Student Name:________________________
Patient Profile Worksheet (Profile Part I)
Student Name:________________________
A. Personal Information
Room #_______Gender ________Ethnicity_____________Age if < 90:_________
Place of Residence:______________________ MD______________________________
EmergencyContact:________________________MaritalStatus____________________
Admitting Diagnosis:______________________________________________________
Co-Morbidities:__________________________________________________________
Date of Admission:____________Date of Surgery:_________Allergies:______________
Code Status:_________________________Mental Status:_________________________
B. Activity and Nutrition
Diet order:_________________Route/Rate:___________________Last Wt:__________
Level of Activity (bedrest, up ad lib, BRP, turning):______________________________
Level of self-care:_________________________________________________________
C. Nursing Care:
Drainage devices (foley, NGT, JPs, T-tube, etc.):_________________________________
NGT Flushes:____________________________
Wound care/Dressing (be specific):____________________________________________
IV access (peripheral, central, location, care):____________________________________
IVF:___________ @_____mL/hr Saline Lock?_______ TPN?_________
Frequency of vital signs (including pulse oximetry):____________________________
Frequency of Glucometer:___________ Supplemental oxygen:________ OSA__________
Falls Risk__________________________
Precautions:______________________________________________________________
Student Name:________________________
Most Recent Labs (include date of labs):
Common Hematology/Chemistries/RFTs
Lab Normal range Patient value Date/time Out of range?
WBC
Hb
Hct
Plts
Na+
K+
Cl-
HC03
BUN
Cr
Glucose
Other Pertinent Labs (make sure to document important trends):
Patient History Worksheet:
Chief Complaint
History of Present Illness (discuss clinical course from admission until current
date):
Past Medical History
Past Surgical History
Family History
Tobacco_________ Alcohol ___________Illegal Drugs_____________
Occupational Status
Religious Preference
Cultural Support Needs
Profile Part II
PHYSICAL ASSESSMENT
Student Name:________________________
GENERAL (statement of overall assessment – Patient is a 55 year old Caucasian
male who appears to be well nourished etc)
HEENT:
CARDIAC: (heart sounds, rate, rhythm, central and peripheral pulses, circulation)
RESPIRATORY: (lung sounds, work of breathing, O2 sat)
ABDOMEN/GI: (bowel sounds, overall assessment)
GU: (urinary output, catheters)
MUSCULOSKELETAL: (strength, gait, mobility status)
INTEGUMENT: (list any wounds, dressings, other issues)
NEURO: , (A&O x 4, pupils etc)
PATHOPHYSIOLOGY
Student Name:________________________
Student Name:________________________
II. Medications
Student should also have medication cards or book available on clinical.
Include PRNs that have been administered with the last 24 hours.
Medication
Generic &
Trade
Route Dosage & Frequency Category/Mechanis
m of Action
Contraindication
s / Cautions
Side Effects Use for
this
patient
Morphine/
Astramorph
PO, IM,
SubQ,
Rect< IV,
Epidural, IT
Oral, Rectal (Adults ≥50 kg)- 30-
40mg
Oral, Rectal (Adults and Children
<50 kg)-0.3 mg/kg
Oral (Children >1 mo)- o.2-o.5
mg/kg/dose
Intramuscular, Intravenous,
Subcutaneous (Adults ≥50 kg)- 4-
10 mg
Intramuscular, Intravenous,
Subcutaneous (Adults and Children
<50 kg)- 0.05-0.2 mg/kg
Intramuscular, Intravenous,
Subcutaneous (Neonates)- 0.05
mg/kg
Intravenous, Subcutaneous
(Adults)-0.8–10 mg/hr
Intravenous, Subcutaneous
(Children >1 mo): -0.01–0.04
mg/kg/hr
Intrathecal (Adults): 0.2–1 mg.
Binds to opiate receptors in the
CNS. Alters the perception of
and response to painful stimuli
while producing generalized
CNS depression. Therapeutic
Effects: Decrease in severity of
pain. Addition of naltrexone in
Embedaproduct is designed to
prevent abuse or misuse by
altering the formulation.
Naltrexone has no effect unless
the capsule is crushed or
chewed.
Contraindicated in:
Hypersensitivity; Some
products contain
tartrazine, bisulfites, or
alcohol and should be
avoided in patients with
known hypersensitivity.
Use Cautiously in: Head
trauma; ↑ intracranial
pressure; Severe renal,
hepatic, or pulmonary
disease; Hypothyroidism;
Seizure disorder; Adrenal
insufficiency; History of
substance abuse;
Undiagnosed abdominal
pain; Prostatic
hyperplasia; Patients
undergoing procedures
that rapidly ↓ pain
(cordotomy, radiation);
long-acting agents should
be discontinued 24 hr
before and replaced with
short-acting agents;
Geriatric: Geriatric or
debilitated patients (dose
reduction suggested);
Obstetric: Lactation:
Avoid chronic use; has
been used during labor
but may cause respiratory
depression in the
newborn; Pediatric:
Epidural liposomal
injection only-not
CNS: confusion,
sedation, dizziness,
dysphoria, euphoria,
floating feeling,
hallucinations,
headache, unusual
dreams. EENT:
blurred vision,
diplopia, miosis.
