Nursing responsibilities to:

Magnesium sulfate
Before Assess for contraindicated conditions. Monitor knee-jerk reflex before repeated parenteral administration. Give as laxative as temporary measure. Reserve IV use in eclampsia for life-threatening situations. Observe the 15 rights in drug administration. During Give IM route by deep IM injection. Monitor serum magnesium levels. Do not give oral MgSO4 with abdominal pain, nausea, or vomiting. Do not administer if knee-jerk reflexes are suppressed Monitor bowel function. After Arrange to discontinue administration as soon as levels are within normal limits and desired clinical response is obtained. Discontinue if diarrhea or cramping occurs. Arrange for dietary measures, exercise and environmental control to return to normal bowel activity. Report sweating, flushing, muscle tremors or twitching, inability to move extremities. Maintain urine output at a level of 100 mL every 4 hr during parenteral administration

Ferrous sulfate
Advise patient to take medicine as prescribed. Caution patient to make position changes slowly to minimize orhtostatic hypotension Instruct patient to avoid concurrent use of alcohol or OTC medicine without consulting the physician. Advise patient to consult physician if irregular heartbeat, dyspnea, swelling of hands and feet and hypotension occurs. Inform patient that angina attacks may occur 30 min. after administration due reflex tachycardia. Encourage patient to comply with additional intervention for hypertension like proper diet, regular exercise, lifestyle changes and stress management.

Antibiotics
Before beginning therapy, assess drug allergies: hepatic, liver and cardiac function; and other lab studies. Be sure to obtain thorough patient health history, including immune status. Assess for conditions that may be contraindications to antibiotic use, or that may indicate cautious use. Assess for potential drug interactions. It is essential to obtain cultures from appropriate sites before beginning antibiotic therapy. Patients should be instructed to take antibiotics exactly as prescribed and for the length of time prescribed; they should not stop taking the medication early when they feel better. Assess for signs and symptoms of superinfection; fever, perineal itching, cough, lethargy, or any unusual discharge. For safety reasons, check the name of the medication carefully since there are many agents that sound alike or have similar spellings.\ Each class of antibiotics has specific side effects and drug interactions that must be carefully assessed and monitored. The most common side effects of antibiotics are nausea, vomiting, and diarrhea. All oral antibiotics are absorbed better if taken with at least 6 to 8 ounces of water.

Sulfonamides Should be taken with at least 2400 ml fluid per day, unless contraindicated. Due to photosensitivity, avoid sunlight and tanning beds. These agents reduce the effectiveness of oral contraceptives.

Penicillins Any patient taking a penicillin should be carefully monitored for an allergic reactions for at least 30minutes after its administration. The effectiveness of oral penicillins is decreased when taken with caffeine, citrus fruit, cola beverages, fruit juices, or tomato juice.

Cephalosphorin Orally administred forms should be given with food to decrease GI upset, eventhough this will delay absorption. Some of these agents may cause an antabuse-like reaction when taken with alcohol.

Tetracyclines Milk products, iron preparations, antacids, and other dairy products should be avoided because of the chelation and drug binding that occurs. All medications should be taken with 6 to 8 ounces of fluid, preferably water. Due to photosensitivity, avoid sunlight and tanning beds.

Aminoglycosides Monitor peak and trough blood vessels of these agents to prevent nephrotoxicity and ototoxicity. Symptoms of ototoxicity include dizziness, tinnitus, and hearing loss. Symptoms of nephrotoxicity include urinary casts, proteinuria, and increased BUN and serum creatinine levels.

Quinolones Should be taken with at least 3L fluid per day, unless otherwise specified.

Macrolides Those agents are highly protein bound and will cause severe interactions with other protein bound drugs. The absorption of oral erythromycin is enhanced when taken on an empty stomach, but because of the high incidence of GI upset , many agents are taken after meal or snack. Monitor for therapeutic effects: -Disappearance of fever, lethargy, drainage, and redness.

