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    DRUG MECHANISMOF ACTION

    INDICATIONS/CONTRAINDICATI

    ONS

    SIDEEFFECTS/ADVE

    RSEREACTIONS

    NURSINGRESPONIBILIT

    IES

    Generic name:epinephrine(adrenaline),

    epinephrinebitartrate,epinephrineborate,epinephrinehydrochloride

    Trade name:Aerosol:Primatene Mist

    Ophthalmicsolution: Epinal

    Injection, OTCnasal solution:

    AdrenalinChloride

    Insect-stingemergencies:EpiPen Auto-Injector

    (delivers 0.3 mgIM adult dose),EpiPen Jr. Auto-Injector(delivers 0.15mg IM forchildren)

    OTC solutionsfor nebulization:

    AsthmaNefrin,

    microNefrin,Nephron, S2

    Classification:Sympathomimetic, Alpha-adrenergicagonist, Beta1-and beta2-adrenergicagonist, Cardiac

    stimulant,Vasopressor,Bronchodilator,

    Antasthmatic,Nasaldecongestant,Mydriatic

    Dosage:Epinephrine

    Epinephrine,an activeprinciple of the

    adrenalmedulla, is adirect-actingsympathomimetic. Itstimulates -and -adrenergicreceptorsresulting inrelaxation ofsmooth muscleof thebronchial tree,cardiacstimulation anddilation ofskeletal musclevasculature. Itis frequentlyadded to localanaesthetics toretard diffusion

    and limitabsorption, toprolong theduration ofeffect and tolessen thedanger oftoxicity.

    IndicationsIV: In ventricular

    standstill after allother measureshave failed torestorecirculation, givenby trainedpersonnel byintracardiacpuncture andintramyocardialinjection;treatment andprophylaxis ofcardiac arrestand attacks oftransitory AVheart block withsyncopal seizures(Stokes-Adamssyndrome);syncope due tocarotid sinussyndrome; acute

    hypersensitivity(anaphylactoid)reactions, serumsickness,urticaria,angioneuroticedema; in acuteasthmatic attacksto relievebronchospasmnot controlled byinhalation orsubcutaneousinjection;relaxation ofuterinemusculature;additive to localanestheticsolutions forinjection toprolong theirduration of action

    and limit systemicabsorption

    Injection: Relieffrom respiratorydistress ofbronchial asthma,chronicbronchitis,

    CNS effects;GIdisturbances;

    epigastricpain; CVdisorders;difficulty inmicturitionwith urinaryretention;dyspnoea;hyperglycaemia; sweating;hypersalivation; weakness,tremors;coldness ofextremities;hypokalaemia.Gangrene,tissue necrosisand sloughing(extravasation) when usedin addition tolocal

    anaesthetics.Eye drops:Severesmarting,blurred vision,photophobia;naso-lachrymalductsobstruction.Oedema,hyperaemiaandinflammationof the eyeswith repeatedadministration.

    WARNING:Use extremecaution when

    calculatingandpreparingdoses;epinephrineis a verypotent drug;small errorsin dosage cancause seriousadverseeffects.Double-checkpediatricdosage.

    Use minimaldoses forminimalperiods oftime;"epinephrine-fastness" (aform of drug

    tolerance)can occurwithprolongeduse.

    Protect drugsolutionsfrom light,extremeheat, andfreezing; donot use pinkor brownsolutions.Drugsolutionsshould beclear andcolorless(does notapply tosuspensionfor injection).

    Shake thesuspensionfor injectionwell beforewithdrawingthe dose.

    Rotatesubcutaneousinjection sites

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    injection

    Cardiacarrest: 0.51mg (510mL of1:10,000

    solution) IVor byintracardiacinjection intoleftventricularchamber;duringresuscitation, 0.5 mg q 5min.

    Intraspinal

    0.20.4 mL of a1:1,000 solutionadded to anestheticspinal fluid mixture.

    Other usewith localanesthetic:Concentratio

    ns of1:100,0001:20,000 areusually used.

    1:1,000 solution

    Respiratorydistress:0.30.5 mLof 1:1,000

    solution(0.30.5mg),subcutaneously or IM, q20 min for 4hr.

