolones; prolonged QT interval, hypokalemia Adverse Reaction CNS: headache, dizziness, insomnia, fatigue, somnolence, depression, nervousness, anxiety, paresthesia CV: Palpitations, tachycardia, hypertensions, hypotension, prolonged QT interval GI: Nausea, vomiting, dry mouth, diarrhea, anorexia, gastritis, stomatitis Hematologic: Altered PT, eosinophilia, thrombocytopenia Respiratory: Asthma, cough, dyspnea, pharyngitis, rhinitis Others: Fever, rash, Nursing Responsibility Assess allergy for fluoroquinolones, prolonged QT interval, hypokalemia, hepatic dysfunction and seizures Assess for skin status,T, orientation, reflexes, affect; R, adventitious sounds; P, BP; mucous membranes, bowel sounds; ECG, CBC Arrange for culture and sensitivity test before beginning therapy. Continue therapy as indicated for condition being treated. Instill the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and

Bactericidal; interferes Management of with DNA replication, infections and repair, transcription, bacterial exacerbation and recombination in at left eye susceptible gramnegative and grampositive bacteria, preventing cell reproduction and leading to cell death

BSN4A (GROUP 2)12 sweating, photosensitivity, tendonitis continue your regular dosing schedule. Do not instill a double dose to make up for a missed one. How to use: Wash your hands thoroughly with soap and water. Check the dropper tip to make sure that it is not chipped or cracked. Avoid touching the dropper tip against your eye or anything else; eye drops and droppers must be kept clean. While tilting your head back, pull down the lower lid of your eye with your index finger to form a pocket. Hold the dropper (tip down) with the other hand, as close to the eye as possible without touching it.

BSN4A (GROUP 2)13 Brace the remaining fingers of that hand against your face. While looking up, gently squeeze the dropper so that a single drop falls into the pocket made by the lower eyelid. Remove your index finger from the lower eyelid. Close your eye for 2 to 3 minutes and tip your head down as though looking at the floor. Try not to blink or squeeze your eyelids. Place a finger on the tear duct and apply gentle pressure. Wipe any excess liquid from your face with a tissue. If you are to use more than one drop in the same eye, wait at least 5 minutes before instilling the next drop. Replace and tighten the cap on the

BSN4A (GROUP 2)14 dropper bottle. Do not wipe or rinse the dropper tip. Wash your hands to remove any medication. Health teaching: Inform the client and SO to report if any of these symptoms are severe or do not go away: 1. red, irritated, itchy, or teary eyes 2. blurred vision 3. eye pain 4. dry eyes 5. broken blood vessels in the eyes 6. runny nose 7. cough; Report immediately if following symptoms occur: 1. sore throat, fever, chills and other signs of infection 2. ear pain or fullness 3. rash 4. hives 5. itching 6. difficulty

BSN4A (GROUP 2)15 breathing or swallowing 7. swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs Storage: Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture.

BSN4A (GROUP 2)16 Drug Study # 7 Name of the Drug Generic Name: oxacillin sodium Trade Name: Oxacillin Sodium Classification: Antibiotic, Penicillinaseresistant penicillin Dosage/ Route/ Timing Dosage: 220mg Route: IVTT ANST(-) Timing: Q6 Mechanism of Action Bactericidal; interferes with DNA replication, repair, transcription, and recombination in susceptible gramnegative and grampositive bacteria, preventing cell reproduction and leading to cell death Indication Contraindication Nursing Responsibility CNS: Lethargy, Assess if patient is hallucinations, seizures allergy to penicillins, GI: Glossitis, cephalosporins, or stomatitis, gastritis, other allergens; renal sore mouth, furry or disorders black hair tongue, Assess culture nausea, vomiting, infection; for skin diarrhea, abdominal status, lesion; R, pain, bloody diarrhea, adventitious sounds; enterocolitis, bowel sounds; CBC, pseudomembranous renal function tests, colitis, nonspecific serum electrolytes, hepatitis Hct, urinalysis Arrange culture GU: Nephritisinfection before oliguria, proteinuria, treatment hematuria, casts, Continue therapy as azotemia, pyuria indicated for condition being Hematologic: treated. Anemia, Assess the insertion thrombocytopenia, site for fluid leukopenia, infiltration neutropenia, prolonged Inspect the insertion bleeding time(more site for phlebitis common than with (inflammation of a other penicillinasevein). Assess IV site resistant penicillins) for swelling, Adverse Reaction

