Pamantasan ng Lungsod ng MarikinaJ.P. Rizal St. Concepcion Uno, Marikina City

 __________________________

   DENGUE HEMORRHAGIC FEVER  __________________________

 A Group Case Study

  Submitted to: 

Mr. Ryan E. Aliwalas, RN

 In Partial Fulfillment

of the Requirement for the CourseNCM 101

RLE

 H-Vill Hospital

 Submitted by:

Gomez, Richerylle C.Gutierrez, Floren Angelie V.Hernandez, Richelle Joy T.Hussin, Johanna Fariza T.

Ison, Sheila May H.Javier, Jayson R.

Jayme, Carolyn Eleanor F.Labide, Prima Encar T.

Ladjahasan, Irish Princess A.Lagumbay Joanne B.Lardillo, Catherine A.

Lomocso, Jamielyn Kate B.

GROUP 7AUGUST 2009

INTRODUCTION

We live in our world today where everything seems to be in a fast face.

As it is, we cannot deny that things change over or in a certain period of

time. New technologies were being invented, clothes for fashion, jewelries,

luxuries mode of entertainment, etc. It’s just like having a new mode of

socialization, cultures, beliefs, perceptions, adaptation to life and environment.

With all of these, one aspect of human being which are greatly affected and the

one which we have to be most concern of would be in the side of our heath and

well being.

In the Philippines there are many diseases illness arising because of

environmental changes that may be caused by human activities and

geographical conditions. It is considered as one of the tropical country and so

disease can spread through out the country.

One example of these is disease is what we called Dengue Fever and

dengue Hemorrhagic Fever (DHF). It is considered as one of the acute febrile

diseases caused by one of the four closely related virus serotype of the genus

flavivirus. It can be transmitted by Aedes Aegypti mosquito to humans usually

attacking during the day. One will experience onset of fever, severe headaches,

muscle and joint pains which will give name to Breakbone Fever or Bonecrusher.

There are also rashes characterized by bright red petechaie commonly seen on

the lowers limbs and on the chest. There may also be gastritis associated to

abdominal pain, nausea, vomiting, or diarrhea. Proper attention of health care

provider should be given including good assessment, early detection or diagnosis

and medications which are essential for total interference of prevention.

GOAL

General Goal:

To be knowledgeable about the nature of Dengue Fever Syndrome,

management and treatment to be able to render effective nursing

care to the client.

Specific Goal:

To be familiar with the etiology of the disease

To know the pathophysiology of the disease

To be aware of the signs and symptoms

To know its complications

To be knowledgeable on how to prevent the disease

To know the treatment and how to apply it

To know the diagnostic exam

PATIENT’S PROFILE

Name: CJS

Age: 13 years old

Gender: Male

Address: # 32 Natividad St. Malanday San Mateo, Rizal

Date of Birth: October 24, 1995

Place of Birth: Marikina

Nationality: Filipino

Religion: Roman Catholic

Civil Status: Single

Occupation: N/A

Date of Admission: August 24, 2009

Time of admission: 9:00 pm

Physician: Dra. Del Valle

Place of Admission: H-Vill Hospital

Admitting Diagnosis: Dengue Fever Syndrome

a.1 CHIEF COMPLAIN

The patient complains of abdominal pain, headache, fever and general

flushing of skin with on and off vomiting.

a.2 PRESENT ILLNESS

Four days prior to admission, the patient had an intermittent fever

associated with abdominal pain, headache, and general flushing of the

skin with on and off vomiting. A few hours prior to admission still the above

sign and symptoms remain but already have (-) vomiting with

accompanying chills and was diagnosed with Dengue fever Syndrome.

a.3 PAST MEDICAL YEARS

It was according to the patient that he wasn't been hospitalized yet not

until when he was diagnosed with Dengue Fever Syndrome. Before that

diagnosis, he was already experiencing fever and his mom gives him a

Paracetamol for remedy.

a.4 FAMILY HISTORY

According to his grandmother the only disease that the family has

genetically is Diabetes Mellitus and no other diseases noted.

a.5 SOCIAL HISTORY

CJS is the son of Mr. and Mrs. SJ. CJS is currently on the secondary level

of education at Roosevelt College at Malanday, Marikina City, near their

place.

His father works as a seaman while his mother is a housewife; his

grandmother is also living with them. Hence, his grandmother and his

mother were the ones responsible in all the household chores.

According to CJS, he eats vegetables and fish instead he prefers

eating hotdogs. Furthermore he has no other vices except for computer

games. After school hours, he goes directly to the computer shop together

with his brother and friends.

a.6 ENVIRONMENTAL HISTORY

According to the patient the environment that the family have has an open

drainage, wherein big rats and cockroaches can be seen. The house is

cleaned by his mother and grandmother. It was described by the patient

that there are parts of their house that is deprived from light.

C. HISTORY OF ILLNESS

During the mid of August, CJS, started experiencing fever that persist only

at night. As a remedy his mom gave him Paracetamol to lower his body

temperature. Except from fever he’s also experiencing abdominal pain,

headache and general flushing of the skin with on and off vomiting.

As the above signs and symptoms persists, his parent decided to bring

him to the hospital.

Upon the physical assessment and after several diagnostic procedures

that the patient had undergone, he was diagnosed with Dengue Fever

Syndrome (DFS) and was admitted under the service of Dra. Del Valle.

THEORETICAL FRAMEWORK

CJS, is at the stage of puberty, was diagnosed of having Dengue Fever

Syndrome (DFS).At the clinical check-up, the physician was able to identify some

clinical signs of it and was referred to Dra. Del Valle. The case of CJS can be

correlated with the theory of Florence Nightingale

Application Theory:

The case of CJS can be correlated with the theory of Nightingale wherein,

the environment of the patient is a factor leading to recovery. Having a clean,

well ventilated and quite environment is important in. With a nurturing

environment, the body could repair itself.

PHYSICAL EXAMINATION

PHYSICAL ASSESSMENT

1. Received Patient on bed awake conscious and coherent 2. With IVF D5LR 1000ml at 450 cc level and regulated at 25gtts/min.

I. LINEAR MEASUREMENT

1. Height: 5’4’’2. Weight : 51kgs.

PHYSICAL ASSESSMENTNAME: CJSDATE OF ASSESSMENT: August 24, 2009VITAL SIGNS:BP: 10070 mmHg PR: 76bpmRR: 22bpm Temp: 36.5˚C

General Appearance: Received lying on bed, conscious and coherent. Pale and has general flushing with rashesArea assessed TechniqueUsedNormal Findings Actual Findings Rationale

Area Assessed Method Used Normal Findings Actual Findings RationaleSKINColor and pigmentation

LesionsTextureMoistureTemperatureMobility and turgor

NAILSNail bed colorShapeLesionsThicknesscapillary refill

Inspection

InspectionPalpationPalpationPalpationPalpation

InspectionInspectionInspectionPalpationPalpation

Light to deep brown

No lesions, scars or inflammationSmoothMoistThe skin springs back to its previous state after being pinched

PinkConvexNo inflammation ofthe skin around the nailFirm

General flushing

No lesions, but presence of scars SmoothMoistThe skin springs backto its previous stateafter being pinched

PaleConvexNo inflammation of theskin around the nail

Decrease WBCin the body

NormalNormalNormalNormalNormal

Decrease RBCin the bodyNormalNormalNormal

FirmNormal capillary refill

Normal (less than 3secs)