    1:200 suspension(for subcutaneousadministration only)

    Respiratorydistress:0.10.3 mL(0.51.5mg)subcutaneously.

    Inhalation

    emphysema,other COPDs

    Aerosols andsolutions fornebulization:Temporary relief

    from acuteattacks ofbronchial asthma,COPD

    Topical nasalsolution:Temporary relieffrom nasal andnasopharyngealmucosalcongestion due toa cold, sinusitis,hay fever, orother upperrespiratoryallergies;adjunctivetherapy in middleear infections bydecreasingcongestionaround

    eustachian ostia

    0.1% ophthalmicsolution:Conjunctivitis,during eyesurgery to controlbleeding, toproducemydriasis

    Contraindications:Pre-existinghypertension;occlusive vasculardisease; angle-closure glaucoma(eye drops);hypersensitivity;cardiacarrhythmias or

    tachycardia.When used inaddition to localanaesthetics:Proceduresinvolving digits,ears, nose, penisor scrotum.

    to preventnecrosis;monitorinjection sitesfrequently.

    WARNING:Keep a

    rapidly actingalpha-adrenergicblocker(phentolamine) or avasodilator (anitrate)readilyavailable incase ofexcessivehypertensivereaction.

    WARNING:Have analpha-adrenergicblocker orfacilities forintermittentpositivepressure

    breathingreadilyavailable incasepulmonaryedemaoccurs.

    WARNING:Keep a beta-adrenergicblocker(propranolol;acardioselective beta-adrenergicblocker, suchas atenolol,should beused inpatients withrespiratorydistress)

    readilyavailable incase cardiacarrhythmiasoccur.

    Do notexceedrecommended dosage of

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    (aerosol)

    Begintreatment atfirstsymptoms ofbronchospas

    m.Individualizedosage. Wait15 minbetweeninhalationsto avoidoverdose.

    Inhalation(nebulization)

    Place 815drops intothe nebulizerreservoir.Placenebulizernozzle intopartiallyopenedmouth.Patient

    inhalesdeeply whilebulb issqueezedone to threetimes. If norelief in 5min, give 23 additionalinhalations.Use four tosix times perday usuallymaintainscomfort.

    Topical nasalsolution

    Apply locallyas drops orspray orwith a sterile

    swab, asrequired.

    Ophthalmicsolution

    Vasoconstriction,mydriasis:

    inhalationproducts;administerpressurizedinhalationdrug formsduring

    second halfof inspiration,because theairways areopen widerand theaerosoldistribution ismoreextensive. Ifa secondinhalation isneeded,administer atpeak effect ofpreviousdose, 35min.

    Use topicalnasalsolutions onlyfor acutestates; do not

    use forlonger than35 days,and do notexceedrecommended dosage.Reboundnasalcongestioncan occuraftervasoconstriction

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    Instill 12drops intothe eye oreyes; repeatonce ifnecessary.

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    DRUG MECHANISMOF ACTION

    INDICATIONS/CONTRAINDICATIO

    NS

    SIDEEFFECTS/ADVERSE REACTIONS

    NURSINGRESPONIBILITI

    ES

    Genericname:Prednisone

    Trade name:Apo-Prednisone(CAN),Deltasone,Liquid Pred,Meticorten,Novo-Prednisone(CAN),Orasone,Panasol-S,Prednicen-M,Prednisone-Intensol,SterapredDS, Winpred(CAN)

    Classification:

    Corticosteroid(intermediate acting),Glucocorticoid, Hormone

    Dosage,frequencyand route:40-60 mgdaily for 3-10 days;give assingle or in2 divideddoses PO

    Prednisone is aglucocorticoidreceptoragonist. It is

    firstmetabolized inthe liver to itsactive form,prednisolone.Prednisolonecrosses cellmembranesand binds withhigh affinity tospecificcytoplasmicreceptors. Theresult includesinhibition ofleukocyteinfiltration atthe site ofinflammation,interference inthe function ofmediators ofinflammatory

    response,suppression ofhumoralimmuneresponses, andreduction inedema or scartissue. Theantiinflammatory actions ofcorticosteroidsare thought toinvolvephospholipase

    A2 inhibitoryproteins,lipocortins,which controlthebiosynthesis ofpotentmediators ofinflammation

    such asprostaglandinsandleukotrienes.

