Delantar 3bsna Parotidectomy Pleomorophic Adenoma

Pamantasan ng Cabuyao
Banaybanay, Cabuyao City, Laguna 4025, Philippines
COLLEGE OF HEALTH AND ALLIED SCIENCES
Name: Delantar, Joshua B. Yr.&Section: 3 BSN-A Prof. Mike Zulueta Isanan
1. WHAT IS PAROTIDECTOMY?
- Parotidectomy is the partial or

complete surgical excision (removal)
of the parotid gland, the major and largest
of the salivary glands. Surgical
candidates present for a variety of
reasons that can include inflammatory
conditions, certain infectious processes,
congenital malformations, benign, or
malignant neoplasms. The procedure is
most typically performed due to
neoplasms (tumors), which are growths of
rapidly and abnormally dividing cells.
WHAT HAPPENS WHEN PAROTID GLAND IS REMOVED?

- Permanent damage is possible but usually occurs in only the most difficult cases. Depending on the
branch of the nerve that is damaged you may experience: Weakness of the lower lip, leading to a
slightly crooked smile. Weakness of the eyelids, making it difficult to keep the eye closed.
OVERVIEW OF SURGERY SIDE EFFECTS

• It is normal for patients to feel tired, have pain, worry, and generally not feel like themselves after
parotid surgery. The significant complication rate, and the number of problems requiring serious
intervention after parotid surgery is low.
• It is important that patients are aware of the potential side effects from having parotid surgery, so they
are prepared for what to expect after surgery.
• Patients should know the difference between a normal side effect, and the types of side effects that
may require medical attention.
NORMAL SIDE EFFECTS OF SURGERY:

✓ Incisional and facial swelling
✓ Mild incisional redness
✓ Skin numbness
✓ Jaw stiffness
✓ Muffled or plugged ear feeling
✓ Some pain/discomfort
✓ Fatigue
✓ Temporary facial weakness

✓ Difficulty Closing Eyelids
✓ Throat Soreness
✓ General Body Soreness
✓ Abnormal sensations (twitching, zapping,
phantom itching, feeling of things
crawling under skin)
✓ Frey’s Syndrome
✓ First Bite Syndrome
ABNORMAL SIDE EFFECTS OF SURGERY:

• Ear drainage
• Wound edge drainage other than very mild clear yellow fluid
• Rapid swelling of the cheek (particularly after eating)
• Saliva draining from wound (signs of a sialocele or fistula)
• Bruising of the skin with rapid swelling (signs of a hematoma)
• Fever above 101.5 degrees
2. PATHOPHYSIOLOGY OF PLEOMORPHIC ADENOMA

o Microscopically pleomorphic adenoma has a highly variable appearance, hence the name
pleomorphic. It is characterized by mixed proliferation of polygonal epithelial and spindle-
shaped myoepithelial cells in a variable stroma matrix of mucoid, myxoid, cartilaginous or
hyaline origin.
o What causes a pleomorphic adenoma?
The causes of pleomorphic adenomas are still unknown and the risk factors have not been fully
ascertained yet. In addition to age, risk factors may be related to smoking habits, alcohol abuse,
a diet rich in cholesterol and previous radiation therapy treatments in the face and neck regions.
o Where does pleomorphic adenoma occur?
Pleomorphic adenoma (PA), also known as benign mixed tumor, is the most common salivary
tumor, constituting up to two-thirds of all salivary gland neoplasms (1). Mostly, PA is located in
the parotid glands (85%), minor salivary glands (10%), and the submandibular glands (5%) (2).
o How do you diagnose pleomorphic adenoma?
Although sonographic findings can suggest the diagnosis of pleomorphic adenoma in many
small tumors, CT or MRI is needed to fully evaluate large tumors. Even in patients in whom the
diagnosis is made by means of sonography and biopsy, CT or MRI is needed for preoperative
planning.
o What are the components of pleomorphic adenoma?
Pleomorphic adenoma is a benign salivary gland tumor that exhibits wide cytomorphologic and
architectural diversity. The tumor has the following three components: epithelial cell,
myoepithelial cell, and stromal/mesenchymal.
o How can pleomorphic adenoma be prevented?

One strategy to reduce the rate of recurrence is to re-evaluate surgical margins using intraoperative
frozen sections. In addition, the optimal regimen should involve total parotidectomy, rather than
enucleation or superficial parotidectomy
3. Create 3 NCP
4. Do 5 drug study
Nursing Care Plans

ASSESSMENT NURSING
PLANNING
GOAL / EXPECTED NURSING
DIAGNOSIS RATIONALE EVALUATION
OUTCOME
INTERVENTIONS
Subjective: Risk for Short-Term Independent: Short-Term

Patient complains Infection Goal: Goal:
pre-auricular related to 1. Establish Rapport to 1. To gain the trust
mass. Pre auricular After 6-8 hours the patient of the patient After 6-8
mass of continuous hours of
Objective: as nursing 2. Determine etiology 2. Prior continuous
Room no: 610 evidenced intervention, (e.g., acute or chronic assessment of nursing
Date of Birth: by mass in patient will be wound, burn, wound etiology is intervention,
August 27, 1980 the right able to: dermatological lesion, critical for the patient was
Age: 41 years side - Remain pressure ulcer, leg ulcer). proper able to:
old, Male of the face afebrile identification of - Remain
Religion: Roman and achieve nursing afebrile
Catholic timely healing interventions. and achieve
Objective: as 3. Monitor timely healing
BMI: 39, Obese appropriate. temperature. 3. Temperature as
ECG: elevation may appropriate.
Sinus Rhythm Long-Term occur (if not
Nonspecific Goal: masked by Long-Term
Intraventricular corticosteroids Goal:
Conduction Delay After 2-4 days or anti-
Poor R Wave of continuous inflammatory After 2-4
Progression nursing drugs) because days of
Nonspecific St T intervention, the of various continuous
Wave Changes patient can factors nursing
Chest X-Ray: easily (chemo therapy intervention,
The lungs are perform side effects, patient was
clear intervention to disease process, able to easily
The pulmonary reduce the risk or infection). perform
vessels are not for infection Early intervention
dilated identification of to
The heart is not infectious reduce the
enlarged process enables risk
The appropriate for infection
hemidiaphragms therapy to be
and costrophrenic started
suici are intact 4. Assess all promptly
There are small systems (skin, 4. Early
osteophytes respiratory, recognition
along the thoracic genitourinary) for and intervention

