A Case Of Electrical Burn

MEDICAL MANAGEMENT Doctor’s order Admitting orders 3/12/09 2:35 pm EB 110% TBSA SPT-DPT inv R hand and L leg Open Fracture Fx L forearm

Rationale

 Pls admit patient to burn unit under the service of Dr. H. Santos(Charity)

 the patient had major burn injury thus, he needed to be properly monitored and taken care of in the burn unit

 Secure consent for admission and management

 to document that the patient has granted permission for admission and management

 NPO

 to prevent aspiration of vomitus because Nausea and vomiting typically occur due to paralytic ileus resulting from the stress of injury

 Start Venoclysis c PNSS 1L>180 cc/hr.  for CBC c BT  Na,K

 BUN, Crea  -U/A

 to replace lost fluids and electrolytes to prevent irreversible shock -To determine blood volume and blood type - to determine serum Na levels( hyponatremia is usually present)Serum Na levels vary in response to fluid resuscitation  to assess renal function  to check on the hydration status  to assess renal function  to check for any abnormalities in the urine that can aid in diagnosing certain diseases

 -ECG-done outside  to evaluate cardiac function.

 X-ray L forearm AP,L done outside  X-ray R hand and forearm  X-ray L ankle include foot  -Start Cefazolin 2 g IV LD ANST (-) then 1 g q8h

 Omeprazole 40 mg/ vial 1 vial OD per IV

 Tramadol 100 mg/amp 1 amp q8h for pain  Refer to Ortho for evaluation and management

Electrical current immediately contracts muscle and cardiac dysrhythmias and spinal injuries often result from the muscular contraction  to determine the type of fracture

 an anti infective used to prevent the develepmont of infection and as a surgical prophylaxis  a proton pump inhibitor that blocks final step of gastric acid secretion to prevent patient from developing stress ulcer brought about by the injury  indicated for moderate to severe acute pain  for evaluation and management of the patient

 please insert IFC

 to monitor urine output

 pls. monitor VS q2h

 to determine irregularities from the patient’s normal VS  Check on the stability of the Patient

 Monitor UO q 1h  to assess renal function and hydration status  inform plastic surgeon once admitted  Refer 9: 40 pm to OR Anesthesia post-op order

 for further management

 to PACU

 for easy access to experienced medical team members, monitoring and support, special equipment and medications

 O2 inhalation via FM @ 6Lpm  For adequate oxygenation  Monitor VS q 15 min until stable

 to determine irregularities from the patient’s VS  Check on the stability of the Patient

 Diet-DAT once fully awake  regulate IVF PNSS q 30 gtts/min  IVF TF D5LR 1Lx12 Meds:  Nalbuphine 10 mg amp TIV q 4h x 6 doses  Ketorolac 30 mg TIV q 6h x 4 doses  Continue Cefazolin 1g TIV q8h

 For nutritional needs. Patient can eat his food preference as tolerated  for correct infusion rate  to prevent phlebitis and infiltration  for fluid replacement  Indicated for Post-op somatic & visceral pain  Possesses anti-inflammatory, analgesic, and anti pyretic effects

 Moderate high back rest  To prevent infection  Encourage DBE  to prevent aspiration

 Keep warm and comfortable

 to clear secretions, help expel residual anesthetic agents, mobilize secretions and prevent alveolar collapse  to promote relaxation and comfort

 Refer  6:15 pm-Give Paracetamol 1 amp now IV

 as an immediate relief for fever and pain

3/14/09  Pls give Paracetamol 200 mg IV PRN basis( T of >38.0)

 symptomatic relief of fever and pain

 IVTF PNSS 1L x8h x3 cycles  for fluid and electrolyte balance  Refer 3/15/09  IVTF D5LR 1L x8h x 3 cycles

 for fluid and electrolyte balance

 refer  3/16/09  will refer to senior on duty  Maintain IVF/ IV meds

 Daily wound care

 for close monitoring of patient’s condition  For the maintenance of therapeutic effects of IVF and medications

