Name of Drug: Ceftazidime Therapeutic Class: Antibiotics Pharmacologic Class: Cephalosporins

(Bacteriacidals)
Dosage: 500 mg Route: IV Frequency: q&h
ACTION INDICATION CONTRAIND SIDE EFFECTS/ NURSING IMPLICATIONS
S ICATIONS ADVERSE
EFFECTS

Inhibits Ceftazidime is Hypersensitiv Occasional (14%– Monitor CBC, - It is essential to

bacterial cell indicated for ity to 5%): Vomiting, BMP, renal complete drug
wall the treatment avibactam- nausea, abdominal ASSESSMENT
function PATIENT/FAMILY
therapy despite
synthesis by of lower containing pain, anxiety, rash. periodically. For EDUCATION
symptom
binding to respiratory products, pts with changing improvement.
one or more tract Ceftazidime, Rare (4%–2%): renal function, Early
of the infections, cephalosporin Constipation, monitor renal discontinuation
penicillin- skin and skin s. dizziness. function test daily may result in
binding structure and adjust dose antibacterial
proteins infections, Cautions: Lower Respiratory accordingly. resistance or
(PBPs) which urinary tract History of Tract Infections Diligently monitor increased risk of
in turn infections, renal I&Os. Observe recurrent infection.
inhibits the bacterial impairment, Skin and Skin- daily pattern of
final septicemia, seizure Structure bowel activity, Report any
transpeptidat bone and joint disorder, Infections  stool consistency episodes of
ion step of infections, encephalopat (increased severity diarrhea, esp. in
peptidoglyca gynecologic hy, recent C. Urinary Tract may indicate the most following
n synthesis in infections, difficile (C- Infections antibiotic- treatment
bacterial cell intra- diff) infection associated colitis). completion.
walls, thus abdominal or antibiotic Bacterial If frequent Frequent diarrhea,
inhibiting cell infections associated Septicemia  diarrhea occurs, fever, abdominal
wall (including colitis. obtain C. difficile pain, blood-
biosynthesis. peritonitis), Hypersensitiv Bone and Joint toxin screen and streaked stool may
Bacteria and central ity to Infections  initiate isolation indicate infectious
eventually nervous penicillin, precautions until diarrhea and may
lyse due to system other beta- Gynecologic test result be contagious to
ongoing infections lactams. Infections confirmed; others.
activity of (including manage proper
cell wall meningitis) Intra-abdominal fluids levels/PO Report abdominal
autolytic caused by Infections intake, electrolyte pain, black/tarry
enzymes susceptible levels, protein stools, bruising,
(autolysins bacteria. Central Nervous intake. yellowing of skin
and murein Ceftazidime is System Infections Antibacterial or eyes; dark urine,
hydrolases) indicated in drugs that are not decreased urine
while cell combination directed against C. output; skin
wall with avibacta difficile infection problems such as
assembly is m to treat may need to be development of
arrested. infections discontinued. sores, rash, skin
caused by Report any sign of bubbling/necrosis.
susceptible hypersensitivity
Gram- reaction. Drink plenty of
negative fluids.
organisms,
including Report any
complicated nervous system
intra- changes such as
abdominal anxiety, confusion,
infections hallucinations,
(cIAI), in muscle jerking, or
conjunction seizure-like
with metronid activity.
azole, and
complicated Severe allergic
urinary tract reactions such as
infections hives, palpitations,
(cUTI), shortness of
including breath, rash,
pyelonephriti tongue-swelling
s, in patients may occur.
aged three
months and
older. This
combination
is also
indicated to
treat hospital-
acquired and
ventilator-
associated
bacterial
pneumonia
(HABP/VAB
P) in patients
aged 18 years
and older.

Name of Drug: Clindamycin Therapeutic Class: Pharmacologic Class:

Dosage: 600 mg Route: oral Frequency: q6h
ACTION INDICATION CONTRAIND SIDE EFFECTS/ NURSING IMPLICATIONS
S ICATIONS ADVERSE
 EFFECTS

