DEFINITIONS

OF
DIAGNOSIS
 Hyperthyroidism is an excess
production of thyroid hormone by the
thyroid gland.

Hyperthyroidism is a pathological
disorder in which excess thyroid
hormone is synthesized and secreted
by the thyroid gland.

Hyperthyroidism is a clinical
syndrome characterized by
hypermetabolic state due to the
increased free serum thyroxine (T4)
and free triiodothyronine (T3).
 Euthyroid: The normal state of the
thyroid gland function. As opposed
to hyperthyroid (overactive thyroid)
or hypothyroid (underactive
thyroid).

Euthyroid is the term given to

describe a state of normal thyroid
function in the body.

Euthyroid is the state of having

normal thyroid gland function.
DRUGS
Date Ordered - 1/21/2020
Generic name – Didolfenac
Classification - Analgesic, anti-inflammatory.
Mode of action - Reversibly inhibits cyclo-oxygenase-1 and -2 (COX-1 and
COX-2) enzymes, resulting in decreased formation of prostaglandin
precursors.
Dosage and Route - 37.5mg IVTT for three times a day
Side Effects - Headache, abdominal cramps, constipation, diarrhea, nausea,
dyspepsia, burning, stinging on instillation, ocular discomfort, rash,
peripheral edema, fluid retention, visual disturbances, vomiting,
drowsiness
Adverse effects - Overdose may result in acute renal failure. In patients
treated chronically, peptic ulcer, GI bleeding, gastritis, severe hepatic
reaction (jaundice), nephrotoxicity (hematuria, dysuria, proteinuria),
severe hypersensitivity reaction (bronchospasm, angioedema) occur
rarely.
Indications - Post-operative pain
Contraindications - Hypersensitivity to diclofenac or other NSAIDs. Aspirin-
sensitive asthma, risk factors for volume depletion (inj). Moderate to
severe heart failure, ischaemic heart disease, peripheral arterial disease,
cerebrovascular disease. Gastrointestinal ulceration, perforation or
haemorrhage, proctitis (rectal). Treatment in the setting of CABG.
Concomitant use of other NSAIDs, antiplatelets, anticoagulants. Severe
hepatic or renal impairment. Pregnancy (3rd trimester).
Nursing Interventions
 Monitor CBC, renal function, LFT, urine output, occult blood test, B/P.
 Monitor for headache, dyspepsia.
 Monitor daily pattern of bowel activity, stool consistency.
 Assess for therapeutic response: relief of pain, stiffness, swelling;
increased joint mobility; reduced joint tenderness; improved grip
strength.
Date Ordered - 1/21/2020
Generic name - Mefenamic Acid
Classification - Nonsteroidal anti-inflammatory drug
Mode of action - Mefenamic acid, an anthranilic acid derivative, is an NSAID. It
reversibly inhibits cyclooxygenase-1 and -2 (COX-1 and -2), thus resulting
in reduced rate of prostaglandin synthesis. It exhibits analgesic, anti-
inflammatory and antipyretic properties.
Dosage and Route - 500mg every 6 hours
Side Effects - Abdominal pain, constipation, diarrhea, indigestion, gas gross
bleeding/perforation, heartburn, nausea, GI ulcers (gastric/duodenal),
vomiting, abnormal renal function, anemia, dizziness, swelling, elevated
liver enzymes, headaches, increased bleeding time, itching, rashes and
