Medical Surgical Management
Content
MEDICAL AND SURGICAL MANAGEMENT Drug Order Mechanism of Action Indication Contraindication Adverse Effect Nursing Res onsi!i"ities
Generic Name: insulin Brand Name: Humulin Classification: Antidiabetic Drug Dosage: 70/30 Route: SC Frequency: 25 “6” in am
Exact mechanism is not understood; possibly increases peripheral utilization o glucose! glucose production and alters intestinal absorption o glucose"
Diabetes
#ontraindicated in patients $ith history o systemic allergic reaction to por% $hen porcine & deri'ed products are used or hypersensiti'ity to any component o preparation"
ENDOCRINE# - hypoglycemia - (actic acidosis GI# - 'omiting! - anorexia - epigastric discom ort - heartburn - nausea - heartburt - diarrhea - latulence $%&ERSENSITI'IT%# - Allergic s%in reactions - eczema - pruritus - erthema - urticaria
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)is% o se'ere lactic acidosis! monitor patient! and treat any suspicion o lactic acidosis" *onitor urine or serum glucose le'els re+uently to determine e ecti'eness o drug dosage" Arrange or trans er to insulin therapy during periods o high stress Don,t discontinue this medication $ithout consulting your health care pro'ider(
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Drug Order
Mechanism of Action
Indication
Contraindication
Adverse Effect
Nursing Res onsi!i"ities
Generic Name: aspirin Brand Name: Bayer Classification: nonsteroida" antiinf"ammator) drug *NSAID+ Dosage: -. mg Route: /0 Frequency: 0D e'ery a ter lunch
Analgesic and antirheumatic e ects are attributable to aspirin,s ability to inhibit the synthesis o prostaglandins! important mediators o in lammation" Antipyretic e ects are not ully understood! but aspirin probably acts in the thermoregulatory center o the hypothalamus to bloc% e ects o endogenous pyrogen by inhibiting synthesis o the prostaglandin intermediary" 1nhibition o platelet aggregation is attributable to the inhibition o platelet synthesis o thromboxane A2! a potent 'asoconstrictor and inducer o platelet
2*ild to moderate pain 23nlabeled use4 /rophylaxis against cataract ormation $ith long&term use
#ontraindicated $ith allergy to salicylates or 56A1Ds 7more common $ith nasal polyps! asthma! chronic urticaria8; allergy to tartrazine 7cross&sensiti'ity to aspirin is common8; hemophilia! bleeding ulcers! hemorrhagic states! blood coagulation de ects! hypoprothrombinemia ! 'itamin 9 de iciency 7increased ris% o bleeding8
Acute as irin to,icit)# -)espiratory al%alosis! hyperpnea! tachypnea! hemorrhage! excitement! con usion! asterixis! pulmonary edema! seizures! tetany! metabolic acidosis! e'er! coma! #: collapse! renal and respiratory ailure 7dose related! 2.;25 g in adults! < g in children8 -As irin into"erance# Exacerbation o bronchospasm! rhinitis 7$ith nasal polyps! asthma! rhinitis8 -GI# 5ausea! dyspepsia! heartburn! epigastric discom ort! anorexia! hepatotoxicity &$emato"ogic# 0ccult blood loss! hemostatic de ects -$) ersensitivit)# Anaphylactoid reactions to
& 3se the drug only as suggested; a'oid o'erdose" A'oid the use o other o'er& the&counter drugs $hile ta%ing this drug" *any o these drugs contain aspirin! and serious o'erdose can occur" =a%e the drug $ith ood or a ter meals i >1 upset occurs" Do not cut! crush! or che$ sustained&release products" 0'er&the&counter aspirins are e+ui'alent" /rice does not re lect e ecti'eness" ?ou may experience these side e ects4 5ausea! >1 upset! heartburn 7ta%e drug $ith 2
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aggregation" =his e ect occurs at lo$ doses and lasts or the li e o the platelet 7days8" Higher doses inhibit the synthesis o prostacyclin! a potent 'asodilator and inhibitor o platelet aggregation
anaphylactic shoc% &Sa"ic)"ism# Dizziness! tinnitus! di iculty hearing! nausea! 'omiting! diarrhea! mental con usion! lassitude 7dose related8
ood8; easy bruising! gum bleeding 7related to aspirin,s e ects on blood clotting8" )eport ringing in the ears; dizziness! con usion; abdominal pain; rapid or di icult breathing; nausea! 'omiting! bloody stools"
