INTRODUCTION:

The Rh factor (i.e., Rhesus factor) is a red blood cell surface antigen that was named after the
monkeys in which it was first discovered. Rh incompatibility, also known as Rh disease, is a condition
that occurs when a woman with Rh-negative blood type is exposed to Rh-positive blood cells, leading
to the development of Rh antibodies.
Rh incompatibility can occur by 2 main mechanisms. The most common type occurs when an
Rh-negative pregnant mother is exposed to Rh-positive fetal red blood cells secondary to feto-maternal
hemorrhage during the course of pregnancy from spontaneous or induced abortion, trauma, invasive
obstetric procedures, or normal delivery. Rh incompatibility can also occur when an Rh-negative female
receives an Rh-positive blood transfusion. In part, this is the reason that blood banks prefer using blood
type "O negative" or "type O, Rh negative," as the universal donor type in emergency situations when
there is no time to type and crossmatch blood.
Our patient, is atypical second born baby of a RH + and RH – parent. She was admitted in the
Pediatric ward on October 31,2018 due to generalized jaundice as a complication of RH incompatibility.
To date, the patient is under observation even after a series of phototherapy and antibiotic.

DEMOGRAPHIC DATA

Patient name: L.L

Birthdate: October 27, 2018

Birthplace: Marikina

Age: Newborn/25days

Address: Marikina City

Religion: Catholic

Nationality: Filipino

Gender: Female

Source of Information: Mother

Source of Income: Parents & Relatives

HEALTH HISTORY

Chief Complaint: Generalized jaundice at 6 hours of life

History of Present Illness: 6 hours after birth while still admitted at a private hospital, patient
was seen to have jaundice on her face progressing to her whole body. the nursery nurses informed the
patients pediatrician who in turn have informed her parents of her conditions. Patient was then put on
drop light phototherapy which partially relieved her jaundice. Patient was started on IV antibiotics
ampicillin and Cefuroxime as well as ranitidine. Patient was treated as a case of Rh incompatibility
were in they were advised to transfers to a bigger hospital for further care and management hence
admission UERM.

Birth and Maternal History: Patient was born full-term at 40-week AOG to a 28-year-old
G2P2 (2002) Mother via NSD at a private hospital assisted by a physician. There were no noted
complications on delivery. APGAR score was recalled as 8 and 8, birth length was 50 cm, birth weight
as 2.975 kg. Patient had good cry and pinkish color when she was delivered.

Feeding History: Patient was fed formula milk NAN H.A. as the patient’s mother was not
allowed to breastfeed first. The patient currently has difficulty in initiating breastfeeding but could
take a few minutes before sucking the nipples of her mother. Usual bottle feeding of 210 cc every 8
hours apart from breastfeeding.

Client’s immunization record:

N/A BCG
N/A _ Measles:
N/A Hep B: ( )1 ( )2 ( )3
N/A DPT: ( )1 ( )2 ( )3
N/A OPV: ( )1 ( )2 ( )3
_____ Others (Specify)
FAMILY HISTORY

DM
DM HTN

- The patient is known to have RH incompatibility with no other comorbidity, the mother
has stated she has history of Diabetes and his husband had history of Diabetes and
Hypertension.

PSYCHOSOCIAL HISTORY
According to the patients’ mother, her baby is developing sense of trust, whenever the baby
cries, she always looks for the significant others like her mother and father.

PSYCHOSEXUAL HISTORY
The patient is in Oral Stage where all things that she held will put directly on his mouth.
GORDON’S FUNCTIONAL HEALTH PATTERN

HEALTH PATTERN DURING HOSPITALIZATION NURSING DIAGNOSIS

O: Noted to have icteric sclera,
jaundice, full flat anterior fontanel,
open anterior and posterior fontanel,
dry lips and yellowish tongue

Contraptions present are nasal

cannula with O2, pulse oximeter at
right foot, and IV line at left arm
with restraint

A. Health Blood Chemistry 11-12-18

Perception - Health Direct Bilirubin Substc 155
Risk for injury related to
Management Pattern Total Bilirubin Substc 323
Physical properties of
Indirect Bilirubin Substc 168
therapeutic intervention
and effects on body
Currently undergoing Phototherapy
regulatory mechanisms
CBC 11-12-18
Hemoglobin 35g/L
Hematocrit 24 g/L
Risk for bleeding related
WBC 13.6
to abnormal liver function
Platelet 60

O: Noted to have OGT inserted

Feeding of breastmilk via OGT - 60mL
Risk for Aspiration
+ 30 mL of water Q4
related to OGT feeding
-skin is cold

