XII. Drug Study

Mechanism of

Action

Indication Contraindication Adverse

Reactions

Nursing Responsibilities Nursing Implication

Generic Name:

Ranitidine

Brand name:

Zantac

Classification:

Gastointestinal

agent;

Antisecretory

(H2-receptor

antagonist)

Source:

◙ Nursing 2007

Drug Handbook

27th Edition,

Lippincot Williams

& Wilkins

Dosage:

50mg

Frequency:

Q8°

Route:

IVTT while

on NPO

Competitive

inhibition of

histamine at H2-

receptors of the

gastric parietal

cells, which inhibits

gastric acid

secretion, gastric

volume, and

hydrogen ion

concentration are

reduced. Does not

affect pepsin

secretion,

pentagastrin-

stimulated intrinsic

factor secretion, or

serum gastrin.

Used to

prevent ulcer

while patient is

on NPO.

Hypersensitivity to

ranitidine or any

component of the

formulation.

♣ Constipation

♣ Diarrhea

♣ Fatigue

♣ Headache

♣ Insomnia

♣ Muscle pain

♣ Nausea

♣ Vomiting

♣ Agitation

♣ Anemia

♣ Confusion

♣ Depression

♣ Easy bruising

or bleeding

C - Gastointestinal agent;

Antisecretory (H2-receptor

antagonist)

H - Reduced amount of acid in

the stomach that may result to

prevented ulcer incidence.

E - Every 8 hours while patient is

on NPO.

C - Instruct client to report any

adverse reaction to the

physician or nurse. Tell patient

that antacids may decrease the

absorption of ranitidine.

K - Ranitidine can interfere with

the metabolism of alcohol.

Patients taking ranitidine who

drink alcohol may have

elevated blood alcohol levels.

◙ Inform patient that the

medication may cause

drowsiness, dizziness,

or fatigue (use caution

when driving or

engaging in tasks

requiring alertness).

◙ Instruct patient to

avoid taking any new

medication during

therapy without

consulting prescriber.

◙ Instruct patient to

avoid alcohol and

follow diet as

prescriber recommends.

Mechanism of Indication Contraindication Adverse Nursing Responsibilities Nursing Implication

Action Reactions

Generic Name:

Tramadol

Brand name:

Ultram

Classification:

Analgesic

Source:

◙ Nursing 2007

Drug Handbook

27th Edition,

Lippincot

Williams &

Wilkins

Dosage:

50mg

Frequency:

Q6°

Route:

IVTT x 6

doses

Binds to -opiate

receptors in the

CNS causing

inhibition of

ascending pain

pathways, altering

the perception of

and response to

pain; also inhibits

the reuptake of

norepinephrine and

serotonin, which

also modifies the

ascending pain

pathway.

Management

of pain in the

operation site.

Hypersensitivity to

tramadol, opioids, or

any component of the

formulation; opioid-

dependent patients;

acute intoxication

with alcohol,

hypnotics, centrally-

acting analgesics,

opioids, or

psychotropic drugs

♣ Dizziness

♣ Nausea

♣ Drowsiness

♣ Dry mouth

♣ Constipation

♣ Headache

♣ Sweating

♣ V omiting

♣ Itching

♣ Rash

♣ Visual

disturbances

♣ Vertigo

C - Analgesic

H - Relief of pain in the

operation site.

E - Every 6 hours x 6 doses.

May be taken with or without

food.

C - Instruct client to report any

adverse reaction to the

physician or nurse. Tell

patient that tolerance or drug

dependence may result from

extended use (withdrawal

symptoms have been

reported); abrupt

discontinuation should be

avoided.

K - You should not take

Ultram if you have ever been

addicted to drugs or alcohol.

Should be used only with

extreme caution in patients

receiving MAO inhibitors

◙ Tell patient that

driving or operating

machinery should be

avoided until the effect

of drug wears off.

◙ Instruct patient to

repot cravings to

physician immediately.

◙ Inform client that

medication may cause

CNS depression and/or

respiratory depression,

particularly when

combined with other

CNS depressants

Mechanism of

Action

Indication Contraindication Adverse

Reactions

Nursing Responsibilities Nursing Implication

Generic Name:

Ketorolac

Brand name:

Toradol

Classification:

Nonsteroidal

Anti-

Inflammatory

Drugs (NSAIDs)

Source:

◙ Nursing 2007

Drug Handbook

27th Edition,

Lippincot

Williams &

Wilkins

Dosage:

30mg

Frequency:

Q6°

Route:

IVTT x 6

doses

Inhibits

prostaglandin

synthesis by

decreasing the

activity of the

enzyme,

cyclooxygenase,

which results in

decreased

formation of

prostaglandin

precursors,

chemicals that cells

of the immune

system make that

cause the redness,

fever, and pain of

inflammation and

that also are

believed to be

important in the

production of non-

inflammatory pain.