ringing in the ears (tinnitus).
Adverse effects - CV thrombotic events including MI and stroke,
gastrointestinal inflammation, bleeding, ulceration, perforation. Rarely,
exfoliative dermatitis, toxic epidermal necrolysis, Stevens-Johnson
syndrome, fulminant hepatitis, liver necrosis, hepatic failure,
Indications - For acute pain and primary dysmenorrhea.
Contraindications - Hypersensitivity. Patients with active or history of
recurrent peptic ulcer/haemorrhage, history of gastrointestinal bleeding
or perforation (related to previous NSAID therapy), inflammatory bowel
disease, severe heart failure, history of asthma, bronchospasm, rhinitis,
angioedema, urticaria, or allergic-type reactions after taking aspirin or
other NSAIDs. Treatment of peri-operative pain in the setting of CABG
surgery. Renal (CrCl <30 mL/min) and severe hepatic impairment.
Pregnancy (3rd trimester).
Nursing Interventions
 Monitor patients with concomitant use of mefenamic acid with
anticoagulants (e.g.,warfarin), antiplatelet agents (e.g., aspirin), selective
serotonin reuptake inhibitors (ssris), and serotonin norepinephrine
reuptake inhibitors (snris) for signs of bleeding.
 Monitor blood pressure to ensure that the desired blood pressure is
obtained.
 Monitor for signs of worsening renal function.
 Assess renal function at the beginning of the concomitant treatment and
periodically thereafter. 
Date Ordered - 1/21/2020
Generic name - Tramadol
Classification - Analgesic
Mode of action - Binds to mu-opioid receptors, inhibits reuptake of
norepinephrine, serotonin, inhibiting ascending and descending pain
pathways. To reduces pain.
Dosage and Route - 50mg IVTT every 6 hours
Side Effects - Dizziness, vertigo, nausea, constipation, headache, drowsiness,
vomiting, pruritus, CNS stimulation (e.g., nervousness, anxiety, agitation,
tremor, euphoria, mood swings, hallucinations), asthenia, diaphoresis,
dyspepsia, dry mouth, diarrhea, malaise, vasodilation, anorexia, flatulence,
rash, blurred vision, urinary retention/frequency.
Adverse effects - Seizures reported in patients receiving tramadol within
recommended dosage range. May have prolonged duration of action,
cumulative effect in patients with hepatic/renal impairment, serotonin
syndrome (agitation, hallucinations, tachycardia, hyperreflexia). May
cause suicidal ideation and behavior.
Indications - For moderate to moderately severe pain, renal impairment
and hepatic impairment.
Contraindications - Hypersensitivity to tramadol, opioids. (Additional)
Immediate-Release, Extended-Release: Acute alcohol intoxication,
concurrent use of centrally acting analgesics, hypnotics, opioids,
psychotropic drugs, hypersensitivity to opioids.
Nursing Interventions
 Monitor pulse, B/P, renal/hepatic function.
 Assist with ambulation if dizziness, vertigo occurs.
 Dry crackers, cola may relieve nausea.
 Palpate bladder for urinary retention.
 Monitor daily pattern of bowel activity, stool consistency.
 Sips of water may relieve dry mouth.
 Assess for clinical improvement, record onset of relief of pain.
Date Ordered - 1/21/2020

