Nursing Path

CARING is the essence of NURSING. -Jean Watson

Nursing Path

Knowing is not enough, we must APPLY. Willing is not enough, we must DO. -Bruce Lee

Nursing Path

Treat the patient as a whole, not just the hole in the patient.

Nursing Path

Success is not final. Failure is not fatal. It is the courage to continue that counts. -Winston Churchill

Nursing Path

A problem is a chance for you to do your best. -Duke Ellington


Drug Name
Generic Name: aminophylline (theophylline ethylenediamine)
Brand Name: Truphylline
Classification: Bronchodilator, Xanthine
Pregnancy Category C

  • Individualize dosage: Base adjustments on clinical responses; monitor serum theophylline levels; maintain therapeutic range of 10–20 mcg/mL; base dosage on lean body mass; 127 mg aminophylline dihydrate = 100 mg theophylline anhydrous.

  • Acute symptoms requiring rapid theophyllinization in patients not receiving theophylline: An initial loading dose is required, as indicated below:
 Patient Group Loading  Followed by  Maintenance
 Young adult smokers 7.6 mg/kg 3.8 mg/kg q 4 hr × 3 doses 3.8 mg/kg q 6 hr
 Adult nonsmokers who are otherwise healthy 7.6 mg/kg 3.8 mg/kg q 6 hr × 2 doses 3.8 mg/kg q 8 hr
*Expressed as aminophylline
  • Long-term therapy: Usual range is 600–1,600 mg/day PO in three to four divided doses.

  • 500 mg q 6–8 hr by rectal suppository or retention enema.

Children are very sensitive to CNS stimulant action of theophylline; use caution in younger children unable to complain of minor side effects.

  • < 6 mo: Not recommended.
  • < 6 yr: Use of timed-release products not recommended.

  • Acute therapy: For acute symptoms requiring rapid theophyllinization in patients not receiving theophylline, a loading dose is required. Recommendations are as follows:
 Patient Group  Loading  Followed by  Maintenance
 Children 6 mo–9 yr 7.6 mg/kg 5.1 mg/kg q 4 hr × 3 doses 5.1 mg/kg q 6 hr
 Children 9–16 yr 7.6 mg/kg 3.8 mg/kg q 4 hr × 3 doses 3.8 mg/kg q 6 hr
  • Long-term therapy: 20.3 mg/kg or 508 mg/day (immediate-release) or 15.2 mg/kg or 508 mg/day (extended-release) PO; slow clinical adjustment of the oral preparations is preferred; monitor clinical response and serum theophylline levels. In the absence of serum levels, adjust up to the maximum dosage shown below, providing the dosage is tolerated.
 Age Maximum Daily Dose
 < 9 yr 30.4 mg/kg/day
 9–12 yr 25.3 mg/kg/day
 12–16 yr 22.8 mg/kg/day
 > 16 yr 16.5 mg/kg/day or 1,100 mg, whichever is less
*Expressed as aminophylline
Therapeutic actions
  • Relaxes bronchial smooth muscle, causing bronchodilation and increasing vital capacity, which has been impaired by bronchospasm and air trapping; in higher concentrations, it also inhibits the release of slow-reacting substance of anaphylaxis (SRS-A) and histamine.
  • Symptomatic relief or prevention of bronchial asthma and reversible bronchospasm associated with chronic bronchitis and emphysema
  • Unlabeled uses: Respiratory stimulant in Cheyne-Stokes respiration; treatment of apnea and bradycardia in premature babies
Adverse effects
  • Serum theophylline levels < 20 mcg/mL: Adverse effects uncommon
  • Serum theophylline levels > 20–25 mcg/mL: Nausea, vomiting, diarrhea, headache, insomnia, irritability (75% of patients)
  • Serum theophylline levels > 30–35 mcg/mL: Hyperglycemia, hypotension, cardiac arrhythmias, seizures, tachycardia (> 10 mcg/mL in premature newborns); brain damage
  • CNS: Irritability (especially children); restlessness, dizziness, muscle twitching, seizures, severe depression, stammering speech; abnormal behavior characterized by withdrawal, mutism, and unresponsiveness alternating with hyperactive periods
  • CV: Palpitations, sinus tachycardia, ventricular tachycardia, life-threatening ventricular arrhythmias, circulatory failure
  • GI: Loss of appetite, hematemesis, epigastric pain, gastroesophageal reflux during sleep, increased AST
  • GU: Proteinuria, increased excretion of renal tubular cells and RBCs; diuresis (dehydration), urinary retention in men with prostate enlargement
  • Respiratory: Tachypnea, respiratory arrest
  • Other: Fever, flushing, hyperglycemia, SIADH, rash
  • Contraindicated with hypersensitivity to any xanthine or to ethylenediamine, peptic ulcer, active gastritis; rectal or colonic irritation or infection (use rectal preparations).
  • Use cautiously with cardiac arrhythmias, acute myocardial injury, CHF, cor pulmonale, severe hypertension, severe hypoxemia, renal or hepatic disease, hyperthyroidism, alcoholism, labor, lactation, pregnancy.
Nursing considerations
  • History: Hypersensitivity to any xanthine or to ethylenediamine, peptic ulcer, active gastritis, cardiac arrhythmias, acute myocardial injury, CHF, cor pulmonale, severe hypertension, severe hypoxemia, renal or hepatic disease, hyperthyroidism, alcoholism, labor, lactation, rectal or colonic irritation or infection (aminophylline rectal preparations)
  • Physical: Bowel sounds, normal output; P, auscultation, BP, perfusion, ECG; R, adventitious sounds; frequency of urination, voiding, normal output pattern, urinalysis, LFTs, renal function tests; liver palpation; thyroid function tests; skin color, texture, lesions; reflexes, bilateral grip strength, affect, EEG
  • Administer to pregnant patients only when clearly needed—neonatal tachycardia, jitteriness, and withdrawal apnea observed when mothers received xanthines up until delivery.
  • Caution patient not to chew or crush enteric-coated timed-release forms.
  • Give immediate-release, liquid dosage forms with food if GI effects occur.
  • Do not give timed-release forms with food; these should be given on an empty stomach 1 hr before or 2 hr after meals.
  • Maintain adequate hydration.
  • Monitor results of serum theophylline levels carefully, and arrange for reduced dosage if serum levels exceed therapeutic range of 10–20 mcg/mL.
  • Take serum samples to determine peak theophylline concentration drawn 15–30 min after an IV loading dose.
  • Monitor for clinical signs of adverse effects, particularly if serum theophylline levels are not available.
  • Ensure that diazepam is readily available to treat seizures.
Teaching points
  • Take this drug exactly as prescribed; if a timed-release product is prescribed, take this drug on an empty stomach, 1 hour before or 2 hours after meals.
  • Do not to chew or crush timed-release preparations.
  • Administer rectal solution or suppositories after emptying the rectum.
  • It may be necessary to take this drug around-the-clock for adequate control of asthma attacks.
  • Avoid excessive intake of coffee, tea, cocoa, cola beverages, and chocolate.
  • Smoking cigarettes or other tobacco products impacts the drug’s effectiveness. Try not to smoke. Notify your health care provider if smoking habits change while taking this drug.
  • Frequent blood tests may be necessary to monitor the effect of this drug and to ensure safe and effective dosage; keep all appointments for blood tests and other monitoring.
  • You may experience these side effects: Nausea, loss of appetite (taking this drug with food may help if taking the immediate-release or liquid dosage forms); difficulty sleeping, depression, emotional lability (reversible).
  • Report nausea, vomiting, severe GI pain, restlessness, seizures, irregular heartbeat.