 DAT

 To prevent proliferation infection-causing microorganisms in the wound

 for transfer of service to Ortho. Please inform

 for nutritional needs. Patient can eat his food preference as tolerated

 Refer

of

 For better management

3/17/09  Decrease VS monitoring to q 4h  IVF D5LR 1L @ 30 gtts/min  To determine irregularities in VS  Patient referral ortho to Sr. we’ll co-manage the patient  for “E” debridement,irrigation L forearm

 for correct infusion rate  to prevent phlebitis and infiltration  for better management

 secure consent for procedure

 to remove tissue contaminated by bacteria and foreign bodies and to remove devitalized tissues

 for OR on call  Refer

 to document that the patient has granted permission for admission and management  for preparation of an operating procedure

March 18, 2009  IVFTF D5LR TL for 8 hrs x 3 cycles 

Maintain on NPO



I&O monitoring q 4

 For fluid replacement  To prepare patient for the surgical procedure  To monitor fluid status

 Refer March 20, 2009  For blood replacement  Please transfuse 2U PRBC properly typed and cross matched  Still for BT

 To evaluate BT outcome

 Repeat H&H p BT  Refer  Addendum: Start O2 @3 lmp

 For adequate oxygenation

 TSB c/o relatives

 To decrease body temp via evaporation

 Continue monitoring q 4hours  To determine irregularities in VS ORTHO  For COD today  For transfusion of 2U PRBC properly typed

 To prevent proliferation of infection causing microorganism in the wound  For blood replacement  To avoid blood agglutination

March 22, 2009  COD done

 To prevent proliferation of infection causing microorganism in the wound

 Cont. IVF/ IV meds  Daily wound care

 For the maintenance of therapeutic effects of IVF and medications  To prevent proliferation of infection causing microorganism in the wound

 Repeat H&H  Transfer pt. to ortho penthouse

 To evaluate BT outcome  For better management

March 23, 2009  Transfer pt. to ortho ward under the service of DR. Geromilla

 For better management

9:30am  Pls. facilitate BT 4U PRBC once available

 For blood replacement

 Start FeSO4 1 tab TID

 For Iron supplementation

 For COD today  Refer accdgly.

 To prevent proliferation of infection causing microorganism in the wound

March 24, 2009 9:30  High protein diet  Green leafy veg. to diet

 For tissue repair  For Iron supplementation

 Cont. IV meds

 For the maintenance of therapeutic effects of medications

 IVF to FF: PNSS 1L x KVO

 For fluid replacement and hydration status

 Facilitate BT pls.

 For blood replacement

 Wound care pls.

 To prevent proliferation of infection causing microorganism in the wound

 Refer to rehab for bedside conditioning

 To prepare the patient for ambulation

March 25, 2009  Pls. facilitate transfusion of 1U of PRBC  BT precautions pls.  Paracetamol 300 mg IV RTC for T > 38°C  Refer

 To increase O2 carrying capacity in symptomatic anemia  To prevent Anaphylactic shock  symptomatic relief of fever and pain

March 26, 2009 7:00 am  For COD today  For H&H  d/c IFC: WOF bladder distention  Continue IVF/IV meds  IVF to FF: PNSS 1L x KVO

 To prevent proliferation of infection causing microorganism in the wound  To evaluate BT outcome  To assess urinary retention  For the maintenance of therapeutic effects of IVF and medications  For fluid replacement and hydration status

March 27, 2009  H&H noted

 To evaluate BT outcome

 For transfusion of 2U PRBC properly typed & cross matched

 For blood replacement

 Cont. IVF/IV meds

 For the maintenance of therapeutic effects of IVF and medications

 IVF to FF: PNSS 1L x KVO

 For fluid replacement and hydration status

 For COD tom.

 To prevent proliferation of infection causing microorganism in the wound

 Refer March 29, 2009 6:30 am  For COD tomorrow

 to prevent infection and to keep the wound from moisture that is a good medium for bacterial proliferation

 Cont IVF/ IV meds  for the maintenance of

 Encourage wheelchair  IVF to ff: PNSS 1L x KVO  Still for referral for total body casting  Refer March 30, 2009 9:05  Still for BT of 2 “U” PRBC properly typed and crossmatched

therapeutic effects of IVF and medications  for ambulation without overexertion of the patient’s energy  for fluid replacement and hydration status  to prevent further injuries and damage

 to replace lost blood products

 IVF: PNSS 1L x KVO  Cont. oral meds  Refer April 01, 2009  Still for transfusion of 1 “U” PRBC properly typed and crossmatched  Cont IVF/ IV meds

 for fluid replacement and hydration status  for the maintenance of therapeutic effects of oral medications

 to replace lost blood products; to prevent blood reaction

 IVF: PNSS 1L x KVO

 for the maintenance of therapeutic effects of IVF and medications

 For COD today

 for fluid replacement and hydration status

2 pm  For COD today  For referral for total body casting April 07, 2009

 to prevent proliferation of infection-causing bacteria in the wound  to prevent proliferation of infection-causing bacteria in the wound

