Medication
 Dose
 Frequency
 Route

Purpose/action
 C- Category
 H - How this category
works
 W - Why my pt is on it
Famotidine (Pepcid)
 20 mg
 BID
 Per J tube

H2 receptor antagonist

 Blocks the action of
histmamine at the H2
receptors, inhibits

gastric acid secretion
Pt has GERD --- short term tx
of GERD and esophagitis d/t
GERD
T - heartburn &
GERD symptoms
decrease
C - headache,
dizziness,
diarrhea,
constipation

Anticoagulant

 Heparin inactivates

factor Xa, therefore

inhibiting thrombus &
clot formation by
blocking the
formation of
prothrombin -->
thrombin & fibrinogen
--> fibrin (which are
the final steps in the
clotting process)
 5000 units for
prophylaxis of
postoperative
thromboembolism
For clot prophylaxis
t-blood thins out
c-bruising
l-hemorrhage,
white clot
syndrome


Local anesthetic,

antiarrhythmic
 Blocks the conduction
of sensory nerves,

also decreases
automaticity of
ventricular cells
Pt needed the back of his
throat numbed so they could 
insert and NG tube at the
bedside despite him not
having an esophagus
T - pt will not feel 
the NG tube going 
down
C - burning,
stinging,
tenderness,
swelling, tissue
irritation
Seizures,
anaphylactoid
reactions
A - P, BP, LOC

W - any seizures or
anaphylactoid
reactions

P - pt will not
feel the NG tube
going down
A - goal met, pt
gagged but did
not feel pain
Antiemetic

 Txs N&V, GERD, &
heartburn caused by a 
stomach problem
called gastroparesis
(when stomach
cannot/delays
emptying stomachdoes not involve a
blockage) in diabetes
pts
t-pt does not have 
heartburn

c-tardive
dyskinesia

(involuntary
movements, esp.
of the lower face)
A- ????

w- involuntary
movements?

Iv- give Reglan IVP
over >1 minute
p- pt will not c/o
GERD
a- goal met-pt
did not c/o
GERD

Heparin
 5000 units
 Subcut
 q8h


Lidocaine injection
 1 mL
 Nebulization
 Once


Metoclopramide HCl
(Reglan)
 10 mg
 BID
 J tube

Side effects
 T-therapeutic
 C-common
 L -life
threatening
Nursing Implications
 A - assess
before giving
 W - watch for?
 IV - drugs alcohol, dilute,
etc

Liver or renal lab
values
Diarrhea
Outcomes
 P - predicted
outcome
 A - Actual
outcome



a-PTT lab value
w-any bruising,
internal bleeding
(sudden increase
in HR then
decrease in BP)
Subcut-alcohol
swab, pinch skin,
45-90 degree
angle


P - pt will not
have symptoms
of GERD
A - Goal met, pt
was also npo
p-blood clot will
not form
a-goal met-clot
did not form (if
pt ambulated it
would have
helped)
Metoprolol (Lopressor)
 12.5 mg
 oral
 BID

Pt has both GERD

Beta

blocker/antihypertensive
 Blocks betaadrenergic receptors 
of the heart thus
decreasing the release
of renin & lowering BP
Pt has HTN, for HR > 110

t-pt's BP will

decrease to below
120/80
c-orthostatic

hypotension,
heart failure,
cardiac
dysrhythmias
l-bronchospasm,
stroke,
laryngospasm
a-HR, BP

 Hold for SBP
<100
w-HR & BP

fluctuations,
dizziness when
standing r/t
orthostatic
hypotension
p-pt's BP will
stay below
120/80
A - goal not met
- pts BP at 11:48
was 129/89
Fluid/electrolyte

replenishment
 Supplement, D5W
gives calories

 1000 mL
Pt is on TPN and is on this for
extra calories & so K doesn’t
decrease?
t-electrolytes and 
fluids will be high
enough
c-fluid overload

a-intake and
output levels, K
level
w-fluid overload,
hyperkalemia
Iv-give lumen 2

p-pt will have
adequate fluids
and K
a-goal met, K
was within
normal limits
and did not pop
up on the main
page

t-pain level will

decrease
c-n/v, dizziness,

sedation
l-RESPIRATORY

DISTRESS, apnea,
circulatory
depression,
respiratory arrest,
shock, cardiac
arrest
a-pain level,
RESPIRATIONS
w-respiratory
distress
Iv-clean port w/
alcohol pad

T - area will

become numb for 
pain relief
C - numbness of
cheeks, tongue, or
mouth
L - allergic
reaction
A - pain level
W - allergic
reaction


D5W & 0.45% NaCl w/ KCL 
20 mEq
 1000 mL
 Continuous
 IV @ 75 mL/h

Hydromorphone
(Dilaudid)
 PCA pump
 6 mg
 IV
 Continuous
 0.1 mg every 6
minutes


Phenol (sore throat) spray 
 No dose/rate
 Prn

Opiod analgesic
 Acts at specific muopioid receptors in
the CNS to produce
analgesia, euphoria,
sedation
 For injection-1-10 mL
Pt is in pain from
esophatectomy


Anesthetic

 Numbs part of mouth
Pt had his esophagus taken
out


Sodium chloride 0.9%
 20 mL/h
 IV
 Continuous
Diphenhydramine
(Benadryl)
 25 mg oral or 12.5
mg IV
 Q6h PRN




