The Goal For Punishment Is Justified - 956 Words

Scenario #2 The goal for punishment that I have for this offender is retribution. She believes that drugs are victimless crimes and I want to show her otherwise with retribution because I want to inflict punishment on a person who has infringed on the rights of others and she does deserve to be penalized. Also this will serve as reminder to the general public of the rules and values of law, which may help my reelection as well. Also another goal for punishment is deterrence but I will only pursue this goal if she was not under the influence and that she thought before she acted. Since she believes that this is a victimless crime she will most likely commit the same crime again. So I would like to impose specific deterrence and impose a punishment on her so that she would be discourage to commit this crime in the future. Also pursuing this goal of specific deterrence I am also pursuing general deterrence. By showing the public that I do not take light of drug offenses and that if individuals com mit this crime I will want them to believe that they will be caught, prosecuted, and that there will be punishment. Also by pursuing the goal of deterrence allows myself to be viewed positively in the public eye showing that I am doing my job to the best of my ability and it also shows my opponent that I take my job seriously as well. I will also pursue the goal of rehabilitation. I believe that if she was under the influence of cocaine she may need to receive help from a treatmentShow MoreRelatedJustification And Justification Of The Penal System1171 Words   |  5 PagesPunishment in general can obviously be justified (in the traditional sense of the term) on utilitarian grounds. Nevertheless, usually its justification is not asked for. Because justification of punishment, in general is unnecessary. It is the justification of particular infliction of pain (or punishment) that can be enquired of. As a man can legitimately ask for justification of a particular law of a state. Howe ver, nobody enquires of the justification of legal system or of law in general. It isRead MoreCapital Punishment : Deontology Vs. Consequentialism1165 Words   |  5 Pages Capital Punishment: Deontology vs. consequentialism Subject: Analyze the deontological and consequentialist arguments on both sides of the issue of capital punishment in Gregg v Georgia. In this paper I will present the moral arguments of deontology and consequentialism used to determine whether or not using the death penalty was in fact constitutional. I will present both sides of the arguments and present them in the context of this trial and of similar situations where the arguments couldRead MoreC.S. Lewis and The Humanitarian Theory of Punishment1194 Words   |  5 Pageshumanitarian framework for punishment saying that, â€Å"The Humanitarian theory removes from punishment the concept of Deserts. But the concept of deserts is the only connecting link between punishment and justice† (C.S. Lewis). He is correct that the humanitarian framework does remove the concept of deserts, and that there is a connecting link between justice and punishment. However, he is wrong in suggesting that humans should only be seen through a retributive framework for punishment. A humanitarian frameworkRead MoreOrange is the New Black Essay1710 Words   |  7 Pagesas we fin d out, can be a long and frustrating process. While it seems a bit absurd that Piper is being locked away for a crime committed ten years ago, I do think it is justified. What she did was illegal and when you break the laws you go to jail. That being said, I can understand why one would think that this was not justified for two reasons, the first being the fact that she committed her drug trafficking and money laundering crime ten years ago. This may be true, but that doesn’t mean it wasRead MoreArguments Against The Death Penalty Essay1482 Words   |  6 Pagesdeath penalty. Bedau argues against capital punishment through his argument â€Å"The Minimal Invasion Argument Against the Death Penalty’. His argument strongly encourages life imprisonment over the death penalty for various reasons. Below I will provide a strength, a weakness and how I could alter the weakness to make it compatible. In his argument Mr. Bedau is announcing that the death penalty fails to satisfy a necessary condition of justified punishment. By doing so, he proceeds to supporting hisRead More Capital Punishment Is Necessary1130 Words   |  5 Pagesthat number. Something