Used for

treating

inflammation

and pain in

the operation

site.

Hypersensitivity to

ketorolac, aspirin, other

NSAIDs, or any component

of the formulation; patients

who have developed nasal

polyps, angioedema, or

bronchospastic reactions to

other NSAIDs; active or

history of peptic ulcer

disease; recent or history of

GI bleeding or perforation;

patients with advanced renal

disease or risk of renal

failure; labor and delivery;

nursing mothers; prophylaxis

before major surgery;

suspected or confirmed

cerebrovascular bleeding;

hemorrhagic diathesis;

concurrent ASA or other

NSAIDs; epidural or

intrathecal administration;

concomitant probenecid;

pregnancy (3rd trimester

♣ Rash

♣ Ringing in

the ears

♣ Headaches

♣ Dizziness

♣ Drowsiness

♣ Abdominal

pain

♣ Nausea

♣ Diarrhea

♣ Constipation

♣ Heartburn

♣ Fluid

retention

C - Nonsteroidal Anti-

Inflammatory Drugs

(NSAIDs)

H - Pain as well as

inflammation and its

signs and symptoms -

redness, swelling, fever,

and pain are reduced.

E - Every 6 hours x 6

doses.

C - Instruct client to report

any adverse reaction to

the physician or nurse.

Tell patient that adverse

reactions can occur with

overuse.

K - Do not drink alcohol

while taking ketorolac.

Alcohol can increase the

risk of stomach bleeding

caused by ketorolac.

◙ Instruct client to avoid

alcohol and maintain

adequate hydration (2-3

L/day of fluids) unless

instructed to restrict fluid

intake.

◙ Monitor for signs of

pain relief, such as an

increased appetite and

activity

◙ Instruct client to avoid

taking ketorolac with

aspirin or other NSAIDs

such as ibuprofen

(Motrin, Advil),

naproxen (Aleve,

Naprosyn), piroxicam

(Feldene), etc.

Mechanism of

Action

Indication Contraindication Adverse

Reactions

Nursing Responsibilities Nursing Implication

Generic Name:

Ampicillin

Brand name:

Omnipen,

Polycillin,

Principen

Classification:

Antibiotic

(penicillins)

Source:

◙ Nursing 2007

Drug Handbook

27th Edition,

Lippincot Williams

& Wilkins

Dosage:

500mg

Frequency:

Q6°

Route:

IVTT

Inhibits bacterial cell

wall synthesis by

binding to one or

more of the penicillin

binding proteins

(PBPs); which in

turn inhibits the final

transpeptidation step

of peptidoglycan

synthesis in bacterial

cell walls, thus

inhibiting cell wall

biosynthesis.

Bacteria eventually

lyse due to ongoing

activity of cell wall

autolytic enzymes

(autolysins and

murein hydrolases)

while cell wall

assembly is arrested.

Used for treating

bacterial infection.

Hypersensitivity

to ampicillin, any

component of the

formulation, or

other penicillins

♣ Nausea

♣ Vomiting

♣ Loss of

appetite

♣ Diarrhea

♣ Abdominal

pain

♣ Rash

♣ Itching

♣ Headache

♣ Confusion

♣ Dizziness

C - Antibiotic

H - Pain as well as

inflammation and its

signs and symptoms -

redness, swelling, fever,

and pain are reduced.

E - Every 6 hours

C - Instruct client to

report any adverse

reaction to the physician

or nurse. Tell patient

that Antibiotic

medicines can cause

diarrhea, which may be

a sign of a new

infection.

K - Do not take the

medication in larger

amounts, or take it for

longer than recommended

by your doctor.

◙ Tell patient that

medication may cause

nausea or vomiting

(small, frequent

meals, frequent

mouth care, sucking

lozenges, or chewing

gum may help); or

diarrhea (buttermilk,

boiled milk, or yogurt

may help).

◙ Instruct client to

maintain adequate

hydration (2-3 L/day

of fluids) unless

instructed to restrict

fluid intake.

