Nursing Process Focus:
Patients Receiving Ranitidine (Zantac)
Assessment
Prior to administration· Obtain complete health history including allergies, drug history and possible drug interactions
· Assess for presence/history gastroesophageal reflux disease, gastric ulcer
· Obtain vital signs
· Assess liver and kidney function, pregnancy status and complete blood count. /
Potential Nursing Diagnoses
· Injury, Risk for (falls) related to drowsiness secondary to drug therapy· Nutrition, Risk for Imbalanced: Less than body requirements related to adverse effects of drug therapy
· Pain, related to gastric irritation secondary to ineffective response to drug therapy
· Knowledge, Deficient related to drug therapy and side effects
Planning: Patient Goals and Expected Outcomes
The patient will:· Remain free of side effects including abdominal pain, heartburn, jaundice, hematemesis, and respiratory difficulty.
· Demonstrate understanding of risks and benefits of drug therapy.
· Remain free of physical injury
· Maintain balanced nutrition, and weight within expected levels
Implementation
Interventions and (Rationales) /Patient Education/Discharge Planning
· Monitor serum creatinine, AST, ALT alkaline phosphatase and total bilirubin. / · Advise patient to:· Report symptoms of liver dysfunction including jaundice, pruritus, fatigue
· Stop smoking while on drug therapy
· Abstain from alcohol while taking this medication, as it may potentiate drowsiness
· Monitor for bleeding, bruising, including complete blood count. (Drug may cause thrombocytopenia.) / · Instruct patient to report signs of unusual bleeding such as petechiae or excessive bruising
· Institute safety procedures to protect the patient who experiences dizziness. / · Advise patient not to drive or operate heavy machinery until the response to drug therapy can be evaluated.
Evaluation of Outcome Criteria
Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see “Planning”).Nursing Process Focus:
Patients Receiving Omeprazole (Prilosec)
Assessment
Prior to administration· Obtain complete health history including allergies, drug history and possible drug interactions
· Assess for presence/history Gastrointestinal distress, gastrointestinal bleeding
· Assess alcohol use, complete blood count, renal function, and stool for occult blood. /
Potential Nursing Diagnoses
· Injury, Risk for (fall) related to drowsiness secondary to drug therapy· Pain, Risk for related to gastric irritation
· Nutrition, Risk for Imblance: less than body requirements related to ineffective response to drug therapy
Planning: Patient Goals and Expected Outcomes
The patient will:· Remain free of signs of side effects including headache, dizziness, diarrhea, abdominal pain, hematuria and rash
· Demonstrate understanding of the risks and benefits of drug therapy.
Implementation
Interventions and (Rationales) /Patient Education/Discharge Planning
· Monitor the smoking and food habits of the patient. (Smoking increases stomach acid production.) / Advise patient to:· Abstain from alcohol use while taking this medication
· Refrain from spicy foods, caffeine and smoking which may increase gastric irritation
· Monitor elimination pattern. (Drug may cause diarrhea.) / · Advise patient to keep a food diary to help correlate symptoms with foods eaten.
· Periodically monitor urine for the presence of blood and/or protein. / · Instruct patient to report change in urine color to health care provider.
Evaluation of Outcome Criteria
Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see “Planning”).Nursing Process Focus:
Patients Receiving Diphenoxylate with Atropine (Lomotil)
AssessmentPrior to administration:· Obtain complete health history including allergies, drug history and possible drug interactions
· Assess for presence/history of diarrhea, dehydration, electrolyte imbalance
· Assess sodium level, chloride level, potassium level, stool culture, presence of dehydration, vital signs and EKG. / Potential Nursing Diagnoses
· Fluid volume, Risk for Imbalance: less than body requirements related to fluid loss secondary to diarrhea
· IMpaired skin integrity, Risk for related to diarrhea stools
· Injury, Risk for (falls) related to drowsiness secondary to drug therapy
· Knowledge, Deficient related to drug action and side effects
Planning: Patient Goals and Expected Outcomes
The patient will:· Demonstrate understanding of instructions necessary for drug therapy.
· Immediately report persistent diarrhea, constipation, abdominal pain, blood in stool, confusion, dizziness or fever.
Implementation
Interventions and (Rationales) / Patient Education/Discharge Planning· Monitor abdomen for distention and degree and location of abdominal pain. (This may be sign of toxic megacolon.) / Advise patient to:
· Record the frequency of stools. Instruct patient to note if any blood is present.
· Report any abdominal pain or abdominal distention to the health care provider immediately
· Monitor frequency, volume, characteristics, and consistency of stools. / Instruct patient to:
· Report worsening of diarrhea to health care provider
· Report occurrence of bloody stools to health care provider
· Increase fluid intake and to drink electrolyte enriched fluids.