Hypothermia related to
B. Nutrition -
exposure to cold
Metabolic Pattern CBC 11-12-18
environment and decrease
Hemoglobin 35g/L
in hemoglobin as
Hematocrit 24 g/L
manifested by an axillary
WBC 13.6
temperature of 36.1
Platelet 60
 VS
HR 135 bpm
RR 46 bpm
Temp 36.1 C
O2 Sat 93%

O: Change of diapers Q4 as needed

Urine: yellow-greenish
C. Elimination Readiness for enhanced
Stool: Loose stool with yellow-green
Pattern urinary elimination
color

Weight of Diaper: 90 grams + stool

Risk for Aspiration
related to positioning
during feeding
O: Patient maintained supine on bed
rest, only repositioned to fowler’s
position during and after feeding

CBC 11-12-18
Hemoglobin 35g/L
Ineffective tissue
Hematocrit 24 g/L
perfusion related to
WBC 13.6
destruction of RBCs as
D. Activity - Platelet 60
manifested by low levels
Exercise Pattern
of hemoglobin 35 g/L and
Blood Chemistry 11-12-18
hematocrit 24 g/L
Direct Bilirubin Substc 155
Total Bilirubin Substc 323
Indirect Bilirubin Substc 168

Arterial Blood Gas 11/10/18

PCO2 32
HCO3 20.9
 O:
Patient can be seen crying when awake,
but can be consoled using a pacifier

VS
E. Cognitive - HR 135 bpm Readiness for enhanced
Perceptual RR 46 bpm comfort
Temp 36.1 C
O2 Sat 93%

Readiness for enhanced

F. Sleep - Rest O: Sleeps 18-20 hours a day
sleep-rest pattern
O: Noted to have icteric sclera,
jaundice, full flat anterior fontanel,
open anterior and posterior fontanel,
dry lips and yellowish tongue

VS Risk for injury related to

HR 135 bpm Physical properties of
RR 46 bpm therapeutic intervention
Temp 36.1 C and effects on body
O2 Sat 93% regulatory mechanisms
G. Self - Perception,
Self - Concept
Currently undergoing Phototherapy

Contraptions present are nasal Risk for bleeding related

cannula with O2, pulse oximeter at to abnormal liver function
right foot, and IV line at left arm
with restraint

CBC 11-12-18
Hemoglobin 35g/L
Hematocrit 24 g/L
WBC 13.6
Platelet 60
 Blood Chemistry 11-12-18
Direct Bilirubin Substc 155
Total Bilirubin Substc 323
Indirect Bilirubin Substc 168

Arterial Blood Gas 11/10/18

PCO2 32
HCO3 20.9
Readiness for integration
O: Mother present at all times.
H. Role - into family related to
Father of patient visits ever day due to
Relationship acceptance of family
working schedule.
members
I. Sexuality -
N/A N/A
Reproductive
O: Patient can be seen crying when
awake, but can be consoled using a
J. Coping / Stress Readiness for enhanced
pacifier
Tolerance comfort

O: Both parents are Roman Catholic.

Readiness for enhanced
K. Value - Belief Picture of saint present on crib
religiosity

LABORATORY AND BLOOD EXAMINATIONS

Complete Blood Count

It is a test that measures the cells that make up your blood: red blood cells, white blood cells, and
platelets.

REFEREN RESULTS RESULTS RESULTS INTERPRETATI

CE 10/31/18 11/02/18 11/12/18 ON
Hemoglob 120-140 94 157 35 Decreased
in haemoglobin is
due to
autoimmune
hemolytic anemia
and increased
haemoglobin id
due to
compensatory
 mechanism of
spleen and liver
Hematocri 37-47 27 41 24 Decreased RBC
t is due to
destruction of red
blood cells with
positive antigen
RBC 4.5-5.5 2.5 5.0 2.7 Decreased RBC
is due to
destruction of red
blood cells with
positive antigen
MCHC 32-37 34 38 35 Concenrated
hemoglobin
MCH 27.5-33.2 36.9 31.4 31.1 autoimmune
hemolytic anemia
MCV 80-94 108 83 89 Indicates some
RBC are
macrocytic (large
average RBC
size)
RDW 11.0-15.0 19.5 11.7 14.9 Increased RDW
indicate iron
deficiency
anemia
WBC 5.0-10.0 21.8 18.2 13.6 Indicates
presence of
infection
Differenti
al count
Neutrophil 37-72 72 51 58 Within normal
s limits
Lymhotcyt 20-50 27 48 37 Within normal
es limits
Monocyte 0-14 - - 0 Within normal
s limits
Eosinohils 0-6 1 1 5 Within normal
limits
Basophils 0-1 - 0 0 Within normal
limits
Platelet 150-440 287 160 60 Hemolysis and
liver overwok
MPV 7.5-11.5 9.0 10.3 10.0 Within normal
limits
RBC SL NORMOCHRO HYPOCHROM
Morpholo HYPOCHROM MIC, IC,
gy IC, NORMOCYTIC NORMOCYTI
NORMOCYTI C
C
Blood Chemistry

This is a test that measure amounts of certain chemicals in a sample of blood and shows certain organs are
working or not.

