Generic Name

Rebamipide

Brand Name Classification Suggested dose Mode of Action

Remapride Antiulcerant; Antacids PO Gastritis; Peptic ulcer 100 mg 3 times/day. Rebamipide is a mucosal protective agent and is postulated to increase gastric blood flow, prostaglandin biosynthesis and decrease free oxygen radicals.

Drug Interactions Indication

None noted. Treatment for peptic ulcer disease Prevention of NSAID-induced gastropathy

Contraindication

Contraindicated with patients who are hypersensitive to the drug, lactating, pregnant, and children.

Adverse Reaction

Rash, pruritus, constipation, diarrhea, dry mouth, dry lips, abdominal distention, constipation.

Nursing Responsibilities

1. Ten Rights. 2. Do not give more than three tablets per day of this

medication. 3. Ask the client to take in food which are high in fiber to prevent constipation. 4. Ask the client to wear lip-balm or place a petroleum jelly on the lips to prevent it from cracking since the drug may cause dry lips. 5. Ask the client to increase fluid intake because the drug may cause dry mouth. 6. Instruct the client to report presence of rash. 7. Encourage the client to verbalize relief from hyperacidity. 8. Watch out for abdominal distention. 9. Monitor intake and output. 10. Inform the client of the possible side effects.

Generic Name

Calcium Carbonate

Brand Name Classification Suggested dose

TUMS Calcium-containing Antacids As Antacid: Chew 2-4 tablets as symptoms occur. Repeat hourly if symptoms return, or as directed by a physician. Maximum Daily Dose: 15 tablets equivalent to 7.5 g calcium carbonate.

As a Calcium Supplement: Chew 2 tablets twice daily with a meal. Maximum Daily Dose: 4 tablets equivalent to 2 g calcium carbonate. Mode of Action Calcium carbonate is an inorganic salt used as an antacid. It is a basic compound that acts by neutralizing hydrochloric acid in gastric secretions. Subsequent

increases in pH may inhibit the action of pepsin. An increase in bicarbonate ions and prostaglandins may also confer cytoprotective effects. Calcium carbonate may also be used as a nutritional supplement or to treat

hypocalcemia

Drug Interactions

Digoxin: may increase risk for arrhytmiasif hypercalcemia occurs Fluroquinolones bisphospanates, throid hormones,

phenytoin tetracyclines: may decrease oral absorption of these drugs Indication Symptomatic treatment of heartburn, hyperacidity, dyspepsia, sour stomach and acid indigestion. As a source of daily calcium. Contraindication Patients with prior hypersensitivity reaction;

hypercalcemia, hypercalciuria or on a low-phosphate diet. Adverse Reaction Chalky taste, Hypotension, flushing, feeling of warmth, nausea, vomiting, pain rash, redness diaphoresis. Nursing Responsibilities 1. Ten rights. 2. Inform the client of the side effects of the drug. 3. Make sure to give the drug 30 minutes to 1 hour after meals. 4. Remomber not to give calcium within two hours of consuming other oral drugs or fiber containing food.

5. Remind the client not to swallow the tablet. 6. Ask the client to chew the tablet before swallowing. 7. Advice the client not to drink water immediately after taking the drug. 8. Inform the client that the drug may cause feeling of warmth, thus wearing of loose clothing is suggested. 9. Do not give the more than 15 tablets per day. 10. Monitor the heart rate and blood pressure of the client because the drug may cause hypotension.

Date and Time N O V E M B E

Cues

Needs

Nursing Diagnosis

Goal of Care

Nursing Interventions

Evaluation

Objective:
local pain

Impaired tissue N U T R I T I : Tissues were broken down upon insertion of IJ shunt. integrity related to open IJ shunt insertion

Within 5 hours of nursing interventions, the patient:

1) Elicit details of injury GOAL MET and treatment.

November 27,

noted (pain scale: mild) Guarding noted Wound dressing not 4

: to know proper 2012 interventions to be done. 2) Assess for purulent 8:00 pm drainage.

