ASU-INS 01

Aklan State University Series No. 000101

Date: July 30, 2018
School of Arts and sciences
Banga, Aklan
Bachelor of Science in Nursing

DRUG STUDY
Name of Patient: C.D.T Attending Physician:
Age: 88 yo Area/Ward/Bed Number: Medical Ward Impression/Diagnosis: CVA

Dosage, Route, Mechanism of

Name of Drug Indication Adverse Reactions Special Precautions Nursing Responsibilities
Freq., Timing Action

Generic: Dosage: Binds to fibrin in a To treat acute ischemic CNS: Cerebral edema, Dose should be given Monitor for bleeding
Alteplase 50 mg thrombus and stroke cerebral herniation, within the first 3 hrs of the especially at arterial
converts fever, seizure, stroke onset of symptoms to puncture sites. (overt blood,
trapped plasminogen avoid acute bleeding occult blood in any body
to plasmin. Plasmin CV: Arrhythmias complications. substance).
breaks down fibrin, (including bradycardia
fibrinogen, and other and electromechanical Alteplase therapy may Monitor for arrythmia. Check
clotting factors, which dissociation), cardiac cause arrhythmias from B/P, pulse, respirations
dissolves the arrest, cardiac sudden reperfusion of q15min until stable, then
thrombus. tamponade, cardiogenic the myocardium. Monitor hourly. Auscultate lung
shock, cholesterol continuous ECG for sounds.
embolism, coronary arrhythmias during drug
thrombolysis, heart therapy Discontinue alteplase
failure, hypotension, immediately if serious
mitral insufficiency, bleeding occurs.
myocardial reinfarction Elderly: May have
or rupture, pericardial increased risk of Avoid any trauma that might
effusion, pericarditis, bleeding; monitor closely increase risk of bleeding
venous thrombosis and (e.g., injections).
embolism Recent (within 10 days)
major surgery or Monitor for chest pain relief
EENT: Epistaxis, GI bleeding, organ and notify physician of
gingival bleeding, biopsy, recent trauma or continuation or
laryngeal edema CPR, left heart thrombus, recurrence (note location,
endocarditis, severe type, intensity).
GI: GI bleeding, nausea, hepatic disease,
retroperitoneal cerebrovascular disease, Teach the folks to
bleeding, vomiting diabetic retinopathy, immediately report bleeding,
thrombophlebitis, including from the nose or
 GU: GU bleeding occluded AV cannula at Gums and limit physical
infected activity during alteplase
RESP: Pleural effusion, site. administration to reduce risk
pulmonary edema, of injury and bleeding.
pulmonary re-
embolization

SKIN: Bleeding at
puncture sites,
ecchymosis, rash,
urticaria

Other: Anaphylaxis
Route:
IV

Classification: Frequency: Contraindications: Side Effects:

Functional:
Thrombolytic PRN Active internal bleeding, Frequent: Superficial
AV malformation or bleeding at puncture
Tissue aneurysm, sites, decreased B/P.
plasminogen bleeding diathesis CVA,
activator (tPA) intracranial neoplasm, Occasional:
intracranial or intraspinal Allergic reaction (rash,
surgery or trauma, wheezing, bruising).
recent (within past 2
mos), severe
uncontrolled
hypertension, suspected
aortic dissection
Chemical:
Purified
glycoprotein

Students Name: Ma. Mechile D. Martinez BSN 3-2A

Clinical Instructor: Zyra Gay S. Torda, RN
 ASU-INS 01
Aklan State University Series No. 000101
Date: July 30, 2018
School of Arts and sciences
Banga, Aklan
Bachelor of Science in Nursing

DRUG STUDY
Name of Patient: C.D.T Attending Physician:
Age: 88 yo Area/Ward/Bed Number: Medical Ward Impression/Diagnosis: CVA

Dosage, Route, Mechanism of

Name of Drug Indication Adverse Reactions Special Precautions Nursing Responsibilities
Freq., Timing Action

Generic: Dosage: Inhibits binding of To reduce the risk of Agranulocytosis, Severe hepatic/renal Monitor for signs and
Clopidogrel enzyme adenosine stroke aplastic impairment, pts at risk of symptoms of bleeding
phosphate (ADP) to anemia/pancytopenia, increased bleeding (e.g., (urine, stool, hematoma,
its platelet receptor thrombotic trauma), concurrent use epistaxis, petechiae).
and subsequent ADP- thrombocytopenic of anticoagulants. Avoid
mediated activation purpura (TTP) occurs concurrent use of Provide comfort measures
of a glycoprotein rarely. Hepatitis, CYP2C19 inhibitors (e.g., for headache because pain
complex. hypersensitivity reaction, omeprazole). due to headache may
anaphylactoid decrease patient
reaction have been compliance to treatment
reported. regimen.

