NCM 116-C ORTHOPEDIC NURSING DRUG STUDY –

OSTEOARTHRITIS
1. TRAMADOL HYDROCHLORIDE

Date and Time Ordered: 08/03/2021 8:00 am; 08/04/2021 11:00 am

Generic Name: Tramadol Hydrochloride
Brand Name: Ultram
Drug Classification: Opioid analgesic
Dosage, Route, Frequency: Tramadol Hydrochloride 50 mg/ml IV stat for pain
then q 6 hrs
Mechanism of Action: Tramadol inhibits reuptake of norepinephrine, serotonin
and enhances serotonin release. It alters perception and response to pain by binding to
mu-opiate receptors in the CNS. Tramadol is similar to substances in the brain called
endorphins where they bind to receptors and the receptors then decrease the pain
messages that the body sends to the brain.
Desired Effect: This drug was given to relieve pain.

Nursing Responsibilities:
Nursing Responsibilities Rationale
1. Verify doctor’s order To avoid errors and to promote correct
administration of medication
2. Explain the drug to the client and to To gain cooperation and promote
significant others compliance
3. Observe the 12 R’s in drug To prevent error in drug administration
administration.
4. Discontinue drug and notify physician To prevent further complications.
if S&S of hypersensitivity occur.
5. Restrict visitors To allow the patient to rest
6. Dim the lights and reduce noise To provide comfort and promote sleep
7. Provide a cold compress To relieve pain
8. Encourage to practice relaxation such as To elicit a relaxation response that
deep breathings, listening to music decreases the effects of stress on pain.
9. Encourage patient to cough and breathe To prevent atelectasis and pneumonia.
deeply every 2 hr.
10. Provide safety measure such as raise To prevent injuries.
side rails
11. Document relevant data. To promote continuity of care, prevent
duplication of drug administration and for
legal purposes

2. CELECOXIB

Date and Time Ordered: 08/03/2021 8:00 a.m.

Generic Name: Celecoxib
 Brand Name: Celebrex
Drug Classification: Nonsteroidal Anti-Inflammatory Drug (NSAID)
Dosage, Route, Frequency: Celecoxib 200 mg PO BID
Mechanism of Action: Due to selective inhibition of cyclooxygenase-2 (COX-2),
which is responsible for prostaglandin synthesis, an integral part of the pain and
inflammation pathway. This pharmacologic activity gives celecoxib its analgesic, anti-
inflammatory, and antipyretic effects.
Desired Effect: This drug was given to reduce inflammation and relieve pain

Nursing Responsibilities:
Nursing Responsibilities Rationale
1. Verify doctor’s order To avoid errors and to promote correct
administration of medication
2. Explain the drug to the client and to To gain cooperation and promote
significant others compliance
3. Observe the 12 R’s in drug To prevent error in drug administration
administration.
4. Discontinue drug and notify physician To prevent further complications.
if S&S of hypersensitivity occur.
5. Administer with food if GI upset is To alleviate GI effects
severe. Provide small, frequent meals.
6. Check all drugs being taken for possible To avoid toxic levels
salicylate ingredients and monitor dose
7. Monitor for severe reactions if they To avoid problems and provide emergency
occur procedures such as gastric lavage,
induction of vomiting and administration of
charcoal
8. Restrict visitors To allow the patient to rest
9. Provide environmental control by To provide comfort
adjusting light or temperature of the
room
10. Ensure that the patient is well hydrated To decrease the risk of toxicity
during therapy
11. Encourage to practice relaxation such as To help the patient relax
deep breathings, listening to music
12. Provide safety measure such as raise To prevent injuries.
side rails
13. Document relevant data. To promote continuity of care, prevent
duplication of drug administration and for
legal purposes
 3. PREDNISONE
Date and Time Ordered: 08/03/2021 8:00 a.m.
Generic Name: Prednisone tablets, USP
Brand Name: Prednisone
Drug Classification: Corticosteroids
Dosage, Route, Frequency: Prednisone 20mg PO OD
Mechanism of Action: Prednisone decreases inflammation via suppression of the
migration of polymorphonuclear leukocytes and reversing increased capillary
permeability. It also suppresses the immune system by reducing the activity and the
volume of the immune system. They promote the up-regulation of anti-inflammatory
genes and down-regulation of pro-inflammatory genes. It inhibits the inflammatory
effects of circulating monocytes and eosinophils, thus contributing to relief of acute
symptoms.
Desired Effect: Prednisone helps to reduce the swelling and stiffness in the joints and
ease the pain.

