DRUG STUDY

Drug Data Classification Mechanism of Indication/ Adverse Effect Nursing

Action Contraindication Responsibilities
Inhibits Indications: Assessment:
Generic: Classification: vasoconstrictive Treatment of Adverse effect: BEFORE:
LOSARTAN cardiovascular and hypertension, CNS: Headache, -Assess patients
agent; aldosterone- alone or in dizziness, syncope, health history.
angiotensin secreting action combination with insomnia -Assess patients
Brand: II receptor of angiotensin other C V: Hypotension blood pressure.
Cozaar antagonist; II by blocking antihypertensive Dermatologic: Rash, -Assess patients
antihypertensive angiotensin II Agents. urticaria, pruritus, renal function.
Ordered: receptor on the Treatment of alopecia, dry skin DURING:
Give 50mg surface of diabetic GI: Diarrhea, -Monitor
1tab, OD vascular neuropathy with abdominal pain, patients intake
smooth muscle an elevated nausea, constipation, and output.
Timing: and other serum creatinine dry mouth -Administer drug
8 am tissue cells. and proteinuria Respiratory: URI at daytime.
in patients with symptoms, cough, AFTER:
Duration: type 2 (non sinus disorders -Be alert for
unknown insulin- Other: Back pain, adverse
dependent) fever, gout, muscle reaction.
Other diabetes and a weakness -Monitor
forms: history of patients
Tablets: 25 hypertension Interactions sleeping pattern.
mg, 50 mg, Drug-drug
100 mg Decreased serum
CONTRA levels and
INDICATIONS: effectiveness if taken
Hypersensitivity concurrently with
to Nifedipine phenobarbital
pregnant and Losartan is converted
lactating mothers to an active metabolite

24
by cytochrome P450-
3A4. Drugs that inhibit
3A4 (ketoconazole,
fluconazole, diltiazem)
may decrease the
antihypertensive
effects of losartan.

25
 Mechanism of Indication/ Contra- Nursing
Name Classification Side Effect
Action indication Responsibilities

Generic Analgesic; Non- Mefenamic acid Indications: - Bloody nose 1 Assess patients
name: steroidal anti- binds the - Rheumatoid - Black, tarry stools who develop
Mefenamic inflammatory drug prostaglandin arthritis - Blood in the urine or severe
Acid synthetase - Mild to moderate stools diarrhea and
receptors COX-1 pain - Vomiting blood vomiting for
Brand name: and COX-2, - Dental pain - Red or purple spots on dehydration
Ponstel inhibiting the - Postoperative pain the skin. and
action of - Dysmenorrhoea - Nausea electrolyte
1 cap 500mg prostaglandin - Osteoarthritis - Fatigue imbalance.
BID PO synthetase. As - Menorrhagia - Yellowing of the skin or 2 Discontinue
these receptors whites of the eyes drug promptly
have a role as a (jaundice) if diarrhea,
major mediator Contraindications: - Excessive tiredness dark stools,
of inflammation - Inflammatory - Swelling of the face or hematemesis,
and/or a role for intestinal body ecchymoses,
prostanoid diseases - Blisters epistaxis, or
signaling in - Active peptic - Unexplained skin rash rash occur
activity- ulcers - Wheezing and do not
dependent - Hypersensitivity to - Difficulty breathing use again.
plasticity, the aspirin - Chest pain Contact
symptoms of (acetylsalicylic - Shortness of breath physician.
pain are acid) or other - Weakness on one side 3 Notify physician
temporarily non-steroidal of your body if persistent
reduced. anti- - Slurred speech GI discomfort,
inflammatory sore throat,
agents fever, or
- Renal failure malaise occur.
4 Lab tests: With
long-term

26
therapy (not
recommended
) obtain
periodic
complete
blood counts,
Hct and Hgb,
and kidney
function tests.