Avoid grapefruit products in

the diet of the patient.

Inform other health care

members that the patient is
taking Clopidogrel.

Patient/Family Teaching
Discourage use of NSAIDs,
including OTC preparations,
during clopidogrel therapy
because of potential for
bleeding.

Caution patient that

bleeding may continue
longer than usual. Instruct
 him to report unusual
bleeding or bruising.

Because he has an
increased risk of bleeding,
urge patient to inform all
other healthcare providers,
including dentists, that he
takes clopidogrel before
having surgery or other
procedures or taking a new
drug.

Instruct patient to inform his

health care providers about
his clopidogrel therapy.
Brand: Route:
Plavix

Classification: Frequency: Contraindications: Side Effects:

Functional:
Antiplatelet Hypersensitivity to Frequent (15%): Skin
clopidogrel. Active disorders
bleeding (e.g.,
peptic ulcer, intracranial Occasional (8%–6%):
hemorrhage). Upper respiratory tract
infection, chest pain, flu-
like symptoms,
headache, dizziness,
arthralgia.

Rare
(5%–3%): Fatigue,
edema, hypertension,
abdominal pain,
dyspepsia, diarrhea,
nausea, epistaxis,
dyspnea, rhinitis
Chemical:
Thienopyridine
derivative

Students Name: Ma. Mechile D. Martinez BSN 3-2A

Clinical Instructor: Zyra Gay S. Torda, RN

ASU-INS 01
Aklan State University Series No. 000101
Date: July 30, 2018
School of Arts and sciences
Banga, Aklan
Bachelor of Science in Nursing
 DRUG STUDY
Name of Patient: C.D.T Attending Physician:
Age: 88 yo Area/Ward/Bed Number: Medical Ward Impression/Diagnosis: CVA

Dosage, Route, Mechanism of

Name of Drug Indication Adverse Reactions Special Precautions Nursing Responsibilities
Freq., Timing Action

Generic: Dosage: Exerts antidepressant, To treat depression Hyponatremia, Use cautiously in patients Provide safety measures
Paroxetine ant obsessional, and seizures, have been with history of seizures, (e.g. adequate lighting,
anti-panic effects by reported. renal/hepatic impairment, raised side rails, etc.) to
potentiating serotonin Serotonin syndrome pts with suicidal prevent injuries, in case of
activity in CNS and (agitation, confusion, tendencies, elderly pts, seizure and since patient
inhibiting serotonin diaphoresis, narrow-angle can feel dizziness and
reuptake at hallucinations, glaucoma, alcohol use. drowsiness from medication
presynaptic neuronal hyperreflexia) occurs
membrane. Blocked rarely. Be aware that serotonin Assess behavior, speech
serotonin reuptake syndrome in its most pattern, orientation, mood.
increases severe form may Watch for mania and
levels and prolongs resemble neuroleptic akathisia (inner sense of
activity of serotonin at malignant syndrome, restlessness) and
synaptic receptor sites which includes psychomotor agitation,
hyperthermia, muscle especially during the first
rigidity, and autonomic few weeks of therapy.
instability with
possibly rapid changes in Administer drug once a day
vital signs and in the morning to achieve
mental status. Stop drug optimal therapeutic effects.
immediately, and
provide supportive care. Provide comfort measures
(e.g. taking food with the
drug) to help patient tolerate
drug effects.

