Generic Name: Dexamethasone Brand Name: N/A Date Ordered: July 30, 2012 Classification: Anti asthamatic, Corticosteroid

Dose, Route and frequency: 4 mg IV through heplock every 6 hours Mechanism of action: This drug enters target cells and binds to specific receptors, initiating many complex reactions that are responsible for its anti-inflammatory and immunosuppressive effects. Desired Effect: This was given to our patient to treat his respiratory problem. Nursing Responsibilities 1. Check the doctors order. To confirm order of drug administration and prevent incorrect administration as to dosage, route and time 2. Ask the patients name. To verify patients identity. 3. Instruct patient to report if severe abdominal pain, tarry stool, unusual swelling, weight gain, tiredness, bone pain, bruising and visual disturbances. For immediate interventions since it is an adverse effect of the drug. 4. Monitor weight daily. For immediate interventions since one of the adverse effect of the drug is weight gain. 5. Monitor input and output. To be able to give alert and give immediate interventions if there is decrease in the urine output. 6. Instruct patient to eat foods rich in protein. To facilitate absorption of drug. To prevent double administration and for continuity of care. 7. Document.

Generic Name: Salbutamol + Ipratropium Nebule Brand Name: Date Ordered: July 30,2012 Classification: anticholinergic bronchodilator (ipratropium); adrenergic, bronchodilator (salbutamol) Dose, Route and frequency: Nebule every 6 hours Mechanism of action: Ipratropium inhibits cholinergic receptors in bronchial smooth muscle resulting in decreased concentration of cyclic guanosine monophosphate (cGMP) which leads to

production of local bronchodilation. Salbutamol produces bronchodilation through stimulation of beta2-adrenergic receptors in bronchial smooth muscle, thereby causing relaxation of muscle fibers. Desired Effect: This was given to our patient to help relax the muscles around his airways thus making his breathing easier since he is experiencing shortness of breath, wheezing, and coughing. Nursing Responsibilities 1. Check the doctors order. To confirm order of drug administration and prevent incorrect administration as to dosage, route and time 2. Ask the patients name. To verify patients identity. 3. Check vital signs before and after administration. To evaluate cardiac response. 4. Before nebulizations, check equipment and medications. For better care rendering. To promote expectoration of secretions through vibration To avoid dryness of patients face a. Teach patient on how to cough out effectively. b. Teach patient to avoid irritants. c. Teach patient on breathing exercises. To enhance the effectiveness of drugs. 5. Do bronchial clapping after nebulization. 6. Instruct proper nebulization procedure. Wash patients face after. 7. Render care that would potentiate drug action.

8. Instruct patient to report physician if the medications fails to provide relief. Because this can signify worsening of pulmonary function and a reevaluation of condition/therapy may be indicated. 9. Document. To prevent double administration and for continuity of care.

Generic Name: Omeprazole Brand Name: N/A Date Ordered: July 30, 2102

Classification: Proton pump inhibitor, Anti-ulcer agent Dose, Route and frequency: 20 mg 1 tab OD Mechanism of action: Binds to an enzyme on gastric parietal cells in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen. Desired Effect: It is given to our patient to counteract the effect of dexamethasone since one of the side effects is GI irritation. Nursing Responsibilities 1. Check the doctors order. To confirm order of drug administration and prevent incorrect administration as to dosage, route and time 2. Ask the patients name. To verify patients identity. 3. Administer before meals. To facilitate absorption of the drug.

4. Instruct the patient to avoid activities requiring alertness. Because dizziness may occur 5. Instruct patient to report if he experience severe headache, worsening of symptoms, fever, chills. For immediate interventions since one of the adverse effect of the drug 6. Document. To prevent double administration and for continuity of care. Generic Name: Acetylcysteine Brand Name: NAC (N-acetyl-L-cysteine ), Fluimucil Date Ordered: July 31,2012 Classification: Mucolytic Dose, Route and frequency: 200 mg 1 sachet glass H20 TID Mechanism of action: This drug exerts an intensive mucolytic-fluidifying action on mucous and mucopurulent secretions, by depolymerizing the mucoproteic complexes and the nucleic acids which confer viscosity to the vitreous and purulent component of the sputum and of the secretions. Desired Effect: This drug was given to our patient to liquefy pulmonary secretions thus facilitating expectoration and to treat his pneumonia.