 NPO p pm  to prevent further injuries and damage  Start D5LR 1L x 8 on NPO Meds  Nalbuphine IV 500 mg April 08, 2009  Maintain on NPO  For CBC today  Refer

April 09, 2009  Still for BT  IVF to ff: PNSS 1L x KVO

 to prevent aspiration once the patient is called for surgical procedure  for fluid replacement and nutritional needs of the patient while on NPO  Relief of moderate to severe pain.  to prevent aspiration once the is called for surgical procedure  to determine blood abnormalities in its components, and volume

 Start Fe SO4 1 tab PO  For H&H  Cont. wound care

 to replace lost blood products

 Refer

 for fluid replacement and hydration status

April 10, 2009 9:20 am  Still for CBG  Cont IVF/ IV meds  For COD today

 for iron supplementation  to evaluate BT outcome  to prevent wound contamination and infection

 Refer accordingly April 11,2009

 to determine blood glucose levels

 Cont. FeSO4 1 tab  IVF to ff: PNSS 1L x KVO  Cont. wound care  Refer April 12, 2009  Facilitate transfusion of 1 “U” PRBC properly typed and crossmatched  Facilitate CBC c APC  Refer April 14, 2009

 for the maintenance of therapeutic effects of IVF and medications  to prevent proliferation of infection-causing bacteria in the wound

 for iron supplementation  for fluid replacement and hydration  to prevent wound contamination and infection

 NPO p mn  to replace lost blood products  Start D5LR 1L x 8 once on NPO  Cont. meds

 to determine blood abnormalities in its components, and volume

 Refer April 15, 2009  Maintain on NPO  For emergency debridement

 Fixator & ex H x L  For COD today  Refer

 to prevent aspiration once the patient is called for surgical procedure  for fluid replacement and nutritional needs of the patient while on NPO  for the maintenance of therapeutic effects of oral medications

9:30 pm  DAT then NPO p mn

 to prevent aspiration once the patient is called for surgical procedure

 IVF to ff: PNSS 1L x KVO

 to remove tissue contaminated c bacteria and foreign bodies and to remove devitalized tissues

 Refer April 16, 2009  For CBC c APC total  Maintain in NPO

 attached to bone fragments to stabilize them  to prevent proliferation of infection-causing bacteria in the wound  to prevent aspiration once the patient is called for surgical procedure  for fluid replacement and hydration status

 to determine blood abnormalities in its components, and volume  to prevent aspiration once the patient is called for surgical procedure

PATIENT’S PROFILE BIOGRAPHICAL DATA: Name: M.D.M. Age: 25 yrs old Sex: Male Civil status: Single Address: Towerville 2, Hector block 38 lot 6 , San Jose del Monte, Bulacan Religion: Roman Catholic Nationality: Filipino ADMISSION DATA: Admission date: March 12, 2009 Admission time: 3:00 pm Attending physician: Dr. Tamayo Admitting diagnosis: Electrical Burn Chief complaint: difficulty of flexing due to pain HISTORY OF PAST AND PRESENT ILLNESS History of present illness •

Few hours prior to admission patient fell while tapping on an electric post thus sustaining injury

Past Medical History •

No known past medical illnesses

Family History •

No known hereditary diseases

Personal history • High school graduate • Unemployed

•

No allergies to foods

PHYSICAL ASSESSMENT Admission(March 12,2009) VITAL SIGNS PR=75 bpm RR=21 cpm TEMP=37.3 °C PHYSICAL ASSESSMENT Skin    

Skin color – deep brown Skin turgor – slowly goes back to its previous state Skin warm to touch Visible skin lesions

Hair  Evenly distributed hair  Thick hair  No infestations Nails     

Fingernail plate shape- convex curvature Texture- smooth Bed- highly vascular and pink Tissues- intact epidermis Capillary refill test- return to its normal color

