DRUG STUDY Date Ordered: 7/22/13 Generic Name: Mannitol Brand Name: Osmitrol Classification: Osmotic Diuretic Dosage,

Route, and Frequency: 20% 100 cc IV fast drip Indication: Reduction of intracranial pressure and treatment of cerebral edema; of elevated IOP when the pressure cannot be lowered by other means. Mechanism of Action: Increases osmotic pressure of glomerular filtrate, inhibiting tubular reabsorption of water and electrolyte; drugs elevates plasma osmolality, increasing water flow into extracellular fluid. Desired effect: Reduction of intracranial pressure and brain mass. Promotion of urinary excretion of toxic materials.

Side Effect: CNS: seizures, dizziness, headache, fever CV: edema, thrombophlebitis, hypotension, hypertension, tachycardia, chest pain Dermatologic: urticaria, skin necrosis with infiltration Respiratory: pulmonary congestion, rhinitis GI: nausea, anorexia, dry mouth, thirst GU: diuresis, urinary retention Hematologic: fluids and electrolyte imbalance, hyponatremia

Adverse Effect: CNS: dizziness, headache, fever GI: dry mouth, thirst

Nursing Responsibilities: 1. Observe 10Rs -To potentiate drug action and to decrease adverse effects/side effects 2. Observe aseptic technique in giving the drugs 3. To prevent transfer of organism

Do not expose solution in low temperature Because crystallization may occur

4.

Report difficulty of breathing, pain, at the I.V site To prevent futher complication

5.

Give frequent mouth care or fluids To relieve thirst

6.

Observe the IV site regularly To prevent infiltration.

Date Ordered: 7/23/13 Generic Name: Ranitidine Brand Name: Zantac Classification: H2 receptors antagonist Dosage, Route, Frequency: Ranitidine 5 mg IV q 8 hrs. Mechanism of Action: Competitively inhibits the action of histamine at the histamine2 (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 agonist, gastrin, and pentagastrin. Indication: Short- term treatment of active, benign gastric ulcer Maintenance therapy for duodenal or gastric ulcer

Desired Effect: Because the patient is NPO Side Effect: CNS: headache, malaise, vertigo EENT: blurred vision Hepatic: jaundice Other: anaphylaxis, angioedema, burning and itching at injection site Adverse Effect: CNS: headache Other: burning and itching at injection site Nursing Responsibilities 1. Observe 10Rs For proper administration

2. Observe aseptic technique in giving the drug To prevent transfer of organism

3. Inform the patient the action, use and the reason of taking such drug. So that the client is aware of what he is taking in, to gain cooperation during the

drug therapy 4. Check for previous hypersensitivity to the drug. 5. To determine any sensitivity reaction to the drug.

Monitor patient continually if giving intravenous dosage. To allow early detection of potentially serious adverse effects on liver enzyme

systems. 6. Encourage patient to have small frequent feeding with balanced diet and avoid spicy foods. To minimize nausea and vomiting. For us not to trigger HCL production, the

patient must avoid spicy foods. 7. Advice patient not to do activities requiring alertness. The drug can cause drowsiness or dizziness.

8. Provide thorough patient teaching, including drug name, prescribed dosage, measure for avoidance of adverse effects such as diarrhea or constipation, dizziness, headache, confusion, cardiac arrhythmias, and hypotension, and warnings signs that may indicate possible problems. Instruct the patients about the need for periodic monitoring and evaluation. - To enhance patient knowledge about drug therapy and to promote compliance. Date ordered: 7/23/13 Generic Name: Lactulose Brand Name: Cephulac Classification: disaccharides Dosage, Route and Frequency: 30 ml now Indication: Treatment for constipation Mechanism of Action; Reduce an osmotic effect in colon, resulting distention promote peristalsis. Also decreased ammonia, probably as a result of bacterial degradation which lowers the pH of colon content. Desired Effect: Increase the osmotic pressure in the colon and slightly acidify the colonic content. Side Effect: GI: transient flatulence, distention, intestinal cramps, belching Other: acid- base balance Adverse Effect: CNS: transient flatulence Nursing Responsibilities: 1. Observe 10Rs 2. To be accurate in drug administration

Observe aseptic technique To prevent transfer of organism

3.

Give laxative syrup orally with fruit juice, water or milk

4.

Increased palatability

Inform clients mother about the side effect of the drug To gain cooperation

5.

Report diarrhea, severe belching, abdominal pain To avoid secondary complication

Date ordered: July 24, 2013 Generic Name: Omeprazole Brand Name: Prisolec Classification: Anti- ulcer Dosage, route and frequency: 40 g IV now, then OD Mechanism of action: Inhibits activity of acid (proton) pump and binds to hydrogen k-adenoside Triphosphate at secretory surface of gastric parietal cells to blocks formation of gastric acid. Indication: Short-term treatment of active benign gastric ulcer Side effect: CNS: asthenia, dizziness, headache GI: abdominal pain, constipation, diarrhea, flatulence, N/V< musculoskeletal, back pain RESP: cough, upper respiratory tract infection SKIN: rash Adverse effect: CNS: dizziness, headache Desired effect: Completely block the proton pump

Nursing Responsibilities: 1. Observe for 10 Rs -To be accurate in drug administration 2. Let patient assume comfortable position - To avoid further irritation of the stomach

3. Encourage patient to do divertional activities like listening to sounds from his phone - To decrease pain intensity 4. Check for the patency of the IV line. - To avoid wastage of the drug. 5. Administer the drug slowly. - To prevent phlebitis. 6. Advice patient to avoid activities requiring alertness. - Because it may cause dizziness and drowsiness. 7. In cases of rashes, advice patient not to scratch the affected areas. - Because it may lead to bruises and also it will increase the tendency of infection. 8. Instruct patient to avoid eating sour tasting foods. - To prevent further irritation of gastric mucosa. 9. Instruct patient to avoid eating large meal. - To avoid aggravating the condition.

Date ordered: Generic Name: Cefuroxime Classification: Anti- infective Mode of Action: It inhibits cell-wall synthesis, binds to bacterial cell membrane Dosage, Route, Frequency: 750 mg IV every 8 hrs. Desired Effect: this was given to our patient to treat a wide variety of bacterial infectionsand to help prevent infection.

Side effects: Adverse effects: GI: Diarrhea, pseudomembranous colitis Hematologic: eosinophilia, thrombocytosis, leukopenia Skin: rash; induration, pain, ecchymosis, and tenderness at injection site.

Nursing Responsibilities:

1. Observe the 10 Rs before administration for an effective treatment regimen.

2. Obtain specimen for culture and sensitivity tests before giving first dose. Therapy may begin pending results. to determine appropriate medications.

3. Before initiating the therapy, obtain a history to determine previous use of and reaction to penicillin or cephalosphorins.

4. Observe patient for signs and symptoms of anaphylaxis such as rash, pruritus, laryngeal edema, and wheezing. to institute proper measures and prevent further complications.

5. Monitor site frequently for thrombophleibitis(pain, redness, swelling).

6. Change IV site every 48-72 hours to prevent phlebitis