must be done to keep citizens safe and to keep the murder rates low. Capital Punishment is a rightly justified penalty because it is moral retribution, constitutional, and it deters crime. One reason that Capital Punishment is just is the idea that it is moral retribution to the murderer. According to David Gelernter, the death penalty supporter’s view is that the main goal in executing murderers is to make a point that murder is completely intolerable in today’s societyRead MoreNegative Effects Of Corporal Punishment1273 Words   |  6 PagesCorporal punishment is a type of negative reinforcement, something that has close to no positive effect on children; it also discourages integrity and does not prepare them for adulthood. Knowing this information, there is no justification for using violent punishment on children. However, there will still be some people who believe they need to hit their kids; it’s difficult to defy what we have been raised to believe. It does become substantially easier, though, once one is educated about the harmRead MoreIs Torture justified?1704 Words   |  7 Pagesï » ¿ ENGL 1301 Composition I November 9, 2013 Is Torture justified? What is torture? Basically, this is the action of physically or psychologically hurting a person without their permission and against their will. The torture has many goals such as obtaining a confession or information of the victim, revenge for an act committed by the victim or just for entertainment morbid and sadistic of the torturer. According to the 1984  United Nations Convention against Torture, the torture is: â€Å"anyRead MoreThe Death Penalty Is Not Morally Permissible?1231 Words   |  5 Pages  For thousands of years, punishment for crime has been met with several different styles of execution. In 1976, the United States government reinstalled the death penalty four short years after having banned it claiming that it violated the Constitution s ban on cruel and unusual punishment (MacKinnon, Ethics 289). Since 1976, the morality of execution as just punishment has been a highly discussed topic. The death penalty is not morally permissible because dissolving one s basic human rightRead MoreDealth Penalty Is Not a Solution Essay1003 Words   |  5 Pagesto crime. The ultimate purpose of the justice system is to control crime by punishing criminals and protect people by imprisoning them. Compared to the death penalty, life imprisonment not only achieves the same goals but also in many ways it can be more effective than capital punishment. In the Vincent Brothers’ case of 2004 , Brothers murdered five of his family members- his wife, children, and mother in law. During his trial, his only surviving daughter Margaret Kerns-Brothers gave a heart-wrenching

Kate Chopin s The Hour - 1361 Words

One of the greatest concerns of critics who have analyzed â€Å"The Story of the Hour† has been whether or not Mrs. Mallard was oppressed in her marriage or if she was depressed due to the lack of time she and her husband spent together. Time plays a crucial role in the story, from the time they have spent together, to the period of the story, and to the short time in which the story takes place. â€Å"The Story of the Hour,† is a story written by feminist author, Kate Chopin in 1894 that deals with marital instability from a woman’s perspective. Chopin, whose husband died when she was in her early thirties, wrote stories about healthy women during a time of female sexual liberation. She wrote stories about women who wished for freedom or who were trapped in an unbalanced marriage and longed for more. The protagonist of the story, Louise Mallard, she is emotionally detached from her deceased husband who was killed in a train accident, Brently Mallard. In my analysis, I talked about how Chopin uses different writing techniques, such as foreshadowing and situational irony, to adequately describe the feelings Mrs. Mallard won t say. Now, I can take the critical views of other writers and compare their ideas to mine. In doing so, I can discover more techniques Chopin possessed from a new perspective. Critics like Lawrence I. Berkove have analyzed the story and presented their views. Berkove notes that we all can agree that the story â€Å"tells a tale of female liberation from anShow MoreRelatedKate Chopin s An Hour1812 Words   |  8 PagesAuthor Kate Chopin is famous for some of the most influential feminist stories and novels in the Western canon. â€Å"The Story of an Hour† is one such text. In this story, Chopin tackles many of the