vertebrae signs and may prevent
symptoms of progression to
Impression: Mild infection on a more serious
osseous continual basis. situation or
degenerative sepsis.
changes of the 5. Reposition
thoracic spine frequently; keep 5. Reduces
linens dry and pressure and
wrinkle-free. irritation to
tissues and may
prevent skin
breakdown
(potential site for
bacterial
growth).
6. Avoid or limit
invasive 6. Reduces risk of
procedures. contamination,
Adhere to aseptic limits portal of
techniques. entry for
infectious
Dependent: agents.
7. Monitor CBC with
differential WBC 7. 6. Bone marrow
and granulocyte activity may be
count, and inhibited by
platelets as effects of
indicated. chemotherapy,
the disease
state, or
radiation
therapy.
Monitoring
status of
myelosuppressio
n is important
for preventing
further
complications
(infection,
anemia, or
hemorrhage)
and scheduling
drug delivery.
8. Obtain cultures as
indicated. 8. Identifies
causative
organism(s) and
appropriate
therapy.
9. Administer
antibiotics as 9. May be used to
indicated. treat identified
infection or
given
prophylactically
in immuno-
compromised
patient.
Collaborative:
10. Promote
adequate rest and 10. imits fatigue,
exercise periods. yet encourages
sufficient
movement to
prevent stasis
complications
(pneumonia,
decubitus, and
thrombus
formation).
11. Stress
importance of 11. Development
good oral hygiene of
stomatitis
increases risk of
infection and
secondary
overgrowth
ASSESSMENT NURSING
PLANNING
GOAL / EXPECTED NURSING EVALUATION
DIAGNOSIS OUTCOME RATIONALE
INTERVENTIONS
Subjective: Fear and Short-Term Independent: Short-Term

Patient complains Anxiety Goal: Goal:
pre-auricular related 1. Establish Rapport to 1. To gain the trust
mass. to After 6-8 hours the patient of the patient After 6-8
superficial of continuous hours of
Objective: parotidecto nursing 2. Review patient’s 2. Clarifies continuous
Room no: 610 my intervention, and SO’s patient’s nursing
Date of Birth: patient will be previous perceptions; intervention,
August 27, 1980 able to: experience with assists in patient was
Age: 41 years - display cancer. identification of able to:
old, Male appropriate Determine what fear(s) and - display
Religion: Roman range the doctor has misconceptions appropriate
Catholic of feelings and told patient and based on range
Objective: lessened fear. what conclusion diagnosis and of feelings
BMI: 39, Obese Appear relaxed patient has experience with and
ECG: and report reached. cancer. lessened
Sinus Rhythm anxiety is fear.
Nonspecific reduced to a 3. Encourage patient 3. Provides Appear
Intraventricular manageable to share thoughts opportunity to relaxed
Conduction Delay level. and feelings. examine realistic and report
Poor R Wave fears and anxiety is
Progression Long-Term misconceptions reduced to a
Nonspecific St T Goal: about diagnosis. manageable
Wave Changes level.
Chest X-Ray: After 2-4 days 4. Provide open 4. Helps patient
The lungs are of continuous environment in feel accepted in Long-Term
clear nursing which patient present Goal:
The pulmonary intervention, the feels safe to condition
vessels are not patient will be discuss feelings without feeling After 2-4
dilated able to or to refrain from judged, and days of
The heart is not demonstrate talking promotes sense continuous
enlarged use of dignity and nursing
The of effective control. intervention,
hemidiaphragms coping patient was
and costrophrenic mechanisms 5. Maintain frequent 5. Provides able to
suici are intact and contact with assurance that demonstrate
There are small active patient. Talk with patient is not use
osteophytes participation in and touch patient alone or of effective
along the thoracic treatment as appropriate. rejected; coping
vertebrae regimen conveys respect
for and mechanisms

Impression: Mild acceptance of the and
osseous person, active
degenerative fostering trust. participation
changes of the in
thoracic spine 6. Assist patient and 6. Coping skills are treatment
SO in recognizing often stressed regimen
and clarifying after diagnosis
fears to begin and during
developing different phases
coping strategies of treatment.
for dealing with Support and
these fears. counseling are
often necessary
to enable
individual to
recognize and
deal with fear
and to realize
that control and
coping
strategies are
available.
7. Provide accurate, 7. Can reduce