Contraindicated with Infections due to allergies to penicillins, penicillinasecephalosporins, or other producing allergens. staphylococci; may be used to initiate Use cautiously with treatment when a renal disorders staphylococci infection is suspected at both eyes

BSN4A (GROUP 2)17 erythema, tenderness, leakage of fluid, or warmth. If phlebitis is detected, discontinue the infusion and apply warm compress to the venipuncture site. Do not use this injured vein for further infusion. Warning: Keep epinephrine, IV fluids, vasopressors, bronchodilators, oxygen, and emergency equipment readily available in case of serious hypersensitivity reaction. Health teaching: Teach the client ways to maintain the infusion system, Call for assistance if the solution stops dripping or the venipuncture site becomes

Hypersensitivity: Rash,fever, wheezing,anaphylaxis Local: Pain, phlebitis, thrombosis at the injection site

BSN4A (GROUP 2)18 swollen Avoid sudden twisting or turning movements of the arm with the needle or catheter. Avoid stretching or placing tension on the tubing. Try to keep the tubing from dangling below the level of the needle Notify nurse if: a) There is a sudden change in the flow rate or if the solution stops dripping. b) The solution container is nearly empty. c) There is blood in the IV tubing d) Discomfort or swelling is experienced at the IV site

BSN4A (GROUP 2)19 Teach client that side effects may be experienced, such as: upset stomach, nausea, diarrhea (small frequent meals), mouth sores (perform frequent mouth care) and pain at injection site. Report difficulty of breathing, rashes, severe diarrhea, severe pain at injection site, mouth sores.

BSN4A (GROUP 2)20 Drug Study # 8 Name of the Drug Generic Name: sodium hyaluronate ophthalmic Trade Name: Lubristil Classification: Eye Lubricant Dosage/ Route/ Timing Dosage: 1 drop Route: Optic OU Timing: Q6 Mechanism of Action Sodium hyaluronate moistens and lubricates the surface of your eye. It provides a stable coating on the surface of the eye thus allowing, for its lubricating and hydrating properties, a very low resistance to movement such as blinking and assuring protection during the healing processes of corneal epithelium. Indication It is indicated for use in all cases of eye discomfort, in particular to help relieve irritation or dryness due to poor quality or amount of tears (lachrymal film) caused by environmental factors such as dust, glare, pollen, air pollution and use of computer monitors. It will also protect the eye surface during the healing processes following abrasions. Contraindication Hypersensitivity or allergic to any ingredients of the drug Nursing Responsibility The use of the product Assess if patient has may occasionally allergic reaction to cause intolerance (mild sodium hyaluronate burning or or to any other eye irritation). If this occurs discontinue use drops. and consult your If the vision doctor. becomes blurred after using the drops, tell the patient and SO to avoid activities that require clear vision until they can see clearly again. How to use: Instil 1-2 drops four times a day in the conjunctival sac (inside the lower eyelid). Avoid touching the eye or any surface with the tip of the container. If the drop Adverse Reaction

BSN4A (GROUP 2)21 of medication is not retained for any reason, another drop should be instilled. Leave an interval of at least 10 minutes before the instillation of another eye drop. Instructions to SO: 1. Wash your hands 2. Open a single unit dose by twisting and pulling off the cap 3. Carefully pull down the lower eyelid to form a space between the eye and the eyelid 4. Gently squeeze a drop into the eye but do not touch the eye with the tip 5. Close the eye for 30 seconds then open your eyes and blink a few times

