Lyza CS Slide

8/8/2019 Lyza CS Slide

1/71

DiagnosticExams


2/71

Date Test with

normal

values

Rationale Result Interpreta

tion &

Significa

nce

Nursing

Responsibi

lities

Novem

ber 6,

2010

&

December 14,

2010

Hemoglo

bin

120-160

g/dL

- the purpose

of this test is

to know the

values of the

componentsof blood to

determine

bodies

reaction

towards

something

foreign in the

body

q126

g/dLNor

mal

q98g/dLLow

A low red

blood cell

count or

low

hemoglobin may

suggest

anemia,

which can

have

many

causes.

Advise the

client to eat

food rich in

iron such as

seafoodsand red

meat to

increase in

iron helps in

the

manufacture

of

hemoglobin.


3/71

Erythroc

ytes

4.0-5.0

10^12L

-it is a

measure

of the

settling ofred blood

cells in a

tube of

blood

during one

hour. The

rate is an

indication

of

inflammati

on andincreases

in many

diseases.

3.87

10^12/L

Low

3.15

10^12

/L

Norm

al

-low

erythr

ocytes

is notusuall

y a

cause

for

concer

n, it

can be

seen

with

conditi

onsthat

inhibit,

Instruct the

client to

minimize

oral fluidintake to

prevent

further

fluid

retention.


4/71

the normal

sedimentation of

RBCs, such as

polycythemia,

extreme

leukocytosis and

some protein

abnormalities.Some changes in

red cell shape

(such as sickle

cells in sickle cell

anemia) also lower

the erythrocytes.


5/71

Mean

Corpusc

ular

Hemogl

obin

(MCH)

27.0-33.0 pg

-it is the average

amount of

hemoglobin

per red blood

cell in a blood

sample, used

to help

diagnose the

type (cause)

and severity

of anemia.

32.6 pg

Normal

31.2 pg

Normal

-within

normal

range of

mean

corpuscul

ar

hemoglob

ing is

normochr

omic

anemia (a

form of

anemia in

which the

concentra

tion of

hemoglobin in the

red blood

cells is

within the

standard

range)

Advise the

client to

always

follow the

doctors

order to

normally

maintain her

normal MCH

count.


6/71

Mean

Corpuscu

lar

Volume

(MCV)80-96 fl

-is a blood test that

measures the

average red

blood cell

volume (size), isused to tell the

difference

between types

(causes) of

anemia.

100.0 fl

Normal

93.6 fl

Normal

-A high MCV,

indicating

macrocytic

anemia (is

an in whichthe

erythrocyte

s are

larger than

their

normal

volume),can have a

variety of

causes

including

alcoholism,

liver

disease,and

deficiencie

s of

vitamin

B12 and

folic acid

(folate).

Instruct the client

to avoid

alcohol intake

as to

decrease theMCV volume

and prevent

further liver

complications


7/71

Mean

Corpus

cular

Hemoglobin

Concen

tration

(MCHC)

32-36 g/dL

-to know the

mean cell

hemoglobin

concentration, the

average

concentratio

n of

hemoglobin

in a given

volume of

blood, it is

used to help

diagnose the

type (cause)and severity

of anemia.

32.6 g/dL

Normal

-Normal

Mean

Corpusc

ularHemoglo

bin

Concent

ration is

associat

ed with

pernicio

us

anemia.

Advise the

client to

religiously

follow thedoctors

order as to

prevent

any

complicatio

ns from

happening.


8/71

Leukocyte

5.0-10.0

10^9

-it measures the

number of

WBCs (also

called

leukocytes) inthe blood

which help the

body fight

infection, are

bigger than

red blood cells

and there arefar fewer of

them in the

bloodstream

11.5

10^9/

L

o High

25.7

10^9/

L

High

-a high White

Blood

Cell

count

(leukocytosis) may

signify an

infection

somewhe

re in the

body or,

lesscommonl

y, it may

signify an

underlyin

g

malignan

cy.

Encourage the

patient to

increase

Vitamin C

intake tostrengthen

the bodys

resistance

to

microorgani

sms. The

nurseshould

perform

proper hand

washing

before and

after coming

in contact

with patient

as to

prevent

further

spreading of

infection.


9/71

Neutrophils

0.55-0.65 %

are the most

common type of

white blood cell,

comprising about

50-70% of all whiteblood cells. They

are phagocytic,

meaning that they

can ingest other

cells, though they

do not survive the

act. Neutrophils arethe first immune

cells to arrive at a

site of infection,

through a process

known as

chemotaxis.

0.70 %

o High

0.81 %

High

-Can increase

in

response

to bacterial

infection orinflammato

ry disease.

Severe

elevations

in

neutrophils

may becaused by

various

bone

marrow

disorders,

such as

chronicmyelogeno

us

leukemia.

Wash hands

before and

after being in

contact with

patient andinstruct

patient to

increase

intake of

foods rich

vitamin C

such orangesand

pineapples.


10/71

Lymphocy

te

0.25-0.40

%

-a small white

blood cell

(leukocyte)

that plays a

large role in

defending

the body

against

disease.

Lymphocyte

s areresponsible

forimmune

responses.

0.20 %

q Low

0.07 %

Low

-Decreased

lymphoc

yte

levels

can

indicate

disease

s that

affect

the

immunesystem,

such as

lupus,

and the

later

stagesof HIV

infection

.

Increase

intake of

foods rich

in vitamin

C and

Vitamin E

such as

peanuts

and egg

yolks as

vitamin Eis an

antioxidant

that slows

down the

symptoms

of agingand

strengthen

s body

cells that

fight

infection.


11/71

Monocytes

0.02-0.06 %

-a white blood cell

that has a

single nucleus

and can

ingest (take

in) foreign

material. (In

other words, a

monocyte is

thus a

mononuclear

phagocytethat circulates

in the blood.)

