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

Abdominal Aortic Aneurysm Nursing Care Plan and Management

  • An aortic aneurysm is an abnormal dilation of the arterial wall caused by localized weakness and stretching in the medial layer or wall of an artery.
  • The aneurysm can be located anywhere along the abdominal aorta.
  • The goal of treatment is to limit the progression of the disease by modifying risk factors , controlling the BP to prevent strain on the aneurysm, recognizing symptoms early, and preventing rupture.
Abdominal Aortic Aneurysm
  1. Prominent, pulsating mass in abdomen, at or above the umbilicus
  2. Systolic bruit over the aorta
  3. Tenderness on deep palpation
  4. Abdominal or lower back pain
Diagnostic Evaluation
  1. Chest radiograph, angiogram, transesophageal echocardiography, and magnetic resonance imaging(MRI).
  2. Duplex ultrasonography or computed tomography (CT)
Primary Nursing Diagnosis
  • Risk for fluid volume deficit related to hemorrhage
Other Diagnoses that may occur in Nursing Care Plans For Abdominal Aortic Aneurysm
  • Acute pain related to surgical tissue trauma
  • Anxiety related to threat to health status
  • Decreased cardiac output related to:
    • changes in intravascular volume
    • increased systemic vascular resistance
    • third-space fluid shift
  • Deficient knowledge (preoperative and postoperative care) related to newly identified need for aortic surgery
  • Ineffective breathing pattern related to:
    • effects of general anesthesia
    • endotracheal intubation
    • presence of an abdominal incision
Medical Management
Medical or surgical treatment depends on the type of aneurysm. For a rupture aneurysm, prognosis is poor and surgery is performed immediately. When surgery can be delayed, medical measures include:
  • Strict control of blood pressure and reduction in pulsatile flow.
  • Systolic pressure maintained at 100 to 120 mm Hg with antihypertensive drugs, such as nitroprusside.
  • Pulsatile flow reduced by medications that reduce cardiac contractility, such as propanolol.
Surgical Management
  • Removal of the aneurysm and restoration of vascular continuity with a graft (resection and bypass graft or endovascular grafting) is the goal of surgery and the treatment of choice for abdominal aortic aneurysms larger than 5.5 cm (2 inches) in diameter or those that are enlarging. Intensive monitoring in the critical care unit is required.
Nonsurgical Intervention
  1. Modify risk factors.
  2. Instruct the client regarding the procedure for monitoring BP.
  3. Instruct the client on the importance of regular physician visits to follow the size of the aneurysm.
  4. Instruct the client that if severe back or abdominal pain or fullness, soreness over the umbilicus, sudden development of discoloration in the extremities, or a persistent elevation of BP occurs to notify the physician immediately.
  5. Instruct the client with a thoracic aneurysm to report immediately the occurrence of chest or back pain, shortness of breath, difficulty swallowing, or hoarseness.
Pharmacologic Highlights
  1. 1-10 mg IV of opioid analgesic (morphine) to relieve surgical pain.
  2. 50–100 mcg IV of opioid analgesic (Fentanyl) to relieve surgical pain.
  3. Antihypertensives and/or diuretics for rising BP may stress graft suture lines.
  4. 80-400 mg/day in divide doses of Beta blocker (propanolol) to use in people with small aneurysms without risk for rupture; decreases rate of AAA expansion
Nursing Intervention
  1. Monitor vital signs.
  2. Assess risk factors for the arterial disease process.
  3. Obtain information regarding back or abdominal pain.
  4. Question the client regarding the sensation of palpation in the abdomen.
  5. Inspect the skin for the presence of vascular disease or breakdown.
  6. Check peripheral circulation, including pulses,temperature, and color.
  7. Observe for signs of rupture.
  8. Note any tenderness over the abdomen.
  9. Monitor for abdominal distention.
Documentation Guidelines
  • Location,intensity,and frequency of pain,and the factors that relieve pain
  • Appearance of abdominal wound (color,temperature,intactness,drainage)
  • Evidence of stability of vital signs,hydration status,bowel sounds,electrolytes
  • Presence of complications: Hypotension, hypertension, cardiac dysrhythmias, low urine out- put,thrombophlebitis,infection,graft occlusion,changes in consciousness,aneurysm rupture, excessive anxiety,poor wound healing
Discharge and Home Healthcare Guidelines
  1. Wound care. Explain the need to keep the surgical wound clean and dry. Teach the patient to observe the wound and report to the physician any increased swelling,redness,drainage,odor,or separation of the wound edges. Also instruct the patient to notify the physician if a fever develops.
  2. Activity restriction. Instruct the patient to lift nothing heavier than 5 pounds for about 6 to 12 weeks and to avoid driving until her or his physician permits. Braking while driving may increase intra-abdominal pressure and disrupt the suture line. Most surgeons temporarily discourage activities that require pulling, pushing, or stretching—activities such as vacuuming,changing sheets,playing tennis and golf,mowing grass,and chopping wood.
  3. Smoking cessation. Encourage the patient to stop smoking and to attend smoking cessation classes.
  4. Complications following surgey. Discuss with the patient the possibility of clot formation or graft blockage.
  5. Complicatios for patients not requiring surgery. Compliance with the regime of monitoring the size of the aneurysm by computed tomography over time is essential. The patient needs to understand the prescribed medication to control hypertension. Advise the patient to report abdominal fullness or back pain,which may indicate a pending rupture.

Amyotrophic Lateral Sclerosis (ALS) Nursing Care Plan and Management

  • Amyotrophic lateral sclerosis (ALS) is a disease of unknown cause in which there is a loss of motor neurons (nerve cells controlling muscles) in the anterior horns of the spinal cord and the motor nuclei of the lower brain stem.
  • It is often referred to as Lou Gehrig’s disease.
Risk Factors
  • Autoimmune
  • Free radical damage
  • Oxidative stress
  • Cigarette smoking
  • As motor neuron cells die, the muscle fibers that they supply undergo atrophic changes. Neuronal degeneration may occur in both the upper and lower motor neuron systems.
  • The leading theory held by researchers is that over excitation of nerve cells by the neurotransmitter glutamate leads to cell injury and neuronal degeneration.
Assessment/Clinical Manifestations/Signs and Symptoms
The signs and symptoms presented depend on the location of the affected neuron. Generally, the following presentations are evident:
  • Fatigue
  • Progressive muscle weakness
  • Cramps
  • Twitching
  • Incoordination
Anterior horns
  • Progressive weakness
  • Muscle atrophy (arms, trunk, legs)
  • Spasticity
  • Brisk or overreactive muscle reflexes
Cranial nerves
  • Muscle weakness
  • Difficulty talking
  • Difficulty swallowing
  • Difficulty breathing
  • Soft palate and upper esophageal weakness
  • Weakness on the posterior tongue
Bulbar muscles
  • Progressive difficulty in speaking
  • Difficulty in swallowing
  • Articulation and speech effects
  • Compromised respiratory function
Diagnostic Tests
The following tests and assessment tools are used to verify the presence of Amyotrophic Lateral Sclerosis:
  • EMG studies of affected muscles indicate reduction in the number of functioning motor units
  • MRI may show high signal intensity in the corticospinal tracts
Medical Management
No specific therapy exists for ALS. The main focus of medical and nursing management is on interventions to maintain or improve function, well-being and quality of life.
  • Symptomatic treatment and rehabilitative measures are employed to support the patient and improve the quality of life.
  • Baclofen (Lioresal), dantrolene sodium (Dantrium), or diazepam (Valium) may be useful for patients troubled by spasticity, which causes pain and interferes with self-care.
  • A patient experiencing problems with aspiration and swallowing may require enteral feeding.
  • Mechanical ventilation (using negative-pressure ventilators) is an option if alveolar hypoventilation develops.
  • Patients are encouraged to complete an advance directive or “living will” to preserve their autonomy in decision making.
Nursing Diagnosis
  • Impaired mobility related to muscle wasting, weakness, and spasticity
  • Impaired communication related to impairment of the muscles of speech
  • High risk for aspiration related to impaired muscles of swallowing
  • Ineffective breathing pattern related to impaired muscles of breathing
Nursing Management
  1. Provide intellectual stimulating activities, because the client typically experiences no cognitive deficits and retains mental abilities.
  2. Provide client and family teaching.
  3. Promote measures to enhance body image.
  4. Promote client and family coping as the client and his family deal with the poor prognosis and the grieving process
  5. Provide referrals.
  6. Maximize functional abilities
    • Prevent complications of immobility
    • Promote self-care
    • Maximize effective communication
  7. Ensure adequate nutrition
  8. Prevent respiratory complications
    • Promote measures to maintain adequate airway
    • Promote measures to enhance gas exchange, such as oxygen therapy and ventilator assistance.
    • Promote measures to prevent respiratory infection