BSN4A (GROUP 2)22 6. Repeat these instructions for the other eye if required. 7. Wash your hands

BSN4A (GROUP 2)23 Drug Study # 9 Name of the Drug Generic Name: tropicamide ophthalmic Trade Name: Mydriacyl Classification: Mydriatics Cycloplegics Dosage/ Route/ Timing Dosage: 1 drop Route: Optic OD Timing: Q6 Mechanism of Action Blocks acetylcholine resulting in relaxation of cholinergically innervated iris sphincter muscle. Adrenergic innervation to radial muscle is therefore unopposed and pupil becomes dilated. Indication This medication is used to widen (dilate) the pupil of the eye in preparation for certain eye examinations. It belongs to a class of drugs known as anticholinergics. Tropicamide works by relaxing certain eye muscles; also used to treat swelling in different parts of the eye. Contraindication Hypersensitivity; Known or suspected angle-closure glaucoma, presence of a shallow anterior chamber unless gonioscopic observation of the chamber angle is possible Cautions Hypertension, hyperthyroidism, diabetes mellitus, cardiac disorders Remove contact lenses before instilling drops Possibility of undiagnosed glaucoma should be considered Risk of potentially dangerous CNS disturbances in Peds May cause increased IOP 0.5% solution incapable of producing Adverse Reaction Increased IOP Transient stinging Dry mouth Blurred vision Photophobia with or without corneal staining Tachycardia Headache Parasympathetic stimulation Allergic reactions Nursing Responsibility Assess for history of allergies to tropicamide and any other allergies Assess for medical history of glaucoma (open-angle), high blood pressure, hyperthyroidism How to use: To apply eye drops, wash your hands first. To avoid contamination, do not touch the dropper tip or let it touch your eye or any other surface. Tilt the head back, look upward, and pull down the lower eyelid to make a pouch. Hold the dropper directly over your eye and place 1 or 2 drops into the pouch,

BSN4A (GROUP 2)24 satisfactory cycloplegia usually 15 to 20 minutes before an eye examination or as directed by the doctor. Look downward and gently close your eyes for 1 to 2 minutes. Place one finger at the corner of your eye (near the nose) and apply gentle pressure for 2 to 3 minutes. This will prevent the medication from draining out and being absorbed by your body. Try not to blink and do not rub your eye. Repeat these steps for your other eye if so directed. Do not rinse the dropper. Replace the dropper cap after each use. If you are using another kind of eye medication (e.g., drops or ointments),

BSN4A (GROUP 2)25 wait at least 5 to 10 minutes before applying other medications. Use eye drops before eye ointments to allow the drops to enter the eye. Wash your hands after using this medication. If giving this medication to a child, do not let the medication get into the child's mouth. Also wash the child's hands after giving this medication. Health teaching: After you apply this drug, your vision may become temporarily blurred. Do not drive, use machinery, or do any activity that requires clear vision until you are sure you can perform such activities safely.

BSN4A (GROUP 2)26 This medication may make your eyes more sensitive to light. Protect your eyes in bright light. Use dark sunglasses when outdoors. Eye stinging, temporary blurred vision, dry mouth, or eye sensitivity to light may occur. If any of these effects persist or worsen, report promptly. Seek immediate medical attention when a very serious allergic occurs which includes: rash, itching/swelling (especially of the face/tongue/throat) , severe dizziness, trouble breathing.

Storage: Store at room temperature between 68-77 degrees F (20-

BSN4A (GROUP 2)27 25 degrees C) away from light. Do not refrigerate or store at high temperatures. Keep container tightly closed. Keep all medicines away from children and pets. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed.