Skull and Face  Rounded  Smooth skull contour  Absence of nodules

 Symmetric facial movements

Eyes    

Eyebrows evenly distributed and symmetrically aligned Eyelashes equally distributed Eyelids- skin intact, no discharge, no discoloration Pupils- black in color, equal in size. Round

Ears  Auricles- color same as facial skin  Symmetrical, aligned with outer canthus Nose  Symmetric and straight  No discharge  No tender or lesions Mouth  Outer: soft, moist, smooth  Inner: pink color, moist, smooth Thorax and Lungs     

Symmetric Spine is aligned Skin intact No lesions Full and symmetric chest expansion

Abdomen  No lesions  flat Extremities  No edema  Skin lesions  Right forearm amputated

 With external fixator on left arm  With elastic bandage of the left lower leg due to2nd degree burn LABORATORY TEST RESULTS

HEMATOLOGY HEMATOLOGY Components

Result Normal Values

Interpretation

WBC

16.3 4.5 – 11X103/cu mm

Increase in value may indicate that the patient has an acute bacterial infection or infectious disease, or he is in inflammatory state

Hemoglobin

14.9 M: 14.0 – 17.0 gm/dL F: 12.0 – 14.0 gm/dL NB: 18.7 – 20.1 gm/dL

Normal Decreased level would suggest anemia, acute blood loss, and severe hemorrhage while elevated value may indicate dehydration and polycythemia vera

Hematocrit

43.3%

M: 40 – 50% F: 38 – 48% NB: 49 – 58%

Normal Values decreases in anemia and increases in dehydration and polycythemia

DIFFERENTIAL COUNT Neutrophil

76%

45 – 65%

Increase in value may be due to presence of acute bacterial infection, inflammation, stress or drug reaction

Lymphocyte s

18%

25 – 40%

Decreased level may suggest that the patient has an aplastic anemia, leukemia, immunodeficiency

Monocytes

3%

2 – 6% Normal Values increases in viral infection, parasitic disease, collagen and hemolytic disorder Values decreases when patient is taking corticosteroid, or suffers in RA and HIV infection

Eosinophil

3%

2 – 4% Normal Values increases during allergic reaction, parasitic infestation and eosinophilic leukemia, and decreases

in patient with endocrine disorders, and during stress Platelet

204

Mean Corpuscular Volume (MCV)

90.2

Mean Corpuscular Hemoglobin (MCH)

31.0

Mean 34.4% Corpuscular Hemoglobin Concentrati on (MCHC)

Red Blood Cell Distribution Width (RDW)

13.0

150 – Normal 450,00 Thrombocytopenia is associated with anemias. 0/mm3 Thrombocytosis (elevated platelet count) occurs in polycythemia vera. 80 – 100 µm3

Normal Decreased level is associated with microcytic anemia like iron deficiency anemia Values increases in macrocytic anemias like aplastic, hemolytic and pernicious

27 – 31 Normal pg It is decreased in hypochromic anemias, and increased in hyperchromic anemias. 32 – 36%

Normal It is diminished (hypochromic) in microcytic anemias, and normal (normochromic) in macrocytic anemias (due to larger cell size, though the hemoglobin amount or MCH is high, the concentration remains normal). MCHC is elevated in hereditary spherocytosis.

11.6 - Normal 14.6 % Vitamin B12 deficiency produces a macrocytic (large cell) anemia with a normal RDW. However, iron deficiency anemia initially presents with a varied size distribution of red blood cells, and as such shows an increased RDW. And in the case of a mixed iron and B12 deficiency we will have a mix of both large cells and small cells hence the RDW will usually be elevated.