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Drug Order
Mechanism of Action
Indication
Contraindication
Adverse Effect
Nursing Res onsi!i"ities
Generic Name#
1nhibits H*>&#o A reductase! the enzyme atro'astatin that catalyzes the irst step in the cholesterol .rand Name# synthesis path$ay! resulting in a decrease (ipitor in serum cholesterol! serum (D(s C"assification# 7associated $ith increased ris% o #AD8! Antihyper & lipidemic and increases serum HD(s 7associated $ith Dosage# decreased ris% o #AD8; increases -. mg@ tab hepatic (D( recapture sites! enhances Route# reupta%e and /0 catabolism o (D(; lo$er strig lyceride /re0uenc)# le'els" 0D A H6
2 =o increase HD(&# in patients $ith primary hypercholesterol emia and mixed dyslipidemia 2AdBunct to diet totreat ele'ated serum triglyceride le'els
2 #ontraindicated $ith allergy to ator'astatin! ungal by products! acti'e li'er disease or unexplained and persistent ele'ations o transaminase le'els! pregnancy! lactation" 2 3se cautiously $ith impaired endocrine unction
CNS# Headache!asthenia
GI# Clatulence! abdominal pain! cramps! constipation! nausea! dyspepsia! heartburn! li'er E Administer drug $ithout ailure regard to ood! but at same time each day" Res irator)# 6inusitis! pharyngitis & =a%e this drug once a day! at about the same time each Other# day! pre erably in the )habdomyolysis $ith e'ening; may be ta%en $ith acuterenal ood" Do not drin% grape ruit ailure!arthralgia!myalgia Buice $hile ta%ing this drug"
& Ensure that patient has tried cholesterol&lo$ering diet regimen or D;6 mo be ore beginning therapy"
& Arrange to ha'e periodicblood tests $hile you areta%ing this drug" & Alert any health carepro'ider that you are on thisdrug; it $ill need to bediscontinued i acute inBuryor illness occurs"
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Drug Order
Mechanism of Action
Indication
Contraindication
Adverse Effect
Nursing Res onsi!i"ities
Generic Name: cipro loxacin Brand Name: /lasil Classification: Anti&in ecti'es Dosage: 200mg Route: IVTT Frequency: q 24 hr
1nhibits bacterial D5A synthesis by inhibiting D5A gyrase" =herapeutic E ects4 Death o susceptible bacteria" 6pectrum4 Froad acti'ity includes many gram&positi'e pathogens
#ipro loxacin isused to treat in ections o the s%in! lungs! air$ays! bones! and Boints caused by susceptible bacteria
#ontraindicated in hypersensiti'ity! cross&sensiti'ity among agents may occur"
3se cautiously in underlying #56 pathology! rena GI#pseudomembranous limpairment! cirrhosis" colitis! abdominal pain! diarrhea!nausea! altered taste GU# interstitial cystitis! 'aginitis Derm# rash
CNS# 6eizures! dizziness! dro$siness! headache! insomnia! acute psychoses! agitation! con usion! hallucinations! increased intracranial pressure! tremors"
Endo#hyperglycemia!hypo glycaemia Loca"# phlebitis at 1:site MS# tendinitis!tendon rupture*isc4hypersensiti'it yreactions includinganaphylaxis!6te' ens&Gohnson
− Instruct patient not to take ciprofloxacin with dairy products such as milk or yogurt, or with calcium-fortified juice. He may eat or drink dairy products of calcium-fortified juice with a regular meal, but do not use them alone when taking ciprofloxacin. They could make the medication less effective. − Instruct patient to take ciprofloxacin with a full glass of water ! ounces". − Instruct patient to avoid taking antacids, vitamins or mineral supplements, sucralfate #arafate", or didanosine $idex" powder or chewable tablets within % hours before or & hours after 5
you take ciprofloxacin. These other medicines canmake ciprofloxacin muchless effective when taken atthe same time. − Inform patient that #iprofloxacin may cause swelling or tearing of a tendon the fiber that connects bones to musclesin the body", especially in the 'chilles( tendon of the heel. These effects may be more likely to occur if you are over %), if you take a noral steroid medication, or if you have had a kidney, heart, or lung transplant.