HEADSizeSymmetry

HAIRColorTextureOther findings

SCALPDistribution of hairLesionsOther findings

FACESkin colorTextureFacial movement

EYES

InspectionInspection

InspectionInspectionInspection

InspectionInspectionInspection

InspectionInspectionInspection

Proportion to the bodyand the skull isrounded and smoothSymmetrical

BlackCurly hair, straightNo nits/lice present

Evenly distributedNo inflammation,lumps or masses

Light to deep brownSmoothSymmetric facialmovement

Proportion to the bodyand the skull is roundedand smoothSymmetricalNo nits/lice present

No inflammation, lumpsor masses

PinkishSymmetric facialSymmetric facialmovement

NormalNormal

NormalNormalNormal

NormalNormalNormal

Due to feverNormalNormal

External structureEyebrowsEyelashesEyelids

EARSColorSymmetryShape and size

NOSEColorShapeDischarges

MOUTH LipsSymmetryMoisture

TONGUEPositionColor

InspectionInspectionInspectionInspection

InspectionInspectionInspection

InspectionInspectionInspection

InspectionInspectionInspection

InspectionInspection

Evenly distributedEvenly distributed,Evenly distributed, curved outward

Same as facial colorSymmetrical at thelevel of the eyescornerSymmetric to headNo discharges andinflammationSame as facial color

Same with facial colorSymmetricNo discharges

SymmetricPinkMoist

Positioned at thecenter can movefreely

Pink conjunctivaEvenly distributedEvenly distributed

Symmetric to headNo discharges andinflammationNormal

Same with facial colorSymmetricNo discharges

SymmetricPinkDry

Central positionDull red

NormalNormalNormal

NormalNormalNormal

NormalNormalNormal

NormalNormalD/t poornutrition

Normal

TextureMobilityLesions

NECKPositionSymmetryRange of movements

UPPER AND LOWEREXTREMITIESSizeSymmetryDistribution of hairSkin colorLesions

Temperature

InspectionInspectionInspection

InspectionInspectionInspectionPalpation

InspectionInspectionInspectionInspectionInspection

Inspection

Dull redSmoothCan move freelyNo lesions orinflammation

Head centeredSymmetricalSmooth movementswithout discomfortSymmetric and atmidline position

Equal sizeSymmetricalEvenly distributedLight to deep brownNo lesions,deformities orinflammation

Normal

SmoothCan move freelyNo lesions orinflammation

Head centeredSymmetricalSmooth movementswithout discomfortSymmetric and atmidline position

Equal sizeSymmetricalEvenly distributedLight to deep brownNo lesions,deformities orinflammation

Normal

NormalNormalNormalNormal

NormalNormalNormalNormal

NormalNormalNormalNormalDue todisease

Normal

GORDON’S 11 FUNCTIONAL HEALTH PATTERN

FUNCTION BEFORE

HOSPITALIZATIONDURING

HOSPITALIZATIONINTERPRETATION

Nutrition Eats 3x a day He loves to

eat bread & processed foods such as hotdog, tocino, longanisa, and others.

He doesn’t eat vegetables and fish

Seldom drinks water

Mostly eat bread

This time he frequently

drinks water

The Doctor ordered DAT diet to the patient except dark colored food

To replace fluid loss

Elimination He is able to urinate & defecate normally everyday by himself

He doesn’t have any problem on his elimination

Defecates usually early in the morning before going to school

He can still urinate & defecate by himself even without an assistance

His condition doesn’t affected his elimination pattern

Sleeping Has a regular sleeping pattern

Normal sleep is 6-8 hrs. per day but he naps for 1-2 hrs in the afternoon

Disturbed sleeping pattern

Due to adherence to time of medication & vital signs monitoring

Cognitive-Perceptual

Pattern

Has a normal cognitive perception

He is responsive & can

Portraying cooperativeness

Can comprehend well

He responds appropriately to verbal & physical stimuli

communicate well

Self- Perception-Self concept

Perceived himself as a good friend, brother & son.

This time he perceives himself as an approachable person

Due to his ability to establish good rapport to other people

Role Relationship

Pattern

He was able to do his responsibilities as a son & brother

This time his role as a patient is not fully met

Due to his condition, he is not aware of performing his real role in this field.

Sexuality-Reproductive

Pattern

He doesn’t think of the things like having a girlfriend & getting married.

Same Due to his youthful mind, it is still not his priority in life

Coping Stress & Tolerance

Pattern

He doesn’t fully identifies his stressors.

Same At his age, he still has a playful mind & he doesn’t mind the stressors in life.

Activity-Exercise Pattern

His daily routine on playing computer. His daily activities were limited in waking up in the morning to attend his class & after that going to computer shop.

He interacts with his grandmother & other people around him

Cooperates well to the doctor & nurses.

He only focuses on simple things.

Value-Belief Pattern

He is a Catholic

Due to their culture preferences & parent’s influence

Health Perception – Health Management

Pattern

He perceived his health in the state of good condition

He thinks that he is not healthy

Due to his illness

HEMATOLOGY

EXAMINATION REFERENCE VALUE

EXAM RESULTS

INTERPRETATION

Aug. 24,2009 Aug. 26, 2009RBC COUNT 4-6X1012/ L 5.1 4.7 Within normal rangeWBC COUNT 5-10X10g/L 3.0 2.4HEMOGLOBIN Male: 140-

170gms/ L155 138 Within normal range

Female: 120-140gms/L

HEMATOCRIT Male:0.43-0.54

0.47 0.42 Within normal range

Female: 0.37-0.45

DIFFERENTIAL COUNTSEGMENTERS 0.55-0.65 0.57 0.40LYMPHOCYTES 0.25-0.35 0.43 0.60MONOCYTES 0.02-0.06 -----------EOSINOPHIL 0.01-0.03 -----------BASOPHIL 0.01-1.0 -----------CLOTTING TIME ----------- -----------BLEEDING TIME ----------- -----------BLOOD TYPE ----------- -----------ESR ----------- -----------STAB ----------- -----------PLATELETS 150-400x103

g/L172 166 Within normal range

Brand name/ Generic name

Classification Action Indication Adverse Effect Contraindication Nursing consideration

Acetaminophen(Paracetamol)

Nonopoiod analgesics and anti pyretics

Produce analgesia by blocking pain impulses by inhibitinfg synthesis of prostaglandin in the CNS or of other substances that sensitize pain receptors to stimulation.

Symptomatic relief of pain and fever. Relief of headache, toothachge, back pain, dysmenorrheal,myalgias,neuralgias, etc. Analgesics and anti pyretic for patients hypersensitive to aspirin

Rash, nausea, vomiting, blood dyscrasias , anemia, analgesic nephropathy , nephrotoxicity , hypersensitivity reactions

Hypersensitivity. Patients

Patients with alcoholic liver disease. Impaired liver or kidney function

Assessment Nursing Diagnosis

Planning Nursing Intervention

Rationale Evaluation

Subjective:“Nangangati ako” as verbalized by the patient

Objective:V/S taken: Aug 24,2009 as of 4pm

BP – 100/70mmHgTemp. – 36.5˚CRR – 22 bpmPR – 76bpm

- Redness of the skin- Skin rashes

Risk for impaired skin integrity related to

Short Term Goal:

Within 2hours of nursing intervention, patient will demonstrate behavior in preventing skin impairment.

Long Term Goal:

After period of hospitalization, the patient will be able to understand and apply treatment/ or therapy, regimen to the skin impairment.

Independent Nursing Action:-Monitor vital signs

- Provide skin hygiene through sponge bathing & changing regularly

- Keep bed clothes dry, use non- irritating materials, & keep bed wrinkled free

- Palpate skin lesions for size, shape, consistency, texture & hydration

- Encourage reposition schedule for client

-Provide information to the

- Serves as baseline data to determine any discrepancies -To maintain skin integrity at optimal level.

-To avoid lesions, scratching of skin & harboring of microorganism.