BSN4A (GROUP 2)28 Drug Study # 10 Name of the Drug Generic Name: vitamin K Trade Name: Phytomenadione Classification: Hemostatic Antihemorrhagic Dosage/ Route/ Timing Dosage: 10 mg x 2 doses Route: IVTT Timing: Q24 Mechanism of Action An antihemorrhagic actor that promotes hepatic formation of active prothrombin. Indication This medication is a haemostatic agent, prescribed for blood clotting and bone formation; and used to treat and to prevent vitamin K deficiency. It is also used as an antidote to warfarin. Prothrombine time result with Activity of 52.7% Contraindication Hypersensitivity Adverse Reaction Anaphylaxis, difficulty in breathing, cyanosis, pain, swelling, vein inflammation at the injection site, increased sweating, dizziness, low blood pressure rapid and weak pulse, diaphoresis, flushing, erythema, Nursing Responsibility Assess for allergic reactions to vitamin k before Asses for medical history, especially of blood disorders, kidney disease, liver disease. Avoid excess dosage. Do not give Warfarin (Coumadin) interacts with VITAMIN K at the same time Monitor PT to determine dosage effectiveness as ordered. If severe bleeding occurs, dont delay other measures, such as fresh frozen plasma or whole blood. Inspect the insertion site for phlebitis

BSN4A (GROUP 2)29 (inflammation of a vein). Assess IV site for swelling, erythema, tenderness, leakage of fluid, or warmth. If phlebitis is detected, discontinue the infusion and apply warm compress to the venipuncture site. Do not use this injured vein for further infusion. Alert: watch for signs of flushing, weakness, tachycardia and hypotension; may progress to shock. Storage: Store in a cool, dry place, away from direct heat and light. Wrap infusion container with aluminum foil.

BSN4A (GROUP 2)30 XIII. Health Teaching Plan Medication 1.) Paracetamol Classification: - Analgesic How do you know its effective: - Relief from signs and symptoms of fever and pain Exact time: - 200mg/ IVTT/ Q4 Client teaching: - Paracetamol should not be used in hypersensitivity to the preparation and in severe liver diseases. - Take the temperature before and 1 hour after giving the medication. -Provide tepid sponge if fever occurs. - Has no significant antiinflammatory effect. - Warn patient that high doses or unsupervised chronic use can cause Exercise Do ROM on extremities (may be active or activepassive) such as: Shoulder > Flexion > Extension > Hyperextension > Abduction > Adduction (anterior and posterior) > Horizontal flexion > Horizontal extension > Circumduction > External rotation > Internal rotation Elbow > Flexion > Extension > Rotation for Supination > Rotation for pronation Wrist > Flexion > Extension > Hyperextension > Circumduction > Radial Flexion Treatment Antibiotics to reduce the inflammation process Mydriatic or Cycloplegic agents to help relax papillary muscles thus dilates the pupils Take medication regiously and as prescribed by the physician. Vital signs are continuously monitored. STAT Intravitreal and Intracameral tap and injection of antibiotics is the proposed operations which leads to the evisceration of abscess both eyes Hygiene Outpatient Teaching Maintain a proper diet and take the medications prescribed to you as your doctor directs. Follow up with your physician on a regular basis to monitor progress of the disease and the needed interventions After surgery, follow treatment regimen and maintenance of the newly operated eye to prevent further injury Consult doctor if severe eye discomfort or other sign and symptoms is experienced. Consult the doctor for any adverse effects of drugs or treatment. Follow doctors may go home instructions Follow the drug Diet Encourage fluid intake of 8-10 glasses a day of water to avoid dehydration and have a good skin turgor. Give diet as tolerated by the patient. Increase caloric intake due to increase metabolic process Eat more carbohydrates such as rich, cereals, corns, root crops Eat a protein rich diet such as chicken, meat, and pork Eat salmon, tuna and other fish products that are rich in omega-3 fatty acid which help to improve dry eyes Eat more fruits which are rich in Vit.