Resp: respiratory
depression. CV:
hypotension,
bradycardia. GI:
constipation, nausea,
vomiting. GU:
urinary retention.
Derm: flushing,
itching, sweating.
Misc: physical
dependence,
psychological
dependence,
tolerance.
Pain Relief
Student Name:________________________
recommended; Pediatric:
Neonates and infants <3
mo (more susceptible to
respiratory depression);
Pediatric: Neonates (oral
solution contains sodium
benzoate which can cause
potentially fatal gasping
syndrome).
Dilaudid/
Hydromorphone
PO, SubQ,
IM, IV, Rect
Oral (Adults ≥50 kg): -4–8 mg q 3–
4 hr
Oral (Adults and Children <50 kg):
0.06 mg/kg
Intravenous, Intramuscular,
Subcutaneous (Adults ≥50 kg): 1.5
Intravenous, Intramuscular,
Subcutaneous (Adults and Children
<50 kg): 0.015 mg/kg mg
Intravenous (Adults): Continuous
infusion (unlabeled)—0.2–30 mg/hr
Rectal (Adults): 3 mg
Binds to opiate receptors in the
CNS. Alters the perception of
and response to painful stimuli
while producing generalized
CNS depression. Suppresses
the cough reflex via a direct
central action. Therapeutic
Effects: Decrease in moderate
to severe pain. Suppression of
cough.
Contraindicated in:
Hypersensitivity; Some
products contain bisulfites
and should be avoided in
patients with known
hypersensitivity; Severe
respiratory depression (in
absence of resuscitative
equipment); Paralytic
ileus (extended-release
only); Prior GI surgery or
narrowing of GI tract
(extended-release only);
Opioid non-tolerant
patients (extended-release
only); Obstetric:
Lactation: Avoid chronic
use during pregnancy or
lactation. Use Cautiously
in: Head trauma; ↑
intracranial pressure;
Severe renal, hepatic, or
pulmonary disease;
Hypothyroidism; Seizure
disorder; Adrenal
insufficiency; Alcoholism;
Undiagnosed abdominal
pain; Prostatic
hypertrophy; Biliary tract
disease (including
pancreatitis); Geriatric:
Geriatric and debilitated
patients may be more
susceptible side effects;
dose ↓ recommended.
CNS: confusion,
sedation, dizziness,
dysphoria, euphoria,
floating feeling,
hallucinations,
headache, unusual
dreams. EENT:
blurred vision,
diplopia, miosis.
Resp: respiratory
depression. CV:
hypotension,
bradycardia. GI:
constipation, dry
mouth, nausea,
vomiting. GU:
urinary retention.
Derm: flushing,
sweating. Misc:
physical dependence,
psychological
dependence,
tolerance.
Pain Relief
Fentanyl/ IM, IV, Preoperative Use Binds to opiate receptors in the Contraindicated in: CNS: confusion, Pain Relief
Student Name:________________________
Sublimaze Transderma
l
Intramuscular, Intravenous (Adults
and Children > 12 yr): 50–100 mcg
30–60 min before surgery.
Adjunct to General Anesthesia
Intramuscular, Intravenous (Adults
and Children > 12 yr): Low dose–
minor surgery—2 mcg/kg.
Moderate dose–major surgery—2–
20 mcg/kg. High dose–major
surgery—20–50 mcg /kg.
Adjunct to Regional Anesthesia
Intramuscular, Intravenous (Adults
and Children > 12 yr): 50–100
mcg.
Postoperative Use
Intramuscular, Intravenous (Adults
and Children > 12 yr): 50–100 mcg
General Anesthesia
Intravenous (Adults and Children >
12 yr): 50–100 mcg/kg
(Intravenous (Children 1–12 yr):
2–3 mcg/kg.
Sedation/Analgesia
Intravenous (Adults and Children >
12 yr): 0.5–1 mcg/kg/dose
Intravenous (Children 1–12 yr):
Bolus—1–2 mcg/kg/dose, may
repeat at 30–60 min intervals.
Continuous infusion—1–5
mcg/kg/hr following bolus dose.
Intravenous (Neonates): Bolus—
0.5–3 mcg/kg/dose. Continuous
infusion—0.5–2 mcg/kg/hr
following bolus dose. Continuous
infusion during ECMO—5–10
mcg/kg bolus followed by 1–5
mcg/kg/hr,
CNS, altering the response to
and perception of pain.
Produces CNS depression.
Therapeutic Effects:
Supplement in anesthesia.