    Indications- Replacement therapy

    in adrenal cortical

    insufficiency

    Hypercalcemia

    associated with cancer

    Short-term

    management of

    various inflammatory

    and allergic disorders,

    such as rheumatoid

    arthritis, collagen

    diseases (eg, SLE),

    dermatologic diseases(eg, pemphigus),

    status asthmaticus,

    and autoimmune

    disorders

    Hematologic

    disorders:

    thrombocytopenia

    purpura,

    erythroblastopenia

    Ulcerative colitis,acute exacerbations of

    multiple sclerosis and

    palliation in some

    leukemias and

    lymphomas

    Trichinosis with

    neurologic or

    myocardial

    involvement

    Contraindications:Contraindicatedwith infections,especiallytuberculosis, fungalinfections,amebiasis, vacciniaand varicella, andantibiotic-resistantinfections;lactation

    Vertigo, headache,

    paresthesias,

    insomnia,

    convulsions,psychosis,

    cataracts,

    increased

    intraocular

    pressure, glaucoma

    (long-term

    therapy)

    Hypotension,

    shock,

    hypertension andCHF secondary to

    fluid retention,

    thromboembolism,

    thrombophlebitis,

    fat embolism,

    cardiac

    arrhythmias

    Administer once-

    a-day doses

    before 9 AM to

    mimic normalpeak

    corticosteroid

    blood levels.

    Increase dosage

    when patient is

    subject to stress.

    Taper doses

    when

    discontinuing

    high-dose or long-term therapy.

    Do not give live

    virus vaccines with

    immunosuppressiv

    e doses of

    corticosteroids.

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    DRUG MECHANISMOF ACTION

    INDICATIONS/CONTRAINDICATIO

    NS

    SIDEEFFECTS/ADVERSE REACTIONS

    NURSINGRESPONIBILITI

    ES

    Genericname:Methimazole

    Tradename:

    Tapozole

    Classification:

    Antithyroidagent

    Dosage:20mg

    Frequency:BID

    Route:PO

    Inhibits thesynthesis ofthyroidhormones.

    Indicated forpalliativetreatment ofhyperthyroidism.

    IndicationsMethimazole isindicated in the

    medical treatment ofhyperthyroidism. Long-term therapy may leadto remission of thedisease. Methimazolemay be used toamelioratehyperthyroidism inpreparation forsubtotal thyroidectomyor radioactive iodinetherapy. Methimazoleis also used whenthyroidectomy iscontraindicated or notadvisable.

    Contraindications:Hepatitis caused byDrugs, AbnormalLiver FunctionTests, Pregnancy,

    UnderactiveThyroid, AcquiredDecrease of AllCells in the Blood,Decreased Functionof Bone Marrow,Decrease in theBlood-ClottingProteinProthrombin,Decreased BloodPlatelets,Deficiency ofGranulocytes aType of WhiteBlood Cell,Decreased WhiteBlood Cells

    fever, chills,sore throat,body aches, flusymptoms;

    easy bruisingor bleeding,unusualweakness;

    blood in yoururine or stools;

    severeblistering,peeling, andred skin rash;or

    nausea,stomach pain,low fever, lossof appetite,dark urine,clay-coloredstools,

    jaundice(yellowing ofthe skin oreyes).

    Less serious sideeffects ofmethimazole mayinclude:

    headache,drowsiness,dizziness;

    mild nausea,vomiting, orstomachupset;

    itching, minorskin rash; muscle, joint,

    or nerve pain; swelling; or hair loss.

    Assess patient forhypersensitivity.