0.08 %

o High

0.07 %

High

-can increase

in

response

to

infection

of all

kinds as

well as to

inflammat

ory

disorders

.Monocyte

counts

are also

increased

in certain

malignant

disorders,

including

leukemia.

Encourage the

client to

minimize

sugar and

allergens on

their daily

diet as too

much sugar

can impair

white blood

cells up to

50% in avery short

period of

time.


12/71

Eosinophils

0.01-0.05

%

-a type of

leukocyt

e (white

blood

cell) with

coarse

round

granules

of

uniform

size

within its

cytoplas

m and

typically

a

bilobate(two-

lobed)

nucleus.

0.02 %

Norma

l

0.04 %

Norma

l

High numbers of

eosinophils

(eosinophilia)

are usually

associated withAllergic

diseases

and infections

from parasites

such as worms.

A lower-than-

normal

eosinophilcount may be

due

to:

Alcohol

intoxication

Over production

of certainsteroids

in the body

(such

as cortisol)

Instruct the

client to

always

follow the

doctorsorders as to

maintain

the normal

values of

her

eosinophils.

Tell theclient to

avoid

eating raw

and street

food as it is

mostly

whereparasitic

worms

develops.


13/71

Basophils

0.00-

0.005 %

-a type of

leukocyt

e (white

blood

cell) with

coarse

bluish-

black

granules

of

uniform

size

within

the

cytoplas

m and

typicallya

bilobate

(two-

lobed)

nucleus.

0.00 %

Nor

mal

It can

increase

in cases

of

leukemia,

chronic

inflammati

on, the

presence

of a

hypersen

sitivity

reaction

to food, or

radiation

therapy.

Administer

the

appropriat

e

medicatio

n for

allergic

reactions.

Advice the

patient to

avoid

eating

foods that

she is

aware of

being

allergic to.

0.01 %

Hig

ho


14/71

Basophils

0.00-

0.005 %

-a type of

leukocyt

e (white

blood

cell) with

coarse

bluish-

black

granules

of

uniform

size

within

the

cytoplas

m and

typicallya

bilobate

(two-

lobed)

nucleus.

0.00 %

Nor

mal

It can

increase

in cases

of

leukemia,

chronic

inflammati

on, the

presence

of a

hypersen

sitivity

reaction

to food, or

radiation

therapy.

Administer

the

appropriat

e

medicatio

n for

allergic

reactions.

Advice the

patient to

avoid

eating

foods that

she is

aware of

being

allergic to.

0.01 %

Hig

ho


15/71

Thrombocyt

e

150.0-

300.010^9/L

-to know the

numbers

, size,

and

health ofthrombo

cytes

209

10

^9/

L

Norm

al

218

10

^9/

L

No

rm

al

If platelet count is

normal and thus

indicates that

the bone

marrow isfunctioning

normally and the

platelets are not

being eaten

away rapidly.

Encourage

the patient

to

maintain a

healthylifestyle

and follow

the

doctors

order as

to

maintainthe normal

values of

her

thrombocy

tes.


16/71

Generic Name: cephalexin

Brand name: Apo-Cephalex, Keflex, Novo-Lexin,

N

u-Cephalex, Panixine, Cefalin

Classification:

Therapeutic: anti-infective

Pharmacologic: first-generation cephalosporin

Date ordered: 12/13/10

Ordered dose of frequency: 500mg i tab

Route/ Dosage:

PO (Adults): Most infections-250-500 mg q 6 hr. Uncomplicated

cystitis, skin and soft tissue infections, streptococcal pharyngitis-

500 mg q 12 hr.

PO (Children): Most infections-25-50 kg/day divided by q 6-8 hr.

Uncomplicated cystitis, skin and soft tissue infections,

streptococcal pharyngitis-12.5-25 mg/kg q 12 hr. Otitis media-

18.75-255 mg/kg mg q 6 hr.


17/71

Mechanism of Action:

Bind to bacterial cell wall membrane, causing cell death.

Therapeutic effects: bactericidal action against susceptible bacteria.

Spectrum:Active against many gram-positive cocci.

Indication: Treatment of skin and skin structure infections,

Pneumonia, Otitis media, urinary tract infections, Bone and joint infections,

Septicemia caused by susceptible organisms.

Contraindication: Hypersensitivity to cephalosporins. Serioushypersensitivity to penicillinase

Adverse Reactions/ Side effects: CNS:seizures (high doses). GI:

pseudomembranous colitis, diarrhea, nausea, vomiting, cramps. Derm:

rashes, pruritis, urticaria. Local: pain at IM site, phlebitis at IV site.

Drug interaction:

Drug-drug: Probenicid decreases excretion and increases blood

levels of renally excreted cephalosprins. Concurrent use of loop diuretics

or aminoglycosides may increase risk of renal toxicity.


18/71

Nursing responsibilities:

Assess for infection at beginning and during therapy.

Before initiating therapy, obtain a history to determine previous useof and reactions to penicillin and cephalosporin

Obtain specimens for culture and sensitivity before initiating

therapy.

Observe patient with signs and symptoms of anaphylaxis and

advise patient to report signs of superinfection (furry overgrowth onthe tongue, vaginal itching or discharge, loose or foul-smelling

stools) and allergy.

Administer around the clock. May be administered on full or empty

stomach.

Advise patient to notify health care professional if fever anddiarrhea develop, especially if diarrhea contains blood, mucus, or

pus. Advise not to treat diarrhea without consulting health care

professional.

Advise patient not to take drugs with dairy of Caffeinated products.


19/71

Generic Name: cefazolin

Brand name: Ancef

Classification:Therapeutic: anti-infectives

Pharmacologic: first-generation

cephalosporins


Ordered dose of frequency: 1 gm IVTT q 6hours

Route/ Dosage:

IM, IV (Adults):

Moderate to severe infection-500mg 1g q 6-8 hr. Mild

infections with gram-positive cocci-250-500 mg q 8hr.

Uncomplicated UTI-1 g q 12 hr.

