DOCTOR’S ORDER

Date/ Doctor’s Rationale Remark

Time Order s
2/10/ Please For close monitoring of the Admitte
11 admit patient and proper d
patient at management of his condition.
8:00
CIU w/ The crisis intervention unit is
pm
watcher a special unit operating on a
24-hour basis, which serves
as a receiving and action
center for walk-in referred,
and rescued individuals and
families in crisis situation.
DAT Diet as tolerated by the body Done
enables a regular intake that
is enough for the person to
consume. This is done to give
appropriate and adequate
nourishment to the patient.
Monitor Vital signs are important for Taken
VS q4 & baseline assessment and to and
record monitor patient’s condition recorde
please which evaluates the whole d.
treatment course, especially
the medications he receives
that could be a contributing
factor in the variation results
of the vital signs
Meds:

Olanzipine Atypical psychotic

10mg vial medication, short term
Done
IM now treatment for bipolar mania,
where it acts as a mood
stabilizer.
labs : CBC
Done

The CBC is used as a broad

screening test to check for
such disorders as anemia,
May give infection and many other
Haloperid disease Done
ol 5mg 1
amp IM
now in Haloperidol is an

lieu of antipsychotic agent that aids

Olanzipin in the management of
e aggressive and agitated
behavior.

Homicidal This is ordered so that the Done

/ Suicidal/ patient will be monitored
Escape closely and to avoid the
precautio harming of patient's life or
n others.
For 2 Psychiatric facilities often use Done
point medical interventions in the
restrain form of restraints to reduce
safety risks posed by violent
patients and to prevent
patients from harming
themselves and others.
refer This may create a Done
collaborative treatment
among the client and the
health care providers; thus it
also makes a good
 coordination on the
treatment of the client.
2/11/ For 2 Psychiatric facilities often use Done
11 point medical interventions in
restrain restraining both hands of the
6:35
patient to reduce safety risks
pm
posed by violent patients and Done
(+) to prevent patients form
hyper harming themselves and
active others.

Still for
Chlorpromazine is used to Done
Chloropro
mazine treat psychotic disorders
200mg ½ such as schizophrenia or
tab in AM manic-depression, and
severe behavioral problems.

Done

Chlorpromazine has strong

alpha-adrenergic blocking
activity and can cause
orthostatic hypotension.
 Lithuim
Carbonate
Lithium carbonate is
450mg 1
indicated in the treatment of
tan BID
manic episodes of manic-
depressive illness.
Maintenance therapy
prevents or diminishes the
Biperiden intensity of subsequent
HCL 2mg Done
episodes in those manic-
1 tab BID depressive patients with a
PRN for history of mania.
EPS

Biperiden is used to control

extrapyramidal disorders.
2/12/ May give Haloperidol is an Done
11 Haloperid antipsychotic agent that aids
ol 5mg 1 in the management of
12:30
amp IM aggressive and agitated
am
now behavior.

Done

Continue To promote the patient's

10:45 Meds. well-being and to
continuously control the
am Good
symptoms.
sleep

Good
Appetite
2/13/
11
Continue To promote the patient's Done
3:35
Meds well-being and to
pm
continuously control the
symptoms.
2/14/
11
Continue To promote the patient's Done
7:35
Meds well-being and to
am
continuously control the
symptoms.

ff up Labs
Labs exams are important for Followe
the diagnosis of the disease. d up
Following up the lab exams
may mean that the doctor
Still for
may need these results
Chloropro
mazine
Chlorpromazine is used to
200mg ½
treat psychotic disorders
tab in AM Done
such as schizophrenia or
manic-depression, and
severe behavioral problems.
 Drug Study

General Name: Lithium Carbonate

Brand Name: Lithotabs

Classification: Anti-manic

Dosage and Frequency: 450mg i tab BID

Action of Mechanism:

Preclinical studies have shown that lithium alters sodium transport in

nerve and muscle cells and effects a shift toward intraneuronal metabolism
of catecholamines, but the specific biochemical mechanism of lithium action
in mania is unknown

Indication:

Lithium is indicated in the treatment of manic episodes of Bipolar

Disorder.