Generic Name : cholestyramine
Brand Name: Cholestyramine Light, Prevalite, Questran, Questran Light
Classification: Antihyperlipidemic, Bile acid sequestrant
Pregnancy Category Not Established
Dosage & Route
  • Initially, 4 g one to two times per day PO. Individualize dose based on response. For maintenance, 8–16 g/day divided into two doses. Increase dose gradually with periodic assessment of lipid/lipoprotein levels at intervals of > 4 wk. Maximum dose 6 packets or scoopfuls. May be administered 1–6 doses/day. Dosage may be as high as 36 g every day.
    • Skin and skin structure infections: 500 mg PO q 12 hr. Larger doses may be needed in severe cases; do not exceed 4 g/day.
Pediatric Patients
  • Safety and efficacy not established.
Therapeutic actions
  • Binds bile acids in the intestine, allowing excretion in the feces; as a result, cholesterol is oxidized in the liver to replace the bile acids lost; serum cholesterol and LDL are lowered.
  • Adjunctive therapy: Reduction of elevated serum cholesterol in patients with primary hypercholesterolemia (elevated LDL)
  • Pruritus associated with partial biliary obstruction
  • Unlabeled uses: Antibiotic-induced pseudomembranous colitis; chlordecone (Kepone) pesticide poisoning to bind the poison in the intestine; treatment of thyroid hormone overdose, treatment of digitalis toxicity
Adverse effects
  • Constipation; fecal impaction; hemorrhoids; abdominal discomfort or pain; heartburn; flatulence; nausea; vomiting; diarrhea; increased bleeding tendency (chronic use); osteoporosis; stetorrhea (high doses); skin rashes; pruritus of the tongue, skin and perianal region; hyperchloremic acidosis.
  • Complete biliary obstruction; hypersensitivity.
Nursing considerations
  • History: Allergy to bile acid sequestrants, tartrazine; complete biliary obstruction; abnormal intestinal function; lactation, pregnancy
  • Physical: Skin lesions, color, T; orientation, affect, reflexes; P, auscultation, baseline ECG, peripheral perfusion; liver evaluation, bowel sounds; lipid studies, LFTs, clotting profile
  • Mix contents of one packet or one level scoop of powder with 2–6 fluid oz of beverage (water, milk, fruit juices, noncarbonates), highly fluid soup, pulpy fruits (applesauce, pineapple); do not give drug in dry form.
  • Administer drug before meals.
  • WARNING: Monitor intake of other oral drugs due to risk of binding in the intestine and delayed or decreased absorption, give oral medications 1 hr before or 4–6 hr after the cholestyramine.
  • Alert patient and concerned others about high cost of drug.
Teaching points
  • Take drug before meals; do not take the powder in the dry form; mix one packet or one scoop with 2–6 ounces of fluid—water, milk, juice, noncarbonated drinks, highly fluid soups, cereals, pulpy fruits such as applesauce or pineapple.
  • Take other medications 1 hour before or 4–6 hours after cholestyramine.
  • You may experience these side effects: Constipation (ask about measures that may help); nausea, heartburn, loss of appetite (eat frequent small meals); dizziness, drowsiness, vertigo, fainting (avoid driving and operating dangerous machinery); headache, muscle and joint aches and pains (may lessen with time).
  • Report unusual bleeding or bruising, severe constipation, severe GI upset, chest pain, difficulty breathing, rash, fever.


Chlorpheniramine maleate is an antihistamine indicated for symptomatic relief of symptoms associated with
perennial and seasonal allergic rhinitis; vasomotor rhinitis; allergic conjunctivitis.
Generic Names & Brand Names
chlorpheniramine maleate
(klor fen ir a meen)
Aller-Chlor; Allergy; Chlo-Amine; Chlor-Trimeton Allergy 4 hr, 8 hr, and
12 hr; Chlor-Tripolon (CAN); Efidac 24
Pregnancy Category B
Drug class
Antihistamine (alkylamine type)
Therapeutic actions
Competitively blocks the effects of histamine at H1-receptor sites; has atropine-like, antipruritic, and sedative effects.
  • Symptomatic relief of symptoms associated with perennial and seasonal allergic rhinitis; vasomotor rhinitis; allergic conjunctivitis.
Contraindications and cautions
  • Contraindicated with allergy to any antihistamines, narrow-angle glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, asthmatic attack, bladder neck obstruction, pyloroduodenal obstruction, third trimester of pregnancy, lactation.
  • Use cautiously in pregnancy.
Available forms
Chewable tablets—2 mg; tablets—4 mg; ER tablets—8, 12, 16 mg; syrup—2 mg/5 mL; SR capsules—8, 12 mg
Tablets or syrup
  • 4 mg PO q 4–6 hr; do not exceed 24 mg in 24 hr.
  • 8–12 mg PO hs or q 8–12 hr during the day; do not exceed 24 mg in 24 hr.
Extended-release (Efidac 24)
  • 16 mg with liquid PO q 24 hr.
Tablets or syrup
  • 2–< 6 yr: 1 mg q 4–6 hr PO; do not exceed 4 mg in 24 hr.
  • 6–12 yr: 2 mg q 4–6 hr PO; do not exceed 12 mg in 24 hr.
  • < 6 yr: Not recommended.
  • 6–12 yr: 8 mg PO hs or during the day.
  • More likely to cause dizziness, sedation, syncope, toxic confusional states, and hypotension in elderly patients; use with caution.
Oral0.5–6 hr2–6 hr
Metabolism: Hepatic; T1/2: 12–15 hr
Distribution: Crosses placenta; may enter breast milk
Excretion: Urine
Adverse effects
  • CNS: Drowsiness, sedation, dizziness, disturbed coordination, fatigue, confusion, restlessness, excitation, nervousness, tremor, headache, blurred vision, diplopia, vertigo, tinnitus, acute labyrinthitis, hysteria, tingling, heaviness and weakness of the hands
  • CV: Hypotension, palpitations, bradycardia, tachycardia, extrasystoles
  • GI: Epigastric distress, anorexia, increased appetite and weight gain, nausea, vomiting, diarrhea or constipation
  • GU: Urinary frequency, dysuria, urinary retention, early menses, decreased libido, impotence
  • HematologicHemolytic anemia, hypoplastic anemia, thrombocytopenia, leukopenia, agranulocytosis, pancytopenia
  • Respiratory: Thickening of bronchial secretions, chest tightness, wheezing, nasal stuffiness, dry mouth, dry nose, dry throat, sore throat
  • Other: Urticaria, rash, anaphylactic shock, photosensitivity, excessive perspiration, chills
  • Increased depressant effects with alcohol, other CNS depressants
Nursing considerations
  • History: Allergy to any antihistamines; narrow-angle glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, asthmatic attack, bladder neck obstruction, pyloroduodenal obstruction, pregnancy, lactation
  • Physical: Skin color, lesions, texture; orientation, reflexes, affect; vision examination; P, BP; R, adventitious sounds; bowel sounds; prostate palpation; CBC with differential
  • Administer with food if GI upset occurs.
  • Caution patient not to crush or chew SR preparations.
  • Arrange for periodic blood tests during prolonged therapy.
Teaching points
  • Take as prescribed; avoid excessive dosage. Take with food if GI upset occurs; do not cut, crush, or chew the SR preparations.
  • Avoid OTC drugs; many contain ingredients that could cause serious reactions if taken with this antihistamine.
  • Avoid alcohol; serious sedation may occur.
  • You may experience these side effects: Dizziness, sedation, drowsiness (use caution driving or performing tasks that require alertness); epigastric distress, diarrhea, or constipation (take with meals; consult care provider if severe); dry mouth (frequent mouth care; sucking on sugarless lozenges may help); thickening of bronchial secretions, dryness of nasal mucosa (use a humidifier).
  • Report difficulty breathing; hallucinations, tremors, loss of coordination; unusual bleeding or bruising; visual disturbances; irregular heartbeat.

