Question

1. What pharmacologic interventions do you expect will be ordered for this patient? What routes of administration will be best indicated for this patient? (Include mechanism of action, indication for use and desired outcomes)
2. What are the nursing implications for the above listed pharmacologic treatments (teaching pearls, things to anticipate, adverse reactions)?

Gladys Young is a 68 year old female that resides in an Independent Living facility with her husband. She presents to her primary care physicians office with complaints of fever, chills, nausea and vomiting. She also states that she has had some mild hemoptysis occasionally with her persistent coughing. She has recently completed treatment with Chemotherapy for Breast cancer and is concerned that she may have an infection. You are the nurse caring for her.

You complete the following assessment:

Subjective Data:

She is able to complete a sentence in its entirety, but she is persistently coughing during the history. She is a former smoker, she smoked ½ pack of cigarettes per day for 30 years and quit when she was diagnosed with breast cancer 6 months ago. She denies shortness of breath or chest tightness. She has not yet gotten her influenza vaccine, but did receive the Pneumovax vaccine last year. She has had problems with persistent coughing at night which has prevented her from getting a good night’s sleep for the past two weeks. She also states that she has been waking up soaked in sweat in the morning.

Objective Data:

• Temp – 38.6 C; HR – 132 beats/min; RR—28; BP – 168/87; O2 sat – 90% on Room Air
• Auscultation: Lungs with faint crackles at bases bilaterally. No wheezing present.
• Patient is flushed and warm to touch.

Answer 1

Oseltamivir

Antibiotic ;- antiviral drug

Route of administration :- oral route 75 mg BID

Indication :- used for treatment and prophylaxis of infection with influenza viruses A and B.

Mechanism of action :- it's a prodrug, hydrolyzed to it's active form oseltamivir carboxylate ( OC ). OC inhibits influenza virus neuraminidase, an enzyme known to cleave the budding viral progeny from it's cellular envelope attachment point ( neuraminic acid ) just prior to release.

Things to anticipate :- may be administered without regard to meals, take with food to improve tolerance.

Adverse drug reaction :- headache, nausea, vomiting.

Acetaminophen (USP) / paracetamol (INN)

acetanilide, analgesic and antipyretic drug

Route of administration :- oral 650 mg ,Q 4-6h

Maximum daily dose : 3250 mg daily

Indication :- temporary relief of fever and ache/ pain.

Mechanism of action :- analgesic effects are believed to be due to activation of descending serotonergic inhibitory pathway in the CNS. Interactions with other nociceptive system may be involved as well.

Antipyresis is produced from inhibition of hypothalamic heat regulating center.

Teaching pearls :- advise patient to take with a full glass of water , avoid alcohol , unsafe to take more than 4000 mg / day.

Adverse drug reaction :- skin rashes , nausea , vomiting , headache , Hypersensitivity reaction.

pantoprazole

Proton pump inhibitor

Route of administration:- IV 40 mg ,OD

Indication :- gastroesophageal reflux disease ( erosive/ non erosive)

Mechanism of action :- suppressee gastric acid secretions by inhibiting the parietal cell H+/K+ ATP pump.

Teaching pearls :- flush IV line before and after administration with D5W ,NS / LR. In line filter not required.

Adverse drug reaction :- headache , dizziness.