Maintain proper hygiene by: taking a bath daily, or have a sitz bath (protect the eye) changing clothes daily, observe good dental hygiene, properly brushing teeth two to three times a day every after meals, do mouth gargle before meals practice proper grooming, and cutting of nails at least once a week. do hand washing to prevent spread of infection avoid scratching, rubbing and touching the infected eye with Laboratory Test: bare hands use alcohol-based Eye examinations by hand rub when soap using a special eye and water is not microscope, known as available

BSN4A (GROUP 2)31 hepatic damage. Excessive ingestion of alcoholic beverages may increase the risk of hepatoxicity. - Should not be used for self-medication of marked fever (greater than 39.5C), fever persisting longer than 3 days, or recurrent fever unless directed by doctor. - Inspect the insertion site for phlebitis (inflammation of a vein). - Assess IV site for swelling, erythema, tenderness, leakage of fluid, or warmth. (abduction) > Ulnar Flexion (adduction) Hands and Fingers > Flexion > Extension > Hyperextension > Abduction > Adduction Thumb > Flexion > Extension > Abduction > Adduction > Opposition Circumduction Deep breathing exercises regularly-used to improve pulmonary gas exchange or to maintain respiratory function Position client in supine or sitting position Intruct patient to inhale air through the nose and hold breath (3-5 sec) and exhale through the mouth intermittently bypurse-lip a slit lamp. To make the ulcer easier to see, he or she will put a drop containing the dye fluorescein into your eye. Complete-blood count reveals presence of inflammation and disease process. A white blood cell count may reveals leukocytosis Corneal Scraping/Wound culture and sensitivity testing may be done to identify the infecting organism Corneal topography is another painless investigation which maps the surface of the cornea rather like an ordinance survey map, showing the gradient at each spot and therefore highlighting asymmetries, such as are found in the dystrophic conditions regimen exactly as apply lotion to prevent prescribed dryness of skin Always to have a clean environment supply of medicine always on hand Eye Care 1. Apply cool compresses to the affected eye. 2. Do not touch or rub your eye with your fingers. 3. Limit spread of infection by washing your hands often and drying them with a clean towel. 4. Wear eye protection when exposed to small particles that can enter your eye. 5. Try to avoid dangerous activities where people might be hit in the eye by a sharp object such as a stick or fingernail. 6. If you have dry C to help body fight infection. Eat more foods rich in vit. A and carotenoids, found in leafy green vegetables and yellow vegetables such as pumpkin and squash as well as brightly colored fruits such as oranges or papayas. Increasing intake of these fruits and vegetables helps treat and prevent vitamin A deficiency; vitamin A supplementation will probably also be required for treating existing disease. Eat vegetables and fiber-rich foods to prevent constipation, and promote good health. Consume dairy

2.) Ranitidine Classification: - Histamine-2 (H2) antagonist How do you know if its effective: - Competitively inhibits the action of histamine at the H2 receptors of the

BSN4A (GROUP 2)32 parietal cells of the stomach, inhibiting basal gastric acid secretion and gastric acid secretion that is stimulated by food, insulin, histamine, cholinergic agonists, gastrin and pentagastrin Exact time: - 20mg/ IVTT/ Q8 Client teaching: - Contraindicated with allergy to ranitidine, lactation. - Use cautiously with impaired renal or hepatic function. - Take drug with meals and at bedtime. Therapy may continue for 4-6 weeks or longer. Inspect the insertion site for phlebitis (inflammation of a vein). - Assess IV site for swelling, erythema, tenderness, leakage of fluid, or warmth. - Have regular medical follow-up care to evaluate your response. technique. Repeat for procedure for 3 times Instruct patient to inhale air through the nose, hold breath for 3-5 sec, then cough out or by a huff sound Provide comfort measures (e.g back rub, change of position) to promote blood circulation. Monitor patients ability to ambulate, provide a safe environment, and assist patient in activities of daily living Resume usual activities gradually It is best to start exercising slowly and do more as you get stronger Do have some warm up before going to work and cool down after work. Slowly start to do more each day. Maintain a regular as tolerated (e.g. morning walk, stretching, deep eyes or if your eyelids do not close completely, use artificial teardrops to keep your eyes lubricated. 7. If an eye is red and irritated, do not continue to use over-thecounter eye drops. Have an ophthalmologist examine the eyes to make certain that there is not a serious problem. products as indicated Limit refined products, like sugar, white breads, and white rice If nausea and vomiting occurs, give small frequent feedings with rest period in between, or give crackers.

