GENERAL SANTOS DOCTORS’ MEDICAL SCHOOL FOUNDATION

NCM: 122n RLE EXPOSURE

Area: Intensive Care Unit (ICU) Inclusive Dates: January 2022

Patient: CFG Attending Physician: N/A Student Name: Kusain, Labanero, Labaco, Navarro, Ranes
Age and Sex: 58 years old, female Ongoing Diagnosis: Septic shock secondary to ascending cholangitis s/p ERCP Year and Section: BSN 4
Chief Complain: Abdominal pain Group: 1B

DRUG (Brand DOSAGE

MECHANISM OF NURSING
name and INDICATION (Recommended and ADVERSE REACTION
CLASSIFICATION ACTION RESPONSIBILITIES
Generic name) Actual)
Brand name: Pharmacological: The actions of Intravenous Recommended:  Anterograde  Monitor and record
benzodiazepines amnesia patient response to
Versed Benzodiazepines such as Indicated for promoting Conscious  Euphoria medication and level
midazolam are preoperative sedation, Sedation  Ataxia of sedation.
mediated through anxiolysis, anesthesia  Falls and
the inhibitory induction, or amnesia. Adult: Confusion in the  Continuous
neurotransmitter IM 0.07–0.08 elderly cardiorespiratory
Generic Therapeutic: gamma- Intramuscular mg/kg 30–60 min monitoring.
name: aminobutyric acid before procedure
Antianxiety  Thrombophlebiti
(GABA), which is Indicated for the  IV 1–1.5 mg,  Inspect insertion site
Midazolam agents, s, thrombosis,
one of the major treatment of status may repeat in 2 for redness, pain,
Anxiolytics, and pain on
inhibitory epilepticus in adults. min prn; swelling, and other
Anticonvulsants injection
neurotransmitters signs of extravasation
in the central Nasal Intubated during IV infusion.
 Hypotension and
nervous system. Patients, 0.05–0.2 tachycardia can
Benzodiazepines Indicated for the acute mg/kg/h by  Monitor for
treatment of intermittent, occur with rapid
increase the continuous hypotension,
stereotypic episodes of intravenous
activity of GABA, infusion especially if the
frequent seizure activity administration. A
thereby producing patient is
(i.e., seizure clusters, higher dose can
a sedating effect, IV Induction for premedicated with a
acute repetitive seizures) result in
relaxing skeletal General narcotic agonist
that are distinct from a midazolam
muscles, and Anesthesia analgesic.
patient’s usual seizure infusion
inducing sleep, syndrome and
anesthesia, and pattern in patients with Adult:  Monitor vital signs for
epilepsy 12 years of age respiratory
amnesia. IV Premedicated,  entire recovery
and older. depression.
Benzodiazepines 0.15–0.25 mg/kg period. In obese
bind to the over 20–30 s, patient, half-life is
 Residual
benzodiazepine allow 2 min for prolonged during IV
hangover effect
site on GABA-A effect IV infusion; therefore,
CONTRAINDICATION: can happen with
 Nonpremedicated duration of effects is
Contraindications for , 0.3–0.35 mg/kg nighttime prolonged (i.e.,
the use of midazolam over 20–30 s, administration of amnesia,
include acute angle- allow 2 min for midazolam, postoperative
closure glaucoma, effect which can impair recovery).
receptors, which hypotension, and shock. the cognitive and
potentiates the Careful dose adjustment psychomotor  Observe for overdose
effects of GABA by is necessary in cases of Actual: abilities, which symptoms include
increasing the kidney and liver diseases, can result in falls somnolence,
frequency of alcohol, and drug- in elderly and confusion, sedation,
chloride channel dependent individuals. impaired diminished reflexes,
opening. These Caution is necessary for coordination coma, and untoward
receptors have pregnant individuals, during driving. effects on vital signs.
been identified in children, and individuals
different body with comorbid psychiatric SIDE EFFECTS: Patient Education
tissues including conditions. Administration
the heart and in elderly individuals and  Nausea  Do not drive or
skeletal muscle, acutely ill patients  Vomiting engage in potentially
although mainly requires caution to hazardous activities.
 Dizziness
appear to be prevent the accumulation  Drowsiness
present in the of active metabolites.
 Coughing
central nervous Extra precautions should
system. be taken in critically ill
individuals as dose
accumulation can occur.