Decreased pain.
Hypersensitivity; cross-
sensitivity among agents
may occur; Known
intolerance. Use
Cautiously in: Geriatric:
Geriatric, debilitated, or
critically ill patients ;
Diabetes; Severe renal,
pulmonary or hepatic
disease; CNS tumors; ↑
intracranial pressure;
Head trauma; Adrenal
insufficiency;
Undiagnosed abdominal
pain; Hypothyroidism;
Alcoholism; Cardiac
disease (arrhythmias);
Obstetric: Lactation:
Pregnancy and lactation.
paradoxical
excitation/delirium,
postoperative
depression,
postoperative
drowsiness. EENT:
blurred/double
vision. Resp: apnea,
laryngospasm,
allergic
bronchospasm,
respiratory
depression. CV:
arrhythmias,
bradycardia,
circulatory
depression,
hypotension. GI:
biliary spasm,
nausea/vomiting.
Derm: facial itching.
MS: skeletal and
thoracic muscle
rigidity (with rapid
IV infusion).
Toradol/ ketorolac PO, IM, IV,
IN
Oral (Adults <65 yr): 20 mg Inhibits prostaglandin
synthesis, producing
Contraindicated in:
Hypersensitivity; Cross-
CNS: stroke,
drowsiness,
Pain Relief
Student Name:________________________
Oral (Adults ≥65 yr, <50 kg, or
with renal impairment): 10 mg q 4–
6
Intramuscular (Adults <65 yr):
Single dose—60 mg. Multiple
dosing—30 mg q 6 hr
Intramuscular (Adults ≥65 yr, <50
kg, or with renal impairment):
Single dose—30 mg. Multiple
dosing—15 mg q 6 hr
.
Intravenous (Adults <65 yr): Single
dose—30 mg. Multiple dosing—30
mg q 6 hr
Intravenous (Adults ≥65 yr, <50 kg,
or with renal impairment): Single
dose—15 mg. Multiple dosing—15
mg q 6 hr
Intranasal (Adults <65 yr): 1 spray
in each nostril q 6–8 hr
Intranasal (Adults ≥65 yr, <50 kg,
or with renal impairment): 1 spray
in only one nostril q 6–8 hr
peripherally mediated
analgesia. Also has antipyretic
and anti-inflammatory
properties. Therapeutic Effects:
Decreased pain.
sensitivity with other
NSAIDs may exist;
Preoperative use; Active
or history of peptic ulcer
disease or GI bleeding;
Known alcohol
intolerance (injection
only); Perioperative pain
from coronary artery
bypass graft (CABG)
surgery; Cerebrovascular
bleeding; Advanced renal
impairment or at risk for
renal failure due to
volume depletion;
Concurrent use of
pentoxifylline or
probenecid; Obstetric:
Chronic use in 3rd
trimester may cause
constriction of ductus
arteriosus. May inhibit
labor and ↑ maternal
bleeding at delivery;
Lactation: Lactation. Use
Cautiously in:
Cardiovascular disease or
risk factors for
cardiovascular disease
(may ↑ risk of serious
cardiovascular thrombotic
events, myocardial
infarction, and stroke,
especially with prolonged
use); Heart failure;
Coagulation disorders;
Mild-to-moderate renal
impairment (dosage
reduction may be
required); Hepatic
impairment; Pediatric:
Safety not established;
Geriatric: Appears on
Beers list; ↑ risk of GI
bleeding.
abnormal thinking,
dizziness, euphoria,
headache. EENT: ↑
lacrimation (spray),
nasal discomfort
(spray), throat
irritation (spray).
Resp: asthma,
dyspnea. CV:
myocardial
infarction, edema,
pallor, vasodilation.
GI: gi bleeding,
abnormal taste,
diarrhea, dry mouth,
dyspepsia, GI pain, ↑
liver enzymes,
nausea. GU:
oliguria, renal
toxicity, urinary
frequency. Derm:
exfoliative dermatitis,
stevens-johnson
syndrome, toxic
epidermal necrolysis,
pruritus, purpura,
sweating, urticaria.
Hemat: prolonged
bleeding time. Local:
injection site pain.
Neuro: paresthesia.
Misc: allergic
reactions including,
anaphylaxis.
Student Name:________________________
Zofran/
ondansetron
PO, IV, IM Oral (Adults): Prevention of
nausea/vomiting associated with
highly-emetogenic chemotherapy—
24 mg 30 min prior to
chemotherapy.
Oral (Adults and Children >11 yr):
Prevention of nausea/vomiting
associated with moderately
emetogenic chemotherapy—8 mg
30 min prior to chemotherapy
Prevention of radiation-induced
nausea/vomiting—8 mg 1–2 hr
prior to radiation;.
