Ncpdrug Electro
Ncpdrug Electro
Ncpdrug Electro
DEPENDENT:
Administer analgesics as
prescribed To relieve headache
DEPENDENT:
COLLABORATIVE:
Consult with dietitian and nutrition Helpful in assessing client’s
specialist nutritional needs in light of
changes in indigestion and
intestinal function, including
absorption of vitamins and
minerals
Assessment Diagnosis Planning Interventions Rationale Expected outcome
INDEPENDENT:
Subjective: SHORT TERM GOAL: Establish rapport listening Friendly relationship with SHORT TERM GOAL:
carefully and attending to client’s patient and to be able to
“Minsan nakakausap Impaired Verbal After series of nursing verbal and non verbal know her concerns After series of nursing
naman sya pero hindi Communication related intervention, the client will expressions intervention, the client
maintindihan” as to loss of mental be able to communicate will communicate and
verbalized by the function and processes and participate to Assess the degree of This will determine the participate to
nurse of the patient secondary to loss of therapeutic disorientation to time, place, amount of reorientation therapeutic
neuronal function communication and person and situation. and intervention the communication and
Objective: responsible for memory interventions needed. patient will need. interventions needed.
and speech as
Showing evidenced by showing LONG TERM GOAL: LONG TERM GOAL:
Evaluate mental status, note Evaluating the mental
decrease level of decrease level of
presence of psychotic status of the patient is
consciousness consciousness, By the time of discharge, By the time of discharge,
conditions. Assess psychological vital to determine
and impaired impaired verbal the patient will be able to the patient will build
response to communication contributing factors.
verbal communication and build reality-based reality-based cognitive
impairment, willingness to find
communication mental status cognitive process, process, stablish the
alternate means of
Mental status examination reveals stablish the relationship, relationship, seek aid
communicating
examination loss of cognition, seek aid and support as and support as required,
Dysphasia assessment
reveals loss of comprehension and required, remain calm remain calm and
Assess for the presence of provides you with
cognition, disturbed thought and oriented, verbalize oriented, verbalize being
expressive dysphasia (inability to invaluable information. It
comprehension process being control of his/her control of his/her life,
cover information verbally) and allows you to establish
and disturbed life, and communicate receptive dysphasia (word the type of dysphasia and communicate
thought process effectively. meaning may be scrambled your client has, along effectively.
during the process of information with severity of it, and
by the patient’s brain). strengths and
weaknesses.
Glagow Coma Scale
Score:
To promote positive
Listen to the client carefully sense for leaning
13 | 5-22-22 about the thought process and
readiness to non-verbal
communication
11-12 | 5-23-22 To avoid overwhelming
Use simple words and short the client with numerous
sentences while communicating verbal stimuli
To make communication
Ask simple questions that can be process simple
answered by yes or no
To compensate for
Make use of gestures and sign verbal communication
language appropriate to the and for better
communication understanding
COLLABORATIVE:
Risk for Self care deficit SHORT TERM GOAL: INDEPENDENT: SHORT TERM GOAL:
Subjective:
related to impaired
mobility secondary to Within hospitalization, Assess the patient’s strength to The patient may only need Within hospitalization, the
neuronal dysfunction the patient will be able accomplish ADLs efficiently and help with some self-care patient will perform
Objective:
causing impaired function to perform activities of cautiously on a daily basis using a measures. FIM measures 18 activities of daily living as
of the extremities daily living as proper assessment tool, such as the self-care items related to independently as
independently as Functional Independence Measures eating, bathing, grooming, possible and recognize
possible, and (FIM). dressing, toileting, bladder when he or she needs
recognize when he or and bowel management, assistance
she needs assistance transfer, ambulation, and
stair climbing. LONG TERM GOAL:
LONG TERM GOAL:
Assess patient’s ability to perform To provide interventions After hospitalization, the
After hospitalization, self are based on the ability of the patient remain free form
the patient will remain patient the risk of having self
free form the risk of care deficit
having self care deficit Encourage the client in setting To promote the sense of well
realistic goals based on their ability being and satisfaction
and help them to achieve
independence care.
Meet all the activities of daily living To meet the self care needs
and self care like bathing, oral care, and improve hygiene
perineal care etc. at the bed side
DEPENDENT:
* Observe patient
closely for neurologic
adverse effects
following IV
administration. Have on
hand oxygen, atropine,
vasopressor, assisted
ventilation, seizure
precaution equipment
(mouth gag, nonmetal
airway, suction
apparatus).
