Ncp-drug Study 2

ASSESMENT Subjective: “inuubo p rin sya” as verbalized by the grandmother. Objective: - received awake lying on bed ĉ ongoing IVF of #6 D5IMB iL @ 950cc remaining level to run for 12o, infusing well @ left hand - conscious and coherent - ĉ productive cough - ĉ good skin turgor -ĉ good capillary refill in 2-3 secs - s respiratory distress (RR: 26 CPM) - on HAD - ĉ good appetite, consumed all of the food served - ambulatory - afebrile (36.7 oC)

DIAGNOSIS

SCIENTIFIC EXPLANATION Ineffective Maintaining a airway clearance patent airway is r/t retained vital to life. bronchial Coughing is the secretions main mechanism for clearing the airway. However, the cough may be ineffective in both normal and disease states secondary to factors such as pain from surgical incisions/ trauma, respiratory muscle fatigue, or neuromuscular weakness. Other mechanisms that exist in the lower bronchioles and alveoli to maintain the airway include the mucociliary system, macrophages, and the lymphatic. Factors such as anesthesia and dehydration can affect function of the mucociliary system. Likewise, conditions that cause increased production of secretions (e.g., pneumonia, bronchitis, and chemical irritants)

PLANNING Within the 8˚ shift, the client will be able to demonstrate behaviors to improve clear airway by expectoration of retained secretions.

INTERVENTION - establish rapport - position the patient comfortably - monitor vital signs

- elevate head of bed

- Auscultate lungs for presence of normal or adventitious breath sounds - Assess respirations; note quality, rate, pattern, depth, flaring of nostrils, dyspnea on exertion, and position for breathing - Assess cough for effectiveness and productivity

- Assist patient in performing coughing and breathing maneuvers - encourage increase oral fluid intake

RATIONALE - to facilitate cooperation as well as to gain pt’s trust - to promote comfort - to note any significant changes that can affect the pt’s condition - These promote better lung expansion and improved air exchange - These may indicate presence of mucus plug or other major airway obstruction - Abnormality indicates respiratory compromise

- Consider possible causes for ineffective cough (e.g., respiratory muscle fatigue, severe bronchospasm, or thick tenacious secretions). - These improve productivity of the cough - Increased fluid intake reduces the viscosity of mucus

EVALUATION Goal partially met. After the shift, the client was able to demonstrate behaviors to improve clear airway but wasn’t able to expectorate retained secretions.

DRUG STUDY BRAND NAME Ventolin Expectorant

GENERIC NAME Salbutamol

DOSAGE

ACTION

INDICATION

5 ml, TID

Stimulates beta-2 receptors of bronchioles by increasing levels of cAMP which relaxes smooth muscles to produce bronchodilatation. Also causes CNS stimulation, cardiac stimulation, increased diuresis, skeletal muscle tremors, and increased gastric acid secretion. Longer acting than isoproterenol.

Relief of bronchospasm in bronchial asthma, chronic bronchitis, emphysema and other reversible, obstructive pulmonary diseases. Also useful for treating bronchospasm in patients with coexisting heart disease of hypertension.

CONTRAINDICATION

NURSING CONSIDERATIONS Hypersensitivity to  Assess cardiosalbutamol, also to respiratory function; atropine and its BP, heart rate and derivatives. Threatened rhythm, and breath abortion during the first sounds. or second trimester.  Determine history Cardiac arrhythmias of previous associated with medication tachycardia caused by (theophylline), and digitalis intoxication. ability to self Hypertrophic medicate to prevent obstructive additive. cardiomyopathy or  Monitor for tachyarrhythmia. evidence of allergic Thyrotoxicosis. reactions and Prevention of paradoxical premature labor bronchospasm. associated with toxemia of pregnancy or antepartum hemorrhage. Lactation. Use of non-selective beta-blockers.

BRAND NAME Tergicef

GENERIC NAME Cefixime

DOSAGE

ACTION

INDICATION

CONTRAINDICATION

5 ml, TID

Inhibits bacterial cell wall synthesis, rendering cell wall osmotically unstable, leading to cell death.

Bronchitis, bronchiectasis with infection, secondary infections of chronic respiratory tract diseases, pneumonia, otitis media, sinusitis. Pyelonephritis, cystitis, gonococcal urethritis, cholecystitis. Scarlet fever.

Hypersensitivity. History of shock due to any ingredient of this product.

NURSING CONSIDERATIONS  Assess patient’s previous reaction to penicillin or other cephalosporins. Cross-sensitivity between penicillin and cephalosporins is common.  Assess patient for signs and symptoms of infection before and during treatment; fever, earache, characteristics of wounds, sputum, urine, stool, and WBC >10,000/mm3  Obtain C&S before beginning drug therapy to identify if correct treatment has been initiated.  Assess for allergic reactions.  Assess renal function before and during therapy; urine output. BUN and creatinine.