- To assess extent of involvement of skin impairment.

-To prevent friction that may cause irritation of the skin

- To promote wellness by

After 8 hours of rendering effective nursing intervention the goal was completely met as evidenced by patient’s demonstration of behavior in preventing skin impairment.-patient verbalizes comfortability, decrease feeling of itchiness and gradual disappearance of rashes.-patient’s skin color(pigmentation) becomes normal (absence of redness)

client about the importance of regular observation & effective skin care

gaining knowledge on treatment/ therapy

Assessment Nursing Diagnosis

Planning Nursing Intervention

Rationale Evaluation

Subjective:“Masakit ang tiyan ko” as verbalized by the patient.

Objective:V/S taken: Aug 24,2009 as of 4pm

BP – 110/70mmHgTemp. – 35.5˚CRR – 30bpmPR – 67bpm

- Guarding of stomach- Facial grimace- Pain scale of 8

Acute pain related to clinical manifestations of dengue hemorrhagic fever

Short Term Goal:

Within 8 hours of effective nursing intervention patient will be able to feel less pain on his abdomen.

Long Term Goal:

After period of hospitalization, the patient will be able to maintain a relax and calm abdomen.

Independent Nursing Action:-Perform a comprehensive assessment of pain

- Provide nonpharmacologic management like change of position & applying warm compress- Encourage divers ional activities - Encourage rest period

Dependent nursing

- To improve quality, frequency & location of pain. -To alleviate pain.

-To divert his attentions to the pain - To prevent fatigue

After 8 hours of rendering effective nursing intervention the goal was partially met as evidenced by less guarding of stomach and patient’s verbalize partial relieve of pain.

intervention:- Administer medications as order by physicians such s gastroflora

- To alleviate pain.

Assessment Nursing Diagnosis

Planning Nursing Intervention

Rationale Evaluation

Subjective:“Mainit po ang katawan ko”as verbalized by the patient.

Objective:V/S taken: Aug 25,2009 as of 6pm

BP – 110/70mmHgTemp. – 38.6˚CRR – 30bpmPR – 67bpm

Elevated body temperature related to

Short Term Goal:

Within 8 hours of effective nursing intervention patient body temperature will be decrease from 38.6- 37.5˚C

Long Term Goal:

After period of hospitalization, the patient will be able to know the proper management of

Independent Nursing Action:-Monitor vital sign

- Monitor intake and output

- Perform TSB

-Increase oral fluid intake

- Provide safe & quite environment

- Serves at baseline data. -To know the fluid balance of the body

- To reduce body temperature through the process of conduction- To prevent dehydration and support circulating volume.- To provide

After 8 hours of rendering effective nursing intervention the goal was completely met as evidenced by patient’s body temperature decreases from 38.6-37.5˚C. Patient’s skin not warm to touch. Normal complexion of the skin.

- Flushing of skin- Skin warm to touch

hyperthermia -Inform the patient about proper management of fever

Dependent nursing intervention:- Administer medications as order by physicians such as Paracetamol or any anti –pyretic drugs.

conducive place to rest .Inform the patient about proper management of fever- To be able for the patient to know the proper management.

-To elevate the patient’s body temperature.

PATHOPHYSIOLOGY

↓

Bite of a aedes aegypti mosquito carrying a virus↓

Virus goes into the circulation↓

Infects cells & generate cellular response↓

Initiates destruction of the platelet↓

↑ Potential for hemorrhage↓

Stimulates intense inflammatory response ▼ ▼Release of exogenous pyrogens The body releases anti- ↓ inflammatory mediators↑ WBC (Neutrophils & Macrophages) (Histatin, Kinins) ↓ ↓Release of endogenous pyrogens Vascular response ↓ ↓ Reset of hypothalamic thermostat Redness & Heat ↓ ↓ Fever Headache, Vomiting ▼ ▼ Epistaxis, Abdominal pain Muscle contract Blood vessels Circulatory Collapse Shock To produce construct to ↓ Additional heat prevent loss of body heat DEATH ↓ ↓SHIVERING CHILLS

Non- predisposing Factor:- Age:13 y/o- Male

Predisposing Factor:-Immuno compromised - Environment

Discharge Planning

A. Patient's Name:> C.J.S a thirteen year-old male patient, who was diagnosed with Dengue Hemorrhagic Fever.

B. Diet:> Encourage nutritious foods like vegetables, meat and fruits.

C. Medications:> Give acetaminophen in case the temperatures increases.> Give oresol to replace fluid in the body.

D. Treatment:> Increased oral fluid intake.

E. Health Teaching:> D- discuss the possible source of infection of the disease.> E- educate the family/patient on how to eliminate those vectors.> N- Never stocked water in a container without cover.> G- Gallon, container and tires must have proper way of disposal.> U- Use insecticides at home to kill or reduce mosquito.> E- Encourage the family of the patient to clean the surroundings to destroy the

breeding places of mosquito.

REVIEW OF ANATOMY AND PHYSIOLOGYBLOODBlood is considered the essence of life because the uncontrolled loss of it can result todeath. Blood is a type of connective tissue, consisting of cells and cell fragments surrounded by aliquid matrix which circulates through the heart and blood vessels. The cells and cell fragmentsare formed elements and the liquid is plasma. Blood makes about 8% of total weight of the body.Functions of Blood:>transports gases, nutrients, waste products, and hormones>involve in regulation of homeostasis and the maintenance of PH, body temperature, fluid balance, and electrolyte levels>protects against diseases and blood lossPLASMAPlasma is a pale yellow fluid that accounts for over half of the total blood volume. Itconsists of 92% water and 8% suspended or dissolved substances such as proteins, ions,nutrients, gases, waste products, and regulatory substances.Plasma volume remains relatively constant. Normally, water intake through the GITclosely matches water loss through the kidneys, lungs, GIT and skin. The suspended anddissolved substances come from the liver, kidneys, intestines, endocrine glands, and immunetissues as spleen.

PREVENTING BLOOD LOSSWhen a blood vessel is damaged, blood can leak into other tissues and interfere with thenormal tissue function or blood can be lost from the body. Small amounts of blood from the bodycan be tolerated but new blood must be produced to replace the loss blood. If large amounts of  blood are lost, death can occur.BLOOD CLOTTINGPlatelet plugs alone are not sufficient to close large tears or cults in blood vessels. When a blood vessel is severely damaged, blood clotting or coagulation results in the formation of a clot.A clot is a network of threadlike protein fibers called fibrin, which traps blood cells, platelets andfluids.The fo rma t ion o f a b lood c lo t depends on a number o f p ro t e in s found w i th in p l a sma called clotting factors. Normally the clotting factors are inactive and do not cause clotting.Following injury however, the clotting factors are activated to produce a clot. This is a complex process involving chemical reactions, but it can be summarized in 3 main stages; the chemicalreactions can be stated in two ways: just as with platelets, the contact of inactive clotting factorswith exposed connective tissue can result in their activation. Chemicals released from injuredtissues can also cause activation of clotting factors. After the initial clotting factors are activated,they in turn activate other clotting factors. A series of reactions results in which each clottingfactor activates the next clotting factor in the series until the clotting factor prothrombin activator i s   f o r med .  P ro th rombin   ac t i va t o r   a c t s   on   an   i nac t i ve   c lo t t i ng  f ac to r   c a l l ed  p ro th r ombin . Prothrombin is converted to its active form called thrombin. Thrombin converts the inactiveclotting factor fibrinogen into its active form, fibrin. The fibrin threads form a network which traps blood cells and platelets and forms the clots.CONTROL OF CLOT FORMATIONWithout control, clotting would spread from the point of its initiation throughout thee n t i r e   c i r c u l a t o r y   s y s t e m .   T o   p r e v e n t   u n w a n t e d   c l o t t i n g ,   t he   b l o o d   c o n t a i n s   s e v e r a l anticoagulants which prevent clotting factors from forming clots. Normally there are enoughanticoagulants in the blood to prevent clot formation. At the injury site, however, the stimulationfor activating clotting factors is very strong. So many clotting factors are activated that theanticoagulants no longer can prevent a clot from forming.CLOT RETRACTION AND DISSOLUTIONAf te r a c l o t ha s fo rmed , i t beg in s t o condense i n to a dense r compac t s t r uc tu r e by a  process known as clot retraction. Serum, which is plasma without its clotting factors, is squeezedout of the clot during clot retraction. Consolidation of the clot pulls the edges of the damagedvessels together, helping the stop of the flow of blood, reducing the probability of infection andenhancing healing. The damaged vessel is repaired by the movement of fibroblasts into damaged  area and the formation of the new connective tissue. In addition, epithelial cells around thewound divide and fill in the torn area.The clot is dissolved by a process called fibrinolysis. An inactive plasma protein called plasminogen is converted to its active form, which is called plasmin. Thrombin and other

