CARE PLAN MED LIST 2023

Student: Client Initials: Date: 2023 MEDICATION LIST Generic and trade name: Classification For this patient: Dose and route: Recommended range Pharmacologic action: How does it work Reason this patient is getting this drug Common Side effects Life Threatening Side Effects Contra- indications Labs that must be monitored regularly Nursing Considerations, Pre and Post Assessments for this patient and this drug Cranberry Juice Powder Cranberry Herbal/Diet Supplement (Drugs.com) 425 mg capsule 2 caps PO (850 mg) TID @ 0800 , 1200, 1800 Range: 200- 8000 mg/day Prevents bacteria from sticking to cells that line the bladder, large doses may lower urine pH, making it acidic so that it is harder for bacteria to grow. Helps prevent urinary tract infections Common: Stomach upset or diarrhea with large doses Life Threatening: Anaphylaxis Allergy to cranberry. Caution with diabetes, liver disease, or hx of kidney stones Labs : None Assess for urinary frequency, dysuria, hematuria Vitamin E / Aquasol E Vitamin E, fat soluble vitamin (Skidmore-Roth, 2016. pp 1213- 1214) 400 unit capsule 1 cap PO QD @ 0800 400 units/day for pt with heart disease Range: 50-1000 units for adults Antioxidant, helps prevent damage to the body’s cells, needed for digestion of fats (polyunsaturated); decreases blood clot formation by decreasing platelets ability to stick together. Prevent blood clots, decreases edema Common: None High doses: nausea, diarrhea, stomach cramps, fatigue, headache, blurred vision, and bleeding Life Threatening: None identified IV use in infants Labs : None Assess and evaluate Edema Sennosides (OTC) Senna Plus Laxative- stimulant (Skidmore-Roth, 2016) 8.5-50 mg 1 tab PO QHS @ 2000 Range: 2-4 tabs daily in divided doses Acts on the nerves, specifically the Auerbach’s plexus, in the intestine to make the muscles contract, which helps move feces through the intestine. Also softens feces by increasing water and electrolytes in the intestine. Constipation, prevention of dry, hard stools Nausea, abdominal cramps, diarrhea Hypersensitivity, fecal impaction, N & V Labs : Electrolytes Assess for cramping, rectal bleeding, N & V, last BM Urine and feces may turn yellow-brown to red Assess Labs for electrolyte imbalance due to the movement of water and electrolytes to the

Student: Client Initials: Date: 2023 intestine Labs: NA+ 135-145 mEq/L K+ 3.5-5 mEq/L Cl- 97-107 mEq/L CO2 22-26 mmol/L Ca 8.2-11.2 mg/dL Agap 8-16mEq/L (Van Leeuwen, Poelhuis-Leth, Bladh, 2011) Multivitamin Many brands: One A Day, MultiVit Vitamin, dietary supplement (Skidmore-Roth, 2016) 1 tab PO QD @ 0800 Range: depends on brand Provides extra vitamins and minerals that may be missing from diet. Dietary supplement Common: None known at recommended doses Life Threatening: None known at recommended doses Hypersensitivity, conditions where ingredients are contraindicated Labs : none Assess nutritional status Potassium chloride Klor-Con, Epiklor, K-Tab, Micro-K, Electrolyte, mineral replacement (Skidmore-Roth, 2016. pp 937- 938) 10 mEq 1 cap PO QD @ 0800 Range: 20 mEq/ day in 1-2 divided doses Potassium is needed for normal muscle function, especially the heart. It is also needed for the communication of messages by your nerves. Potassium is found inside the cells of your body, and help to keep them healthy by maintaining ion balance. Potassium replacement due to use of diuretic (furosemide), prevention of hypokalemia Common: N & V, cramps, diarrhea Life Threatening: Cardiac depression, dysrhythmias, cardiac arrest, peaking T waves, lowered R waves, depressed RST waves, prolonged P-R interval, widened QRS complex Renal disease, hemolytic disease, Addison’s disease, hyperkalemia, acute dehydration, extensive tissue breakdown Labs : Potassium DO NOT break, crush or chew Assess hyperkalemia: fatigue, muscle weakness, confusion, dyspnea, palpitations, EKG Check I & O, (decreased urinary output) Cardiac: rate & rhythm Avoid antacids and salt substitutes Assess potassium