consistent anxiety and
information enable patient to
regarding make decisions
diagnosis and and choices
prognosis. Avoid based on
arguing about realities.
patient’s
perceptions of
situation.
8. Permit 8. Acceptance of
expressions of feelings allows
anger, fear, patient to begin
despair without to deal with
confrontation. situation.
Give information
that feeling are
normal and are to
be appropriately
expressed.
9. Explain 9. Accurate
procedures, information
providing allows patient to
opportunity for deal more
questions and effectively with
honest answers. reality of
Stay with patient situation,
during anxiety- thereby reducing
producing anxiety and fear
procedures and of the unknown.
consultations.
Collaborative:
10. Note ineffective 10. Identifies
coping (poor individual
social problems and
interactions, provides support
helplessness, for patient and
giving up SO in using
everyday effective coping
functions and skills.
usual sources of
gratification).
11. Provide reliable 11. Allows for

and consistent better
information and interpersonal
support for SO. interaction and
reduction of
anxiety and fear.
12. Include SO as 12. Provides a

indicated or support system
patient desires for patient and
when major allows SO to be
decisions are to involved
be made. appropriately.
ASSESSMENT NURSING
PLANNING
GOAL / EXPECTED NURSING EVALUATION
DIAGNOSIS OUTCOME RATIONALE
INTERVENTIONS
Subjective: Risk for Short-Term Independent: Short-Term

Patient complains Impaired Goal: Goal:
pre-auricular Skin 1. Establish Rapport to 1. To gain the trust
mass. Integrity as After 6-8 hours the patient of the patient After 6-8
evidenced of continuous hours of
Objective: by nursing 2. Assess skin 2. A reddening or continuous
Room no: 610 superficial intervention, frequently for tanning effect nursing
Date of Birth: parotidecto patient will be side effects of (radiation intervention,
August 27, 1980 my able to: cancer therapy; reaction) may patient was
Age: 41 years - identify note breakdown develop within able to:
old, Male interventions and delayed the field of - identify
Religion: Roman appropriate for wound healing. radiation. Dry interventions
Catholic specific Emphasize desquamation appropriate
Objective: condition importance of (dryness and for
BMI: 39, Obese reporting open pruritus), moist specific
ECG: Long-Term areas to desquamation condition
Sinus Rhythm Goal: caregiver. (blistering),
Nonspecific ulceration, hair Long-Term
Intraventricular After 2-4 days loss, loss of Goal:
Conduction Delay of continuous dermis and
Poor R Wave nursing sweat glands After 2-4
Progression intervention, the may also be days of
Nonspecific St T patient will be noted. In continuous
Wave Changes able to addition, skin nursing
Chest X-Ray: participate in reactions intervention,
The lungs are techniques to (allergic rashes, patient was
clear prevent Hyper able to
The pulmonary complications/ pigmentation, participate in
vessels are not promote pruritus, and techniques to
dilated healing alopecia) may prevent
The heart is not as appropriate. occur with some complications
enlarged chemotherapy / promote
The agents. healing
hemidiaphragms as
and costrophrenic 3. Bathe with 3. Maintains appropriate.
suici are intact lukewarm water cleanliness
There are small and mild soap. without irritating
osteophytes the skin.
along the thoracic
vertebrae 4. Encourage 4. Helps prevent
patient to avoid skin friction and

Impression: Mild vigorous rubbing trauma to sensitive
osseous and scratching and to pat tissues.
degenerative skin
changes of the dry instead of
thoracic spine rubbing.
5. Turn or reposition 5. Promotes

frequently. circulation and
prevents undue
pressure on skin
and tissues.
6. Avoid applying 6. Helps control

heat or dampness or
attempting to pruritus.
wash off marks Maintenance
or tattoos placed care is required
on skin to identify until skin and
area of tissues have
irradiation. regenerated and
are back to
normal.
7. Assess skin and 7. Presence of

IV site and vein phlebitis, vein
for erythema, flare (localized
edema, reaction) or
tenderness; extravasation
wet-like patches, requires
itching and immediate
burning; or discontinuation
swelling, burning, of antineoplastic
soreness; blisters agent and
progressing to medical
ulceration or intervention.
tissue necrosis.
8. Review expected 8. Anticipatory

dermatologic side guidance helps
effects seen with decrease
chemotherapy concern if side
(Rash, Hyper effects do occur.
pigmentation, and peeling
of skin on palms)
Compilations of Drug Study