IM, IV (Children and infants): 6.25-25 mg/kg q 6 hr


20/71



Therapeutic effects: bactericidal action against susceptible

bacteria.

Spectrum:Active against many gram-positive cocci.

Indication: Preoperative prophylaxis

Contraindication: Hypersensitivity to cephalosporins.

Serious hypersensitivity to penicillinaseDrug interaction:

Drug-drug: Probenicid decreases excretion and increases

blood levels of renally excreted cephalosprins. Concurrent

use of loop diuretics or aminoglycosides may increase risk of

renal toxicity

Adverse Reactions/ Side effects: CNS:seizures (high

doses). GI: pseudomembranous colitis, diarrhea, nausea,

vomiting, cramps. Derm: rashes, pruritis, urticaria. Local: pain

at IM site, phlebitis at IV site.


21/71



Before initiating therapy, obtain a history to determine

previous use of and reactions to penicillin and cephalosporin

Obtain specimens for culture and sensitivity before initiating

therapy.

Observe patient with signs and symptoms of anaphylaxis and

advise patient to report signs of superinfection (furryovergrowth on the tongue, vaginal itching or discharge, loose

or foul-smelling stools) and allergy.

Administer around the clock. May be administered on full or

empty stomach.

Advise patient to notify health care professional if fever and

diarrhea develop, especially if diarrhea contains blood,

mucus, or pus. Advise not to treat diarrhea without consulting

health care professional.


22/71

Generic Name: cefuroxime

Brand name: Ceftin, Zinasef

Classification:Therapeutics: anti-infective

Pharmacologic: second-generation cephalosporin

Date ordered: home medication

Ordered dose of frequency: 500mg tab 3x a day

Route/ Dosage:PO (Adults and children >12 yr):

Most infections-250-500 mg q 12 hr.

UTI-125-250 mg q 12 hr

PO (Children


23/71



Therapeutic effects: bactericidal action against susceptible bacteria.

Spectrum: Similar to that of the first generation cephalosporin but active against

other gram-negative pathogens.Indication: Treatment of: Respiratory tract infections, Skin and skin

structure infections, bone and joint infections, urinary tract and gynaecologic

infection, septicaemia, Meningitis, Otitis media, Perioperative prophylaxis.

Contraindication: Hypersensitivity to cephalosporins. Serious

hypersensitivity to penicillinase

Drug interaction:Concomitant administration of probenecid with cefuroxime axetil tablets increases

the area under the serum concentration versus time curve by 50%. The peak

serum cefuroxime concentration after a 1.5-g single dose is greater when taken

with 1 g of probenecid (mean = 14.8 mcg/mL) than without probenecid (mean =

12.2 mcg/mL).

Drugs that reduce gastric acidity may result in a lower bioavailability of CEFTINcompared with that of fasting state and tend to cancel the effect of postprandial

absorption.

In common with other antibiotics, cefuroxime axetil may affect the gut flora,

leading to lower estrogen reabsorption and reduced efficacy of combined oral

estrogen/progesterone contraceptives.

Adverse Reactions/ Side effects: seizures,


24/71



Before initiating therapy, obtain a history to determine previous

use of and reactions to penicillin and cephalosporin.Obtain specimens for culture and sensitivity before initiating

therapy.

Instruct patient to take medication around the clock at evenly

spaced times and to finish the medication completely, even if

feeling better.Advise patient to report signs of superinfection (furry overgrowth

on the tongue, vaginal itching or discharge, loose or foul-smelling

stools) and allergy.

Advise patient to notify health care professional if fever and

diarrhea develop, especially if diarrhea contains blood, mucus, orpus. Advise not to treat diarrhea without consulting health care

professional.

Cefuroxime tablets should be swallowed whole, not crushed.

Tablets may be taken without regard to meals. Suspension must be

taken with meals. Shake well eachtime before using


25/71

Generic Name: lactulose

Brand Name: Cephulac, Cholac,Chronulac, Constilac,

Constulose, Duphalac, Enulose, Evalose,

Heptalac, Kritalose

Classification:

Therapeutic: laxativesPharmacologic: osmotic


Ordered dose of frequency: 30ml

Route/ Dosage:

PO (Adults): 15-30 ml/day up to 60ml/day as

liquid or 10-20g as powder for oral solution

PO (Children): 7.5ml daily


26/71


Increases water content and softens the stool. Lowers the

pH of the colon, which inhibits the diffusion of ammoniafrom the colon into the blood, thereby reducing blood

ammonia levels.

Therapeutic Effects: Relief of constipation. Decreased blood

ammonia levels with improved mental status PSE

Indication: treatment of chronic constipation in adultsand geriatric patients. Adjunct in the management of portal-

systemic (hepatic) encephalophaty (PSE)

Contraindication: Low-galactose diets

Drug interaction:

Drug-drug: Should not be used with other laxatives in the

treatment of hepatic encephalopathy

Adverse Reactions/ Side effects: belching, cramps,

distention, flatulence, diarrhea, hyperglycemia


27/71


Assist patient for abdominal distention,presence of bowel sounds, and normal pattern

of bowel functions.

Assess color, consistency, and amount of

stool produce.Monitor cause increased blood glucose levels

in diabetic patients

Monitor serum electrolytes periodically when

used chronically. May cause diarrhea with

resulting hypokalemia and hyponatremia.


28/71

Generic Name: promethazine

Brand Name: Antinaus, Histanil,

Pentazine, Phenadoz,Phenergan, Promacot,Promet, Prorex

Classification:

Therapeutic: antiemetics,

antihistamines, sedative

Pharmacologic: phenothiazines


Ordered dose of frequency: 12.5mg slow

1VTT stat

Route/ Dosage:Sedation during labor

IM,IV (Adults): 50 mg in early labor; when

labor is established, additional doses of 25-75

mg may be given 1-2 times at 4-hr intervals


29/71


Blocks the effects of histamine.