After 8 hours of

R 27,
soaked with blood

care, the patient: : purulent drainage from incision site willingness for indicates presence of a) Verbalized infection. lifestyle change 3) Assess for elevated understanding
such as agreeing to eat the right body temperature. that high blood

O N A L M

2 0 1 2

1 day Post Dialysis

: elevated sugar level temperature is an amount of food indication of infection. delays wound 4) Assess patients level and avoid food healing of discomfort; note which has high b) Demonstrated pain. amounts of sugar no signs of : to know how pain to promote affects the clients rest infection periods that may delay

3:00pm

E T A B O L

healing. b) will verbalize

understanding of health teachings on proper wound care at home

setting.

I
c) will show no

signs of infection such as

P A T T E R N

increased temperature and abnormal amount discharges. d) will willingness learn show to of

recovery of tissues. c) Understood 5) Determine clients that pressure nutritional status. might cause : nutritional status may delay recovery. bleeding to the 6) Apply hot and cold affected area. compress just above d) Understood the incision site. that BP taking : warmth rushes blood to the affected should be done area to promote healing; cold at the left upper compress may reduce edema and promote arm to reduce some numbing thereby promoting pressure on the comfort. 7) Administer analgesics right where the as prescribed. : to reduce pain due to incision. 8) Promote optimum nutrition by advising IJ shunt is

inserted.

the patient to eat right amounts of food.

cleaning

techniques participating

by 9)

: to facilitate healing. Encourage adequate periods of rest and

during teaching process.

the sleep. : to limit metabolic demands, maximize energy available for healing, and meet comfort needs. 10) Promote early mobility. : to promote blood circulation. 11) Assist with exercises. : to prevent excessive tissue pressure; to prevent bed sore from prolonged bed rest. 12) Instruct client to note changes condition changes in such in her as pain and

characteristics

unusual discomfort.

physical

: promotes early intervention; reduces potential for complications. 13) Instruct client to avoid eating sweet food/food which may alter blood sugar level. : increased blood sugar delays wound healing. 14) Check wound dressing for signs of active bleeding; note amount of secretions. : secretions may be due to infection; active bleeding may indicate opening of incision. 15) Teach client of proper care of area; minimize

paper. : adding pressure to the area might cause bleeding. 16) Instruct the patient to finish all prescribed

antibiotics. : to minimize or prevent bacterial growth. 17) Teach client of the early signs of infection such as fever and

abnormal instruct physician

secretions; to if tell these

signs are felt. : early detected infections are easier to cure.

PHYSICAL ASSESSMENT

General Survey Received patient lying on bed awake and responsive with Hep-lock on right cephalic vein and a right IJ shunt. She appears appropriate to the stated chronological age. Client has good body symmetry with no deformity; appears restless. Body fat is evenly distributed. Limbs and trunk appear proportional to the bodys height. Body odor and halitosis not noted. Client appears clean and neatly dressed. Clothing of choice was appropriate for the weather. Client is not irritable. When she is asked, it she answers immediately.

Vital Signs (November 27, 2012) BP: 150/90 mmHg PR: 74 bpm RR: 24 cpm Temp: 36.9 C

Skin, Hair and Nails Clients skin is uniformly light brown in color. No areas of increased vascularity, ecchymosis, or bleeding noted. No lesions noted upon inspection. The skin is moist with a minimum of perspiration. No tenderness noted. Skin is smooth, even and firm. Good skin turgor noted as evidenced by skin retraction in less than 3 second when pinched at the anterior chest, under the clavicle, and the abdomen. Edema not noted. Rashes noted on both of her arms.

Hair is originally black but has mixture of white hair and evenly distributed. The scalp is pale white in color. There are no signs of infestation or lesions. Seborrhea not noted. Hair is thin, and wavy. Hair is shiny and resilient when traction was applied, hair wont come out in clumps in hands.

Nails are clean and well trimmed with light pink nail beds. Capillary refill is two seconds. The nail surface is smooth and slightly rounded. The angle of the nail base is approximately 160 degrees. Surrounding tissues were intact; no lesions or lacerations were observed.

Head, Neck and Regional Lymphatics The head is normocephalic and proportional to body size. The skull is smooth, nontender, and without masses or depressions. The scalp is shiny, intact, and without lesions or masses. The facial features and movements are symmetrical. The shape of the face is round. No edema, disproportionate structures, or involuntary movements noted. The patient experienced no discomfort with movement. The temporomandibular joint articulate smoothly and without crepitus. The patient was able to raise her eyebrows, close her eyes, frown and smile. The muscles of the neck are symmetrical with the head in a central position. The client is able to move the head through a full range of motion without complaint of discomfort or noticeable limitation. The muscles are symmetrical without palpable masses or spasms.

