medical managemen hodgskin_s

8/13/2019 Medical Managemen Hodgskin_s

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Medicalmanagement


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Date/Time Doctors Order Rationale

Dec 06, 2013 Please admit to ICU under the service of

Dr. Gonzales

Secure Consent for admission andmanagement

TPR q shift and record

Diet: DAT

IVF, PNSS 1L x 120cc/hr

For Legality &Documentation

To start hydration

Laboratory:CBC w/ Platelet count, Na, K, CREA,BUN, Hgt, LDH

Cranical CT SCAN w/ contrast ECG

To determine bloodcoagulopathies, Electrolyteimbalance, and Renalfunction

To aid in diagnosing anddetermine possible brainmets

Medications:Neuquinon 1 TAB OD

Diazepam 5mg IV PRNDolcet tab, 1 TAB TID PRNPlasil 1 amp q 8 PRN

Alopurinol 100mg 1 TAB 2x/day

Cardiovascular drug

For frank seizuresFor pain reliefAnti-emeticTo lower uric acid


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Shift procedure to hydrocortisone 100mgIV q 8

5:33pm Start Keppra 500mg tab ODFor cranial MRI w/ gadolinium contrast

Continue present management

AP Updated

Anti-convulsant

7:15pm Cetrizine 10mg 1 TAB now

Continue Meds

Discontinue Alopurinol

for itchiness & allergy


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DIAGNOSTICEXAMS


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Complete Blood Count 12/06/13 1:31pm

Test Name ResultReference

ValuesInterpretation Significance

Hemoglobin 107 gm/L 110-140

Hematocrit0.36 gm/L 0.37-0.47

Indicatesanemia

RBC 4.51 x10^12/1 4-5.5

WBC 7.78 x10^9/1 5.0-10.0

Segmenters0.86 x10^9/1 0.50-0.70

Increase withmalignantdisease

Lymphocytes

0.09 x10^9/1 0.20-0.40

Decrease in

use ofcorticosteroid

Monocytes 0.04 x10^9/1 0-0.05

Basophiles 0.01 x10^9/1 0-0.01

MCV 80.2 n 80-98

MCH23.7pg 26-32

IndicateshypochromicRBCs

MCHC293 g/L 320-360

Indicateshypochromicanemia

Platelet Count Increase in


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DRUG STUDY


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DRUG MECHANISM OFACTION

INDICATION CONTRAINDICATION SIDEEFFECTS

NURSINGINTERVENTION

GENERIC NAME:Ubidecarenone

BRAND NAME:Nequinon

CLASSIFICATION:CardiovascularDrugs

DOSAGE:1 TAB OD

ROUTE:Oral

Inhibits lipidperoxidation by

preventing theproduction of lipidperoxyl radicals

Heart FailureAngina pectoris

Hypersensitivity NauseaGastric

discomforts

Take aftermeals

Instruct patientto report forworseningsymptoms.


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NURSINGINTERVENTION

GENERIC NAME:Diazepam

BRAND NAME:Anxiol

CLASSIFICATION:Benzodiazepines

DOSAGE:5mg IV PRN

ROUTE:IV

Enhances theeffect of the

neurotransmitterGABA by bindingto thebenzodiazepinesite on the GABAleading to CNSdepression

AnxietyPanic

InsommiaSeizures

Respiratorydepression

Sedation Assess patientfor respiratory

depression


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NURSINGINTERVENTION

GENERIC NAME:Tramadol HCl

BRAND NAME:Dolcet

CLASSIFICATION:Analgesics

DOSAGE:1 Tab TID PRN

ROUTE:Oral

Binds to mu opioidreceptors and

inhibits thereuptake ofnorepinephrineand serotonincauses manyeffects similar tothe opioids.

Relief ofmoderate to

moderatelysevere pain

Contraindicated withallergy to tramadol or

opioids

SedationDizziness

HypotensionBradycardia

Explain to thepatient that they

may feel dizzy

Report forseveringsymptoms


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NURSINGINTERVENTION

GENERIC NAME:Metoclopromide

BRAND NAME:Plasil

CLASSIFICATION:Anti-emetics

DOSAGE:1 amp q 8 PRN

ROUTE:

IV

Stimulates motilityof upper GI tract

without stimulatinggastric, biliary orpancreaticsecretions. Andincrease loweresophagealsphincter pressure

Vomitting Hypersensitivity RestlessnessDrowsiness

Fatigue

Monitor BPduring IV

administration

Monitorextrapyramidalreactions.