clottingf a c t o r s   a c t i v a t e d   d u r i n g   c l o t   f o r m a t i o n ,   o r   t i s s u e   p l a s m in o g e n   a c t i v a t o r   r e l e a s e d   f r o m surrounding tissues, stimulate the conversion of plasminogen to plasmin. Over a period of a fewdays the plasmin slowly breaks down the fibrin.

DRUG STUDYISOPRINOSINED o s a g e :   2   t s p   T I D   2 5 0  m g Classification: AntiviralsIndication:Rhinovirus; herpes genitalis; measles; encephalitis; influenza; herpes zoster; herpessimplex; type A & B hepatitis; AIDS related complex; neoplastic diseases; anergy andhypoergy prior to major surgeryAction:>Synthetic antiviral: it stimulates T-lymphocytes; used for HIV and Hepatitis>non-toxic immune system stimulantAdverse Reactions:>Transient increase in urine and serum uric acid level; very rarely skin rashes; pruritis;GI upset; nausea; fatigue; malaiseContraindications:>Hypersensitivity. Patients w/ adnormally low neutrophil counts (< 0.75 x 10x9/L), or abnormally low haemoglobin levels (< 7.5 g/dL or 4.65 mmol/L) Nx Considerations:>Monitor increase in serum uric acid level, gout, urolithiasis or renal dysfunction; pregnancy and lactation>Monitor hematological parametersPatient Teaching:>Inform patient that the drug must be taiken 1 hour apart on an empty Stomach>Instruct the patient to notify prescriber if unusual effects occurs

GENERIC NAME: cefuroxime

BRAND NAME: Ceftin, Zinacef

DRUG CLASS AND MECHANISM: Cefuroxime is a semisynthetic cephalosporin antibiotic, chemically similar to penicillin. Cephalosporins stop or slow the growth of bacterial cells by preventing bacteria from forming the cell wall that surrounds each cell. The cell wall protects bacteria from the external environment and keeps the contents of the cell together. Without a cell wall, bacteria are not able to survive. Cefuroxime is effective against a wide variety of bacteria, such as Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, E. coli ,  N. gonorrhea, and many others. The FDA approved cefuroxime in December 1987.PRESCRIPTION: YesGENERIC AVAILABLE: YesPREPARATIONS: Tablets: 125, 250 and 500 mg.

Powder for Oral Suspension: 125 or 250 mg per 5 ml (teaspoon).

Injection: 750 mg, 1.5 g and 7.5 g.

STORAGE: Tablets should be stored at room temperature between 15-30 C (59-86 F).

The oral suspension should be stored between 2-30 C (36-86F) prior to mixing and refrigerated between 2-8 C (3646 F) after mixing. The suspension should be discarded after 10 days.

PRESCRIBED FOR: Cefuroxime is effective against susceptible bacteria causing infections of the middle ear (otitis media), tonsillitis, throat infections, laryngitis, bronchitis, and pneumonia. It also is used for treatingurinary tract infections, skin infections, and gonorrhea. Additionally, it is useful in treating acute bacterial bronchitis in patients with chronic obstructive pulmonary disease (COPD).DOSING: Typical adult oral doses are 250 or 500 mg twice daily for 7-20 days depending on the type and severity of the infection. A single 1000 mg dose may used for uncomplicated gonorrhea. The tablets and suspension are not interchangeable.DRUG INTERACTIONS: Probenecid increases the concentration of cefuroxime in the blood. Drugs that reduce acidity in the stomach (for example, antacids, H2-blockers, proton pump inhibitors) may reduce absorption of cefuroxime.PREGNANCY: Cephalosporins are usually considered safe for use duringpregnancy.NURSING MOTHERS: Cefuroxime is excreted in breast milk and may cause adverse effects in the infant. Cefuroxime is approved for pediatric patients 3 months and older.SIDE EFFECTS: Cefuroxime is generally well tolerated, and side effects are usually transient. Side effects include diarrhea, nausea, vomiting, abdominal pain, headache, rash, hives, vaginitis, and mouth ulcers. Allergic reactions, severe skin reactions, anemia, and seizures also may occur. Since cefuroxime is chemically related to penicillin, patients allergic to penicillin may develop an allergic reaction (sometimes even anaphylaxis) to cefuroxime. Cefuroxime like other antibiotics can alter the colon's normal bacteria, leading to overgrowth of a bacterium called Clostridium difficile. Overgrowth of this bacterium leads to the release of toxins that contribute to the development of Clostridium difficile-associated diarrhea, which may range in severity from mild diarrhea to fatal pseudomembranous colitis.

GENERIC NAME:DiazepamBRAND NAME:ValiumCLASSIFICATION:Antianxiety agents, anticonvulsants, sedative/hyptonics, skeletal muscle relaxants (centrally acting)

DOSAGE:10 mg IMMECHANISM OF ACTION:- Depress the CNS, probably by potentiating GABA, an inhibitory neurotransmitter.- Produces skeletal muscle relaxation by inhibiting spinal polysynaptic afferent pathways.- Has anticonvul-sant properties due to enhanced presynaptic inhibi-tion.Therapeutic effects:(1) Relief of Anxiety(2) Sedation(3) Amnesia(4) Skeletal muscle relaxant(5) Decreased seizure activityINDICATION:-Adjunct in the management of:1) Anxiety2) Preoperative sedation3) Conscious sedation- Provides light anesthesia and anterograde amnesia- Treatment of status epilepticus/ uncontrolled seizures- Skeletal muscle relaxant- Management of the symptoms of alcohol withdrawalCONTRAINDICATIONS:- Hypersensitivity- Cross-sensitivity with other benzodiazepines may occurs- Comatose patients- Pre-existing CNS depression- Uncontrolled severe painUse cautiously in:1) Hepatic dysfunction2) Severe renal impairment3) History of suicide attempt or drug dependenceSIDE EFFECTS/ ADVERSE EFFECTS:- CNS:1) dizziness2) drowsiness3) lethargy4) hangover5) headache6) depression

- EENT:1) blurred vision- RESP:1) respiratory depression- CV:1) hypotension- GI:1) constipation2) diarrhea3) nausea4) vomiting- DERM:1) rashes- LOCAL:1) pain (IM)2) phlebitis (IV)3) venous thrombosis- MISC:1) physical & psychological depen-dence2)tolerance

NURSING IMPLICATIONS/RESPONSIBILITIES:- Monitor BP, PR,RR prior to periodically throughout therapy and frequently during IV therapy.- Assess IV site frequently during administration, diazepam may cause phlebitis and venous thrombosis.- Prolonged high-dose therapy may lead to psychological or physical dependence. Restrict amount of drug available to patient. Observe depressed patients closely for suicidal tendencies.- Observe and record intensity, duration and location of seizure activity. The initial dose of diazepam offers seizure control for 15-20 min after administration.- IM injections are painful and erratically absorbed. If IM route is used, inject deeply into deltoid muscle for maximum absorption.- Caution patient to avoid taking alcohol or other CNS depressants concurrently with this medication.- Effectiveness of therapy can be demonstrated by decrease anxiety level; control of seizures; decreased tremulousness.