amikacin sulfate

Drug Name
Generic Name: amikacin sulfate Brand Name: Amikin Classifications: Anti-infective; Aminoglycoside Pregnancy Category: C
  • 250 mg/mL, 50 mg/mL injection
  • Semisynthetic derivative of kanamycin with broad range of antimicrobial activity that includes many strains resistant to other aminoglycosides.
  • Pharmacologic properties are essentially the same as those of gentamicin.
  • Appears to inhibit protein synthesis in bacterial cell and is usually bactericidal.
Therapeutic Effects
  • Effective against a wide variety of gram-negative bacteria including Escherichia coli, Enterobacter, Klebsiella pneumoniae, most strains of Pseudomonas aeruginosa, and many strains of Proteus species, Serratia, Providencia stuartii, Citrobacter freundii, Acinetobacter. Also effective against penicillinase- and non-penicillinase-producing Staphylococcus species, and against Mycobacterium tuberculosis and atypical mycobacteria.
  • Primarily for short-term treatment of serious infections of respiratory tract, bones, joints, skin, and soft tissue, CNS (including meningitis), peritonitis burns, recurrent urinary tract infections (UTIs).
  • Unlabeled Uses: Intrathecal or intraventricular administration, in conjunction with IM or IV dosage.
  • History of hypersensitivity or toxic reaction with an aminoglycoside antibiotic.
  • Safety during pregnancy (category C), lactation, neonates and infants, or use period exceeding 14 years old is not established.
Cautious Use
  • Impaired renal function; eighth cranial (auditory) nerve impairment; preexisting vertigo or dizziness, tinnitus, or dehydration; fever; older adults, premature infants, neonates and infants; myasthenia gravis; parkinsonism; hypocalcemia.
Route & Dosage
Moderate to Severe Infections
  • Adult: IV/IM 5–7.5 mg/kg loading dose, then 7.5 mg/kg q12h
  • Child: IV/IM 5–7.5 mg/kg loading dose, then 5 mg/kg q8h or 7.5 mg/kg q12h
  • Neonate: IV/IM 10 mg/kg loading dose, then 7.5 mg/kg q12–24h
Uncomplicated UTI
  • Adult: IV/IM 250 mg q12h
  • Use the 250 mg/mL vials for IM injection. Calculate the required dose and withdraw the equivalent number of mLs from the vial.
  • Give deep IM into a large muscle.
  • Verify correct IV concentration and rate of infusion with physician for neonates, infants, and children.
Adverse Effects
  • CNS: Neurotoxicity: drowsiness, unsteady gait, weakness, clumsiness, paresthesias, tremors, convulsions, peripheral neuritis.
  • Special Senses: Auditory–ototoxicity, high-frequency hearing loss, complete hearing loss (occasionally permanent); tinnitus; ringing or buzzing in ears;
  • Vestibular: dizziness, ataxia.
  • GI: Nausea, vomiting, hepatotoxicity.
  • Metabolic: Hypokalemia, hypomagnesemia.
  • Skin: Skin rash, urticaria, pruritus, redness.
  • Urogenital: Oliguria, urinary frequency, hematuria, tubular necrosis, azotemia.
  • Other: Superinfections.
  • Drug: ANESTHETICS, SKELETAL MUSCLE RELAXANTS have additive neuromuscular blocking effects; acyclovir, amphotericin B, bacitracin, capreomycin, cephalosporins, colistin, cisplatin, carboplatin, methoxyflurane, polymyxin B, vancomycin, furosemide, ethacrynic acid increase risk of ototoxicity and nephrotoxicity.
  • Peak: 30 min IV; 45 min to 2 h IM.
  • Distribution: Does not cross blood–brain barrier; crosses placenta; accumulates in renal cortex.
  • Elimination: 94%–98% excreted renally in 24 h, remainder in 10–30 d.
  • Half-Life: 2–3 h in adults, 4–8 h in neonates.
Nursing Considerations
Assessment & Drug Effects
  • Baseline tests: Before initial dose, C&S; renal function and vestibulocochlear nerve function (and at regular intervals during therapy; closely monitor in the older adult, patients with documented ear problems, renal impairment, or during high dose or prolonged therapy).
  • Monitor peak and trough amikacin blood levels: Draw blood 1 h after IM or immediately after completion of IV infusion; draw trough levels immediately before the next IM or IV dose.
  • Lab tests: Periodic serum creatinine and BUN, complete urinalysis. With treatment over 10 d, daily tests of renal function, weekly audiograms, and vestibular tests are strongly advised.
  • Monitor serum creatinine or creatinine clearance (generally preferred) more often, in the presence of impaired renal function, in neonates, and in the older adult; note that prolonged high trough (>8 mg/mL) or peak (>30–35 mg/mL) levels are associated with toxicity.
  • Monitor S&S of ototoxicity (primarily involves the cochlear (auditory) branch; high-frequency deafness usually appears first and can be detected only by audiometer); indicators of declining renal function; respiratory tract infections and other symptoms indicative of superinfections and notify physician should they occur.
  • Monitor for and report auditory symptoms (tinnitus, roaring noises, sensation of fullness in ears, hearing loss) and vestibular disturbances (dizziness or vertigo, nystagmus, ataxia).
  • Monitor & report any changes in I&O, oliguria, hematuria, or cloudy urine. Keeping patient well hydrated reduces risk of nephrotoxicity; consult physician regarding optimum fluid intake.
Patient & Family Education
  • Report immediately any changes in hearing or unexplained ringing/roaring noises or dizziness, and problems with balance or coordination.
  • Do not breast feed while taking this drug without consulting physician.

aluminum hydroxide

Drug Name
Generic Name: aluminum hydroxide Brand Name: Alu-Cap, Alugel, Alu-Tab, Amphojel, Dialume

Classifications: gastrointestinal agent; antacid; adsorbent
  • Aluminum Hydroxide 300 mg, 400 mg, 500 mg, 600 mg tablets; 300 mg, 400 mg, 500 mg, 600 mg capsules; 320 mg/5 mL, 450 mg/5 mL, 600 mg/5 mL, 675 mg/5 mL suspension
  • Nonsystemic antacid with moderate neutralizing action. Decreases rate of gastric emptying and has demulcent, adsorbent, and mild astringent properties. Reduces acid concentration and pepsin activity by raising pH of gastric and intraesophageal secretions.
Therapeutic Effects
  • Reduces gastric acidity by neutralizing the stomach acid content. Aluminum carbonate lowers serum phosphate by binding dietary phosphate to form insoluble aluminum phosphate, which is excreted in feces.
  • Symptomatic relief of gastric hyperacidity associated with gastritis, esophageal reflux, and hiatal hernia; adjunct in treatment of gastric and duodenal ulcer. More commonly used in combination with other antacids. Aluminum carbonate is used primarily in conjunction with a low phosphate diet to reduce hyperphosphatemia in patients with renal insufficiency and for prophylaxis and treatment of phosphatic renal calculi.
  • Prolonged use of high doses in presence of low serum phosphate; pregnancy (category C).
Cautious Use
  • Renal impairment; gastric outlet obstruction; older adults; decreased bowel activity (e.g., patients receiving anticholinergic, antidiarrheal, or antispasmodic agents); patients who are dehydrated or on fluid restriction.
Route & Dosage
  • Antacid (hydroxide & phosphate)
  • Adult: PO 600 mg t.i.d. or q.i.d.
  • Tablet must be chewed until it is thoroughly wetted before swallowing.
  • Note for antacid use: Follow well-chewed tablet with one-half glass of water or milk; follow liquid preparation (suspension) with water to ensure passage into stomach. For phosphate lowering: follow tablet, capsule, or suspension with full glass of water or fruit juice.
  • Store between 15°–30° C (59°–86° F) in tightly closed container.
Adverse Effects ( 1%)
  • GI: Constipation, fecal impaction, intestinal obstruction.
  • CNS: Dialysis dementia (thought to be due to aluminum intoxication). Metabolic: Hypophosphatemia, hypomagnesemia.
  • Drug: Aluminum will decrease absorption of chloroquine, cimetidine, ciprofloxacin, digoxin, isoniazid, iron salts, NSAIDs, norfloxacin, ofloxacin, phenytoin, phenothiazines, quinidine, tetracycline, thyroxine. Sodium polystyrene sulfonate may cause systemic alkalosis.
  • Absorption: Minimal absorption.
  • Peak: Slow onset.
  • Duration: 2 h when taken with food; 3 h when taken 1 h after food.
  • Elimination: Excreted in feces as insoluble phosphates.
Nursing Considerations
Assessment & Drug Effects
  • Note number and consistency of stools. Constipation is common and dose related. Intestinal obstruction from fecal concretions has been reported.
  • Lab tests: Monitor periodic serum calcium and phosphorus levels with prolonged high-dose therapy or impaired renal function.
  • Patient & Family Education
  • Increase phosphorus in diet when taking large doses of these antacids for prolonged periods; hypophosphatemia can develop within 2 wk of continuous use of these antacids. The older adult in a poor nutritional state is at high risk.
  • Note: Antacid may cause stools to appear speckled or whitish.
  • Report epigastric or abdominal pain; it is a clinical guide for adjusting dosage. Keep physician informed. Pain that persists beyond 72 h may signify serious complications.
  • Seek medical help if indigestion is accompanied by shortness of breath, sweating, or chest pain, if stools are dark or tarry, or if symptoms are recurrent when taking this medication.
  • Seek medical advice and supervision if self-prescribed antacid use exceeds 2 wk