concerns that are essential to feminism, including the willpower and expression of a woman’s distinctive identity separate from the identity of her husband and the right of a woman to identify and experience her own interests. While there is an aspect of this story that is provocative, namely, that Mrs. MallardRead MoreKate Chopin s An Hour857 Words   |  4 Pagesunderstanding of how various emotions can effect an individual; this is a consequence of being human. The broad variety of different emotions that Kate Chopin fit into à ¢â‚¬Å"The Story of an Hour† presents the story with a perspective that is very intelligible. While some readers may not understand what it is like to live a sheltered life due to marital convention, Chopin laid out the emotional path that the protagonist takes and simplified it into individual, coherent feelings that a woman in the late nineteenth-centuryRead MoreKate Chopin s An Hour899 Words   |  4 PagesThe author has to choose the gender of their main character, and by Kate Chopin choosing a woman it set a completely different mood to the story rather than it being a man. The time this story was written were women were suppose to be submissive and loyal to their husbands, caring and nurturing for their children, and well-bred, catering hostesses. If a woman were to overstep such boundaries, she would be considered unladylike, scandalous, or even immoral. Society looks differently upon a personRead MoreKate Chopin s An Hour1273 Words   |  6 Pagesthe probation to ban the consumptions of alcohol, because alcohol attributed to their husbands’ abusive behaviors. Three stories serve as great examples for how women were treated/viewed in overtime. One of those stories is the story of â€Å"An Hour†, by Kate Chopin, which shows us how shows us how women were in oppressive marriages and desired freedom. Another story called â€Å"Proof†, which was written by David Auburn, demonstrates the negative treatment of women in a male dominated work force. Finally,Read MoreKate Chopin s The Story Of An Hour1579 Words   |  7 PagesKate Chopin’s The Story of an Hour written in 1984 is a story of a woman who, through the erroneously reported death of her husband, experienced true freedom. Both tragic and ironic, the story deals with the boundaries imposed on women by society in the nineteenth century. The author Kate Chopin, like the character in her story, had first-hand experience with the male-dominated society of that time and ha d experienced the death of her husband at a young age. The similarity between Kate Chopin andRead MoreKate Chopin s The Story Of An Hour1336 Words   |  6 Pagesstatus in society as married women. In the story of an hour, the author, Kate Chopin describes the emotions of a woman who is married and tied down to this oath for the rest of her life. The author uses the ways of the society during that time to construct a story that accurately reflects the feelings of majority of women of that time. The goal of the story is to examine how women were indirectly oppressed during those times. The story of an hour is an interesting short story that begin with tellingRead MoreKate Chopin s Story Of The Hour Essay982 Words   |  4 PagesKate Chopin was an American author who wrote two novels that got published and at least a hundred short stories. In Kate’s short story The Story of the Hour she uses some of her traumatic event that happened in her lifespan in the short story even though it the story is fictional. A lot of her fictions were set in Louisiana and her best-known works focused on the lives of sensitive intelligent women. One-third of Mrs. Chopin’s stories are children’s stories. A lot of Mrs. Chopin’s novels were forgottenRead MoreKate Chopin s The Hour928 Words   |  4 Pagesâ€Å"The Story of The Hour† fully answers its title. It is a story about a woman living her last hour. Not so many things happen during that hour, but in contrast, many thoughts fly through main character’s head and a reader can form an accurat e portrait of a woman’s life from these thoughts. Somebody tells her that her husband is dead. After that she dives into the whirl of thoughts regarding the impact of husband’s death on her future. Some facts or beliefs make this woman think that her husband’sRead MoreKate Chopin s Story Of An Hour993 Words   |  4 Pageswriter’s base their stories of real life experiences and feelings. Kate Chopin largely based her stories off of her own life. Kate Chopin spent her childhood years in an alternative and matriarchal Louisiana town