DRUG (Brand MECHANISM OF INDICATION DOSAGE ADVERSE REACTION NURSING

name and CLASSIFICATION ACTION (Recommended and RESPONSIBILITIES
Generic name) Actual)
Brand name: Pharmacological: Norepinephrine Indicated to restore BP Recommended:  Arrhythmias  Monitor constantly
functions as a in certain acute  Convulsions while patient is
Levophed Catecholamine peripheral hypotensive states such Adult:  Chest pain receiving
vasoconstrictor as shock, IV Start with 8–12  Photophobia norepinephrine. Take
by acting on pheochromocytomectomy, mcg/min, titrate to  Blurred vision baseline BP and
alpha-adrenergic spinal anesthesia, maintenance  Restlessness pulse before start of
receptors. It is poliomyelitis, MI, dose of 2–4 therapy, then q2min
Generic Therapeutic:  Anxiety
also an inotropic septicemia, blood mcg/min from initiation of drug
name:  Tremors
stimulator of the transfusion, and drug until stabilization
Alpha and Beta heart and dilator reactions. Also as adjunct  Pallor occurs at desired
Norepinephri Adrenergic  Plasma volume
of coronary in treatment of cardiac level, then every 5
ne Agonist Actual: depletion
arteries as a arrest. min during drug
(Sympathomimetic result of it's  Edema administration.
) activity at the CONTRAINDICATION:  Hemorrhage
beta-adrenergic  Vomiting  Observe carefully and
receptors. Use as sole therapy in record mental status
hypovolemic states, (index of cerebral
except as temporary SIDE EFFECTS: circulation), skin
emergency measure; temperature of
mesenteric or peripheral  Headache extremities, and color
vascular thrombosis;  Vomiting (especially of
profound hypoxia or  Palpitation earlobes, lips, nail
hypercarbia; use during  Dizziness beds) in addition to
cyclopropane or halothane vital signs.
anesthesia; pregnancy
(category D), lactation.  Monitor I&O. Urinary
retention and kidney
shutdown are
possibilities,
especially in
hypovolemic patients.
Urinary output is a
sensitive indicator of
the degree of renal
perfusion. Report
decrease in urinary
output or change in
I&O ratio.

 Be alert to patient's
 complaints of
headache, vomiting,
palpitation,
arrhythmias, chest
pain, photophobia,
and blurred vision as
possible symptoms of
overdosage. Reflex
bradycardia may
occur as a result of
rise in BP.

 Continue to monitor
vital signs and
observe patient
closely after
cessation of therapy
for clinical sign of
circulatory
inadequacy.

DRUG (Brand DOSAGE

MECHANISM OF NURSING
name and INDICATION (Recommended and ADVERSE REACTION
CLASSIFICATION ACTION RESPONSIBILITIES
Generic name) Actual)
Brand name: Pharmacological: By binding to Indicated for the Recommended: Body as a  Instruct or educate
specific treatment of infection Whole: Similar to those the patient to take
Unasyn Aminopenicillin penicillin-binding (Respiratory, GI, UTI and Systemic for penicillin G. ampicillin with a full
proteins (PBPs) meningitis) due to E. coli, Infections Hypersensitivity glass of water on an
located inside P. mirabilis, enterococci, (pruritus, urticaria, empty stomach (at
the bacterial cell Shigella, S. typhosa and Adult: eosinophilia, hemolytic least 1 h before or 2 h
Generic Therapeutic: wall, Ampicillin other Salmonella, PO 250–500 mg anemia, interstitial after meals) for
name: inhibits the third nonpenicillinase-producing q6h nephritis, anaphylactoid maximum absorption.
Broad Spectrum and last stage of N. gononhoeae, H. IV/IM 250 mg–2 g reaction); Food hampers rate
Ampicillin Anti-infective bacterial cell wall influenzae, staphylococci q6h superinfections. and extent of oral
synthesis. Cell and streptococci. absorption.
lysis is then CNS: Convulsive
mediated by CONTRAINDICATION: Actual: seizures with high  Determine previous
bacterial cell wall doses. hypersensitivity
autolytic Hypersensitivity to reactions to
enzymes such penicillin derivatives; Skin: Rash. penicillins,
as autolysins; it infectious mononucleosis. cephalosporins, and
is possible that SIDE EFFECTS: other allergens prior
Ampicillin to therapy.
interferes with an  Diarrhea
autolysin  Nausea  Lab tests: Baseline
inhibitor.  Vomiting C&S tests prior to
initiation of therapy.
Baseline and periodic
assessments of renal,
hepatic, and
hematologic
functions, particularly
during prolonged or
high-dose therapy.