CHEMISTRY Test

Result

Sodium

137.5

Potassium

4.21

Normal Values

Interpretation

135 – 148 Normal mEq/L Value increases in increased intake, either orally or parentally of sodium Decrease in value is associated with burns, Addison’s disease, sodium-losing nephropathy, vomiting, diarrhea, fistulas, tube drainage, ascites, renal insufficiency with acidosis 3.50 – 5.30 mEq/L

Normal Blood levels of potassium may be higher than normal when patient is suffering from diabetic ketosis, renal failure, and Addison’s disease. Value decreases when patient is taking Thiazide diuretics and steroid therapy, or also may suggest cushing’s syndrome, cirrhosis with ascites, hyperaldosteronism, malignant hypertension, poor dietary habits, chronic diarrhea, diaphoresis, renal tubular necrosis, malabsorption syndrome, vomiting

March 12, 2009 CHEMISTRY Test

Result

Normal Values

Creatinine

100

53115,000 mmol/L

Resul t Conv ersio n 1.13

Unit

Normal Values

Interpretation

m g/d L

0.5 – 1.3

Normal Values increases in skeletal muscle necrosis/atrophy, starvation, hyperthyroidism, kidney disease,

March 20, 2009 HEMATOLOGY Componen Result Normal Values ts

Interpretation

Hemoglobi n

6.0

M: 13 – 18 gm/dL F: 12 – 16 gm/dL

Decrease level suggest anemia and may also be associated with blood loss (traumatic injury, surgery, bleeding), nutritional deficiency, bone marrow problems, immunosuppression

Hematocri t

17.6 %

M: 42 – 52% F: 35 – 47%

A low hematocrit is referred to as being anemic. Some of the more common reasons are loss of blood (traumatic injury, surgery, bleeding colon cancer), nutritional deficiency (iron, vitamin B12, folate), bone marrow problems (replacement of bone marrow by cancer, suppression by chemotherapy drugs, kidney failure), and abnormal hematocrit (sickle cell anemia).

March 26, 2009 HEMATOLOGY Componen Result Normal Values ts

Interpretation

Hemoglobi n

8.5

M: 13 – 18 gm/dL F: 12 – 16 gm/dL

Decreased level would suggest anemia, acute blood loss, and hemodilution

Hematocri t

24.9 %

M: 42 – 52% F: 35 – 47%

Values decreases in anemia

March 31, 2009 CROSSMATCHING RESULT Blood Typing

Result

Interpretation

ABO

“O”

Individuals with type O blood can receive blood from donors of only type O, so as to prevent hemolytic transfusion reaction.

RH

(+)

Individual who inherited the D antigen. This is to prevent Rh incompatibility reaction. Blood Component

PRBC

Extraction Date: March 28, 2009 Expiration Date: April 1, 2009

To increase oxygen carrying capacity in symptomatic anemia patients

April 7, 2009 CROSSMATCHING RESULT Blood Typing

Result

Interpretation

ABO

“O”

Individuals with type O blood can receive blood from donors of only type O, so as to prevent hemolytic transfusion reaction.

RH

(+)

Individual who inherited the D antigen. This is to prevent Rh incompatibility reaction. Blood Component

PRBC

Extraction Date: April 5, 2009 Expiration Date: May 10, 2009

To increase oxygen carrying capacity in symptomatic anemia patients

Generic Name: cefazolin sodium Brand Name: Ancef, Kefzol Classification: First generation cephalosporin (anti-infective)

MECHANISM OF ACTION

DOSAGE/ FREQUEN CY Interferes with Cefazolin 1 bacterial cell gm TIV q wall synthesis, 8h causing cell to rupture and die.

INDICATION Treatment variety of infections due to susceptible organism: Respiratory tract, GIT, GUT, OTIC, bone, skin soft tissues, post-op infection, bacteremia, septicemia, endocaditis, surgical prophylaxis

ADVERSE REACTION

CONTRAINDICATI ON

Drug induce fever, Hypersensitivity to GI side effects, cephalosporins skin rashes, eosinophilia, allergic nephritis, anaphylactic reaction, hematological changes, headache, dizziness, malaise, shock, cytopenia, thrombocytopenia , alteration of bacterial flora.

NURSING CONSIDERATIO N Monitor CBC, Prothrombin time, Kidney and liver function test result Watch for signs and symptoms of superinfection and other serious adverse reaction Tell patient to report reduce urinary output, persistent diarrhea, bruising and bleeding Instruct the patient to take the drug exactly as prescribed and to complete full course of drug therapy even when he feels better. As appropriate review all other significant life threatening reactions and interactions especially those related to the drugs, test and behaviors

Generic Name: omeprazole Brand Name: Omepron Classification: Proton Pump inhibitor

