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Patients Profile:Name: Anita DevioAge: 66

Diagnosis: Neurotrophic ulcer secondary to bacterial infection; HCVD; CAD; DM type II

Drug Name Indication/Dosage Action AdverseReactions

Contraindications NursingResponsibilities

MetforminHydrochloride /Fortamet

Elderly patients:Dosage should beconservativebecause ofpotential decreasein renal function.

Tablets: 500 mg

Decreaseshepatic glucoseproduction andintestinalabsorption ofglucose and

improves insulinsensitivity(increasesperipheral glucoseuptake and use).

GI: diarrhea,nausea, vomiting,abdominalbloating,flatulence,anorexia, taste

perversion.Hematologic:megaloblasticanemia.Metabolic: lacticacidosis,HYPOGLYCEMIA.

Contraindicated inpatientshypersensitive todrug and in thosewith hepaticdisease or

metabolicacidosis.Contraindicated inpatients with renaldisease and inthose with acreatinineclearance greaterthan or equal to1.5 mg/dl (males)

or greater than orequal to 1.4 mg/dl(females).Contraindicated inpatients with heartfailure requiringpharmacologicintervention and

Before therapybegins and atleast annuallythereafter, assesspatient's renalfunction. If renal

impairment isdetected, adifferentantidiabetic maybe indicated.Give with meals.Maximum dosesmay be bettertolerated if totaldose is divided

into t.i.d. dosingand given withmeals.When switchingpatients fromchlorpropamide tometformin, takecare during the


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patients withconditionspredisposing to

renal dysfunction,CV collapse, MI,hypoxia, andsepticemia.Temporarilywithhold frompatients havingradiologic studiesinvolving use ofcontrast media

containing iodine.Contraindicated inpatients older thanage 80, unlesscreatinineclearanceindicates normalrenal function.Use caution whengiving drug to

elderly,debilitated, ormalnourishedpatients and tothose with adrenalor pituitaryinsufficiencybecause of

first 2 weeks ofmetformin therapybecause the

prolongedretention ofchlorpropamideincreases the riskof hypoglycemiaduring this time.Monitor patient'sglucose levelregularly toevaluate

effectiveness oftherapy. Notifyprescriber ifglucose levelincreases despitetherapy.If patient hasn'tresponded to 4weeks of therapywith maximum

dosage, an oralsulfonylurea canbe added whilekeeping metforminat maximumdosage. If patientstill doesntrespond after


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increased risk ofhypoglycemia.

several months oftherapy with bothdrugs at maximum

dosage, prescribermay stop both andstart insulintherapy.Monitor patientclosely duringtimes of increasedstress, such asinfection, fever,surgery, or

trauma. Insulintherapy may beneeded in thesesituations.Risk of drug-induced lacticacidosis is verylow. Reportedcases haveoccurred primarily

in diabetic patientswith significantrenal insufficiency;in those with othermedical orsurgical problems;and in those withother drug


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regimens. Riskincreases withdegree of renal

impairment andpatient age.Alert: Stop drugimmediately andnotify prescriber ifpatient develops acondition relatedto hypoxemia ordehydrationbecause of risk of

lactic acidosis.Stop drugtemporarily forsurgicalprocedures(except minorprocedures thatdontrestrict intake offood and fluids)

and for patientsundergoingradiologic studiesinvolving use ofcontrast mediacontaining iodine.Don't restart druguntil patient's oral


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intake hasresumed andrenal function has

been deemednormal byprescriber.Monitor patient'shematologicstatus forevidence ofmegaloblasticanemia. Patientswith inadequate

vitamin B12 orcalcium intake orabsorption appearto be predisposedto developingsubnormal vitaminB12 level. Thesepatients shouldhave routinevitamin B12 level

determinationsevery 2 to 3 years.Look alike-soundalike: Don'tconfuseGlucophage withGlucovance.


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Drug Name Indication/Dosage Drug Action Adverse Reaction Contraindication NursingResposibilities

Iberet-FolicAcid / filmtab

Treatment &prevention of Fe-deficiency &concomitant folicacid deficiency w/associateddeficient intake orincreased need

for vit B-complexin nonpregnantadults.