Has inhibitory effect on the chemoreceptor trigger zone in the medulla,

resulting in antiemetic properties.Alters the effects of dopamine in the CNS.

Produces CNS depression by indirectly decreased sstimulation of the

CNS reticular system.

Indication: Treatment of various allergic conditions and motion

sickness. Preoperative sedation. Treatment and prevention of nausea

and vomiting. Adjunct to anesthesia and analgesia.

Contraindication: Hypersensitivity; Comatose patients; Prostatic

hypertrophy

Drug interaction: Drug-drug:Additive CNS depression with other

CNS depressants, including alcohol, other antihistamines and other

sedatives; Additive anticholinergic properties.Adverse Reactions/ Side effects: CNS: confusion, disorientation,

sedation, dizziness, fatigue, insomnia, nervousness. EENT: blurred

vision, diplopia. CV: hypertension, tachycardia, bradycardia,

hypotension. GI: constipation, dry mouth. Derm: rashes, photosensiivity.

MS:joint pain.


30/71

Nursing responsibilities:Monitor blood pressure, pulse, and respiratory

rate frequently in patients receiving IV doses.

Assess patient for level of sedation after

administrationAssess allergy symptoms before and

periodically throughout the course of therapy.

Assess for nausea and vomiting before and

after administration.


31/71

Generic Name: Ferrous sulfate, Folic

acid,

Pregnancy/lactation vitamins &/orminerals,

Vitamin B-complex

Brand Name: Hemarate

Classification: A11JB - Vitamins

with minerals ; Used as dietarysupplements.


Ordered dose of frequency: 1 tab

bid

Route/ Dosage:

PO: 1 tab daily.


32/71

Mechanism of Action: Iron is an essential component in

the physiological formation of hemoglobin, adequate amounts of

which are necessary for effective erythropoiesis and the

resultant oxygen transport capacity of the blood. A similar

function is provided by iron in myoglobin production. Iron also

serves as a cofactor of several essential enzymes, including

cytochromes that are involved in electron transport. Iron is

necessary for catecholamine metabolism and the proper

functioning of neutrophils.

Indication: Prevention & treatment of Fe deficiency anemia,

folate deficiency & for the lowering of plasma homocysteine.

Contraindication: Hemochromatosis, peptic ulcer, regional

enteritis, ulcerative colitis.

Drug interaction: Vitamins & Minerals (Pre & Post

Natal) / Antianemics

Adverse Reactions/ Side effects: Nausea, vomiting, bloating,

upper abdominal discomfort, diarrhea or constipation, staining of

teeth, darker stools.


33/71


Instruct the patient that drug should be

taken on an empty stomach (Best taken

between meals. May be taken w/ meals toreduce GI discomfort.).


34/71

Generic Name: mefenamic acid

Brand name: Revalan

Classification: Decreases inflammation,

pain, and fever, probably through inhibition ofcyclooxygenase activity and prostaglandin

synthesis.


Ordered dose of frequency:

500g/tab 1 tab q 6 hrsRoute/ Dosage:

Adults andChildren (14 yr or age and older)

:

Acute Pain

PO 500 mg, followed by 250 mg every 6 has needed. Usually not used more than 1 wk.

Primary Dysmenorrhea

PO 500 mg, followed by 250 mg every 6 h

starting with onset of bleeding and associated

symptoms.


35/71

Mechanism of Action: inhibits reuptake of serotonin norepinephrine CNS.

Indication: Relief of moderate pain lasting less than 1 wk; treatment of

primary dysmenorrhea.Contraindication: Patients in whom aspirin, iodides, or any NSAID

has caused allergic-type reactions; preexisting renal disease; active

ulceration or chronic inflammation of GI tract.

Drug interaction: Anticoagulants

Increased risk of gastric erosion and bleeding.

CyclosporineNephrotoxicity of both agents may be increased.

CYP-450

Exercise caution when coadministering mefenamic acid with drugs known

to inhibit the isoenzyme 2C9.

LithiumSerum lithium levels may be increased.

Methotrexate

Increased methotrexate levels.

Salicylates

Additive GI toxicity.


36/71

Nursing Responsibilities:

Inform patient not to use drug for longer than 1 wk. If given for

dysmenorrhea, instruct patient to begin taking drug with onset of bleeding

and associated symptoms.Warn patient about potential for bleeding, and advise patient to notify

other health care professionals that drug is being taken.

Advise patient to discontinue medication if rash develops and to contact

health care provider.

Instruct patient to report the following symptoms to health care provider:rash, visual problems, dark stools, decreased urinary output, persistent

headache or stomach pain and unusual bruising or bleeding.

Advise patient to avoid intake of alcoholic beverages.

Instruct patient that drug may cause drowsiness and to use caution while

driving or performing other activities requiring mental alertness.

Caution patient to avoid prolonged exposure to sunlight and to usesunscreen or wear protective clothing to avoid photosensitivity reaction.

Instruct patient not to take OTC medications, including aspirin and

ibuprofen or other prescription drugs, without consulting health care

provider.


37/71

Generic Name: Ivermectin + Pyrantel

Ferrous Gluconate 250mg, Vit B12, intrinisic factor

7.5mcg, Vit C 50mg, Folic Acid 1mg, Sorbitol 25mg,copper Sulphate 200mcg, Manganese Sulphate

200mcg; caps, Ferrous Gluconate 129.5mg, Vit B1-

1mg, Vit B2-1mg, Vit B6-1.5mg, Nicotinamide 15mg,

biotin 300mcg/5ml; syp

Brand name: Sangobion

Classification:

B03AE10 - Various combinations ; Belongs to the

class of iron in other combinations. Used in the

treatment of anemia.

Date ordered:12/13/10

Ordered dose of frequency: 1 tab bid

Route/ Dosage:

Cap 1-2 cap daily. SyrProphylaxis 1 tsp

daily. Therapy 3-6 tsp daily.