Student: Client Initials: Date: 2023 (Van Leeuwen, et al., 2011) Overdose treatment: Lavage, IV atropine for bradycardia, IV theophylline for bronchospasms, dextrose for hypoglycemia, digoxin, Oxygen, diuretic for cardiac failure, hemodialysis. Acetaminophen Tylenol Nonopioid analgesic, antipyretic (Skidmore-Roth, 2016. pp 9-11) 500 mg tab 2 tabs (1000 mg), PO QID @ 0500, 1200,1800,0000 Range: 325 – 650 mg q 4-6 hrs. Max dose 4 g/day Onset: 10-30 minutes Peak: ½ - 2 hours Duration: 4-6 hours Blocks the pain messages that are sent by your nerves in response to an injury or swelling, so they do not reach your brain by stopping the body from making prostaglandins, a fatty acid that is responsible for causing pain and inflammation. Stopping this fatty acid also reduces fever. Hip pain, Pain from RA Common: None Life Threatening: Hepatotoxicity, hepatic seizure (OD), GI bleed, renal failure (high doses), leukopenia, neutropenia, hemolytic anemia (long-term use), thrombocytopenia, pancytopenia, cyanosis, anemia, jaundice, pancytopenia, CNS stimulation, delirium followed by vascular collapse, coma, seizures, death Hypersensitivity Labs : Increases LFT’s, potassium, bilirubin, LDH, and pro-time. Decreases Hgb, Hct, albumin, magnesium, phosphate. Assess I & O ratio, decreased output may signify renal failure Hepatotoxicity: dark urine, clay colored stools, jaundice, abd pain, diarrhea Assess Hip pain Assess chronic OD: bleeding, bruising, malaise, fever, sore throat Assess renal and hepatic studies, drug is metabolized by the liver and excreted by kidneys. Hepatotoxicity and renal toxicity can occur with long term therapy. CBC and PT should be monitored with long term use.

Student: Client Initials: Date: 2023 Labs : WBC 4.5-11.0 RBC 3.7-5.3 HGB 11.7-16.1 g/dL HCT 34-46 % Platelets 150,000- 450,000/mm 2 MCV 78-98 MCH 26-34 MCHC 32-36 RDW 11.6-14.8 BUN 8-21 mg/dL Creatinine 0.5-1.1 mg/dL Albumin 3.2-4.6 g/dL AST 10-35 units/L ALT 7-35 units/L Total Bilirubin 0.3-1.2 mg/dL Delta Bilirubin < 0.2 mg/dL (Van Leeuwen, et al., 2011) Overdose treatment: gastric lavage, activated charcoal. Admin oral acetylcysteine to prevent liver damage. Monitor bleeding. Allopurinol Aloprim, Zyloprim Antigout, antihyper- uricemic 100 mg tab 1 tab PO QD @ 0800 Range: 100 mg/day, may increase weekly up to 800 Helps to prevent your body from making uric acid, specifically by interfering with the enzyme xanthine oxidase. Too much uric acid can lead to gout. Methotrexate, levodopa and furosemide decreases uric acid excretory transport, to prevent gout or uric acid build up in Common: N & V, malaise Life Threatening: none listed Hypersensitivity Labs : Order before treatment and periodically throughout: Uric Acid, CBC, BUN, AST, Creatinine. Assess sx of gout or kidney stones Assess I & O ratio (increase fluids to prevent stones and toxicity) (avoid alcohol and