Patient/Family Teaching
 Advise the folks to closely
observe patient for
increased suicidal thinking
and behavior, and report
to physician.
 Avoid tasks that require
 alertness, motor skills
until response to drug is
established.
 Don’t stop drug abruptly.
Withdrawal or
discontinuation syndrome
may occur if drug is
stopped abruptly. Taper
drug slowly over 1 to 2
weeks.
 Avoid alcohol to prevent
St. John’s wort.
 Medication can cause dry
mouth.
 Therapeutic effect may be
noted within 1–4 wks.
Brand: Route:
Paxil

Classification: Frequency: Contraindications: Side Effects:

Functional:
Antidepressant  Hypersensitivity to Frequent (26%–8%):
paroxetine or its Nausea, drowsiness,
components headache, dry mouth,
 Pimozide therapy asthenia, constipation,
 Use within 14 days of dizziness, insomnia,
an MAO inhibitor diarrhea, diaphoresis,
 Thioridazine therapy tremor.
 Severely depressed,
suicidal patients. Occasional (6%–3%):
Decreased appetite,
respiratory disturbance
(e.g., increased cough),
anxiety, flatulence,
paresthesia, yawning,
decreased libido, sexual
dysfunction, abdominal
discomfort.
 Rare: Palpitations,
vomiting, blurred vision,
altered taste,
confusion.
Chemical:

Phenylpiperidin
e derivative

Students Name: Ma. Mechile D. Martinez BSN 3-2A

Clinical Instructor: Zyra Gay S. Torda, RN

ASU-INS 01
Aklan State University Series No. 000101
Date: July 30, 2018
School of Arts and sciences
Banga, Aklan
Bachelor of Science in Nursing

DRUG STUDY
Name of Patient: C.D.T Attending Physician:
Age: 88 yo Area/Ward/Bed Number: Medical Ward Impression/Diagnosis: CVA

Dosage, Route, Mechanism of

Name of Drug Indication Adverse Reactions Special Precautions Nursing Responsibilities
Freq., Timing Action

Generic: Dosage: Inhibits ACE, To treat hypertension CNS: Fever Use cautiously in patients Provide safety measures
Captopril preventing conversion CV: Chest pain, with impaired (e.g. adequate lighting,
of angiotensin I to hypotension, orthostatic renal function or serious raised side rails, etc.) to
angiotensin II, a hypotension, autoimmune disease, prevent injuries, since
potent palpitations, tachycardia especially systemic lupus patient can experience
vasoconstrictor. Less EENT: Loss of taste erythematosus, and in hypotension.
 angiotensin II GU: Dysuria, impotence, those who have been
decreases peripheral nocturia, oliguria, exposed to other drugs Closely monitor patient’s
arterial resistance, polyuria, that affect WBC counts or blood pressure, especially
Decreasing proteinuria, urinary immune response. when therapy starts and
aldosterone secretion, frequency dosage increases. Keep
which reduces sodium HEME: Eosinophilia patient supine if
and water retention MS: Arthralgia hypotension occurs.
and lowers blood RESP: Cough
pressure. SKIN: Photosensitivity, Take the I&O of the pt. to
pruritus, rash watch for renal evidence as
Other: Angioedema, oliguria, polyuria, and
hyperkalemia, urinary frequency or other
hyponatremia, positive signs of impaired renal
ANA titer function.

Limiting salt in the diet.

Brand: Route:
Capoten Patient/Family Teaching
 Advise to rise the patient
slowly from sitting or
lying to minimize
orthostatic hypotension

Frequency:
Classification: Contraindications: Side Effects:
Functional:  Tell to avoid sunlight or
Anti- Hypersensitivity to Frequent (7%–4%): wear sunscreen in direct
hypertensive captopril, other ACE Rash. sunlight because
inhibitors, or their photosensitivity may
components Occasional (4%–2%): occur.
Pruritus, dysgeusia.  Advise folks not to use
salt substitutes to
Rare (less than 2%): patient’s diet that contain
Headache, cough, potassium and to consult
insomnia, dizziness, prescriber before
fatigue, paresthesia, increasing potassium
malaise, nausea, intake to avoid increasing
diarrhea or constipation, risk of hyperkalemia.
dry mouth, tachycardia.  Advise folks tell
prescriber about signs
and symptoms of
infection, such as sore
 throat or fever
Chemical:
ACE inhibitor

Students Name: Ma. Mechile D. Martinez BSN 3-2A

Clinical Instructor: Zyra Gay S. Torda, RN
:

ASU-INS 01
Aklan State University Series No. 000101
Date: July 30, 2018
School of Arts and sciences
Banga, Aklan
Bachelor of Science in Nursing

DRUG STUDY
Name of Patient: C.D.T Attending Physician:
Age: 88 yo Area/Ward/Bed Number: Medical Ward Impression/Diagnosis: CVA

Dosage, Route, Mechanism of

Name of Drug Indication Adverse Reactions Special Precautions Nursing Responsibilities
Freq., Timing Action