Hygiene and Comfort

Factor Influencing Individual Hygienic Practices
CultureNorth American culture places a high value on cleanliness. Many North Americans bathe or shower once or twice a day, whereas people from some other cultures bathe once a week. Some cultures consider privacy essential for bathing, whereas others practice communal bathing. Body odor is offensive in some cultures and accepted normal in others.
ReligionCeremonial washings are practiced by some religion
EnvironmentFinances may affect the availability f facilities for bathing. For example, homeless people may not have warm water available; soap, shampoo, shaving lotion, and deodorants may be too expensive for people who have limited resources.
Developmental LevelChildren learn hygiene in home. Practices vary according to the individual’s age; for example, preschoolers can carry out most tasks independently with encouragement.
Health and EnergyIll people may not have the motivation or energy to attend to hygiene. Some clients who have neuromuscular impairments may be unable o perform hygienic care.
Personal PreferencesSome people prefer a shower to tub bath. People have different preferences regarding the time of bathing (e.g. morning versus evening)
Skin Care
General Guidelines for Skin Care
  1. An intact, healthy skin is the body’s first line of defense
  2. The degree to which the skin protects the underlying tissues from injury depends on the amount of subcutaneous tissue and the dryness of the skin.
  3. Moisture in contact with the skin can result in increased bacterial growth and irritation.
  4. Body odors are caused by resident skin bacteria acting on the body secretions. Cleanliness is the best deodorant.
  5. Skin sensitivity to irritation and injury varies among individuals and in accordance with their health.
  6. Agents used for skin care have selective actions and purposes. E.g. soap, detergent, bath oil, cream, lotion, powder, deodorant, and antiperspirant.
Common Skin Problem
Problem and AppearanceNursing Implication
  • Superficial layers of the skin are scraped or rubbed away. Area is reddened and may have localized bleeding or serous weeping.
  1. Prone to infection; therefore, wound should be kept clean and dry.
  2. Do not wear rings or jewelry when providing care to avoid causing abrasions to clients.
  3. Lift, do not pull, a client across a bed.
  4. Use two or more people for assistance.
Excessive Dryness
  • Skin can appear flaky and rough.
  1. Prone to infection if the skin cracks; therefore, provide alcohol-free lotions to moisturize the skin and prevent cracking.
  2. Bathe client less frequently; use no soap, or use nonirritating soap and limit its use. Rinse skin thoroughly because soap can be irritating and drying.
  3. Encourage increased fluid intake if health permits to prevent dehydration.
Ammonia Dermatitis (Diaper Rash)
  • Caused by skin bacteria reacting with urea in the urine. The skin becomes reddened and is sore.
  1. Keep skin dry and clean by applying protective ointments containing zinc oxide to areas at risk (e.g., buttocks and perineum).
  2. Boil an infant’s diaper or wash them with an antibacterial detergent to prevent infection. Rinse diapers well because detergent is irritating to an infant’s skin.
  • Inflammatory condition with papules and pustules.
  1. Keep the skin clean to prevent secondary infection.
  2. Treatment varies widely.
  • Redness associated with a variety of conditions, such as rashes, exposure to sun, elevated body temperature.
  1. Wash area carefully to remove excess microorganisms.
  2. Apply antiseptic spray or lotion to prevent itching, promote healing, and prevent skin breakdown.
  • Excessive hair on a person’s body and face, particularly in women.
  1. Remove unwanted hair by using depilatories, shaving, electrolysis, or tweezing.
  2. Enhance client’s self concept.
  • Bathing removes accumulated oil, perspiration, dead skin cells, and some bacteria.
  • Excessive bathing, can interfere with the intended lubricating effect of sebum, causing dryness of the skin.
  • Bathing stimulates circulation
  • Bathing offers an excellent opportunity for the nurse to assess all clients.
Cleaning baths
Given chiefly for hygiene purposes and include these types:
  • Complete bed bath. The nurse washes the entire body of a dependent client in bed.
  • Self- help bed bath. Clients confined to bed are able to bathe themselves with help from the nurse for washing the back and perhaps the feet.
  • Partial bath (abbreviated bath). Only the parts of the client’s body that might cause discomfort or odor, if neglected, are washed: the face, hands, axillae, perineal area and back.
  • Bag bath. This bath is a commercially prepared product that contains 10 to 12 presoaked disposable washcloths that contain no- rinse cleanser solution.
  • Tub bath. Tub baths are often preferred to bed baths because it is easier to wash and rinse in a tub.
  • Shower. Many ambulatory clients are able to use shower facilities and require only minimal assistance from the nurse.
Ear Care
Nursing Interventions
  • Cleanse the pinna with moist wash cloth
  • Remove visible cerumen by retracting the ears downward. If this is ineffective, irrigate the ear as ordered.
  • Do not use bobby pins, toothpicks or cotton-tipped applicators to remove cerumen. These can rupture the tympanic membrane or traumatize the ear canal. Cotton- tipped applicators can push wax into the ear canal, which can cause blockage.
Eye Care
Nursing Interventions
  • Cleanse the eyes from the inner cantus to the outer cantus. Use a new cotton ball for each wipe. To prevent contamination of the nasolacrimal ducts.
  • If the client is comatose, cover the ayes with sterile moist compresses. To prevent dryness and irritation of the cornea.
  • Eyeglass should be cleaned with warm water and soap; dried with soft tissue.
  • Clean contact lens as directed by the manufacturer
  • To remove artificial eyes, wear clean gloves, depress the client’s lower eyelid.
  • Hold the artificial eye with thumb and index finger
  • Clean the artificial eye with warm normal saline, then place in a container with water or saline solution.
  • Avoid rubbing the eyes. This may cause infection.
  • Maintain adequate lighting when reading.
  • Avoid regular use of eye drops
  • If dirt/ foreign bodies get into eyes, clean them with copious, clean, tepid water as an emergency treatment.
Nose Care
Nursing Interventions
  • Clean nasal secretions by blowing the nose gently into the soft tissue.
  • Both nares should be open when blowing the nose to prevent forcing debris into the middle ear, via Eustachian tube.
  • May use cotton tipped applicator moistened with saline or water to remove encrusted, dried secretions. Insert only up to cotton tip.
Oral Cavity Care
Measures to Prevent Tooth Decay
  • Brush the teeth thoroughly after meals and at bedtime.
  • Floss the teeth daily.
  • Ensure adequate intake of food rich in calcium, phosphorous, Vit. A, C and D and fluoride.
  • Avoid sweet foods and drinks between meals
  • Eat coarse, fibrous foods (cleansing foods) such as fresh fruits ant raw vegetables.
  • Have dental check up every 6 months.
  • Have topical fluoride applications as prescribed by the dentists.
Brushing and Flossing the Teeth
  1. To remove food particles from around and between the teeth.
  2. To remove dental plaque.
  3. To enhance the client’s feelings of well- being
  4. To prevent sordes and infection of the oral tissues.
Nursing Interventions When Providing Oral Care for Conscious Patient
  • Inform the client and explain purpose of the procedure.
  • Provide privacy.
  • Assist in sitting or side-lying position.
  • Place towel under the client’s chin.
  • Moisten bristles of toothbrush and apply dentifrice.
  • Hold kidney basin under the chin.
  • Allow the client to brush his teeth, if possible.
  • Use downward strokes fro upper front teeth; upward strokes for lower front teeth; back and forth strokes for the biting surfaces of the teeth; and hold the brush against the teeth with bristles at 45 degrees angle to penetrate and clean under the gingival margins.
  • Rinse the mouth with adequate amount of water. Floss the teeth.
  • Keep the client comfortable.
  • Do after-care of the equipment and articles.
  • Document relevant data.
For Unconscious Client
  • Place in side-lying position to prevent aspiration.
  • Have suction apparatus readily available.
  • Use padded tongue blade to open the mouth.
  • Brush teeth and gums, using toothbrush or soft sponge-ended swab.
  • Apply thin layer of petroleum jelly to lips to prevent drying or cracking.
Note: Lemon glycerin swabs can be drying to the oral mucosa if used for extended periods.
Care of Artificial Dentures
  • Wear gloves when handling and cleansing dentures.
  • Place a washcloth in a basin or bowl of sink when brushing dentures to prevent damage if the dentures are dropped.
  • Store the dentures in a container with water.
Common Problems of the Mouth
  1. Plaque. An invisible soft film of bacteria, saliva, epithelial cells and leukocytes that adhere to the enamel surface of the teeth.
  2. Tatar. A visible, hard deposit of plaque and bacteria that forms at the gum lines.
  3. Halitosis. Bad breath.
  4. Glossitis. Inflammation of the tongue.
  5. Gingivitis. Inflammation of the gums.
  6. Stomatitis. Inflammation and dryness of oral mucosa.
  7. Parotitis. Inflammation of the parotid salivary glands (mumps).
  8. Sordes. Accumulation of foul matter (food, microorganisms, and epithelial elements) on the gums and teeth.
  9. Periodontal disease. Gums appear spongy and bleeding (pyorrhea).
  10. Cheilosis. Cracking of the lips.
  11. Dental Caries. Teeth have darkened area, may be painful (cavities).
Hair Care
  • The appearance of the hair may reflect a person’s sense of well being and health status.
  • Brushing and combing the hair stimulate circulation of blood in the scalp; distribute the oil along the hair shaft; help to arrange the hair.
Hair shampoo
  1. To stimulate the circulation of the blood in the scalp through massage.
  2. To clean the hair and improve the client’s sense of well-being.
Nursing Interventions during Hair Shampoo
  • Determine if the institution requires doctor’s order for hair shampoo.
  • Place client diagonally in bed.
  • Remove pins from hair. Comb and brush hair thoroughly. This is to remove tangles.
  • Place Kelly pad under the head, with neck hyper extended.
  • The trough of the Kelly pad should be directed to a pail. To prevent spillage of the water onto the floor.
  • Cover the eyes with wash cloth. To protect them from irritation.
  • Plug the ears with cotton balls. To prevent entry of the water into the external auditory canal.
  • Apply small amount of shampoo.
  • Massage the scalp with the fat pads of the fingers and make a rich lather.
  • Massage promotes circulation on the scalp. Rich lather ensures through cleansing of the hair.
  • Rinse the hair thoroughly. Soap residue in hair may cause irritation of the scalp and may dry hair.
  • Dry the hair thoroughly.
  • Keep he client comfortable.
  • Do after-care of equipment and articles.
  • Make relevant documentation.
Common Hair and Scalp Problems
  • Dandruff. Is a chronic diffuse scaling of the scalp, with pruritus (seborrheic dermatitis).
  • Alopecia. Lair loss or baldness.
  • Pediculosis. Infestation with lice.
    • Padiculosis capitis is head louse
    • Pediculosis corporis is body louse
    • Pediculosis pubis is crab louse
  • The usual treatment for pediculosis is gamma benzene hexachloride (Kwell), which comes in lotion, cream and shampoo. Pubic lice are difficult to remove, so the shampoo may be applied and left on 12 to 24 hours.
  • Linens and clothing used by clients should be washed in hot water.
  • Scabies. Contagious skin infestation by the itch mite. The characteristic of the lesion is the burrow produced by the female mite as it penetrates the skin. The burrows are short, wavy, brown, or black threadlike lesions.
  • Hirsutism. Excessive growth of body hair.
Foot Care
  • Wash the feet daily, and dry them well especially the interdigital spaces.
  • Use warm water for foot soak, to soften the nails and loosen debris under them. Caution: soaking the feet of diabetic clients is no longer encouraged because excessive moisture can contribute to skin breakdown.
  • Use cream or lotion to moisten the skin and soften calluses.
  • Use deodorant sprays or foot powder to prevent or control unpleasant odor
  • File toe nails straight across. To prevent nail splitting and tissue injury around nail.
  • Change socks or stocking daily.
  • Wear comfortable, well-fitted pair of shoes
  • Do not go bare footed
  • Exercise the feet to improve circulation
  • Avoid using constricting clothing or round garters which may decrease circulation
  • Avoid crossing the legs
  • Avoid self-treatment for corns or calluses
Common Foot Problems
  1. Callus. Painless, flat, thickened epidermis, a mass of keratotic material. Often caused by pressure from the shoe on bony prominence.
  2. Corn. Keratosis caused by friction and pressure from a shoe. It commonly affects the fourth and fifth toe. It appears circular and raised.
  3. Unpleasant odors. This results from perspiration and its interaction with microorganism.
  4. Plantar warts. Caused by virus papova-virus hominis . They appear on the sole of the foot and are moderately contagious. They are painful and make walking difficult.
  5. Fissures. Caused by dryness and cracking of the skin.
  6. Tinea pedis. Characterized by scaling and cracking of the skin, particularly between the toes, caused by a fungus. There may be blisters. (also Athlete’s foot, ringworm of the foot.)
  7. Ingrown Toenail. Inward growth of the nail, causing trauma into soft tissues. It is usually due to trimming the lateral edges of the toenails.
Nail Care
  • Trim nails straight across, or follow the contour of the fingers.
  • File nails to have smooth edges.
  • Do not trim nails at the lateral corners to prevent ingrowns.
  • Diabetic clients are advised against cutting hangnails or cuticles.
  • Ingrown is also called unguis incarnate.
  • Separation of the nail from the nail bed is onycholysis.
  • Inflammation of the skin fold at the nail margin is paronychia.
Perineal- Genital Care
Purposes of Perineal-Genital Care
  1. To remove normal perineal secretions and odor.
  2. To prevent infection.
  3. To promote comfort.
Nursing Intervention during Perineal- Genital Care
  • Inform the client and explain purpose of the procedure.
  • Provide privacy. To maintain client dignity.
  • Position and drape the client as follows:
    • Female: dorsal recumbent position; drape the client diagonally.
    • Male: supine position
    • For female clients, use forceps to hold cotton balls for cleansing the perineum.
    • For male clients, wear clean gloves.
For Female Clients
  1. Use anterior to posterior (front to back) stroke to prevent contamination of urethral meatus and vagina with microorganisms from the anus.
  2. Use one cotton ball for each stroke.
  3. Cleanse perineum with soap/ antiseptic solution. Include the inner thigh.
  4. Rinse the area with copious amount of water. To remove soap adequately and prevent irritation of the perineal area.
  5. Dry perineum thoroughly. Moisture supports microbial growth.
For Male Clients
  1. Wash and dry penis using firm strokes, to prevent erection of the penis.
  2. Use circular motion, from the tip of glans penis towards the penile shaft.
  3. If the client is uncircumcised, retract the prepuce (foreskin). This is to remove smegma that collects under the foreskin and facilitates bacterial growth.
  4. Wash and dry the scrotum and buttocks.
  • For post-delivery or menstruating females, apply a perineal pad as needed from front to back. This prevents contamination of urethra and vagina from anal area.
  • Keep the client comfortable
  • Do the after-care of equipment and articles
  • Document relevant data