Ener A Plus Manufacturer Distributor Contents Indications Dosage Administration MIMS Class ATC Classification Poison Schedule Presentation/Packing

Related Information:                                                                                              Abbreviation Index

Manufacturer JB Orchid Pharma

Distributor ECE Pharma

Contents Per 5 mL syrup Vit A palmitate 2000 IU, vit B1 5 mg, vit B2 2 mg, vit B6 2 mg, vit B12 1 mcg, vit C 100 mg, vit D3 400 IU, vit B3 30 mg, lysine monoHCl 100 mg, Zn sulfate 43.86 mg (equiv to Zn 10 mg), taurine 50 mg. Per mL drops Vit A palmitate 3333 IU, vit D3 667 IU, vit E 8.33 IU, vit C 100 mg, vit B12 0.833 mcg, vit B3 8.33 mg, vit B6 1 mg, vit B2 667 mcg, vit B1 667 mcg, taurine 33.33 mg, Zn sulfate (equiv to Zn 1.52 mg) 6.667 mg

Indications Multivit prep as supplement to meet the nutritional needs of infants & childn during rapid growth & development. For mental & visual development. Maximize body resistance against infections.

Dosage Syrup Childn >3 yr 5 mL; 1-3 yr 2.5 mL. Deficiency state 10-15 mL w/in 3-8 mth. Drops Infant 6 mth-2 yr 0.6 mL; up to 6 mth 0.3 mL. To be taken once daily.

Administration May be taken with or without food. May be taken w/ meals for better absorption or if GI discomfort occurs.

MIMS Class Vitamins & Minerals (Paediatric)

ATC Classification A11AA - Multivitamins with minerals ; Used as dietary supplements.

Poison Schedule Non-Rx

Presentation/Packing

Form Packing/Price

Ener A Plus oral drops15 mL x 1's (P77.81/bottle)30 mL x 1's (P106.33/bottle)

Ener A Plus syr60 mL x 1's (P92.00/bottle)120 mL x 1's (P129.59/bottle)240 mL x 1's (P247.10/bottle)

Hydrocortisone

Latest prescription information about Hydrocortisone. Learn how to pronounce the drug’s name, its indications, dosage, how to take, when to take, when not to take, side effects, special precautions, its storage instructions and warnings if any when taken during pregnancy. Also listed are the International and Indian trade name(s) of the drug and its price list.

Generic Name :   Hydrocortisone

Pronunciation : hye droe kor' ti sone

Therapeutic Classification :   Anorectal Preparations

ICD Code :   Y53.9  

Trade Name(s): 

India- Alcort Vial, Arvisone Inj, Cardol Vial, Cipcorlin Inj,

Cortecyclin Oint, Cort-H Oint, Cortola-M Eye Drops, Cort-S Vial,

Cortygard Inj, Drocort Cream, Drucort Vial, Efcorlin Inj Vial, Efficort

Cream, Eldercoid Lipocream, Entofoam Aerosol Foam, Geocort Vial,

H.S Vial, H-Cort Vial, Hisone Tab, Hisone Vial, Hobutide Vial, Hycort

Crm Cream, Hycort Vial, Hycoson Vial, Hydrocortisone Sod

Succinate Inj, Hydrocortisone Sodium Succinate Vial, Hy-Sone Inj,

Hyss Vial, Hyver Inj, Intacorlin Vial, Irays Vial, Labocort Vial,

Lacticare-Hc Lotion, Locoid Lipocrm Cream, Lycor Cream, Lycortin-

S Vial, M-Cort Vial, Multicort Vial, Multifungin-H Cream, Niscort

Vial, Novacort Vial, Primacort Vial, Q.D 4 Cream, Shcorty-H17

Cream, Smuth Cream, Succicort Vial, Tendrone Cream, Tocor Inj,

Unicort Vial, Wycort Inj, Wycort Vial, Wycort With Neomycin Oint. 

International- Cortef, Hydrocortone.

Why it is prescribed (Indications) : 

This medication is a corticosteroid, prescribed for severe allergies,

arthritis, asthma, multiple sclerosis and skin conditions.  It is also

used to treat certain types of cancer.

When it is not to be taken (Contraindications): 

Contraindicated in patients with systemic fungal infection, who are

taking mifepristone and hypersensitivity.

Pregnancy Category :A B C D X

Category C : Animal reproduction studies have shown an adverse

effect on the fetus and there are no adequate and well-controlled

studies in humans, but potential benefits may warrant use of the

drug in pregnant women despite potential risks.

Dosage & When it is to be taken : 

IV- The recommended dose is 20mg per day.

How it should be taken : 

It comes as a solution for injection to be administered by a

healthcare provider into the vein.

Warnings and Precautions : 

* Caution should be exercised in patients with history of liver,

kidney, intestinal, or heart disease, diabetes, underactive thyroid

gland, high blood pressure, mental illness, myasthenia gravis,

osteoporosis, herpes eye infection, seizures, tuberculosis (TB),

ulcers, any allergy, who are taking other medications, during

pregnancy and breastfeeding. 

* It may cause dizziness, do not drive a car or operate machinery

while taking this medication. 

* Avoid contact with people who have infections. 

* It may cause unusual changes in vision; if it is so consult with your

doctor. 

* It may affect blood sugar; monitor blood sugar level regularly

while taking this medication.

Side Effects : 

Fluid and Electrolyte Disturbances - Sodium retention, fluid

retention, heart failure, high blood pressure and potassium loss. 

Musculoskeletal - Muscle weakness, loss of muscle mass, joint

inflammation, vertebral compression fractures and cell death in

thighbone. 

Gastrointestinal - Peptic ulcer, stomach bleeding, abdominal

distention and ulcerative esophagus. 

Skin - Impaired wound healing, facial redness and increased

sweating. 

Central Nervous System - Convulsions, stroke, vertigo and

headache. 

Genitourinary - Menstrual irregularities, development of

Cushingoid state and suppression of growth in pediatric patients. 

Eye - Increased eye pressure and protruding eyeball. 

Other Precautions : 

* Avoid alcohol consumption.

Storage Conditions : 

Keep this medication out of the reach of children. Store it according

to the package directions.

NEOZEP FORTE 

   

Content:Phenylephrine HCl 10 mg, chlorphenamine maleate 2 mg, paracetamol 500 mg

Product category:Respiratory/ Cough, Cold, & Other Nasal Preparations/ Nasal Decongestants, Antiallergics & Related Drugs

Needs a prescription : No

What is this product for:Treatment of common colds, allergic rhinitis and sinusitis.

How to use it (Dosing):Adults and children 12 years and older - 1 tablet every 6 hours. Or as prescribed by the physician.

Available forms: Forte tablet 500 mg.

Company: Unilab Consumer Health

Click here to display precautions, side effects, etc

Read more: Hydrocortisone (Cortef) Drug Information - Indications, Dosage, Side Effects and Precautions | Medindia http://www.medindia.net/doctors/drug_information/hydrocortisone.htm#ixzz2buOtfkwc

Ceftriaxone

Latest prescription information about Ceftriaxone. Learn how to pronounce the drug’s name, its indications, dosage, how to take, when to take, when not to take, side effects, special precautions, its storage instructions and warnings if any when taken during pregnancy. Also listed are the International and Indian trade name(s) of the drug and its price list.