DRUG MECHANISM OF INDICATIONS CONTRA ADVERSE EFFECTS NURSING
ACTION INDICATIONS CONSIDERATIONS
Paracetamol Paracetamol Paracetamol is Do not use this Get emergency Remind the client
(acetaminophen) used to treat medication if you medical help if you of the medication
Generic Name: is a pain reliever many are allergic to have any of these warnings such as:
Acetaminophen and a fever conditions such acetaminophen or signs of an allergic
reducer. as headache, paracetamol. reaction to Do not use any
Brand Name: muscle aches, paracetamol: other over-the-
Tylenol Paracetamol has arthritis, Ask a doctor or hives; counter cough,
a central backache, pharmacist if it is cold, allergy, or
Acetaminophen analgesic effect toothaches, safe for you to - difficulty pain medication
is available that is mediated colds, and take paracetamol breathing; without first asking
under the through fevers. It if you have: - swelling of your your doctor or
following activation of relieves pain in face, lips, tongue, pharmacist.
different brand descending mild arthritis liver disease; or or throat.
names: Tylenol, serotonergic but has no a history of - Skin swelling Paracetamol is
Tylenol Arthritis pathways. effect on the alcoholism; (angioedema) contained in many
Pain, Tylenol Debate exists underlying - Disorientation\ combination
Ext, Little Fevers about its primary inflammation It is not known - Dizziness medicines. If you
Children's site of action, and swelling of whether - Rash (may itch) use certain
Fever/Pain which may be the joint. paracetamol will - Hives products together
Reliever, Little inhibition of harm an unborn - Low levels of red you may
Fevers Infant prostaglandin baby. Before blood cells, white accidentally use
Fever/Pain (PG) synthesis using blood cells, and/or too much
Reliever, and or through an paracetamol, tell platelets paracetamol. Read
PediaCare Single active metabolite your doctor if you - Shortness of the label of any
Dose influencing are pregnant. breath/cough other medicine
Acetaminophen cannabinoid This medication you are using to
Fever receptors. can pass into Stop using this see if it contains
Reducer/Pain breast milk and medication and call paracetamol,
Reliever. Paracetamol may harm a your doctor at once acetaminophen or
reduces fever by nursing baby. Do if you have a APAP.
Dosages of affecting an area not use serious side effect
Acetaminophen of the brain that paracetamol such as: Avoid drinking
Should Be Given regulates our without telling - low fever with alcohol while
as Follows: body your doctor if you nausea, stomach taking this
Adult Dosage temperature (the are breast- pain, and loss of medication.
Forms & hypothalamic feeding a baby. appetite; Alcohol may
Strengths heat-regulating - dark urine, clay- increase your risk
center). colored stools; or of liver damage
Tablets Paracetamol is - jaundice while taking
325 mg about as (yellowing of the paracetamol.
500 mg effective as skin or eyes).
aspirin and - Toxic epidermal Do not use more
Caplets ibuprofen at necrolysis of this medication
325 mg relieving mild to - Severe allergic than is
500 mg moderate pain reaction recommended. An
650 mg and reducing (anaphylaxis) overdose of
fever, but unlike - Liver failure paracetamol can
Capsules these it doesn't - Stevens-Johnson cause serious
500 mg reduce syndrome harm. The
inflammation. - Gastrointestinal maximum amount
Gel caps/ Gel hemorrhage for adults is 1
tabs - Laryngeal edema gram (1000 mg)
500 mg - Kidney toxicity per dose and 4
- Liver toxicity/ liver grams (4000 mg)
Caplets, failure per day.
Extended - Hyperammonemia
Release - Agranulocytosis Stop using
650 mg - Low white blood paracetamol and
cell count call your doctor if:
Tablets, (leukopenia, - you still have a

Chewable neutropenia) fever after 3 days
80 mg - Low platelet count of use;
(thrombocytopenia) - you still have
Oral - Low red and white pain after 7 days
solution/suspen blood cell count of use (or 5 days if
sion and low platelet treating a child);
160 mg/5 mL count - you have a skin
80mg/0.8mL (pancytopenia) rash, ongoing
(oral drops) headache, or any
This is not a redness or
Liquid Oral complete list of swelling; or
500mg/5mL paracetamol side - if your symptoms
160mg/15mL effects and others get worse, or if
500mg/15mL may occur. Call you have any new
your doctor for symptoms.
Oral Syrup medical advice
160mg/5mL about side effects. Urine glucose
tests may produce
Elixir false results while
160mg/5mL you are taking
paracetamol. Talk
to your doctor if
you are diabetic
and you notice
changes in your
glucose levels
during treatment.
Store paracetamol
at room
temperature away
from heat and
moisture. The
rectal
suppositories can
be stored at room
temperature or in
the refrigerator.
DRUG MECHANISM INDICATIONS CONTRA ADVERSE EFFECTS NURSING

OF ACTION INDICATIONS CONSIDERATIONS
Tramadol Tramadol is a Tramadol is an oral Contraindications Side effects This medication
drug with dual medication that is include associated with contains
Generic activity: it is used to help relieve hypersensitivity to use of Tramadol, tramadol. Do not
Name: opioid agonist ongoing moderate tramadol or include the take Ultram,
Tramadol on mu (μ) to moderately opioids. following: Ultram ER,
receptors and severe pain. Ryzolt or ConZip
Brand a monoamine Known or - constipation if you are
Name: reuptake Tramadol is similar suspected - nausea allergic to
Ultram, blocker with to opioid (narcotic) gastrointestinal - dizziness tramadol or any
Ultram ER, consequent analgesics. It works obstruction, - vertigo ingredients
ConZip potentiation of in the brain to including paralytic - headache contained in this
serotoninergic change how your ileus. - drowsiness drug.
Drug Class: and adrenergic body feels and - vomiting
Opioid pathways. responds to pain. Concurrent use of - agitation Keep out of
Analgesics monoamine - anxiety reach of
Tramadol Tramadol is a oxidase inhibitors - mood swings children. In case
Tramadol is modulates the narcotic-like pain (MAOIs) or use - euphoria of overdose, get
available descending relieving oral within last 14 - hallucinations medical help or
under the pain pathways medicine that is days. - nervousness contact a Poison
following within the used as a treatment - muscle spasms Control Center
different central for moderate to Effects of Drug or stiffness immediately.
brand nervous severe pain in Abuse - indigestion
names: system adults. - weakness
Ultram, through the Risk of - itching If your medical

