nsg dx r/t adverse effects of medication

[lwandel]

hello all! this is my first post in this section. I'm in my first semester and my instructor is requesting on this upcoming care plan that we try to use an "adverse side effect of medication" diagnosis. But, honestly, i'm not sure how to come up with Outcomes or Interventions related to adverse side effects, or even if I'm on the right track with using the antibiotic the pt is taking as the culprit for his abnormal lab results. I need help. I'm sure it's staring me in the face, but i'm just overthinking it (common problem).

My pt has very high BUN levels of 39 mg/dL (normal is 7-20) and the pt is taking an antibiotic for pneumonia which lists . There is nothing in the Pt history regarding a history of renal failure. Here are the renal function panel results:

Sodium- 135 (low)

Potassium- 5.2 (high)

Chloride- 102 (normal)

CO2- 26 (normal)

BUN- 36 (high)

Creatinine- 0.9 (normal)

Calcium- 9.5 (nomal)

Blood Glucose- 94 (normal)

Albumin- 2.6 (low)

Phosphorous- 5.2 (high)

Pt also had an elevated Sedementation Rate at 72 mm/hr (normal is 0-30).

The Antibiotic lists it's adverse effects as:

Warnings/Precautions

Concerns related to adverse effects:* Elevated INR: May be associated with increased INR, especially in nutritionally-deficient patients, prolonged treatment, hepatic or renal disease.* Neurotoxicity: Severe neurological reactions (some fatal) have been reported, including encephalopathy, myoclonus, seizures, and nonconvulsive status epilepticus. Risk may be increased in the presence of renal impairment; ensure dose adjusted for renal function or discontinue therapy if patient develops neurotoxicity; effects are often reversible upon discontinuation of cefepime.* Penicillin allergy: Use with caution in patients with a history of penicillin allergy, especially IgE-mediated reactions (eg, anaphylaxis, angioedema, urticaria).* Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.Disease-related concerns:* Gastrointestinal disease: Use with caution in patients with a history of gastrointestinal disease, especially colitis.* Renal impairment: Use with caution in patients with renal impairment (CrCl ≤60 mL/minute); dosage adjustments recommended. May increase risk of encephalopathy, myoclonus, and seizures. * Seizure disorders: Use with caution in patients with a history of seizure disorder; high levels, particularly in the presence of renal impairment, may increase risk of seizures.

Adverse Reactions

>10%: Hematologic & oncologic: Positive direct Coombs test (without hemolysis; 16%)1% to 10%:Cardiovascular: Localized phlebitis (1%)Central nervous system: Headache (1%)Dermatologic: Skin rash (1% to 4%), pruritus (1%)Endocrine & metabolic: Hypophosphatemia (3%)Gastrointestinal: Diarrhea (≤3%), nausea (≤2%), vomiting (≤1%)Hematologic & oncologic: Eosinophilia (2%)Hepatic: Increased serum ALT (3%), abnormal partial thromboplastin time (2%), increased serum AST (2%), abnormal prothrombin time (1%)Local: Local pain (1%)Miscellaneous: Fever (1%)

[Esme12, ASN, BSN, RN]

Care plans are all about patient assessment. What meds is this patient on. In you other thread you mention the patient has a g-tube...are they getting feedings? What feedings are they on? You mentioned they were admitted with respiratory failure....were they in Rehab and the re-admitted to acute care? An elevated BUN means more than renal failure/impairment. What can an elevated sed rate mean?

Lab Tests Online: Welcome!

[lwandel]

Hi Esme,

The pt was in a car accident approx. 3 months ago. His injuries included pelvic fracture, hemoperitonemum, pneumothorax secondary to rib fracture, paraplegia due to T fracture, multiple surgeries to repair serosal tear in small bowel and colon, complex bladder repair and spinal repair surgeries. Radial fractrue at left elbow and thumb. Tracheostomy present. PEJ tube and IV present.

In January of '13 he had cluster seizures and a stroke.

Diet: PEJ Tube: protein supplement q12h, Isosource 250 ml q4h and liquid PO.

Activity: Out of bed to chair bid, restorative care, repositioning q2h.

The 5 medications I chose to work with are Cefepime Hydrochloride (antibiotic), zonisamide (anticonvulsant), famotidine (antiulcer), risperidone (atypical antipsychotic), and metroprololol tartrate (beta-adrenergic blocking agent for hypertension and prophylaxis of migrane headache).

The sedimentation rate test is done to determine status/type of infection and inflammation...along with other things, but these are most like what is related to my pt.

[Esme12, ASN, BSN, RN]

Good! Now the BUN is that an absolute indication of renal u=issues or can it be a indication of hydration? Dos this patient take anything PO? or is this added nutrition for the Stage four?

So the patient doesn't have to be exhibiting side effects of the drug but you need to list what they are?

[Esme12, ASN, BSN, RN]

Patients who take zonisamide may be at increased risk of suicidal thoughts or actions. The risk may be greater in patients who have had suicidal thoughts or actions in the past. Watch patients who take zonisamide closely. Contact the doctor at once if new, worsened, or sudden symptoms such as depressed mood; anxious, restless, or irritable behavior; panic attacks; or any unusual change in mood or behavior occur. Contact the doctor right away if any signs of suicidal thoughts or actions occur. Zonisamide: Indications, Side Effects, Warnings - Drugs.com

Cefepime Hydrochloride - Search results. Page 1 of about 48350 results

Metroprololol tartrate - Search results. Page 1 of about 3387 results

Famotidine - Search results. Page 1 of about 3034 results

[lwandel]

I read that elevated BUN levels suggest impaired kidney function, dehydration and excessive protein breakdown.

Dehydration: The pt's other electrolytes are within normal range, with exception to the potassium, but since he is taking lasix, he is probably being given a potassium supplement that I just didn't mark down, so I don't think it's that. Plus he is on an IV drip of NS 100mL/hr and he can drink thin liquids PO.

Protein Breakdown: he is being given a protein supplement...so since the creatinine levels are within normal range...is this the most likely cause for the elevated BUN levels?

[Esme12, ASN, BSN, RN]

Yup....his albumin remains low so he still needs more protein. If he is on lasix that may be the reason he is hemo concentrated (aka: dehydrated). what else can deplete albumin....lasix?

High concentrated proteins require additional intake of water. While they contain water the high concentration of protein formulas (which he is taking for the wound healing I presume) contain as low as only 60% water and additional water may be required. While the patient his receiving IVF @ 100 per hour...how do we get that fluid inot the cell? Protein right? His albumin is low. (push pull....Nursing Center - CE Article)

You have also already pointed out another cause on your own and don't realize it.....where does this patient have excessive protein breakdown....like a bad chronic would.

You got this....

[nurseprnRN, BSN, RN]

Just so you know, "Adverse drug reaction" is not a nursing diagnosis.

This whole discussion sounds to me as if you are trying to figure out a possible medical diagnosis. This is fine for learning purposes, because it's important to know this stuff, but this is not getting you any closer to planning his nursing care.