38/71


Ivermectin - Microfilaricidal; ivermectin binds selectively and with high affinity to

glutamate-gated chloride ion channels in invertebrate muscle and nerve cells ofthe microfilaria. This binding causes an increase in the permeability of the cell

membrane to chloride ions and results in hyperpolarization of the cell, leading to

paralysis and death of the parasite. Ivermectin also is believed to act as an

agonist of the neurotransmitter gamma-aminobutyric acid (GABA), thereby

disrupting GABA-mediated central nervous system (CNS) neurosynaptic

transmission.Although not macrofilaricidal, ivermectin may also impair normal intrauterine

development ofO. volvulus microfilariae and may inhibit their release from the

uteri of gravid female worms. Action on microfilariae is less abrupt but more

prolonged than that of diethylcarbamazine. Ivermectin promptly decreases skin

microfilarial counts, while the number of microfilariae in the cornea and anterior

chamber of the eye decreases more slowly.

Pyrantel - Not vermicidal or ovicidal; acts as a depolarizing neuromuscular

blocking agent, thereby causing sudden contraction, followed by paralysis, of the

helminths; also acts as a cholinesterase inhibitor and ganglionic stimulant;

helminths are rendered unable to maintain their position in the intestinal lumen

and are expelled from the body in the fecal stream by peristalsis.


39/71

Indication:

Cap Fe-deficiency anemia & anemia during growth,old age & convalescence;megaloblastic

anemia during pregnancy, in sprue or parasitosis;

anemia due to general dietary insufficiency; anemia

prophylaxis in blood donors. Prevention ofmaternal constipation due to pregnancy & iron

intolerability. SyrFe-deficiency anemia in childn,

latent insufficiency of Fe & vit B; in chronic illnesses &

during convalescence.Contraindication:

Fe accumulation; disorders in Fe utilization.


40/71

Drug interaction: Pyrantel - Because of similar

mechanisms of action (and toxicity), pyrantel is recommended not to be

used concurrently with morantel or levamisole. Observation for adverse

effects should be intensified if used concomitantly with an

organophosphate or diethylcarbamazine. Piperazine and pyrantel haveantagonistic mechanisms of action; do not use together.]

Ivermectin - the products that may interact with this drug include:

barbiturates (such as phenobarbital, butalbital), benzodiazepines (such as

clonazepam, diazepam, lorazepam), sodium oxybate (GHB), valproic acid.

Adverse Reactions/ Side effects:As mentioned, certain side effects are associated with using this

medication. Some of these side effects include diarrhea, nausea,

dizziness, skin rash, itching, vision problems, swelling of the lymph nodes,

and swelling of your hands, ankles, or feet. While these are considered

the most common side effects associated with using this medication, they

only affect a small amount of users. A number of severe side effects arealso associated with using ivermectin pyrantel. Some of these side effects

include sudden vision changes, bowel problems, urinary infections, lack of

coordination, confusion, weakness, eye swelling and pain, eye redness,

and convulsions. These side effects are also very rare and do not affect a

large amount of users.


41/71


Administer the medicine with meals.

Teach client proper breathing techniques.Monitor the clients hemoglobin count.


42/71

Generic Name: nalbuphine

Brand name: Nubain

Classification:

Therapeutic: opioid

analgesics

Pharmacologic: opioid agonist/analgesics


Ordered dose of frequency: 2.5mg

slow 1VTT stat

Route/ Dosage: IM,SQ,IV (Adults):

Usual dose is 10 mg q 3-6 hr


43/71

Mechanism of Action: Binds to opiate receptors in the

CNS; Alters the perception of and response to painful stimuli

while producing generalized CNS depression

Indication: Moderate to severe pain. Also provides:analgesia during labor, sedation before surgery. Supplement

to balance anesthesia.

Contraindication: Hypersensitivity t nalbuphine or

bisulfites.

Drug interaction: Drug-drug: Use Additive CNS depression

with alcohol, antihistamines, and sedative.

Adverse Reactions/ Side effects: CNS: dizziness,

headache, sedation, confusion, dysphoria, euphoria, floating

feeling, hallucinations. EENT: blurred vision, diplopia. Resp:respiratory depression. CV: hypertension, orthostatic

hypotension, palpitations. GI: dry mouth, nausea vomiting,

constipation, ileus. GU: urinary urgency. Derm: clammy

feeling, sweating.


44/71

Nursing responsibilities:Assess type, location, and intensity of

pain before and 1 hr after IM or 30 min

after administration.Assess blood pressure, Pulse, and

respirations before and periodically

duringadministration.

Assess previous analgesic history.


45/71

Generic Name: oxytocin

Brand Name: Pitocin; Syntocinon.Classification: Endogenous

hormone with uterine stimulant

properties and vasopressive andantidiuretic effects.

Date Ordered:12/11/10

Ordered Dose: 5cc/hr, titrate q 20

mins with increase of 3 cc/hr untiluterine contrations q 2-3 mins, 60-90

sec duration


46/71

Route/ Dosage:

A. Induction of Stimulation of Labor

Intravenous infusion (drip method) is the onlyacceptable method of administration for the induction

or stimulation of labor.

Accurate control of the rate of infusion flow is

essential. An infusion pump or other such device andfrequent monitoring of strength of contractions and

fetal heart rate are necessary for the safe

administration of oxytocin for the induction or

stimulation of labor. If uterine contractions become too

powerful, the infusion can be abruptly stopped, and

oxytocin stimulation of the uterine musculature will

soon wane.


47/71

1) An intravenous infusion of non-oxytocin containing solution should be

started. Physiologic electrolyte solution should be used except under

unusual circumstances.

2) To prepare the usual solution for infusion, the contents of one 1-mLampul are combined aseptically with 1,000 mL of non-hydrating diluent.