Fluids

 Isotonic fluids to
hydrate patient
Pt is NPO-fluids help to keep 
pt hydrated
T - pt's urine will
not be
concentrated
C - fluid overload



Antihistamine, cough

suppressant, anti motionsickness
 Blocks histamine

effects at h1-receptor
sites, has sedative
t-pt's

itching/inflammati
on will decrease
c-drowsiness,
sedation,

dizziness,



A - for any edema
W - edema
IV - give
continuous


a-give with food if 
GI upset occurs,
where pt is itching
at
w-if itching

decreases
p-pt's pain level
will decrease
from an 8 to
agreed upon 3
A - goal not met,
pts pain was a 6
P - pts pain level
will decrease
from giving this
spray
A - did not give
P - pt will stay
hydrated, will
not have pitting
edema
A - goal met, pt
did not have
edema
p-pt's itching
will decrease to
pt not itching
anymore
a-did not give

Eye lubricant (Duratears)
 Ointment
 No dose
 PRN for dry eyes


effects
 10-50 mL for injection
Pt is also taking dilaudid
which may cause people to
become itchy

Relieves dry, irritated eyes
 Keeps eyes moist
helping to protect
them from infection
Pt stated he had dry eyes at
home



epigastric distress, 
thickening of
bronchial
secretions
l-anaphylactic
shock, 2 anemias,
leukpenia,
agranulocytosis,
pancytopenia.
T - eye moisture
will increase
C - tempoarily
blurred vision
C - eye pain,
change in vision


Iv-clean w alcohol
swab before
A - eye status

M - for any change
in vision

Hydromorphone
(Dilaudid)
 0.5 mg IV or 1 mg
IV
 Q3h PRN


Opiod analgesic
 Acts at specific muopioid receptors in
the CNS to produce
analgesia, euphoria,
sedation
 For injection-1-10 mL
Pt had a bone marrow
biopsy yesterday



t-pain level will

decrease
c-n/v, dizziness,

sedation
l-RESPIRATORY

DISTRESS, apnea,
circulatory
depression,
respiratory arrest,
shock, cardiac
arrest
a-pain level,
RESPIRATIONS
w-respiratory
distress
Iv-clean port w/
alcohol pad


Naloxone (Narcan)

 0.1, 0.2 or 0.4 mg
 Q15m PRN
o For RR
<10/min & if
pt in
unarousable
o Stop PCA,
give O2, &
call house

officer
 IV
Opioid antagonist

 Reverses the effects
of opioids (including
respiratory
depression, sedation, 
hypotension)
 0.1-0.2 mg IV for
postop opioid
depression

Pt in on dilaudid pca (opioid)
t-pt's will become 
arousalable & RR
will increase to

12-18
c-n/v, sweating,

increase HR & BP,
hypotension,
tremulousness
t-fibrillation,
pulmonary
edema, acute
opioid abstinence
syndrome
a-respirations, pt's 
state of condition
w-pt's respirations
& if is arousable
Iv-

Antiemetic

 Blocks receptor sites
which are associated
w n/v in the

chemoreceptor trigger
zone
All of pt's meds may cuase

nausea
t- nausea will

decrease to an
acceptable level 
c- headache,

dizziness,
diarrhea, myalgia
l- prolonged QT
interval
a-nausea &
vomiting level
w-if pt vomited
Iv- give slowly,
clean hub
beforehands
Ondansetron (Zofran)
 0.4 mg
 Q4h prn
 Iv

Oxycodone (Roxicodone)
 5 or mg
 Oral
 Q3h PRN

Opioid analgesic
 Acts as agonist at
specific opioid
receptors in the CNS
to produce analgesia,
euphoria, & sedation

t-pt's pain level
will decrease to
an acceptable
level decided
upon by the pt &
RN





a-pt's pain level,

RESPIRATIONS
wRESPIRATIONS!!!!!
!

P - pt will not
c/o dry eyes and
will voice a need
when he feels
the need to take
Duratears
A - not given
p-pt's pain level
will decrease to
the goal of 3
A - goal not met,
pts pain went to
a 6 from an 8
p-pt's
respirations will
increase to 1218 & pt will
become
arousable
a-not given
p-pt's nausea
will decrease
a-did not
administer
p-pt's pain level
will decrease to
an agreed upon
level bw the RN
& pt
a-not given

Pt has many co-morbidities 
on top of cancer & recently
had his esophagus taken out

c-dizziness,
sedatoin, n/v,
sweating
l-shock, cardiac
arrest, respiratory
arrest,
bronchospasm
Promethazine

(Phenergan)
 12.5 mg IV Q6h prn
o For nausea
Antiemetic

 Blocks histamine-1

receptors, diminishing
the effects of
histamine on cells
 25-50 mg iv, 12.5-50
po
An indication is postop pain
or postop sedation, n/v

t-n/v will decrease 
c-dizziness,

drowsiness,
urinary frequency, 
epigastric distress,
thickening of
bronchial
secretions
l-agranulocytosis,
pancytopenia

a- if pt vomitted

w-n/v decrease, IV
site

Iv-Phenergan =
irritant.. IVP admin
REQUIRES dilution
w/ 10 mL saline,
p-pt's n/v will
decrease
a-did not
administer