Assess for contraindications or cautions for the use of the drug, including any known allergies, to prevent hypersensitivity reactions; cardiac depression, epilepsy, muscle weakness, or rheumatic disorder, which could be exacerbated by the effects of these drugs; pregnancy or lactation, which would be contraindications to use of the drugs; and renal or hepatic dysfunction, which alter metabolism and excretion of the drugs.
Assess temperature; skin color and lesions; CNS orientation, affect, reflexes, bilateral grip strength, and spasticity evaluation; bowel sounds and reported output; and liver and renal function tests to determine baseline status before beginning therapy and for any potential adverse effects.
Nursing diagnoses related to drug therapy might include the following:
药物疗法相关护理诊断可能包括下列：
Acute pain related to GI and CNS effects 急性痛，与GI和CNS效应有关
Disturbed thought processes related to CNS effects 思维程序紊乱，与CNS效应有关
Risk for injury related to CNS effects 损伤风险，与CNS效应有关
Deficient knowledge regarding drug therapy 知识缺乏，与药物疗法有关
Planning 计划
The patient will receive the best therapeutic effect from the drug therapy, relaxation of muscle and relief of discomfort.
患者将获得药物疗法的最佳治疗效果，肌肉松弛，不适缓解
The patient will have limited adverse effects to the drug therapy.
患者会有有限的药物疗法不良效应
The patient will have an understanding of the drug therapy, adverse effects to anticipate, and measures to relieve discomfort and improve safety.
患者将对药物疗法、预期的不良效应和缓解不适、提高安全性的措施有所了解
Implementation with Rationale 实施及说明
Provide additional measures to relieve discomfort—heat, rest for the muscle, NSAIDs, and positioning—to augment the effects of the drug at relieving the musculoskeletal discomfort.
提供其他措施缓解不适：热敷、肌肉休息、NSAIDs和体位，以加强药物的缓解肌肉骨骼不适效果。
Discontinue drug at any sign of hypersensitivity reaction or liver dysfunction to prevent severe toxicity.
一旦发现超敏反应或肝功能障碍征兆立即停药，防止严重毒性
If using baclofen, taper the drug slowly over 1 to 2 weeks to prevent the development of psychoses and hallucinations. Use baclofen cautiously in patients whose spasticity contributes to mobility, posture, or balance to prevent loss of this function.
If patient is receiving baclofen through a delivery pump the patient should understand the pump, the reason for frequent monitoring, and how to adjust the dose and program the unit to enhance patient knowledge and promote compliance.
Monitor respiratory status to evaluate adverse effects and arrange for appropriate dose adjustment or discontinuation of the drug.
监护呼吸状况，评价不良效应，安排适当的剂量调整或停药
Provide thorough patient teaching, including drug name, prescribed dosage, measures for avoidance of adverse effects, warning signs that may indicate possible problems, and the need for monitoring and evaluation to enhance patient knowledge about drug therapy and to promote compliance.
Offer support and encouragement to help the patient cope with the drug regimen.
提供支持与鼓励，帮助患者应对药物治疗方案
Evaluation 评价
Monitor patient response to the drug (improvement in muscle spasm and relief of pain; improvement in muscle spasticity).
监护患者对药物的反应（肌痉挛改善，疼痛缓解，肌痉挛状态改善）
Monitor for adverse effects (CNS changes, GI depression, urinary urgency).
监测有无不良效应（CNS变化、GI抑制、尿频）
Evaluate the effectiveness of the teaching plan (patient can give the drug name and dosage, name possible adverse effects to watch for and specific measures to prevent them, and describe, if necessary, proper intrathecal administration).
Monitor the effectiveness of comfort measures and compliance with the regimen.
监测舒适措施效果及疗程依从性
★Vocabulary ★
cardiac depression – 心脏抑制
muscle weakness – 肌无力
rheumatic disorder – 风湿病
affect – n. 情感
grip strength – 握力
deficient – a. 不足的，缺少的
therapeutic effect – 疗效
drug therapy – 药物疗法
psychosis – n. (重性)精神病
delivery pump – 输送泵
cyclobenzaprine – n. 环苯扎林
Flexeril – n. 盐酸环苯扎林
★Video ★ Neuromuscular Junction
★Test ★
1. A nurse is providing discharge teaching for a patient who will be going home on cyclobenzaprine (Flexeril) prescribed for his acute musculoskeletal pain. The nurse will stress that the patient should avoid what?
A. Drinking alcohol
B. Taking antiemetics
C. Taking antihistamines
D. Taking antibiotics 2. The nurse admits a child diagnosed with tetanus. What medication will the nurse expect to administer?
A. Methocarbamol (Robaxin)
B. Baclofen (Lioresal)
C. Dantrolene (Dantrium)
D. Diphenhydramine (Benadryl)
奥医教育“在线自测”正式上线，复习练习、效果检验，奥医NCLEX-RN/ISPN题库一站完成。
答案 Answers 1. A. Drinking alcohol. Rationale: Taking cyclobenzaprine with alcohol can cause an increase in central nervous system depression. The nurse should stress that this combination should be avoided due to possible injury or severe body system depression that could lead to coma or death. No significant concerns exist with the use of antiemetics, antihistamines, or antibiotics with this drug. 2. A. Methocarbamol (Robaxin) Rationale: Methocarbamol is the drug of choice if a child needs to be treated for tetanus. Baclofen and dantrolene are not recommended for use with children. Diphenhydramine is not indicated for treatment of tetanus.
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