1. MEDICATIONS (Currently Taking)* include generic and trade name prnMEDICATION / CLASSIFICATIONDOSEROUTEFREQUENCYSIGNIFICANCE FOR CLIENTSIDE EFFECTSNURSING IMPLICATIONSCalcium/Vitamin DVitamin supplement500 mgPODailyHypothyroid; Increase med absorptionN & V, loss of appetite, fatigue, dry mouth, costipationAssess calcium levels and effectiveness of Synthroid medication by monitoring TSH, T3 and T4 levels.Iron(Ferrex)Hematinic150 mgPOBIDAnemia, iron supplementBlack stools, constipation, stomach cramps, heartburn, nausea, vomitingNo coffee or tea within 1 hour of meal due to decreased absorption, limit eggs/milk, avoid taking with antacidLevothyroxine Sodium(Synthroid)Thyroid hormone0.05 mgPODaily @0700correction of thyroid hormone balanceanxiety, insomnia, tremors, tachycardia, dysrhythmias,thyroid storm, cardiac arrestAssess TSH, T3 and T4 levels. Assess for nervousness, excitability which may indicate a too high of a dose. Assess for pulse, BP, palpitations or chest pain.Paroxetine HCL(Paxil)Antidepressant, SSRI20 mgPODailyDepressionHeadache, insomnia, anxiety, tremor, seizuresMental Status: mood, depression, panicPioglitazone HCL(Actos) Antidiabetic, Thiazolidinedione30 mgPODailyDecrease Insulin resistance, ^ glucose uptake by muscle HA, aggravated DM, myalgia, URI, fluid retention, ^ cardio vascular risksasses for hypoglycemia, give with meals to ! GI upset. Drug has unknown onset, 6-12wk peak, unknown duration.Simvastatin(Zocor) Antilipidemic, HMG-CoA reductase inhibitor40 mgPODailyreduces cholesterol synthisisliver dysfunction, pancreatitis, myositisassess muscle tenderness & ^ CPK (rhabdomyolysis), monitor bowel pattern. Give 30 min before am & pm meals.<br />MEDICATIONS (Currently Taking)* include generic and trade name prnMEDICATION / CLASSIFICATIONDOSEROUTEFREQUENCYSIGNIFICANCE FOR CLIENTSIDE EFFECTSNURSING IMPLICATIONSCarvedilolCoregAlpha and Beta blocker6.25 mgPOBIDHTN, CHFHypotension, easy bruising/bleeding, sore throat, yellow eyes skin, stomach painKeep pt warm, get pt up slowly, monitor I&O, watch for electrolyte imbalanceInsulin Aspart(Novolog-use for Humalog) Antidiabetic, Rapid acting InsulinSee SlidingScaleSubcutAS AndHSDiabetes controlonset 15-30min, peak 1/2 - 1 1/2hr, duration 3-4hr.hypoglycemia, lipidystrophy, anaphylaxisMonitor FSBS. Rotate inj sites, assess for hypoglycemia: sweating, weakness, dizziness, chills, weak rapid pulse, mental status. Give within 10-20 min of meals.Furosemide(Lasix)Loop Diuretic40 mgIV PushQ6HCHF, HTNHyponatremia, hypokalemia, low BPAssess patient for edema, lung sounds and BP, pulse. Monitor sodium and potassium levels.Pantoprazole Sodium(Protonix)Proton Pump Inhibitor40 mgIV PushBIDGERDHeadache, insomnia, HyperglycemiaAssess bowel sounds every 8 hrs, abdominal pain, swellingReconstitute with 10 ml of NS and administer over 2 minutes.Sodium Chloride Flush2 mlIV PushPRNKeep line patentAir embolism, infectionGive before and after admin of IV Med<br />PATIENT #2<br />MEDICATIONS (Currently Taking)* include generic and trade name prnMEDICATION / CLASSIFICATIONDOSEROUTEFREQUENCYSIGNIFICANCE FOR CLIENTSIDE EFFECTSNURSING IMPLICATIONSCeftriaxone Sodium Dextrose(Rocephin)Broad Spectrum Antibiotic, Cephalosporin50 ml @ 100 ml/hrIV primary in 5% Dextrose 50 ml bagQ24HInfectionDiarrhea,N & V, Eosinophilia, thrombocytosis, leukopenia, headache, dizziness, heart failureAssess for nephrotoxicity by monitoring or increase in BUN, and decreased urine output. Do not mix medication with calcium salts/ Aspirin(Aspirin)NSAID, analgesic, anti-pyretic81 mgPODailyMI preventionNausea, hemorrhage, epigastric discomfortAssess for pain. Location, frequency and type. Use pain scale 0-10. Monitor CBC; check occult stool. Clonidine HCLAntihypertensive, central A-Adrenernic agonist0.2 mgPOBIDHTNDrowsiness, CHF, headache, fatigue, ortho BP, N&V, palpitationsAssess BP and pulse. Assess neutrophils, decreased platelets, protein, BUN, creatinine because ^ levels indicate nephritic syndrome. EZETIMIBE(Zetia)Anti-lipemic, cholesterol absorption inhibitor10 mgPODailyHyper-cholesterolemia Fatigue, dizziness, headache, diarrhea, abdominal pain, chest pain.Assess lipid levels and encourage patient to consume a low fat diet. IsosorbideMononitrateAntianginal, vasodilator (Nitrate)30 mgPODailyrelief and prevention of angina pectorisvascular HA, flushing, dizziness, postural hypotension, methemoglobinemiaassess for chest pain, monitor orthostatic BP (onset 15-30min, duration 4-6hr)Pantaprozole Sodium(Protonix)Proton Pump inhibitor40 mgPODailyGERDHeadache, insomnia, HyperglycemiaAssess bowel sounds every 8 hrs, abdominal pain, swellingReconstitute with 10 ml of NS andminister over 2 minutes. <br />MEDICATIONS (Currently Taking)* include generic and trade name prnMEDICATION / CLASSIFICATIONDOSEROUTEFREQUENCYSIGNIFICANCE FOR CLIENTSIDE EFFECTSNURSING IMPLICATIONSPotassium ChlorideE-Lyte, mineral replacement10 MEQPODailyprevention and treatment of hypokalemiadysrhythmias, arrest, peaking T waves, lowered R and depressed RST, prolonged PR intervalAssess ECG changes, monitor K+ (3.5-5.0), Monitor I&O, assiss cardiac status. Give with meal or pcMetoprolol Tartrateantihypertensive, antianginal (beta 1 adrenergic blocker)50 mgPOBIDdecrease BP, HR, AV conductioninsomnia, dizziness, palpitations, N&V, diarrhea,CHF, cardiac arrest, bradycardia,bronchospasm, pulmonary edema, chest pain. Do not crush, do not give with MAOIs. Monitor BP, HR, assess for edema, I&O, crackels, JVD, hydration statusFurosemide(Lasix)Loop Diuretic40 mgPOBID @ 0900 and 1700CHF, HTNHyponatremia, hypokalemia, low BPAssess patient for edema, lung sounds and BP, pulse. Monitor sodium and potassium levels.GlyburideAntidiabetic, Sulfonylurea1.25 mgPODaily @0730Control diabetesHeadache, N & V. Diarrhea, weakness, hypoglycemiaMonitor FSBS. Assess for signs of hypoglycemia such as shakiness, sweating, pale skin, dizziness, headache. Warfarin Sodium(Coumadin)Anticoagulant5 mgPODaily @1700prevention of clot associated with A fibrillation fever, diarrhea, hematuria, hemorrhage, agranulocytosis, leukopenia, eosinophiliamonitor labs (INR 2-3), monitor for bruising and bleeding, monitor intake of Vit K rich foods(green leafy veggies)Insulin Aspart(Novolog-use for Humalog) Rapid acting InsulinSee SlidingScaleSubcutAS AndHSDiabetes controlonset 15-30min, peak 1/2 - 1 1/2hr, duration 3-4hr.hypoglycemia, lipidystrophy, anaphylaxismonitor FBS 2hr pc. Rotate inj sites, assess for hypoglycemia: sweating, weakness, dizziness, chills, weak rapid pulse, mental status. Give within 10-20 min of meals.