Vitamins &Minerals (Pre &PostNatal) / Antianemics

Allergic reactions,

GI effects,

hyperbilirubinemia,

acneform vulgaris

deterioration or

acneform

exanthema

eruption, brightyellow urine

discoloration,

flushing, dizziness

or faintness,

peripheral sensory

neuropathies,

stone formation,

crystalluria &

oxalosis, black

discoloration of

stool

Thalassemia,sideroblasticanemia,hemochromatosis& hemosiderosis.

Can be givenbefore or aftermeals.
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multiforme,exfoliativedermatitis

Other: accidentalinjury.

anemia,symptomatic liverdisease,

hypertension,edema, heartfailure, or asthmaand in poorCYP2C9metabolizers.Use cautiously inelderly ordebilitatedpatients.

alcoholism, olderage, and pooroverall health.

Alert: NSAIDsmay increase therisk of seriousthrombotic events,MI, or stroke. Therisk may begreater with longeruse or in patientswith CV diseaseor risk factors for

CV disease.Although drugmay be used withlow aspirindosages, thecombination mayincrease risk of GIbleeding.Watch for signsand symptoms of

overt and occultbleeding.Drug can causefluid retention;monitor patientwith hypertension,edema, or heartfailure.


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Assess patient forCV risk factorsbefore therapy.

Drug may behepatotoxic; watchfor signs andsymptoms of livertoxicity.Before startingdrug therapy,rehydratedehydratedpatient.

Drug can be givenwithout regard tomeals, but foodmay decrease GIupset.Look alike-soundalike: Don'tconfuse Celebrexwith Cerebyx orCelexa.


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Drug Name Indication/Dosage Drug Action Adverse

Reaction

Contraindication Nursing

ResponsibilitiesTelmisartan /Micardis

Treatment ofessential hypertension. 40mg 1tab OD

Angiotensin IIAntagonists

Headache,upper resp tractinfection,dizziness,fatigue.

Pregnancy &lactation, biliaryobstructivedisorders, severehepaticimpairment.

Monitor forhypotensionfollowing initiationof drug. Placepatient in supineposition ifhypotensionoccurs andadminister IV

normal saline ifneeded, asordered.Most of theantihypertensiveeffect occurswithin 2 weeks.Maximal bloodpressurereduction is

generally reachedafter 4 weeks.Diuretic may beadded if bloodpressure is notcontrolled by drugalone.
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Drug Name Indication/Dosage Drug Action Adverse Reaction Contraindication Nursing

ResponsibilitiesSultamicillin /Sultamicillin

Urinary tractinfectionsAdult: 375-750mg TID.

Inhibits bacterialprotein synthesisby binding to the50S subunit of theribosome

Diarrhoea, nausea,

vomitting, rashes,

pruritus, blood

dyscrasias,

superinfections,

dizziness,

dyspnoea.

Potentially

Fatal: Anaphylaxis.

Hypersensitivity to

drug or other

penicillin

Obtain specimenfor culture andsensitivity testsbefore giving firstdose. Therapymay beginpending resultsMonitor renal,hepatic, and

hematopoeticfunctions duringprolongedtherapy, asordered.Observe patientfor signs ofsuperinfection.


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Drug Name Indication/Dosage Drug Action Adverse Reaction Contraindication NursingResponsibilities

AmpicillinSulbactam

Intra-abdominal,gynecologic and skinstructure infections due

to susceptible strains

Adult:POSusceptible infections 0.25-0.5 g6 hrly.

Anaminopenicillinthat inhibits cell-

wall synthesisduringmicroorganismmultiplication.Sulbactaminhactivatesbacterial beta-lactamase,whichinactivates

ampicillin,causingbacterialresistance to it

GI upset, nausea,

vomiting, diarrhoea;

blood dyscrasias;

urticaria, exfoliativedermatitis, rash;

fever, seizures;

interstitial nephritis.

Potentially

Fatal: Anaphylactic

shock;

pseudomembranous

colitis;

neuromuscularhypersensitivity;

electrolyte

imbalance.

Hypersensitivity

to drug or other

penicillins;

infectiousmononucleosis.