Contraindication:

Lithium should generally not be given to patients with significant renal or

cardiovascular disease, severe debilitation or dehydration, or sodium
depletion, and to patients receiving diuretics, since the risk of lithium toxicity
is very high in such patients. If the psychiatric indication is life-threatening,
and if such a patient fails to respond to other measures, lithium treatment
may be undertaken with extreme caution, including daily serum lithium
determinations and adjustment to the usually low doses ordinarily tolerated
by these individuals. In such instances, hospitalization is a necessity.

Side Effect:

Fine hand tremor, polyuria, thirst, and nausea.

Adverse Reaction:

Lithium Toxicity, diarrhea, vomiting, drowsiness, muscular weakness,

ataxia, and blurred vision

Nursing Responsibility:

1. Monitor Vital Signs.

2. Monitor mental status, weight, urinalysis, and ECG.

3. To be taken with food or immediately after meals. Avoid any

caffeinated beverages/food; may aggravate mania.

4. Monitor for persistent diarrhea; may need supplemental fluids or salt.

5. Maintain a constant level of salt intake to avoid fluctuations in lithium

activity. Weight gain and swelling may be related to sodium retention.

6. Increase fluid intake, to avoid dehydration.

7. Do not engage in physical activities that requires alertness or physical

coordination until drug effects are realized; may cause drowsiness.

8. Monitor for any adverse reactions and side effects.

General Name: Olanzapine

Brand Name: Zyprexa

Classification: Anti-psychotic

Dosage and Frequency: 10 mg/vial IM now

Action of Mechanism:

Olanzapine is an atypical antipsychotic with affinity for serotonin 5-HT2A/2C,

dopamine, muscarinic M1-M5, histamine H1and adrenergic α1 receptors.

Indication:

Acute mixed or manic episodes in bipolar disorder; control of agitation

and disturbed behaviour in schizophrenia or mania.

Contraindication:

Angle-closure glaucoma; lactation. IM: History of CVS disease, heart

surgery.

Side Effect:

Dizziness, drowsiness, dry mouth.

Adverse Reaction:

Postural hypotension; constipation; dizziness; wt gain; agitation;

insomnia;

Nursing Responsibility:

1. Monitor vital signs.

2. Take only as directed; don not share medications; do not exceed

prescribed dosage.

3. Do not perform activities that require mental alertness until drug

effects realized; may experience drowsiness, trouble in thinking,
trouble in controlling movements, or trouble in seeing clearly.

4. Avoid changing positions suddenly, especially from lying to standing

position.

5. Avoid prolonged/excessive exposure to direct or artificial light.

 6. Report any suicidal ideations, abnormal bleeding, sudden muscle pain/
irregular hearbeat.

7. Avoid alcohol, CNS depressants or OTC agents.

8. Do not give by IV or SC routes.

General Name: Biperiden HCl

Brand Name: Akineton

Classification: Anti-parkinson

Dosage and Frequency: 2mg/tab BID

Action of Mechanism:

Biperiden is a tertiary amine antimuscarinic with central and peripheral

actions. It stimulates and then depresses the CNS, it also has
antispasmodic actions on smooth muscle and reduces secretions,
especially salivary and bronchial secretions.

Indication: Idiopathic parkinsonism

Contraindication: Hypersensitivity; bowel obstruction

Side Effect:

Agitation, blurred vision, constipation, drowsiness, nausea,

nervousness

Adverse Reaction:

Dryness of the mouth with difficulty in swallowing and talking, thirst

and flushing and dryness of the skin

Nursing Responsibility:

1. Monitor Vital signs.

2. Should be taken with food. Take after meals to avoid gastric irritation.

3. Do not use antacids or antidiarrheal for 1-2 hour after taking drug.

4. Avoid activities that require mental alertness until drug effects

realized. May cause dizziness, drowsiness, blurred vision.
5. Change positions slowly to prevent sudden drop of BP.

