JMJ Marist Brothers

Notre Dame of Marbel University

City of Koronadal, Province of South Cotabato

Date Ordered November 16, 2018

Doctor’s Order Dexamethasone 4 mg IV 20 min prior giving Ceftri

Generic Name dexamethasone

Brand Name Decadron

Classifications

Therapeutic Cortecosteroid Glucocorticoid

Pharmacologic Hormone

Action Dexamethasone is a glucocorticoid agonist. Unbound

dexamethasone crosses cell membranes and binds with

high affinity to specific cytoplasmic glucocorticoid

receptors. This complex binds to DNA elements

(glucocorticoid response elements) which results in a

modification of transcription and, hence, protein synthesis

in order to achieve inhibition of leukocyte infiltration at the

site of inflammation, interference in the function of

mediators of inflammatory response, suppression of

 JMJ Marist Brothers
Notre Dame of Marbel University
City of Koronadal, Province of South Cotabato

humoral immune responses, and reduction in edema or

scar tissue. The antiinflammatory actions of

dexamethasone are thought to involve phospholipase

A2 inhibitory proteins, lipocortins, which control the

biosynthesis of potent mediators of inflammation such as

prostaglandins and leukotrienes.

Indications 1. As an anti-inflammatory medication.

2. Dexamethasone relieves inflammation in various

parts of the body.

3. It is used specifically to decrease swelling (edema).

Contraindications Contraindicated with infections, especially tuberculosis,

systemic fungal infections, amebiasis, vaccinia and

varicella, and antibiotic-resistant infections, allergy to any

component of preparation used.

Adverse Effects CNS: seizures, vertigo, headache, insomnia, mood swing,

pseudotumor cerebri, euphoria, deppression, psychosis,

intracerebral hemorrhage, cataracts, IOP, glucoma.

CV: hypertension, heart failure, necrotizing angitis

 JMJ Marist Brothers
Notre Dame of Marbel University
City of Koronadal, Province of South Cotabato

GI: peptic or esophageal ulcer, pancreatitis, abdominal

distention

GU: amenorrhea, irregular menses

Hematologic: fluid and electrolyte disturbances, negative

nitrogen balance, increased blood sugar, glycosuria,

increased serum cholesterol, decreased serum T3 and T4

levels

Hypersensitivity: Anaphylactoid or hypersensitivity

reactions

Musculoskeletal: muscle weakness, steroid myopathy,

loss of muscle mass, osteoporosis, spontaneous fractures

Other: impaired wound healing, petechiae, ecchymoses,

increased sweating, thin and fragile skin, acne,

immunosuppression and masking signs of infection,

activation of latent infections including TB, fungal, and viral

eye infections, pneumonia, abscess, septic Infection, GI

and GU infections
 JMJ Marist Brothers
Notre Dame of Marbel University
City of Koronadal, Province of South Cotabato

Nursing Responsibilities 1. Monitor and record vital signs.

2. Make sure the IV line is patent.

3. Administer by slow, direct IV injection over 1

minute.

4. Monitor blood glucose levels. Dietary restrictions

may be needed.

5. Taper doses when discontinuing.

6. Instruct client to report unusual swelling of the

extremities, muscle weakness, black tarry stools,

fever, other signs of infections.

Rationale This drug was given to decrease inflammation of the brain

because of meningitis.
 JMJ Marist Brothers
Notre Dame of Marbel University
City of Koronadal, Province of South Cotabato

Date Ordered November 16, 2018

Doctor’s Order Mannitol 20% 100 cc q 8O

Generic Name mannitol

Brand Name Osmitrol

Classifications

Therapeutic Diagnostic agent

Pharmacologic Osmotic diuretic, Urinary irrigant

Action Mannitol reduces the concentration of free radicals that

promote cell membrane lipid peroxidation and ultimately

destruction of cellular tissue. It also promotes cerebral

blood flow by reducing blood viscosity and microcirculatory

resistance.

Indications 1. Reduction of intracranial pressure

 JMJ Marist Brothers
Notre Dame of Marbel University
City of Koronadal, Province of South Cotabato

2. Treatment of cerebral edema

3. Treatment of elevated IOP when the pressure

cannot be lowered by other means

Contraindications 1. Well established anuria due to severe renal disease.

2. Severe pulmonary congestion or frank pulmonary

edema.

3. Active intracranial bleeding except during craniotomy.

4. Severe dehydration.

5. Progressive renal damage or dysfunction after

institution of mannitol (mannitol (mannitol injection)

injection) therapy, including increasing oliguria

and azotemia.

6. Progressive heart failure or pulmonary congestion after

institution of mannitol (mannitol (mannitol injection)

injection) therapy.

7. Do not administer to patients with a known

hypersensitivity to mannitol.
 JMJ Marist Brothers
Notre Dame of Marbel University
City of Koronadal, Province of South Cotabato

Adverse Effects CNS: headache, dizziness, blurred vision, seizures

CV: hypotension, hypertension, edema, heart failure,

thrombophlebitis, tachycardia, chest pain

GI: nausea, anorexia, dry mouth, thirst

GU: diuresis, urine retention

Hematologic: fluid and electrolyte imbalances,

hyponatremia

Respiratory: pulmonary congestion, rhinitis

 JMJ Marist Brothers
Notre Dame of Marbel University
City of Koronadal, Province of South Cotabato

Nursing Responsibilities 1. Monitor and record vital signs.

2. Check the patency of IV lines.

3. Do not expose solution to low temperatures,

crystallization may occur. If crystals are observed,

warm solution to dissolve.

4. Use an infusion set with a filter if concentrated

mannitol is used.

5. Monitor serum electrolytes periodically.

6. Instruct patient that she may experience side

effects such as increased urination, G.I upset, dry

mouth, headache, blurred vision.

7. Give small frequent meals if GI upset occurs.

8. Encourage to report difficulty breathing, pain at IV

site, chest pain.

 JMJ Marist Brothers
Notre Dame of Marbel University
City of Koronadal, Province of South Cotabato

Rationale This drug was given to reduce intracranial pressure and to

treat cerebral edema because of meningitis.