Inhibits Clindamycin Hypersensitiv Antibiotic- Obtain baseline Continue therapy

protein is used to ity to associated colitis, WBC. Question pt for full length of
synthesis of treat bacterial clindamycin. other ASSESSMENT
for history of PATIENT/FAMILY
treatment.
bacterial cell infections that Cautions: superinfections allergies. Avoid, if EDUCATION
wall by affect the Severe hepatic (abdominal possible, Doses should be
binding to lungs, skin, dysfunction; cramps, severe concurrent use of evenly spaced.
bacterial blood, female history of GI watery diarrhea, neuromuscular
ribosomal reproductive disease fever) may occur blocking agents. Take oral doses
receptor sites. organs, and (especially during and several with at least 8 oz
Topically, internal colitis). weeks after Monitor daily water.
decreases organs. clindamycin pattern of bowel
fatty acid Clindamycin therapy (including activity, stool Use caution when
concentration belongs to a topical form). consistency. applying topical
on skin class of drugs Blood dyscrasias Report diarrhea clindamycin
known as (leukopenia, promptly due to concurrently with
lincomycin thrombocytopenia) potential for peeling or abrasive
antibiotics. It , nephrotoxicity serious colitis acne agents, soaps,
acts by (proteinuria, (even with topical alcohol-containing
slowing or azotemia, oliguria) or vaginal cosmetics to avoid
preventing occurs rarely. administration). cumulative effect.
bacterial Thrombophlebitis Assess skin for
development. with IV rash (dryness, Do not apply
administration. irritation) with topical
topical application. preparations near
With all routes of eyes, abraded
administration, be areas.
alert for
superinfection: Report severe
fever, vomiting, persistent
diarrhea, diarrhea, cramps,
anal/genital bloody stool.
pruritus, oral
mucosal changes Vaginal: In event
(ulceration, pain, of accidental
erythema). contact with eyes,
rinse with large
amounts of cool
tap water.

Do not engage in
sexual intercourse
during treatment.
 Wear sanitary pad
to protect clothes
against stains.
Tampons should
not be used.

Name of Drug: Felodipine Therapeutic Class: Pharmacologic Class: Calcium channel

Antihypertensive blockers
Dosage: Route: Oral Frequency: OD
ACTION INDICATION CONTRAIND SIDE EFFECTS/ NURSING IMPLICATIONS
S ICATIONS ADVERSE
EFFECTS

Inhibits Felodipine is Hypersensitiv Frequent (22%– Assess B/P, apical Do not abruptly
ASSESSMENT PATIENT/FAMILY
EDUCATION
calcium a medication ity to 18%): Headache, pulse immediately discontinue
movement used to treat felodipine or peripheral edema. before drug medication.
across high blood other calcium administration (if
cardiac, pressure channel Occasional (6%– pulse is 60 or Compliance with
vascular (hypertension blocker. 4%): Flushing, less/min or therapy regimen is
smooth ). Lowering Cautions: respiratory systolic B/P is less essential to control
muscle cell high blood Severe left infection, than 90 mm Hg, hypertension.
membranes. pressure aids ventricular dizziness, light- withhold
in the dysfunction, headedness, medication, To avoid
Therapeutic prevention of HF, hepatic asthenia. contact physician). hypotensive effect,
Effect: strokes, heart impairment, Question history of go from lying to
Relaxes attacks, and hypertrophic Rare (less than HF, hepatic standing slowly.
coronary kidney cardiomyopat 3%): Angina, impairment,
vascular disorders. A hy with gingival valvular disease. Avoid tasks that
smooth calcium outflow tract hyperplasia, require alertness,
muscle and channel obstruction, paresthesia, Assist with motor skills until
causes blocker is peripheral abdominal ambulation if response to drug is
vasodilation. Felodipine. edema, severe discomfort, dizziness occurs. established.
Increases This medicine aortic anxiety, muscle Assess for
myocardial relaxes and stenosis, cramping, cough, peripheral edema. Report
oxygen expands elderly. diarrhea, Monitor pulse rate palpitations,
delivery. blood arteries Concomitant constipation. for bradycardia. shortness of
by inhibiting CYP3A4 Assess skin for breath,
calcium, inhibitors. Overdose produces flushing. Monitor pronounced
allowing nausea, hepatic function. dizziness, nausea.
blood to flow drowsiness, Question for
more freely. confusion, slurred headache, Swallow tablet
speech, asthenia. whole; do not
hypotension, chew, crush,
bradycardia. dissolve, or divide.

Avoid grapefruit
products, alcohol.

Report
exacerbation of
angina.
Name of Drug: Potassium Therapeutic Class: Pharmacologic Class:
Chloride
Dosage: 50 mEqs Route: IV Frequency: 12 hours
ACTION INDICATION CONTRAIND SIDE EFFECTS/ NURSING IMPLICATIONS
S ICATIONS ADVERSE
EFFECTS