REFERENC RESULT RESULTS RESULTS RESULTS INTERPRETATION

E S 11/02/18 11/07/18 11/12/18
10/31/18
SGOPT 10-30 35 Increase in reading
may indicate altered
liver functon
SGPT 6-37 11 Within normal limits
ALBUMIN 38-50 40 35 Ineffective clearing of
MASS C bilirubin by the liver.
Destruction of RBC.
Presence of jaundice.
DURECT 1.7-6.8 66.6 3.3 155 Ineffective clearing of
BILIRUBIN bilirubin by the liver.
SUBSTC Destruction of RBC.
Presence of jaundice
TOTAL 8.6-25.7 642.0 27.6 323 Ineffective clearing of
BILIRUBIN bilirubin by the liver.
SUBSTC Destruction of RBC.
Presence of jaundice
INDIRECT 6.9-18.9 575.4 19.3 168 Ineffective clearing of
BIL bilirubin by the liver.
Destruction of RBC.
Presence of jaundice
SODIUM 135-155 139 Within normal limits
POTASSIUM 3.5-5.3 3.2 Shifting of potassium
and bicarbonate
CHLORIDE 103-116 106 Within normal limits

Arterial Blood Gas

This is a test measures oxygen and carbon dioxide levels in your blood. It also measures your body’s
acid-base balance.

REFERENCE RESULTS RESULTS RESULTS RESULTS

(11/2/18) (11/6/18) (11/9/18) (11/10/18)
pH 7.35-7.45 7.45 7.39 7.38 7.42
PCO2 35-45 25 37 29 32
PO2 80-100 253 148 138 94
HCO3 22-26 17.3 22.3 16.9 20.9
Interpretation Respiratory Increased Hyperventilation, Hyperventilation,
alkalosis- oxygen levels Shifting of Shifting of
excess O2 in the inhaled potassium and potassium and
excretion air bicarbonate, bicarbonate,
Microbiology- Preliminary Report

SPECIMEN
BLOOD
Preliminary Report:
NOVEMBER 10,2018
POSITIVE FOR GRAM POSITIVE COCCI

CHEST X-RAY
November 8 2018-12-01

Follow-up chest radiograph since November 01, 2018 (AP and lateral view) shows thickening of minor
fissure which may denote minimal pleural effusion.

The rest lung fields are clear.

Heart and great vessels are within normal limits size and configuration.

No abdominal paratracheal lymphadenopahies noted.

An endotracheal tube is seen in place with its tip approximately 1.3cm above the carina.

Other chest structures are not remarkable.

SONOLOGY REPORT

(November 13, 2018)

Clinical data: Jaundice

The liver is normal in size with regular marginal outline and homogenous echopattern. The liver
span measures 7.6cm. Parenchymal echogenicity is within normal limits. There is no focal solid or cystic
mass 10esion seen. The inrahepatic biliary raddicles, portal vein and its tributaries are not dilated. The
gallbladder is not dilated.

The gallbladder is distended measuring 24.5x 3.3 mm. The lumen is anechoic with no demonstrable
calculus , wall thickening (0.4mm) or focal mass lesion. The common duct is dilated measuring 1.2mm.
It shows no abnormal intralumenal echoes. The cystic duct is not dilated.

IMPRESSION:

Normal sonogram of the liver nad gallbladder.

Non-dilated intra- or extra hepatic biliary tree.
 SEROLOGY TEST

(October 31,2018)
Examination desired/Clinical Impression:
ABO BLOOD TYPE: ‘A’
RH TYPE: POSITIVE
(November 02, 2018)
Examination desired/Clinical Impression:
COOMB’S TEST
DIRECT: 2+

URINALYSIS REPORT

(October 29,2018)

MACROSCOPIC
Color AMBER

Transparency SLIGHTLY TURBID

Specific Gravity 1.005

Reaction ACIDIC

Albumin NEGATIVE

Sugar NEGATIVE
 CONCEPT MAP
Non- Modifiable Factors
-2nd baby
-Mother is RH-
Hypothermia related to
exposure to cold environment
and decrease in hemoglobin
as manifested by an axillary Rh- mother diffuses anti-Rh IgG agglutins
temperature of 36.1 through placenta to the baby.