Amoebiasis Nursing Management Nursing Management

  • Amoebiasis is an infection of small intestine, which is caused by an protozoan called Entamoeba histolytica. It is simply called – Amoebic dysentery. This is usually contracted by ingesting water or food contaminated by amoebic cysts. Amoebic abscesses may form in the liver , lungs , and brain and elsewhere in the body.
  • Amoebae are parasites that can be very easily found in contaminated food or drink. They enter the body through the mouth when the contaminated food or drink is swallowed. The amoebae are then able to move through the digestive system and take up residence in the intestine and cause infections like amoebiasis.
Amoebiasis and Amoeba
There are several different species of amoeba, but the most dangerous, such as Entamoeba histolytica, live predominantly in tropical areas. People living in rural areas or persons traveling in such areas are at highest risk of developing this disease, which occurs when something infected with the parasite is eaten or swallowed.
There are mainly two types of amoebiasis:-
  • Intestinal Amoebiasis:- It is frequently asymptomatic and varies from fulminant dysentery with fever, chills, and bloody or mucoid diarrhea to mild abdominal discomfort with diarrhea containing blood or mucus alternating with periods of constipation or remission.
  • Extraintestinal Amoebiasis:- It occurs when the parasite invades other organs such as liver, lung, brain or skin. The incubation period varies from a few days to several months or years (commonly 2-4 weeks).
Causes of Amoebiasis:
The main cause of amoebiasis is- single cell parasite called entamoeba histolytica.  The parasite burrows into the wall of the intestine to cause small abscesses and ulcers . From there they enter the veins of the intestine and are carried to the liver .
Even though there is constant spread of infection, (within a family) some people are resistant to amoebiasis. Even if infected, they only act as a carrier to the disease and do not develop themselves. This shows that the ultimate cause of suffering is hidden than the exposed causative factor i.e. amoeba.
Some Possible Causes of Amoebiasis includes:-
  • Eating or Drinking contaminated water or food is one of the primary cause of amoebiasis.
  • Touching, and bringing to your mouth, cysts (eggs) picked up from surfaces that are contaminated with entamoeba histolytica.
  • Eating a food on which mosquito had sat, after sitting on the stool of a person infected with entamoeba histolytica, may lead to amoebiasis.
  • Eating vegetables and fruits which have been contaminated by the harmful bacteria, may cause amoebiasis.
  • Eating Non-Veg foods (meat and intestines of animals – goat, pig, beef, etc.), may lead to the condition of amoebiasis.
  • Even vegetables grown in soil contaminated by faeces can transmit the disease.
  • As, amoebiasis is a highly contagious disease – so, it may be transmitted from one person to other through direct contact.
  • Unhygienic Conditions and Poor Sanitation areas are more susceptible to amoebiasis.
  • Amoebic dysentery can also be spread by anal sex or directly from person to person contact.
Risk factors
  • Alcoholism
  • Cancer
  • Malnutrition
  • Older or younger age
  • Pregnancy
  • Recent travel to a tropical region
  • Use of corticosteroid medication to suppress the immune system
Signs and Symptoms
The symptoms are in two forms:
1. By burrowing the intestines and making ulcers, which bleed and cause anaemia or other diseases due to added infection
2. Absorbing the food from the host or letting out toxic substances in the intestines
Some important symptoms of amoebiasis includes:-
  • Passing of more number of stools is one of the main symptom in amoebiasis. In this case, patient may pass about 10-12 stools during an acute episode. The presence of mucus is common in stools.
  • Stools can sometimes also be accompanied with blood
  • Usually symptoms start with diarrhea and pain in right hypochondrium.
  • Jaundice.
  • The other most common symptom is colic or pain in abdomen.
  • It could be associated with a low-grade fever too.
  • Sometimes allergic reactions can occur throughout the body, due to release of toxic substances or dead parasites inside the intestines.
  • Loss of Weight and Stamina is encountered with person suffering from amoebiasis.
  • Around one in ten people who are infected with amoebiasis become ill from the disease.
  • Tenesmus, may occur during amoebiasis.
  • Foul smelling stools.
  • Loss of Appetite.
  • There will be pain over the liver, when pressure is applied just under the ribs on the right side.
  • Stomach Cramps.
  • Amoebic liver abscesses can also present as pyrexia of unknown origin. The abscess can sometimes rupture into the pleural, peritoneal or pericardial cavities.
  • You will feel weakness or tiredness, if you are suffering from amoebiasis.
  • Pain in the right shoulder could occur in chronic condition.
  • Nausea.
Pathophysiology of Amoebiasis
When cyst is swallowed, it passes through the stomach unharmed and shows no activity while in an acidic environment. When it reaches the alkaline medium of the intestine, the metacyst begins to move within the cyst wall, which rapidly weakens and tears. The quadrinucleate amoeba emerges and divides into amebulas that are swept down into the cecum. This is the first opportunity of the organism to colonize, and its success depends on one or more metacystic trophozoites making contact with the mucosa.Mature cyst in the large intestines leaves the host in great numbers (the host remains asymptomatic). The cyst can remain viable and infective in moist and cool environment for at least 12 days, and in water for 30 days. The cysts are resistant to levels of chlorine normally used for water purification. They are rapidly killed by purification, desiccation and temperatures below 5 and above 40 degrees.
The metacystic trophozoites of their progenies reach the cecum and those that come in contact with the oral mucosa penetrate or invade the epithelium by lytic digestion.
The trophozoites burrow deeper with tendency to spread laterally or continue the lysis of cells until they reach the sub-mucosa forming flash-shape ulcers. There may be several points of penetration.
From the primary site of invasion, secondary lesions maybe produced at the lower level of the large intestine.
Progenies of the initial colonies are squeezed out to the lower portion of the bowel and thus, have the opportunity to invade and produce additional ulcers. Eventually, the whole colon may be involved.
E. histolytica has been demonstrated in practically every soft organ of the body.
Trophozoites which reach the muscularis mucosa frequently erode the lymphatics or walls of the mesenteric venules in the floor of the ulcers, and are carried to the intrahepatic portal vein.
If thrombi occur in the small branches of the portal veins, the trophozoites in thrombi cause lytic necrosis on the wall of the vessels and digest a pathway into the lobules.
The colonies increase in size and develop into abscess.
  • A typical liver abscess develops and consists of:
  • Central zone necrosis
  • Median zone of stoma only
  • An outer zone of normal tissue newly invaded by amoeba. Most amoebic abscess of the liver are in the right lobe.
Next to the liver, the organ which is the frequent site of extra-intestinal amoebiasis is the lungs. This commonly develops as an extension of the hepatic abscess.
patho of amoebiasis
Etiologic Agent
Enatamoeba Histolytica
  • Prevalent in unsanitary areas
  • Common in warm climate
  • Acquired by swallowing
  • Cysts survives a few days outside of the body
  • Cyst passes to the large intestine and hatch into trophozoites. It passes into the mesenteric veins, to the portal vein, to the liver, thereby forming amoebic liver abscess.
  • Entamoeba Histolytica has two developmental stages:
    1. Trophozoites/vegetative form
      • Trophozoites are facultative parasites that may invade the tissues or may be found in the parasitized tissues and liquid colonic contents.
    2. Cyst
      • Cyst is passed out with formed or semi-formed stools and are resistant to environmental conditions.
      • This is considered as the infective stage in the cycle of E. histolytica
Source: Human Excreta
Incubation Period: The incubation period in severe infection is three days. In subacute and chronic form it lasts for several months. In average cases the incubation period varies from three to four weeks
Period of Communicability: The microorganism is communicable for the entire duration of the illness.
Modes of Transmission:
  1. The disease can be passed from one person to another through fecal-oral transmission.
  2. The disease can be transmitted through direct contact, through sexual contact by orogenital, oroanal, and proctogenital sexual activity.
  3. Through indirect contact, the disease can infect humans by ingestion of food especially uncooked leafy vegetables or foods contaminated with fecal materials containing E. histolytica cysts.
Food or drinks maybe contaminated by cyst through pollution of water supplies, exposure to flies, use of night soil for fertilizing vegetables, and through unhygienic practices of food handlers.
Diagnosis of Amoebiasis / Amoebic Dysentery
  • Stool examination – Microscopic examination for identifying demonstrable E.H cysts or trophozoites in stool samples is the most confirmative method for diagnosis. Trophozoites survive only for a few hours, so the diagnosis mostly goes with the presence of cysts. But fresh warm faeces always show trophozoites. The cysts are identified by their spherical nature with chromatin bars and nucleus. They are noticed as brownish eggs when stained with iodine.
  • Biopsy also can point out E.H cysts or trophozoites.
  • Culture of the stool also can guide us for diagnosis.
  • Blood tests may suggest infection which may be indicated as leucocytosis (increased level of white blood cells), also it can indicate whether any damage to the liver has occurred or not.
  • Ultrasound scan – it should be performed when a liver abscess is suspected
Medical Management
  • Metronidazole (Flagyl) 800mg TID X 5 days
  • Tetracyline 250 mg every 6 hours
  • Ampicillin, quinolones sulfadiazine
  • Streptomycin SO4, Chloramphenicol
  • Lost fluid and electrolytes should be replaced
Several antibiotics are available to treat amoebiasis. Treatment must be prescribed by a physician. You will be treated with only one antibiotic if your E. histolytica infection has not made you sick. You probably will be treated with two antibiotics (first one and then the other) if your infection has made you sick.
Nursing Management
  1. Observe isolation and enteric precaution2.Provide health education:
    • Boil water for drinking or use purified water;
    • Avoid washing food from open drum or pail;
    • Cover leftover food;
    • Wash hands after defecation or before eating; and
    • Avoid ground vegetables (lettuce, carrots, and the like).
  2. Proper collection of stool specimen
    • Never give paraffin or any oil preparation for at least 48 hours prior to collectionof specimen.
    • Instruct patient to avoid mixing urine with stools.
    • If whole stool cannot be sent to laboratory, select as much portion as possiblecontaining blood and mucus.
    • Send specimen immediately to the laboratory; stool that is not fresh is nearlyuseless for examination
    • Label specimen properly.
  3. Skin care
    • Cleanliness, freedom from wrinkles on the sheet will be helpful with all the usual precautionary measures against pressure sores.
  4. Mouth care
  5. Provide optimum comfort.
    • Patient should be kept warm. Dysenteric patient should never be allowed to feel,even for a moment.
  6. Diet
    • During the acute stage, fluids should be forced.
    • In the beginning of an attack, cereal and strained meat broths without fat should be given.
    • Chicken and fish maybe added when convalescence is established.
    • Bland diet without cellulose or bulk-producing food should be maintained for along time.
Common Nursing Diagnosis
  • Altered nutrition: Less than body requirement
  • Alteration in bowel elimination
  • High risk for infection
  • Anxiety
  • Altered body temperature
Methods of Prevention
  1. Health education
  2. Sanitary disposal of feces
  3. Protect, chlorinate, and purify drinking water
  4. Observe scrupulous cleanliness in food preparation and food handling
  5. Detection and treatment of carriersf.Fly control (they can serve as vector)