Generic: Dosage: Selectively blocks To reduce the risk of CNS: Syncope Use cautiously to pts with Monitor for signs of
Apixaban 5 mg active site of factor stroke HEME: Excessive hepatic impairment, risk bleeding.
Xa, a key factor in the bleeding, including of severe bleeding
intrinsic and extrinsic hemorrhage, (severe uncontrolled Ready 2 packed of RBC in
pathway of blood SKIN: Rash hypertension, history of case the patient experience
coagulation Other: Anaphylaxis, bleeding ulcers, adverse effects of
cascade. Prevents angioedema upper or lower GI potentially fatal bleeding.
 new clot formation, bleeding, severe renal
secondary May cause serious, impairment), recent Monitor B/P, heart rate, PR
thromboembolic potentially fatal, surgery. and RR.
complications which bleeding, accompanied
inhibit by one or Avoid use in pts Use resistant footwear when
clot-induced platelet more of the following: a with severe hepatic assisting the patient in
aggregation, fibrin decrease in Hgb impairment, prosthetic ambulation. Do not let the
clot formation. of 2 g/dL or more; a heart valve. patient walk barefoot.
need for 2 or more
units of packed RBCs. Let the other health care
team n

Patient/Family Teaching
Advise folks not to stop
taking apixaban to patient
without first consulting
prescriber.

Advise folks to report any

unusual bleeding or bruising
to the prescriber. Inform
that it may take longer for
her to stop bleeding and to
take bleeding precautions,
such as avoiding the use of
a razor and using a soft-
bristle toothbrush.

Do not let the patient walk

barefoot.
Brand: Route:
Eliquis PO Report headache,
abdominal pain, frequent
bruising, bloody urine or
stool, bleeding gums, joint
pain or swelling

Classification: Frequency: Contraindications: Side Effects:

Functional: BID
Anticoagulant Active pathological Rare (3%–1%): Nausea,
 Timing: bleeding, severe ecchymosis.
8 am hypersensitivity to
8 pm apixaban or its
components
Chemical:
Factor XA
Inhibitor

Students Name: Ma. Mechile D. Martinez BSN 3-2A

Clinical Instructor: Zyra Gay S. Torda, RN

ASU-INS 01
Aklan State University Series No. 000101
Date: July 30, 2018
School of Arts and sciences
Banga, Aklan
Bachelor of Science in Nursing

DRUG STUDY
Name of Patient: C.D.T Attending Physician:
Age: 88 yo Area/Ward/Bed Number: Medical Ward Impression/Diagnosis: CVA

Dosage, Route, Mechanism of

Name of Drug Indication Adverse Reactions Special Precautions Nursing Responsibilities
Freq., Timing Action

Generic: Dosage: Inhibits calcium To treat hypertension Overdose produces Use cautiously to pts with Ready the antidote,
Diltiazem movement across nausea, drowsiness, renal/hepatic impairment, Glucagon, in case adverse
cardiac, vascular confusion, slurred HF, concurrent use with effect occurs.
smooth-muscle cell speech, profound beta-blocker,
membranes (causes bradycardia. hypertrophic obstructive Provide safety measures
dilation of coronary cardiomyopathy. (e.g. adequate lighting,
 arteries, peripheral raised side rails, etc.) to
arteries, arterioles) prevent injuries, since
patient can experience
dizziness.

Monitor BP for hypotension

and heart rate for
bradycardia.

Extremely assist with

ambulation if dizziness
occurs to stroke patient.

Wear compression stocking

during the day and taking off
before bed time to lessen
edema while limiting salt
intake.
.
Brand: Route:
Diltiazem

Classification: Frequency: Contraindications: Side Effects:

Functional: Acute MI, pulmonary Frequent (10%–5%): Patient/Family Teaching
Antihypertensiv congestion, Peripheral edema,  To avoid postural
e hypersensitivity to dizziness, light- dizziness, assist the
diltiazem, second- or headedness, headache, patient from lying to
third-degree AV block bradycardia, asthenia. standing slowly.
(except in presence of  Do not abruptly
pacemaker), Occasional (5%–2%): discontinue medication to
severe hypotension (less Nausea, constipation, avoid withdrawal
than 90 mm Hg, flushing, symptoms.
systolic), sick sinus EKG changes.  Do not allow the pt. to
syndrome (except move without support to
in presence of Rare (less than 2%): avoid injury since the
pacemaker). Rash, micturition medication can cause
disorder (polyuria, dizziness and
nocturia, dysuria, lightheadedness.
frequency of urination),  Limit salt in the diet.
abdominal discomfort,  Report if the pt.
drowsiness palpitations, shortness of
 breath, pronounced
dizziness, nausea,
constipation.
Chemical:
Calcium
Channel
Blockers

