Module 2.

1 Nursing Process Focus: Care Patients Receiving ___Metoclopramide

NAME: RANADA, VALERIE ROSE O. BLOCK: A
DATE OF SUBMISSION: February 19, 2024
CYCLE AND SCHEDULE: Special Area

Classification of the Drug: GI stimulants, Miscellaneous antiemetics

Common Indications of the Drug: used to treat GI motility disorders, including gastroparesis in
diabetic patients. It’s also used to prevent chemotherapy-induced nausea and vomiting.
Common Brand Names: Metozolv ODT, Reglan

Assessment Possible Nursing Diagnoses

• Assess the patient’s condition before therapy • Ineffective health maintenance related to the
and regularly thereafter. underlying condition
• Assess for adverse reactions and drug • Risk for deficient fluid volume related to the
interactions. underlying condition
• Assess the patient’s and family’s knowledge • Deficient knowledge related to drug therapy
of drug therapy.
Planning: Patient Outcomes

• The patient will exhibit improved health as evidenced by decreased vomiting.

• The patient will maintain adequate fluid volume balance as evidenced by intake and output, vital
signs, and electrolyte evaluations.
• The patient and his family will demonstrate an understanding of drug therapy
Implementation
Interventions with Rationales Patient Education/Discharge Planning

• Monitor the patient for the drug’s effect. •

Take exactly as directed by your doctor. Do
• Administer the drug as directed to promote GI not increase or decrease the dosage without
effectiveness and relieve distress. his or her advice.
• Give IM injections deeply into a large muscle• Metoclopramide should only be taken by
mass. Rotate injection sites. adults and preferably for less than 12 weeks
• Don’t give antiemetics subcutaneously. duration.
• For prevention of motion sickness, tell the • Do not drink alcohol while you are taking
patient to take the drug 30 to 60 minutes before metoclopramide because it may make some
travel. side effects worse.
• Warn the patient to avoid alcohol and • Contact your doctor urgently if you develop
hazardous activities until the drug’s CNS thoughts about self-harm, an unexplained
effects are known. high fever, stiff muscles, problems thinking,
• Stop the drug 4 days before allergy skin tests. rapid or erratic heartbeat, sweat excessively,
develop new, unusual, or uncontrollable
muscle movements, or have any other
worrying side effects.
• Diabetics may need to adjust their insulin
dosage or administration time if
metoclopramide is being used to treat
diabetic gastric stasis.
• Do not take any other medications, including
those bought over the counter, without
checking with a doctor or pharmacist that
the new medication is compatible with
metoclopramide.
Evaluation of Outcome Criteria (Met, Partially met, Not met)

• Patient responds well to therapy.

• Patient maintains fluid volume.
• Patient and his family demonstrate an understanding of drug therapy.

Reference:

NPF Drug Study No. 1

Module 2.1 Nursing Process Focus: Care Patients Receiving ___ Midazolam
NAME: RANADA, VALERIE ROSE O. BLOCK: A
DATE OF SUBMISSION: February 19,2024
CYCLE AND SCHEDULE: Special Area

Classification of the Drug: Benzodiazepine

Common Indications of the Drug: Premedication before surgery or a procedure, Sedation for
procedures that require anesthesia or breathing assistance, Febrile seizure or epilepsy, Anxiety
Common Brand Names: Versed, Seizalam, Anquil, Benquil

Assessment Possible Nursing Diagnoses

 Assess the use of prescription,  Risk for injury related to impaired

nonprescription, and herbal remedies, sensory perception from anesthetic
especially those taken within the past 3 or sedative drugs.
days.
 Risk for ineffective breathing
Recognizing risk factors: pattern related to respiratory
 Assess the patient’s drug allergies and risk depression.
factors for complications of anesthesia and
surgery (cigarette smoking, obesity, limited  Deficient knowledge related to drug
exercise or activity, and chronic therapy
cardiovascular, respiratory, renal, or other
disease processes).
 Assess the patient’s vital signs, laboratory
data, and physical condition to establish
baseline measurements for monitoring
changes.

Planning: Patient Outcomes

• The risk of injury to the patient will be minimized.

• While under anesthesia, the patient will maintain adequate ventilation and breathing pattern.
• The patient and his family will verbalize an understanding of the purpose and intended effect of
drug therapy.

Implementation
Interventions with Rationales Patient Education/Discharge Planning

 Explain expectations for the preoperative • Talk with your doctor before you use
and postoperative phases of the recovery alcohol, marijuana or other forms of
period. cannabis, or prescription or OTC drugs
 Review postoperative recovery that may slow your actions.
requirements, such as deep breathing • If you experience slow, shallow, or
exercises, coughing, leg exercises, early troubled breathing, seek medical
ambulation, maintaining fluid balance, and attention immediately.
urine output. • If you’re taking midazolam with
 Monitor the patient’s vital signs, LOC, opioids, watch out for excessive
respiratory and cardiovascular status, and sleepiness, dizziness, or breathing
laboratory results, as indicated. difficulties.
 Monitor the patient’s response to pain • Avoid consuming grapefruit products
medication. for a short period.
• You may feel drowsy for 24 to 48 hours
after receiving midazolam. Refrain from
driving or engaging in hazardous
activities during this time to prevent
accidents or injuries.