Non-Pharmacotherapy includes the following: Conduct passive to activeROM Deep breathing and coughing exercise Positioning

Post-Operative General Instructions: For 12 hours following surgery avoid strenuous and heavy activities. You may wish to start eating lighter, with liquids and progressing to your regular diet as tolerated by your stomach. Unless directed by your surgeon, do not remove your eye patch except when applying

BSN4A (GROUP 2)33 - Report sore throat, fever, unsual bruising or bleeding, tarry stools, confusion, hallucination, dizziness, severe headache, muscle or joint pain. 3.) Ceftazidime Classification: - Antibiotic Cephalosporin (third generation) How do you know if its effective: - Bactericidal: the bacteria is lessen or treated -Lessens or no signs and symptoms of infection Exact time: -570mg/ IVTT/ Q8 Client teaching: -Before using ceftriaxone, tell your doctor or pharmacist if you are allergic to it; or to other cephalosporins; or to penicillins; or if breathing exercises).Exercising makes the heart stronger, lowers blood pressure, and helps keep you healthy Take a rest or nap to balance the bodies activities and to recover more Avoid lifting heavy objects or excessive activities. Avoid overexertion and have time for rest and leisure eye drops as directed. In rare instances, a surgical dressing may be placed. Do not remove your eye dressing and do not begin your eye drops until after your first post-operative appointment. You may take pain reliever as needed every 4 hours for pain. Continue your regular medications as directed by your physician including any eyedrops prescribed for the other eye. Your first postoperative appointment will be the day following surgery. At this time your eye will be examined. Your post-operative care schedule and medications will be

BSN4A (GROUP 2)34 you have any other allergies. - Contraindicated with allergy to cephalosphorins or penicillins - Use cautiously with renal failure - Arrange for culture and sensitivity before treatment - Inspect the insertion site for phlebitis (inflammation of a vein). - Assess IV site for swelling, erythema, tenderness, leakage of fluid, or warmth. - If phlebitis is detected, discontinue the infusion and apply warm compress to the venipuncture site. - Report severe diarrhea, difficulty breathing, unsual tiredness or fatigue, pain at injection site. - May experience side effects: Stomach upset or diarrhea 4.) Amikacin Sulfate reviewed.

Post- Operative Limitations (for 4 weeks): You may bath or shower if indicated by the doctor; protect the eye from soapy water by patching it securely. Always turn your back against the shower spray. Always wear your eye patch while sleeping. Avoid sleeping on the side of your operated eye. Do not bend at the waist to pick up objects on the floor. If you must, squat or bend at the knees and use your hand to stabilize yourself. Do not lift heavy objects

BSN4A (GROUP 2)35 Avoid straining your bowel Avoid coughing and sneezing as much as possible. Do not submerge your eye under water

Classification: - Aminoglycoside How do you know its effective: - Bactericidal: the bacteria is lessen or treated -Lessens or no signs and symptoms of infection Exact time: - 125mg/ IVTT/ Q12 Client teaching: - Contraindicated with allergy to any aminoglycosides, renal or hepatic disease, preexisting hearing loss, myasthenia gravis, parkinsonism. - Use cautiously with elderly patients, any patient with diminished hearing, decreased renal function, dehydration, neuromuscular disorders. - Inspect the insertion site for phlebitis (inflammation of a vein). - Assess IV site for

Post-Operative Eye Care: Wash your hands before caring for the eye. If the lids are sticky or itchy in the morning, they may be gently cleaned with a cotton ball moistened with sterile water. Wipe from your nose toward you ear, in one direction only. Be careful not to rub or put pressure on the eye. The operated eye should be protected at