Students Name: Ma. Mechile D. Martinez BSN 3-2A

Clinical Instructor: Zyra Gay S. Torda, RN

ASU-INS 01
Aklan State University Series No. 000101
Date: July 30, 2018
School of Arts and sciences
Banga, Aklan
Bachelor of Science in Nursing

DRUG STUDY
Name of Patient: C.D.T Attending Physician:
Age: 88 yo Area/Ward/Bed Number: Medical Ward Impression/Diagnosis: CVA

Dosage, Route, Mechanism of

Name of Drug Indication Adverse Reactions Special Precautions Nursing Responsibilities
Freq., Timing Action

Generic: Dosage: Interferes with hepatic Treatment of Use cautiously to pts with Monitor for signs of
Warfarin synthesis of vitamin thromboembolic active tuberculosis, acute bleeding.
K–dependent clotting disorders and embolic infection, diabetes,
factors, resulting in complications arising heparin-induced Maintain antidotes on
depletion of from atrial fibrillation, thrombocytopenia and bedside 10 mg Vitamin K
coagulation factors II, including stroke. deep vein thrombosis, pts (PO or IV) to promptly
VII, IX, X. Thus, at risk for hemorrhage, treat drug overdose.
 prevents further moderate to severe renal
extension of formed impairment, moderate to Monitor B/P, heart rate, PR
existing clot; prevents severe hypertension, and RR to detect
new clot formation, thyroid disease, hemorrhage.
secondary polycythemia vera,
thromboembolic vasculitis, open wound, Use resistant footwear when
complications. disruption of GI normal assisting the patient in
flora, history of peptic ambulation. Do not let the
ulcer disease, protein C patient walk barefoot.
deficiency, elderly.
Avoid I.M. injections during
warfarin therapy, if possible,
Be aware of the because they can result
increased risk for in bleeding, bruising, and
intracranial hemorrhage if hematoma.
patient has
cerebral ischemia. Patient/Family Teaching
Advise folks not to stop
taking warfarin to patient
without first consulting
prescriber.

Advise folks to report any

unusual bleeding or bruising
to the prescriber. Also, to
take bleeding precautions,
such as avoiding the use of
a razor and using a soft-
bristle toothbrush.

Do not let the patient walk

barefoot.
Brand: Route:
Coumadin Advise patient to eat
consistent amounts
of vitamin K-rich foods, such
as dark green, leafy
vegetables as these foods
can affect the way warfarin
works.
Classification: Frequency: Contraindications: Side Effects:
Functional: Explain that drug may cause
Anticoagulant Bleeding or bleeding Bleeding complications reversible purple-toe
Timing: tendencies; blood ranging from local syndrome and that this
dyscrasias; cerebral or ecchymoses to major syndrome isn’t harmful.
dissecting aneurysm; hemorrhage (Intracranial
cerebrovascular hemorrhage, Advise folks to carry medical
hemorrhage; GI/GU/nasal/oral/rectal identification that reveals
diverticulitis; eclampsia bleeding) may occur. the pt.’s taking warfarin.
or preeclampsia; history Hepatotoxicity, blood
ofwarfarin-induced dyscrasias, necrosis, Notify prescriber
necrosis; hypersensitivity vasculitis, local immediately about unusual
to warfarin or its thrombosis occurs bleeding and
components; malignant rarely. any unexplained symptoms,
or severe uncontrolled such as abnormal vaginal
hypertension; bleeding; dizziness; easy
malnutrition and bruising; gum bleeding;
emaciation; mental state headache; nosebleeds;
or condition that leads to prolonged bleeding from
lack of patient cuts; red, black, or tarry
cooperation; pericardial stool; red or dark brown
effusion; pericarditis; urine; swelling; and
polyarthritis; pregnancy; weakness
prostatectomy; recent or
planned neurosurgery,
ophthalmic surgery, or
spinal puncture; severe
hepatic or renal disease
Chemical:
Coumarin
Derivative

Students Name: Ma. Mechile D. Martinez BS N 3-2A

Clinical Instructor: Zyra Gay S. Torda, RN