Drug name
Generic Name: alprazolam

Brand Name: Alprazolam Intensol, Apo-Alpraz (CAN), Niravam, Novo-Alprazol (CAN), Nu-Alpraz (CAN), Xanax, Xanax TS (CAN), Xanax XR

Classification: Benzodiazepine, Anxiolytic

Pregnancy Category D
Controlled Substance C-IV
  • Individualize dosage; increase dosage gradually to avoid adverse effects.

  • Anxiety disorders: Initially, 0.25–0.5 mg PO tid; adjust to maximum daily dose of 4 mg/day in divided doses or extended-release form once per day in the AM once dosage is established (immediate release, intensol solution).
  • Panic disorder: Initially, 0.5 mg PO tid; increase dose at 3- to 4-day intervals in increments of no more than 1 mg/day; ranges of 1–10 mg/day have been needed; extended-release form once per day in AM once dosage is established (Xanax products, Niravam).

  • Social phobia: 2–8 mg/day PO.
  • PMS: 0.25 mg PO tid.
Therapeutic actions
  • Exact mechanisms of action not understood; main sites of action may be the limbic system and reticular formation; increases the effects of GABA, an inhibitory neurotransmitter; anxiety blocking effects occur at doses well below those necessary to cause sedation, ataxia.
  • Management of anxiety disorders, short-term relief of symptoms of anxiety; anxiety associated with depression.
  • Treatment of panic attacks with or without agoraphobia
  • Unlabeled uses: Social phobia, premenstrual syndrome, depression
Adverse effects
  • CNS: Transient, mild drowsiness initially; sedation, depression, lethargy, apathy, fatigue, light-headedness, disorientation, anger, hostility, episodes of mania and hypomania, restlessness, confusion, crying, delirium, headache, slurred speech, dysarthria, stupor, rigidity, tremor, dystonia, vertigo, euphoria, nervousness, difficulty in concentration, vivid dreams, psychomotor retardation, extrapyramidal symptoms; mild paradoxical excitatory reactions during first 2 wk of treatment
  • CV: Bradycardia, tachycardia, CV collapse, hypertension, hypotension, palpitations, edema
  • Dermatologic: Urticaria, pruritus, rash, dermatitis
  • EENT: Visual and auditory disturbances, diplopia, nystagmus, depressed hearing, nasal congestion
  • GI: Constipation, diarrhea, dry mouth, salivation, nausea, anorexia, vomiting, difficulty in swallowing, gastric disorders, hepatic impairment
  • GU: Incontinence, changes in libido, urinary retention, menstrual irregularities
  • Hematologic: Elevations of blood enzymes—LDH, alkaline phosphatase, AST, ALT; blood dyscrasias—agranulocytosis, leukopenia
  • Other: Hiccups, fever, diaphoresis, paresthesias, muscular disturbances, gynecomastia. Drug dependence with withdrawal syndrome when drug is discontinued; more common with abrupt discontinuation of higher dosage used for longer than 4 mo
  • Contraindicated with hypersensitivity to benzodiazepines, psychoses, acute narrow-angle glaucoma, shock, coma, acute alcoholic intoxication with depression of vital signs, pregnancy (crosses the placenta; risk of congenital malformations, neonatal withdrawal syndrome), labor and delivery (“floppy infant” syndrome), lactation (secreted in breast milk; infants become lethargic and lose weight).
  • Use cautiously with impaired liver or kidney function, debilitation.
Nursing considerations
CLINICAL ALERT! Name confusion has occurred among Xanax (alprazolam), Celexa (citalopram), and Cerebyx (fosphenytoin), and between alprazolam and lorazepam; use caution.
  • History: Hypersensitivity to benzodiazepines; psychoses; acute narrow-angle glaucoma; shock; coma; acute alcoholic intoxication with depression of vital signs; labor and delivery; lactation; impaired liver or kidney function; debilitation
  • Physical: Skin color, lesions; T; orientation, reflexes, affect, ophthalmologic examination; P, BP; liver evaluation, abdominal examination, bowel sounds, normal output; CBC, LFTs, renal function tests
  • Arrange to taper dosage gradually after long-term therapy, especially in epileptic patients.
  • Do not administer with grapefruit juice.
  • Taper drug slowly; decrease by no more than 0.5 mg every 3 days.
Teaching points
  • Take this drug exactly as prescribed; take extended-release form once a day in the morning; place rapidly disintegrating tablet on top of tongue, where it will disintegrate and can be swallowed with saliva.
  • Do not drink grapefruit juice while on this drug.
  • Do not stop taking drug (in long-term therapy) without consulting health care provider; drug should not be stopped suddenly.
  • Avoid alcohol, sleep-inducing, or over-the-counter drugs.
  • You may experience these side effects: Drowsiness, dizziness (these effects will be less pronounced after a few days, avoid driving a car or engaging in other dangerous activities if these occur); GI upset (take drug with food); fatigue; depression; dreams; crying; nervousness.
  • Report severe dizziness, weakness, drowsiness that persists, rash or skin lesions, difficulty voiding, palpitations, swelling in the extremities.