Ultram ER, binding of The extended- potentiating opioid - diarrhea doctor is using
Ryzolt, and parent and M1 release-tablet addiction, abuse, - dry mouth this medicine to
ConZip. metabolite to formulation of this and misuse, which - sweating treat your pain,
μ-opioid drug is used to can lead to - feeling unwell your doctor or
receptors and treat moderate to overdose and (malaise) pharmacist may
the weak severe chronic pain death; assess each - menopausal already be aware
inhibition of when treatment is patient's risk prior symptoms of any possible
the reuptake needed around the to prescribing and - rash drug interactions
of nor- clock. monitor all - urinary and may be
epinephrine patients regularly frequency monitoring you
and serotonin. This medication for the - urinary retention for them. Do not
must be prescribed development of - dilation of blood start, stop, or
by a doctor and is these behaviors or vessels change the
available by conditions. (vasodilation) dosage of any
prescription only. - visual medicine before
Short-Term disturbances checking with
Effects - abnormal gait your doctor,
None. - amnesia health care
- cognitive provider, or
Long-Term Effects dysfunction pharmacist first.
None. - depression
- difficulty in Severe
Pregnancy and concentration Interactions of
Lactation - feeling uneasy Tramadol
PREGNANCY: - painful urination Include:
Prolonged use of - fatigue
opioid analgesics - menstrual Alvimopan
during pregnancy dysphoric disorder Procarbazine
for medical or - motor system Rasagiline
nonmedical weakness Selegiline
purposes can -lightheadedness
result in physical upon standing Mild
dependence in the (orthostatic interactions of
neonate and hypotension) Tramadol
neonatal opioid - numbness and Include:
withdrawal tingling
syndrome shortly seizures Asenapine
after birth. - suicidal Brimonidine
tendencies Darifenacin
Medical - fainting Dextroampheta

professionals (syncope) mine
should observe - fast heart rate Dronedarone
newborns for - tremors Eucalyptus
symptoms of - abnormal Lidocaine
neonatal opioid electrocardiogram Maraviroc
withdrawal (ECG) Marijuana
syndrome and - swelling Naloxone
manage (angioedema) Nilotinib
accordingly. - cough Parecoxib
Neonatal seizures, - flushing Paroxetine
neonatal - high blood Ranolazine
withdrawal pressure Sage
syndrome, fetal (hypertension) Tipranavir
death, and - low blood Ziconotide
stillbirth have been pressure
reported with (hypotension),
tramadol during may be severe
post-approval use - reduced blood
of tramadol flow to the heart
immediate-release (myocardial
products. ischemia)
- palpitations
LACTATION: - hives
Monitor infants - withdrawal
exposed through syndrome
breast milk for - life threatening
excess sedation, respiratory
respiratory depression
depression, or - neonatal opioid
other health withdrawal
problems; syndrome
withdrawal - adrenal
symptoms can insufficiency
occur in breastfed - abdominal pain
infants when - serotonin
maternal syndrome
administration of - severe allergic
an opioid analgesic reaction
is stopped, or (anaphylaxis)
when - androgen
breastfeeding is deficiency
stopped.
Talk with your

doctor if you have
any questions
about pregnancy
and breastfeeding
while taking this
medicine.
DRUG MECHANISM OF INDICATIONS CONTRA ADVERSE NURSING

ACTION INDICATIONS EFFECTS CONSIDERATIONS
Celecoxib The mechanism of Indications Contraindicated NSAIDs such as Assess range of
action of celecoxib Osteoarthritis. in: celecoxib may motion, degree of
Brand is due to selective Rheumatoid cause ulcers, swelling, and pain
Names: inhibition of arthritis. Hypersensitivity; bleeding, or holes in affected joints
Celebrex, cyclooxygenase-2 Ankylosing Cross-sensitivity in the stomach or before and
Consensi, (COX-2), which is spondylitis. may exist with intestine. These periodically
Elyxyb, responsible for Juvenile other NSAIDs, problems may throughout
Seglentis prostaglandin rheumatoid including aspirin; develop at any therapy.
synthesis, an arthritis. History of time during
Generic integral part of the Acute pain. allergic-type treatment, may Assess patient for
Name: pain and Primary reactions to happen without allergy to
Celecoxib inflammation dysmenorrhea. sulfonamides; warning sulfonamides,
pathway. This History of symptoms, and aspirin, or NSAIDs.
Drug Bank pharmacologic - Celecoxib is an asthma, urticaria, may cause death. Patients with these
Accession activity gives NSAID used to treat or allergic-type allergies should
Number: celecoxib its osteoarthritis, reactions to not receive
DB00482 analgesic, anti- rheumatoid aspirin or other celecoxib.
inflammatory, and arthritis, acute pain, NSAIDs, including
Trade antipyretic effects. menstrual the aspirin triad Assess patient for
Name(s) symptoms, and to (asthma, nasal skin rash
CeleBREX reduce polyps is polyps, and frequently during
familial severe therapy.
Therapeutic Celecoxib, a adenomatous hypersensitivity

Class: selective polyposis. reactions to Discontinue at first
Anti- cyclooxygenase-2 aspirin); sign of rash; may
rheumatics (COX-2) inhibitor, - Celecoxib is a Advanced renal be life-threatening.
is a nonsteroidal nonsteroidal anti- disease; SJS may develop.
Pharm. anti-inflammatory inflammatory drug Severe hepatic
Class. drug (NSAID) (NSAID) used to impairment; Treat
cox 2 which is known for treat mild to Coronary artery symptomatically;
inhibitors its decreased risk moderate pain and bypass graft may recur once
temporary of causing help relieve (CABG) surgery; treatment is
class gastrointestinal symptoms of OB: Avoid use stopped.
nonsteroidal bleeding arthritis (eg, after 30 weeks
anti- compared to other osteoarthritis, gestation; Monitor for signs
inflammator NSAIDS.16 It is rheumatoid - Dehydration and symptoms of
y drugs used to manage arthritis, or juvenile - Anemia DRESS (fever,
(NSAIDs) symptoms of rheumatoid - An increased rash,
various types of arthritis), such as risk of bleeding lymphadenopathy,
arthritis pain and inflammation, - Alcoholism facial swelling)
in familial swelling, stiffness, -High blood periodically during
adenomatous and joint pain. pressure therapy.
polyposis (FAP) to - Heart attack
reduce - Celecoxib is - Chronic heart Discontinue
precancerous indicated for failure therapy if
polyps in the symptomatic - Abnormal symptoms occur.
colon.15 It is treatment of adult bleeding in the Lab Test
marketed by Pfizer osteoarthritis (OA) brain resulting in Considerations:
under the brand and adult damage to brain
name Celebrex, rheumatoid arthritis tissue, called a May cause ↑ AST
and was initially (RA). Celecoxib is hemorrhagic and ALT levels.
granted FDA not a substitute for stroke
approval in aspirin for - Blood clot May cause
1998.27 cardiovascular - Asthma hypophosphatemia
event prophylaxis. - Ulcer , hyperkalemia,
Interestingly, - Stomach or and ↑ BUN.
selective COX-2 - It may be also be intestinal ulcer
inhibitors used to treat acute - Liver problems
(especially pain from various - Stomach or
celecoxib), have sources, juvenile intestinal bleeding
been evaluated as rheumatoid arthritis / rupture
potential cancer in children over 2,
chemopreventive ankylosing - Kidney