Oral (Children 4–11 yr):
Prevention of nausea/vomiting
associated with moderately
emetogenic chemotherapy—4 mg
30 min prior to chemotherapy
Intravenous (Adults): Prevention of
chemotherapy-induced
nausea/vomiting—0.15 mg/kg 15–
30 min prior to chemotherapy,
Intramuscular, Intravenous
(Adults): Prevention of
postoperative nausea/vomiting—4
mg before induction of anesthesia
or postoperatively.
Intravenous (Children 6 mo–18 yr):
Prevention of chemotherapy-
induced nausea/vomiting—0.15
mg/kg 15–30 min prior to
chemotherapy,
Intravenous (Children 1 mo–12 yr
and >40 k g): Prevention of
postoperative nausea/vomiting—4
mg.
Intravenous (Children 1 mo–12 yr
and ≤40 kg): Prevention of
Blocks the effects of serotonin
at 5-HT3–receptor sites
(selective antagonist) located
in vagal nerve terminals and
the chemoreceptor trigger zone
in the CNS. Therapeutic
Effects: Decreased incidence
and severity of nausea and
vomiting following
chemotherapy or surgery.
Contraindicated in:
Hypersensitivity; Orally
disintegrating tablets
contain aspartame and
should not be used in
patients with
phenylketonuria;
Congenital long QT
syndrome; Concurrent use
of apomorphine. Use
Cautiously in: Hepatic
impairment (daily dose
not to exceed 8 mg);
Abdominal surgery (may
mask ileus); Obstetric:
Lactation: Pediatric:
Pregnancy, lactation, or
children ≤3 yr (PO) or <1
mo (parenteral) (safety
not established) .
CNS: headache,
dizziness, drowsiness,
fatigue, weakness.
CV: torsade de
pointes, QT interval
prolongation. GI:
constipation,
diarrhea, abdominal
pain, dry mouth, ↑
liver enzymes. Neuro:
extrapyramidal
reactions.
To help with
nausea
Student Name:________________________
postoperative nausea/vomiting—
0.1 mg/kg.
Phenergan/
promethazine
PO, IM,
Rectal, IV
Antihistamine
Oral (Adults): 6.25–12.5 mg
.
Oral (Children ≥2 yr): 0.1
mg/kg/dose q 6 hr during the day
and 0.5 mg/kg/dose at bedtime
Intramuscular, Intravenous, Rectal
(Adults): 25 mg;
Rectal (Children ≥2 yr): 0.125
mg/kg q 4–6 hr or 0.5 mg/kg at
bedtime.
Antivertigo (Motion Sickness)
Oral (Adults): 25 mg 30–60 min
before departure;
Oral, Rectal (Children ≥2 yr): 0.5
mg/kg (not to exceed 25 mg) 30–60
min before departure;
Sedation
Oral, Rectal, Intramuscular,
Intravenous (Adults): 25–50 mg;
Oral, Rectal, Intramuscular
(Children >2 yr): 0.5–1 mg/kg (not
to exceed 50 mg) q 6 hr as needed.
Sedation during Labor
Intramuscular, Intravenous
(Adults): 50 mg in early labor;
when labor is established,
additional doses of 25–75 mg may
be given 1–2 times at 4-hr intervals
Antiemetic
Oral, Rectal, Intramuscular,
Intravenous (Adults): 12.5–25 mg
Oral, Rectal, Intramuscular,
Intravenous (Children ≥2 yr):
Blocks the effects of histamine.
Has inhibitory effect on the
chemoreceptor trigger zone in
the medulla, resulting in
antiemetic properties. Alters
the effects of dopamine in the
CNS. Possesses significant
anticholinergic activity.
Produces CNS depression by
indirectly decreased
stimulation of the CNS
reticular system. Therapeutic
Effects: Relief of symptoms of
histamine excess usually seen
in allergic conditions.
Diminished nausea or
vomiting. Sedation.
Contraindicated in:
Hypersensitivity;
Comatose patients;
Prostatic hypertrophy;
Bladder neck obstruction;
Some products contain
alcohol or bisulfites and
should be avoided in
patients with known
intolerance; Angle-closure
glaucoma; Pediatric: May
cause fatal respiratory
depression in children <2
yr. Use Cautiously in: IV
administration may cause
severe injury to tissue;
Hypertension;
Cardiovascular disease;
Impaired liver function;
Prostatic hypertrophy;
Glaucoma; Asthma; Sleep
apnea; Epilepsy;
Underlying bone marrow
depression; Pediatric: For
children >2 yr, use lowest
effective dose, avoid
concurrent respiratory
depressants; Obstetric:
Has been used safely
during labor; avoid
chronic use during
pregnancy; Lactation:
Safety not established;
may cause drowsiness in
infant;Geriatric: Appears
on Beers list. Sensitive to
anticholinergic effects and
have ↑ risk for side
effects.
CNS: neuroleptic
malignant syndrome,
confusion,
disorientation,
sedation, dizziness,
extrapyramidal
reactions, fatigue,
insomnia,
nervousness. EENT:
blurred vision,
diplopia, tinnitus.