Ineffective Tissue
Attachment of anti-Rh to the Rh+ present RH TYPE: DIRECT:
Perfusion r/t to
in the RBC of the baby. POSITIVE 2+
destruction of RBC amb H
& H levels of 35 and 24 g/L

Agglutination occurs. Release of bilirubin

Hemoglobin 34 g/L
Hematocrit 24 g/L Macrophages destroy RBCS. Hyperbilirubinemia
RBC - 2.7
Platelet - 60
Hemolysis through the help of other Jaundice, icteric sclera,
organs = spleen. yellowish tongue
Hypoxia
93% O2 Saturation
Conversion of UCB to CB
through macrophages. SGOT – 35; Albumin - 35
Direct bilirubin – 155 umol/L
Indirect bilirubin – 168 umol/L
Aminophylline 4.5 mg Extramedullary hematopoiesis Total bilirubin – 323 umol/L
Dexamethasone .5 mg = liver and spleen

Nutrition regimen: Phenobarbital 10 mg

The gallbladder is distended Ursodeoxycholic
OGT Feeding measuring 24.5x 3.3 mm acid 300 mg

Risk for Aspiration Presence of late onset of sepsis

related to OGT feeding Phototherapy

Specimen: blood
+++ growth of stap. haemolyticus

Ampicillin 20 mg, Cefotaxime 155 mg, Meropenem 50 mg, Vancomycin 500 mg, Amikacin 47 mg
NURSING CARE PLAN 1

ASSESSMENT NURSING SCIENTIFIC PLANNING INTERVENTIONS RATIONALE EVALUATION

DIAGNOSIS RATIONALE

Subjective: Ineffective At the end of 8 Independent: After 8 hours of

tissue hours, patient will Assess and monitor Particular clusters nursing
No verbal perfusion be able to shows vital signs every 2 of signs and interventions,
response. related to no further hours. symptoms occur patient was able
destruction worsening of the with differing to show no
Objective: of RBCs as condition and will Reassess and causes. Evaluation further
manifested be able to maintain monitor laboratory provides a baseline worsening of
Patient by low levels maximum tissue data. for future the condition
maintained of perfusion to vital comparison. and was able to
supine on bed hemoglobin organs, as maintain
rest, only 35 g/L and evidenced by Monitor input and Sufficient fluid maximum
repositioned to hematocrit present and strong output accurately intake maintains tissue perfusion
fowler’s 24 g/L peripheral pulses, and note the urine adequate filling to vital organs,
position during vitals within color. Maintain pressures and as evidenced by
and after patient’s normal optimal prescribed optimizes cardiac present and
feeding range and an IV fluid rate. output needed for strong
increase of tissue perfusion. peripheral
CBC 11-12-18 haemoglobin level pulses, vitals
Hemoglobin from 84 to 100 Assist in providing Phototherapy is the within patient’s
35g/L g/L. phototheraphy. process of using normal range
Hematocrit light to eliminate and an increase
24g/L bilirubin in the of haemoglobin
WBC 13.6 blood. The baby's level from 35 to
Platelet 60 skin and blood 100 g/L.
absorb these light
Blood waves.
Chemistry 11-
12-18
Direct Apply patches to Prevents possible
Bilirubin closed eyes; inspect damage to the
Substc 155 eyes every 2 hours retina and
Total when patches are conjunctiva from
Bilirubin removed for high-intensity light.
Substc 323 feedings. Monitor
Indirect placement
Bilirubin frequently.
Substc 168
Reposition neonate Allows equal
Arterial Blood every 2 hr. exposure of skin
Gas 11/10/18 surfaces to
PCO2 32 fluorescent light.
HCO3 20.9
Administer Fluids compensate
Vital Signs: parenteral fluid as for insensible and
HR - 135 bpm indicated. intestinal fluid
RR - 46 bpm Feeding of losses and supplies
Temp - 36.1 C breastmilk via nutrients if
O2 Sat 93% OGT - 60mL + 30 feedings are
mL of water Q4 withheld during
phototherapy for
infants with severe
hyperbilirubinemia.

Dependent:
Provide oxygen This ensures
therapy as adequate perfusion
necessary. of vital organs.

Administer Consultants are

phenobarbital and helpful in ensuring
Ursodeoxycholic
Acid as indicated that proper
in the treatment treatments are met.
and prevention of
hyperbilirubinemia
in neonates.