Acute Respiratory Distress Syndrome Nursing Care Plan & Management

  1. Acute respiratory distress syndrome is a form of acute respiratory failure that occurs as a complication of some other condition, is caused by a diffuse lung injury, and leads to extravascular lung fluid.
  2. The major site of injury is the alveolar capillary membrane.
  3. The interstitial edema causes compression and obliteration of the terminal airways and leads to reduced lung volume and compliance.
  4. The ABG’s identify respiratory acidosis and hypoxemia that does not respond to an increase percentage of oxygen.
  5. The chest X-ray film shows interstitial edema.
  6. Some of the causes includes sepsis, fluid overload, shock, trauma, neurological injuries, burns, disseminated intravascular coagulation, drug ingestion and inhalation of toxic substances.
Acute Respiratory Distress Syndrome
Causes & Risk Factors
ARDS can be caused by any major swelling (inflammation) or injury to the lung. Some common causes include:
  • Breathing vomit into the lungs (aspiration)
  • Inhaling chemicals
  • Pneumonia
  • Septic shock
  • Trauma
ARDS leads to a buildup of fluid in the air sacs. This fluid prevents enough oxygen from passing into the bloodstream.
The fluid buildup also makes the lungs heavy and stiff, and decreases the lungs’ ability to expand. The level of oxygen in the blood can stay dangerously low, even if the person receives oxygen from a breathing machine (mechanical ventilator) through a breathing tube (endotracheal tube).
ARDS often occurs along with the failure of other organ systems, such as the liver or the kidneys. Cigarette smoking and heavy alcohol use may be risk factors.
  1. Tachypnea
  2. Dyspnea
  3. Decrease breath sounds
  4. Deteriorating gas levels
  5. Hypoxemia despite high concentration of delivered oxygen
  6. Decreased pulmonary compliance
  7. Pulmonary infiltrates
Diagnostic Evaluation
  1. Based on clinical criteria history of risk factors acute onset of respiratory distress bilateral pulmonary infiltrates absence of left heart failure and severe refractory hypoxemia.
  2. Chest X-ray shows bilateral infiltrates and pulmonary edema.
Primary Nursing Diagnosis
  • Impaired gas exchange related to increased alveolar-capillary permeability, interstitial edema and decreased lung compliance
Other Diagnoses that may occur in Nursing Care Plans For ARDS
  • Ineffective airway clearance
  • Ineffective breathing pattern
  • Activity intolerance
  • Anxiety (specify level: mild, moderate, severe, panic)
  • Risk for aspiration
Medical Management
  • Identify and treat the underlying condition insure early detection; use aggressive supportive treatment; prevent infection ( intubation and mechanical ventilation).
  • As disease progresses, use positive and expiratory pressure PEEP ( neuromuscular blocking agent such as pancuronium (pavulon and vecuronium) (norcuron) maybe used to paralyzed patient for easier ventilation.
  • Monitor arterial blood gas values , pulse symmetry , and pulmonary function testing.
  • Provide circulatory support; treat hypovolemia carefully ; avoid overload
  • Provide adequate fluid management ; administer intravenous solutions
  • Provide nutritional support; (35 to 45 kilocalories per kilogram daily)
  • Pharmacologic therapy may include human recombinant interleukin-1 receptor antagonist, neutrophil inhibitors, pulmonary- specific vasodilators, surfactant replacement therapy, antisepsis agents, antioxidant therapy, and corticosteroids (late in the course of ARDS).
Pharmacologic Intervention
  • General Comments: Use of genetically engineered surfactant has been studied in ARDS but has not demonstrated the success that has occurred in premature infants with surfactant deficiency. Corticosteroids have been widely used in ARDS, yet studies have not consistently demonstrated any improvement in patient outcomes and remain controversial. Some evidence exists that prolonged treatment with low-dose corticosteroids may benefit patients with unresolving ARDS, particularly by reversing the process of fibroproliferation. If the patient is difficult to ventilate, she or he may receive skeletal muscle relaxants such as vecuronium (Norcuron), which are neuromuscular-blocking agents that paralyze the patient’s skeletal muscles. These medications are used only when the patient’s gas exchange is so poor as to threaten his or her life. Neuromuscular-blocking agents paralyze the patient without affecting mental status, so the patient requires sedation to counteract the accompanying fear and anxiety that occur when the patient is unable to move.
  • Nitric oxide Inhalation route a pulmonary vascular vasodilator to decreases pulmonary vascular resistance with increased perfusion to ventilated areas
Nursing Intervention
  1. Identify and treat cause of the Acute respiratory distress syndrome
  2. Administer oxygen as prescribed.
  3. Position client in high fowler’s position.
  4. Restrict fluid intake as prescribed.
  5. Provide respiratory treatment as prescribed.
  6. Administer diuretics, anticoagulants or corticosteroids as prescribed.
  7. Prepare the client for intubation and mechanical ventilation using PEEP.
Documentation Guidelines
  • Respiratory status of the patient: respiratory rate, breath sounds, and the use of accessory muscles; arterial blood gas (ABG) levels; pulse oximeter and chest x-ray results
  • Response to treatment, mechanical ventilation, immobility, and bedrest
  • Presence of any complications (depends on the precipitating condition leading to ARDS)
Discharge and Home Healthcare Guidelines
  • PREVENTION. Prompt attention for any infections may decrease the incidence of sepsis,which can lead to ARDS.
  • COMPLICATIONS. If patients survive ARDS, few residual effects are seen. Complications are directed to any other conditions the patient may have.

chloral hydrate

Generic Name : chloral hydrate
Brand Name: Aquachloral Supprettes, PMS-Chloral Hydrate (CAN), Chloral Hydrate-Odan (CAN), Somnote
Classification: Sedative-hypnotic (nonbarbiturate)
Pregnancy Category C
Controlled Substance C-IV
Dosage & Route
Single doses or daily dose should not exceed 2 g.
  • Hypnotic: 500 mg–1 g PO or rectally 15–30 min before bedtime or 30 min before surgery. It is not usually considered safe practice to give oral medication to patients who are NPO for anesthesia or surgery.
  • Sedative: 250 mg PO or rectally tid after meals.
Pediatric Patients
  • Hypnotic: 50 mg/kg/day PO up to 1 g per single dose; may be given in divided doses.
  • Sedative: 25 mg/kg/day PO up to 500 mg per single dose; may be given in divided doses.
Therapeutic actions
  • Chloral hydrate is used principally as a hypnotic in the treatment of insomnia; effective only for short-term use. Its CNS depressant effect, similar to those of paraldehyde and barbiturates, may be attributed to its metabolite, trichloroethanol.
  • Nocturnal sedation
  • Preoperative sedation to lessen anxiety and induce sleep without depressing respiration or cough reflex
  • Adjunct to opiates and analgesics in postoperative care and control of pain
Adverse effects
  • Gastric irritation, abdominal distention and flatulence, vertigo, ataxia, staggering gait, rashes, malaise, lightheadedness, headache, ketonuria, excitement, nightmares, delirium (especially in elderly), eosinophilia, reduction in white blood cell count; dependence on prolonged use.
  • Hepatic or renal impairment, cardiac disease, hypersensitivity, porphyria, esophagitis, gastritis. Pregnancy and lactation.
Nursing considerations
  • History: Hypersensitivity to chloral derivatives, allergy to tartrazine, severe cardiac disease, gastritis, hepatic or renal impairment, acute intermittent porphyria, lactation
  • Physical: Skin color, lesions; orientation, affect, reflexes; P, BP, perfusion; bowel sounds, normal output, liver evaluation; LFTs, renal function tests, CBC and differential, stool guaiac test
  • Give capsules with a full glass of liquid; ensure that patient swallows capsules whole; give syrup in half glass of water, fruit juice, or ginger ale.
  • Supervise dose and amount of drug prescribed for patients who are addiction prone or alcoholic; give least amount feasible to patients who are depressed or suicidal.
  • Withdraw gradually over 2 wk if patient has been maintained on high doses for weeks or months; if patient has built up high tolerance, withdrawal should occur in a hospital, using supportive therapy similar to that for barbiturate withdrawal; fatal withdrawal reactions have occurred.
  • Reevaluate patients with prolonged insomnia; therapy for the underlying cause (eg, pain, depression) is preferable to prolonged use of sedative–hypnotic drugs.
Teaching points
  • Take this drug exactly as prescribed: Swallow capsules whole with a full glass of liquid (take syrup in half glass of water, fruit juice, or ginger ale).
  • Do not discontinue the drug abruptly. Consult your health care provider if you wish to discontinue the drug.
  • Avoid alcohol, sleep-inducing, or over-the-counter drugs; these could cause dangerous effects.
  • You may experience these side effects: Drowsiness, dizziness, light-headedness (avoid driving or performing tasks requiring alertness); GI upset (eat frequent small meals); sleep-walking, nightmares, confusion (use caution: close doors, keep medications out of reach so inadvertent overdose does not occur while confused).
  • Report rash, coffee ground vomitus, black or tarry stools, severe GI upset, fever, sore throat.