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Generic Name: insulin Brand Name: Humulin Classification: Antidiabetic Drug Dosage: 70/30 Route: SC Frequency: 25 “6” in am
Exact mechanism is not understood; possibly increases peripheral utilization o glucose! glucose production and alters intestinal absorption o glucose"
Diabetes
#ontraindicated in patients $ith history o systemic allergic reaction to por% $hen porcine & deri'ed products are used or hypersensiti'ity to any component o preparation"
ENDOCRINE# - hypoglycemia - (actic acidosis GI# - 'omiting! - anorexia - epigastric discom ort - heartburn - nausea - heartburt - diarrhea - latulence $%&ERSENSITI'IT%# - Allergic s%in reactions - eczema - pruritus - erthema - urticaria
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)is% o se'ere lactic acidosis! monitor patient! and treat any suspicion o lactic acidosis" *onitor urine or serum glucose le'els re+uently to determine e ecti'eness o drug dosage" Arrange or trans er to insulin therapy during periods o high stress Don,t discontinue this medication $ithout consulting your health care pro'ider(
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Drug Order
Mechanism of Action
Indication
Contraindication
Adverse Effect
Nursing Res onsi!i"ities
Generic Name: aspirin Brand Name: Bayer Classification: nonsteroida" antiinf"ammator) drug *NSAID+ Dosage: -. mg Route: /0 Frequency: 0D e'ery a ter lunch
Analgesic and antirheumatic e ects are attributable to aspirin,s ability to inhibit the synthesis o prostaglandins! important mediators o in lammation" Antipyretic e ects are not ully understood! but aspirin probably acts in the thermoregulatory center o the hypothalamus to bloc% e ects o endogenous pyrogen by inhibiting synthesis o the prostaglandin intermediary" 1nhibition o platelet aggregation is attributable to the inhibition o platelet synthesis o thromboxane A2! a potent 'asoconstrictor and inducer o platelet
2*ild to moderate pain 23nlabeled use4 /rophylaxis against cataract ormation $ith long&term use
#ontraindicated $ith allergy to salicylates or 56A1Ds 7more common $ith nasal polyps! asthma! chronic urticaria8; allergy to tartrazine 7cross&sensiti'ity to aspirin is common8; hemophilia! bleeding ulcers! hemorrhagic states! blood coagulation de ects! hypoprothrombinemia ! 'itamin 9 de iciency 7increased ris% o bleeding8
Acute as irin to,icit)# -)espiratory al%alosis! hyperpnea! tachypnea! hemorrhage! excitement! con usion! asterixis! pulmonary edema! seizures! tetany! metabolic acidosis! e'er! coma! #: collapse! renal and respiratory ailure 7dose related! 2.;25 g in adults! < g in children8 -As irin into"erance# Exacerbation o bronchospasm! rhinitis 7$ith nasal polyps! asthma! rhinitis8 -GI# 5ausea! dyspepsia! heartburn! epigastric discom ort! anorexia! hepatotoxicity &$emato"ogic# 0ccult blood loss! hemostatic de ects -$) ersensitivit)# Anaphylactoid reactions to
& 3se the drug only as suggested; a'oid o'erdose" A'oid the use o other o'er& the&counter drugs $hile ta%ing this drug" *any o these drugs contain aspirin! and serious o'erdose can occur" =a%e the drug $ith ood or a ter meals i >1 upset occurs" Do not cut! crush! or che$ sustained&release products" 0'er&the&counter aspirins are e+ui'alent" /rice does not re lect e ecti'eness" ?ou may experience these side e ects4 5ausea! >1 upset! heartburn 7ta%e drug $ith 2
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aggregation" =his e ect occurs at lo$ doses and lasts or the li e o the platelet 7days8" Higher doses inhibit the synthesis o prostacyclin! a potent 'asodilator and inhibitor o platelet aggregation
anaphylactic shoc% &Sa"ic)"ism# Dizziness! tinnitus! di iculty hearing! nausea! 'omiting! diarrhea! mental con usion! lassitude 7dose related8
ood8; easy bruising! gum bleeding 7related to aspirin,s e ects on blood clotting8" )eport ringing in the ears; dizziness! con usion; abdominal pain; rapid or di icult breathing; nausea! 'omiting! bloody stools"