Nursing Responsibilities: 8. Check the doctors order. To confirm order of drug administration and prevent incorrect administration as to dosage, route and time 9. Ask the patients name. To verify patients identity. 10. Mix with juice or cola. Because drug smells strongly like sulfur so as to improve its palatability.

11. Monitor for cough type and frequency.

To be able to note the effectiveness of the treatment. a. Teach patient on how to cough out effectively. b. Teach patient to avoid irritants. c. Teach patient on breathing exercises. To enhance the effectiveness of drugs

12. Render care that would potentiate drug action.

13. Instruct patient to report rashes, pruritus, nausea, vomiting, fever, syncope, sweating, blurred vision, rhinorrhea, drowsiness, clamminess, chest tightness and bronchoconstriction For immediate interventions since it is an adverse effect of the drug.

14. Document. To prevent double administration and for continuity of care.

Generic name: Digoxin Brand Name: Lanoxin Date Ordered: August 2, 2012 Classification: Inotropics, antiarrhythmics Mode of action: Digoxin is a cardiac glycoside which has positive inotropic activity characterized by an increase in the force of myocardial contraction. It also reduces the conductivity of the heart through the atrioventricular (AV) node. It also exerts direct action on vascular smooth muscle and indirect effects mediated primarily by the autonomic nervous system and an increase in vagal activity. Dosage, Route, Frequency: 0.25 mg tab OD

Desired Effect: This drug was given to our patient to counteract the effect of Acetylcysteine drug which has the ability to stimulate cardiac muscle. Nursing Responsibilities: 1. Check the doctors order. To confirm order of drug administration and prevent incorrect administration as to dosage, route and time 2. Ask the patients name. To verify patients identity. 3. Monitor apical pulse or pulse rate for 1 min before administering; hold dose if pulse < 60; retake pulse in 1 hr. If adult pulse remains < 60, hold drug and notify prescriber. *Note any change from baseline rhythm or rate. To prevent the aggravation of the side effects. 4. Check dosage and preparation carefully. Therapeutic dose is very near to toxic dose. 5. Administer drug 1 hour before or 2 hours after meals. Giving this drug with meals decreases the absorption of drug. 6. Have emergency equipment ready; have K+ salts, lidocaine, phenytoin, atropine, cardiac monitor on standby. In preparation, in case toxicity develops. 7. Monitor for therapeutic drug levels: 0.52 mg/mL. To avoid occurrence of digitalis toxicity. 8. Instruct patient to report unusually slow pulse, irregular pulse, rapid weight gain, loss of appetite, nausea, vomiting, blurred or "yellow" vision, unusual tiredness and weakness, swelling of the ankles, legs or fingers, difficulty breathing. These are manifestations of digitalis toxicity, thus, to treat it earlier. 9. Instruct patient to increase intake of potassium like citrus fruits and banana. To increase the absorption of the drug. 10. Document. To prevent double administration and for continuity of care.

Generic Name: Levofloxacin Date Ordered: August 3, 2012 Classification: Anti- infectives, Flouroqinolones Mechanism of action: It interferes with DNA by inhibiting DNA gyrase replication in susceptible gram negative and gram positive bacteria, preventing cell reproduction. Dosage, Route, Frequency: 500 mg 1 tab OD for 7 days

Desired Effect: This drug is given to the patient to treat infection since he has pneumonia. Nursing Responsibilities: 1. Check the doctors order. To confirm order of drug administration and prevent incorrect administration as to dosage, route and time 2. Ask the patients name. To verify patients identity. 3. Explain therapeutic value of medication before administration. To enhance knowledge of the patient about the drug and to gain cooperation. 4. Tell patient to take drug as prescribed, even if signs and symptoms disappear. To guarantee effectivity of treatment and avoid reactivation of pathogen.

5. Instruct patient to avoid activities requiring alertness. The drug may cause dizziness and drowsiness.

6. Advise patient to avoid excessive sunlight exposure, use sunblock, and wear protective clothing when outdoors. The drug may cause photosensitivity. 7. Instruct patient to repot if he is experienced severe loose stools or diarrhea. For immediate interventions since these are signs of GI toxicity.

8. Instruct patient to stop drug and notify doctor if rash or other signs or symptoms of hypersensitivity develop. For immediate interventions since it is an adverse effect of the drug.

9. Tell patient to notify the doctor if he experiences pain or inflammation. For immediate interventions since this drug can cause tendon rupture.

10. Document. To prevent double administration and for continuity of care.