cetirizine HCl

Cetirizine HCl (Zyrtec) is an antihistamine used in the management of seasonal allergic rhinitis.
Generic Names & Brand Names
cetirizine hydrochloride
(se teer i zeen)
Reactine (CAN), Zyrtec
Pregnancy Category B
Drug class
Therapeutic actions
Potent histamine (H1) receptor antagonist; inhibits histamine release and eosinophil chemotaxis during inflammation, leading to reduced swelling and decreased inflammatory response
  • Management of seasonal and perennial allergic rhinitis
  • Treatment of chronic, idiopathic urticaria
  • Treatment of year-round allergic rhinitis and chronic idiopathis urticaria in infants > 6 mo
Contraindications and cautions
  • Contraindicated with allergy to any antihistamines, hydroxyzine.
  • Use cautiously with narrow-angle glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, asthmatic attack, bladder neck obstruction, pyloroduodenal obstruction (avoid use or use with caution as condition may be exacerbated by drug effects); lactation.
Available forms
Tablets—5, 10 mg; chewable tablets—5, 10 mg; syrup—5 mg/5 mL
  • 5–10 mg daily PO; maximum dose 20 mg/day.
  • 6 mo–5 yr: 2.5 mg (one-half teaspoon) PO once daily. In children 1 yr and older, may increase to maximum 5 mg daily given as one-half teaspoon q 12 hr; 2–5 yr—one 5 mg chewable tablet per day.
  • 6–11 yr: 5 or 10 mg daily PO.
  • > 12 yr: Use adult dosage.
  • 5 mg PO daily.
OralRapid1 hr24 hr
Metabolism: Hepatic; T1/2: 7–10 hr
Distribution: Crosses placenta; enters breast milk
Excretion: Urine and feces
Adverse effects
  • CNS: Somnolence, sedation
  • CV: Palpitation, edema
  • GI: Nausea, diarrhea, abdominal pain, constipation
  • Respiratory: Bronchospasm, pharyngitis
  • Other: Fever, photosensitivity, rash, myalgia, arthralgia, angioedema
Nursing considerations
CLINICAL ALERT! Name confusion has occurred between Zyrtec (cetirizine) and Zyprexa (olanzapine); use caution.
  • History: Allergy to any antihistamines, hydroxyzine; narrow-angle glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, asthmatic attack, bladder neck obstruction, pyloroduodenal obstruction; lactation
  • Physical: Skin color, lesions, texture; orientation, reflexes, affect; vision examination; R, adventitious sounds; prostate palpation; renal function tests
  • Give without regard to meals.
  • Provide syrup form or chewable tablets for pediatric use if needed.
  • Arrange for use of humidifier if thickening of secretions, nasal dryness become bothersome; encourage adequate intake of fluids.
  • Provide skin care for urticaria.
Teaching points
  • Take this drug without regard to meals.
  • You may experience these side effects: Dizziness, sedation, drowsiness (use caution if driving or performing tasks that require alertness); thickening of bronchial secretions, dryness of nasal mucosa (humidifier may help).
  • Report difficulty breathing, hallucinations, tremors, loss of coordination, irregular heartbeat.

Acute Renal Failure Nursing Care Plan & Management

  • Is a sudden decline in renal function, usually marked by increased concentrations of blood urea nitrogen (BUN; azotemia) and creatinine; oliguria (less than 500 ml of urine in 24 hours); hyperkalemia; and sodium retention.
  • Acute renal failure are classified into following:
    • Prerenal failure – results from conditions that interrupt the renal blood supply; thereby reducing renal perfusion (hypovolemia, shock, hemorrhage, burns impaired cardiac output, diuretic therapy).
    • Postrenal failure – results from obstruction of urine flow.
    • Intrarenal failure – results from injury to the kidneys themselves (ischemia, toxins, immunologic processes, systemic and vascular disorders).
  • The disease progresses through three clinically distinct phase which is oliguric-anuric, diuretic, and recovery, distinguished primarily by changes in urine volume and BUN and creatinine levels.
  • Complication of ARF include dysrhythmias, increased susceptibility to infection, electrolyte abnormalities, GI bleeding due to stress ulcers, and multiple organ failure. Untreated ARF can also progress to chronic renal failure, end-stage renal disease, and death from uremia or related causes.
patho of acute renal failureAssessment:
  1. Oliguric-anuric phase: urine volume less than 400 ml per 24 hours; increased in serum creatinine, urea, uric acid, organic acids, potassium, and magnesium; lasts 3 to 5 days in infants and children, 10 to 14 days in adolescents and adults.
  2. Diuretic phase: begins when urine output exceeds 500 ml per 24 hours, end when BUN and creatinine levels stop rising; length is availabe.
  3. Recovery phase: asymptomatic; last several months to 1 year; some scar tissue may remain.
  4. In prerenal disease: decreased tissue turgor, dryness of mucous membranes, weight loss, flat neck veins, hypotension, tachycardia.
  5. In postrenal disease: difficulty in voiding, changes in urine flow.
  6. In Intrarenal disease: presentation varies; usually have edema, may have fever, skin rash.
  7. Nausea, vomiting, diarrhea, and lethargy may also occur.
Diagnostic Evaluation:
  1. Urinalysis shows proteinuria, hematuria, casts. Urine chemistry distinguishes various forms of ARF(prerenal, postrenal, intrarenal).
  2. Serum creatinine and BUN levels are elevated; arterial blood gas (ABG) levels, serum electrolytes may be abnormal.
  3. Renal ultrasonography estimates renal size and rules out treatable obstructive uropathy.
Primary Nursing Diagnosis
  • Fluid volume deficit related to excessive urinary output,vomiting,hemorrhage
Other Diagnoses that may occur in Nursing Care Plans For Acute Renal Failure
  • Ineffective tissue perfusion (renal)
  • Excess fluid volume
  • Risk for infection
Therapeutic and Pharmacologic Interventions:
  1. Surgical relief of obstruction may be necessary.
  2. Correction of underlying fluid excesses or deficits.
  3. Correction and control of biochemical imbalances.
  4. Restoration and maintenance of blood pressure through I.V. fluids and vasopressors.
  5. Maintenance of adequate nutrition: Low protein diet with supplemental amino acids and vitamins.
  6. Initiation of hemodialysis, peritoneal dialysis, or continuous renal replacement therapy for patients with progressive azotemia and other life-threatening complications.
Nursing Interventions:
  1. Monitor 24-hour urine volume to follow clinical course of the disease.
  2. Monitor BUN, creatinine, and electrolyte.
  3. Monitor ABG levels as necessary to evaluate acid-base balance.
  4. Weigh the patient to provide an index of fluid balance.
  5. Measure blood pressure at various times during the day with patients in supine, sitting, and standing positions.
  6. Adjust fluid intake to avoid volume overload and dehydration.
  7. Watch for cardiac dysrhythmias and heart failure from hyperkalemia, electrolyte imbalance, or fluid overload. Have resuscitation equipment available in case of cardiac arrest.
  8. Watch for urinary tract infection, and remove bladder catheter as soon as possible.
  9. Employ intensive pulmonary hygiene because incidence of pulmonary edema and infection is high.
  10. Provide meticulous wound care.
  11. Offer high-carbohydrate feedings because carbohydrates have a greater protein-sparing power and provide additional calories.
  12. Institute seizure precautions. Provide padded side rails and have airway and suction equipment at the bedside.
  13. Encourage and assist the patient to turn and move because drowsiness and lethargy may reduce activity.
  14. Explain that the patient may experience residual defects in kidney function for a long time after acute illness.
  15. Encourage the patient to report routine urinalysis and follow-up examinations.
  16. Recommend resuming activity gradually because muscle weakness will be present from excessive catabolism.
Documentation Guidelines
  • Physical findings:Urinary output and description of urine, fluid balance, vital signs, findings related to original disease process or insult,presence of pain or pruritus,mental status,GI status, and skin integrity
  • Condition of peritoneal or vascular access sites
  • Nutrition: Response to dietary or fluid restrictions, tolerance to food, maintenance of body weight
  • Complications:Cardiovascular,integumentary infection
Discharge and Home Healthcare Guidelines
All patients with ARF need an understanding of renal function,signs and symptoms of renal failure ,and how to monitor their own renal function. Patients who have recovered viable renal function still need to be monitored by a nephrologist for at least a year. Teach the patient that she or he may be more susceptible to infection than previously. Advise daily weight checks. Emphasize rest to prevent overexertion. Teach the patient or significant others about all medications, including dosage, potential side effects, and drug interactions. Explain that the patient should tell the healthcare professional about the medications if the patient needs treatment such as dental work or if a new medication is added. Explain that ongoing medical assessment is required to check renal function. Explain all dietary and fluid restrictions. Note if the restrictions are life-long or temporary.
Patients who have not recovered viable renal function need to understand that their condition may persist and even become chronic. If chronic renal failure is suspected, further outpatient treatment and monitoring are needed. Discuss with significant others the lifestyle changes that may be required with chronic renal failure.