Necessary for Potassium Renal failure, Occasional: Assess for Foods rich in
multiple chloride is hyperkalemia, Nausea, vomiting, hypokalemia potassium include
cellular used to conditions in diarrhea, ASSESSMENT
(weakness, fatigue, PATIENT/FAMILY
beef, veal, ham,
metabolic prevent or which flatulence, polyuria, EDUCATION
chicken, turkey,
processes. treat low potassium abdominal polydipsia). PO fish, milk, bananas,
Primary potassium retention is discomfort with should be given dates, prunes,
action is levels in the present. Solid distention, with food or after raisins, avocados,
intracellular. blood oral dosage phlebitis with IV meals with full watermelon,
(hypokalemia form in pts in administration glass of water, cantaloupe,
Therapeutic ). Potassium whom there is (particularly when fruit juice apricots, molasses,
Effect: levels can fall structural, potassium (minimizes GI beans, yams,
Required for because of a pathologic concentration of irritation). broccoli, brussels
nerve sickness, the cause for greater than 40 sprouts, lentils,
impulse use of certain delay in mEq/L is infused). Monitor serum potatoes, spinach.
conduction, medications, passage potassium
contraction of or a lengthy through GI Rare: Rash. (particularly in Report paresthesia,
cardiac, illness tract. renal impairment). feeling of
skeletal, characterized Hyperkalemia If GI disturbance is heaviness of lower
smooth by diarrhea or Cautions: (more common in noted, dilute extremities, tarry
muscle; vomiting. Cardiac elderly, pts with preparation or bloody stools,
maintains disease, acid- renal impairment) further or give weakness, unusual
normal renal base manifested as with meals. Be fatigue.
function, disorders, paresthesia, feeling alert to decreased
acid-base potassium- of heaviness in urinary output
balance. altering lower extremities, (may be indication
disorders, cold skin, grayish of renal
digitalized pallor, insufficiency).
pts, hypotension, Monitor daily
concomitant confusion, pattern of bowel
therapy that irritability, flaccid activity, stool
increases paralysis, cardiac consistency. Assess
serum arrhythmias. I&O diligently
potassium during diuresis, IV
(e.g., ACE site for
inhibitors), extravasation,
renal phlebitis. Be alert
impairment. to evidence of
Do not hyperkalemia (skin
administer IV pallor/coldness,
undiluted. complaints of
paresthesia, feeling
of heaviness of
lower extremities)
Name of Drug: Clonidine Therapeutic Class: Pharmacologic Class: Adrenergic
Antihypertensive (centrally acting)
Dosage: 75 mcg Route: PO (tablet) Frequency: once/day
ACTION INDICATION CONTRAIND SIDE EFFECTS/ NURSING IMPLICATIONS
S ICATIONS ADVERSE
EFFECTS

Stimulates Clonidine Hypersensitiv Frequent (40%– Obtain B/P Sugarless gum,

alpha2 lowers blood ity to 10%): Dry mouth, immediately sips of water may
-adrenergic pressure by Clonidine. drowsiness, ASSESSMENT
before each dose is PATIENT/FAMILY
relieve dry mouth.
receptors, slowing your Epidural: dizziness, sedation, administered, in EDUCATION
reducing heart rate and Contraindicat constipation. addition to regular Avoid tasks that
sympathetic relaxing your ed in pts with monitoring (be require alertness,
CNS blood vessels, bleeding Occasional (5%– alert to B/P motor skills until
response. allowing diathesis or 1%): Tablets, fluctuations). response to drug is
blood to flow infection at Injection: established.
Epidural: more readily the injection Monitor B/P,
Prevents pain through your site; pts Depression, pedal pulse, mental To reduce
signal body. receiving edema, loss of status. Monitor hypotensive effect,
transmission anticoagulatio appetite, decreased daily pattern of rise slowly from
to brain and n therapy. sexual function, bowel activity, lying to standing.
produces Cautions: itching eyes, stool consistency.
analgesia at Depression, dizziness, nausea, If Clonidine is to Skipping doses or
pre- and elderly. vomiting, be withdrawn, voluntarily
post-alpha- Severe nervousness. discontinue discontinuing drug
adrenergic coronary concurrent beta- may produce
receptors in insufficiency, Transdermal: blocker therapy severe rebound
spinal cord. recent MI, Pruritus, redness several days before hypertension.
cerebrovascul or darkening of discontinuing
ADHD: ar disease, skin. Clonidine Avoid alcohol.
Mechanism chronic renal (prevents
of action impairment, Rare (less than Clonidine If patch loosens
unknown. preexisting 1%): Nightmares, withdrawal during 7-day
bradycardia, vivid dreams, hypertensive application period,
Therapeutic sinus node feeling of coldness crisis). Slowly secure with
Effect: dysfunction, in distal reduce Clonidine adhesive cover.
Reduces conduction extremities (esp. dosage over 2–4
peripheral disturbances; the digits). days.
resistance; concurrent
decreases use with Overdose produces
B/P, heart digoxin, profound
rate. diltiaZEM, hypotension,
Produces metoprolol, irritability,
analgesia. verapamil. bradycardia,
respiratory
depression,
hypothermia,
miosis (pupillary
constriction),
arrhythmias,
apnea. Abrupt
withdrawal may
result in rebound
hypertension
associated with
nervousness,
agitation, anxiety,
insomnia,
paresthesia,
tremor, flushing,
 diaphoresis. May
produce sedation
in pts with acute
CVA.