Drug Name
Generic Name: allopurinol
Brand Name: Aloprim, Apo-Allopurinol (CAN), Purinol (CAN), Zyloprim
Classification: Antigout drug
Pregnancy Category C
  • Gout and hyperuricemia: 100–800 mg/day PO in divided doses, depending on the severity of the disease (200–300 mg/day is usual dose).
  • Maintenance: Establish dose that maintains serum uric acid levels within normal limits.
  • Prevention of acute gouty attacks: 100 mg/day PO; increase the dose by 100 mg at weekly intervals until uric acid levels are < 6 mg/dL.
  • Prevention of uric acid nephropathy in certain malignancies: 600–800 mg/day PO for 2–3 days with a high fluid intake; maintenance dose should then be established as above.
  • Recurrent calcium oxalate stones: 200–300 mg/day PO; adjust dose based on 24-hr urinary urate determinations.
  • Parenteral: 200–400 mg/m2/day IV to maximum of 600 mg/day as continuous infusion or at 6, 8, 12 hr intervals.

  • Secondary hyperuricemia associated with various malignancies:
    • 6–10 yr: 300 mg/day PO.
    • < 6 yr: 150 mg/day; adjust dosage after 48 hr of treatment based on serum uric acid levels.
  • Parenteral: 200 mg/m2/day IV as continuous infusion or at 6-, 8-, 12-hr intervals.
Therapeutic actions
  • Inhibits the enzyme responsible for the conversion of purines to uric acid, thus reducing the production of uric acid with a decrease in serum and sometimes in urinary uric acid levels, relieving the signs and symptoms of gout
  • Management of the signs and symptoms of primary and secondary gout
  • Management of patients with malignancies that result in elevations of serum and urinary uric acid
  • Management of patients with recurrent calcium oxalate calculi whose daily uric acid excretion exceeds 800 mg/day (males) or 750 mg/day (females)
  • Orphan drug use: Treatment of Chagas’ disease; cutaneous and visceral leishmaniasis
  • Unlabeled uses: Amelioration of granulocyte suppression with 5-FU; as a mouthwash to prevent 5-FU-induced stomatitis
Adverse effects
  • CNS: Headache, drowsiness, peripheral neuropathy, neuritis, paresthesias
  • Dermatologic: Rashes—maculopapular, scaly or exfoliative—sometimes fatal
  • GI: Nausea, vomiting, diarrhea, abdominal pain, gastritis, hepatomegaly, hyperbilirubinemia, cholestatic jaundice
  • GU: Exacerbation of gout and renal calculi, renal failure
  • Hematologic: Anemia, leukopenia, agranulocytosis, thrombocytopenia, aplastic anemia, bone marrow depression
  • Contraindicated with allergy to allopurinol, blood dyscrasias.
  • Use cautiously with liver disease, renal failure, lactation, pregnancy.
Nursing considerations
  • History: Allergy to allopurinol, blood dyscrasias, liver disease, renal failure, lactation
  • Physical: Skin lesions, color; orientation, reflexes; liver evaluation, normal urinary output; normal output; CBC, LFTs, renal function tests, urinalysis
  • Administer drug following meals.
  • Encourage patient to drink 2.5 to 3 L/day to decrease the risk of renal stone development.
  • Check urine alkalinity—urates crystallize in acid urine; sodium bicarbonate or potassium citrate may be ordered to alkalinize urine.
  • WARNING: Discontinue drug at first sign of skin rash; severe to fatal skin reactions have occurred.
  • Arrange for regular medical follow-up and blood tests.
Teaching points
  • Take the drug after meals.
  • Avoid over-the-counter medications. Many of these preparations contain vitamin C or other agents that might increase the likelihood of kidney stone formation. If you need an over-the-counter preparation, check with your health care provider.
  • You may experience these side effects: Exacerbation of gouty attack or renal stones (drink 2.5–3 liters of fluids per day while on this drug); nausea, vomiting, loss of appetite (takes after meals or eat frequent small meals); drowsiness (use caution while driving or performing hazardous tasks).
  • Report unusual bleeding or bruising; fever, chills; gout attack; numbness or tingling; flank pain, skin rash.

Alfuzosin hydrochloride

Drug Name
Generic Name: alfuzosin hydrochloride
(al foo zow sin)
Brand Name: Uroxatral
Pregnancy Category B
Drug classes
  • Alpha adrenergic blocking agent
  • BPH drug
Therapeutic actions
Blocks the smooth muscle alpha-1 adrenergic receptors in the prostate, prostatic capsule, prostatic urethra, and bladder neck, leading to the relaxation of the bladder and prostate and improving the flow of urine and improvement in symptoms in patients with BPH.
  • Treatment of the signs and symptoms of BPH
Contraindications and cautions
  • Contraindicated with allergy to any component of the product; hepatic insufficiency, pregnancy, lactation.
  • Use cautiously with hypotension, renal insufficiency, prolonged QTc interval, CAD.
Available forms
ER tablets—10 mg
10 mg/d PO after the same meal each day.
Safety and efficacy not established.


OralVaries8 hr
Metabolism: Hepatic; T1/2: 10 hr
Distribution: Crosses placenta; may enter breast milk
Excretion: Urine and feces
Adverse effects
  • CNS: Dizziness, headache
  • CV: Orthostatic hypotensionsyncope, tachycardia, chest pain
  • GI: Abdominal pain, dyspepsia, constipation, nausea
  • GU: Impotence, priapism
  • Respiratory: Cough, bronchitis, sinusitis, pharyngitis, upper respiratory tract infection
  • Other: Fatigue, pain
  • Increased serum levels and risk of adverse effects of alfuzosin if combined with CYP3A4 inhibitors, ketoconazole, itraconazole, ritonavir; use of these combinations is contraindicated
  • Increased risk of orthostatic hypotension and syncope if combined with antihypertensive medications; monitor patient closely and adjust antihypertensive dosage accordingly
  • Increased risk of adverse effects if combined with other adrenergic blockers; monitor patients closely and adjust dosages as needed
Nursing considerations
  • History: Allergy to alfuzosin, hepatic or renal dysfunction, CAD, prolonged QTc interval, pregnancy, lactation
  • Physical: Body weight; skin color, lesions; orientation, affect, reflexes; P, BP, orthostatic BP; R, adventitious sounds; PSA level; voiding pattern, normal output, urinalysis
  • Ensure that patient does not have prostatic cancer before beginning treatment; check for normal PSA levels.
  • Administer once a day, after the same meal each day.
  • Ensure that patient does not crush, chew, or cut tablet. Tablet should be swallowed whole.
  • Store tablets in a dry place, protected from light.
  • WARNING: Monitor patient carefully for orthostatic hypotension; chance of orthostatic hypotension, dizziness, and syncope are greatest with the first dose. Establish safety precautions as appropriate.
Teaching points
  • Take this drug exactly as prescribed, once a day. Do not chew, crush, or cut tablets; tablets must be swallowed whole. Use care when beginning therapy; dizziness and syncope are most likely at the beginning of therapy. Change position slowly to avoid increased dizziness. Take the drug after the same meal each day. Do not take the drug on an empty stomach.
  • You may experience these side effects: Dizziness, weakness (these are more likely to occur when you change position, in the early morning, after exercise, in hot weather, and when you have consumed alcohol; some tolerance may occur after you have taken the drug for a while. Avoid driving a car or engaging in tasks that require alertness while you are experiencing these symptoms; remember to change position slowly, use caution when climbing stairs, lie down for a while if dizziness persists); GI upset (eat frequent small meals); impotence (you may wish to discuss this with your health care provider); fatigue.
  • Report frequent dizziness or fainting, worsening of symptoms, chest pain.