27
Drug Data Classification Mechanism of Indication/Contra Adverse Effect Nursing
Action indication Responsibilities
Nifedipine CLASSIFICATION Inhibits the INDICATIONS: CNS: Dizziness, light- ASSESSMENT
20mg PO S: movement of Hypertension headedness, History:
TID Calcium channel- calcium ions Chronic stable headache, asthenia, Allergy to
blocker across the angina fatigue, nifedipine;
Antianginal membranes of nervousness, sleep pregnancy;
Angina pectoris
cardiac and disturbances, blurred lactation
Antihypertensive due to coronary
arterial vision Physical:
artery spasm
muscle cells; C V:Peripheral edema, Skin lesions,
inhibition of angina, hypotension, color, edema;
transmembrane arrhythmias, AV orientation,
CONTRAINDICATI
calcium flow block, asystole reflexes; P,
ONS:
results in the BP, baseline
depression of
Hypersensitivity to Dermatologic:
Nifedipine Flushing, rash, ECG,
impulse peripheral
pregnant and dermatitis, pruritus,
formation in perfusion,
lactating mothers urticaria
specialized auscultation;
cardiac
GI: Nausea, diarrhea,
constipation, R,
pacemaker cells, adventitious
in slowing of the cramps, flatulence,
hepatic injury sounds; liver
velocity of evaluation,
conduction of Other: Nasal
congestion, cough, normal GI
the cardiac output; liver
impulse, in the fever, chills, shortness
of breath, muscle function tests
depression of
myocardial cramps, joint stiffness,
sexual difficulties INTERVENTION
contractility, and S
in
Monitor
the dilation of
patient
coronary arteries
carefully (BP,
and arterioles
cardiac
and peripheral
rhythm, and
arterioles; these
output) while
effects lead
drug is being
to decreased
adjusted to
cardiac work,
therapeutic
decreased
dose; the
cardiac energy
dosage may
consumption,
be increased
and increased
more rapidly28
delivery
in
of oxygen to
hospitalized
myocardial cells.
patients
under close
29
 Name Classification Mechanism of Action Indication/ Adverse Effect Nursing
Contraindication Responsibilities
Generic Therapeutic Pharmacodynamics: General Indication: CNS: seizures, Before:
Name: vitamins and Prevention and dizziness,head Monitor blood
Multivitami minerals; Chemical Effects treatment of iron- ache, syncope studies of pt.
ns + antianemics An essential mineral vitamin and dietary Assess for
FeSO4 found in deficiency anemias. CV: intake of other
hemoglobin, Used in anemia due hypotension, multivitamin
Pharmaco myoglobin, and to blood loss during hypertension, products within
Patients logic: many enzymes. menstruation, tachycardia 2 hours, may
Dose: water-soluble Enters the infections, surgery, result to
1 cap PO vitamins; iron bloodstream and is delivery, GI: nausea, vitamin
OD supplements transported to the intoxications, constipation, overdose.
organs of the parasitosis or other dark stools,
Observe proper
Minimum Pregnancy reticuloendothelial causes and diarrhea,
dosage of
Dose: Category system (liver, anemias during epigastric
medication to
125 mg Risk: spleen, bone pregnancy pain, GI
prevent
A marrow), where it is bleeding, taste
overdose or
Maximum separated out and Contraindicated in: disorder,
toxic effect of
Dose: becomes part of iron Hemochromatosis, vomiting
the drug.
750 mg stores. hemosiderosis, or
other evidence of Derm:
Assess for
Contents: Therapeutic Effects: iron overload; flushing, colostomy or
Fe sulfate Prevention/treatmen Anemias not due to urticaria ileostomy.
200 mg, t of iron deficiency iron deficiency; Note other drug
folic acid some products Resp: cough, that the pt are
400 mcg, Pharmacokinetics contain alcoh02ol, dyspnea taking to avoid
vit B1 2 tartrazine or possible
mg, vit Absorption: sulfites and should MS: arthralgia, interactions
B2 2 mg, 510% of dietary be avoided in myalgia Verify pt.s
vit B6 2 iron is absorbed (up patients with identity
mg, vit to 30% in deficiency known intolerance Misc: staining
B12 10 mcg, states). or hypersensitivity of teeth, During:
vit C 100 Therapeutically anaphylaxis, Most effectively
mg administered PO Precaution: sweating absorbed if
iron may be 60% Use cautiously in administered 1
absorbed via an peptic ulcer; Local: pain at hour before or
Availability: active and passive ulcerative colitis or IM site 2 hrs after
tablets: transport process. regional enteritis meal.
150 mg, Vitamins well (condition may be Take tablets
300 mg, absorbed following aggravated); and capsules
500 mg administration Alcoholism; Severe 30
with a full
capsules: hepatic glass of water
300 mg, Distribution: impairment; or juice.
500 mg Remains in the body Severe renal
Do not crush or
 Nursing Care Plan