CV: bradycardia,
hypertension,
hypotension,
tachycardia. GI:
constipation, drug-
induced hepatitis, dry
mouth. Derm:
photosensitivity,
severe tissue necrosis
upon infiltration at IV
site, rashes. Hemat:
blood dyscrasias.
Allergic
reactions,
prevention of
nausea
Student Name:________________________
0.25–1 mg/kg
Lasix/ furosemide PO, IM, IV Edema
Oral (Adults): 20–80 mg/day
Oral (Children > 1 mo): 2 mg/kg
Oral (Neonates): 1–4 mg/kg/dose
Intramuscular, Intravenous
(Adults): 20–40 mg
Intramuscular, Intravenous
(Children): 1–2 mg/kg/dose
Intramuscular, Intravenous
(Neonates): 1–2 mg/kg/dose
Hypertension
Oral (Adults): 40mg twice daily
initially
Inhibits the reabsorption of
sodium and chloride from the
loop of Henle and distal renal
tubule. Increases renal
excretion of water, sodium,
chloride, magnesium,
potassium, and calcium.
Effectiveness persists in
impaired renal function.
Therapeutic Effects: Diuresis
and subsequent mobilization of
excess fluid (edema, pleural
effusions). Decreased BP.
Contraindicated in:
Hypersensitivity; Cross-
sensitivity with thiazides
and sulfonamides may
occur; Hepatic coma or
anuria; Some liquid
products may contain
alcohol, avoid in patients
with alcohol intolerance.
Use Cautiously in: Severe
liver disease (may
precipitate hepatic coma;
concurrent use with
potassium-sparing
diuretics may be
necessary); Electrolyte
depletion; Diabetes
mellitus;
Hypoproteinemia (↑ risk
of ototoxicity); Severe
renal impairment (↑ risk
of ototoxicity); Obstetric:
Lactation: Safety not
established; Pediatric: ↑
risk for renal calculi and
patent ductus arteriosis in
premature neonates;
Geriatric: May have ↑
risk of side effects,
especially hypotension
and electrolyte imbalance,
at usual doses.
CNS: blurred vision,
dizziness, headache,
vertigo. EENT:
hearing loss, tinnitus.
CV: hypotension. GI:
anorexia,
constipation,
diarrhea, dry mouth,
dyspepsia, ↑ liver
enzymes, nausea,
pancreatitis,
vomiting. GU: ↑
BUN, excessive
urination,
nephrocalcinosis.
Derm: stevens-
johnson syndrome,
toxic epidermal
necrolysis,
photosensitivity,
pruritis, rash. Endo:
hypercholesterolemia
, hyperglycemia,
hypertriglyceridemia,
hyperuricemia. F and
E: dehydration,
hypocalcemia,
hypochloremia,
hypokalemia,
hypomagnesemia,
hyponatremia,
hypovolemia,
metabolic alkalosis.
Hemat: aplastic
anemia,
agranulocytosis,
hemolytic anemia,
leukopenia,
thrombocytopenia.
MS: muscle cramps.
Neuro: paresthesia.
Misc: fever.
Diuretic,
helps with
hypertension
, and helps
eliminate
fluid
Solumedrol
methylprednisolon
PO, IM, IV Oral (Adults): Multiple sclerosis—
160 mg/day
Suppresses inflammation and
the normal immune response.
Contraindicated in: Active
untreated infections (may
Adverse
reactions/side effects
Suppression
of the
Student Name:________________________
e
Oral (Children): Anti-
inflammatory/Immunosuppressive-
0.5–1.7 mg/kg/day or 5–25
mg/m2/day in divided doses
Intramuscular, Intravenous
(Adults): Most uses:
methylprednisolone sodium
succinate—40–250 mg
Intramuscular, Intravenous
(Children): Anti-
inflammatory/Immunosuppressive
— 0.5–1.7 mg/kg/day
Intramuscular (Adults):
Methylprednisolone acetate—40–
120 mg
Has numerous intense
metabolic effects (see Adverse
Reactions and Side Effects).
Suppresses adrenal function at
chronic doses of 4 mg/day. Has
negligible mineralocorticoid
activity. Therapeutic Effects:
Suppression of inflammation
and modification of the normal
immune response. Replacement
therapy in adrenal
insufficiency.
be used in patients being
treated for tuberculous
meningitis); Lactation:
Avoid chronic use; Known
alcohol, bisulfite, or
tartrazine hypersensitivity
or intolerance (some
products contain these
and should be avoided in
susceptible patients);
Administration of live
virus vaccines. Use
Cautiously in: Chronic
treatment (will lead to
adrenal suppression; use
lowest possible dose for
shortest period of time);
Pediatric: Chronic use
will result in ↓ growth;
use lowest possible dose
for shortest period of
time; Stress (surgery,
infections); supplemental
doses may be needed;
Potential infections may
mask signs (fever,
inflammation); Obstetric:
Safety not established;
Pediatric: Neonates
(avoid use of benzyl
alcohol containing
injectable preparations,
use preservative-free
formulations).
are much more
common with high-
dose/long-term
therapy
CNS: depression,
euphoria, headache,
↑ intracranial
pressure (children
only), personality
changes, psychoses,
restlessness. EENT:
cataracts, ↑
intraocular pressure.