Generic Name :   Ceftriaxone

Pronunciation : SEF-trye-AX-one

Therapeutic Classification :   Antibiotics

ICD Code :   Y40.1  

Trade Name(s): 

India- Acticef Inj, Afzone Vial, Alitax Inj, Alkaceff Inj, Alnacef Inj,

Amcef Tab, Arixon Vial, Avcef Inj, Axocare Vial, Axone Vial, Axtrum

Inj, Becef Vial, Bintrax Vial, Broadcef Vial, Brucef Inj, C Tri Inj Vial,

Cadizone Vial, Cafage Vial, Cafzone Vial, Cebay Trx Inj, Cef Inj Inj,

Cefaday Vial, Cefamed Vial, Cefast Vial, Cefaxone Inj Vial, Cefcin

Vial, Cefera Vial, Cefezone Vial, Cefirone-V Ivvial, Cefmac Inj,

Cefmol Vial, Cefoat Inj, Cefocef Vial, Cefogram Vial, Cefotec Inj,

Cefritz Vial, Cefs Vial, Cefset Vial, Cefsine Inj, Ceftraset Vial,

Ceftrax Vial, Ceftrian Vial, Ceftril Vial, Ceftrisone Inj, Ceftrol Vial,

Ceftron Vial, Cefxi Vial, Cefzox Vial, Cepoxit-Cx Vial, Ceptradin Vial,

Cetazone Vial, Cetriax Vial, Cezone Vial, Champione Vial, Chuncif

Vial, Ciforion Vial, Ciplacef Dp-Inj, Comtrix Vial, Controx Vial,

Costrex Inj, Cotyx Inj, Cruzone Inj, Csi Inj, Ct Ceff Inj, C-Tech Vial,

Ct-Xone Vial, Cucef Vial, Cuxone Vial, Cx-One Inj, Daltrix Vial, D-Cef

Vial, Deczone Vial, Dewcef Inj, Dewcef Vial, E-Cef Inj Vial, E-Cef

Vial, Efectal Vial, Efoceft Vial, Eftanu Inj, Ekcef Vial, Emtri Vial,

Emtriaxone Inj Vial, Eracef Inj, Extacef-I Vial, Finetriax Vial, Fixi Inj

Vial, Forone Vial, Geminate Amp, Glen Vial, Glicef Inj, Gloriax Vial,

Gramocef Vial, Gutencef Vial, Haxone Vial, Hicef Inj, Hocef Inj,

Ifytrox Vial, Incef Inj Vial, Indocef Inj, Indoxone Inj, Inj Safelo Vial, I-

Tone Vial, Ivixone Vial, Kafi Vial, Keftra Vial, Kexone Inj, Labxone

Inj, Lezone Dry Syr, Lezone Vial, Lifecare Inj, Lisel Vial, Lyceft Inj,

Magtrax Vial, Marcef Vial, Mediceft Vial, Mocef Vial, Monocef I.V

Vial, Monotax Vial, Multi-Xone Vial, Nefzon Vial, Nexef-O Vial,

Nizotrax Vial, Nkcef Vial, Nosocef Vial, Novaceft Vial, Novatrax Inj,

Nu Axiom Vial, Nutracip Inj, O-Cef Vial, Oframax Vial, Omisafe Inj,

Omna One Vial, Oncef Vial, Ostri Inj, Pancef Vial, Petxone Inj,

Pfitrax Inj, Powercef Vial, Powerzip Vial, Proxone Inj, Recozone Inj,

Refzon Vial, Robitrax Vial, Safegard Vial, Sasucef Vial, Sayotex Vial,

Scotrum Vial, Sefsal Vial, Sefta Vial, Seftriax Inj, Septacel Inj, Siacef

Inj Inj, Sicef Vial, Simcef Vial, Sioxon Vial, Sologard Inj, Solotaz Vial,

Starone Inj, Stax Vial, Stercef Vial, Sulbasure-P Vial, Suntrix Vial,

Supercef Inj, Supraxone Vial, Symtrax Vial, Taxone Vial, Texar Vial,

Tgcef Vial, Ticef Vial, Torocef Vial, Traxocef Vial, Traxol Vial,

Traxton Vial, Trialex Inj, Triax Vial, Triazid Vial, Trikair Vial, Trilex

Vial, Trixon Vial, Trixone Vial, Troxone Vial, Vanco Plus Vial, Varcef

Vial, Vegacef Vial, Vikcef Inj, Virexim Vial, Wavocef Vial, Welcef Inj,

Wicef Inj Vial, Wycef Inj Vial, Xari Inj, Xixone Inj, Xone Vial,

Xoneceff Vial, Zefone Vial, Zencef Inj, Zenocef Vial, Zetri Vial, Z-One

Vial, Zotacef Vial, Zutex Vial, Zytrix Vial.

International- Rocephin.

Why it is prescribed (Indications) : 

This medication is a cephalosporin antibiotic, prescribed for certain

bacterial infections such as gonorrhea, pelvic inflammatory disease,

middle ear infection, meningitis (inflammation of the covering of the

brain), and infections of the lungs, ears, skin, urinary tract, blood,

bones and joints and typhoid. 

When it is not to be taken (Contraindications): 

Hypersensitivity to cephalosporins; neonates. Do not use calcium or

calcium-containing solutions or products with or within 48 hours of

ceftriaxone administration due to risk of calcium-ceftriaxone

precipitate formation in neonates.

Pregnancy Category :A B C D X

Category B : Animal reproduction studies have failed to

demonstrate a risk to the fetus and there are no adequate and well-

controlled studies in pregnant women OR Animal studies have

shown an adverse effect, but adequate and well-controlled studies in

pregnant women have failed to demonstrate a risk to the fetus in

any trimester.

Dosage & When it is to be taken : 

Middle ear infection: Children - IM A single dose of 50 mg/kg (max,

1 gram) is recommended.

Meningitis in children: Children - IV: Recommended initial dose is

100 mg/kg (max, 4 gram), followed by 100 mg/kg/day (max, 4

gram/day) for 7 to 14 days.

Skin or Skin Structure Infections: Children - IV/IM: Recommended

daily dosage is 50 to 75 mg/kg once a day or in equally divided

doses twice daily (max, 2 gram/day).

Surgical Prophylaxis: Adults - IV: 1 gram as a single dose 30 min to

2 hours before surgery. 

Uncomplicated Gonococcal Infections: Adults - IM: 250 mg as single

dose. 

Miscellaneous Infections: Adults - IV: Usual adult daily dosage is 1

to 2 g once a day or in equally divided doses twice daily, depending

on the type and severity of infection (max, 4 gram/day).

Children- IV: Recommended daily dose is 50 to 75 mg/kg IV once a

day or in divided doses every 12 h (max, 2 gram/day). IV/IM:

Recommended daily dose is 50 to 75 mg/kg IV/IM in divided doses

every 12 h (max, 2 gram/day). 

Acute Bacterial Otitis Media Persistent/Treatment Failure: Children

- IM/IV 50 mg/kg/ IM or IV (not to exceed 1 gram) daily for 3 days. 

Pelvic Inflammatory Disease (mild to moderate): Adults - IM 250 mg

given IM as a single dose with doxycycline 100 mg orally twice daily

for 14 days, with or without metronidazole 500 mg orally twice daily

for 14 days. 

Uncomplicated Gonococcal Infections: Adults - IM 125 mg given IM

as a single dose. 