* Monitor patients
receiving parenteral
potassium closely with
cardiac monitor.
Irregular heartbeat is
usually the earliest
clinical indication of
hyperkalemia.
Be alert for potassium
intoxication may result
from any therapeutic
dosage, and the patient
may be asymptomatic.
* The risk of
hyperkalemia with
potassium supplement
increases (1) in older
adults because of
decremental changes in
kidney function
associated with aging,
(2) when dietary intake
of potassium suddenly
increases, and (3) when
kidney function is
significantly
compromised.
DRUG NAME DOSAGE AND INDICATION CONTRAINDICATION MECHANISM OF NURSING
ADMINISTRATION ACTION RESPONSIBILITIES
BRAND NAME: .
Paracetamol is a mild Hypersensitivity to Paracetamol has a * Check the patient’s
300mg IV q4h PRN analgesic and paracetamol or any central analgesic effect serum potassium levels.
antipyretic, and is component of the that is mediated through Check for current
recommended for the product. activation of descending medications that include
GENERIC NAME: treatment of most serotonergic pathways. anticoagulants as these
painful and febrile Renal Insufficiency Debate exists about its should be used
Paracetamol conditions, for example, Anemia primary site of action, cautiously with
headache including which may be inhibition acetaminophen.
migraine, toothache, of prostaglandin (PG)
neuralgia, colds and synthesis or through an * Advise the patient that
influenza, sore throat, active metabolite Do not exceed
CLASSIFICATION: backache, rheumatic influencing cannabinoid 4gm/24hr. In adults and
pain and receptors. 75mg/kg/day in children.
CENTRAL NERVOUS dysmenorrhoea.
SYSTEM AGENT; * Do not take for >5days
NONNARCOTIC for pain in children, ten
ANALGESIC, days for pain in adults,
ANTIPYRETIC or more than three days
for fever in adults.
* Report paleness,
weakness, and
heartbeat skips
Report abdominal pain,
jaundice, dark urine,
itchiness, or clay-
colored stools.
Phenmacetin may
cause urine to become
dark brown or wine-
colored.
* Avoid alcohol.
* N-acetylcysteine – For
those with more severe
or complicated
paracetamol or
acetaminophen
overdose, parenteral
administration of N-
aetylcysteine, an amino
acid, is the drug of
choice and antidote to
counteract its toxic
effects.
DRUG NAME DOSAGE AND INDICATION CONTRAINDICATION MECHANISM OF NURSING
ADMINISTRATION ACTION RESPONSIBILITIES
BRAND NAME: .
1 gram (g) injected into Moderate-to-severe: Hypersensitivity to The bactericidal activity .
Invanz a vein or injected into a complicated intra- ertapenem; of ertapenem results * Lab tests: Perform
muscle once a day. abdominal infections, hypersensitivity to from the inhibition of cell C&S tests prior to
complicated skin and amide-type local wall synthesis and is therapy. Monitor
skin structure infections, anesthetics such as mediated through periodically liver and
GENERIC NAME community-acquired lidocaine; ertapenem binding to kidney function.
pneumonia, complicated hypersensitivity to penicillin binding
Ertapenem urinary tract infections meropenem or proteins (PBPs). In * Determine history of
(including imipenem; previous Escherichia coli, it has hypersensitivity
pyelonephritis), acute anaphylactic reaction to strong affinity toward reactions to other beta-
pelvic infections beta-lactams. PBPs 1a, 1b, 2, 3, 4 and lactams,
including postpartum 5 with preference for cephalosporins,
endomyometritis, septic PBPs 2 and 3. penicillins, or other
CLASSIFICATION: abortion, and Ertapenem is stable drugs. Discontinue drug
ANTIINFECTIVE; postsurgical gynecologic against hydrolysis by a and immediately report
BETA-LACTAM infections. Prophylaxis variety of beta- S&S of hypersensitivity.
ANTIBIOTIC of surgical site infection lactamases, including
following elective penicillinases, and * Report S&S of
colorectal surgery. cephalosporinases and superinfection or
extended spectrum pseudomembranous
beta-lactamases. colitis.
Ertapenem is
hydrolyzed by metallo- * Monitor for seizures
beta-lactamases. especially in older adults
and those with renal
insufficiency.