Republic of the Philippines

College of Nursing
Bicol University
Legazpi City

DRUG STUDY FORMAT

DRUG MECHANISM OF ADVERSE NURSING

CLASSIFICATION INDICATION CONTRAINDICATION
NAME ACTION REACTION RESPONSIBILITIES
Generic Pharmacotherapeutic NAHCO3 · Management of · Hypersensitivity to Side Effects: Before Administration
Name:  Alkalinizing agent administered metabolic sodium · Abdominal  Identify the patient’s
Sodium intravenously acidosis related bicarbonate distension name.
Bicarbonate Clinical dissociates to form to: · Hypernatremia · Flatulence  Inform the patient
sodium (Na) and - Severe renal · Metabolic and · Belching
Brand  Antacid electrolyte bicarbonate (HCO3) about the IV
disease respiratory
Name:  Urinary/systemic ions. Increased medication to be
- Uncontrolled alkalosis Adverse Effects:
Neut alkalinizer hydrogen ion diabetes · Unknown · Excessive administered.
Sodium concentrations, - Circulatory abdominal pain chronic use  Secure patient’s
Bicarbonate bicarbonate ions insufficiency · Hypocalcemia may produce consent before
combine with due to shock · Severe pulmonary metabolic administration.
Actual hydrogen ions to form - Anoxia or edema alkalosis
dosage: carbonic acid and  Explain the purpose or
severe - Irritability use of the IV
50 mEq dissociates to CO2, dehydration Cautions: - Tetany
which is excreted by medication.
- Extracorporeal · Heart failure - Twitching
Route: lungs. circulation of  Follow the rights of
· Edematous states - Paresthesia
Intravenous blood medication
(IV) It increases plasma · Renal insufficiency (Burning or
- Severe primary · Cirrhosis prickling administration.
bicarbonate levels,
lactic acidosis sensation)  Refer to doctor’s order
Frequency: known to buffer
· Gastric acidity - Cyanosis to ensure
q8h (8 am – excess hydrogen ion
treatment - Slow or shallow appropriateness and
4 pm – 12 concentration which
mn) raises solution’s pH · Alkalinization respirations accuracy of IV
to fight signs and agent for urine - Headache
· Management of medication order to
symptoms of - Thirst
cardiac arrest client. Verify the
acidosis. - Nausea
 · Hyperkalemia · Fluid overload name, dosage,
It alkalinizes the treatment (Hypervolemia) amount, duration,
urine, capable of · Management of - Headache route of
changing precipitants overdose of - Weakness administration, type of
in urine and a tricyclic - Blurred vision
medium for solution and expiry
antidepressants - Behavioral
neutralizing tubular and aspirin date of the IV
changes
acid concentration · Treatment of medication.
- Incoordination
gradients to control certain drugs  Ensure to review
- Muscle
high fluctuations in intoxications: important information
twitching
serum acid-base barbiturates and prior to medication
- Elevated BP
status changes. salicylates or administration (age,
- Bradycardia
methyl alcohol weight and condition
It works for - Tachypnea
· Prevention of of the patient, target
alkalization process - Wheezing
contrast-media vein condition, limb
enabling compounds - Coughing
nephrotoxicity mobility, severity of
that would normally - Distended neck
precipitate in renal veins the acidosis,
tubules in acidic · Extravasation contraindications,
conditions to be may occur at laboratory results,
buffered within renal the IV site allergies, potential
tubule, which - Tissue necrosis interactions, side
prevents mechanical - Ulceration effects, IV
or chemical damage compatibilities and
while providing incompatibilities and
increased efficient medical history).
within kidney tubules  Ensure that the fluid
to excrete acidified inside the vial is
substances without colorless and the seal
disrupting is tight; otherwise,
electrochemical replace.
gradient.
 Follow aseptic
technique in the
preparation and
administration of the
IV medication.
During Administration
 Select and disinfect
site of IV fluid insertion
and ensure proper
lighting to ensure that
the target vein is what
is punctured.
 Incorporate the IV
medication with the IV
fluid (1L of D5W) as
secondary infusion.
 Regulate the drip rate.

After Administration
 Ensure that the fluid
container or the IV
bag is at least 3 feet
above the IV site to
facilitate flow of the
fluid.
 Assist the patient in
comfortable position
after the IV infusion.
 Instruct the patient to
avoid too much
movement and keep
the arm that has the
IV infusion in a steady
position.
 Observe the site of IV
infusion during and
after infusion and
watch for signs of
 blood backflow,
swelling, infiltration,
thrombosis and blood
clotting.
 Inspect the patient’s
arm for streaking or
venous cords; assess
skin temperature.
 Monitor patient’s vital
signs and observe for
side effects. Closely
monitor cardiac,
respiratory and
neurologic status for
changes. Report any
untoward signs and
symptoms as well as
adverse reactions.
 Discontinue IV
infusion if an adverse
reaction occurs.
Evaluate the patient,
institute appropriate
therapeutic
countermeasures and
save the remainder of
the IV fluid for
examination if deemed
necessary.
 Assess for signs and
symptoms of
metabolic alkalosis as
caused by excessive
 use such as irritability,
twitching, cyanosis,
headache, thirst,
nausea and shallow
respirations.
 Assess for signs and
symptoms of fluid
overload such as
cramps, edema,
nausea and reduced
saliva.
 Watch out for clinical
improvement of
metabolic acidosis as
evidenced by relief
from hyperventilation,
weakness and
disorientation.
 Assess the IV line
every hour, ensure
that the drip rate is
maintained and
ensure IV patency by
checking if there are
bubbles, kinks or
bends in the IV tubing
that causes
obstruction of flow.
 Ensure that the IV
infusion is finished
within the ordered
duration to avoid
overdosing.
 If the IV fluid is not
consumed on time or
does not meet the IV
off schedule,
recalculate the drip
rate, regulate the flow
and reposition the
arm.
 Record patient’s
intake and output.
 Document the whole
IV infusion procedure
including time of start
and end of IV infusion,
when and where the
line was placed, when
and where the
catheter was inserted,
what sterile technique
was maintained, what
type of dressing was
applied, how the
patient tolerated the
procedure and any
adjustments /
modifications carried
out.
 Actively participate in
the reconciliation
process of
medications.
 Dispose unused or
damaged medications
 according to hospital
policy.
 Assist the client in
taking laboratory tests
to confirm
improvement from
chronic kidney
disease such as blood
test for GFR, serum
creatinine, urine
creatinine, serum
albumin and urine
albumin tests.

Sources:
Kizior, R. J., Hodgson,K. J. (2019). Saunders Nursing Drug Handbook 2019. 1072 – 1074.
Senewiratne, N. L., Woodall, A.. (2021). Sodium Bicarbonate. StatPearls.