CV: hypertension.
GI: peptic ulceration,
anorexia, nausea,
vomiting. Derm:
acne, ↓ wound
healing, ecchymoses,
fragility, hirsutism,
petechiae. Endo:
adrenal suppression,
hyperglycemia. F and
E: fluid retention
(long-term high
doses), hypokalemia,
hypokalemic
alkalosis. Hemat:
thromboembolism,
thrombophlebitis.
Metab: weight gain,
weight loss. MS:
muscle wasting,
osteoporosis,
avascular necrosis of
joints, muscle pain.
Misc: cushingoid
appearance (moon
face, buffalo hump),
↑ susceptibility to
infection.
inflammator
y response
Rocephin/
ceftriaxone
IM, IV Intramuscular, Intravenous
(Adults): Most infections—1–2 g
Intramuscular, Intravenous
Binds to the bacterial cell wall
membrane, causing cell death.
Therapeutic Effects:
Bactericidal action against
Contraindicated in:
Hypersensitivity to
cephalosporins; Serious
hypersensitivity to
CNS: seizures (high
doses). GI:
pseudomembranous
colitis, diarrhea,
Antibiotic,
helps fight
infection
Student Name:________________________
(Children): Most infections—50–75
mg/kg/day, Meningitis—100
mg/kg/day, or Uncomplicated
gonorrhea—125 mg IM
susceptible bacteria. Organism
Spectrum: Similar to that of
second-generation
cephalosporins, but activity
against staphylococci is less,
while activity against gram-
negative pathogens is greater,
even for organisms resistant to
first- and second-generation
agents. Notable is increased
action against: Acinetobacter, ,
Enterobacter, , Haemophilus
influenzae (including β-
lactamase-producing strains), ,
Haemophilus parainfluenzae, ,
Escherichia coli, , Klebsiella
pneumoniae, , Morganella
morganii, , Neisseria, ,
Proteus, , Providencia, ,
Serratia, , Moraxella
catarrhalis.. Has some activity
against anaerobes,
includingBacteroides fragilis.
Not active against methicillin-
resistant staphylococci or
enterococci.
penicillins; Pediatric:
Neonates ≤28 days (use in
hyperbilirubinemic
neonates may lead to
kernicterus); Pediatric:
Neonates ≤28 days
requiring calcium-
containing IV solutions (↑
risk of precipitation
formation). Use
Cautiously in: Combined
severe hepatic and renal
impairment (dose
reduction/↑ dosing
interval recommended);
History of GI disease,
especially colitis;
Obstetric: Lactation:
Pregnancy and lactation.
cholelithiasis,
gallbladder sludging.
Derm: rashes,
urticaria. Hemat:
bleeding,
eosinophilia,
hemolytic anemia,
leukopenia,
thrombocytosis.
Local: pain at IM
site, phlebitis at IV
site. Misc: allergic
reactions including
anaphylaxis,
superinfection.
Azithromycin/
Zmax
PO, IV Most Respiratory and Skin
Infections
Oral (Adults): 500 mg on 1st day,
then 250 mg/day for 4 more days
Oral (Children ≥ 6 mo): 10 mg/kg
(not >500 mg/dose) on 1st day,
then 5 mg/kg for 4 more days
Otitis media
Oral (Children ≥6 mo): 30 mg/kg
single dose
Acute bacterial exacerbations of
chronic bronchitis
Oral (Adults): 500 mg on 1st day,
then 250 mg/day for 4 more days
Community-Acquired Pneumonia
Inhibits protein synthesis at the
level of the 50S bacterial
ribosome. Therapeutic Effects:
Bacteriostatic action against
susceptible bacteria. Organism
Spectrum: Active against the
following gram-positive
aerobic bacteria:
Staphylococcus aureus,,
Streptococcus pneumoniae,, S.
pyogenes (group A strep)..
Active against these gram-
negative aerobic bacteria:
Haemophilus influenzae,,
Moraxella catarrhalis,,
Neisseria gonorrhoeae.. Also
active against: Mycoplasma,,
Legionella,, Chlamydia
pneumoniae,, Ureaplasma
Contraindicated in:
Hypersensitivity to
azithromycin,
erythromycin, or other
macrolide anti-infectives;
History of cholestatic
jaundice or hepatic
dysfunction with prior use
of azithromycin. Use
Cautiously in: Severe liver
impairment (dose
adjustment may be
required); Severe renal
impairment (CCr <10
mL/min); Myasthenia
gravis (may worsen
symptoms); Obstetric:
Lactation: Safety not
established; Pediatric:
CNS: dizziness,
seizures, drowsiness,
fatigue, headache.