with a family that was unconventional. She challenged her nineteenth century sexist society and used her own life to put strength and feminism into her stories like â€Å"The Storm†, â€Å"Desiree’s Baby† and of course â€Å"The Story of an Hour†. She lived with her mother, grandmother and great grandmotherRead MoreKate Chopin s The Story Of An Hour1921 Words   |  8 Pagesapproaches. For Kate Cho pin, the famous author of â€Å"The Awakening† and â€Å"The Story of an Hour†, her most successful approach was to provide audiences with short stories that proposed meaningful and strong messages. However, Kate Chopin’s powerful feminist images that were present throughout her writing has mostly flaunted Chopin as only a â€Å"pioneering feminist writer,† which has led to other messages Chopin incorporated in her writing into being overlooked. In Kate Chopin’s, â€Å"The Story of an Hour†, the short

Written Critique of Drug Therapy in Nursing Practice Free Essays

According to Wayne K. Anderson, Dean, State University of New York, School of Pharmacy, â€Å"statistically, if you take six different drugs, you have an 80% chance of at least one drug-drug interaction. † The drug regimen of Mrs. We will write a custom essay sample on Written Critique of Drug Therapy in Nursing Practice or any similar topic only for you Order Now Brown includes six drugs that may interact with each other if not administered and monitored carefully. This is the reason why healthcare providers should be aware of the possible adverse affects that may happen related to her drug regimen. Necessary precautions should be observed to get the full benefits of the needed drugs and minimize possible drug-drug interactions. Nursing Management Mrs. Brown has a history of seizure, therefore, necessary measures should be provided to ensure the patient’s safety. It is also known that seizure is one of the many side effects of the drug metronidazole (Drugs. com, 2010). To prevent injury to patient, the nurse should provide comfort and safety measures if the CNS effect occurs such as siderails, and assistance with ambulation if dizziness and weakness are present† (Karch, 2006, p. 170). Since Mrs. Brown has numerous risk factors and health conditions, the nurse should â€Å"monitor for drug-drug interactions to arrange to adjust dosages appropriately† (Karch, 2006, p. 47). The drug regimen of Mrs. Brown may present several adverse effects that should be observed, the nurse â€Å"monitor adverse effects and provide appropriate supportive care as needed to help patient cope with these effects† (Karch, 2006, p. 347). To achieve therapeutic effects, it is also important that the nurse is aware how to â€Å"administer the drug as prescribed in appropriate relationship to meals† (Karch, 2006, p. 572). The nurse should provide supportive management to the drug regimen so she should â€Å"monitor the patient’s clinical status closely especially during the initial stages of treatment† (Karch, 2006, p. 34). This includes daily monitoring of serum lithium and phenytoin levels, blood glucose, prothrombin time (PT) and hepatic functioning. It i s essential to promote compliance to the patient. The nurse should â€Å"provide thorough patient teaching, including drug name and prescribed dosage, as well as 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† (Karch, 2006, p. 347). Some of the teaching points that should be included are any sign of blood loss ( petechiae,bleeding gums, bruises, dark colored stools, dark colored urine) to evaluate the effectiveness of warfarin and symptoms of phenytoin toxicity, including drowsiness, visual disturbances, change in mental status, nausea, or ataxia. Indications and Actions The indications and actions of Mrs. Brown’s regimen is presented to help verify the purpose of the drugs and their effects on the overall condition of the patient. Metronidazole (Flagyl, MetroGel, Noritate) Metronidazole is used for the treatment of intestinal amebiasis, trichomoniasis, inflammatory bowel disease, H. pylori infection causing peptic ulcers, bacterial vaginosis, and anaerobic infections and perioperative prophylaxis in colorectal surgery† (Kee Hayes, 2006, p. 470). In this case, it is also used to treat abscesses in the pelvis caused by susceptible anaerobic bacteria. It is classified as â€Å"an antiprotozoal agent that acts to inhibit DNA synthesis in susceptible protozoa, leading it to unable to reproduce and subsequent cell death† (Karch, 2006,p. 169). Paracetamol (Acetaminophen) Acetaminophen is indicated for the