Drug  Name
Generic Name :  acyclovir (acycloguanosine)
Brand Name:  Alti-Acyclovir (CAN), Avirax (CAN), Zovirax
Classification: Antiviral, Purine nucleoside analogue
Pregnancy Category B
Dosages & Route

  • 5–10 mg/kg infused IV over 1 hr, q 8 hr (15 mg/kg/day) for 7–10 days.
  • Initial genital herpes: 200 mg q 4 hr (1,000 mg/day) for 10 days.
  • Long-term suppressive therapy: 400 mg bid for up to 12 mo.
  • Acute herpes zoster: 800 mg q 4 hr five times daily for 7–10 days.
  • Chickenpox: 800 mg qid for 5 days.
  • HSV infections < 12 yr: 10 mg/kg infused IV over 1 hr q 8 hr for 7 days.
  • Shingles, HSV encephalitis: 20 mg/kg IV over 1 hr q 8 hr for 10 days.
  • Neonatal HSV: 10 mg/kg infused over 1 hr q 8 hr for 10 days.

  • < 2 yr: Safety not established.
  • 2 yr and < 40 kg: 20 mg/kg per dose qid (80 mg/kg/day) for 5 days.
  • 40 kg: Use adult dosage.
  • 12 yr: Use adult dosage.
Therapeutic actions
  • Antiviral activity; inhibits viral DNA replication.
  • Initial and recurrent mucosal and cutaneous HSV-1 and HSV-2 and varicella zoster infections in immunocompromised patients
  • Severe initial and recurrent genital herpes infections in selected patients
  • Herpes simplex encephalitis
  • Treatment of neonatal herpes simplex virus infections
  • Acute treatment of herpes zoster (shingles) and chickenpox
  • Ointment: Initial HSV genital infections; limited mucocutaneous HSV infections in immunocompromised patients
  • Cream: Recurrent herpes labialis (cold sores) in patients > 12 yr
  • Unlabeled uses: Cytomegalovirus and HSV infection following transplant, herpes simplex infections, varicella pneumonia, disseminated primary eczema herpeticum
Adverse effects
Systemic administration

  • CNS: Headache, vertigo, depression, tremors, encephalopathic changes
  • Dermatologic: Inflammation or phlebitis at injection sites, rash, hair loss
  • GI: Nausea, vomiting, diarrhea, anorexia
  • GU: Crystalluria with rapid IV administration, hematuria
Topical administration

  • Dermatologic: Transient burning at site of application
  • Contraindicated with allergy to acyclovir, seizures, CHF, renal disease, lactation.
  • Use cautiously with pregnancy.
Nursing considerations
  • History: Allergy to acyclovir, seizures, CHF, renal disease, lactation, pregnancy
  • Physical: Skin color, lesions; orientation; BP, P, auscultation, perfusion, edema; R, adventitious sounds; urinary output; BUN, creatinine clearance

Systemic administration
  • Ensure that the patient is well hydrated.
Topical administration

  • Start treatment as soon as possible after onset of signs and symptoms.
  • Wear a rubber glove or finger cot when applying drug.
Teaching points
Systemic administration
  • Complete the full course of oral therapy, and do not exceed the prescribed dose.
  • Oral acyclovir is not a cure for your disease but should make you feel better.
  • Avoid sexual intercourse while visible lesions are present.
  • You may experience these side effects: Nausea, vomiting, loss of appetite, diarrhea; headache, dizziness.
  • Report difficulty urinating, rash, increased severity or frequency of recurrences.
Topical administration

  • Wear rubber gloves or finger cots when applying the drug to prevent autoinoculation of other sites and transmission to others.
  • This drug does not cure the disease; application during symptom-free periods will not prevent recurrences.
  • Avoid sexual intercourse while visible lesions are present.
  • This drug may cause burning, stinging, itching, rash; notify your physician if these are pronounced.

acetaminophen (N-acetyl-p-aminophenol)

Drug Name
Generic Name: acetaminophen (N-acetyl-p-aminophenol)
Brand Name:

  • Suppositories: Abenol (CAN), Acephen
  • Oral: Aceta, Apacet, Atasol (CAN), Genapap, Genebs, Liquiprin, Mapap, Panadol, Tapanol, Tempra,Tylenol
Classification: Antipyretic, Analgesic (nonopioid)
Pregnancy Category B

  • PO or PR
  • By suppository, 325–650 mg q 4–6 hr or PO, 1,000 mg tid to qid. Do not exceed 4 g/day.

  • PO or PR
  • Doses may be repeated 4–5 times/day; do not exceed five doses in 24 hr; give PO or by suppository.
 Age Dosage (mg)
 0–3 mo 40
 4–11 mo 80
 12–23 mo 120
 2–3 yr 160
 4–5 yr 240
 6–8 yr 320
 9–10 yr 400
 11 yr 480
Therapeutic actions
  • Antipyretic: Reduces fever by acting directly on the hypothalamic heat-regulating center to cause vasodilation and sweating, which helps dissipate heat.
  • Analgesic: Site and mechanism of action unclear.
  • Analgesic-antipyretic in patients with aspirin allergy, hemostatic disturbances, bleeding diatheses, upper GI disease, gouty arthritis
  • Arthritis and rheumatic disorders involving musculoskeletal pain (but lacks clinically significant antirheumatic and anti-inflammatory effects)
  • Common cold, flu, other viral and bacterial infections with pain and fever
  • Unlabeled use: Prophylactic for children receiving DPT vaccination to reduce incidence of fever and pain
Adverse effects
  • CNS: Headache
  • CV: Chest pain, dyspnea, myocardial damage when doses of 5–8 g/day are ingested daily for several weeks or when doses of 4 g/day are ingested for 1 yr
  • GI: Hepatic toxicity and failure, jaundice
  • GU: Acute kidney failure, renal tubular necrosis
  • Hematologic: Methemoglobinemia—cyanosis; hemolytic anemia—hematuria, anuria; neutropenia, leukopenia, pancytopenia, thrombocytopenia, hypoglycemia
  • Hypersensitivity: Rash, fever
  • Contraindicated with allergy to acetaminophen.
  • Use cautiously with impaired hepatic function, chronic alcoholism, pregnancy, lactation.
Nursing considerations
  • History: Allergy to acetaminophen, impaired hepatic function, chronic alcoholism, pregnancy, lactation
  • Physical: Skin color, lesions; T; liver evaluation; CBC, LFTs, renal function tests
  • Do not exceed the recommended dosage.
  • Consult physician if needed for children < 3 yr; if needed for longer than 10 days; if continued fever, severe or recurrent pain occurs (possible serious illness).
  • Avoid using multiple preparations containing acetaminophen. Carefully check all OTC products.
  • Give drug with food if GI upset occurs.
  • Discontinue drug if hypersensitivity reactions occur.
  • Treatment of overdose: Monitor serum levels regularly, N-acetylcysteine should be available as a specific antidote; basic life support measures may be necessary.
Teaching points
  • Do not exceed recommended dose; do not take for longer than 10 days.
  • Take the drug only for complaints indicated; it is not an anti-inflammatory agent.
  • Avoid the use of other over-the-counter preparations. They may contain acetaminophen, and serious overdosage can occur. If you need an over-the-counter preparation, consult your health care provider.
  • Report rash, unusual bleeding or bruising, yellowing of skin or eyes, changes in voiding patterns.

History of Nursing Periods

Intuitive Nursing
  • From Prehistoric times up to the early Christian Era
  • Untaught and Instinctive
  • Nursing performed out of compassion
  • Nursing belonged to women
Apprentice Nursing
  • From the founding of the Religious orders in the 11th century up to 1836 with the establishment of the Kaiserwerth Institute for training of Deaconesses
  • Period of “on-the-job training”
  • Nursing performed without any formal education and by people who were directed by more experienced nurses
  • Important personalities in this period:
    • St. Clare-gave nursing care to the sick and the afflicted
    • St. Elizabeth of Hungary- Patrones of nurses
    • St. Catherine of Siena- First lady with a lamp
  • Dark period of Nursing
  • From the 17th century up to 19th century
  • Nursing became the work of the least desirable of women
Educated Nursing
  • Began on June 15, 1860 when Florence Nightingale School of nursing opened St. Thomas Hospital in London
  • Development of nursing was strongly influenced by trends resulting from wars, from an arousal of social consciousness, from the increased educational opportunities offered to women
Contemporary Nursing
  • Covers the period after the world war II to the present
  • Marked by scientific and technological developments as well as social changes