and therapeutic spondylitis, and transplant or
drugs in clinical primary donation
trials for a variety dysmenorrhea. - Visible water
of malignancies.7 - Celecoxib, in retention
combination with - Abnormal liver
tramadol, is function tests
indicated for the - Tobacco
management of smoking
acute pain in adults - Chronic kidney
severe enough to disease stage 4 &
require an opioid 5 (severe &
analgesic and in failure)
whom alternative - Chronic kidney
treatments are disease stage 5
inadequate. (failure)
DRUG MECHANISM OF INDICATIONS CONTRA ADVERSE NURSING

ACTION INDICATIONS EFFECTS CONSIDERATIONS
Metoclopramide Metoclopramide Metoclopramide This drug is not Adverse effects Metoclopramide is
works by has been approved recommended for of lipid-soluble,
Brand Name: blocking a by the FDA use in children metoclopramide giving it a large
Reglan natural specifically to treat due to an use include half-life and a
substance nausea and increased risk of extrapyramidal large volume of
Generic Name: (dopamine). It vomiting in patients serious side symptoms, distribution. Its
metoclopramide; speeds up with effects (such as including the half-life can range
stomach gastroesophageal muscle following: from 4.5 hours to
Drug Class: emptying and reflux disease or spasms/uncontrol 8.8 hours. It is
Antiemetic movement of diabetic led muscle Acute dystonic also important to
Agents, the upper gastroparesis by movements). reactions note that the
Prokinetic intestines. increasing gastric Torticollis efficacy of
Agents. motility. It is also Metoclopramide Trismus metoclopramide
Metoclopramide used to control is Opisthotonus can be diminished
works by nausea and contraindicated Akathisia if the patient is
antagonizing vomiting in in patients with Dystonia also taking
central and chemotherapy the following: Oculogyric crisis anticholinergics or
peripheral patients. Gastrointestinal Laryngospasm narcotic analgesic
dopamine-two bleeding Hyper- medications
receptors in the Obstruction prolactinemia because these
medullary Perforation drugs decrease
chemoreceptor Tardive the rate of gastric

trigger zone in Other dyskinesia emptying.
the area contraindications Parkinson Metoclopramide
postrema, include the symptoms decreases the
usually following: Neuroleptic absorption rate of
stimulated by Pheochromo- malignant drugs generally
levodopa or cytoma syndrome absorbed from the
apomorphine. It Seizures stomach, like
achieves this by Depression Though digoxin, while
decreasing the Parkinson disease neuroleptic increasing the
sensitivity of History of tardive malignant absorption of
visceral afferent dyskinesia syndrome is a drugs absorbed
nerves that Metoclopramide rarer adverse from the small
transmit from is contraindicated effect, it is intestine, like
the gastro- in patients with among the most cyclosporine.
intestinal system depression serious because
to the vomiting because it can it manifests as Enhancing
center in the cause major the following: Healthcare Team
area postrema in depressive Outcomes
the disorder. It is Hyperthermia
chemoreceptor contraindicated in “Lead pipe” Metoclopramide is
trigger zone. patients with rigidity widely used in
seizures because Leukocytosis most hospitals,
Administration it lowers the Elevated creatine and it is an
of this drug seizure threshold phosphokinase effective drug for
leads to and can result in levels gastroparesis and
prokinetic longer and more Altered postoperative
effects via frequent seizures. consciousness nausea and
inhibitory actions It is Symptoms of vomiting.
on presynaptic contraindicated in autonomic However, the drug
and postsynaptic patients with instability does have a
D2 receptors, depression and (potentially) number of side
agonism of Parkinson disease Diaphoresis effects which all
serotonin 5-HT4 because of the Tachycardia healthcare workers
receptors, and aforementioned Incontinence must be familiar
antagonism of adverse effects of Pallor with, so an
muscarinic major depressive Irregular blood interprofessional
receptor disorder and pressure or pulse team approach is
inhibition. Parkinson Cardiac necessary. The
symptoms. It is arrhythmias nurse and
Metoclopramide contraindicated in pharmacist are in