6. Avoid overheating; drug reduces perspiration.

7. Record stools; increase intake of fluids, fruit juices, and fiber to avoid
constipation;

8. Report adverse effects/loss of response; dose may require adjustment.

9. Use sugarless gum/candies, rinse mouth often to control dry mouth

effects.
General Name: Chlorpromazine

Brand Name: Laractyl

Classification: Antipsychotic - Antiemetic

Dosage and Frequency: 200mg 1 tab, QID

Action of Mechanism:

Chlorpromazine is a neuroleptic that acts by blocking the postsynaptic

dopamine receptor in the mesolimbic dopaminergic system and inhibits the
release of hypothalamic and hypophyseal hormones. It has antiemetic,
serotonin-blocking, and weak antihistaminic properties and slight ganglion-
blocking activity.

Indication:

The management of psychotic disorders including manifestations of manic

depressive illness, manic phase and severe behavioral problems in children;
nausea and vomiting due to stimulation of the chemoreceptor trigger zone.

Contraindication:

Comatose or depressed states due to CNS depressants; blood dyscrasias;

bone marrow depression; liver damage. Hypersensitivity to chlorpromazine.
Cross allergenicity with other phenothiazines may occur.

Should be avoided in children or adolescents with signs or symptoms

suggestive of Reye's Syndrome. Its antiemetic effect may mask the signs
and its CNS effect may be confused with the signs of Reye's Syndrome or
other encephalopathies.

Side Effect:

drowsiness,insomnia,nasal congestion, ejaculation problems, impotence, also

known as erectile dysfunction,dry mouth,nausea, vomiting, diarrhea, or
constipation, difficulty passing urine, blurred vision.

Adverse Reaction:

In general members of the aliphatic group of phenothiazines have strong

sedative, hypotensive and anticholinergic properties and mild to moderate
extrapyramidal effects.

Nursing Responsibility:
1. Assess mental status prior to and periodically during therapy.

2. Drug may be given with or without meal.

3. Monitor patient for hypersensitivity to the drug.

4. Monitor Vital signs.

5. Observe patient carefully when administering medication, to ensure

that medication is actually taken and not hoarded.

6. Monitor input and output ratios and daily eight. Assess patient for signs
and symptoms of dehydration.

7. Monitor for development of neuroleptic malignant syndrome

8. Monitor for any side effects and adverse reaction.

Generic Name: haloperidol

Brand Name: Haldol

Dosage: 0.5 mg tablet

Classification: Antipsychotic; Typical

Mode of Action: Competitively blocks dopamine receptors to cause

sedation and also causes alpha-adrenergic and anticholinergic
blockade. It depresses cerebral cortex, hypothalamus and limbic
system, which control activity and aggression but also cause
significant extra pyramidal effects. The mechanism for
antipsychotic effects are unclear.

Indications: Management of Tourette disorder; control of adults;

management of sever behavioral problems in children and adults;
management of sever behavioral problems in children; short-term
treatment of hyperactive children. Long-term antipsychotic therapy
(haloperidol decanoate).

Contraindications: Severe toxic CNS depression or comatose states from

any cause; Parkinson disease. Hypersensitivity, blood
dyscrasias, coma, bone marrow depression, alcohol and
bartiturate withdrawal states. Angina, epilepsy, urinary
retention, narrow-angle glaucoma.

Drug Interactions: Anticholinergics may decrease the efficacy of

haloperidol in treating schizophrenic patients. There may be an
increase in the hepatic metabolism of haloperidol due to the
induction of microsomal enzymes by the barbiturate. Taking
lithium and haloperidol concurrently may produce unexpected
toxic effects. Patients may experience EPS, persistant
dyskinesias, impairment of consciousness, encephalopathy,
hyperthermia, leukocytosis, and increases serum enzymes.
Concurrent intake with propranolol may increase the
hypotensive activity of both drugs to an addictive or
synergistic pharmacologic activity. CNS depressant drugs,
alcohol, hypnotics, sedatives or strong analgesics.