· Offer ice, gum or sour candy. May swab lips with a glycerine-based emollient. (The medication may cause dry mucous membranes.) / · Advise patient to suck on sour candy or chew gum to relieve sensations of dry mouth.
· Initiate safety measures to prevent falls. (The medication may cause drowsiness.) / Advise patient to:
· Not drive or operate heavy machinery due to drowsiness.
· Abstain from the use of alcohol while using this medication
· Monitor electrolyte levels. / · Advise patient to keep all laboratory appointments.
Evaluation of Outcome Criteria
Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see “Planning”).Nursing Process Focus:
Patients Receiving Prochlorperazine (Compazine)
Assessment Prior to administration:· Obtain complete health history including allergies, drug history and possible drug interactions
· Assess for presence/history severe
nausea, vomiting
· Obtain vital signs
· Assess for presence of dehydration, sodium level, chloride level, potassium level, and temperature. / Potential Nursing Diagnoses· Injury, Risk for (fall) related to dizziness secondary to drug therapy
· Fluid volume, Risk for Imbalance: deficit related to ineffective response to drug therapy
· Nutrition, Risk for Imbalanced: less than body requirements related to nausea and vomiting
· Knowledge, Deficient, related to drug therapy and side effects
Planning: Patient Goals and Expected Outcomes
The patient will:· Demonstrate understanding of need for drug therapy and will comply with all instruction given
· Remain free of drug side effects including rash, blurred vision, jaundice, tremor and changes in vision.
· Maintain adequate fluid balance
· Maintain adequate nutrition
· Remain free of physical injury
Implementation
Interventions and (Rationales) / Patient Education/Discharge Planning· Monitor neurological status (Seizure threshold is decreased. May need to increase seizure medication.) / · Advise patient with a seizure disorder that there is an increased risk for seizures with this medication.
· Monitor intake and output (to evaluate drug effectiveness), / Advise patient:
· To report continue nausea and vomiting
· That medication may cause urine to appear reddish brown
· Monitor elimination pattern. (Medication may cause urinary retention.) / · Instruct patient to report difficult urination to health care provider.
· Institute safety procedures to prevent patient falls or injuries. / · Advise patient to avoid driving or operating heavy machinery due to sedating effects of medication.
· Monitor changes in skin integrity. (Medication may cause gray–blue discoloration of skin.) / Advise patient:
· To protect skin from direct sunlight and to use sunscreen
· That medication may cause sun exposed skin to turn gray blue
Evaluation of Outcome Criteria
Evaluste the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see “Planning”).Nursing Process Focus:
Patients Receiving Sibutramine (Meridia)
AssessmentPrior to administration:
· Obtain complete health history including allergies, drug history and possible drug interactions
· Assess for presence/history obesity, desire to lose weight
· Assess weight, blood pressure, pulse, EKG, liver function and kidney function / Potential Nursing Diagnoses· Nutrition, Risk for Imbalanced: more than body requirements related to ineffective response to drug therapy
· Tissue perfusion, Risk for Ineffective related to adverse effects of drug therapy
· Gas exchange, Risk for Impaired related to respiratory difficulty secondary to adverse effects of drug therapy
· Injury, Risk for (anaphylaxis) related to adverse effects of drug therapy
· Knowledge, Deficient related to drug action and side effects
Planning: Patient Goals and Expected Outcomes
The patient will:· Remain free of adverse reaction to drug including severe headache, fever, muscle aches, tachycardia, rash, nausea, vomiting, profuse sweating, tremor, irritability and respiratory difficulty.
· Demonstrate weight loss within expected range
· Maintain adequate tissue perfusion
· Demonstrate knowledge of drug action and side effects
Implementation
Interventions and (Rationales) / Patient Education/Discharge Planning· Obtain medication history for concurrent use of SSRIs. (Medication may cause serotonin syndrome.) / · Instruct patient to immediately report the development of any rash, fever or difficulty breathing.
· Monitor weight pattern (to evaluate effectiveness of drug therapy). / Advise patient to:
· Keep weight record
· Report weight increase to health care provider
· Monitor intake and output (to evaluate compliance with treatment regimen.) / Encourage patient to:
· Remain compliant with prescribed dietary and lifestyle modifications
· Take medication as prescribed by the health care provider
· Monitor liver function, bilirubin, alkaline phosphatase and lipid profile. (There is an increased risk of liver dysfunction.) / · Advise patient to keep all laboratory appointments.
· Monitor patients with narrow angle glaucoma for increased intraocular pressure (Medication may worsen condition.) / · Advise patient to report any vision changes to the health care provider immediately.