Mefenamic acid
Assess patients who develop severe diarrhea and vomiting for dehydration and electrolyte imbalance. Lab tests: With long-term therapy (not recommended) obtain periodic complete blood counts, Hct and Hgb, and kidney function tests. Discontinue drug promptly if diarrhea, dark stools, hematemesis, ecchymoses, epistaxis, or rash occur and do not use again. Contact physician. Notify physician if persistent GI discomfort, sore throat, fever, or malaise occur. Do not drive or engage in potentially hazardous activities until response to drug is known. It may cause dizziness and drowsiness. Monitor blood glucose for loss of glycemic control if diabetic. Do not breast feed while taking this drug without consulting physician

Postoperative Nursing Management

Post Anesthesia Care Unit (PACU) AKApost anesthesia recovery room Located adjacent to Operating Rooms Has soft pleasing colors, soundproof ceiling, equipments that control noise(rubber) Well ventilated (decrease anxiety and promote comfort) Phases of Post Anesthesia Care Phase I PACU immediate recovery phase, Intensive nursing care is provided Phase II PACU patients who require less frequent observation and nursing care,also referred as STEP-down Sit-up, or progressive Care units Nursing Management in the PACU To provide Nursing care until the patient has recovered from the effects of ANESTHESIA -Resumption of Motor and Sensory Function - Oriented -Has stable Vital Signs -Shows no evidence of Hemorrhage Assessing the Patient Patent Airway Cardiovascular Function Condition of the surgical site Function of the Central Nervous System Hypopharyngeal Obstruction Signs -Choking -Noisy and Irregular respirations -O2 Saturation Scores -Cyanosis Because movement of the thorax and the diaphragm does not necessarily indicate that the patient is breathing, the nurse needs to place the palm of the hand at the patients nose and mouth to feel the exhaled breath.

TREATMENT FOR HYPOPHARYNGEAL OBSTRUCTION Use of an airway to prevent respiratory difficulty after anesthesia.The airway passes over the base of the tongue and permits air to passinto the pharynx in the region of the epiglottis. Patients often leave the operatingroom with an airway in place. The airway should remain in place until the patient recovers sufficiently to breathe normally. As the patient regains consciousness, the airway usually causes irritation and should be removed.

Classic SIGNS of SHOCK -Pallor -Cool, moist skin -Rapid breathing -Cyanosis of the lips, gums, and tongue -Rapid, weak, thready pulse -decreased pulse pressure -decrease blood pressure and concentrated urine Nursing intervention for SHOCK Primary VOLUME REPLACEMENT -Infusion of lactated Ringers Solution -Position Patient flat on bed with legs elevated at 20 and knees straight -Special considerations for JEHOVAHs witness or those who decline blood transfusions Nausea and Vomiting Turn patient to the one side to promote mouth drainage & prevent aspiration of vomitus (can cause asphyxiation and death)

Anti-emetics: -Ondansetron (Zofran) -Droperidol (Inapsine) -Metoclopromide(Reglan) -Promethazine(Phenergan) Readiness for DISCHARGE from the PACU Stable Vital SIGNS Orientation & Minimal Pain Uncompromised Pulmonary FXN Adequate O2 sat levels Urine Output at least 30ml/hr N & V under control Many hospitals use a scoring system (eg, Aldrete score) to determine the patients general condition andreadiness for transfer from the PACU (Quinn, 1999). The patient is assessed at regular intervals (eg, every 15 or 30 minutes), and thescore is totaled on the assessment record. Patients with a score lower than 7 must remain inthe PACU until their condition improves or they are transferred to an intensive care area, depending on their preoperative baseline scores. The patient is discharged from the phase I PACU by the anesthesiologist or anesthetist to the critical care unit, the medicalsurgical unit, the phase II PACU, or home with a responsible familymember (Quinn, 1999). Patients being discharged directly to home require verbal and written instructions andinformation about follow-up care.

Aldrete Score (Similar to APGAR scoring)

Nursing Management AFTER Surgery PR, BP and RR every 15 mins(1st hour) PR,BP and RR every 30 mins(next 2 hours) Less frequently = more stable VS Temperature every 4 hours (1st 24 hours)

Respiratory Complication Atelectasis (alveolar collapse) Pneumonia Hypostatic pulmonary congestion Subacute hypoxemia Episodic hypoxemia Nursing Interventions Turn frequently and deep breathing every 2 hours Encourage coughing (contraindicated in head and eye injuries) Encourage YAWNING (lung expansion) or take sustained maximal inspirations Use of Incentive spirometer (10 deep breaths every hour while awake)

Encourage early ambulation (increases metabolism and pulmonary aeration) the day of surgery or no later than the 1st post-op day prevents pulmonary complications in elderly --The patient first exhales, then places the lips around the mouthpiece and slowly inhales, trying to drive the piston on the device to a marked goal. Using a spirometer has several advantages: it encourages the patient to participate actively in treatment; it ensures that the maneuver is physiologically appropriate and is repeated; and it is a cost-effective way of preventing complications.