Transfuse 2 PRBC 1 Packed RBC

as ordered. increase blood
level to 1g/dL.

Collaborative:
Submit patient to A variety of tests
diagnostic testing are available
as indicated. depending on the
cause of the
impaired tissue
perfusion.
NURSING CARE PLAN 2

ASSESSMENT NURSING SCIENTIFIC PLANNING INTERVENTIONS RATIONALE EVALUATION

DIAGNOSIS RATIONALE

Subjective: Hypothermia At the end of 8 Independent:

related to hours of Note and monitor For baseline At the end of 8
No verbal exposure to nursing patient’s temperature. data. Further hours of nursing
output cold interventions, decease will interventions,
environment patient will be serve as a patient was able
Objective: and decrease able to have warning. to have normal
in hemoglobin normal temperature as
Noted to have as manifested temperature as Monitor the patient These are signs evidenced by an
OGT inserted by an axillary evidenced by HR, RR, and BP. of progression increase of .9
Feeding of temperature an increase of hypothermia. degree Celsius
breastmilk via of 36.1 from 36.1 to from 36.1 to 37.
OGT - 60mL + 37. Evaluate the patient’s Poor nutrition
30 mL of water nutrition and weight. contributes to
Q4 decreased
-skin is cold energy reserves
and restricts the
body’s ability
CBC 11-12-18 to generate heat
Hemoglobin by caloric
35g/L consumption.
Hematocrit 24
g/L Monitor fluid intake Decreased
WBC 13.6 and urine output. output may
Platelet 60 indicate
dehydration or
poor renal
Vital Signs: perfusion.
HR - 135 bpm
RR - 46 bpm Regulate the Provide for a
Temp - 36.1 C environment more gradual
O2 Sat 93% temperature. warming of the
body.

Give extra covering Warm blankets

(passive warming), provide a
such as clothing and passive method
blankets. for rewarming.

Provide extra heat This measure

source like heat lamp. raise the core
temperature and
improve
circulation.

Dependent:
Transfuse 2 PRBC as 1 Packed RBC
ordered. increase blood
level to 1g/dL.

Collaborative:
Submit patient to To further
diagnostic testing as facilitate other
indicated factors causing
hypothermia
NURSING CARE PLAN 3

ASSESSMENT NURSING SCIENTIFIC PLANNING INTERVENTIONS RATIONALE EVALUATION

DIAGNOSIS RATIONALE

Subjective: Risk for At the end of Independent: At the end of 8

Aspiration 8 hours of Assess level of The primary risk hours of nursing
No verbal related to nursing consciousness. factor of interventions,
response. OGT feeding interventions, aspiration is client was be
client will be decreased level able to swallow
able to of consciousness and digests oral
swallow and gastric feeding
digests oral Check residuals Large amounts of without
gastric before feeding, or residuals indicate aspiration.
feeding every 4 hours if delayed gastric
without feeding is emptying and can
aspiration. continuous. Hold cause distention
feedings if amount of the stomach,
of residuals is leading to reflux
large, and notify emesis.
the physician.

Assess position of Proper

OGT before positioning will
feeding. decrease risk of
aspiration during
feeding.

Maintain patient on Semi-fowlers

semi fowlers contributes to the
during feeding and gravitational pull
30 minutes after. of fluids into the
stomach.
Collaborative:
Collaborate with Breastmilk
dietician for should be given
appropriate OGT Q4.
feeding for the
neonate.
DRUG ANALYSIS

GENERIC & MODE OF ACTION DRUG CONTRAINDICATION NURSING

BRAND NAME INTERACTION RESPONSIBILITIES

Ampicillin Binds to bacterial cell Hypersensitivity to  Determine previous

wall, resulting in cell penicillin. hypersensitivity
death. reactions to penicillins,
cephalosporins, and
other allergens prior to
therapy.
 Ampicillin rash is
believed to be
nonallergenic and
therefore its appearance
is not an absolute
CLASSIFICATION PHARMACOKINETICS INDICATION SIDE EFFECTS
contraindication to
Anti-infective Absorption: duodenum Skin and skin Diarrhea, rashes future therapy.
structure infections.  Observe patient for side
Distribution: body tissues effects and refer
and fluids accordingly
Metabolism and Excretion:
DOSAGE liver and renal