Generic name – Ranitidine

Classification - Histamine H2 -receptor antagonist/ antiulcer.

Mode of action - Action Inhibits histamine action at histamine H2 -receptors

of gastric parietal cells or inhibits gastric acid secretion. Reduces gastric
volume, hydrogen ion concentration.
Dosage and Route - 50mg IVTT every 8 hours

Side Effects - Diarrhea, constipation and headache.

Adverse effects - Reversible hepatitis and blood dyscrasias.

Indications - Duodenal ulcer, gastric ulcer (benign), hypersecretory
conditions, GERD, erosive esophagitis and prevention of heartburn.

Contraindications - Hypersensitivity to ranitidine, do not use if trouble or

pain when swallowing food, vomiting with blood, or bloody or black stool
is present, do not use 150 mg with kidney disease (unless medically
advised) and renal/hepatic impairment, elderly patients, history of acute
porphyria.

Nursing Interventions
 Assess mental status in elderly.
 Question present abdominal pain, and GI distress.
Date Ordered - 1/22/2020
Generic name - Cefpodoxime
Classification - Third-generation cephalosporin/antibiotic.
Mode of action - Binds to bacterial cell membranes, inhibits cell wall
synthesis/bactericidal.
Dosage and Route - 200mg 1 tablet per orem every 12 hours
Side Effects - Oral candidiasis (thrush), mild diarrhea, mild abdominal
cramping, vaginal candidiasis, allergic reaction (pruritus, rash, urticaria).
Adverse effects - Antibiotic-associated colitis, other superinfections
(abdominal cramps, severe watery diarrhea and fever) may result from
altered bacterial balance in GI tract. Nephrotoxicity may occur, esp. in
patients with preexisting renal disease. Patients with history of penicillin
allergy are at increased risk for developing a severe hypersensitivity
reaction (severe pruritus, angioedema, bronchospasm and anaphylaxis).
Indications -Renal and hepatic impairment

Contraindications - History of hypersensitivity/anaphylactic reaction to

cefpodoxime, cephalosporins.

Nursing Interventions
 Assess oral cavity for white patches on mucous membranes, tongue
(thrush).
 Monitor daily pattern of bowel activity, stool consistency. Mild GI effects
may be tolerable.
 Monitor I&O, renal function tests for nephrotoxicity.
 Be alert for superinfection: fever, vomiting, diarrhea, anal/genital pruritus,
oral mucosal changes (ulceration, pain, erythema).
Date Ordered - 1/22/2020
Generic name - Ferrous Sulfate (Iron)

Classification - Iron preparation

Mode of action - Elevates the serum iron concentration which then helps to
form High or trapped in the reticuloendothelial cells for storage and
eventual conversion to a usable form of iron

Dosage and Route - 1 tablet once a day

Side Effects - Constipation, upset stomach, black or dark-colored stools,
temporary and staining of the teeth

Adverse effects - Dizziness, Nasal Congestion, Dyspnea, Hypotension, CHF, MI,

Muscle cramps, Flushing

 
Indications - The prevention or treatment of iron deficiency anemia due to
inadequate diet, malabsorption pregnancy, and blood loss.
Contraindications - Hypersensitivity and Severe hypotension

Nursing Interventions
 Caution patient to make position changes slowly to minimize orthostatic
hypotension.
 Instruct patient to avoid concurrent use of alcohol or OTC medicine
without consulting the physician.
Date Ordered - 1/22/2020

Generic name - Propylthiouracil 

Classification - Thiourea derivative/Antithyroid agent.

Mode of action - Blocks conversion of thyroxine to triiodothyronine in

peripheral tissues/Inhibits synthesis of thyroid hormone.

Dosage and Route - PTU 50mg 2 tablets once a day

Side Effects - Drowsiness, lymphadenopathy, vertigo.

Adverse effects - Agranulocytosis (may occur as long as 4 mos. after therapy),

pancytopenia, fatal hepatitis have occurred.
Indications - Hyperthyroidism and renal/hepatic impairment
Contraindications - Hypersensitivity to propylthiouracil. Cautions: In
combination with other agranulocytosis-inducing drugs.
Nursing Interventions
 Monitor pulse, weight daily.
 Check for skin eruptions, pruritus, swollen lymph glands.
 Be alert for signs, symptoms of hepatic injury, hepatitis (nausea, vomiting,
drowsiness, jaundice).
 Monitor hematology results for bone marrow suppression.

 Observe for signs of infection, bleeding.

 
Date Ordered - 1/22/2020

Generic name - Propranolol

Classification - Nonselective beta-adrenergic blocker/antihypertensive,
antianginal, antiarrhythmic and antimigraine
Mode of action - Blocks beta1, beta2 adrenergic receptors/slows heart rate;
decreases B/P, myocardial contractility, myocardial oxygen demand.
Dosage and Route - Propanolol 10g 1 tablet once a day