Evaluation of Outcome Criteria (Met, Partially met, Not met)

• Patient remains free from major complications.

 • Patient maintains adequate ventilation.
• Patient and his family state an understanding of drug therapy

Reference:

NPF Drug Study No. 2

Module 2.1 Nursing Process Focus: Care Patients Receiving Morphine
NAME: RANADA, VALERIE ROSE O. BLOCK: A
DATE OF SUBMISSION: February 19,2024
CYCLE AND SCHEDULE: Special Area

Classification of the Drug: Opiate (narcotic) analgesics.

Common Indications of the Drug: used to treat moderate to severe pain
Common Brand Names: Morphine Sulfate ER, MS Contin, Roxanol, Statex, Morphine Sulfate IR

Assessment Possible Nursing Diagnoses

 Obtain a baseline assessment of the  Acute pain related to the underlying

patient’s pain and reassess frequently condition
to determine drug effectiveness.  Ineffective breathing pattern related to
depressive effect on respiratory system
When breathing easy is hard work:  Deficient knowledge related to drug
 Evaluate the patient’s respiratory status therapy
before each dose; watch for a
respiratory rate below the patient’s
baseline level and for restlessness,
which may be compensatory signs of
hypoxia. Respiratory depression may
last longer than the analgesic effect.
 Monitor the patient for other adverse
reactions.
 Monitor the patient for tolerance and
dependence. The first sign of tolerance
to opioids is usually a shortened
duration of effect
Planning: Patient Outcomes

• The patient will acknowledge a reduction in pain.

• Throughout therapy, the patient will maintain adequate breathing function.
• The patient and his family will verbalize an understanding of the
purpose and intended effect of drug therapy.
Implementation
Interventions with Rationales Patient Education/Discharge Planning

 Keep resuscitative equipment and a  Take the drug exactly as prescribed.

narcotic antagonist (naloxone) Call the prescriber if you don’t
available. experience the desired effect or if you
 Give the IV form of the drug by slow experience significant adverse
injection, preferably in diluted solution. reactions.
Rapid IV injection increases the risk of  Be careful when getting out of bed and
adverse effects. walking. Avoid hazardous activities
 Give IM or subcutaneous (subcut) until the drug’s effects are known.
injections cautiously to a patient with a  Avoid alcohol while taking opioid
decreased platelet count and to a patient agonists because it causes additive
who’s chilled, hypovolemic, or in central nervous system depression.
shock; decreased perfusion may lead to  To prevent constipation, increase fiber
drug accumulation and toxicity. Rotate in the diet and use a stool softener.
injection sites to avoid induration.  Breathe deeply, cough, and change
 Carefully note the strength of the position every 2 hours to avoid
solution when measuring a dose. Oral respiratory complications.
solutions of varying concentrations are  Report continued pain.
available.
 For maximum effectiveness, give the
drug on a regular dosage schedule
rather than as needed.
 Institute safety precautions.
 Encourage a postoperative patient to
 turn, cough, and breathe deeply every 2
hours to avoid atelectasis.
 If GI irritation occurs, give oral forms
of the drug with food

Evaluation of Outcome Criteria (Met, Partially met, Not met)

 Patient states that pain is relieved.
 Patient maintains adequate ventilation, as evidenced by normal respiratory rate and rhythm
and pink skin color.
 Patient and his family state an understanding of drug therapy

Reference:

NPF Drug Study No. 3

Module 2.1 Nursing Process Focus: Care Patients Receiving Nicardipine

NAME: RANADA, VALERIE ROSE O. BLOCK: A
DATE OF SUBMISSION: February 19,2024
CYCLE AND SCHEDULE: Special Area

Classification of the Drug: Calcium channel blockers

Common Indications of the Drug: used to treat Acute aortic syndromes/acute aortic dissection, Acute
ischemic stroke, BP management with reperfusion therapy, Intracerebral hemorrhage, acute, blood
pressure management, Subarachnoid hemorrhage, blood pressure management
Common Brand Names: Cardene, Cardene IV, Cardene SR

Assessment Possible Nursing Diagnoses

 Obtain a history of the patient’s  Decreased cardiac output related to

underlying condition before therapy, arrhythmias or myocardial depression
and reassess regularly thereafter.  Risk for injury related to adverse
 Assess the patient’s arrhythmia before reactions
therapy and regularly thereafter.  Deficient knowledge related to drug
 Monitor the ECG continuously when therapy
therapy starts and when the dosage is
adjusted.
 Monitor the patient’s vital signs
frequently, and assess for signs of
toxicity and adverse reactions..
 Be alert for adverse reactions and drug
interactions.
 Evaluate the patient’s and family’s
knowledge of drug therapy.
Planning: Patient Outcomes