Name of Drug: Mannitol Therapeutic Class: Diuretics Pharmacologic Class: Osmotic Agent
Dosage: 150 cc Route: IV Frequency: q4h
ACTION INDICATION CONTRAIND SIDE EFFECTS/ NURSING IMPLICATIONS
S ICATIONS ADVERSE
EFFECTS

Elevates Mannitol is a Hypersensitiv Frequent: Dry Obtain baseline Expect increased

osmotic diuretic that is ity to mouth, thirst. B/P, pulse. Assess urinary
pressure of used to mannitol. ASSESSMENT
skin turgor, PATIENT/FAMILY
frequency/volume
glomerular increase urine Severe Occasional: mucous . EDUCATION
filtrate, output in dehydration, Blurred vision, membranes,
inhibiting persons who active increased urinary mental status, May cause dry
tubular have acute intracranial frequency/volume muscle strength. mouth.
reabsorption (sudden) bleeding , headache, arm Obtain baseline
of water and renal failure. (except pain, backache, weight, chemistry
electrolytes, Mannitol during studies. Assess
resulting in injection can craniotomy), nausea, vomiting, I&O.
increased also be used severe urticaria, dizziness,
urine output. to treat pulmonary hypotension, Monitor urinary
Reduces swelling and edema, hypertension, output to ascertain
intracranial pressure congestion, tachycardia, fever, therapeutic
pressure by inside the eye severe renal angina-like chest response. Monitor
decreasing or disease pain. serum electrolytes,
blood surrounding (anuria), serum osmolarity,
viscosity, the brain. progressive Fluid, electrolyte ICP, renal
thereby HF. Cautions: imbalance may function, LFT.
increasing Concurrent occur due to rapid Assess vital signs,
cerebral nephrotoxic administration of skin turgor,
blood agents, large doses or mucous
flow/oxygen conditions inadequate urine membranes.
transport. increasing output resulting in Weigh daily.
sensitivity to overexpansion of Monitor for signs
Therapeutic bronchoconstr extracellular fluid. of hypernatremia
Effect: iction (e.g., Circulatory (confusion,
Produces recent overload may drowsiness, thirst,
diuresis; abdominal, produce dry mouth,
reduces thoracic pulmonary edema, cold/clammy
intraocular surgery), HF. Excessive skin); signs of
pressure sepsis, diuresis may hypokalemia
(IOP), preexisting produce (changes in muscle
intracranial renal disease, hypokalemia. Fluid strength, tremors,
pressure hypernatremi loss in excess of muscle cramps,
(ICP), a. electrolyte altered mental
cerebral excretion may status, cardiac
edema. produce arrhythmias).
hypernatremia, Signs of
hyperkalemia. hyperkalemia
include colic,
diarrhea, muscle
twitching followed
by weakness,
paralysis,
arrhythmias.
 NURSING CARE PLANS
NCP #1

BACKGROUND NURSING INTERVENTION

CUES DIAGNOSIS GOALS AND OBJECTIVES EVALUATION
KNOWLEDGE AND RATIONALE
Risk for NOC: Risk Control: NIC: Aspiration precaution
aspiration r/t Aspiration
impaired
swallowing as
evidenced by
Goal:
nasogastric tube
and feeding.
Experience no aspiration as
evidenced by noiseless
respirations; clear breath
sounds; and clear, odorless
secretions.

Identify causative/risk
factors.

Demonstrate techniques to
prevent and/or correct
aspiration.

Along the course of

interventions, the following
objectives are to be achieved.

Assess
causative/contributing
factors:

Identify at-risk clients

1. Assess according to condition or
causative/contributin disease process, as listed in
g factors Risk Factors, to determine
when observation and/or
interventions may be
required

Note the client’s level of

consciousness, awareness of
surroundings, and cognitive
function, as impairments in
these areas increase the
client’s risk of aspiration
owing to the inability to
cough or swallow well
and/or the presence of an
artificial airway, mechanical
ventilation, and/or tube
feedings.