Student: Client Initials: Date: 2023 better, so that the neurons are not so excited, which leads to less feelings of anxiety. eosinophilia, resp. depression fever, sore throat, bruising, rash, jaundice Assist w/ambulation; dizziness Assess labs, alert for blood dyscrasias. Assess hepatic studies for liver function, medication is metabolized by liver. Labs: RBC 3.7-5.3 WBC 4.5-11.0 Hgb 11.7-16.1 g/dL Hct 34-46 % Platelets 150,000- 450,000/mm 2 AST 10-35 units/L ALT 7-35 units/L Total Bilirubin 0.3-1.2 mg/dL Delta Bilirubin < 0.2 mg/dL (Van Leeuwen, et al., 2011) Overdose Treatment : ECG monitoring, induce emesis, lavage, activated charcoal. Diazepam IV for seizures. Ibuprofen Advil, Motrin, Ibutab 400 mg tab 1 tab PO TID @ 0800 , 1200, 2000 It blocks 2 proteins in the body, COX-1 and COX-2, which are needed to cause inflammation, or Leg and hip pain Common: Headache, anorexia Life Threatening: Hypersensitivity, asthma, severe renal/hepatic disease Black Box: GI bleeds & perforation Assess: Leg and hip pain

Student: Client Initials: Date: 2023 NSAID (Skidmore-Roth, 2016. pp 600- 602) Range: 200-400 mg q 4-6 hrs, max 1200 mg/day Onset: ½ hour Peak: 1-2 hours ½ life: 1.8-2 hours swelling, and fever. By blocking these proteins, it stops the inflammation, which causes pain. Blocking COX-1 limits the ability of the platelets in your blood to stick together to form clots, and helps to lower fever. COX-1 also protects your stomach, so by blocking COX-1, stomach irritation may occur. By blocking COX-2, there is less swelling and inflammation. Anaphylaxis, hepatitis, Steven- Johnson syndrome, necrotizing fasciitis, blood dyscrasias, nephrotoxicity, GI bleeding, GI ulceration, GI perforation, necrotizing enterocolitis, MI, Stroke, CV thrombotic events. Labs: Increases BUN, creatinine, LFTs. Decreases Hgb, Hct, blood glucose, WBC, and platelets. Cardiac status: BP, tachycardia, palpitations Infection, may mask symptoms. Nephrotoxicity: decreased urinary output, increased weight and edema, fever, blood in urine. Assess Labs: renal and hepatic function. Hgb for blood loss or bleeding. Monitor electrolytes. Labs: BUN 8-21 mg/dL Creatinine 0.5-1.1 mg/dL Albumin 3.2-4.6 g/dL AST 10-35 units/L ALT 7-35 units/L Total Bilirubin 0.3-1.2 mg/dL Delta Bilirubin < 0.2 mg/dL Hgb 11.7-16.1 g/dL Hct 34-46% WBC 4.5-11 NA+ 135-145 mEq/L K+ 3.5-5 mEq/L Cl- 97-107 mEq/L CO2 22-26 mmol/L Ca 8.2-11.2 mg/dL Agap 8-16mEq/L Glucose < 110 mg/dL (Van Leeuwen, et al., 2011)

Student: Client Initials: Date: 2023 count nadir occur on day 7; BUN, Uric acid and electrolytes monitored for renal function. Labs: Uric Acid 250-750 mg/24 hrs WBC 4.5-11.0 RBC 3.7-5.3 Hgb 11.7-16.1 g/dL Hct 34-46 % Platelets 150,000- 450,000/mm 2 MCV 78-98 MCH 26-34 MCHC 32-36 RDW 11.6-14.8 BUN 8-21 mg/dL Creatinine 0.5-1.1 mg/dL NA+ 135-145 mEq/L K+ 3.5-5 mEq/L Cl- 97-107 mEq/L CO2 22-26 mmol/L Ca 8.2-11.2 mg/dL Agap 8-16mEq/L (Van Leeuwen, et al., 2011) Cyanocobalamin (vitamin B12) Nascobal, Rubramin PC water soluble vitamin (Skidmore-Roth, 2016. pp 295- 297) Tablet 1000 mcg PO QD @ 0800 Range: 500- 1000mcg per day Replaces vitamin B12 in the body; needed for your nerves to work properly, aids in the breakdown of carbohydrates and protein during digestion, needed for normal growth, development of red blood cells, and new Vitamin B12 deficiency (can be side effect of using methotrexate) Common: Diarrhea Life Threatening: CHF, pulmonary edema, anaphylactic shock Hypersensitivity to product, cobalt, benzyl alcohol; optic nerve atrophy Labs : None Assess for diarrhea or constipation Assess for pulmonary edema, worsening of CHF