Ineffective tissue perfusion related to interruption of arterial flow

Significant Findings Scientific Basis Expected Outcome Interventions Actual Outcomes

Objective: Raynaud phenomenon in Within 8 hours of I. Safe & Quality GOALS
-Stiffening of joints systemic sclerosis is the nursing care, client Nursing Care PARTIALLYMET.
and fingers exaggeration of the normal will be able to 1.). Assess the After 2 days of
Noted response to cold increase arterial blood patient for the blood nursing
-pale skin temperatures. The clinical flow circulation, colour and intervention, the
-bluish discoloration manifestation of Raynaud -promote good blood sensation at the client was able to
of fingers noted phenomenon is caused by circulation as extremities. demonstrates
CRT= 5 seconds vasoconstriction (narrowing) evidenced by R- For further light
of blood vessels (arteries and decrease Capillary investigation and increased perfusi
arterioles) that results in refill time from 5 treatment on as
reduced blood flow to the seconds to 2-3 II. Management of evidenced by
skin (ischemia), while seconds. Resources and increased in
cyanosis (blue skin) is Environment hemoglobin
created by deoxygenation of 2. Apply warm (110.0g/L),
slow-flowing blood in small compress at the hematocrit
blood vessels (arterioles and affected area (34),RBC(4.20
capillaries) in the skin. The R- To promote good 10^12/L)and
skin blood circulation WBC

31
feels cold and appears as a Management of (9.9010^9/L)
pale demarcated area (white Resources and but still with the
fingers or toes) or cyanotic Environment presence of
skin limited to the fingers 3 Administer the pallor, edema,
or toes. Some people will feel medication as delayed capillary
generally cold and have prescribed by doctor refill.
mottled pale skin of the ears, such as vasodilator,
nose, facial area, knees, or calcium channel
other exposed skin. blockers and alpha
A Raynaud event typically blockers
starts after cold exposure R- To vasodilate the
or an emotionally stressful blood vessel and
situation in one or several increase blood supply
digits and then spreads to the extremities
symmetrically to all fingers of
both hands. It is common for Safe & Quality
numbness, tingling and Nursing Care
clumsiness of finger use to 4Monitor the blood
accompany the digital circulation to the
color changes. extremities every two
Source: hourly (circulation

32
Brunner & Suddarths chart)
textbook of medical R- To observe for any
surgical nursing, 12th edition further complication
page 320 Safe & Quality
Nursing Care

5. Encourage patient
to perform extremities
exercises while sitting
or during work
R- Muscular exercises
promotes blood flow
and the development
of collateral
circulation

Ethico-Moral
Responsibility
Respects the
rights of
patient.

33
 Accepts
responsibility
and
accountability
for own actions.
VI. Personal and
Professional
Development
Displays
appropriate
behavior at all
times.
VII. Quality
Improvement
Constructs and
implements
therapeutic
solutions for
the well being
of the patient.
VIII. Research

34
 Utilizes findings
in research in
the provision of
nursing care
IX.Records
Management
Completes
updated
documentation
of patient care.
X. Communication
Listens
attentively to
patients
feelings
Encourage
patient to
express
feelings to
others to gain
self-worth.

35
 XI. Collaboration and
Teamwork
Refer patient to
appropriate
personnel.
Encourage attendance
in group activities.

Risk for Aspiration related to difficulty swallowing As evidenced by Dysphagia

36
Significant Findings Scientific Basis Expected Outcome Interventions Actual Outcomes
Subjective: maglisod Scleroderma can After 8 hours Safe & Quality Nursing After 8 hours
gihapon ko ug tulon decrease motility anyw of nursing Care of nursing
mura kog matuk-an here in the intervention pt. Assess for gag reflex intervention client
as verbalized gastrointestinal will demonstrate and swallowing was able to
tract. The most measures to prevent R: Impaired swallowing demonstrate
Objective: common source of aspiration. may cause aspiration. measures to prevent
Difficulty swallowing decreased motility is Safe & Quality Nursing aspiration
noted upon eating. the esophagus and the Care
lower esophageal Elevate the head of the
sphincter, leading bed or Upright position
to dysphagia and chest when eating
pain. As scleroderma R-To aid breathing and
progresses, esophageal promotes lung
involvement from expansion.
abnormalities in
decreased motility may Management of
worsen due to Resources and
progressive fibrosis Environment
(scarring). If this is left Place pt. on lateral
untreated, acid from position or change the