Determine the presence of

neuromuscular disorders,
noting muscle groups
involved, degree of
impairment, and whether
they are of an acute or
progressive nature (e.g.,
stroke, Parkinson’s disease,
progressive supranuclear
palsy, and similar disabling
brain diseases; Guillain-Barré
syndrome, or amyotrophic

lateral sclerosis). This may

result in temporary or
chronic, progressive
impairment of protective
muscle functions.

Assess for coughing and note

amount and consistency of
respiratory secretions. Helps
differentiate the potential
cause for risk of aspiration.

Auscultate lung sounds

periodically (especially in a
client who is coughing
frequently or not coughing at
all; a client with artificial
airways, endotracheal and
tracheostomy tubes; or a
ventilator client being tube-
fed, immediately following
extubation), and observe
chest radiographs to
determine decreased breath
sounds, rales, or dullness to
percussion that could
indicate the presence of
aspirated secretions, and
 “silent aspiration” leading to
aspiration pneumonia.

LABORATORY STUDY
NAME OF DATE INDICATIONS FOR NORMAL VALUE ACTUAL SIGNIFICANCE OF THE FINDINGS
 TEST/PROCEDURE DONE THE TEST FINDINGS
Feb Feb
16 21
Complete Blood Count Feb 14 It is used to assess a WBC 4-11 x 109/L 12.2 13.6 The patient's WBC level was high or
and 15, patient's overall health RBC 4-6 x 109/L 4.79 5.01 increased because of the inflammatory
2010 and discover a variety HGB 120-180g/L 142 145 response, as was the patient's body
of illnesses. It is HCT 0.37-0.54 0.426 0.453 temperature. Antibiotic and antipyretic
MCV 80-100 fL 89 90.5
recommended for medication will help with the elevated body
MCH 27-31ug 29.6 29
patient JB who has MCHC 320-360g/L 333 321
temperature. He also has a high neutrophil
been diagnosed with RDW 11-16% 14 13.5 count due to an infection, which explains
CVD to have a Platelet cnt 150-450 109/L 264 211 why the patient is taking clyndamycin for a
complete blood count, bacterial infection.
platelets, and white
blood cells counted. Neutrophils 0.500-0.700 0.798 .789 Patient lymphocytes are a result of stress,
Lymphocytes 0.200-0.500 0.138 .142 which is why the patient is taking
Monocytes 0.062 .06 ceflazidime. Furthermore, a high level of
0.020-0.090
Eosinophils 0.001 .003 basophil might indicate that the body is in
0.000-0.006 0.001
Basophils .003 a state of chronic inflammation.
0.000-0.002

NAME OF DATE INDICATIONS FOR NORMAL VALUE ACTUAL FINDINGS SIGNIFICANCE OF THE FINDINGS
TEST/PROCEDURE DONE THE TEST Feb Feb Feb Feb
19 21 22 24
Blood Chemistry Feb. It is a method in Glucose 4.1-6.1 mmol/L 5.2 The patient's salt level has
19, 21, which a blood Creatinine 53-115 umol/L 93 109 96 increased. It is necessary for
22 sample is examined Sodium 136-145mmol/L 141 150 146 regulating blood pressure, blood
to determine the Potassium 3.5-5.1 mmol/L 3.3 3.4 3.1 volume, and osmotic balance,
Chloride 99-110 mmol/L 
number of however having an excess or large
105
compounds released CBG (done 96
quantity of salt in the body causes
80-120 mg/dl
into the body by everyday, pre meals) fluid retention and hypertension.
organs and tissues. Because the patient already has
The presence of a hypertension, mannitol and
material in unusually clonidine are being prescribed for
high or low his CDV and hypertension.
concentrations can
be a symptom of Lastly, patient JB has a low
sickness in the organ potassium level, which produces
or tissue that headaches, dizziness, and arm
produces it. numbness. A low potassium level
can impair nerve function.

NAME OF DATE DONE INDICATIONS FOR NORMAL VALUE ACTUAL FINDINGS SIGNIFICANCE OF
TEST/PROCEDURE THE TEST THE FINDINGS
Urinalysis Feb 16, 2010 It is used to detect RBC 0-3 3-6 Because of the shift in
and manage a wide WBC 0-4 9-14 localized acidity and the
range of problems, Epithelium 0 few generation of free
including UTI, renal Color Pale to amber yellow radicals because of
disease, and Sp. gravity 1.005-1.030 1.030 metabolic disturbance,
diabetes, as well as Sugar (-) (-) RBC levels are elevated.
to aid in the diagnosis Transparency Clear hazy A greater level of WBC
Protein (-) (-)
of hypertension and was a sign of
bacteria (-) few
other metabolic inflammatory and
pH 4.6-8.0 6.0
diseases. bacterial UTI, justifying
the use of ceftazidime
and clindamycin.