    Use cautiously in

    patients 40 yearsold and above.Drug may causeagranulocytosis

    Monitor patients

    vital signs

    If the patientmisses to take thedrug, ask thepatient to take itas soon asremembered

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    DRUG MECHANISM OF

    ACTION

    INDICATIONS/CONTRAINDICATION

    S

    SIDEEFFECTS/ADVERSE REACTIONS

    NURSINGRESPONIBILITI

    ES

    Genericname:

    Amikacin

    Trade name:Amikacide

    Classification:

    Antibioticaminoglycosi

    de

    Dosage:200mg

    Route:Intravenous

    Inhibitsprotein

    synthesis bybindingdirectly tothe 30Sribosomalsub unit;bactericidal.

    Indication:

    Serious infectioncause bysensitiverestrains ofPseudomonasaeruginusa,E.coli, Proteus,Klebsiella,staphylococcus

    UncomplicatedUTI caused byorganism

    susceptible toless toxic drugs.

    Activetuberculosis, withotherantituberculoticsMycobacteriumavium complex(MAC) infection.

    Contraindication:Renal insufficiency,anemia.

    Clients withcardiac andpulmonarydiseases aremore susceptibletoacetaminophentoxicity

    Tinnitus,hearing

    impairment,renalimpairment,headache,tremor,lethargy,rashes, fever,

    joint pain.

    Obtainspecimen

    for cultureandsensitivitytest beforegiving firstdose.Therapymay beginwhileawaitingthe results.

    Evaluatepatientshearingbefore andduringtherapy ifhe will bereceivingdrug forlongerthan 2weeks.

    Notifyprescriberif patienthastinnitus,vertigo, orhearingloss.

    Weighpatientand reviewrenal

    functionstudiesbeforetherapybegins.

    Correctdehydration beforetherapybecause ofincrease

    risk oftoxicity.

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    DRUG MECHANISM OF

    ACTION

    INDICATIONS/CONTRAINDICATION

    S

    SIDEEFFECTS/ADVERSE REACTIONS

    NURSINGRESPONIBILITI

    ES

    Genericname:

    Doxycycline

    Tradename:

    Periostat

    Classification:

    Tertacycline

    Dosage:250mg

    Route:PO

    To inhibitbacterialproteinsynthesis at

    level or 30Sand 50Sbacterialribosomesand to altercytoplasmicmembrane ofsusceptibleorganisms

    Indication:

    To reduce thedevelopment of

    drug-resistantbacteria andmaintain theeffectiveness ofSumycin 250 andSumycin 500

    Tablets (TetracyclineHydrochlorideTablets) and otherantibacterial drugs,Sum- ycin 250 andSumycin 500Tablets (TetracyclineHydrochlorideTablets) should beused only to treat orprevent infectionsthat are proven orstrongly suspectedto be caused bysusceptible bacteria.When culture andsusceptibility

    information areavailable, theyshould beconsidered inselecting ormodifyingantibacterialtherapy. In theabsence of suchdata, localepidemiology andsusceptibilitypatterns maycontribute to theempiric selection oftherapy.

    Contraindication:

    Contraindicatedin patientshypersensitive todrug or

    Use cautiously inpatients withimpaired renalfunction orneuromusculardisorders, inneonates andinfants and inelderly patients

    anorexia,epigastricdistress,nausea,

    vomiting,diarrhea,bulkyloose stools,stomatitis,sorethroat,glossitis,blackhairytongue,dysphagia,hoarseness,enterocolitis,andinflammatorylesions (withcandidalovergrowth) inthe anogenitalregion,includingproctitis andpruritus ani.Rare instancesofesophagitisand

    esophagealulceration havebeen reportedin patientsreceivingparticularly thecapsule andalso the tabletforms oftetracyclines

    Monitor fors/s of superinfectionand

    hypersensitivityreaction.

    With long-term use,monitorCBC, liverfunctiontests, andbonegrowth

    Assessneurologicstatus, stayalert firbenignintra cranialhypertension

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    DRUG MECHANISM OF

    ACTION

    INDICATIONS/CONTRAINDICATIO

    NS

    SIDEEFFECTS/ADVERSE REACTIONS

    NURSINGRESPONIBILITI

    ES

    Generic name:Azithromycin

    Trade name:Zithromax

    Classification:Macrolide

    Dosage:300mg

    Frequency:OD

    Route:PO

    Azithromycinblocks

    transpeptidation by bindingto 50sribosomalsubunit ofsusceptibleorganismsanddisruptingRNA-dependentprotein

    synthesis atthe chainelongationstep.