37
the stomach can back position.
up into the esophagus,
causing esophagitis R: Reduces the risk
and GERD. Further of aspiration by
scarring from acid allowing secretions
damage to the lower to drain.
esophagus many times
leads to the Health Education
development of fibrotic 4. Encourage pt. to
narrowing, also known drink fluids when
as strictures which can eating.
be treated by dilatation,
andBarrett's esophagus R: To prevent
Esophageal motility blockage on the
becomes impaired, and passage of food.
the lower esophageal
sphincter becomes Health Education
incompetent; 6. Instruct pt. to
gastroesophageal reflux eat with small
and secondary amount of food.
strictures can develop.

38
 The intestinal R: To prevent
muscularis mucosa obstruction on airway
degenerates, leading to and aspiration.
pseudodiverticula in the XI. Collaboration and
Teamwork
colon and ileum.
Refer patient to
(Med-surg, p.302) appropriate
personnel.
Encourage attendance
in group activities.

Impaired physical mobility related to hardening of the skin and stiffening of joints secondary to systemic sclerosis

39
Significant Scientific Basis Expected Outcome Interventions Actual Outcomes
Findings
Subjective: Hand involvement is After 8 hours of nursing Safe & Quality Nursing Patient The goal was
dili ko ka lihok sa often the first clinical intervention, the client Care met.
akong mga tudlo sa manifestation during will be able to: 1Determine diagnosis
kamot ug sa akong the course of SSc . It -perform Passive ROM that contributes to After 1-2 weeks of
mga lutahan as occurs mainly due to immobility nursing
verbalized skin and periarticular -Improve physical R-Identifying barriers intervention, the
thickening causing movements to mobility patient able to
significant contracture Safe & Quality Nursing maintain or increase
Objective: and limitation of -increase strength Care strength and
-Weakness finger movements and Note factors affecting function of affected
-Slowed movement hand deformity. Hand current situation and and compensatory
-Limited range of functions are also potential time body part
motion compromised because involved.
of the overlapping of R-The risk for effects of
Raynauds immobility such as
phenomenon and pain muscle weakness, skin
due to arthralgias, breakdown are also to
arthritis, be considered in
tenosyn+vitis, ulcers patients with

40
and calcinosis temporary immobility
(Pathophysiology by Safe & Quality Nursing
Lorraine M. Wil-son Care
fourth edition p.982) Assess clients
developmental level,
motor skills, ease and
capability of
movement, posture
and gait.
R-Examines
development or
recession of
complications. May
require to delay
augmenting exercises
and hold until further
healing occurs.
Management of
Resources and
Environment
Evaluate for

41
presence/degree of
pain, listening to
clients description
about manner in which
pain limits mobility.
R-This helps out in
retraining neuronal
pathways, promoting
proprioception and
motor response.
Safe & Quality Nursing
Care
Ascertain clients
perception of
activity/exercise needs
and impact of current
situation.
R-Identify cultural
beliefs and
expectations affecting
recovery/response to

42
long-term limitations.
Quality Improvement
Assess nutritional status
and clients report of energy
level.
Correct nutrition is
necessary to keep sufficient
energy level. The patient
will need adequate,
properly balanced intake of
carbohydrates, fats,
proteins, vitamins, and
minerals to provide energy
resources.