Historical Evolution of Nursing

Period of Intuitive Nursing/Medieval Period
  • Nursing was “untaught” and instinctive. It was performed of compassion for others, out of the wish to help others.
  • Nursing was a function that belonged to women. It was viewed as a natural nurturing job for women. She is expected to take good care of the children, the sick and the aged.
  • No caregiving training is evident. It was based on experience and observation.
  • Primitive men believed that illness was caused by the invasion of the victim’s body of evil spirits. They believed that the medicine man, Shaman or witch doctor had the power to heal by using white magic, hypnosis, charms, dances, incantation, purgatives, massage, fire, water and herbs as a mean of driving illness from the victim.
  • Trephining – drilling a hole in the skull with a rock or stone without anesthesia was a last resort to drive evil spirits from the body of the afflicted.
Period of Apprentice Nursing/Middle Ages
  • Care was done by crusaders, prisoners, religious orders
  • Nursing care was performed without any formal education and by people who were directed by more experienced nurses (on the job training). This kind of nursing was developed by religious orders of the Christian Church.
  • Nursing went down to the lowest level
    • Wrath/anger of Protestantism confiscated properties of hospitals and schools connected with Roman Catholicism.
    • Nurses fled their lives; soon there was shortage of people to care for the sick
    • Hundreds of Hospitals closed; there was no provision for the sick, no one to care for the sick
    • Nursing became the work of the least desirable of women – prostitutes, alcoholics, prisoners
  • Pastor Theodore Fliedner and his wife, Frederika established the Kaiserswerth Institute for the training of Deaconesses (the 1st formal training school for nurses) in Germany.
    • This was where Florence Nightingale received her 3-month course of study in nursing.
Period of Educated Nursing/Nightingale Era 19th-20th century
  • The development of nursing during this period was strongly influenced by:
  1. trends resulting from wars – Crimean, civil war
  2. arousal of social consciousness
  3. Increased educational opportunities offered to women.
  • Florence Nightingale was asked by Sir Sidney Herbert of the British War Department to recruit female nurses to provide care for the sick and injured in the Crimean War.
  • In 1860, The Nightingale Training School of Nurses opened at St. Thomas Hospital in London.
    • The school served as a model for other training schools. Its graduates traveled to other countries to manage hospitals and institute nurse-training programs.
    • Nightingale focus vision of nursing Nightingale system was more on developing the profession within hospitals. Nurses should be taught in hospitals associated with medical schools and that the curriculum should include both theory and practice.
    • It was the 1st school of nursing that provided both theory-based knowledge and clinical skill building.
  • Nursing evolved as an art and science
  • Formal nursing education and nursing service begun
Facts about Florence Nightingale
  • Mother of modern nursing. Lady with the Lamp because of her achievements in improving the standards for the care of war casualties in the Crimean war.
  • Born may 12, 1800 in Florence, Italy
  • Raised in England in an atmosphere of culture and affluence
  • Not contended with the social custom imposed upon her as a Victorian Lady, she developed her self-appointed goal: To change the profile of Nursing
  • She compiled notes of her visits to hospitals and her observations of the sanitary facilities, social problems of the places she visited.
  • Noted the need for preventive medicine and god nursing
  • Advocated for care of those afflicted with diseases caused by lack of hygienic practices
  • At age 31, she entered the Deaconesses School at Kaiserswerth in spite of her family’s resistance to her ambitions. She became a nurse over the objections of society and her family.
  • Worked as a superintendent for Gentlewomen Hospital, a charity hospital for ill governesses.
  • Disapproved the restrictions on admission of patients and considered this unchristian and incompatible with health care
  • Upgraded the practice of nursing and made nursing an honorable profession for women.
  • Led nurses that took care of the wounded during the Crimean war
  • Put down her ideas in 2 published books: Notes on Nursing, What It Is and What It Is Not and Notes on Hospitals.
  • She revolutionized the public’s perception of nursing (not the image of a doctor’s handmaiden) and the method for educating nurses.
Period of Contemporary Nursing/20th Century
  • Licensure of nurses started
  • Specialization of Hospital and diagnosis
  • Training of Nurses in diploma program
  • Development of baccalaureate and advance degree programs
  • Scientific and technological development as well as social changes marks this period.
    1. Health is perceived as a fundamental human right
    2. Nursing involvement in community health
    3. Technological advances – disposable supplies and equipments
    4. Expanded roles of nurses was developed
    5. WHO was established by the United Nations
    6. Aerospace Nursing was developed
    7. Use of atomic energies for medical diagnosis, treatment
    8. Computers were utilized-data collection, teaching, diagnosis, inventory, payrolls, record keeping, and billing.
    9. Use of sophisticated equipment for diagnosis and therapy