BSN4A (GROUP 2)36 swelling, erythema, tenderness, leakage of fluid, or warmth. - If phlebitis is detected, discontinue the infusion and apply warm compress to the venipuncture site. Do not use this injured vein for further infusion. - Report pain at injection site, severe headache, dizziness, loss of hearing, changes in urine pattern, difficulty breathing, rash or skin lesions. - Patient may experience side effects: ringing in the ears, headache, dizziness - Safety measures may need to be taken if: severe nausea, vomiting, loss of appetite 5.) Ibuprofen Classification: - Analgesic, NSAID, Propionic Acid Derivative all times by either glasses (prescription or sunglasses) or the polycarbonate goggles. When the glasses are removed for showering, gently tape the metal shield over the eye. A soft eye patch may also be used under the shield/goggles if desired. Give medications properly as indicated.

BSN4A (GROUP 2)37 How do you know its effective: - Relief from signs and symptoms of pain and fever Exact time: - 200mg/5ml/ PO/ Q6 Client teaching: -With allergy to ibuprofen salicylates, or other NSAIDS (more common in patients with rhinitis, asthma, chronic urticaria, nasal polyps). Contraindicated for treatment of perioperative pain after coronary artery bypass graft. - Observe patients with history of cardiac decompensation closely for evidence of fluid retention and edema. - Do not self-medicate with ibuprofen if taking prescribed drugs or being treated for a serious condition without consulting physician. - Do not take aspirin

BSN4A (GROUP 2)38 concurrently with ibuprofen. - Notify physician immediately of passage of dark tarry stools, coffee ground emesis, frankly bloody emesis or other GI distress, as well as blood or protein in urine and onset of skin rash, pruritus, jaundice. - Monitor for therapeutic effectiveness. 6.) Moxifloxacin Hydrochloride Classification: - Antibiotic, Flouroquinolone How do you know its effective: - Bactericidal: the bacteria is lessen or treated -Lessens or no signs and symptoms of infection Exact time: - 1 drop/Optic OU/1 drop Q15 for 3 hours as loading dose, then 1 drop

BSN4A (GROUP 2)39 Q1 OU thereafter Client teaching: - Contraindicated with allergy to fluoroquinolones; prolonged QT interval, hypokalemia. - Arrange for culture and sensitivity test before beginning therapy. - Continue therapy as indicated for condition being treated. - Instill the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not instill a double dose to make up for a missed one. -Inform the client and SO to report if any of these symptoms are severe or do not go away: red, irritated, itchy, or teary eyes blurred vision eye pain

BSN4A (GROUP 2)40 dry eyes broken blood vessels in the eyes runny nose cough; - Report immediately if following symptoms occur: sore throat, fever, chills and other signs of infection ear pain or fullness rash hives itching difficulty breathing or swallowing 7.) Oxacillin Sodium Classification: - Antibiotic, Penicillinase-resistant penicillin How do you know its effective: - Bactericidal: the bacteria is lessen or treated -Lessens or no signs and symptoms of infection

BSN4A (GROUP 2)41 Exact time: - 220mg/ IVTT,ANST()/Q6 Client teaching: - Assess if patient is allergy to penicillins, cephalosporins, or other allergens; renal disorders - Assess culture infection; for skin status, lesion; R, adventitious sounds; bowel sounds; CBC, renal function tests, serum electrolytes, Hct, urinalysis - Arrange culture infection before treatment - Continue therapy as indicated for condition being treated. - Assess the insertion site for fluid infiltration - Inspect the insertion site for phlebitis (inflammation of a vein). Assess IV site for swelling, erythema, tenderness, leakage of fluid, or warmth. - If phlebitis is detected, discontinue the infusion

BSN4A (GROUP 2)42 and apply warm compress to the venipuncture site. Do not use this injured vein for further infusion. - Teach client that side effects may be experienced, such as: upset stomach, nausea, diarrhea (small frequent meals), mouth sores (perform frequent mouth care) and pain at injection site. - Report difficulty of breathing, rashes, severe diarrhea, severe pain at injection site, mouth sores. 8.) Sodium Hyaluronate Classification: - Eye Lubricant How do you know its effective: - Moistens and lubricates the surface of your eye Exact time: - 1 drop/ Optic OU/ Q6