Typhoid:Adult- IV: 4gm/day for 2 days, followed by 2g/day. Child-

75mg/day for 2 days.

How it should be taken : 

It comes as a solution for injected to be administered intravenously

(into a vein) or intramuscularly (into a muscle), by a healthcare

provider.

Warnings and Precautions : 

*Caution should be exercised in patients with history of penicillin

allergy; severe renal impairment; pregnancy and lactation; problem

with digestive system, especially colitis (inflammation of the large

intestine), malnutrition (you do not eat or cannot digest the

nutrients needed for good health), super infection. 

Be sure for the full course of treatment. If you do not, the medicine

may not clear up your infection completely.

Side Effects : 

Central Nervous System- Dizziness, Headache. 

Gastrointestinal- Diarrhea, nausea and vomiting. 

Blood- High concentration of eosinophils, platelet counts in the

blood, decrease in white blood cells, low prothrombin levels,

bleeding. 

Lab tests- Increase in liver enzyme, elevated BUN (Blood urea,

nitrogen). 

Local- Indurations/tightness/warmth. 

Genitourinary- Vaginal inflammation. 

Miscellaneous- Fatal ceftriaxone-calcium precipitates in lung and

kidneys of neonates.

Other Precautions : 

*Avoid long-term or repeated use, otherwise it will secondary

infection.

Storage Conditions : 

Injection: Store below 25°C. Store it at room temperature and keep

away from children.

Generic Name:MetoclopramideBrand Name:Clopra, Emex , Maxeran , Maxolon, ReglanClassifications:gastrointestinal agent; prokinetic agent (gi stimulant); autonomic nervous system agent; direct-acting cholinergic (parasympathomimetic); antiemeticPregnancy Category:BAvailability  5 mg, 10 mg tablets;  5 mg/5 mL solution;  5 mg/mL injectionActions  Potent central dopamine receptor antagonist. Structurally related to procainamide but has little antiarrhythmic or anesthetic activity. Exact mechanism of action not clear but appears to sensitize GI smooth muscle to effects of acetylcholine by direct action.Therapeutic effectsIncreases resting tone of esophageal sphincter, and tone and amplitude of upper GI contractions. As a result, gastric emptying and intestinal transit are accelerated with little effect, if any, on gastric, biliary, or pancreatic secretions. Antiemetic action results from drug-induced elevation of CTZ threshold and enhanced gastric emptying. In diabetic gastroparesis, indicated by relief of anorexia, nausea, vomiting, persistent fullness after meals.Uses   Management of diabetic gastric stasis (gastroparesis); to prevent nausea and vomiting associated with emetogenic cancer chemotherapy (e.g., cisplatin, dacarbazine); to facilitate intubation of small bowel; symptomatic treatment of gastroesophageal reflux.Contraindicatons  Sensitivity or intolerance to metoclopramide; allergy to sulfiting agents; history of seizure disorders; concurrent use of drugs that can cause extrapyramidal symptoms; pheochromocytoma; mechanical GI obstruction or perforation; history of breast cancer. Safety during pregnancy (category B) or lactation is not established.Cautious Use  CHF; hypokalemia; kidney dysfunction; GI hemorrhage; history of intermittent porphyria.Route & DosageGastroesophageal Refluxadult:PO  10–15 mg q.i.d. a.c. and h.s.child:PO/IV/IM  0.4–0.8 mg/kg/d in 4 divided dosesDiabetic Gastroparesisadult:PO  10 mg q.i.d. a.c. and h.s. for 2–8 wkgeriatric:PO  5 mg a.c and h.s.

Small-bowel Intubation, Radiologic Examinationadult:IM/IV  10 mg administered over 1–2 minchild:IM/IV  <6 y, 0.1 mg/kg over 1–2 min; 6–14 y, 2.5–5 mg over 1–2 minChemotherapy-induced Emesisadultchild:PO  2 mg/kg 1 h before antineoplastic administration, may repeat q2h for 3 more doses if neededIM/IV  2 mg/kg 30 min before antineoplastic administration, may repeat q2h for 2 doses, then q3h for 3 doses if neededAdverse effects:CNS:restlessness,drowsiness,fatigue,insomia,dizziness,anxietyCV:tansient hypertensionGI:nausea and diarrheaNursing Implications  Assessment & Drug Effects

Report immediately the onset of restlessness, involuntary movements, facial grimacing, rigidity, or tremors. Extrapyramidal symptoms are most likely to occur in children, young adults, and the older adult and with high-dose treatment of vomiting associated with cancer chemotherapy. Symptoms can take months to regress.

Be aware that during early treatment period, serum aldosterone may be elevated; after prolonged administration periods, it returns to pretreatment level.

Lab tests: Periodic serum electrolyte. Monitor for possible hypernatremia and hypokalemia, especially if patient

has CHF or cirrhosis. Adverse reactions associated with increased serum prolactin

concentration (galactorrhea, menstrual disorders, gynecomastia) usually disappear within a few weeks or months after drug treatment is stopped.

Patient & Family Education Avoid driving and other potentially hazardous activities for a few hours

after drug administration. Avoid alcohol and other CNS depressants. Report S&S of acute dystonia, such as trembling hands and facial

grimacing,immediately. Do not breast feed while taking this drug without consulting physician.

What is multivitamin ()?

Multivitamins are a combination of many different vitamins that are normally found in foods and other natural sources.

Multivitamins are used to provide vitamins that are not taken in through the diet. Multivitamins are also used to treat vitamin deficiencies (lack of vitamins) caused

by illness, pregnancy, poor nutrition, digestive disorders, and many other conditions.

Multivitamins may also be used for other purposes not listed in this medication guide.

Nephrovite Rx

round, yellow, imprinted with RD 12Prev 1 2 Next

What are the possible side effects of multivitamins ()?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

When taken as directed, multivitamins are not expected to cause serious side effects. Less serious side effects may include:

upset stomach; headache ; or unusual or unpleasant taste in your mouth.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

What is the most important information I should know about multivitamins ()?

Never take more than the recommended dose of a multivitamin. Avoid taking more than one multivitamin product at the same time unless your doctor tells you to. Taking similar vitamin products together can result in a vitamin overdose or serious side effects.

Many multivitamin products also contain minerals such as calcium, iron, magnesium, potassium, and zinc. Minerals (especially taken in large doses) can cause side effects such as tooth staining, increased urination, stomach bleeding, uneven heart rate, confusion, and muscle weakness or limp feeling. Read the label of any multivitamin product you take to make sure you are aware of what it contains.

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of vitamins A, D, E, or K can cause serious or life-threatening side effects. Certain minerals contained in a multivitamin may also cause serious overdose symptoms if you take too much.

Overdose symptoms may include stomach pain, vomiting, diarrhea, constipation, loss of appetite, hair loss, peeling skin, tingly feeling in or around your mouth, changes in menstrual periods, weight loss, severe headache, muscle or joint pain, severe back pain, blood in your urine, pale skin, and easy bruising or bleeding.

Do not take this medication with milk, other dairy products, calcium supplements, or antacids that contain calcium. Calcium may make it harder for your body to absorb certain ingredients of the multivitamin.

What is omx capsule?In: Uncategorized [Edit categories]

Drug   Research Therapeutically Focused Contract Research Organization Phase I - IV www.incresearch.com/ Ads

Answer:OMX (OHHIRA MOUNTAIN FRUITS EXTRACT) CAPSULE

Content:12 strains of lactobacillus and bifidus bacteria/FOS vitamins B6, B12, B3, niacinamide, folic acid, pantothenic acid, biotin, inositol, thiamine, iron, potassium, potassium (K+), phosphorus, sodium (Na+)

PPD Drug Class:Gastrointestinal (GI) Drugs/ Digestives, Dietary/ Dietary Supplements (registered as Food w/ FDA)/ Dietary Supplements, Other (reg. as Food)

Needs aPrescription:

No

Indications:Immune booster. For maintenance and restoration of intestinal microbial balance during and after treatment with antibiotics, chemotherapy, diarrhea, and other digestive disorder.