CV: chest pain,
hypotension,
palpitations, QT
interval prolongation
(rare). GI:
hepatotoxicity,
pseudomembranous
colitis, abdominal
pain, diarrhea,
nausea, cholestatic
jaundice, ↑ liver
enzymes, dyspepsia,
flatulence, melena,
oral candidiasis,
pyloric stenosis. GU:
nephritis, vaginitis.
Antibiotic,
helps fight
infection
Student Name:________________________
Intravenous, Oral (Adults): More
severe—500 mg IV q 24 hr for at
least 2 doses, then 500 mg PO q 24
hr for a total of 7–10 days; less
severe—500 mg PO, then 250
mg/day PO for 4 more days or 2 g
single dose as extended-release
suspension (Zmax).
Oral (Children >6 mo): 10 mg/kg
on 1st day, then 5 mg/kg for 4 more
days.
Pelvic Inflammatory Disease
Intravenous, Oral (Adults): 500 mg
IV q 24 hr for 1–2 days, then 250
mg PO q 24 hr for a total of 7 days.
Endocarditis Prophylaxis
Oral (Adults): 500 mg 1 hr before
procedure.
Oral (Children): 15 mg/kg 1 hr
before procedure.
Nongonococcal Urethritis,
Cervicitis, Chancroid, Chlamydia
Oral (Adults): Single 1-g dose.
Oral (Children): Chancroid: Single
20-mg/kg dose (not >1000
mg/dose). Urethritis or cervicitis:
Single 10-mg/kg dose
Gonorrhea
Oral (Adults): Single 2-g dose.
Prevention of Disseminated MAC
Infection
Oral (Adults): 1.2 g once weekly
(alone or with rifabutin).
Oral (Children): 5 mg/kg once
daily (not >250 mg/dose) or 20
mg/kg (not >1200 mg/dose) once
weekly (alone or with rifabutin).
Cystic Fibrosis
urealyticum,, Borrelia
burgdorferi,, M. avium.. Not
active against methicillin-
resistant S. aureus.
Children <5 yr (safety not
established).
Hemat: anemia,
leukopenia,
thrombocytopenia.
Derm: stevens-
johnson syndrome,
toxic epidermal
necrolysis,
photosensitivity, rash.
EENT: ototoxicity. F
and E: hyperkalemia.
Misc: angioedema.
Student Name:________________________
Oral (Children ≥6 yrs, weight ≥25
kg to <40 kg): 250 mg q MWF. ≥40
kg: 500 mg q MWF.
Ciprofloxacin/
Cipro
PO, IV Urinary tract infections
Oral (Adults): 250–500 mg q 12
hr; or 1000 mg q 24 hr for 10–14
days as extended-release tablets.
Uncomplicated urinary tract
infections—100 mg q 12 hr for 3
days or 500 mg q 24 hr for 3 days
as extended-release tablets.
Oral (Children 1–17 yr):
Complicated urinary tract
infections—10–15 mg/kg every 12
hr (not to exceed 750 mg/dose)for
10–21 days.
Intravenous (Adults): 200 mg q 12
hr .
Intravenous (Children 1–17 yr):
Complicated urinary tract
infections—6–10 mg/kg every 8 hr
for 10–21 days.
Inhalational Anthrax
Oral, Intravenous (Adults): 400 mg
q 12 hr IV, change to 500 mg PO
twice daily when clinically
appropriate for a total of 60 days;
one or two other anti-infectives
may be added initially, depending
on clinical situation.
Oral, Intravenous (Children): 10
mg/kg q 12 hr IV (maximum: 400
mg/dose), change to 15 mg/kg PO q
12 hr when clinically appropriate
for a total of 60 days;
Cutaneous anthrax
Oral (Adults): 500 mg twice daily
for 60 days;
Inhibits bacterial DNA
synthesis by inhibiting DNA
gyrase enzyme. Therapeutic
Effects: Death of susceptible
bacteria. Organism Spectrum:
Active against gram-positive
pathogens, including:
Staphylococcus aureus, ,
Staphylococcus epidermidis, ,
Staphylococcus
saprophyticus, , Streptococcus
pyogenes, , Streptococcus
pneumoniae, , Enterococcus
faecalis, , Bacillus anthracis
(anthrax).. Gram-negative
spectrum notable for activity
against: Escherichia coli, ,
Klebsiella pneumoniae, ,
Enterobacter cloacae, ,
Salmonella typhi, , Shigella
spp, , Proteus mirabilis, ,
Proteus vulgaris, , Providencia
stuartii, , Providencia rettgeri, ,
Morganella morganii, ,
Pseudomonas aeruginosa, ,
Serratia marcescens, ,
Haemophilus influenzae, , , ,
Moraxella catarrhalis, ,
Campylobacter jejuni..