Obtain specimenfor culture andsensitivity tests

before giving firstdose. Therapymay beginpending results.Observe patientclosely. With largedoses andprolongedtherapy, bacterialor fungal

superinfectionmay occurspecially inimmunosupressedpatients.Dosage should bedecreased inpatients with


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impaired renalfunction

Drug Name Indication/Dosage Drug Action AdverseReaction

Contraindication NursingResponsibilities

Clindamycin

/ Abanxl

For the treatmentofliverabscess, actinomycosis

, staphylococcal bone &joint infections, thecarrier stateofdiphtheria,gasgangrene, variousgynecological infectionsincluding bacterialvaginosis, endometritis,pelvic inflammatorydisease,pharyngitis, pn

eumonia, septicemia &skin infections.

Usual dose: 150-300

mg every 6 hr. Severe

infections 450 mg

every 6 hr.

Inhibits bacterial proteinsynthesis by binding tothe 50S subunit of the

ribosome

Abdominalpain.Pseudomembra

nous colitis,esophagitis,nausea,vomiting,diarrhea, skinrashes &pruritus.

Hypersensitivityto clindamycin orlincomycin.

Obtainspecimen forculture and

sensitivity testsbefore givingfirst dose.Therapy maybegin pendingresultsMonitor renal,hepatic, andhematopoeticfunctions during

prolongedtherapy, asordered.Observe patientfor signs ofsuperinfection.
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Drug Name Indication/Dosage Drug Action Adverse Reaction Contraindication NursingResponsibilities

Amlodipine /Norvasc

Chronic stableangina,vasospastic

angina(Prinzmetal's orvariant angina)Adults: Initially, 5to 10 mg P.O.daily. Mostpatients need 10mg daily.

Inhibits calciumion influx acrosscardiac and

smooth-musclecells, dilatescoronary arteriesand arterioles,and decreasesblood pressureand myocardialoxygen demand.

CNS: headache,somnolence,fatigue, dizziness,

light-headedness,paresthesia.CV: edema,flushing,palpitations.GI: nausea,abdominal pain.GU: sexualdifficulties.Musculoskeletal:

muscle pain.Respiratory:dyspnea.Skin: rash,pruritus.

Contraindicated inpatientshypersensitive to

drug.Use cautiously inpatients receivingother peripheralvasodilators,especially thosewith severe aorticstenosis, and inthose with heartfailure. Because

drug ismetabolized bythe liver, usecautiously and inreduced dosage inpatients withsevere hepaticdisease.

Alert: Monitorpatient carefully.Some patients,

especially thosewith severeobstructivecoronary arterydisease, havedevelopedincreasedfrequency,duration, orseverity of angina

or acute MI afterinitiation ofcalcium channelblocker therapy orat time of dosageincrease.Monitor bloodpressure


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frequently duringinitiation oftherapy. Because

drug-inducedvasodilation has agradual onset,acute hypotensionis rare.Notify prescriber ifsigns of heartfailure occur, suchas swelling ofhands and feet or

shortness ofbreath.Alert: Abruptwithdrawal of drugmay increasefrequency andduration of chestpain. Taper dosegradually undermedical

supervision.Look alike-soundalike: Don'tconfuseamlodipine withamiloride.


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Problem Justification

Noncompliance to therapeutic regimen

related to inadequate knowledge andfinancial constraints

This problem is given top priority due to

the fact that if this problem is resolved,then it would eliminate the need andthe presence of the other problems

Infection related to open woundsecondary to diabetes mellitus

This problem is ranked second even ifit is an actual problem because withoutclearing the first problem, problemssuch as these will continue to arise.The correction of the first problem will

reduce or eliminate the emergence ofthis problem

Skin integrity related to extremes ofage

This problem is ranked last because itis not life threatening and that the clienthas expressed the least concern for it.


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Cues NursingDiagnosis

Analysis Goal/Objectives Intervention Rationale Evaluation

Subjective:Umiinom akodati ng niresetasakin ng doctorna Neoblocpara sapresyon kopero di na akoumiinom pag dinaman

sumasakit angulo ko

minsan di narin akogumagamit nginsulin kasiminsan wala rinnaman kasikaming pambili

Objective:o Behavioralcharacteristics:

Evidence ofdevelopment of

Noncompliance totherapeuticregimenrelated toinadequateknowledgeand financialconstraints

Degree ofcompliance mayrange fromdisregardingevery aspect oftherecommendations following thetherapeuticplans. There are

many reasonswhy somepeople complyand others donot:Factorsinfluencingcompliance-Degree oflifestyle change

necessary-over-all cost ofprescribedtherapyReference:Fundamentalsof nursing byKozier, 5th

Goal:After 8 hours

nursingintervention, theclient will be ableto comply with thetreatmentregimen

Objectives:

Afternursingmanagement, the clientwill be ableto verbalizeaccurateconditionandunderstandin

g oftreatmentprocedure

Listento/activelisten toclientschiefcomplaints,comments.

