DRUG ORDER

PHARMACOLO GIC ACTION Anticonvulsant Sedative Barbiturate Long-acting barbiturate. Sedative and hypnotic effects of barbiturates appear to be due primarily to interference with impulse transmission of cerebral cortex by inhibition of reticular activating system. Initially, barbiturates suppress REM sleep, but with chronic therapy REM sleep returns to normal.

INDICATIONS AND CONTRAINDICATIONS INDICATIONS Long-term management of tonic-clonic (grand mal) seizures and partial seizures; status epilepticus, eclampsia, febrile convulsions in young children. Also used as a sedative in anxiety or tension states; in pediatrics as preoperative and postoperative sedation and to treat pylorospasm in infants. CONTRAINDICATIONS Phenobarbital is contraindicated in patients with known phenobarbital sensitivity or a history of manifest or latent porphyria.

ADVERSE EFFECTS OF THE DRUG CNS: Agitation, confusion, hyperkinesia, ataxia, CNS depression, nightmares, nervousness, psychiatric disturbance, hallucinations, insomnia, anxiety, dizziness Respi: Hypoventilation, apnea Cardio: Bradycardia, hypotension, syncope GI: N/V, constipation Other: headache, hypersensitivity, fever, liver damage, megaloblastic anemia

DESIRED ACTION ON THE CLIENT It causes sedation.

NURSING RESPONSIBILITIES /PRECAUTIONS

PHENOBARB ITAL

A therapeutic anticon vulsant level of phenobarbital inserum is 10 to 25 g/mL. The use of phenobarbital carries an associated risk of psychological or physical dependence. Alcohol should not be consumed while taking phenobarbital. Concurrent use of phenobarbital with other CNS depressan ts may result in additional depressant. Phenobarbital may impair mental and physical abilities required for the performance of hazardous tasks.

DRUG ORDER

PHARMACOLO GIC ACTION Osmotic diuretic

INDICATIONS AND CONTRAINDICATIONS It is indicated for the prevention and treatment of the oliguric phase of renal failure, reduction of intracranial pressure and treatment of cerebral edema, reduction of elevated IOP when pressure cannot be lowered by other means. It is sometimes used for the promotion of the urinary excretion of toxic substances. It is contraindicated with anuria due to severe renal disease, and is used cautiously with pulmonary congestion and active intracranial bleeding. Y-Site Incompatibilities: amsacrine, bleomycin, doxorubicin, fluconazole, gentamicin, quinidine, vinblastine, vincristine

MANNITOL Mannitol increases osmolarity of glomerular filtrate, which raises osmotic pressure of fluid in renal tubules resulting to decreased re absorption of water and electrolytes. Therefore, it increases urine output and the excretion of some electrolytes.

ADVERSE EFFECTS OF THE DRUG CNS: Dizziness, headache, blurred vision, seizures CV: Hypotension, hypertension, edema, HF, thrombophlebitis, tachycardia, chest pain Dermatologic: Urticaria, skin necrosis with infiltration GI: Nausea, anorexia, dry mouth, thirst GU: Diuresis, urine retention Hematologic: Fluid and electrolyte imbalances, hyponatremia Respiratory: Pulmonary congestion, rhinitis

DESIRED ACTION ON THE CLIENT It reduces the increased intracranial pressure and cerebral edema of the client.

NURSING RESPONSIBILITIES /PRECAUTIONS Nursing Responsibilities:  Assess neurologic status if drug is given for increased ICP: LOC, ICP reading, pupil size and reaction.  Assess BP before and during therapy.  Give with infusion pump.  Mannitol may crystallize at low temperatures. Warm solution to dissolve.  Run over 30 to 60 minutes in increased ICP. Drug Interactions:  Incompatible with blood or blood products, imipenemcilastatin, potassium chloride and sodium chloride.

PACKED RED BLOOD CELLS

BLOOD COMPONENTS OF BLOOD TRANSFUSION Red blood cells carry oxygen from the lungs to all parts of the body and return carbon dioxide from the body to the lungs. The lungs then remove the carbon dioxide. Certain factors, such as anemia, bleeding, chemotherapy, and radiation treatments, can decrease red blood cells in a person's body. A decrease in red blood cells means less oxygen is being transported throughout the body. When a patient's body receives less oxygen, he or she may feel tired, weak, dizzy, or light-headed. A red-blood-cell transfusion increases the number of red blood cells in the body. The transfusion of one unit of red blood cells usually takes 90 minutes to 2 hours, but may take longer. Bone marrow makes platelets that circulate in the blood. The spleen temporarily stores some of the platelets. Platelets help the body clot blood and repair injured blood vessels; for example, when a cut through the skin begins to bleed, platelets go to the injured site, clump together, and stop the bleeding.

PLATELETS

FRESH FROZEN PLASMA

Conditions that affect patients' bone marrow or spleen can affect how many platelets they have and their bodies' ability to store platelets. For example, leukemia causes bone marrow to produce too many white blood cells. This causes a decrease in the number of platelets produced. If a person's platelets are low, his or her blood will not clot in its usual way. A platelet transfusion increases the number of platelets in the body, and takes about 60 to 90 minutes to receive. Plasma, the straw-colored fluid of whole blood, contains water, protein, hormones, and blood-clotting factors. The body uses plasma to maintain normal blood clotting and to prevent blood loss. People who bleed excessively or who are missing blood-clotting factors sometimes receive plasma transfusions. Plasma is separated from donated whole blood and frozen to keep it fresh. Plasma is thawed before being transfused. A plasma transfusion increases the amount of plasma in the body and prevents blood loss by increasing the amount of blood-clotting factors. The transfusion of each bag of plasma takes 30 to 45 minutes.