The combined solution, rotated in the infusion bottle to insure thorough

mixing, contains 10 mU/mL. Add the container with dilute oxytocin

solution to the system through use of a constant infusion pump or other

such device, to control accurately the rate of infusion.3) The initial dose should be no more than 1-2 mU/minute. The dose may

be gradually increased in increments of no more than 1-2 mU/minute,

until a contraction pattern has been established which is similar to

norma1 labor.

4) The fetal heart rate, resting uterine tone, and the frequency, duration,

and force of contractions should be monitored.5) The oxytocin infusion should be discontinued immediately in the event

of uterine hyperactivity or fetal distress. Oxygen should be

administered to the mother. The mother and the fetus must be

evaluated by the responsible physician.


48/71

B. Control of Postpartum Uterine Bleeding

1)Intravenous Infusion (Drip Method): To control

postpartum bleeding, 10-40 units of oxytocin may beadded to 1,000 mL of a non-hydrating diluent and

run at a rate necessary to control uterine atony.

2)Intramuscular Administration: 1 mL (10 units) of

oxytocin can be given after delivery of the placenta.C. Treatment of Incomplete or Inevitable Abortion

Intravenous infusion with physiologic saline solution,

500 mL, or 5% dextrose in physiologic saline

solution to which 10 units of Syntocinon (oxytocin)have been added should be infused at a rate of 20-

40 drops/minute.


49/71


Uterine:

The uterine myometrium contains receptors specific to oxytocin.

Oxytocin stimulates contraction of uterine smooth muscle byincreasing intracellular calcium concentrations, thus mimicking

contractions of normal, spontaneous labor and transiently impeding

uterine blood flow. Amplitude and duration of uterine contractions

are increased, leading to dilation and effacement of the cervix. The

number of oxytocin receptors and, therefore, uterine response tooxytocin increases gradually throughout pregnancy, reaching its

peak at term.

For diagnosis of fetal distress and utero-placental insufficiency: By

comparing baseline and oxytocin-induced fetal heart rate patterns

and uterine contraction patterns, the oxytocin challenge test mayaid in determining if there is adequate placental reserve for

continuation of a high-risk pregnancy. The occurrence of a fetal

heart rate pattern exhibiting late decelerations with administration of

oxytocin may indicate utero-placental insufficiency.


50/71

Lactation:

Stimulates smooth muscle to

facilitate ejection of milk frombreasts. Oxytocin does not

increase milk production.


51/71

Indication:to stimulate uterine contraction and

improve uterine tonus in induction of

labour

treatment of postpartum hemorrhagetermination of pregnancy during the

second trimester

treatment of uterine atony followingabortion


52/71

Contraindication:

Oxytocin injection (synthetic) is contraindicated in any of the following

conditions:

Significant cephalopelvic disproportion;

Unfavorable fetal positions or presentations which are undeliverable

without conversion prior to delivery, i.e., transverse lies;

In obstetrical emergencies where the benefit-to-risk ratio for either the

fetus or the mother favors surgical intervention;In cases of fetal distress where delivery is not imminent;

Prolonged use in uterine inertia or severe toxemia;

Hypertonic uterine patterns;

Patients with hypersensitivity to the drug;

Induction or augmentation of labor in those cases where vaginal

delivery is contraindicated, such as cord presentation or prolapse, total

placenta previa, and vasa previa.


53/71

Side Effects:

Side effects with oxytocin are not common. Serious side effects

include:

an allergic reaction (shortness of breath; closing of the throat; hives;swelling of the lips, face, or tongue; rash; or fainting);

difficulty urinating;

chest pain or irregular heart beat;

difficulty breathing;

confusion;sudden weight gain or excessive swelling;

severe headache;

rash;

excessive vaginal bleeding; or

seizures.Other, less serious side effects may be more likely to occur. Talk to

your doctor if you experience

redness or irritation at the injection site;

loss of appetite; or

nausea or vomiting.


54/71

Adverse Effects:

The following adverse reactions have been reported in the mother:

Anaphylactic reaction, Postpartum hemorrhage, Cardiac arrhythmia,

Fatal afibrinogenemia, Nausea, Vomiting, Premature ventricularcontractions, and Pelvic hematoma.

Excessive dosage or hypersensitivity to the drug may result in uterine

hypertonicity, spasm, tetanic contraction, or rupture of the uterus.

The possibility of increased blood loss and afibrinogenemia should be

kept in mind when administering the drug.Severe water intoxication with convulsions and coma has occurred,

associated with a slow oxytocin infusion over a 24-hour period. Maternal

death due to oxytocin-induced water intoxication has been reported.

The following adverse reactions have been reported in the fetus or

infant:Due to induced uterine motility: Bradycardia, Premature ventricular

contractions and other arrhythmias, Permanent CNS or brain damage,

and Fetal death.

Due to use of oxytocin in the mother: Low Apgar scores at 5 minutes.

Neonatal jaundice, and Neonatal retinal hemorrhage.


55/71


Monitor and record uterine contractions, heart rate,

BP, intrauterine pressure, fetal heart rate, and bloodloss q15.

Be alert for adverse reaction

Monitor I/O. Antidiuretic effect may lead to fluid

overload, seizures, and comanever give oxytocin simultaneously by more than

one route.>have 20% solution magnesium sulfate

available for relaxation of the myometrium.>If

contractions are less than 2 minutes apart, if theyreabove 50mm Hg ,or if they last 90seconds or longer,

stop infusion, and turn patient on her side, and

notify prescriber.


56/71

Generic Name: Lactated Ringers

Solution with 5% Dextrose(D5LR)Brand Name: Lactated Ringers

Solution with 5% Dextrose(D5LR)

Classification:

Hypertonic, Nonpyrogenic, parenteralfluid, electrolyte and nutrient

eplenisher

Date Ordered: 12/9/10, 12/10/10,

12/11/10, and 12/12/10Ordered Dose: 1 Liter @ 120 cc/hr


57/71

Suggested Dose:

This solution is for intravenous use only.

Dosage is to be directed by a physician and is dependent upon age,weight, clinical condition of the patient and laboratory determinations.