 Inspect skin daily and

instruct patient to do
the same. The
appearance of a rash
should be carefully
evaluated to
differentiate a
nonallergenic
ampicillin rash from a
hypersensitivity
 reaction. Report rash
promptly to physician.

DRUG (Brand DOSAGE

MECHANISM OF NURSING
name and INDICATION (Recommended and ADVERSE REACTION
CLASSIFICATION ACTION RESPONSIBILITIES
Generic name) Actual)
Brand name: Pharmacological: Ceftriaxone works Ceftriaxone is used for Recommended: Body as a  Determine history of
by inhibiting the the treatment of the Whole: Pruritus, fever, hypersensitivity
Rocephin Third-generation mucopeptide infections (respiratory, Moderate to chills, pain, induration reactions to
Cephalosporin synthesis in the skin, soft tissue, UTI, Severe Infections at IM injection site; cephalosporins and
bacterial cell wall. ENT) caused by phlebitis (IV site). penicillins and history
The beta-lactam susceptible organisms. Adult: of other allergies,
moiety of Organisms that are IV/IM 1–2 g q12– GI: Diarrhea, abdomina particularly to drugs,
Generic Therapeutic: ceftriaxone binds to generally susceptible to 24h (max: 4 g/d) l before therapy is
name: carboxypeptidases, ceftriaxone include S. cramps, pseudomembr initiated.
Broad-spectrum endopeptidases, pneumoniae, S. anous colitis, biliary
Ceftriaxone Antibiotic Actual: Lab tests: Check
and pyogenes (group A beta- sludge. 
transpeptidases in hemolytic streptococci), culture and sensitivity
the bacterial coagulase-negative Urogenital: Genital tests before initiation
cytoplasmic staphylococci, Some pruritus; moniliasis. of therapy and
membrane. These Enterobacter spp, H. periodically during
enzymes are influenzae, N. SIDE EFFECTS: therapy.
involved in cell-wall gonorrhoeae, P.
synthesis and cell mirabilis, E. coli,  rash  Inspect injection sites
division. Binding of Klebsiella spp, M.  nausea for induration and
 catarrhalis, B.  vomiting inflammation. Rotate
burgdorferi, and some  upset stomach sites. Note IV
oral anaerobes.  dizziness injection sites for
 headache signs of phlebitis
CONTRAINDICATION: (redness, swelling,
pain).
Hypersensitivity to
cephalosporins and  Monitor for
related antibiotics; manifestations of
pregnancy (category B). hypersensitivity.
Report their
appearance promptly
and discontinue drug.

 Watch for and report

signs: petechiae,
ecchymotic areas,
ceftriaxone to these
epistaxis, or any
enzymes causes
unexplained bleeding.
the enzyme to lose
Ceftriaxone appears
activity; therefore,
to alter vitamin K–
the bacteria
producing gut
produce defective
bacteria; therefore,
cell walls, causing
hypoprothrombinemic
cell death.
bleeding may occur

 Check for fever if

diarrhea occurs:
Report both promptly.
The incidence of
antibiotic-produced
pseudomembranous
colitis is higher than
with most
cephalosporins. Most
vulnerable patients:
chronically ill or
debilitated older adult
patients undergoing
abdominal surgery.
Reference :

https://go.drugbank.com/drugs/DB00683
https://www.ncbi.nlm.nih.gov/books/NBK537321/
http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/M067.html
http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/N042.html
https://go.drugbank.com/drugs/DB00415
https://go.drugbank.com/drugs/DB01212
http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/C050.html
https://www.rxlist.com/ceftriaxone-side-effects-drug-center.htm