<br />MEDICATIONS (Currently Taking)* include generic and trade name prnMEDICATION / CLASSIFICATIONDOSEROUTEFREQUENCYSIGNIFICANCE FOR CLIENTSIDE EFFECTSNURSING IMPLICATIONSHeparin Sodium/DextroseAnticoagulant, antithrombotic25000 units22 ml/hrIV DRIPNAprevention of thrombihematuria, hemorrhage, thrombocytopenia, anemia, anaphylaxismonitor PTT, PTL q 2-3 days, assess for bleeding gums, ecchymosis, black tarry stools. Give sq using 25-G 3/8 in needle, do not massage or aspirate fluidSodium Chloride Flush2 mlIV PushPRNKeep SL patentAir embolism, infectionGive before and after admin of IV MedIpratropium BromideAnticholenergic, bronchodilator0.5 mgINHQ4H (resp)SOBanxiety, HA, palpitations, N&V, cough, bronchospasmmonitor resp function, give this med before other (resp) meds, allow 5min between meds.Levalbuterol HCL(Xopenex) Bronchodilator, adrenergic B2 agonist1.25 mgINHQ4H (resp)SOBtremors, anxiety, HA, HTN, tachycardia, dysthythmia, N&Vassess resp function, do not give if pt is receiving theophylline, monitor for allergic reaction (bronchospasm). Give by nebulization.Acetaminophen(Tylenol)Non-opiod analgesic, antipyretic650 mgPOQ8HPRNPainrenal failure (Lt tx), cyanosis, anemia, neutropenia, jaundiceMonitor renal and LFTs with long term tx. Assess for fever and pain, dark urine and stools, rash urticaria. Do not ecxceed 4 grams daily including other meds with acetaminophenZolpidem Tartrate(Ambien) Sedative-hypnotic, non-benzodiazepine of imidazopyridine class10 mgPOQHSPRNtreat insomnia (CNS depressant: sedation, hypnosis, skeletal muscle relaxant,HA lethargy, daytime drowsy, dizzy, N/V/D, Leukopenia, granulocytopeniaAssess BP, P, hold if SBP drops 20mmHg, CBC (LT tx), ALT, AST, bilirubin, I&O ratio. Give 1/2 to 1hr before HS, give with food or fluids.<br />MEDICATIONS (Currently Taking)* include generic and trade name prnMEDICATION / CLASSIFICATIONDOSEROUTEFREQUENCYSIGNIFICANCE FOR CLIENTSIDE EFFECTSNURSING IMPLICATIONSOndansetron HCL(Zofran)antiemetic, 5-HT receptor antagonist4 mgIVPushQ8HPRNprevent/control N&VHA, diarrhea, constipation, abd pain, urinary retention, bronchospasmgive IV after diluting a single dose in 50ml of 0.9%NaCl or D5W, give over 15min. Assess for hypersensitivity reaction: rash, bronchospasm.Hydralazine HCL(Apresoline) antihypertensive, direct-acting peripheral vasodilator5 mgIVPushQ1HPRNdecrease BP in hypertension, decrease afterload in CHFHA, tremors, dizziness, anxiety, palpitations, reflex tachycardia, angina, N&VAssess BP q5min for 2hr, then q1hr for 2hr, then q4hr. Assess HR & JVD q4hrs. Assess e-lytes, CBC, serum glucose, I&O, edema, crackels, dyspnea.<br />