• Cardiac output will improve as evidenced by stable blood pressure, cardiac monitoring, and
adequate urine output.
• Complications from adverse reactions will be diminished.
• The patient will verbalize an understanding of drug therapy.
Implementation
Interventions with Rationales Patient Education/Discharge Planning

• Don’t crush sustained-release tablets. • Inform your doctor if you are allergic to
• Be aware that sustained-released and nicardipine or any other drugs, foods, or
extended-release medications aren’t substances.
interchangeable. • If you have narrowing of the main artery
• Take safety precautions if adverse CNS from the heart (aorta) or a very narrow heart
reactions occur. valve (aortic stenosis), discuss it with your
• Notify the prescriber about adverse reactions. doctor.
• Know that IV forms are used for treating acute • Regularly check your blood pressure and
arrhythmias; cardiac monitoring is required heart rate as advised by your doctor.
during administration. • Consult your doctor before using over-the-
• If the patient’s systolic pressure is below 90 counter products that may raise blood
mm Hg or his heart rate drops below 60 pressure (such as cough or cold drugs, diet
beats/minute, withhold the dose and notify pills, and NSAIDs).
the prescriber, or follow the prescriber’s • Discuss alcohol consumption with your
ordered parameters for withholding the doctor.
medication.
Evaluation of Outcome Criteria (Met, Partially met, Not met)
• Patient maintains adequate cardiac output as evidenced by normal vital signs and adequate tissue
perfusion.
• Patient has no serious adverse reactions.
• Patient states the importance of compliance with therapy.
Reference:

NPF Drug Study 4

Module 2.1 Nursing Process Focus: Care Patients Receiving Norepinephrine
NAME: RANADA, VALERIE ROSE O. BLOCK: A
DATE OF SUBMISSION: February 19,2024
CYCLE AND SCHEDULE: Special Area

Classification of the Drug: Catecholamines and Vasopressors

Common Indications of the Drug: used to treat Acute Hypotensive States, Vasopressor Medication,
septic shock, pericardial tamponade, and hypotension after a myocardial infarction (MI)
Common Brand Names: Levophed, Levophed Bitartrate, Nortriptyline Hydrochloride
Assessment Possible Nursing Diagnoses

 Assess the patient’s condition before • Decreased cardiac output related to

therapy and regularly thereafter. underlying condition

Keeping an eye on the ECG • Ineffective peripheral tissue perfusion related

to underlying condition
 Continuously monitor
electrocardiogram (ECG), blood • Risk for ineffective renal perfusion related to
pressure, pulmonary artery wedge underlying condition
pressure, cardiac condition, and urine
output. • Risk for injury related to drug-induced
 Monitor electrolyte levels. adverse reactions
 Throughout therapy, assess for adverse
reactions, drug interactions, and • Acute pain related to headache
acidosis, which decrease effectiveness
of dopamine. • Deficient knowledge related to drug therapy
 After dopamine is stopped, watch
closely for a sudden drop in blood
pressure.
 Assess the patient’s and family’s
knowledge of drug therapy
Planning: Patient Outcomes

• The patient will maintain cardiac output.

• The patient will maintain effective tissue perfusion.
• The risk for injury will be minimized.
• The patient’s pain will decrease.
• The patient will demonstrate an understanding of the purpose and intended effect of therapy
Implementation
Interventions with Rationales Patient Education/Discharge Planning

• Watch for irritation and infiltration; • Seek immediate medical attention if

extravasation can cause an inflammatory you experience signs of an allergic
response. reaction (rash, hives, difficulty
• Don’t give catecholamines in the same IV line breathing, swelling).
as other drugs; be aware of incompatibilities. • Report any unusual heart-related
For example, dobutamine is in compatible with symptoms.
heparin, hydrocortisone sodium succinate, • Notify your nurse if you notice redness,
cefazolin, cefamandole, cephalothin, penicillin, pain, swelling, or blisters at the
and ethacrynate sodium. injection site
• Don’t mix dobutamine or dopamine with
sodium bicarbonate injection or phenytoin
because the drug is incompatible with alkaline
solutions.
• Change IV sites regularly to avoid phlebitis.
• Provide patient teaching
Evaluation of Outcome Criteria (Met, Partially met, Not met)
• Patient regains adequate cardiac output (evidenced by stable vital signs, normal urine output, and
clear mental status).
• Patient regains adequate cerebral, cardiopulmonary, and renal tissue perfusion.
• Patient doesn’t experience injury as a result of drug-induced adverse reactions.
• Patient’s headache is relieved with analgesic administration.
 • Patient and his family state an understanding of drug therapy
Reference:

NPF Drug Study