also blocks the pheochromocyto Less acute a prime position to
anti-peristaltic ma because it adverse effects monitor the drug
effects of releases of and, hopefully,
apomorphine, catecholamines metoclopramide, reduce its adverse
allowing and can generally effects by closely
metoclopramide exacerbate reversible and monitoring the
to slow pheochromocyto observed in patient and
apomorphine’s ma, causing a children, include recommending
inhibition of hypertensive the following: discontinuation
gastric crisis, which can Sedation when symptoms
emptying, be treated with Diarrhea arise. Of all the
thereby phentolamine side effects, the
accelerating Rarer psychiatric most concerning
gastric emptying side effects that are the
by increasing have developed extrapyramidal
the amplitude following brief reactions that are
and duration of exposure to more likely to
esophageal metoclopramide occur in diabetics,
contractions. include: children, seniors,
This also Panic disorder and those already
increases the Major depressive taking
resting tone of disorder antipsychotic
the lower Agoraphobia medications. The
esophageal risk of developing
sphincter while tardive dyskinesia
simultaneously from this agent
relaxing the varies from 1 to
duodenal bulb 15%, and the
and pyloric condition is quite
sphincter, debilitating. Hence,
thereby prior to using this
increasing the drug, the nurse,
peristalsis of the pharmacist, and
duodenum and prescriber should
jejunum. obtain informed
consent from the
In addition to patient. All patients
antagonizing should be told
dopamine and about the potential
apomorphine, for developing

metoclopramide dyskinesias before
also acts against treatment. If the
type 3 serotonin patient has an
receptors, adverse risk
though it has a profile, the
weaker effect on pharmacist should
these receptors offer another
than on the agent option to the
previously prescriber for
mentioned consideration. In
dopamine and any case, close
apomorphine monitoring of the
receptors. patient is key to
drive optimal
outcomes.
DRUG MECHANISM INDICATIONS CONTRA ADVERSE NURSING

OF ACTION INDICATIONS EFFECTS CONSIDERATIONS
Co-amoxiclav - Co-amoxiclav Co-amoxiclav is Co-amoxiclav is Common side Nursing
is a indicated for the contraindicated - effects considerations
Brand Names: combination treatment of the in patients with a These may affect - Assess bowel
Amoclan. antibiotic used following infections history of up to 1 in 10 pattern before and
Augmentin. for bacterial in adults and hypersensitivity to people: during treatment
Augmentin ES- infections. It children; beta-lactams, e.g. • thrush (candida as
600. contains - Skin and soft penicillins and – a yeast pseudomembrano
Augmentin XR. amoxicillin (an tissue infections in cephalosporins - infection of the us colitis may
antibiotic from particular cellulitis in patients with a vagina, occur.
Generic Name: the penicillin - animal bites previous history mouth or skin - Report
Amoxicillin- group of - severe dental of amoxicillin- folds) haematuria or
potassium medicines) abscess with clavulanate- • feeling sick oliguria as high
clavulanate mixed with spreading cellulitis associated (nausea), doses can be
clavulanic - Bone and joint jaundice/hepatic especially when nephrotoxic.
Type of acid. The infections, in dysfunction. taking high - Assess
medicine: clavulanic acid particular doses. If this respiratory status.
Penicillin stops bacteria osteomyelitis. Amoxicillin is applies to you, - Observe for
antibiotic from breaking contraindicated in take Co- anaphylaxis.
down What bacteria does patients with a amoxiclav before
Used for: amoxicillin, co-Amoxiclav known serious food
allowing the cover? hypersensitivity • vomiting
Infections (in antibiotic to Pseudomonas spp. reaction (i.e., • diarrhoea (in When should co-
adults and work better. Serratia spp. anaphylaxis) to children). Amoxiclav be
children) Stenotrophomas other beta- given to a patient?
- An antibiotic maltophilia Yersinia lactams. Patients Uncommon side Co-amoxiclav is
Also called: that combines enterolitica with allergies or effects usually given three
Augmentin® amoxicillin and atopic conditions These may affect times a day. This
clavulanic Others: including asthma, up to 1 in 100 should be first
Available as acid. It Chlamydia eczema, hives people thing in the
Tablets, oral destroys pneumoniae (urticaria), or hay • skin rash, morning, early
liquid medicine bacteria by Chlamydia psittaci fever may have a itching afternoon (or after
and injection disrupting Chlamydia spp. greater risk for • raised itchy school) and at
their ability to Coxiella burnetti hypersensitivity rash (hives) bedtime. Ideally,
form cell Mycoplasma spp. reactions to • indigestion these times are at
walls. - penicillins. • dizziness least 4 hours
Clavulanic acid • headache. apart.
blocks the Do not take Co- Uncommon side
chemical amoxiclav: effects that may How to store Co-
defense, show up in your amoxiclav?
known as • if you are blood tests: This medicinal
beta- allergic to • increase in product does not
lactamase, amoxicillin, some substances require any special
that some clavulanic acid, (enzymes) temperature
bacteria have penicillin or any produced by storage conditions.
against of the other the liver. Store in the
penicillin. ingredients of this original
medicine (listed Conditions you package in order
- How does in section 6). need to look out to protect from
co-amoxiclav • if you have ever for light and moisture.
work in the had a severe Allergic reactions: Keep this medicine
body? allergic reaction • skin rash out of the sight
The amoxicillin to nany other • inflammation of and reach of
part of co- antibiotic. This blood vessels children.
amoxiclav can include a skin (vasculitis) Do not use this
works by rash or which may be medicine after the
interfering swelling of the visible as red or expiry date which
with the ability face or neck. purple raised is
of bacteria to • if you have ever spots on the skin, stated on the
form cell had liver but can affect carton and blister
walls. It allows problems or other parts after ‘EXP’. The
holes to jaundice of the body expiry
appear in the (yellowing of the • fever, joint pain, date refers to the
bacterial cell skin) when taking swollen glands in last day of that
walls and this an antibiotic the neck, armpit month.
kills the or groin Do not throw away
bacteria • swelling, any medicines via
causing the sometimes of the wastewater or
infection. face or mouth household waste.
(angioedema), Ask your
- It works by causing difficulty pharmacist how to
stopping the in breathing throw
growth of • collapse. away medicines
bacteria. Contact a doctor you no longer use.
Clavulanic acid immediately if These measures
is in a class of you get any of will help protect
medications these the environment.
called beta- symptoms. Stop
lactamase taking Co-
inhibitors. It amoxiclav.
works by Inflammation of
preventing large intestine
bacteria from Inflammation of
destroying the large
amoxicillin. intestine, causing
Antibiotics will watery
not work for diarrhoea usually
colds, flu, or with blood and
other viral mucus, stomach
infections. pain
and/or fever.
Contact your
doctor as soon as
possible for
advice if
you get these
symptoms.
Very common
side effects
These may affect