    Indication: Treatment of

    lower respiratoryinfections: Acutebacterialexacerbations ofCOPD due toHaemophilusinfluenzae,Moraxellacatarrhalis,Streptococcuspneumoniae;community-

    acquiredpneumonia due toS. pneumoniae, H.influenzae

    Treatment oflowerrespiratoryinfections:Streptococcalpharyngitis

    and tonsillitisdue toStreptococcuspyogenes inthose whocannot takepenicillins

    Treatment ofuncomplicatedskin infectionsdue toStaphylococcus aureus, S.pyogenes,Streptococcusagalactiae

    Treatment ofnongonococcalurethritis andcervicitis dueto Chlamydiatrachomatis;treatment of

    PID Treatment of

    acute sinusitis

    Contraindication Contraindicated

    withhypersensitivity toazithromycin,

    Mild tomoderate

    nausea,vomiting,abdominalpain,dyspepsia,flatulence,diarrhoea,cramping;angioedema,cholestatic

    jaundice;dizziness,

    headache,vertigo,somnolence;transientelevations ofliver enzymevalues.

    Culture siteof infection

    beforetherapy.

    Administeron anemptystomach 1hr beforeor 23 hraftermeals.Foodaffects the

    absorptionof thisdrug.

    PrepareZmax byadding 60mL waterto bottle,shake well.

    Counselpatients

    beingtreated forSTDs aboutappropriateprecautionsandadditionaltherapy.

    Teaching points

    Take thefull courseprescribed.Do nottake withantacids.Tablets andoralsuspensioncan betaken withor without

    food. Prepare

    Zmax byadding 60milliliters(1/4 cup)water tobottle

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    DRUG MECHANIS

    M OFACTION

    INDICATIONS/CONTRAINDICATIO

    NS

    SIDEEFFECTS/ADVERSE REACTIONS

    NURSINGRESPONIBILITI

    ES

    Generic name:Dexamethorp

    han

    Trade name:Mucubron

    Classification:Antitussives

    Dosage:Adult: 15mlPedia: 5-10 ml

    Frequency:BID

    Route:PO

    Supressescough reflexby direct

    action on thecough centerin the medulla

    Indication:

    Relief ofcough due tominor throat &bronchialirritation asmay occurwith thecommon cold,bronchitis orinhaledirritants

    Contraindication:

    Should not be taken

    for persistent/chronic

    cough

    -Whencoughingaccompaniedby excessivesecretions

    Nausea,drowsiness,dizziness

    -Obtain patient

    history of cough

    before therapy

    and reassess after

    giving the drug

    -Assess cough:type, frequency,character includingsputum

    Instruct patient to

    follow exactly the

    direction on

    medication

    -Advice medical

    consultation for

    persistent cough

    more than 7 days

    -Suggest sugarlesslozenges todecrease throatirritation andcough.

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    DRUG MECHANISM OF

    ACTION

    INDICATIONS/CONTRAINDICATION

    S

    SIDEEFFECTS/ADVERSE REACTIONS

    NURSINGRESPONIBILITI

    ES

    Genericname:

    Calcium

    Carbonate

    Tradename:

    Calci-aid

    Classification:

    Calciumpreparationdrugs

    Dosage:Adult: 1-2capsules

    Pedia: 1-2tablets

    Route:PO

    Decreasestotal acidload of GItract.

