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Drug Name

Indications

Pharmacokinetics

Contraindications/Precautions

Nursing Implications

Implementation

Patient/family teaching

Evaluation

Enoxaparin

· Acute coronary syndromes such as ST-elevation myocardial infarction, Non-ST elevation myocardial infarction, and unstable angina.

· Deep venous thrombosis (DVT) treatment.

· Deep venous thrombosis (DVT) prophylaxis.

· Treatment for pulmonary embolism (PE)

· Venous thromboembolism secondary to malignancy.

The absorption of enoxaparin is proportional to the dose, demonstrating linear absorption. The average maximum plasma anti-Xa activity is reached 3 to 5 hours after a subcutaneous injection.

· Known hypersensitivity to enoxaparin (urticaria, anaphylactic reactions) or any heparin products.

· Active major bleeding such as gastrointestinal bleed.

· History of heparin-induced thrombocytopenia within the past 100 days.

· Active gastric or duodenal ulcers.

· Hemorrhagic cerebrovascular accident.

Assess for signs of bleeding and hemorrhage, including bleeding gums, nosebleeds, unusual bruising, black/tarry stools, hematuria, and a fall in hematocrit or blood pressure. Notify physician or nursing staff immediately if enoxaparin causes excessive anticoagulation.

Enoxaparin is used to prevent deep venous thrombosis, a condition in which harmful blood clots form in the blood vessels of the legs. 

Make sure your patient recognizes the significance of informing their healthcare providers, including dentists, that they are taking Lovenox. Instruct them to check with their physician if they notice any possible side effects such as: Bruising or bleeding, especially prolonged bleeding. Bloody or black, tarry stools.

Docusate Sodium

Docusate is often used when straining to have a bowel movement should be avoided (e.g., after a heart attack or surgery). Docusate is a stool softener. It works by increasing the amount of water the stool absorbs in the gut, making the stool softer and easier to pass.

Docusate sodium is a laxative and an anionic detergent that supposedly promotes incorporation of water and fats into stool through a reduction in surface tension, resulting in softer fecal mass 6,4. Docusate's onset of action is 6-72 hours orally and 2-15 minutes rectally 6,7.

· Hypersensitivity reaction to any of the docusate ingredients.

· Avoid concomitant use of mineral oil. …

· Nausea or vomiting. …

· Intestinal obstruction, symptoms of appendicitis, acute abdominal pain, fecal impaction, especially in children.

 Evaluate therapeutic response (decreased constipation). – Drug should be discontinued if cramping, rectal bleeding, nausea or vomiting occur. – Administer alone for better absorption. – Do not administer within one hour of other drugs, antacids or milk

Docusate is a type of medicine called a laxative. It helps to soften your poo and makes your bowel movements easier if you have problems pooing (constipation).

Swallow tablets whole, do not chew them. – Health education: other possible means of avoiding constipation. – Inform that normal bowel movements do not always occur daily. – Do not use in the presence of abdominal pain, nausea, vomiting.

Morphine Sulfate

Morphine sulfate injection is indicated for the relief of moderate to severe pain. Morphine sulfate injection is used especially in pain associated with cancer, myocardial infarction and surgery. Morphine also helps to relieve the anxiety and insomnia which may be associated with severe pain.

After an oral dose, about 60% is excreted in the urine in 24 hours, with about 3% excreted as free morphine in 48 hours. After a parental dose, about 90% is excreted in 24 hours, with about 10% as free morphine, 65 to 70% as conjugated morphine, 1% as normorphine and 3% as normorphine glucuronide.

morphine may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. 

Monitor patient's respiratory rate prior to administration. Reassess pain after administration of morphine. Monitor for respiratory depression and hypotension frequently up to 24 hours after administration of morphine. Place call light signal close to patient.

This medication is used to treat severe pain. Morphine belongs to a class of drugs known as opioid analgesics. It works in the brain to change how your body feels and responds to pain.

· instruct patient on how and when to ask for and take pain medication.

· May cause drowsiness or dizziness. Caution patient to call for assistance when ambulating or smoking and to avoid driving or other activities requiring alertness until response to medication is known.

· Advise patient that morphine is a drug with known abuse potential. Protect it from theft, and never give to anyone other than the individual for whom it was prescribed. Store out of sight and reach of children, and in a location not accessible by others.

Lab Name

Rationale

Normal Range (Adult)

Hgb

If a hemoglobin test reveals that your hemoglobin level is lower than normal, it means you have a low red blood cell count (anemia)

Female : 12 or higher

Male : 13 or higher

HCT

A hematocrit test is needed to check for the proportion of red blood cells.

For men, 38.3 to 48.6 percent. For women, 35.5 to 44.9 percent

WBC

These cells help fight infections by attacking bacteria, viruses, and germs that invade the body. White blood cells originate in the bone marrow but circulate throughout the bloodstream.

 4,500 to 11,000 

Platelets

Platelets stop bleeding by clumping and forming plugs in blood vessel injuries.

 from 150,000 to 450,000 platelets per microliter 

Sodium (Na+)

Sodium is essential for cellular homeostasis and physiological function.

135 and 145 milliequivalents per liter

Potassium (K+)

Potassium is an electrolyte that's essential for proper muscle and nerve function. Even minor increases or decreases in the amount of potassium in your blood can result in serious health problems.

3.6 to 5.2 millimoles per liter (mmol/L).

Chloride (CL)

electrolyte that helps balance the amount of fluid inside and outside of cells. It also helps maintain blood volume, blood pressure, and the pH of body fluids.

96 to 106 milliequivalents per liter (mEq/L)

BUN

A BUN test can reveal whether your urea nitrogen levels are higher than normal, suggesting that your kidneys may not be working properly.

6 to 24 mg/dL (2.1 to 8.5 mmol/L )

HCO3

a byproduct of your body's metabolism. Your blood brings bicarbonate to your lungs, and then it is exhaled as carbon dioxide.

22 to 28

Creatinine

High levels of creatinine may indicate that your kidney is damaged and not working properly

men, 0.74 to 1.35 mg/dL (65.4 to 119.3 micromoles/L) For adult women, 0.59 to 1.04 mg/dL (52.2 to 91.9 micromoles/L)

Glucose

Glucose is either metabolised to produce energy or is stored in the muscles and liver as glycogen

less than 140 mg/dL (7.8 mmol/L)

Prothrombin time

The most common reason for PT tests is to monitor your blood levels if you are taking the blood-thinner warfarin.

10 to 13 seconds

INR

The INR test helps balance the risk of internal bleeding against the risk of blood clotting.

2.0 to 3.0

aPTT

It measures how long it takes your blood to form a clot.

20 to 35

Time

SIM (Room1)

Chart/EHR (Room2)

Skills (Room3)

Activity (Room4)

0900-0945

Group A

Group D

Group B

Group C

0945-1030

Group D

Group A

Group C

Group B

1030-1115

Group C

Group B

Group D

Group A

1115-1200

Group B

Group C

Group A

Group D

Group Debrief

1200-1230

LUNCH

(bring your lunch)

1230-1315

Group A

Group D

Group B

Group C

1315-1400

Group D

Group A

Group C

Group B

1400-1445

Group C

Group B

Group D

Group A

1445-1530

Group B

Group C

Group A

Group D

Group Debrief