Nursing Responsibilities:

Nursing Responsibilities Rationale

1. Verify doctor’s order For verification and to avoid errors
2. Assess for allergy or hypersensitivity To prevent further complication.
reaction to the drug.
3. Explain the drug to the client and to To gain cooperation and promote compliance
significant others
4. Observe the 12 Rs in drug administration. To prevent error in drug administration
5. Administer once-daily doses of prednisone To prevent further complications.
in the morning to match body’s normal
cortisol secretion schedule.
6. Because prednisone can produce many To get the desired effectiveness of the drug
adverse reactions, assess regularly for signs
and symptoms of such reactions as heart
failure and hypertension. Also monitor fluid
intake and output and daily weight.
7. Monitor growth pattern in children. To prevent further complications.
Prednisone may retard bone growth.
8. Be aware that prolonged use of prednisone To prevent further complications.
may cause hypothalamic-pituitary-adrenal
suppression
9. Involve in diversional activities appropriate Refocuses attention, provides stimulation and
for individual situation. enhances self-esteem and feelings of general
well-being.
10. Provide safety measures (e.g. adequate To prevent injuries.
lighting, raised side rails, etc.).
11. Increased intake of food and drink plenty of Provides feeling of well-being
water.
12. Educate client on drug therapy. To promote understanding and compliance.
13. Document relevant data. To prevent error of drug administration

4. IBUPROFEN

Date and Time Ordered: 08/04/2021 11:00 a.m.

Generic Name: Ibuprofen
Brand Name: Caldolor IV
Drug Classification: Non-Steroidal Anti-inflammatory Drug (NSAID)
Dosage, Route, Frequency: Ibuprofen 500 mg IV q 6 hrs
Mechanism of Action: Naproxen blocks arachidonate binding to completely
inhibit both cyclooxygenase (COX) isoenzyme, COX-1 and COX-2 resulting in analgesic
and anti-inflammatory effects.
Desired Effect: This drug was given to reduce swelling/inflammation.

Nursing Responsibilities:
Nursing Responsibilities Rationale
1. Verify doctor’s order To avoid errors and to promote correct
administration of medication
2. Explain the drug to the client and to To gain cooperation and promote
significant others compliance
3. Observe the 12 R’s in drug To prevent error in drug administration
administration.
4. Discontinue drug and notify physician To prevent further complications.
if S&S of hypersensitivity occur.
5. Monitor blood pressure Drug can lead to new-onset HTN or
preexisting HTN, which may contribute to
the increased incidence of CV events.
6. Check all drugs being taken for possible To avoid toxic levels
salicylate ingredients and monitor dose
7. Monitor for severe reactions if they To avoid problems and provide emergency
occur procedures such as gastric lavage,
induction of vomiting and administration of
charcoal
8. Restrict visitors To allow the patient to rest
9. Provide environmental control by To provide comfort and promote sleep
adjusting light or temperature of the
room
10. Provide safety measure such as raise To prevent injuries.
side rails
11. Document relevant data. To promote continuity of care, prevent
duplication of drug administration and for
legal purposes
5. CEFUROXIME AXETIL

Date and Time Ordered: 08/04/2021 8:00 am; 08/04/2021 11:00 am

Generic Name: Cefuroxime
Brand Name: Ceftin
Drug Classification: Second-Generation Cephalosporins
Dosage, Route, Frequency: Cefuroxime 1.5g IV loading dose; then 750 mg IV q
8 hrs after TKA
Mechanism of Action: Cefuroxime is a bactericidal agent that acts by binding to
the bacterial cell wall membrane which causes cell death and the inhibition of bacterial
cell wall synthesis.
Desired Effect: This drug was given as a prophylaxis against infection

Nursing Responsibilities:
Nursing Responsibilities Rationale
1. Verify doctor’s order To avoid errors and to promote correct
administration of medication
2. Explain the drug to the client and to To gain cooperation and promote
significant others compliance
3. Observe the 12 R’s in drug To prevent error in drug administration
administration.
4. Discontinue drug and notify physician To prevent further complications.
if S&S of hypersensitivity occur.
5. Check culture and sensitivity reports To ensure that this is the drug of choice for
the patient
6. Ensure that the patient receives the full To increases effectiveness and the decrease
course of the cephalosporins as the risk of development of resistant strains
prescribed
7. Monitor the patient for any signs of To arrange for treatment if superinfection
superinfection occurs
8. Provide safety measure such as raise To protect the patient from injuries.
side rails, adequate lightning, and
assistance with ambulation
9. Document relevant data. To promote continuity of care, prevent
duplication of drug administration and for
legal purposes