    Increaseesophagealsphinctertone

    Indication:

    Antacid, calciumsupplement,

    osteoporosis

    Contraindication:

    Hypercalcemia,bone tremors,severe renalfailure,hypersensitivity

    PRECAUTION:History of stoneformation,pregnancy

    ADVERSE RXN Constipation,

    flatulence,diarrhea, renaldysfunction,acid rebound

    administer asantacid 1 hr ftermeal and at bedtime

    >administer assupplement 1 hrs after meal andat bed time>advice pt toincrease fluids to2L unlesscontraindicated

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    DRUG MECHANISM OF

    ACTION

    INDICATIONS/CONTRAINDICATIO

    NS

    SIDEEFFECTS/ADVERS

    E REACTIONS

    NURSINGRESPONIBILITI

    ES

    Genericname:

    Digoxin

    Tradename:

    Lanoxin

    Classification:

    Cardiotonic-inotropicagents

    Dosage:80 mg

    Route:PO

    Makes theheart beatslower butstronger;

    improves thepumpingability of theheart;increases theforce ofheartscontraction

    Indication:

    Congestve HeartFailure

    Atrial flutter

    Atrial fibrillation

    Contraindication:

    bsence of UrineFormation,Pancreatitis,HearingProblem, Heart

    Attack, BloodPressure DropUpon Standing,

    Abnormally LowBlood Pressure,Blockage ofUrinary Bladder,EnlargedProstate,Systemic LupusErythematosus,

    BloodCirculationFailure due toSerious HeartCondition, High

    Amount of UricAcid in theBlood,

    Azotemia,DecreasedBlood Volume,

    Acid BaseImbalance ofthe BloodToward theBasic Side,Diabetes, Gout,Low Amount ofMagnesium inthe Blood, Low

    Amount ofCalcium in theBlood, Low

    Amount ofSodium in theBlood, Low

    Amount ofPotassium inthe Blood, Low

    Amount ofChloride in theBlood

    inging inyour ears,hearing loss;

    feeling verythirsty orhot, beingunable tourinate,heavysweating, orhot and dryskin;

    painful ordifficulturination;

    pale skin,unusualbleeding(nose,mouth,vagina, orrectum),purple or redpinpointspots underyour skin;

    Hyponatraemia,

    hypokalaemia,hypomagnesaemia.

    - Hypochloraemicalkalosis.

    - Increasedcalciumexcretion.

    - Hypotension.

    - Nausea.

    - Dizziness.

    Furosemide is

    often given inconjunction with

    a potassium

    supplement or apotassium-sparing diuretic

    to counteractpotassium loss.

    - The medication

    has a rapidonset of effect of

    about one hourwhen taken

    orally and fiveminutes by

    injection.

    - Duration of

    action is about

    six hours so it ispossible to use atwice daily doseif necessary.

    PATIENT

    TEACHING- Explain to

    patients that

    furosemidecontrols highblood pressure

    but does notcure it and

    therefore theyneed to continue

    with themedication even

    if they feel well.

    - Advise patientsnot to stop

    takingfurosemide

    withoutconsulting the

    prescribing

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    health care

    professional.

    - Health

    education shouldbe givenregarding diet

    and exercise.

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    DRUG MECHANISM OF

    ACTION

    INDICATIONS/CONTRAINDICAT

    IONS

    SIDEEFFECTS/ADV

    ERSEREACTIONS

    NURSINGRESPONIBILITIES

    Genericname:

    Isorbidenitrate

    Tradename:

    Imdur Classifica

    tion:

    Nitrates

    Dosage:60mg

    Route:PO

    Nitratesare drugsthat

    act directlyon thesmoothmuscletocauserelaxationandtodepressmuscletone.

    Indication:

    Prevention and

    treatment of AnginaPectoris in Adults

    Contraindication:

    The presence ofany allergiestonitrates. Thesedrugs arealsocontraindicated inthe followingconditions: Severeanemia, head traumaorhemorrhage, pregnancy andlactation.

    CNS)Headache,dizziness,an

    dmyasthenia.(GI) N &

    Vandincontinence. (CV) Hypotension.(SKIN)Flushintg pallor sweatingandincreasedperspiration

    Instruct patient totakemedication asdirected,even if feeling better.

    Takemissed doses as soonasremembered; dosesofisosorbide dinitrateshould betaken at least 2 hr apart (6hrwith extended-releasepreparations);dailydosesof isosorbidemononitrateshould betaken 7 hr apart.Donot double doses. DonotdiscontinueabruptlyCaution patient tomake positionchangesslowly tominimizeorthostatichypotension

    Norjetalexis M Cabrera

    ADZU BSN III B