Side/Adverse Effects: Dizziness, drowsiness, difficulty urinating, sleep

disturbances, headache, and anxiety may occur. Muscle
spasm/stiffness, shaking (tremor), restlessness, mask-like
 facial expression, drooling. May increase your level of a
certain chemical made by the body (prolactin). For females,
this increase in prolactin may result in unwanted breast
milk, missed/stopped periods, or difficulty becoming
pregnant. For males, it may result in decreased sexual
ability, inability to produce sperm, or enlarged breasts. For
males, in the unlikely event you have a painful or prolonged
erection (lasting more than 4 hours). This medication may
rarely cause a condition known as tardive dyskinesia. In
some cases, this condition may be permanent. Patient may
develop any facial/muscle twitching such as tongue
thrusting, chewing movements, puffing or puckering of your
mouth, or uncontrollable shaking. This medication may
rarely cause a serious condition called neuroleptic
malignant syndrome (NMS). Seek immediate medical
attention if you develop any of the following symptoms:
fever, muscle stiffness, severe confusion, increased
sweating, fast/irregular heartbeat. Rare but very serious
side effects occur: dark urine, persistent nausea/vomiting,
stomach/abdominal pain, yellowing of eyes/skin, seizures,
signs of infection (such as fever, persistent sore throat),
slow/fast/irregular heartbeat, severe dizziness, chest pain,
fainting. Symptoms of an allergic reaction include: rash,
itching/swelling (especially of the face/tongue/throat),
severe dizziness, trouble breathing.

Nursing Responsibilities:

1. Assess patient’s disorder and mental status before drug therapy and
reassess regularly thereafter; affect, orientation, mood, behavior, sleep
pattern, presence and type of hallucinations.

2. Monitor for possible adverse reactions.

3. Monitor swallowing of oral administration medication and check for

hoarding or giving of medication to other patients.

4. Monitor vital signs.

5. Assess for constipation and urinary retention daily.

6. Assess for neuroleptic malignant syndrome.

 7. Assess reflexes, gait, coordination and EPS.

Bibliography: PPD’s Nursing Drug Guide 2nd Edition

 DIAGNOSTIC AND LABORATORY EXAMS

COMPLETE BLOOD COUNT 8:00PM

A complete blood count (CBC) is a series of tests used to evaluate the composition and concentration of the cellular
components of blood.
DATE TEST ACTUAL VALUES NORMAL IMPLICATION RATIONALE NURSING
VALUES RESPONSIBILITIES
WBC H13.31 5-10 Leukemia, - To verify infection 1. Explain to the
J or
x10^3/uL bacterial patient the necessity
inflammation in
A infection, severe the body and of undergoing the

sepsis. observe its test that it helps

N
responses to detect occurrence of
U specific yherapies.
anemia and
A
Hemoglo L127 135-175 Low HCT, polycythemia.
R bin
g/L suggest anemia,
- To recognize
Y hemodilution or 2. Notify the patient
the amount of
1 enormous blood that the test requires
O2 carrying
loss. blood sample as well
3 protein
 contained within as the person who

Hemato the RBC. will perform the

2
crit
0.37 0.36-0.48 Normal venipuncture and the
0
- To identify the time.
1
percentage of the
blood
1 3. Inform the patient
volume
that the procedure is
occupied by red
of slight discomfort
RBC blood cells.
and may feel a little

4.92 4.20-6.10 normal

- To know the
x10^6/ uL
amount of RBC

in the blood.

Differe
ntial

Count

Neutrop .
hil
 71% 55-75% Normal - To point out

the presence of
bacterial

infection and

amount of

Leukocyte.
Lympho
cytes

-To recognize if
15% 20-35% A low lymphocyte
count indicates there is an
that the body's
resistance to fight unusual amount
infection has been of lymphocyte
substantially lost
and one may that may
become more
susceptible to indicate viral
certain types of
infection such
infection, namely
cance rand tumor. as HIV.

-Increase of

Monocyt Normal these may

es
respond to
 6% 2-10% corticosteroid,

with pus

conditions,
hemorrhage.

Eosinop
hil -High
1% 0-5%
percentage of
Normal
eosinophil, may

indicate

bacterial

infestation or

Platelet Allergies.
370 450

Normal