Contraindicated in:
Hypersensitivity (cross-
sensitivity within class
may exist); History of
myasthenia gravis (may
worsen symptoms
including muscle
weakness and breathing
problems); Use with
tizanidine; Obstetric: Do
not use unless potential
benefit outweighs
potential fetal risk;
Pediatric: Use only if no
alternatives in children 1–
17 years due to possible
arthropathy. Use
Cautiously in: Known or
suspected CNS disorder;
Renal impairment (dose ↓
if CCr ≤50 mL/min);
Concurrent use of
corticosteroids (↑ risk of
tendinitis/tendon rupture);
Kidney, heart, or lung
transplant patients (↑ risk
of tendinitis/tendon
rupture); Patients with
history of or at risk for
QTc prolongation, may
prolong QTc interval;
Lactation: Safety not
established except for
treatment of anthrax;
Geriatric: ↑ risk of
adverse reactions.
CNS: elevated
intracranial pressure
(including
pseudotumor
cerebri), seizures,
agitation, confusion,
depression, dizziness,
drowsiness,
hallucinations,
headache, insomnia,
nightmares,
paranoia, tremor. GI:
pseudomembranous
colitis, abdominal
pain, diarrhea,
nausea, ↑ liver
enzymes . GU:
vaginitis. Derm:
photosensitivity, rash.
Endo: hyperglycemia,
hypoglycemia.
Hemat: eosinophilia .
Local: phlebitis at IV
site. MS: tendinitis,
tendon rupture.
Neuro: peripheral
neuropathy. Misc:
hypersensitivity
reactions including -
anaphylaxis .
Antibiotic,
helps fight
infection
Student Name:________________________
Oral (Children): 10–15 mg/kg q 12
hr for 60 days (maximum: 1 g/day);
Cystic Fibrosis
Oral (Children 5–17 yrs): 20 mg/kg
q 12 hr.
Intravenous (Children 5–17 yrs):
15 mg/kg q 8 hr for 1 week
followed by oral therapy.
Lopressor/
metoprolol
PO, IV Oral (Adults):
Antihypertensive/antianginal—25–
100 mg/day
Intravenous (Adults): MI—5 mg q 2
min for 3 doses
Blocks stimulation of
beta1(myocardial)-adrenergic
receptors. Does not usually
affect beta2(pulmonary,
vascular, uterine)-adrenergic
receptor sites. Therapeutic
Effects: Decreased BP and
heart rate. Decreased
frequency of attacks of angina
pectoris. Decreased rate of
cardiovascular mortality and
hospitalization in patients with
heart failure
Contraindicated in:
Uncompensated HF;
Pulmonary edema;
Cardiogenic shock;
Bradycardia, heart block,
or sick sinus syndrome (in
absence of a pacemaker).
Use Cautiously in: Renal
impairment; Hepatic
impairment; Geriatric: ↑
sensitivity to beta
blockers; initial dose
reduction recommended;
Pulmonary disease
(including asthma; beta1
selectivity may be lost at
higher doses); Diabetes
mellitus (may mask signs
of hypoglycemia);
Thyrotoxicosis (may mask
symptoms); Patients with
a history of severe allergic
reactions (intensity of
reactions may be
increased); Untreated
pheochromocytoma
(initiate only after alpha
blocker therapy started);
Obstetric: Lactation:
Pediatric: Safety not
established; all agents
cross the placenta and
may cause fetal/neonatal
bradycardia, hypotension,
CNS: fatigue,
weakness, anxiety,
depression, dizziness,
drowsiness,
insomnia, memory
loss, mental status
changes,
nervousness,
nightmares. EENT:
blurred vision, stuffy
nose. Resp:
bronchospasm,
wheezing. CV:
bradycardia, HF,
pulmonary edema,
hypotension,
peripheral
vasoconstriction. GI:
constipation,
diarrhea, drug-
induced hepatitis, dry
mouth, flatulence,
gastric pain,
heartburn, ↑ liver
enzymes, nausea,
vomiting. GU:
erectile dysfunction,
↓ libido, urinary
frequency. Derm:
rashes. Endo:
hyperglycemia,
hypoglycemia. MS:
arthralgia, back pain,
joint pain. Misc:
Blocks beta
1 receptors
to decrease
heart rate
and blood
pressure
Student Name:________________________
hypoglycemia, or
respiratory depression.
drug-induced lupus
syndrome.
V. Top Three Prioritized Medical and Nursing Diagnosis
1.
2.
3.
Care Plan
Medical & Nursing Dx Nursing Outcomes (NOC) Nursing Interventions (NIC) Evaluation
(Include Goal Statement)
Student Name:________________________