Side Effects - Diminished sexual function, drowsiness, difficulty sleeping,

unusual fatigue/weakness, bradycardia, depression, sensation of coldness
in extremities, diarrhea, constipation, anxiety, nasal congestion, nausea,
vomiting, altered taste, dry eyes, pruritus and paresthesia.
Adverse effects - Overdose may produce profound bradycardia, hypotension.
Abrupt withdrawal may result in diaphoresis, palpitations, headache,
tremulousness. Thyroid storm in patients with thyrotoxicosis, peripheral
ischemia in patients with existing peripheral vascular disease.
Hypoglycemia may occur in patients with previously controlled diabetes.
Antidote: Glucagon.
Indications - Hypertension, Angina, Arrhythmia, Obstructive Hypertrophic
Cardiomyopathy, Migraine Headache, Essential Tremor & Renal/Hepatic
Impairment
Contraindications - Hypersensitivity to propranolol. Bronchial asthma,
severe sinus bradycardia, cardiogenic shock, sick sinus syndrome, heart
block greater than first-degree, uncompensated HF. Hemangeol. Cautions:
Diabetes, renal/hepatic impairment, Raynaud’s disease, hyperthyroidism,
myasthenia gravis, psychiatric disease, bronchospastic disease and elderly
patients with history of severe anaphylaxis to allergens.
Nursing Interventions 
 Assess pulse for quality, regularity, bradycardia.

 Monitor EKG for cardiacarrhythmias.

 Assess fingers for color, numbness (Raynaud’s).

 Assess forevidence of HF (dyspnea [particularly on exertion or lying

down], night cough,peripheral edema, distended neck veins).
 Monitor I&O (increase in weight, decrease in urinary output may indicate
HF).
 Assess for rash, fatigue, behavioralchanges. Therapeutic response time
ranges from a few days to several wks.
 Measure B/P near end of dosing interval (determines if B/P is
controlledthroughout day).
Date Ordered - 1/26/2020
Generic name - Amlodipine
Classification - Calcium channel blocker/Antihypertensive and antianginal.
Mode of action - Inhibits calcium movement across cardiac and vascular
smooth muscle cell membranes. Dilates coronary arteries, peripheral
arteries/arterioles. Decreases total peripheral vascular resistance and B/P
by vasodilation.
Dosage and Route - 10mg 1 tablet once a day
Side Effects - Peripheral edema, headache, flushing, dizziness, palpitations,
nausea, unusual fatigue or weakness (asthenia), chest pain, bradycardia,
orthostatic hypotension.
Adverse effects - Overdose may produce excessive peripheral vasodilation,
marked hypotension with reflex tachycardia, syncopy
Indications - Hypertension and coronary artery disease
Contraindications - Hypersensitivity to amlodipine. Cautions: hepatic
impairment, severe aortic stenosis, hypertrophic cardiomyopathy with
outflow tract obstruction.

Nursing Interventions
 Assess B/P (if systolic B/P is less than 90 mm Hg, withhold medication,
contact physician).
 Assess for peripheral edema behind medial malleolus (sacral area in
bedridden patients).
 Assess skin for flushing. Question for headache, asthenia.
Date Ordered - 1/26/2020
Generic name - Magnesium sulfate
Classification - Antacid, anticonvulsant, electrolyte, laxative
Mode of action - Produces seizure control.
Dosage and Route - 5mg of magnesium sulfate + D5W run for 5 hours X 6
doses
Side Effects - Reduced respiratory rate, decreased reflexes, flushing,
hypotension, decreased heart rate.
Adverse effects - Magnesium as antacid, laxative has no known adverse
reactions. Systemic use may produce prolonged PR interval, widening of
QRS interval. Magnesium toxicity may cause loss of deep tendon reflexes,
heart block, respiratory paralysis, cardiac arrest.
Antidote: calcium gluconate
Indications- Eclampsia/Preeclampsia
Contraindications - Appendicitis, symptoms of appendicitis, ileostomy,
intestinal obstruction, severe renal impairment. Laxative: Appendicitis, HF,
colostomy, hypersensitivity, ileostomy, intestinal obstruction and
undiagnosed rectal bleeding.
Nursing Interventions
 Assess for relief of gastric distress.

 Monitor renal function.

 Maintain adequate fluid intake.

 Test patellar reflexes before giving repeated, rapid parenteral doses (used
as indication of CNS depression; suppressed reflexes may be sign of
impending respiratory arrest).
 Initiate seizure precautions.