250 mg Half-life: 1.7-4 hr

Onset: rapid

Peak: end of infusion

Duration: 4-6 hr
GENERIC & MODE OF ACTION DRUG CONTRAINDICATION NURSING
BRAND NAME INTERACTION RESPONSIBILITIES

Cefotaxime Bactericidal Hypersensitivity to  Observe site closely for

cephalophorins extravasation during
administration.
 Observe for signs of
adverse effects,
especially those
suggesting a
superinfection.
 Observe for signs of
renal, hepatic or
haematological
CLASSIFICATION PHARMACOKINETICS INDICATION SIDE EFFECTS
dysfunction during
Anti-infectives Absorption: Treatment of Diarrhea, nausea, prolonged therapy.
infections caused vomiting, rahes  Assess patient for
Third generation Distribution: widely by susceptible adverse effects
cephalosporins distributed organisms  Observe proper drug
Metabolism and Excretion: dosage and
DOSAGE partly metabolzed and administration
partly excreted in the urine
155 mg
Half-life: 1-1.5 hr

Onset: rapid

Peak: end of infusion

Duration: 4-12 hr
GENERIC & MODE OF ACTION DRUG CONTRAINDICATION NURSING
BRAND NAME INTERACTION RESPONSIBILITIES

Ranitidine Potent anti-ulcer drug that May reduce Hypersensitivity to  Be alert for early signs
competitively and absorption of ranitidine of hepatotoxicity:
reversibly inhibits cefpodoxime, jaundice (dark urine,
histamine action at H2- cefuroxime, pruritus, yellow sclera
receptor sites on parietal delavirdine, and skin), elevated
cells, thus blocking gastric ketoconazole, transaminases
acid secretion. Indirectly itraconazole. (especially ALT) and
reduces pepsin secretion LDH.
but appears to have  Long-term therapy may
minimal effect on fasting lead to vitamin B12
and postprandial serum deficiency.
gastrin concentrations or  Observe proper drug
secretion of gastric dosage and
intrinsic factor or mucus. administration

CLASSIFICATION PHARMACOKINETICS INDICATION SIDE EFFECTS

Gastrointestinal Absorption: Incompletely Short-term

agent treatment of active
Peak: 2–3 h duodenal ulcer;
maintenance
therapy for
DOSAGE duodenal ulcer
 Duration: 8–12 h. patient after healing
Metabolism: Metabolized of acute ulcer;
in liver. treatment of
gastroesophageal
Elimination: Excreted in reflux disease;
urine, with some excreted short-term
in feces. treatment of active,
Half-Life: 2–3 h. benign gastric
ulcer; treatment of
pathologic GI
hypersecretory
conditions

GENERIC & MODE OF ACTION DRUG CONTRAINDICATION NURSING

BRAND NAME INTERACTION RESPONSIBILITIES

Phenobarbital increasing liver Sensitivity to barbiturates  Observe proper drug

metabolism and thus dosage and
lowering bilirubin levels administration
 Observe patients
receiving large doses
closely for at least 30
min to ensure that
sedation is not
excessive.
CLASSIFICATION PHARMACOKINETICS INDICATION SIDE EFFECTS  Keep patient under
constant observation
when drug is
CNS agent Absorption: 70–90% Treatment and CNS depression, nausea, administered IV, and
absorbed slowly from GI prevention of vomiting record vital signs at
tract. hyperbilirubinemia least every hour or more
in neonates often if indicated.
Peak: 30 min IV.
Duration: 4–6 h IV.
DOSAGE Distribution: 20–45%
10 mg protein bound;
Metabolism: Oxidized in
liver to inactivated
metabolites.

Elimination: Excreted in
urine.

Half-Life: 2–6 d.
GENERIC & MODE OF ACTION DRUG CONTRAINDICATION NURSING
BRAND NAME INTERACTION RESPONSIBILITIES

Aminophylline It is a respiratory smooth Hypersensitivity to  Observe patients

muscle relaxant that xanthine derivatives or to receiving parenteral
results in bronchodilation. ethylenediamine drug closely for signs of
component; cardiac hypotension,
arrhythmias. arrhythmias, and
convulsions until serum
theophylline stabilizes
within the therapeutic
range.
 Monitor & record vital
signs and I&O. A
CLASSIFICATION PHARMACOKINETICS INDICATION SIDE EFFECTS sudden, sharp,
unexplained rise in
Bronchodilator Absorption: Most products To prevent and Nausea, vomiting heart rate may indicate
are 100% absorbed from relieve symptoms toxicity.
GI tract. of acute bronchial  Children appear more
asthma and susceptible to CNS
Peak: IV 30 min; treatment of stimulating effects of
Duration: 4–8 h bronchospasm xanthines (nervousness,
DOSAGE
associated with restlessness, insomnia,
Metabolism: Extensively hyperactive reflexes,
4.5 mg metabolized in liver. chronic bronchitis twitching, convulsions).
and emphysema. Dosage reduction may
Elimination: Parent drug be indicated.
and metabolites excreted
by kidneys
GENERIC & MODE OF ACTION DRUG CONTRAINDICATION NURSING
BRAND NAME INTERACTION RESPONSIBILITIES