Mechanism of Indication Contraindication Adverse Nursing Nursing

Action Reactions Responsibilities Implication

Generic Name:

Paracetamol

Classification:

Analgesic and

Antipyretic

Source:

◙ Nursing 2007

Drug Handbook

27th Edition,

Lippincot Williams

& Wilkins

Dosage:

500mg

Frequency:

PRN

Route:

IVTT

Reduces fever

by acting on the

hypothalamus

to cause

vasodilatation

& sweating.

Used for the relief of

fever, headaches, and

other and pains

regarding surgical

wound.

Contraindicated with

allergy to acetaminophen

or any component.

Use cautiously with

impaired hepatic

function, chronis

alcoholism, and

pregnancy lactation.

♣ Chest pain

♣ Dyspnea

♣ Rash

♣ Fever

♣ Acute

kidney

failure

♣ Jaundice

♣ Acute

kidney

failure

♣ Hepatic

toxicity and

failure

C - Analgesic and

Antipyretic

H - Relief of fever,

headaches, and other

minor aches and pains.

E - as necessary or when

temperature is more

than 37.80C

C- Instruct client to report

any adverse reaction

like allergies to the

physician or nurse.

Warn patient that high

doses or unsupervised

long –term use can

cause liver damage.

K - Do not exceed the

recommended dosage.

Not to use for marked

fever (temperature

higher than 39.50C).

Fever persisting longer

than 3 days.

◙ Warn patient that

acute overdoses

(above 1000 mg per

single dose and

above 4000 mg per

day for adults,

above 2000 mg per

day if drinking

alcohol) of

paracetamol can

cause potentially

fatal liver damage

and, in rare

individuals, a

normal dose can do

the same; the risk is

heightened by

alcohol .

XIII. Health Teaching Plan

Medication Exercise Treatment Hygiene Outpatient Diet Ranitidine

C - Gastointestinal agent;

Antisecretory (H2-

receptor antagonist)

H - Reduced amount of

acid in the stomach that

may result to prevented

ulcer incidence.

E - Every 8 hours while

patient is on NPO.

C - Instruct client to report

any adverse reaction to

the physician or nurse.

Tell patient that antacids

may decrease the

absorption of ranitidine.

K - Ranitidine can

interfere with the

metabolism of alcohol.

Patients taking ranitidine

who drink alcohol may

have elevated blood

alcohol levels.

•The extended period of

bed rest after a

hysterectomy can weaken

the muscles in the lower

back and stomach.

Following exercises

should be held for five to

10 seconds and repeated

10 times on a daily basis.

•The chin tuck can be

performed while sitting

in a chair or on the side

of your bed. Keep your

arms relaxed and by your

side. Look straight ahead

and pull your chin as

though you are

attempting to create a

double chin.

•The upper back and

shoulder stretch is done

while lying in bed or on a

•Pain relievers

prescribed by the

doctor

•Indwelling

catheter

•Make sure you have enough

sanitary pads for vaginal

bleeding and discharge. You

may have some discharge

and bloody drainage for

several days after your

hysterectomy.

•Keep sanitary environment

one that would not allow

microorganisms to multiply

and cause infection.

•Provide catheter care: Keep

the catheter coiled by the

client’s side to prevent the

tubing to hang in a loop that

allow the urine to sit in the

tubing; maintain external

cleanliness around the

catheter. Keep the drainage

bag off the floor to prevent

microorganisms from

moving up from outside the

•Instruct patient to have follow

up check up consultation and

regular check ups.

•Instruct patient to follow good

compliance to medication

•Instruct patient to limit her

movement at the beginning or

if her doctor authorizes it take

some short walks to keep her

blood circulating and prevent

blood clots from forming in

her legs.

•Avoid all lifting after the

surgery and during the post

hysterectomy period (ask for

assistance).

•Instruct patient avoid

climbing stairs or driving a car

during this recuperation period

(ask family and friends for

•Try eating smaller meals than

normal and have healthy

snacks in between .Eat healthy,

because the patient’s body

needs nutrients to heal (even if

she doesn’t feel like it). Eat

cold-water fish as well as

turkey, chicken, organic bread,

soups, salads, vegetables and

broths.

• Take the best daily multiple

premium vitamins recommend

and vitamin C as well. These

vitamins will help improve

sleep, will make less

susceptibility to colds, flu’s

and viruses less, will increase

energy levels and provide the

patient with sharper and clearer

mind.