Acute Peritonitis Nursing Care Plan & Management

Acute peritonitis is an inflammatory process within the peritoneal cavity most commonly caused by a bacterial infection. Types of acute peritonitis include primary and secondary. Primary peritonitis, otherwise known as spontaneous bacterial peritonitis, most commonly occur inpatients with cirrhosis and clinically significant ascites. Secondary peritonitis most commonly occurs as a result of spillage of intestinal, biliary, or urinary tract contents into the peritoneal space as a result of perforation, suppuration, or ischemic injury. Patients at risk for developing secondary peritonitis include those with recent abdominal surgery, a perforated ulcer or colon, a ruptured appendix or viscus, a bowel obstruction, a gangrenous bowel, or ischemic bowel disease.
Signs and Symptoms
  • Patient assuming a knee-flexed position and complaining of severe localized or generalized abdominal pain.
  • Nausea and vomiting
Physical Examination
Vital signs
  • HR: tachycardia
  • BP: hypotension
  • RR: increased and shallow
  • Temp : elevated
image credit:
image credit:
  • Normal to decreased mentation
  • Pale
  • Flushed
  • Diaphoretic
  • Pulse thready or wear or may be bounding in presence of fever.
  • Breath sounds may be diminished secondary to shallow breathing.
  • Rebound tenderness with guarding
  • May have referred pain to shoulder
  • Rigid, distended abdomen
  • Bowel sounds decrease to absent
Acute Care Management
Nursing Diagnosis: Deficient fluid volume related to intravascular fluid shift to the peritoneal space and inability to ingest oral fluids.
Outcome Criteria
  • Central venous pressure 2 TO 6 MM Hg
  • BP 90 to 120 mm Hg
  • Mean arterial pressure 70 to 105 mm Hg
  • Pulmonary artery systolic 15 to 30 mm Hg
  • Pulmonary artery diastolic 5 to 15 mm Hg
  • HR 60 to 100 beats/min
  • Urine output 30 ml/hr
Patient Monitoring
  1. Obtain pulmonary artery pressure and central venous pressure and monitor mean arterial pressure hourly or more frequently if the patient’s hemodynamic status is unstable.
  2. Not the patient’s response to all therapy.
  3. Monitor fluid volume status by measuring urine output hourly and measure nasogastric and other bodily drainage.
  4. Determine fluid balance every 8 hours.
  5. Continuously monitor ECG fir dysrhythmias resulting from electrolyte disturbances.
Patient Assessment
  1. Assess tissue perfusion. Note level of consciousness, skin color and temperature, pulses, and capillary refill.
  2. Assess hydration status: note skin turgor on inner thigh or forehead, condition of buccal membranes, and development of edema or crackles.
  3. Assess the patient’s abdomen for resolution of rigidity, rebound tenderness, and distention. Auscultate bowel sounds.
Diagnostic Assessment
  1. Review serum sodium and potassium levels, which may become depleted with nasogastric suctioning or fluid shifts.
  2. Review serial WBC count and differentiated to evaluate the course of action.
Patient Management
  1. Administer crystalloid or colloid solutions to improve intravascular volume.
  2. Replace potassium as ordered; validate adequate urine output before administration.
  3. Keep the patient NPO during acute phase and before evaluation by a surgeon.
  4. Provide nutritional support as indicated; most patient will benefit from postpyloric delivery of early enteral nutrients at a minimal hourly rate to prevent v=bacterial translocation and sepsis.
  5. Administer antibiotics as prescribed after appropriate cultures obtained.


Drug Name
Generic Name :  cephalexin
Brand Name: Apo-Cephalex (CAN), Biocef, Keflex, Novo-Lexin (CAN), Nu-Cephalex (CAN)
Classification: Antibiotic, Cephalosporin (first generation)
Pregnancy Category B
Dosage & Route
1–4 g/day in divided doses; 250 mg PO q 6 hr usual dose.
  • Skin and skin structure infections: 500 mg PO q 12 hr. Larger doses may be needed in severe cases; do not exceed 4 g/day.
Pediatric Patients
25–50 mg/kg/day PO in divided doses.
  • Skin and skin structure infections: Divide total daily dose, and give q 12 hr. Dosage may be doubled in severe cases.
  • Otitis media: 75–100 mg/kg/day PO in four divided doses.
Therapeutic actions
  • Bactericidal: Inhibits synthesis of bacterial cell wall, causing cell death.
  • Respiratory tract infections caused by Streptococcus pneumoniae, group A beta-hemolytic streptococci
  • Skin and skin structure infections caused by staphylococcus, streptococcus
  • Otitis media caused by S. pneumoniae, Haemophilus influenzae, streptococcus, staphylococcus, Moraxella catarrhalis
  • Bone infections caused by staphylococcus, Proteus mirabilis
  • GU infections caused by Escherichia coli, P. mirabilis, Klebsiella
Adverse effects
  • CNS: Headache, dizziness, lethargy, paresthesias
  • GI: Nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, pseudomembranous colitis, hepatotoxicity
  • GU: Nephrotoxicity
  • Hematologic: Bone marrow depression
  • Hypersensitivity: Ranging from rash to fever to anaphylaxis; serum sickness reaction
  • Other: Superinfections
  • Contraindicated with allergy to cephalosporins or penicillins.
  • Use cautiously with renal failure, lactation, pregnancy.
Nursing considerations
  • History: Penicillin or cephalosporin allergy, pregnancy, or lactation
  • Physical: Renal function tests, respiratory status, skin status; culture and sensitivity tests of infected area
  • Arrange for culture and sensitivity tests of infection before and during therapy if infection does not resolve.
  • Give drug with meals; arrange for small, frequent meals if GI complications occur.
  • Refrigerate suspension, discard after 14 days.
Teaching points
  • Take this drug with food. Refrigerate suspension; discard any drug after 14 days.
  • Complete the full course of this drug even if you feel better.
  • This drug is prescribed for this particular infection; do not self-treat any other infection.
  • You may experience these side effects: Stomach upset, loss of appetite, nausea (take drug with food); diarrhea; headache, dizziness.
  • Report severe diarrhea with blood, pus, or mucus; rash or hives; difficulty breathing; unusual tiredness, fatigue; unusual bleeding or bruising.
  • Avoid alcohol while taking cephalexin.


Drug Name
Generic Name :celecoxib
Brand Name: Celebrex
Classification: NSAID, Analgesic (nonopioid), Specific COX-2 enzyme blocker
Pregnancy Category C (first and second trimester)
Pregnancy Category D (third trimester) 

Dosage & Route
  • Osteoarthritis
    • Adult: 200 mg as a single dose or in 2 divided doses. May increase to 200 mg bid if necessary.
    • Hepatic impairment: Child-Pugh category B: Reduce dose by 50%. Child-Pugh category C: Avoid use.
  • Rheumatoid arthritis
    • Adult: 100-200 mg bid.
    • Elderly: 100 mg bid.
    • Hepatic impairment: Child-Pugh category B: Reduce dose by 50%. Child-Pugh category C: Avoid use.
  • Dysmenorrhea
    • Adult: Initially, 400 mg followed by 200 mg if necessary on the 1st day. Maintenance: 200 mg bid.
    • Hepatic impairment: Child-Pugh category B: Reduce dose by 50%. Child-Pugh category C: Avoid use.
  • Pain
    • Adult: Initially, 400 mg followed by 200 mg if necessary on the 1st day. Maintenance: 200 mg bid.
    • Hepatic impairment: Child-Pugh category B: Reduce dose by 50%. Child-Pugh category C: Avoid use.
  • Familial adenomatous polyposis
    • Adult: 400 mg bid.
    • Hepatic impairment: Child-Pugh category B: Reduce dose by 50%. Child-Pugh category C: Avoid use.
Therapeutic actions
  • Celecoxib has COX-2 specific inhibitory activity. It inhibits the conversion of arachidonic acid to prostaglandins while having no effect on the formation of prostaglandins that mediate the normal homeostasis in the GI tract, kidneys and platelets catalyzed by COX-1.
    • Absorption: Absorbed from the GI tract (oral); peak plasma concentrations after 3 hr.
    • Distribution: Protein-binding: 97%.
    • Metabolism: Hepatic; converted to inactive metabolites.
    • Excretion: Feces and urine (as metabolites and unchanged drug); 11 hr (elimination half-life).
  • Acute and long-term treatment of signs and symptoms of rheumatoid arthritis and osteoarthritis
  • Reduction of the number of colorectal polyps in familial adenomatous polyposis (FAP)
  • Management of acute pain
  • Treatment of primary dysmenorrhea
  • Relief of signs and symptoms of anklylosing spondylitis
  • Relief of signs and symptoms of juvenile rheumatoid arthritis
Adverse effects
  • Abdominal pain, diarrhea, nausea, edema, dizziness, headache, insomnia, upper respiratory tract infections; rash.
  • Potentially Fatal: Serious skin reactions such as exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis.
  • Hypersensitivity including those in whom attacks of angioedema, rhinitis and urticaria have been precipitated by aspirin, NSAIDs or sulfonamides. Severe hepatic impairment; severe heart failure; inflammatory bowel disease; peptic ulcer; renal impairment (CrCl <30 ml/min); pregnancy and lactation.
Nursing considerations
CLINICAL ALERT! Name confusion has occurred between Celebrex (celecoxib), Celexa (citalopram), Xanax (alprazolam), and Cerebyx (fosphenytoin); use caution.
  • History: Renal impairment, impaired hearing, allergies, hepatic and CV conditions, lactation, pregnancy
  • Physical: Skin color and lesions; orientation, reflexes, ophthalmologic and audiometric evaluation, peripheral sensation; P, edema; R, adventitious sounds; liver evaluation; CBC, LFTs, renal function tests; serum electrolytes
  • BLACK BOX WARNING: Be aware that patient may be at increased risk for CV events, GI bleeding; monitor accordingly.
  • Administer drug with food or after meals if GI upset occurs.
  • Establish safety measures if CNS, visual disturbances occur.
  • Arrange for periodic ophthalmologic examination during long-term therapy.
  • WARNING: If overdose occurs, institute emergency procedures—gastric lavage, induction of emesis, supportive therapy.
  • Provide further comfort measures to reduce pain (eg, positioning, environmental control) and to reduce inflammation (eg, warmth, positioning, and rest).
Teaching points
  • Take drug with food or meals if GI upset occurs.
  • Take only the prescribed dosage; do not increase dosage.
  • You may experience these side effects: Dizziness, drowsiness (avoid driving or the use of dangerous machinery while taking this drug).
  • Report sore throat, fever, rash, itching, weight gain, swelling in ankles or fingers; changes in vision.