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NURSINGINTERVENTION

GENERIC NAME:Allopurinol

BRAND NAME:Zyloprim

CLASSIFICATION:

DOSAGE:100mg TAB, BID

ROUTE:

Oral

Prevents theproduction of uric

acid by blockingthe activity of theenzyme thatconvert purines touric acid

Management ofpatients with

leukemia,lymphoma andmalignancies whoare receivingcancer therapywhich causeselevations ofserum and urinaryuric acid levels

Drug allergy Skin rash anditching

nausea,diarrhea

Administer drug

after meals

Promoteincreased fluidintake

Check urinealkalinity


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NURSINGINTERVENTION

GENERIC NAME:Prednisone

BRAND NAME:

CLASSIFICATION:NSAIDs

DOSAGE:10mg 1 TAB BID

ROUTE:Oral

Prevents therelease of

substances in thebody that causeinflammation andsuppresses theimmune system.

Allergic disordersSkin conditions

Ulcerative colitisArthritisLuposPsoriasisBreathingdisorders

Drug allergyFungal infection

preset

Increasedappetite

Gradual weightgain

Insomia

Take drug withfood

Do not crushchew or break adelayed releasetablet. Swallowit whole.


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NURSINGINTERVENTION

GENERIC NAME:Omeprazole

BRAND NAME:Prilosec

CLASSIFICATION:Protonn pumpinhibitors

DOSAGE:40mg 1 TAB OD

ROUTE:Oral

Block theproduction of acid

by the stomach

GERDAcid induced

inflammationPrevention ofUGIB

Allergies to PPIs Stomach painNausea

vomitingDiarrhea

Administerbefore meals

Report ifworsening ofsymptoms


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NURSINGINTERVENTION

GENERIC NAME:Ascorbic Acid

BRAND NAME:Cecon

CLASSIFICATION:Vitamin

DOSAGE:1 TAB OD

ROUTE:Oral

Water solublevitamin essential

for synthesis admaintenance ofcollagen andintercellularground substanceof body tissuecells, bloodvessels, cartilage,bones teeth skinand tendons

Prophylaxis andtreatment of

scurvy

Use of sodiumascorbate in patients

on sodium restriction

Patients receivingdigitalis

Yellow acidicurine

Take drug withmeal


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NURSINGINTERVENTION

GENERIC NAME:FeSO4

BRAND NAME:

CLASSIFICATION:Iron Prep

DOSAGE:325mg 1 TAB TID

ROUTE:Oral

Elevates serumiron concentration

which then helpsto form high ortrapped inreticuloendothelialcells for storageand eventualconversion to ausable form of iron

Prevention of IDADietary

supplement ofIrom

HypersensitivitySevere hypotension

ConstipationDizziness

Hypotension

Take drug withmeals or with

orange juice

Increase oralfluid intake


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NURSINGINTERVENTION

GENERIC NAME:Leviteracetam

BRAND NAME:Keppra

CLASSIFICATION:Anticonvulsant

DOSAGE:500mg TAB OD

ROUTE:OP

Provides an anti-epileptic effect

Used to treatpartial onset of

seizures

Treats tonic-clonic

Hypersensitivity SomnolenceHostility

Nervousness

Give drug withfood

Establish safetyprecautions


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NURSINGINTERVENTION

GENERIC NAME:Cetrizine HCl

BRAND NAME:Zyrtec

CLASSIFICATION:Anti-histamine

DOSAGE:10mg 1 TAB

ROUTE:OP

Inhibit histaminerelease andeosinophilchemotaxis duringinflammationleading to reducedswelling anddecreasedinflammatoryresponse

Allergies &pruritus

Hypersensitivity DrowsinessSedationDizziness

Take this drugwithout regardto meals

Explain topatient, thatdrowsiness mayoccur.

Limit activityafter taking thedrug

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