Frequent laboratory determinations and clinical evaluation are essential to

monitor changes in blood glucose and electrolyte concentrations, and fluid

and electrolyte balance during prolonged parenteral therapy.

When a hypertonic solution is to be administered peripherally, it should be

slowly infused through a small bore needle, placed well within the lumen ofa large vein to minimize venous irritation. Carefully avoid infiltration.

Fluid administration should be based on calculated maintenance or

replacement fluid requirements for each patient.

The presence of calcium ions in this solution should be considered when

phosphate is present in additive solutions, in order to avoid precipitation.Some additives may be incompatible. Consult with pharmacist. When

introducing additives, use aseptic techniques. Mix thoroughly. Do not store.

Parenteral drug products should be inspected visually for particulate matter

and discoloration prior to administration, whenever solution and container

permit.


58/71

Mode of Action:

5% Dextrose in Lactated Ringer's Injection provideselectrolytes and calories, and is a source of water for

hydration. It is capable of inducing diuresis depending on the

clinical condition of the patient. This solution also contains

lactate which produces a metabolic alkalinizing effect.

Sodium, the major cation of the extracellular fluid, functionsprimarily in the control of water distribution, fluid balance and

osmotic pressure of body fluids. Sodium is also associated

with chloride and bicarbonate in the regulation of the acid-

base equilibrium of body fluid. Potassium, the principal cation

of intracellular fluid, participates in carbohydrate utilization and

protein synthesis, and is critical in the regulation of nerve

conduction and muscle contraction, particularly in the heart.


59/71

Chloride, the major extracellular anion, closely follows the metabolism of

sodium, and changes in the acid-base balance of the body are reflected

by changes in the chloride concentration. Calcium, an important cation,provides the framework of bones and teeth in the form of calcium

phosphate and calcium carbonate. In the ionized form, calcium is

essential for the functional mechanism of the clotting of blood, normal

cardiac function, and regulation of neuromuscular irritability.

Sodium lactate is a racemic salt containing both the levo form, which is

oxidized by the liver to bicarbonate, and the dextro form, which is

converted to glycogen. Lactate is slowly metabolized to carbon dioxide

and water, accepting one hydrogen ion and resulting in the formation of

bicarbonate for the lactate consumed. These reactions depend on

oxidative cellular activity.

Dextrose provides a source of calories. Dextrose is readily metabolized,may decrease losses of body protein and nitrogen, promotes glycogen

deposition and decreases or prevents ketosis if sufficient doses are

provided.


60/71

Indication:

This solution is indicated for use in adults and pediatricpatients as a source of electrolytes, calories and water for

hydration.

Contraindication:

This solution is contraindicated where the administration of

sodium, potassium, calcium, chloride or lactate could beclinically detrimental.

Lactate administration is contraindicated in severe metabolic

acidosis or alkalosis, and in severe liver disease or anoxic

states which affect lactate metabolism.Solutions containing dextrose may be contraindicated in

patients with hypersensitivity to corn products.


61/71

Side Effects:

Allergic reactions or anaphylactoid symptoms such as

localized or generalized urticaria and pruritis; periorbital,

facial, and/orlaryngeal edema, coughing, sneezing, and/ordifficulty with breathing have been reported during

administration of Lactated Ringer's and 5% Dextrose Injection,

USP. The reporting frequency of these signs and symptoms is

higher in women during pregnancy.

Reactions which may occur because of the solution or the

technique of administration include febrile response, infection

at the site of injection, venous thrombosis orphlebitis

extending from the site of injection, extravasation, and

hypervolemia.If an adverse reaction does occur, discontinue the infusion,

evaluate the patient, institute appropriate therapeutic

countermeasures, and save the remainder of the fluid for

examination if deemed necessary.


62/71

Adverse Effects:

Reactions which may occur because of the solution or

the technique of administration include febrile

response, infection at the site of injection, venous

thrombosis or phlebitis extending from the site of

injection, extravasation and hypervolemia.

Too rapid infusion of hypertonic solutions may causelocal pain and venous irritation. Rate of administration

should be adjusted according to tolerance. Use of the

largest peripheral vein and a small bore needle is

recommended.

Symptoms may result from an excess or deficit of one

or more of the ions present in the solution; therefore,

frequent monitoring of electrolyte levels is essential.


63/71

Hypernatremia may be associated with edema and

exacerbation of congestive heart failure due to the retention of

water, resulting in an expanded extracellular fluid volume.

Reactions reported with the use of potassium-containing

solutions include nausea, vomiting, abdominal pain and

diarrhea. The signs and symptoms of potassium intoxication

include paresthesias of the extremities, areflexia, muscular orrespiratory paralysis, mental confusion, weakness,

hypotension, cardiac arrhythmias, heart block,

electrocardiographic abnormalities and cardiac arrest.

Potassium deficits result in disruption of neuromuscular

function, and intestinal ileus and dilatation.

If infused in large amounts, chloride ions may cause a loss of

bicarbonate ions, resulting in an acidifying effect.


64/71

Abnormally high plasma levels of calcium can result in depression,

amnesia, headaches, drowsiness, disorientation, syncope,

hallucinations, hypotonia of both skeletal and smooth muscles,dysphagia, arrhythmias and coma. Calcium deficits can result in

neuromuscular hyperexcitability, including cramps and convulsions.

Although the metabolism of lactate to bicarbonate is a relatively slow

process, aggressive administration of sodium lactate may result in

metabolic alkalosis. Careful monitoring of blood acid-base balance isessential during the administration of sodium lactate.

The physician should also be alert to the possibility of adverse

reactions to drug additives. Prescribing information for drug

additives to be administered in this manner should be consulted.

If an adverse reaction does occur, discontinue the infusion, evaluatethe patient, institute appropriate therapeutic countermeasures and

save the remainder of the fluid for examination if deemed necessary.