Drug Name
Generic Name : cefuroxime, cefuroxime axetil, cefuroxime sodium
Brand Name: Ceftin , Zinacef
Classification: Antibiotic, Cephalosporin (second generation)
Pregnancy Category B
Dosage & Route
  • PO Uncomplicated UTI 125 mg twice daily. Respiratory tract infections 250-500 mg twice daily. Uncomplicated gonorrhea W/ oral probenecid: 1 g as a single dose. IV Meningitis 3 g 8 hrly. IM Gonorrhea W/ oral probenecid: 1.5 g as a single dose. IV/IM Surgical prophylaxis 1.5 g IV per-op, then 750 mg IM 8 hrly for up to 24-48 hr. Susceptible infections750 mg 8 hrly, up to 1.5 g 6-8 hrly for severe infections.
Therapeutic actions
  • Cefuroxime binds to one or more of the penicillin-binding proteins (PBPs) which inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death.
    • Absorption: Absorbed from the GI tract with peak plasma concentrations after 2-3 hr (oral); may be enhanced by the presence of food.
    • Distribution: Pleural and synovial fluid, sputum, bone and aqueous fluids; CSF (therapeutic concentrations). Crosses the placenta and enters breast milk. Protein-binding: Up to 50%.
    • Metabolism: Rapidly hydrolysed (intestinal mucosa and blood).
    • Excretion: Via the urine by glomerular filtration and renal tubular secretion (as unchanged); via bile (small amounts); 70 min (elimination half-life); prolonged in neonates and renal impairment.
Oral (cefuroxime axetil)
  • Pharyngitis, tonsillitis caused by Streptococcus pyogenes
  • Otitis media caused by Streptococcus pneumoniae, S. pyogenes, Haemophilus influenzae, Moraxella catarrhalis
  • Lower respiratory infections caused by S. pneumoniae, Haemophilus parainfluenzae, H. influenzae
  • UTIs caused by Escherichia coli, Klebsiella pneumoniae
  • Uncomplicated gonorrhea (urethral and endocervical)
  • Dermatologic infections, including impetigo caused by Streptococcus aureus, S. pyogenes
  • Treatment of early Lyme disease
Parenteral (cefuroxime sodium)
  • Lower respiratory infections caused by S. pneumoniae, S. aureus, E. coli, Klebsiella, H. influenzae, S. pyogenes
  • Dermatologic infections caused by S. aureus, S. pyogenes, E. coli, Klebsiella, Enterobacter
  • UTIs caused by E. coli, Klebsiella
  • Uncomplicated and disseminated gonorrhea caused by N. gonorrhoeae
  • Septicemia caused by S. pneumoniae, S. aureus, E. coli, Klebsiella, H. influenzae
  • Meningitis caused by S. pneumoniae, H. influenzae, S. aureus, N. meningitidis
  • Bone and joint infections caused by S. aureus
  • Perioperative prophylaxis
  • Treatment of acute bacterial maxillary sinusitis in patients 3 mo–12 yr
Adverse effects
  • Large doses can cause cerebral irritation and convulsions; nausea, vomiting, diarrhea, GI disturbances; erythema multiforme, Stevens-Johnson syndrome, epidermal necrolysis.
  • Potentially Fatal: Anaphylaxis, nephrotoxicity, pseudomembranous colitis.
  • Hypersensitivity to cephalosporins.
Nursing considerations
  • History: Hepatic and renal impairment, lactation, pregnancy
  • Physical: Skin status, LFTs, renal function tests, culture of affected area, sensitivity tests
  • Culture infection, and arrange for sensitivity tests before and during therapy if expected response is not seen.
  • Give oral drug with food to decrease GI upset and enhance absorption.
  • Give oral drug to children who can swallow tablets; crushing the drug results in a bitter, unpleasant taste.
  • Have vitamin K available in case hypoprothrombinemia occurs.
  • Discontinue if hypersensitivity reaction occurs.
Teaching points
Oral drug

  • Take full course of therapy even if you are feeling better.
  • This drug is specific for this infection and should not be used to self-treat other problems.
  • Swallow tablets whole; do not crush them. Take the drug with food.
  • You may experience these side effects: Stomach upset or diarrhea.
  • Report severe diarrhea with blood, pus, or mucus; rash; difficulty breathing; unusual tiredness, fatigue; unusual bleeding or bruising; unusual itching or irritation.
Parenteral drug

  • Avoid alcohol while taking this drug and for 3 days after because severe reactions often occur.
  • You may experience these side effects: Stomach upset or diarrhea.
  • Report severe diarrhea, difficulty breathing, unusual tiredness or fatigue, pain at injection site.

Acute Pancreatitis Nursing Care Plan & Management

  • inflammation of the pancreas, ranging from mild edema to extensive hemorrhage, resulting from various insults to the pancreas.
  • defined by a discrete episode of abdominal pain and serum enzymes elevations
  • function and structure usually return to normal after an acute attack
Risk Factors
  • Alcoholism
  • Cholecystitis
  • Surgery involving or near the pancreas
  • Viral hepatitis, mumps, peptic ulcer disease, periarteritis
  • Hyperlipidemia,hypercalcemia, anorexia nervosa, shock with ischemia
  • Trauma to the pancreas
  • Medications
Pathophysiology and Etiology
  • excessive alcohol consumption
  • biliary tract disease such as cholelithiasis, acute and chronic cholecystitis
  • mortality is high because of shock, anoxia, hypotension or multiple organ dysfunction
  • autodigestion of all or part of the pancreas is involved
Assessment/Clinical Manifestations/Signs and Symptoms
  • abdominal pain, usually constant, midepigastric or periumbilical, radiating to the back or flank
  • nausea and vomiting
  • fever
  • involuntary abdominal guarding, epigastric tenderness
  • dry mucous membranes, hypotension, cold clammy skin, cyanosis or tenderness, tachycardia and mild to moderate dehydration
  • shock with respiratory distress and acute renal failure
  • purplish discoloration of the flanks (Turner’s sign) or of the periumbilical area (Cullen’s sign)
Diagnostic Evaluation
  • serum amylase, lipase, glucose, bilirubin, alkaline phosphatase, lactate dehydrogenase, AST, ALT, potassium and cholesterol may be elevated
  • Serum albumin, calcium, sodium, magnesium and potassium may be low due to dehydration
  • Abdominal x-ray to detect an ileus or isolated loop of small bowel overlying pancreas
  • CT scan is the most definitive study
  • Chest x-ray for detection of pulmonary complications
Medical Management
During the acute phase, management is symptomatic and directed toward preventing or treating complications.
  • Oral intake is withheld to inhibit pancreatic stimulation and secretion of pancreatic enzymes.
  • Parenteral nutrition is administered to the debilitated patient.
  • Nasogastric suction is used to relieve nausea and vomiting, decrease painful abdominal distention and paralytic ileus and remove hydrochloric acid so that it does not stimulate the pancreas.
  • Cimetidine (Tagamet) is given to decrease hydrochloric acid secretion.
  • Adequate pain medication is administered; morphine and morphine derivatives are avoided because they cause spasm of the sphincter of Oddi.
  • Correction of fluid, blood loss, and low albumin levels is necessary.
  • Antibiotics are administered if infection is present.
  • Insulin is necessary if significant hyperglycemia occurs.
  • Aggressive respiratory care is provided for pulmonary infiltrates, effusion and atelactasis.
  • Biliary drainage (drains and stents) results in decreased pain and increased weight gain.
  • Surgical intervention may be performed for diagnosis, drainage, resection or debridement.
  • Pancreatic ascites, abscess or pseudocyst
  • Pulmonary infiltrates, pleural effusion, acute respiratory distress syndrome
  • Hemorrhage with hypovolemic shock
  • Acute renal failure
  • Sepsis and multi-oran dysfunction syndrome
Nursing Diagnosis
  • Pain and discomfort related to edema, distention of the pancreas, and peritoneal irritation
  • Imbalanced nutrition: less than body requirements related to inadequacy dietary intake, impaired absorption, reduced food intake, and increased metabolic demands.
  • Activity intolerance related to fatigue
  • Ineffective breathing pattern related to severe pain, pulmonary infiltrates, pleural effusion and atelactasis
  • Impaired skin integrity resulting from poor nutritional status, bed rest, surgical wound
  • Fear in response to the diagnosis of pancreatitis
  • Ineffective coping related to the diagnosis of pancreatitis
Nursing Management
The client should avoid oral intake to inhibit pancreatic stimulation and secretion of pancreatic enzymes.
  • Total parenteral nutrition is administered to assist with metabolic stress.
Maintain fluid and electrolyte balance.
  • Assess fluid and electrolyte status (e.g. skin turgor, mucous membranes, intake and output); and provide replacement therapy as indicated.
Promote adequate nutrition.
  • Assess nutritional status; monitor glucose levels; monitor IV therapy, provide a high-carbohydrate, low-protein, low-fat diet when tolerate; and instruct the client to avoid spicy foods.
Maintain optimal respiratory status.
  • Place the client in semi-Fowler’s position to decrease pressure on the diaphragm.
  • Teach the client coughing and deep-breathing techniques.
Institute measures to prevent complications of immobility, such as impaired skin integrity, constipation, and deep vein thrombosis.
Monitor for complications, which may include fluid and electrolyte disturbances, pancreatic necrosis, shock, and multiple organ failure.
Administer prescribed medications, which may include opioid or nonopioid analgesics, histamine receptor antagonists, and proton-pump inhibitors.
Maintain patent nasogastric suctioning to relieve nausea and vomiting, decrease painful abdominal distention, and remove hydrochloric acid.