Student: Client Initials: Date: 2023 cell formation in the body. Olanzapine Zyprexa Antipsychotic, neuroleptic (Skidmore-Roth, 2016. pp 861- 864) 7.5 mg tablet 1 tab PO QHS @ 2000 Range: 5-20 mg/day, start at 5 mg, increase cautiously at 1 wk intervals Blocks the receptors for dopamine and serotonin type 2 in the brain. These chemicals can be elevated in persons with schizophrenia and bipolar disorder. Blocking these chemicals helps control symptoms. Schizophrenia and bipolar disorder Common: Dizziness, tremor, drowsiness, abnormal gait, insomnia, fever, dry mouth, N & V, dyspepsia, constipation, weight gain, joint pain, cough, pharyngitis. Life Threatening: Seizures, neuroleptic malignant syndrome (rare), heart failure, hepatitis, and neutropenia. Hypersensitivity Black Box: increased mortality in elderly with dementia related psychosis, postinection delirium/sedation syndrome Labs: Increases LFT’s prolactin and CPK. Assess mental status: orientation, mood, behavior, hallucinations, EPS I & O ratio, palpate bladder for urinary retention Assess BP (orthostatic), pulse and respirations. Report drops of 30 mm Hg. Assess for neuroleptic malignant syndrome: Hyperreflexia, muscle rigidity, altered mental status, acute dystonia. Assess for constipation Assist with ambulation Encourage good oral hygiene, sugarless gum or candy for dry mouth DC product slowly Take extra precautions in heat to avoid heat stroke Assess labs: Liver function,

Student: Client Initials: Date: 2023 specific part of the kidney. Life Threatening: Circulatory collapse, renal failure, thrombocytopenia, agranulocytosis, leukopenia, neutropenia, anemia, Steven- Johnson Syndrome, toxic epidermal necrolysis. Assess for hearing loss Assess for metabolic alkalosis: drowsiness, restlessness Assess Hypokalemia: postural hypotension, malaise, fatigue, tachycardia, leg cramps, weakness Assess labs, as diuretic alters movement of water in system, disrupting electrolytes, BUN, CBC, glucose, creatinine, uric acid, and blood concentrations. Labs: NA+ 135-145 mEq/L K+ 3.5-5 mEq/L Cl- 97-107 mEq/L Ca 8.2-11.2 mg/dL Agap 8-16mEq/L Uric Acid 250-750 mg/24 hrs WBC 4.5-11.0 RBC 3.7-5.3 Hgb 11.7-16.1 g/dL Hct 34-46 % Platelets 150,000- 450,000/mm 2 MCV 78-98 MCH 26-34 MCHC 32-36

Student: Client Initials: Date: 2023 RDW 11.6-14.8 BUN 8-21 mg/dL Creatinine 0.5-1.1 mg/dL Glucose < 110 mg/dL (Van Leeuwen, et al., 2011) Overdose Treatment: Lavage if taken orally. Monitor electrolytes, administer dextrose in saline. Monitor hydration, CV, and renal status. Carbidopa – levodopa Parcopa, Sinemet Antiparkinsonian agent (Skidmore-Roth, 2016. pp 684- 686) 25-250 mg tablet 1 tab PO BID @ 0500,1800 Range: 25-250 mg TID to QID Levodopa is broken down into dopamine in the body. Carbidopa helps the dopamine cross the blood brain barrier, where it can work to decrease the symptoms of Parkinson’s disease. Parkinson’s Disease Common: Involuntary choreiform movements, hand tremors, fatigue, headache, anxiety, confusion, agitation, insomnia, nightmares, orthostatic hypotension, N & V, anorexia, abdominal distress, dry mouth, flatulence, dysphagia Life Threatening: Neuroleptic malignant syndrome, hemolytic anemia, leukopenia, agranulocytosis Hypersensitivity, malignant melanoma, history of malignant melanoma, or undiagnosed skin lesions resembling melanoma Labs : Increases BUN, AST, ALT, bilirubin, alkaline phosphate, LDH, serum glucose. Decreases BUN, creatinine, uric acid. DO NOT crush or chew ER tabs, may be broken in half, adjust dose Results may not be seen for 2-4 months after starting therapy. Assess Parkinson’s symptoms: tremors, pill rolling, drooling, akinesia, rigidity, shuffling gait. Assess orthostatic BP and respirations Urine and sweat may darken Assess Mental status: affect, mood, behavioral changes Assess for toxicity:

Student: Client Initials: Date: 2023 (VanLeeuwen, et al., 2011) Bisacodyl (OTC) Dulcolax, Codulax, Dacodyl, Doxidan, Ex-Lax Ultra, Femilax, Soflax-Ex Laxative, stimulant (Skidmore-Roth, 2016. pp 139- 140) 10 mg suppository 1 suppository rectally prn constipation (insert high in the rectum) Range: 10 mg as single dose rectally Irritates the colon, increasing peristalsis, or the muscle contractions, which moves the stool through the large intestine. Constipation Common: N & V, anorexia, cramps Life Threatening: Tetany Hypersensitivity, abdominal pain, N & V, appendicitis, acute surgical abdomen, ulcerated hemorrhoids, acute hepatitis, fecal impaction, intestinal/biliary tract obstruction Labs: Increases sodium phosphate. Decreases calcium and magnesium. Assess I & O ratio, identify fluid loss Assess GI: cramping, rectal bleeding, N & V (d/c product if occur) Assess cause of constipation Assess labs (electrolytes) due to laxatives alteration of water in the system. Labs: NA+ 135-145 mEq/L K+ 3.5-5 mEq/L Cl- 97-107 mEq/L CO2 22-26 mmol/L Ca 8.2-11.2 mg/dL Agap 8-16mEq/L (Van Leeuwen, et al., 2011) Magnesium hydroxide Dulcolax, MOM, Phillips’ Milk of Magnesia Saline laxative (Skidmore-Roth, 2016. pp 722- 724) 400 mg/5 mL 30 mL PO prn constipation Range: 15-60 mL Draws fluid into the colon to help relieve constipation. Constipation Common: N & V, anorexia, cramps Life Threatening: Flaccid paralysis, circulatory collapse Hypersensitivity, abdominal pain, N & V, obstruction, acute surgical abdomen, rectal bleeding, heart block, myocardial damage. Labs: None Shake suspension well. Assess GI: bowel sounds Assess cause of constipation Assess eclampsia: BP, I & O ratio, thirst confusion Assess: N & V, rectal

Student: Client Initials: Date: 2023 bleeding, cramping (d/c) Citrus fruit may be given after to counteract unpleasant taste Nystatin cream Mycostatin, Nilstat, Nymyc Antifungal (Skidmore-Roth, 2016. pp 1261- 1262) 100,000 unit/gm Apply topically BID to left abd fold, prn Range: up to BID Interferes with the cell wall membrane, causing it to break down and the cell contents leak out. Candida skin infection Common: None Life Threatening: None Hypersensitivity Labs : None Assess skin on left abdominal fold Apply with gloved hand Stinging may occur upon application Oxycodone Oxycontin, Roxicodone Opiate analgesic (Skidmore-Roth, 2016. pp 880- 882) 5 mg Tab 1 tab PO Q 6 hrs prn pain Range: 5-30 mg Q 4 hrs Onset: 15-30 minutes Peak: 1 hour Duration: 2-6 hours Blocks the pain messages in the brain and spinal cord. In the brain, it changes the way we feel about the pain. Pain Common: Drowsiness, dizziness, confusion, headache, sedation, euphoria, N & V, anorexia, constipation, cramps, rash Life Threatening: Respiratory depression Hypersensitivity, addiction (opiate), asthma, ileus Black Box: Respiratory Depression Labs : None Assess pain Assess I & O ratio, urinary retention Assess respirations, before and after Assess bowel status Assess CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction. Assess skin for rash, uticaria Black Box: Respiratory depression, substance abuse, accidental

Student: Client Initials: Date: 2023 times daily difficulty breathing