65/71


Always check the Intravenous fluid and make sure that it is

flowing at the right rate

Always check the IV site for any signs of edemaDo not administer unless solution is clear and container is

undamaged.

Caution must be exercised in the administration of parenteral

fluids, especially those containing sodium ions to patients

receiving corticosteroids or corticotrophin.

Solution containing acetate should be used with caution as

excess administration may result in metabolic alkalosis.

Solution containing dextrose should b used with caution in

patients with known subclinical or overt diabetes mellitus.Discard unused portion.

In very low birth weight infants, excessive or rapid

administration of dextrose injection may result in increased

serum osmolality and possible intracerebral hemorrhage


66/71

MEDICATION

Health Teachings Rationale

Continue taking the vitamins and

medicines prescribed by the physician.

To ensure faster and proper recovery.

Caution patient to avoid prolonged

exposure to sunlight and to use

sunscreen or wear protective clothing

To avoid photosensitivity reaction.

Take medicines with an empty stomachif indicated.

So that the food will not interfere withthe drug mechanism.

Discontinue medication if a rash

develops and consult your physician.

This maybe a sign that you are allergic

to the drug

Complete the prescribed drug treatment. So as not to develop drug resistance.

Before taking the medicine make sure

you have the right dose and take it at

the right time

To avoid over dosage and under dosage

of the drug.

EXERCISE


67/71

EXERCISE


Tighter Abdominals -

Lie on your back in a straight line. Then exhale,

lowering the back, vertebra by vertebra. Repeat

sequence five times.

This exercise helps develop a strong back and

abdominals.

Chin-to-chest on postpartum day 2 To tighten and firm up abdominal muscles

Knee-to-abdomen when perineum has healed To strengthen abdominal and gluteal muscle

Stronger BackSit upright, knees bent, feet flat on the floor, back

straight, arms forward at shoulder level. Inhale, then

exhale and lean back halfway. Inhale again and sit up

slowly. Repeat five times.

This exercise strengthens the back and abdominals.

Flexible Body

Stand upright with arms raised, elbows slightly

relaxed. Inhale, then exhale and bend forward,

keeping back straight and swinging arms down and

back. Then relax your head and stretch your arms up

behind you. Inhale as you swing arms and body up

again, returning to your original position. Repeat

eight times. Go carefully and do not strain.

This exercise is good for thighs, hips, back, arms,

shoulders and neck.

TREATMENT


68/71

TREATMENT


Get patients to ambulate as soon as

possible after delivery.

To improve circulation and prevent the

development of thrombi.Instruct the client to abstain from sexual

intercourse until after the episiotomy is

healed and the lochia has ceased.

Due to childbirth the delicate tissues of

the vagina tissues are inevitably strained,

bruised and torn and it takes some

weeks for these injuries to heal up.

Counsel the patient that menstruation

returns 6 8 weeks if not breast feeding

and 3 4 months if the mother is

breastfeeding.

Through breastfeeding the sensation of

the baby sucking sends a message to the

brain to suppress the hormone that

stimulates ovulation.

The client may be able to experience asudden gush of blood when she first

rises.

Due to normal pooling in vagina when thewoman lies down to rest or sleep; gravity

causes blood to flow out when she

stands.

Encourage the client to lie in a Sims

position when sleeping

Sims position minimizes the strain in the

suture line.

HYGIENE


69/71

HYGIENE


Do not use soap on the breasts when

washing.

it tends to remove natural oils, which

increases the

chance of cracked nipplesInstruct to avoid garters or constricting

clothing.

Can impair circulation

Encourage client to shower as soon as she

can ambulate and to take tub baths if desired

after two weeks.

Recommended daily shower to promote

comfort and a sense of well-being.

Keep clean any areas where there have beenstitches, wash the episiorraphy generously

with water after using the restroom.

To prevent the microorganisms from invadingthe body.

In the event that the lochia is foul-smelling or

becomes persistent, one should seek

consultation right away.

This could be due to poor healing, infection,

or retained placental tissues.

Take home a squirt bottle and fill it with warm

water before either urinating or bowel

movement. After you have washed pat the

area dry instead of rubbing.

To ease the pain while voiding and defecating.

Wash hands before and after breastfeeding. The microorganism being transferred by a

dirty hand can cause illness to the baby.

OUT PATIENT


70/71

OUT-PATIENT


While the patient is staying at the

hospital be sure to provide acomfortable environment.

This will enable the patient to have

adequate rest and sleep.

Visit the hospital 1 2 weeks after of

discharge.

These visits provide an opportunity for

physical assessment as well as

evaluation of the mothers psychological

and informational needs and needs of

the family.

The patient may lose up to 20 pounds

within 10 days after delivery. It is best to

lose about pound per week, after that

be patient.

A well-balanced diet coupled with

exercise will help you return to you pre-

pregnant weight.

Consult a physician immediately if thepatient experiences fever after 24 hours

of childbirth.

Fever 24 hours after deliver is aindication that there might me an

infection.

Encourage the client to express her

feelings openly.

This helps the mother in coping with the

stress of childbirth and to prevent

depression from happening.

DIET


71/71

DIET


Do not diet or start an exercise plan

immediately after giving birth

You should allow your body to recover

first and then consult your doctor.

Take fiber as much as you can. After the

childbirth, you can experience

constipation and bowel problems.

Consuming sufficient amounts of fiber

helps both the constipation and bowel

condition.

Then it is essential for you to eat healthy

and balanced diet consist of more

calories (500 calories/day), liquid,calcium (2000 mg/day) and protein.

To provide the required nutrients to your

baby.

When breastfeeding alcohol

consumption is prohibited.

It makes the breast milk smell differently

and this will affects the babys sleep and

digestion.

Consume a lot of fruits and vegetables.

Make fruit (or veggie) smoothies, use

fruit or vegetable salsas or vegetable

reduction sauces (sauces made from

pured vegetables)

This supplies antioxidant for your body.

Lyza CS Slide

Documents

Transcript of Lyza CS Slide