Developtherapeutic

nurse-clientrelationship.

Helps toidentifyclientsthinkingabout thetreatmentregimen

Developstrust,

provideatmosphere in whichclient/SOcan freelyexpressviews/concerns.

The clientwas able tocomply withthe agreedtreatmentregimen


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complications/exacerbation of

symptoms Behavior

indicative offailure toadhere

Failure toprogress

Failure tokeepappointment

s The client is

jobless andno source ofincome.

DefiningCharacteristics:

Therapeuticeffect not

achieved ormaintained

edition pp.254-255

Afternursingmanagement, the clientwill be ableto identifyfactors thatinterfere hismedication

regime

Identifyfactors thatinterferewith takingmedications or lead tolack ofadherence( e.g.,depression

, activealcoholuse, lowliteracy,lack ofsupport,lack ofbelief in

Adherenceassessment is most

successfulwhenconductedin apositive,nonjudgmentalatmosphere

Forgetfulness is themostcommonreasongiven fornotcomplyingwith thetreatment

plan.


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Afternursingmanagement, the clientwill be able

to verbalizecommitmentto mutuallyagreed upongoals andtreatmentplan

Afternursingmanagementthe nurse willbe able to

treatmentefficacy.)

Determinewhomanagesthemedicationregimenand

whetherindividualknowswhat themedications are andwhy aretheyprescribed

Exploreclientinvolvement in or lackof mutualgoalsetting.

Helps thepatient orSO/s toknow theimportanceofmedication

.

Client willbe morelikely tofollow-through ongoals heparticipated in


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assist theclient inidentifying

communityresourcesand referthem tomedical/charitableinstitutions

Reviewtreatmentstrategies.Identifywhichinterventions in theplan ofcare are

mostimportantin meetingtherapeuticgoals andwhich areleastamenabletocompliance

Involvefamily andfriends inhealthplanningconferences.

developing.

Setsprioritiesandencourages problemsolvingareas ofconflict

Familymembersneed tounderstandthat care isplanned tofocus on


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Refer the

client to ayhealthcareorganizations, socialworkers, oranycharitableinstitutions(PGH,DSWD,

PCSO.)

what ismostimportant

to thepatient.Thisenablesthe patientto maintaina sense ofautonomy.

Neighborh

oodcenters,communitycenters,andoutpatientclinics areequippedto assistpatients in

modifyinglifestylehabits.

Clientswho live inpovertyand have


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loweducational levels are

at greaterrisk forinjury anddisease.Assistingthem insuchinstitutionswillmotivate

them tocomply.(Fundamentals of nursing,Potter, p.824)


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NURSINGDIAGNOSIS

GOAL OFCARE

OBJECTIVESOF CARE

INTERVENTIONMEASURES

RESOURCES EVALUATION

MATERIAL MANPOWER

Noncompliance totherapeuticregimen related toinadequateknowledge andfinancialconstraints

After 4 days ofnursing

intervention,the client will

follow histreatmentregimen

1.to be able toknow the effectsof diabetesmellitus typeII

2. To be able toknow the

importance oftakingmedications

3. To be able toidentify the uses

of eachmedication

4. be able to takemedications ontime prescribed

Collaborative1.Openly have aconversation with theclient regarding DM typeII and let her read aboutit in pamphlets and lether voice out herconcerns about the topic.

CollaborativeDiscuss to the patient

the effects of themedications regardingDM type II and theadverse effects that willshow once themedications are nottaken

CollaborativeDiscuss to the client the

medications that she willtake and its effect on thebody

Independent/DependentAdminister medicationsprior to activity as

pen, smallnotebook,pamphlets

Time andeffort of thestudent nurse,the patient andher relatives.

It will beevaluatedthroughweighing,measuring ofabdominal girthand monitoringintake andoutput.


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by the clientsphysician.

needed- Explain the importanceof strict compliance to

proper medication

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