more than 1 in 10
people
• diarrhoea (in
adults).

Delantar 3bsna Parotidectomy Pleomorophic Adenoma

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Pamantasan ng Cabuyao

Banaybanay, Cabuyao City, Laguna 4025, Philippines

COLLEGE OF HEALTH AND ALLIED SCIENCES

Name: Delantar, Joshua B. Yr.&Section: 3 BSN-A Prof. Mike Zulueta Isanan

- Parotidectomy is the partial or

WHAT HAPPENS WHEN PAROTID GLAND IS REMOVED?

OVERVIEW OF SURGERY SIDE EFFECTS

NORMAL SIDE EFFECTS OF SURGERY:

COLLEGE OF HEALTH AND ALLIED SCIENCES

Name: Delantar, Joshua B. Yr.&Section: 3 BSN-A Prof. Mike Zulueta Isanan

✓ Temporary facial weakness

ABNORMAL SIDE EFFECTS OF SURGERY:

2. PATHOPHYSIOLOGY OF PLEOMORPHIC ADENOMA

COLLEGE OF HEALTH AND ALLIED SCIENCES

Name: Delantar, Joshua B. Yr.&Section: 3 BSN-A Prof. Mike Zulueta Isanan

o How can pleomorphic adenoma be prevented?

COLLEGE OF HEALTH AND ALLIED SCIENCES

Name: Delantar, Joshua B. Yr.&Section: 3 BSN-A Prof. Mike Zulueta Isanan

Nursing Care Plans

Subjective: Risk for Short-Term Independent: Short-Term

COLLEGE OF HEALTH AND ALLIED SCIENCES

Name: Delantar, Joshua B. Yr.&Section: 3 BSN-A Prof. Mike Zulueta Isanan

along the thoracic genitourinary) for and intervention

COLLEGE OF HEALTH AND ALLIED SCIENCES

Name: Delantar, Joshua B. Yr.&Section: 3 BSN-A Prof. Mike Zulueta Isanan

COLLEGE OF HEALTH AND ALLIED SCIENCES

Name: Delantar, Joshua B. Yr.&Section: 3 BSN-A Prof. Mike Zulueta Isanan

Subjective: Fear and Short-Term Independent: Short-Term

COLLEGE OF HEALTH AND ALLIED SCIENCES

Name: Delantar, Joshua B. Yr.&Section: 3 BSN-A Prof. Mike Zulueta Isanan

for and mechanisms

7. Provide accurate, 7. Can reduce

COLLEGE OF HEALTH AND ALLIED SCIENCES

Name: Delantar, Joshua B. Yr.&Section: 3 BSN-A Prof. Mike Zulueta Isanan

11. Provide reliable 11. Allows for

12. Include SO as 12. Provides a

COLLEGE OF HEALTH AND ALLIED SCIENCES

Name: Delantar, Joshua B. Yr.&Section: 3 BSN-A Prof. Mike Zulueta Isanan

Subjective: Risk for Short-Term Independent: Short-Term

COLLEGE OF HEALTH AND ALLIED SCIENCES

Name: Delantar, Joshua B. Yr.&Section: 3 BSN-A Prof. Mike Zulueta Isanan

patient to avoid skin friction and

5. Turn or reposition 5. Promotes

6. Avoid applying 6. Helps control

7. Assess skin and 7. Presence of

8. Review expected 8. Anticipatory

COLLEGE OF HEALTH AND ALLIED SCIENCES

Name: Delantar, Joshua B. Yr.&Section: 3 BSN-A Prof. Mike Zulueta Isanan

Compilations of Drug Study

COLLEGE OF HEALTH AND ALLIED SCIENCES

Name: Delantar, Joshua B. Yr.&Section: 3 BSN-A Prof. Mike Zulueta Isanan

COLLEGE OF HEALTH AND ALLIED SCIENCES

Name: Delantar, Joshua B. Yr.&Section: 3 BSN-A Prof. Mike Zulueta Isanan

Tablets, (leukopenia, - you still have a

COLLEGE OF HEALTH AND ALLIED SCIENCES

Name: Delantar, Joshua B. Yr.&Section: 3 BSN-A Prof. Mike Zulueta Isanan

DRUG MECHANISM INDICATIONS CONTRA ADVERSE EFFECTS NURSING

COLLEGE OF HEALTH AND ALLIED SCIENCES

Name: Delantar, Joshua B. Yr.&Section: 3 BSN-A Prof. Mike Zulueta Isanan

Ultram, through the Risk of - itching If your medical

COLLEGE OF HEALTH AND ALLIED SCIENCES

Name: Delantar, Joshua B. Yr.&Section: 3 BSN-A Prof. Mike Zulueta Isanan

Medical - fainting Dextroampheta