Generic Name: Nalbuphine HCl Brand Name: Nubain [amp] MECHANISM OF DOSAGE/ INDICATIO ADVERSE CONTRAINDICATI ACTION FREQUEN REACTION ON MECHANISM DOSAGE/ INDICATIONN CY OF ACTION FREQUEN ADVERSE CONTRAINDICATI Binds to opiate receptors Nalbuphine Relief of REACTION Sedation. ON Patients who are CY in the CNS, causing IV moderate Infrequentl Hypersensitivity hypersensitive to to Thought to be Omeprazol10 mg Duodenal ulcer, Headache, inhibition of ascending push q 4 to severe y nalbuphine HCl or a gastric e 40 mg/ gastric ulcer, rarely rash, drug or its pain pathways, altering hours x6 pain. Pre- pruritis, sweating, components. any component, pump reflux the perception of vial and doses op GI upsets, including sulfites; inhibitor in pain;1 vial OD esophagitis, dizziness, response to analgesia,parasthesia, vertigo, pregnancy that it blocks per IV associated produces generalized as a dizziness; (prolonged use or the step duodenal gastric somnolence, CNS final depression supplemen dry mouth; high dosages at of acid ulcers, insomnia,ver t to production by gastroduodenal tigo,headache, term) allergic inhibiting the erosion, balanced diarrhea, anesthesia, reactions. H+/K+ ATPHelicobacter constipation, surgical flatulence, ase system of pylori- associated anesthesia, the secretory peptic ulcer increased for obstet surface of the disease, liver ric the enzyme,mal gastric dyspepsia(in parietal cell. relief of analgesia aise,hyperse symptomsduring in nsitivity labor & patient with reaction epigastricrelief of pain pain/discomfort following with or without MI. Post-op heartburn),Zollin ger-Ellisonsomatic & syndromevisceral pain.

NURSING CONSIDERATION NURSING CONSIDERATION Abrupt discontinuation after sustained Consider dosageuse (generally days) adjustment >10 in those mayhepatic cause withdrawal with failure symptoms. Mixed agonist-antagonist: Avoid activities that Incidence of require mental psychomimetic effect is alertness until drug lower than with effects’ realized; may pentazocine; may cause dizziness precipitate withdrawal in narcotic-dependent For short term use patients. only, drug inhibits total gastric secretion. Side effects of prolonged therapy and suppression of acid secretion alter bacterial colonization and lead to hypochlorhydria which may cause an increased risk for gastric tumors

Classification: Anaesthetics - Local & General, Analgesics (Opioid)

Generic Name: Ketorolac tromethamine Brand Name: Apo-Ketorolac Classification: Non-steroidal anti-inflammatory drug

MECHANISM OF ACTION

DOSAGE/ FREQUEN CY Possesses Ketorolac anti30 mg q 6 inflammatory, hours x 4 analgesic, doses and anti pyretic effects

INDICATION

ADVERSE REACTION

CONTRAINDICATI ON

As a single or multiple dose regimen on a regular or as needed schedule for the management of moderate to severe pain that requires analgesia at the opioid level

Systemic use: Headache, dizziness, drowsiness, diarrhea, nausea, dyspepsia/indigestio n, epigastric pain, edema

Hypersensitivity to the drug or allergic symptoms; Active peptic ulcer disease; those at risk for renal failure

NURSING CONSIDERATIO N 1. Use as a part of a regular analgesic rather than on an as needed basis 2. Do not mix IV/IM in a small volume(i.e, a syringe) with morphine sulfate, meperidine, HCL, promethazine HCL, or hydroxyzine HCL; will precipitate from solution

Generic Name: tramadol hydrochloride Brand Name: Ultram Classification: Non-steroidal anti-inflammatory drug

MECHANISM OF ACTION Inhibits re uptake of serotonin and norepinephrin e in the CNS

DOSAGE/ FREQUENC Y Tramado l 100 mg/amp 1 amp q8h for pain

INDICATION

ADVERSE REACTION

CONTRAINDICATI ON

For moderate to severe acute or chronic pain e.g. cancer or post op pain

Seizures, hypersensitivity reactions, respiratory depression; CV, CNS, musculoskeletal and urogenital disorder, nausea, vomiting, abdominal distention,anorexia, dependence,

Acute intoxication with alcohol, analgesics, hypnotics or psycho tropics, patients receiving MAOI’s , severe respiratory depression, cerebral pathology

NURSING CONSIDERATIO N assess patient’s response to drug 30 mins. after dministration Monitor respiratory status, withhold drug and contact prescriber if respiration becomes shallow or slower than 12 cpm Inform patient that drug can cause physical and psychological dependence.