Dexamethasone Antiinflammatory action: BARBITURATES, Systemic fungal infection  Monitor for S&S of a
Prevents accumulation of phenytoin, rifampin hypersensitivity
inflammatory cells at sites increase steroid reaction
of infection; inhibits metabolism—  Report changes in
phagocytosis, lysosomal dosage of appearance and easy
enzyme release, and dexamethasone bruising to physician.
synthesis of selected may need to be These symptoms may
chemical mediators of increased signal
inflammation; reduces hyperadrenocorticism.
capillary dilation and  Discontinue drug
permeability. gradually under the
Immunosuppression: Not guidance of the
clearly understood, but physician.
may be due to prevention  It is important to
or suppression of delayed prevent exposure to
hypersensitivity immune infection, trauma, and
reaction. sudden changes in
environmental factors,
CLASSIFICATION PHARMACOKINETICS INDICATION SIDE EFFECTS
as much as possible,
Steroid Absorption: Readily hematologic Immunosuppression, because drug is an
absorbed from GI tract. disorders delayed wound healing, immunosuppressor.
Onset: Rapid allergic dermatitis

Peak: 8 h IM.

DOSAGE
0.5 mg Duration: 6 d IM;
Elimination:
Hypothalamus-pituitary
axis suppression: 36–54 h.
Half-Life: 3–4.5 h.

GENERIC & MODE OF ACTION DRUG CONTRAINDICATION NURSING

BRAND NAME INTERACTION RESPONSIBILITIES

Meropenem Broad-spectrum Hypersensitivity to  Determine history of

carbapenem antibiotic that meropenem, other hypersensitivity
inhibits the cell wall carbapenem antibiotics reactions to other beta-
synthesis of gram-positive including imipenem, lactams,
and gram-negative bacteria penicillins, cephalosporins,
by its strong affinity for cephalosporins, or other penicillins, or other
penicillin-binding proteins beta-lactams; lactation. drugs.
of bacterial cell wall.  Discontinue drug and
immediately report S&S
of hypersensitivity.
 Report S&S of
CLASSIFICATION PHARMACOKINETICS INDICATION SIDE EFFECTS
superinfection.
Anti-infective Distribution: Attains high Sepsis Diarrhea, nausea,
concentrations in bile, vomiting
bronchial secretions,
cerebrospinal fluid.
DOSAGE Metabolism: Undergoes
renal and extrarenal
50mg/ml metabolism via
dipeptidases or nonspecific
degradation.

Elimination: Excreted
primarily in urine.

Half-Life: 0.8–1 h.

GENERIC & MODE OF ACTION DRUG CONTRAINDICATION NURSING

BRAND NAME INTERACTION RESPONSIBILITIES

Fluconazole Fungistatic; may also be Hypersensitivity to  Monitor for allergic

fungicidal depending on fluconazole or other azole response. Patients
concentration. Interferes antifungals allergic to other azole
with formation of antifungals may be
ergosterol, the principal allergic to
sterol in the fungal cell fluconazole.
membrane that, when  Monitor BUN, serum
depleted, interrupts creatinine, and liver
membrane function. function.
 Drug may cause
elevations of the
CLASSIFICATION PHARMACOKINETICS INDICATION SIDE EFFECTS
following laboratory
Antifungal Absorption: 90% absorbed Oropharyngeal and Nausea, vomiting, serum values: ALT,
from GI tract. systemic candidiasis, diarrhea AST, alkaline
both commonly phosphatase, bilirubin.
Peak: 1–2 h. found in AIDS and  Monitor for S&S of
Distribution: Widely other hepatotoxicity.
DOSAGE distributed, including CSF. immunocompromised
Metabolism: 11% of dose patients
18.6 mg metabolized in liver.
Elimination: Excreted in
urine.

Half-Life: 20–50 h.