Regional Lymphatics No enlargement, masses, or tenderness noted on palpation. Lymph nodes are not palpable. There were no abnormalities in her thyroid gland both anteriorly and posteriorly. Eyes She could only see clearly the things near to her. She mentioned that she has reading eyeglasses but upon assessment she didnt wear such. The eyelids appear symmetrical with no dropping, infections, or tumors. The client can raise both eyelids symmetrically. Eyebrows are present bilaterally and are evenly distributed. Theres no enlargement, swelling, or redness, no large amount of exudates, and minimal tearing. Skin is intact with no noted scaling and flakiness of skin. Eyelashes are evenly distributed and curled slightly outward. No swelling, enlargement, or redness noted in her lacrimal apparatus. Conjunctiva was pink and moist without foreign bodies. Both eyes move smoothly and symmetrically in each of the six fields of gaze and converge on the held object as it moves toward the nose. Sclera is white with some small, superficial vessels and without exudates, lesions or foreign bodies. The pupils are deep black, round, and equal diameter, ranging from two to six mm. Lenses are transparent in color.

Ears, Nose, Mouth, and Throat She was able to hear the ticking sound from our watch in both ears. Auricles are smooth, symmetrical, and no discoloration noted. Her pinna has no noted deformities, lesions, nodules and inflammations. Pinna recoils after it is being folded; it is firm and non-tender. Minimal cerumen in her ear canal was observed. The ears are physically symmetrical and are both located in line with the outer canthus of her eyes. Upon palpation, no pain or tenderness noted.

She was able to repeat a sentence when it was softly said behind her ears, which reveals that she does not have any hearing problems.

Nose is located symmetrically in the midline of the face and is without swelling, bleeding, lesions, or masses. Nasal flaring not noted. The nasal mucosa is pink without swelling or polyps. Both left and right nares were patent, with no discharges. The septum is at the midline and without perforation, lesions, or bleeding. There is no evidence of swelling around the nose and eyes. Client experienced no discomfort/tenderness during palpation or percussion.

Halitosis not noted. Her breath smells fresh. The lips are pink without lipstick. The lips are moist. The tongue is in the midline of the mouth. The tongue moves freely.. Whartons ducts are patent and without inflammation or lesions. Client has 30 teeth, white and smooth edges, in proper alignment and with no caries noted. The hard and soft palates are concave and pink.

Client was asked to speak yes, the soft palate and the uvula rose symmetrically. The uvula is midline. The throat is pink and vascular and without swelling, exudates, and lesions. Tonsils are not inflamed. There were no swellings or lesions. Breast and Regional Nodes The patient refused to be assessed.

Thorax and Lungs Patient has a regular and normal breathing pattern with a respiratory rate of 24cpm upon assessment. She has quiet and rhythmic respirations. The thorax rises and falls in unison in the respiratory cycle. There is no paradoxical movement. No adventitious breath sounds noted on both left and right lung fields during auscultation. Crepitus not noted. Tactile Fremitus on both lungs are symmetrical. Trachea is at midline. Heart and Peripheral Vasculature Murmurs not noted. Point of maximum impulse and beat is auscultated at the 5 th intercostal space midclavicular line. Patient has a cardiac rate of 78bpm, normal. Pulses have regular rhythm. Her pulse rate upon assessment was 74bpm and could be easily felt at her carotid pulse. Abdominal assessment Surgical wound incision noted at her right upper quadrant due to open cholecystectomy done. Pain is felt with a pain scale of 4/10, moderate. Opsite dressing noted with no abnormalities and bleeding noted, and it was dry and intact. Umbilicus is medially located and shows no sign of inflammation/ abnormal discharges. Bowel sounds of 11 per minute were heard upon auscultation. The abdomen rises with inspirations and falls with expiration. Musculoskeletal System She was able to exhibit strong hand grip on both arms. Client was able to extend both arms. Upper and lower extremities were proportional in length. No hand tremors noted. Female Genitalia The patient refused to be assessed.

Ateneo de Davao University College of Nursing SY 2012 - 2013 2nd Semester

DRUG STUDY PHYSICAL ASSESSMENT NCP

Submitted to; Leonardo Molina, RN MN Submitted by: Toni Anne Virocel BSN 3A GROUP 2