Recommended Dosage:

1-3 caps/day for 5 days preferably 1 hour before meals.

Available Forms:Capsule.Company: Pro Bio Pharma, Incorporated 

mercury drug perpetual cost 50.00 each 

 INTRODUCTIONDengue Fever is caused by one of the four closely related, but antigenically distinct, virusse ro types Dengue t ype 1 , Dengue t ype 2 , Dengue t ype 3 , and Dengue t ype 4 o f t he genus Flavivirus and Chikungunya virus. Infection with one of these serotype provides immunity toonly that serotype of life, to a person living in a Dengue-endemic area can have more than oneDengue infection during their lifetime. Dengue fever through the four different Dengue serotypesa r e ma in t a ined i n t he cyc l e wh ich i nvo lve s humans and Aedes aegyp t i o r Aedes a lbop i c tu s mosquito through the transmission of the viruses to humans by the bite of an infected mosquito.The mosquito becomes infected with the Dengue virus when it bites a person who has Dengueand a f t e r a week i t c an t r ansmi t t he v i ru s wh i l e b i t i ng a hea l t hy pe r son . Dengue canno t be transmitted or directly spread from person to person. Aedes aegypti is the most common aedesspecie which is a domestic, day-biting mosquito that prefers to feed on humans.

I N T U B A T I O N   P E R I O D : U n c e r t a i n .   P r o b a b l y 6   d a y s t o 1 0 D a y sPERIOD OF COMMUNICABILITY: Unknown. Presumed to be on the 1stweek of illness whenvirus is still present in the bloodCLINICAL MANIFESTATIONS:First 4 days:>febrile or invasive stage --- starts abruptly as high fever, abdominal pain andheadache; later flushing which may be accompanied by vomiting, conjunctivalinfection and epistaxis4thto 7thday:>toxic or hemorrhagic stage --- lowering of temperature, severe abdominal pain,vomiting and frequent bleeding from GIT in the form of melena; unstable BP,narrow pulse pressure and shock; death may occur; vasomotor collapse7thto 10thday:>convalescent or recovery stage --- generalized flushing with intervening areas of  blanching appetite regained and blood pressure already stableMODE OF TRANSMISSION:Dengue viruses are transmitted to humans through the infective bites of female Aedesmosquito. Mosquitoes generally acquire virus while feeding on the blood of an infected person.After virus incubation of 8-10 days, an infected mosquito is capable, during probing and bloodfeeding of transmitting the virus to susceptible individuals for the rest of its life. Infected femalemos qu i t oe s  may   a l so   t r a nsmi t   t he  v i ru s   t o   t he i r   o f f sp r i ng  by   t r anso va r i a l   ( v i a   t he   eggs ) transmission.Humans are the main amplifying host of the virus. The virus circulates in the blood of  infected humans for two to seven days, at approximately the same time as they have fever. Aedesmosquito may have

acquired the virus when they fed on an individual during this period. Denguecannot be transmitted through person to person mode.CLASSIFICATION:1 . S e v e r e , f r a n k   t y p e >flushing, sudden high fever, severe hemorrhage, followed by sudden drop of temperature, shock and terminating in recovery or death2 . M o d e r a t e >with high fever but less hemorrhage, no shock present3 . M i l d >with slight fever, with or without petichial hemorrhage but epidemiologicallyrelated to typical cases usually discovered in the course of invest or typical cases

 GRADING THE SEVERITY OF DENGUE FEVER:Grade 1:>fever >non-specific constitutional symptoms such as anorexia, vomiting and abdominal pain>absence of spontaneous bleeding>positive tourniquet testGrade 2:>signs and symptoms of Grade 1: plus>presence of spontaneous bleeding: mucocutaneous, gastrointestinalGrade 3:>signs and symptoms of Grade 2 with more severe bleeding: plus>evidence of circulatory failure: cold, clammy skin, irritability, weak tocompressible pulses, narrowing of pulse pressure to 20 mmhg or less, coldextremities, mental confusionGrade 4:>signs and symptoms of Grade 3, declared shock, massive bleeding, pulse lessand arterial blood Pressure = 1 mmhg (Dengue Syndrome/DS)SUSCEPTABILITY, RESISTANCE, AND OCCURRENCE:>all persons are susceptible>both sexes are equally affected>age groups predominantly affected are the pre-school age and school age>adults and infants are not exempted>peak age affected: 5-9 years oldDF is sporadic throughout the year. Epidemic usually occurs during rainy seasons (June –  November). Peak months are September – October. It occurs wherever vector mosquito exists.DIAGNOSTIC TEST:Tourniquet test>Inflate the blood pressure cuff on the upper arm to a point midway between thesystolic and diastolic pressure for 5 minutes.>Release cuff and make an imaginary 2.5 cm square or 1 inch square just belowthe cuff, at the antecubital fossa.>Count the number of petechiae inside the box. A test is positive when 20 or more petechiae per suare are observed.D e n g u e   h a e m o r r h a g i c   f e v e r   ( D H F ) ,   a   p o t e n t i a l l y   l e t h a l  c o m p l i c a t i o n ,   w a s   f i r s t recognized in the 1950s during the dengue epidemics in the Philippines and Thailand, but todayDHF affects most Asian countries and has become a leading cause of hospitalization and deathamong children in several of them.Last June 16, 2008, I encountered a patient with such kind of infection. This patient hascaught my attention and has given the opportunity to study his case. The objective of this study isto help me understand the disease process of Dengue Fever and to orient myself for appropriatenursing interventions that I could offer to the patient. This approach enables me to exercise myduties as student nurse which is to render care. I was given the chance to improve the quality of care I can offer and to pursue my chosen profession as future nurse.I humble myself to present my studied case and submit myself for further corrections towiden the scope of my knowledge and understanding. DENGUE PREVENTION:There is no vaccine to prevent dengue. Prevention centers on avoiding mosquito biteswhen traveling to areas where dengue occurs and when in U.S. areas, especially along the Texas-Mexico border, where dengue might occur. Eliminating

mosquito breeding sites in these areas isanother key prevention measure.Avoid mosquito bites when traveling in tropical areas:Use mosquito repellents on skin and clothing.When outdoors during times that mosquitoes are biting, wear long-sleeved shirts andlong pants tucked into socks.Avoid heavily populated residential areas.When indoors, stay in air-conditioned or screened areas. Use bednets if sleeping areasare not screened or air-conditioned.If you have symptoms of dengue, report your travel history to your doctor.Eliminate mosquito breeding sites in areas where dengue might occur:Eliminate mosquito breeding sites around homes. Discard items that can collect rainor run-off water, especially old tires.Regularly change the water in outdoor bird baths and pet and animal water containers. NURSING HISTORYPresent Health History:Three days prior to admission the patient has fever and loss his appetite. According to theSO of the patient, they went to consult a physician during the first day of his fever. The physician prescribed Paracetamol for the patient. On the third day, the patient still had the said symptoms.He went back for a check-up. He had CBC and was determined that he has dengue. The patientthen was admitted immediately to Saint Paul Hospital on June 14, 2008.Past Health History: According to the SO of the patient the patient did not yet experienced having serioushealth problems other than fever, colds and cough. He had no previous hospitalization.Family Health History:According to the SO of the patient, their family has the history of Hypertension