GENERIC & MODE OF ACTION DRUG CONTRAINDICATION NURSING

BRAND NAME INTERACTION RESPONSIBILITIES

Ursodeoxycholic Reduces elevated liver Contraindicated with  Allergy to bile salts,

acid enzyme levels by allergy to bile salts, hepatic impairment,
facilitating bile flow hepatic impairment, calcified stones,
through the liver and calcified stones, radiopaque stones or
protecting liver cells. radiopaque stones or radiolucent bile pigment
radiolucent bile pigment stones, unremitting
stones, unremitting acute acute cholecystitis,
cholecystitis, cholangitis, cholangitis, biliary
biliary obstruction, obstruction, gallstone
gallstone pancreatitis, pancreatitis, biliary-GI
biliary GI fistula fistula,
CLASSIFICATION PHARMACOKINETICS INDICATION SIDE EFFECTS
 Physical: Liver
Bile acid Not available Hyperbilirubinemia
evaluation, abdominal
PEDIATRIC examination; affect,
PATIENTS orientation; skin color,
lesions; LFTs, hepatic
Safety and efficacy and biliary radiological
DOSAGE not established. studies, biliary
ultrasound
300mg/tab
 Assess patient carefully
for suitability of
ursodiol therapy.
Alternative therapy
should be reviewed
before using ursodiol
GENERIC & MODE OF ACTION DRUG CONTRAINDICATION NURSING
BRAND NAME INTERACTION RESPONSIBILITIES

Vancomycin It acts by interfering with Drug: Adds to Known hypersensitivity Monitor BP and heart rate
cell membrane synthesis in toxicity of to Vancomycin, allergy to continuously through
multiplying organisms. OTOTOXIC and corn or corn products, period of drug
NEPHROTOXIC
previous hearing loss, administration.
DRUGS
concurrent or sequential
use of other ototoxic or Monitor I&O: Report
nephrotoxic agents, IM changes in I&O ratio and
administration. pattern. Oliguria or cloudy
or pink urine may be a sign
of nephrotoxicity (also
manifested by transient
CLASSIFICATION PHARMACOKINETICS INDICATION SIDE EFFECTS elevations in BUN,
albumin, and hyaline and
Antibiotic Absorption: Not absorbed Parenterally for
granular casts in urine).
from GI tract. potentially life-
threatening Monitor serial tests of
Peak: 30 min after end of infections in vancomycin blood levels
infusion. patients allergic, (peak and trough) in
DOSAGE Distribution: Diffuses nonsensitive, or patients with borderline
into pleural, ascitic, resistant to other kidney function, in infants
500 mg pericardial, and synovial less toxic and neonates, and in
fluids; small amount antimicrobial drugs. patients >60 y.
penetrates CSF if
Adhere to drug regimen
meninges are inflamed;
(i.e., do not increase,
crosses placenta.
decrease, or interrupt
dosage. The full course of
 Elimination: 80–90% of prescribed drug therapy
IV dose excreted in urine must be completed).
within 24 h

Half-Life: 4–8 h.

GENERIC & MODE OF ACTION DRUG CONTRAINDICATION NURSING

BRAND NAME INTERACTION RESPONSIBILITIES

Amikacin Sulfate Semisynthetic derivative Drug: History of Monitor peak and trough
of kanamycin with broad ANESTHETICS, hypersensitivity or toxic amikacin blood levels:
range of antimicrobial SKELETAL reaction with an Draw blood 1 h after IM or
MUSCLE immediately after
activity that includes many aminoglycoside
RELAXANTS have completion of IV infusion;
strains resistant to other additive antibiotic. neonates and draw trough levels
aminoglycosides. Appears neuromuscular infants, or use period immediately before the next
to inhibit protein synthesis blocking effects; exceeding 14 d is not IM or IV dose.
in bacterial cell and is acyclovir, established.
usually bactericidal. amphotericin B, Monitor serum creatinine or
bacitracin, creatinine clearance
capreomycin, (generally preferred) more
cephalosporins, often, in the presence of
colistin, cisplatin, impaired renal function, in
carboplatin, neonates, and in the older
methoxyflurane, adult.
polymyxin B,
vancomycin, Monitor & report any
furosemide, changes in I&O, oliguria,
ethacrynic acid hematuria, or cloudy urine.
increase risk of Keeping patient well
 ototoxicity and hydrated reduces risk of
nephrotoxicity. nephrotoxicity; consult
physician regarding
optimum fluid intake.

CLASSIFICATION PHARMACOKINETICS INDICATION SIDE EFFECTS

Aminoglycoside Peak: 30 min IV; 45 min Primarily for short-

Antibiotic to 2 h IM. term treatment of
serious infections
Distribution: Does not
cross blood–brain barrier;
crosses placenta;
DOSAGE accumulates in renal
47 mg cortex.

Elimination: 94–98%
excreted renally in 24 h,
remainder in 10–30 d.

Half-Life: 2–3 h in adults,

4–8 h in neonates.