BSN4A (GROUP 2)43

Client teaching: - Assess if patient has allergic reaction to sodium hyaluronate or to any other eye drops. - If the vision becomes blurred after using the drops, tell the patient and SO to avoid activities that require clear vision until they can see clearly again. -Instructions to SO: 1. Wash your hands 2. Open a single unit dose by twisting and pulling off the cap 3. Carefully pull down the lower eyelid to form a space between the eye and the eyelid 4. Gently squeeze a drop into the eye but do not touch the eye with the tip 5. Close the eye for 30 seconds then open your eyes and blink a few times 6. Repeat these instructions for the other eye if required. 7. Wash your hands

BSN4A (GROUP 2)44

9.) Tropicamide Classification: Mydriatics/Cycloplegics How do you know its effective: - Pupils dilation and abscess comes out Exact time: - 1 drop/ Optic OD/ Q6 Client teaching: - Assess for history of allergies to tropicamide and any other allergies - Assess for medical history of glaucoma (open-angle), high blood pressure, hyperthyroidism - After you apply this drug, your vision may become temporarily blurred. Do not drive, use machinery, or do any activity that requires clear vision until you are sure you can perform such activities safely. - This medication may

BSN4A (GROUP 2)45 make your eyes more sensitive to light. Protect your eyes in bright light. Use dark sunglasses when outdoors. - Eye stinging, temporary blurred vision, dry mouth, or eye sensitivity to light may occur. If any of these effects persist or worsen, report promptly. - Seek immediate medical attention when a very serious allergic occurs which includes: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing. - Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. 10.) Vitamin K Classification: - Hemostatic/ Antihemorrhagic

BSN4A (GROUP 2)46

How do you know its effective: - An antihemorrhagic actor that promotes hepatic formation of active prothrombin Exact time: - 10 mg x 2 doses/IVTT/Q24 Client teaching: - Assess for allergic reactions to vitamin k before - Asses for medical history, especially of blood disorders, kidney disease, liver disease. - Avoid excess dosage. - Do not give Warfarin (Coumadin) interacts with VITAMIN K at the same time - Monitor PT to determine dosage effectiveness as ordered. - If severe bleeding occurs, dont delay other measures, such as fresh frozen plasma or whole blood.

BSN4A (GROUP 2)47 - Inspect the insertion site for phlebitis (inflammation of a vein). - Assess IV site for swelling, erythema, tenderness, leakage of fluid, or warmth. - If phlebitis is detected, discontinue the infusion and apply warm compress to the venipuncture site. Do not use this injured vein for further infusion. -Alert: watch for signs of flushing, weakness, tachycardia and hypotension; may progress to shock.

How to use ophthalmic medications 1. To apply eye drops, wash your hands first. 2. To avoid contamination, do not touch the dropper tip or let it touch your eye or any other

BSN4A (GROUP 2)48 surface. 3. Tilt the head back, look upward, and pull down the lower eyelid to make a pouch. 4. Hold the dropper directly over your eye and place 1 or 2 drops into the pouch, usually 15 to 20 minutes before an eye examination or as directed by the doctor. 5. Look downward and gently close your eyes for 1 to 2 minutes. 6. Place one finger at the corner of your eye (near the nose) and apply gentle pressure for 2 to 3 minutes. This will prevent the medication from draining out and being absorbed by your body. Try not to blink and do not rub

BSN4A (GROUP 2)49 your eye. 7. Repeat these steps for your other eye if so directed. 8. Do not rinse the dropper. Replace the dropper cap after each use. 9. If you are using another kind of eye medication (e.g., drops or ointments), wait at least 5 to 10 minutes before applying other medications. Use eye drops before eye ointments to allow the drops to enter the eye. 10. Wash your hands after using this medication. If giving this medication to a child, do not let the medication get into the child's mouth. Also wash the child's hands after giving this medication.

BSN4A (GROUP 2)50