SAFE & QUALITY NURSING

CARE
Note emotional/behavioral
responses to problems of
immobility
R-cceptance of temporary

43
or more permanent
limitations can vary broadly
between individuals. Each
person has his or her
personal interpretation of
acceptable quality of life.
Health Education
Discuss discrepancies
in movement with
client aware and
unaware of
observation and
methods for dealing with
identified problems.
Quality Improvement
Review/encourage use of
proper body mechanics
MANAGEMENT OF
RESOURCES AND
ENVIRONMENT
Demonstrate/assist with

44
use of side rails, overhead
trapeze, roller pads,
hydraulic lifts/chairs
MANAGEMENT OF
RESOURCES AND
ENVIRONMENT
Support affe01 .cted body
parts/joints using
pillows/rolls, foot
supports/shoes, gel pads,
etc.,
Collaboration and
Teamwork
Encourage clients
participation in self-
care activities,
physical/occupational
therapies as well as
diversional/recreationa
l activities.

45
Disturbed Body Image related to hardening of the skin, stiffening of joints and fingers secondary to systemic
sclerosis

Significant Scientific Basis Expected Outcome Interventions Actual Outcomes

Findings
Subjective: The image of physical After 30minutes Health Education After 30minutes
Claims that she self, or body image, is of nursing -Assess perception of of nursing
cannot move that how a person intervention, the patien change intervention, the pati
much because of perceives the size t will be able to: instructure/function of ent was able to:
appearance, and Demonstrate enhanced body part. Demonstrate
Objective: functioning of the body image and self- R-extent of response is enhanced body
-hardening of the body and its parts. esteem as evidenced by more related to the image and self-
skin in the face and Body image has both ability to look at, touch, valve or importance esteem as evidenced
stiffening of joints cognitive and affective talk about, and care for patient places on the by ability to look at,
and fingers with aspects. The cognitive actual or perceived part of function than touch, talk about,
bluish discoloration is the knowledge of altered the actual value or and care for actual
- the material body; the body part/function importance. or perceived altered
affective includes the Quality Improvement body part/function.
sensations of the -Acknowledge normally
body such as pain, of emotional response
pleasure, fatigue, and to actual or perceived
physical movement. change in body

46
Body image is the structure/function.
sum of these R-stages of grief over
attitudes, conscious loss of a body part or
and conscious, that a function are normal,
person has toward his and typically involve a
or her body. The period of denial
person who has a Health Education
disturbance in body -Help patient identify
image may hide or actual changes
not look at or touch a R-patients may
body part that has perceive changes that
significant changes in are not present/real.
structure. Some Quality Improvement
individuals may also Promotes positive
express feelings of attitude and provides
helplessness, opportunity to set
hopelessness, and goals and plan
vulnerability, and may for future based on
exhibit self- reality.
destructive behaviors Quality Improvement
such as over- or >Words of

47
under-eating or encouragement
suicide attempts. can support
development of
(Kozier, et. al., 2007) positive coping
behaviors.
R- It is worthwhile to
encourage the patient
to separate feelings
about changes in body
structure or function
from feelings about
self-worth. Expression
of feelings can
enhance the patients
coping strategies.
Communication
>maintain open lines
of communication and
provides on ongoing
support for patient and
family.

48
R- This promotes
positive attitude and
provides opportunity to
set goals and plan for
future based on reality.
Quality Improvement
> Promotes ventilation
of feelings and allow
for more helpful
responses to patient.
Quality Improvement
> Prepares patient for
reactions of others and
anticipates ways to
deal with them.
R- This promotes
positive attitude and
provides opportunity to
set goals and plan for
future based on reality.
Quality Improvement

49
> To begin to
incorporate changes in
body image
Management of
Resources and
Environment
Demonstrate/assist with
use of side rails, overhead
trapeze, roller pads,
hydraulic lifts/chairs
R-These are helpful in
identifying ways/devices to
regain and maintain
independence. Patient may
need further assistance to
resolve persistent
emotional problems.
MANAGEMENT OF
RESOURCES AND
ENVIRONMENT
Support affected body

50
parts/joints using
pillows/rolls, foot
supports/shoes, gel pads,
etc.,R- These are helpful in
identifying ways/devices to
regain and maintain
independence. Patient may
need further assistance to
resolve persistent
emotional problems.
Collaboration and
Teamwork
Encourage clients
participation in self-
care activities,
physical/occupational
therapies as well as
diversional/recreationa
l activities.

51