Acromegaly Nursing Care Plan & Management

  • Acromegaly is a rare, chronic, and disabling disorder of body growth and endocrine dysfunction in adults (after closure of the epiphyses) that is caused by excessive levels of growth hormone (GH). It occurs in approximately 40 persons per million. In adults, it is almost always due to a growth hormone–secreting pituitary adenoma. The excess production of GH causes enlargement of tissues and an altered production of glucocorticoids, mineralocorticoids, and gonadotropins. Left untreated, acromegaly causes gross physical deformities, crippling neuromuscular alterations, major organ dysfunctions, and decreased visual acuity. Arthritis or carpal tunnel syndrome may also develop. Acromegaly increases an individual’s risk for heart disease, diabetes mellitus, and gallstones. The resultant cardiac disease reduces life expectancy.
  • The overproduction of GH is a result of hyperpituitarism. More than 90% of patients have a pituitary adenoma. The etiology of adenomas is unknown. Hyperpituitarism can also occur with lung, gastric, breast, and ovarian cancers and may have a genetic cause.
Genetic Considerations
  • While most cases of acromegaly are not inherited, mutations in the GNAS1 gene can cause GH secreting pituitary adenomas (somatotrophinomas). These can be transmitted in an autosomal dominant pattern. Familial acromegaly may also be a feature of multiple endocrine neoplasia type I (MEN I), an autosomal dominant disorder that includes peptic ulcer disease and pituitary, parathyroid, and pancreas endocrine abnormalities.
Gender, Ethnic/Racial, and Life Span Considerations
  • Diagnosis of acromegaly usually occurs after the age of 40 in men and 45 in women, and occurs more frequently in women than in men. Ethnicity and race have no known effects on the risk for acromegaly.

Risk Factors
  • Some rare cases of acromegaly are hereditary.
  • The average age of diagnosis is 40-45 years old.
  • Symptoms usually develop very slowly over time.
  • Acromegaly can cause serious complications and premature death if not treated.
  • In children, excess GH production causes elongation of the bones and associated soft tissue swelling. If not treated, children with this disorder can grow ta height of 7-8 feet.
  • Symptoms and complications in adults may include the following:
    • Abnormally large growth and deformity of the:
      • Hands (rings no longer fit)
      • Feet (need a bigger size shoe)
      • Face (protrusion of brow and lower jaw)
      • Jaw (teeth do not line up correctly when the mouth is closed)
      • Lips
      • Tongue
    • Carpal tunnel syndrome
    • Skin changes, such as:
      • Thickened, oily, and sometimes darkened skin
      • Severe acne
      • Excessive sweating and offensive body order due to enlargement of the sweat glands
    • Deepening voice due to enlarged sinuses, vocal cords, and soft tissues of the throat
    • Fatigue and weakness in legs and arms
    • Sleep apnea
    • Arthritis and other joint problems especially in the jaw
    • Hypothyroidism
    • Enlargement of the liver, kidneys, spleen, heart, and/or other internal organs, which can lead to:
      • Diabetes
      • High blood pressure
      • Cardiovascular disease
  • In women:
    • Irregular menstrual cycles
    • Galactorrhea (abnormal production of breast milk) in 50% of cases
  • In men:
    • In about 50% of cases, impotence
Diagnotic Procedures
  • Blood tests will be done to measure the level of insulin-like growth factor (IGF-I), growth hormone releasing hormone (GHRH) , and other pituitary hormones.
  • A glucose tolerance test may all be given to see if the GH level drops—it will not drop in cases of acromegaly.
  • If these tests confirm acromegaly, the following may be done tlocate the tumor that is causing the disorder:
  • Head CT Scan—a type of x-ray that uses a computer tmake pictures of the inside of the brain and surrounding structures
  • MRI Scan
Primary Nursing Diagnosis
  • Body image disturbance related to anxiety over thickened skin and enlargement of face, hands, and feet
    • OUTCOMES. Self-esteem; Body image; Anxiety control
    • INTERVENTIONS. Body image enhancement; Coping enhancement; Emotional support; Self-esteem enhancement; Support group; Anxiety reduction
Medical Management
  • Reduce production of GH to normal levels
  • Stop and reverse the symptoms caused by over-secretion of GH
  • Correct other endocrine abnormalities (thyroid, adrenal, sex organs)
  • Reduce the tumor size
Treatment may include:
  • Surgical removal of the pituitary tumor, or other tumor, that is believed to be causing acromegaly may be done. In most cases, this is the preferred treatment.
  • Radiosurgery is the use of highly focused external beams of radiation to shrink the tumor. It is used most often in patients which do not respond to conventional surgery or medications.
Radiation Therapy
  • Radiation therapy is used in combination with either medical and/or surgical treatment.
Drugs may be given to reduce the level of GH secretion from the pituitary gland. These include:
  • Cabergoline (Dostinex)—given orally
  • Pergolide (Permax)—given orally
  • Bromocriptine (Parlodel)—may be given before surgery to shrink tumor
  • Octreotide (Sandostatin)—given by injections
  • Pegvisomant—given by injections for patients not responding to their forms of treatment
Medications must often be combined with other therapies treat larger tumors affecting surrounding structures.
Nursing Management
PREOPERATIVE. At the time of diagnosis, the patient requires education and emotional support. Focus education on the cause of the disease, the prescribed medical regimen, and preparation for surgery. Encourage the patient to interact with family and significant others. Reassure the patient that treatment reverses some of the physical deformities. If you note disabling behavior, refer the patient to psychiatric resources.
Prepare the patient and family for surgery. Explain the preoperative diagnostic tests and examinations. For a patient who is undergoing a transsphenoidal hypophysectomy or a transfrontal craniotomy, explain the postoperative need for nasal packing and a mustache dressing.
POSTOPERATIVE. Elevate the patient’s head to facilitate breathing and fluid drainage. Do not encourage the patient to cough, as this interferes with the healing of the operative site. Provide frequent mouth care, and keep the skin dry. To promote maximum joint mobility, perform or assist with range-of-motion exercises. Encourage the patient to ambulate within 1 to 2 days of the surgery. To assure healing of the incision site, explain the need to avoid activities that increase intracranial pressure, such as toothbrushing, coughing, sneezing, nose blowing, and bending.
Documentation Guidelines
  • Physical findings: Respiratory rate and pattern; nasal drainage: color, amount, and presence of
  • glucose
  • Neurological status: Level of consciousness, motor strength, sensation, and vision
  • Presence of postoperative complications: Diabetes insipidus, hypopituitarism, meningitis
  • Psychosocial assessment: Self-esteem, coping, interpersonal relationships, and sexual dysfunction
Discharge and Home Healthcare Guidelines Referrals
Refer patients with advanced acromegaly who experience arthritic changes and require assist devices for ambulation and activities of daily living to a physical therapist.
ACTIVITY RESTRICTIONS. Instruct the patient to avoid activities that increase intracranial pressure for up to 2 months after surgery. Toothbrushing can be resumed in 2 weeks. Instruct the patient to report increased nasal drainage. Incisional numbness and altered olfaction may occur for 4 months after surgery.
MEDICATIONS. If octreotide is prescribed, the patient will need to be able to demonstrate how to administer a subcutaneous or intramuscular injection.
FOLLOW-UP. Patients need to be monitored for development of cardiac disease, diabetes mellitus, and gallstones and a recurrence of symptoms. Advise the patient to wear a medical identification bracelet.