Tramadol

C - Analgesic

H - Relief of pain in the

operation site.

E - Every 6 hours x 6

doses. May be taken with

or without food.

C - Instruct client to report

any adverse reaction to

the physician or nurse.

Tell patient that tolerance

or drug dependence may

result from extended use

(withdrawal symptoms

have been reported);

abrupt discontinuation

should be avoided.

K - You should not take

Ultram if you have ever

been addicted to drugs or

alcohol. Should be used

only with extreme caution

in patients receiving MAO

inhibitors

mat. Bring your hands

over your head and rest

with your palms up.

Press your arms back into

the bed.

•The pelvic tilt can also

be achieved in a lying-

down position. You can

place your hands on your

stomach or put one hand

under your lower back

and keep the remaining

hand on your stomach.

Lightly tighten your

buttocks and stomach

muscles to pull your

lower back down. You

will notice your pelvis or

hip bones roll backward.

bag and into the catheter;

change catheter every 2

weeks to prevent infection.

•Maintain good oral hygiene

•Provide good perineal care.

Change off perineal pad at

least twice a day. Wiping

from front to back.

help).

•Tell patient to avoid drinking

alcoholic beverages for a few

weeks (especially while taking

medication).

•Instruct patient to avoid

aspirin and dairy foods during

the post hysterectomy time

because dairy products will not

help you with constipation.

The pain medicine you will be

taking during the post

hysterectomy time will tend to

make you constipated.

• Instruct patient to change the

dressing over her incision once

a day or sooner if it gets dirty

or wet.

• Keep the wound area

clean by washing it with

mild soap and water.

• Instruct patient to drink

filtered water. And since most

of life is "consumption and

elimination", the patient needs

to consume 8-10 glasses of

water daily to adequately

"flush" her system of toxins

which would otherwise build

up and cause some level of

discomfort or illness.

• Taking omega-3 and fatty

acids should be taken daily

because it has shown that it

reduces inflammation, reduces

the risk of strokes and heart

attacks, help lower cholesterol

and thin the blood.

Ketorolac

C - Nonsteroidal Anti-

Inflammatory Drugs

(NSAIDs)

H - Pain as well as

inflammation and its

signs and symptoms -

redness, swelling, fever,

and pain are reduced.

E - Every 6 hours x 6

doses.

C - Instruct client to report

any adverse reaction to

the physician or nurse.

Tell patient that adverse

reactions can occur with

overuse.

K - Do not drink alcohol

while taking ketorolac.

Alcohol can increase the

risk of stomach bleeding

caused by ketorolac

•You will have to get on

your hands and knees to

carry out the stomach-

strengthening movement.

Start by taking a deep

breath. As you slowly

exhale, keep the rest of

your body still while

tightening your stomach

muscles.

•Exercise as soon as the

doctor authorizes it.

Moderate exercise will

improve immune

defenses and antioxidant

levels.

•Tell patient that she may

remove her wound dressings

(bandages) and take showers if

sutures (stitches), staples, or

glue were used to close her

skin. Instruct her not to soak in

a bathtub or hot tub, or go

swimming, until her doctor

tells her it is okay.

•If tape strips (Steri-Strips)

were used to close her incision,

cover them with plastic wrap

before showering for the first

week. Do not try to wash off

the Steri-Strips or glue. They

should fall off in about a week.

If they are still there after 10

days, she can remove them,

unless her doctor tells her not

to.

Ampicillin

C - Antibiotic

H - Pain as well as

inflammation and its

signs and symptoms -

redness, swelling, fever,

and pain are reduced.

E - Every 6 hours

C - Instruct client to report

any adverse reaction to

the physician or nurse.

Tell patient that

Antibiotic medicines can

cause diarrhea, which

may be a sign of a new

infection.

K - Do not take the

medication in larger

amounts, or take it for

longer than recommended

by your doctor.

Paracetamol

C - Analgesic and

Antipyretic

H - Relief of fever,

headaches, and other

minor aches and pains.

E - as necessary or when

temperature is more than

37.80C

C- Instruct client to report

any adverse reaction like

allergies to the physician

or nurse. Warn patient

that high doses or

unsupervised long –term

use can cause liver

damage.

K - Do not exceed the

recommended dosage.

Not to use for marked

fever (temperature higher

than 39.50C). Fever

persisting longer than 3

days.