Pain in RECOVERY PREVENTIVE approach favored over PRN approach Hypothalamic stress response = platelet aggregation and blood viscosity (can cause phlebothrombosis and pulmonary embolism RELIEVING PAIN Patient Controlled Anesthesia (PCA) 2 reqmts: understanding of the need to self-dose and the physical ability toself-dose. Epidural infusions local opiod + anesthetic Intrapleural anesthesia administration of anesthetic between parietal & visceral pleura Subcutaneous pain management a silicone catheter is attached to a pump that delivers the local anesthetic Nonpharmacologic relief measures Promoting Cardiovascular function Establish BASELINE Vital Signs Report Sys BP 90mmhg and below Report if BP drops 5mmhg every 15mins Intake and Output (<240ml per 8hr must be reported) Promote Early ambulation (prevents DVT and peristalsis) Patient may sit at the edge of bed first. Wound healing Wound drains allow escape of blood and serous fluids that could serve as culture medium for bacteria Record output of wound drains Mark drainage on dressings with pen. Record date and time to note if it is increasing. Portable wound suction provides continues suction and this prevents formation of dead spaces --The dressing can be reinforced with sterile gauze bandages; the time that they were reinforced should be documented. If drainage continues, the surgeon should be notified so that the dressing can be changed. Multiple similar drains are numbered or otherwise labeled (eg, left lower quadrant, left upper quadrant) so that out put measurements can be reliably and consistently recorded. Types of Surgical Drains 1.Penrose 2.Jackson Pratt drain 3.Hemovac

Phases of Wound healing

Second Intention Healing Third Intention Healing Wound Care Keep wound dry and clean Apply hypoallergenic tape Report signs of infection : (R,W,P,C) Swelling is common (Rest, Elevate) Wound dehiscence & evisceration WOUND DEHISCENCE disruption of surgical incision or wound EVISCERATION - protrusion of wound contents Restoring Function N & V common in obese, women, pts. Prone to motion sickness and those with prolonged surgery -Insert NGT (for persistent Vomiting) Hiccups caused by intermittent spasms of the diaphragm 2nd to phrenic nerve irritation -Phenothiazine medication for persistent Hiccups Oral intake stimulates digestive juices, promotes gastric function & peristalsis -Liquids 1st -Water, fruit juices, tea in increasing amounts -Soft foods (gelatin, custard, milk and creamed soups) -Solid foods Return of peristaltic activity -Auscultate bowel sounds -Passage of Flatus -Paralytic ileus and intestinal obstruction potential post-operative complications Voiding expected within 8 hours post-op -Letting water run -Apply heat to the perineum Risk Factors -Dehydration -Venous pooling -Low Cardiac output -Bed rest

Homans Sign Dorsiflexion of the foot causes pain in the calf muscle DVT Management Low-dose heparin (SQ) until ambulatory Low-molecular weight heparin and low-dose warfarin External pneumatic compression Thigh-high elastic compression stockings Wound Classfication

VISION A premier university in historic Cavite recognized for excellence in the development of morally upright and globally competitive individuals.

Republic of the Philippines CAVITE STATE UNIVERSITY Don Severino Delas Alas Campus Indang, Cavite

MISSION Cavite State University shall provide excellent, equitable and relevant educational opportunities in the arts, science and technology through quality instruction and relevant research and development activities. It shall produce professional, skilled and morally upright individuals for global competitiveness.

College of Nursing

Postoperative care
and Nursing responsibilities to common drugs

Submitted by: Floriza D. Batiancila Group 3 Submitted to: Mrs. Ganuelas, RN Clinical Instructor, Level III Date: July 09, 2012

In Partial Fulfillment of the Requirement in 65 for the Degree Bachelor of Science in Nursing

VISION A premier university in historic Cavite recognized for excellence in the development of morally upright and globally competitive individuals.

Republic of the Philippines CAVITE STATE UNIVERSITY Don Severino Delas Alas Campus Indang, Cavite

MISSION Cavite State University shall provide excellent, equitable and relevant educational opportunities in the arts, science and technology through quality instruction and relevant research and development activities. It shall produce professional, skilled and morally upright individuals for global competitiveness.

College of Nursing

Patient with electrolyte imbalance

Nursing care plan, drug study and review of related literature

Submitted by: Floriza D. Batiancila Group 3 Submitted to: Mr. Rolly Antonio, RN Clinical Instructor, Level III

In Partial Fulfillment of the Requirement in 65 for the Degree Bachelor of Science in Nursing