Generic Name: Paracetamol Brand Name: Aeknil Classification: Analgesics (Non-Opioid) & Antipyretics

MECHANISM OF ACTION Paracetamol is

DOSAGE/ FREQUENC Y Paracetamo l 300 mg Iv prn for temp. >380C

INDICATION

ADVERSE REACTION

Pyrexia of

Skin

unknown origin

eruption,

and for

hematologic

symptomatic

al toxicity

relief of fever

e.g.,

and pain

thrombocyto

associated with

penia and

common

leucopenia,

peak plasma

childhood

methemoglo

levels are

disorders,

binaem-ia

attained in 10

tonsillitis, upper which can

min to 1 hr and

respiratory

result in

the half-life is

tract infections,

cyanosis,

75 min to 3 hrs.

post-

and on long-

Distribution of

immunization

term use,

paracetamol to

reactions, after

renal

most body

tonsillectomy

damage can

tissues and

and other

result.

fluids is both

conditions

rapid and

where patient is

uniform.

unable to take

Approximately

oral

85% of a dose

medications but

of paracetamol

where

is excreted in

paracetamol

the urine within

can be

24 hrs after

administered

administration.

with advantage.

rapidly and almost completely absorbed from the GIT. Following oral administration,

Paracetamo l 1 amp IV prn basis for temp >37.80C

For prevention

CONTRAINDICATIO N Nephropathy.

NURSING CONSIDERATION 1. Never take more than 2 tablets (of 500mg each day) at any one time and no more than 4 times in 1 day. 2. Paracetamol may be taken with or without food. 3. If you need pain relief fast, take it on an empty stomach as food may slow down the absorption of paracetamol. 4. Do not double a dose under any circumstances. 5. Do not take paracetamol of you have liver or kidney problem. 6. Do not take this medicine with other products that contain paracetamol. 7. Avoid alcohol

Generic Name: ferrous sulfate Brand Name: Apo ferrous sulfate Classification: Anti Anemic Iron

MECHANISM OF ACTION Iron is absorbed from the duodenum and upper jejunum by anactive mechanism through the mucosal cells where it combines with the protein transferring and is stored in the body as hemosiderin or aggregated ferritin w/c is found in the reticuloendothelia l cells of the liver, spleenand bone marrow

DOSAGE/ FREQUEN CY Ferrous sulfate 1 tab OD

INDICATION Prophylaxis and treatment of iron deficiency and iron deficiency anemia; dietary supplement for iron

ADVERSE REACTION

CONTRAINDICATI ON

GI irritation and blackening of stool, constipation, nausea and anorexia, diarrhea

Hemosiderosis, hemochromatosis, peptic ulcer, regional enteritis, ulcerative colitis. Hemolytic anemia, pyridoxine responsive anemia, liver cirrhosis

NURSING CONSIDERATI ON Eggs, milk, coffee or tea consumed with a meal or 1 hour after may significantly inhibit the absorption of dietary iron Ingestion of calcium and iron supplements with food can decrease absorption by 1/3 Note any GI bleeding, tarry stools or bright blood in stool or vomitus Note any complaints of fatigue, pallor. Poor skin turgor or change in mental status Take with meals

Date: 4/17/09 Subjective: > “ Masakit tong mga sugat ko” as verbalized by the patient.” Pain scale of 8 out of 10. Objective: > V.A.S. >guarding behaviors >restless >narrowed focus Date: 4/17/09 Subjective: “Nadamay lang naman ako eh, tapos ganito na nangyari”, as verbalized by the patient.

Objective: > amputated R arm > Negative feelings about body/self, >fear of rejection >Focus on past appearance, abilities;

Date:4/17/09 Subjective: “Eto nga eh putol na yung kamay ko, tas ung kabila sunog din.”as verbalized by the patient. Objective: >absence of viable tissue on L arm > c multiple lesions on extremities and trunk > presence of fluid exudates on injured areas

PDAGDAG NLNG N2 SA P.A OR SA S & S HYPOTENSIVE UNG PATIENT THROUGHOUT OUR SHIFT