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Drug Order
Mechanism of Action
Indication
Contraindication
Adverse Effect
Nursing Res onsi!i"ities
Generic Name#
1nhibits H*>&#o A reductase! the enzyme atro'astatin that catalyzes the irst step in the cholesterol .rand Name# synthesis path$ay! resulting in a decrease (ipitor in serum cholesterol! serum (D(s C"assification# 7associated $ith increased ris% o #AD8! Antihyper & lipidemic and increases serum HD(s 7associated $ith Dosage# decreased ris% o #AD8; increases -. mg@ tab hepatic (D( recapture sites! enhances Route# reupta%e and /0 catabolism o (D(; lo$er strig lyceride /re0uenc)# le'els" 0D A H6
2 =o increase HD(&# in patients $ith primary hypercholesterol emia and mixed dyslipidemia 2AdBunct to diet totreat ele'ated serum triglyceride le'els
2 #ontraindicated $ith allergy to ator'astatin! ungal by products! acti'e li'er disease or unexplained and persistent ele'ations o transaminase le'els! pregnancy! lactation" 2 3se cautiously $ith impaired endocrine unction
CNS# Headache!asthenia
GI# Clatulence! abdominal pain! cramps! constipation! nausea! dyspepsia! heartburn! li'er E Administer drug $ithout ailure regard to ood! but at same time each day" Res irator)# 6inusitis! pharyngitis & =a%e this drug once a day! at about the same time each Other# day! pre erably in the )habdomyolysis $ith e'ening; may be ta%en $ith acuterenal ood" Do not drin% grape ruit ailure!arthralgia!myalgia Buice $hile ta%ing this drug"
& Ensure that patient has tried cholesterol&lo$ering diet regimen or D;6 mo be ore beginning therapy"
& Arrange to ha'e periodicblood tests $hile you areta%ing this drug" & Alert any health carepro'ider that you are on thisdrug; it $ill need to bediscontinued i acute inBuryor illness occurs"
4
Drug Order
Mechanism of Action
Indication
Contraindication
Adverse Effect
Nursing Res onsi!i"ities
Generic Name: cipro loxacin Brand Name: /lasil Classification: Anti&in ecti'es Dosage: 200mg Route: IVTT Frequency: q 24 hr
1nhibits bacterial D5A synthesis by inhibiting D5A gyrase" =herapeutic E ects4 Death o susceptible bacteria" 6pectrum4 Froad acti'ity includes many gram&positi'e pathogens
#ipro loxacin isused to treat in ections o the s%in! lungs! air$ays! bones! and Boints caused by susceptible bacteria
#ontraindicated in hypersensiti'ity! cross&sensiti'ity among agents may occur"
3se cautiously in underlying #56 pathology! rena GI#pseudomembranous limpairment! cirrhosis" colitis! abdominal pain! diarrhea!nausea! altered taste GU# interstitial cystitis! 'aginitis Derm# rash
CNS# 6eizures! dizziness! dro$siness! headache! insomnia! acute psychoses! agitation! con usion! hallucinations! increased intracranial pressure! tremors"
Endo#hyperglycemia!hypo glycaemia Loca"# phlebitis at 1:site MS# tendinitis!tendon rupture*isc4hypersensiti'it yreactions includinganaphylaxis!6te' ens&Gohnson
− Instruct patient not to take ciprofloxacin with dairy products such as milk or yogurt, or with calcium-fortified juice. He may eat or drink dairy products of calcium-fortified juice with a regular meal, but do not use them alone when taking ciprofloxacin. They could make the medication less effective. − Instruct patient to take ciprofloxacin with a full glass of water ! ounces". − Instruct patient to avoid taking antacids, vitamins or mineral supplements, sucralfate #arafate", or didanosine $idex" powder or chewable tablets within % hours before or & hours after 5
you take ciprofloxacin. These other medicines canmake ciprofloxacin muchless effective when taken atthe same time. − Inform patient that #iprofloxacin may cause swelling or tearing of a tendon the fiber that connects bones to musclesin the body", especially in the 'chilles( tendon of the heel. These effects may be more likely to occur if you are over %), if you take a noral steroid medication, or if you have had a kidney, heart, or lung transplant.
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