Health Promotion Guidelines Across Lifespan

  • To meet the fetal demands for oxygen, the pregnant mother gradually increases her normal blood flow by about one-third, peaking at about 8 months.
  • Respiratory rate and cardiac output increase significantly during this period.
  • Feta circulation travels from the placenta through umbilical arteries, which caries deoxygenated blood away from the fetus.
Nutrition and Fluids
  • The fetus obtains nourishment from the placental circulation and by swallowing amniotic fluid.
  • Nutritional needs are met when the mother eats a well-balanced diet containing sufficient calories and nutrients to meet both her needs and those of the fetus.
  • Adequate folic acid, one of the B vitamins, is important in order to prevent neural tube defects
  • Folic rich foods are green leafy vegetables, oranges, dried beans and suggest she take a vitamin supplement that contain folic acid.
Rest and Activity
  • The fetus sleeps most of the time and develops a pattern of sleep and wakefulness that usually persist after birth.
  • Fetal activity can be felt by the mother at about the fifth lunar month of pregnancy
  • Fetal feces are formed in the intestines from swallowed amniotic fluid throughout the pregnancy, but are normally not excreted until after birth.
  • Urine normally is excreted into the amniotic fluid when the kidneys mature (16 to 20 weeks).
Temperature Maintenance
  • Amniotic fluid usually provides a safe and comfortable temperature for the fetus.
  • Significant changes in the maternal temperature can alter the temperature of the amniotic fluid and the fetus.
  • Significant alter in temperature increases due to illness, hot whirlpool baths, or saunas may result in birth defects.
  • In the last weeks of gestation, the fetus develops subcutaneous fatty tissue stores that will help maintain body temperature at birth.
  • The body systems form during the embryonic period. As a result, the embryo is particularly vulnerable to damage from teratogen, which is anything that adversely affects normal cellular development in the embryo or fetus.
  • It is important for the nurse to inquire about possible pregnancy when giving medications that are known teratogens and also ask when the woman is scheduled for tests that involve radiography (x-ray).
  • Smoking, alcohol, and drugs can affect the environment for the fetus. Smoking has been associated with preterm labor, spontaneous abortion, low-birth weight infants, and sudden infant death syndrome and learning disorders.
  • Fetal alcohol syndrome (FAS), a result of impaired mitochondrial development, leads to microcephaly, mental retardation, learning disorders, and other central nervous system defects.
Health Examinations
  • Screening of newborns for hearing loss; follow-up at 3 months and early intervention by 6 months if appropriate
  • At 2 weeks and at 2,4,6, and 12 months
Protective Measures
  • Immunizations: diptheria,tetanus, acellular pertussis (DTaP), inactivated poliovirus vaccine (IVP), pneumococcal, measles-mumps-rubella (MMR), Haemophilus influenzae type B (HIB), hepatitis B (HepB), varicella and influenza vaccines as recommended
  • Fluoride supplements if there is adequate water fluoridation (less than 0.7 part per million)
  • Screening for tuberculosis
  • Screening for phenylketonuria (PKU) and other metabolic conditions
  • Prompt attention for illnesses
  • Appropriate skin hygiene and clothing
Infant Safety
  • Importance of supervision
  • Car seat, crib, playpen, bath, and home environment safety ,measures
  • Feeding measures (e.g., avoid propping bottle)
  • Provide toys with no small parts or sharp edges
  • Eliminate toxins in the environment (e.g., chemicals, radon, lead, mercury)
  • Use smoke and carbon monoxide (CO) detectors in home
  • Breast-feeding to age 12 months
  • Breast-feeding and bottle feeding techniques
  • Formula preparation
  • Feeding schedule
  • Introduction of solid foods
  • Need for iron supplements at 4 to 6 months
  • Characteristics and frequency of stool and urine elimination
  • Diarrhea and its effects
Rest/ Sleep
  • Establish routine for sleep and rest patterns
Sensory Stimulation
  • Touch: holding, cuddling, rocking
  • Vision: colorful, moving toys
  • Hearing: soothing voice tones, music, singing
  • Play: toys appropriate for development
Health Examinations
  • At 15 and 18 months and then as recommended by the primary care provider
  • Dental visit starting at age of 3 or earlier
Protective Measures
  • Immunizations: continuing DTaP, IPV series, pneumococcal, MMR, Haemophilus influenzae type B, hepatitis, hepatitis A, and influenza vaccines as recommended
  • Screenings for tuberculosis and lead poisoning
  • Fluoride supplements if there is inadequate water fluoridation (less than 0.7 part per million)
Toddler Safety
  • Importance of constant supervision and teaching child to obey commands
  • Home environment safety measures (e.g., lock medicine cabinet)
  • Outdoor safety measures (e.g., close supervision near water)
  • Appropriate toys
  • Eliminate toxins in environment (e.g., pesticides, herbicides, mercury, lead, arsenic in playground materials)
  • Use smoke and carbon monoxide (CO) detectors in home
  • Importance of nutritious meals and snacks
  • Teaching simple mealtime manners
  • Dental care
  • Toilet training techniques
  • Dealing with sleep disturbances
  • Providing adequate space and variety of activities
  • Toys that allow “acting on” behaviors and provide motor and sensory stimulation
Health Examinations
  • Every 1 to 2 years
Protective Measures
  • Immunizations: continuing DTaP, IPV series, MMR, hepatitis, pneumococcal, influenza, and other immunizations as recommended
  • Screenings for tuberculosis
  • Vision and hearing screening
  • Regular dental screenings and fluoride treatment
Preschooler Safety
  • Educating child about simple safety rules (e.g., crossing the street)
  • Teaching child to play safely (e.g., bicycle and playground safety)
  • Educating to prevent poisoning; exposure to toxic materials
  • Importance of nutritious meals and snacks
  • Teaching proper hygiene (e.g., washing hands after using bathroom)
Rest/ Sleep
  • Dealing with sleep disturbances (e.g., night terrors, sleepwalking)
  • Providing times for group play activities
  • Teaching child simple games that require cooperation and interaction
  • Providing toys and dress-ups for role-playing
School-Age Children
Health Examinations
  • Annual physical examination or as recommended
Protective Measures
  • Immunizations as recommended (e.g., MMR, meningococcal, tetanus-diphtheria, adult preparation [Td])
  • Screening for tuberculosis
  • Periodic vision, speech, and hearing screenings
  • Regular dental screenings and fluoride treatment
  • Providing accurate information about sexual issues (e.g., reproduction, AIDS)
School-Age Child Safety
  • Using proper equipment when participating in sports and other physical activities (e.g., helmets, pads)
  • Encouraging child to take responsibility for own safety (e.g., participating in bicycle and water safety courses)
  • Importance of child not skipping meals and eating balance diet
  • Experiences with food that may lead to obesity
  • Utilizing positive approaches for elimination problems (e.g., enuresis)
Play and Social Interactions
  • Providing opportunities for a variety of organized group activities
  • Accepting realistic expectations of child’s abilities
  • Acting as role models in acceptance of other persons who may be different
  • Providing a home environment that limits TV viewing and video games and encourages completion of homework and healthy exercise
Health Examinations
  • As recommended by the primary care provider
Protective Measures
  • Immunizations as recommended, such as adult tetanus –diphtheria vaccine, MMR, pneumococcal, and hepatitis B vaccine
  • Screening for tuberculosis
  • Periodic vision and hearing screenings
  • Regular dental assessments
  • Obtaining and providing accurate information about sexual issues
Adolescent Safety
  • Adolescent’s taking responsibility for using motor vehicles safely (e.g., completing a driver’s education course, wearing seat belt and helmet)
  • Making certain that proper precautions are taken during all athletic activities (e.g., medical supervision, proper equipment)
  • Parent’s keeping lines of communication open and being alert to signs of substance abuse and emotional disturbances in the adolescent
Nutrition and Exercise
  • Importance of healthy snacks and appropriate patterns of food intake and exercise
  • Factors that may lead to nutritional problems (e.g., obesity , anorexia nervosa, bulimia)
  • Balancing sedentary activities with regular exercise
Social Interactions
  • Encouraging and facilitating adolescent success in school
  • Encouraging adolescent to establish relationships that promote discussion of feelings, concerns, and fears.
  • Parents’ encouraging adolescent peer group activities that promote appropriate moral and spiritual values
  • Parents’ acting as role models for appropriate social interactions
  • Parents’ providing a comfortable home environment for appropriate adolescent peer group activities
  • Parents’ expecting adolescents to participate in and contribute to family activities
Young Adults
Health Test and Screenings
  • Routine physical examination (every 1 to 3 years for females; every 5 years for males)
  • Immunizations as recommended, such as tetanus-diphtheria boosters every 0 years, meningococcal vaccine if not given in early adolescence, and hepatitis B vaccine
  • Regular dental assessments (every 6 months)
  • Periodic vision and hearing screenings
  • Professional breast examination every 1 to 3 years
  • Papanicolaou smear annually within 3 years of onset of sexual activity
  • Testicular examination every year
  • Screening for cardiovascular disease (e.g., cholesterol test every 5 years if results are normal; blood pressure to detect hypertension; baseline electrocardiogram at age 35)
  • Tuberculosis skin test every 2 years
  • Smoking: history and counseling if needed
  • Motor vehicle safety reinforcement (e.g., using designated drivers when drinking, maintaining brakes and tires)
  • Sun protection measures
  • Workplace safety measures
  • Water safety reinforcement (e.g., no diving in shallow water)
Nutrition and Exercise
  • Importance of adequate iron intake in diet
  • Nutritional and exercise factors that may lead to cardiovascular disease (e.g., obesity, cholesterol, and fat intake, lack of vigorous exercise)
Social Interactions
  • Encouraging personal relationship that promote discussion of feelings, concerns, and fears
  • Setting short-and long- term goals for work and career choices
Middle-Aged Adults
Health Test and Screening
  • Physical examination (every 3 to 5 years until age 40, then annually)
  • Immunizations as recommended, such as a tetanus booster every 10 years, and current recommendations for influenza vaccine.
  • Regular dental assessments (e.g., every 6 months)
  • Tonometry for signs of glaucoma and other eye diseases every 2 to 3 years or annually if indicated
  • Breast examination annually by primary care provider
  • Testicular examination annually by primary care provider
  • Screenings for cardiovascular disease (e.g., blood pressure measurement; electrocardiogram and cholesterol test as directed by the primary care provider)
  • Screenings for colorectal, breast, cervical, uterine, and prostate cancer
  • Screening for tuberculosis every 2 years
  • Smoking: history and counseling, if needed
  • Motor vehicle safety reinforcement, especially when driving at night
  • Workplace safety measures
  • Home safety measures: keeping hallways and stairways lighted and uncluttered, using smoke detector, using nonskid mats and handrails in the bathrooms
Nutrition and Exercise
  • Importance of adequate protein, calcium, and vitamin D in diet
  • Nutritional and exercise factors that may lead to cardiovascular disease (e.g., obesity, cholesterol and fat intake, lack of vigorous exercise)
  • An exercise program that emphasizes skill and coordination
Social Interactions
  • The possibility of a middle crisis: encourage discussion of feelings, concerns, and fears
  • Providing time to expand and review previous interests
  • Retirement planning (financial and possible diversional activities), with partner if appropriate
Health Test and Screening
  • Total cholesterol and high density lipid protein measurement every 3 to 5 years until age 75
  • Aspirin, 81 mg daily, if in high- risk group
  • Diabetes mellitus screen every 3 years, if in high-risk group
  • Smoking cessation
  • Screening mammogram every 1 to 2 years (women)
  • Clinical breast exam annually (women)
  • Pap smear annually if there is a history of abnormal smears or previous hysterectomy of malignancy (United States Preventive Services Task Force, 2003)
    • Older women who have regular, normal Pap smear or hysterectomy for nonmalignant causes do NOT need Pap smear beyond the age of 65
  • Annual digital rectal exam
  • Annual prostate-specific antigen (PSA)
  • Annual fecal occult blood test (FOBT)
  • Sigmoidoscopy every 5 years; colonoscopy every 10 years
  • Visual acuity screen annually
  • Hearing screen annually
  • Depression screen periodically
  • Family violence screen periodically
  • Height and weight measurements annually
  • Sexually transmitted disease testing, if high- risk group
  • Annual flu vaccine if over 65 or in high-risk group
  • Pneumococcal vaccine at 65 and every 10 years thereafter
  • Td vaccine every 10 years
  • Home safety measures to prevent falls, fire, burns, scalds, and electrocution
  • Working smoke detectors and carbon monoxide detectors in the home
  • Motor vehicle safety reinforcement, especially when driving at night
  • Elder driver skills evaluation (some states require for license renewal)
  • Precautions to prevent pedestrian accidents
Nutrition and Exercise
  • Importance of a well-balanced diet with fewer calories to accommodate lower metabolic rate and decreased physical activity
  • Importance of sufficient amounts of vitamin D and calcium to prevent osteoporosis
  • Nutritional and exercise factors that may lead to cardiovascular disease (e.g., obesity, cholesterol and fat intake, lack of exercise)
  • Importance of 30 minutes of moderate physical activity daily; 20 minutes of vigorous physical activity 3 times per week
  • Importance of adequate roughage in the diet, adequate exercise, and at least six 8-once glasses of fluid daily to prevent constipation
Social Interaction
  • Encouraging intellectual and recreational pursuits
  • Encouraging personal relationships that promote discussion of feelings, concerns, and fears
  • Assessment of risk factors for maltreatment
  • Availability of social community centers and programs for seniors