treatment of pain and fever associated with a variety of conditions, including influenza; for the prophylaxis of children receiving diptheria-pertussis-tetanus (DPT) immunizations; and for the relief of musculoskeletal pain associated with arthritis† (Karch, 2006, p. 241). Paracetamol was prescribed for the presence of pain in the client’s perineal area. Metformin (Glucophage) â€Å"Metformin is a biguanide compound used for the management of type 2 diabetes† (Kee Hayes, 2006, p. 787). In this case, the patient was known to have diabetes. This medication could be considered as a new mechanism for the management of her type 2 diabetes. This oral diabetic agent â€Å"acts by decreasing hepatic production of glucose from stored glycogen† (Kee Hayes, 2006, p. 787). It is said to diminish the increase in serum glucose after meals and lessen the degree of postprandial hyperglycemia. Phenytoin (Dilatin) â€Å"Phenytoin is the protoype hydantoin used in the treatment of tonic-clonic seizures and status epilepticus, as well as in the prevention and treatment of seizures after neurosurgery† (Karch, 2006, p. 342). Since the patient has a history of seizure disorder, this medication was prescribed for maintenance. It acts as â€Å"an anticonvulsant drug that works by suppressing sodium influx through the drug binding to the sodium channel when it is inactivated, thus prolonging the channel inactivation and thereby preventing neuron firing† (Kee Hayes, 2006, p. 341). Warfarin ( Coumadin) â€Å"Warfarin (Coumadin) is an anticoagulant drug in oral form that is used to maintain a state of anticoagulation in situations in which the patient is susceptible to potentially dangerous clot formation† (Karch, 2006, p. 38). The patient was given this medication since she has a history of atrial fibrillation that makes her susceptible to thrombus and embolus formation. The drug Warfarin inhibits the formation of thrombus and embolus formation by decreasing certain clotting factors. â€Å"Warfarin causes a decrease in the production of vitamin K-dependent clotting factors (II [prothrombin], VI I, IX and X) in the liver† (Karch, 2006, p. 740). Lithum Carbonate â€Å"Lithium is used as a mood stabilizers which is used to treat bipolar affective disorder† (Key Hayes, 2006, p. 399). Mrs. Brown has a bipolar mood disorder so this drug was prescribed to control her periods of mania and depression. It is said to function in several ways, â€Å"it alters sodium transport in nerve and musle cells; inhibits the release of norepinephrine and dopamine, but not serotonin, from stimulated neurons; increases the intraneuronal stores of norepinephrine and dopamine slightly; and decreases intraneuronalcontent of second messengers† (Karch, 2006, p. 330). Common Drug Interactions Drug to Drug Interactions Metronidazole (Flagyl, MetroGel, Noritate) This drug is known to produce interactions with phenytoin, oral coagulants and lithium. â€Å"Coadministration with a nitromidazole may increase the serum concentration of phenytoin† (Drugs. com, 2010). It is known to induce microsomal liver enzyme activity such as phenytoin that may accelerate the elimination of metronidazole resulting in reduced plasma; impaired clearance of phenytoin has been reported† (DailyMed, 2009). In this case, pharmacologic responses and serum phenytoin should be checked frequently whenever metronidazole is being administered to the patient. The drug dosage should be adjusted as necessary. Another thing to do is to educate the patient the signs and symptoms of phenytoin toxicity for immediate physician notification. â€Å"Metronidazole has been reported to potentiate the anticoagulant effect of warfarin and other oral coumarin anticoagulants, resulting in a prolongation of prothrombin time† (DailyMed, 2009). Mrs. Brown should be advised to report any signs of bleeding to her physician. INR should be checked frequently for adjustments in warfarin dosage, specifically after starting or discontinuing metronidazole. And lastly, lithium is said to produce interactions when administered with metronidazole. â€Å"Concurrent use of metronidazole with lithium may provoke lithium toxicity due to reduced renal clearance† (Rxlist, 2010). Since Mrs. Brown has a bipolar mood disorder, lithium is a long drug regimen. The serum lithium and creatinine levels should be monitored after the initiation of metronidazole. Phenytoin (Dilantin) Besides the impaired clearance of phenytoin with the use of metronidazole, there are other drug interactions that can happen in reference to Mrs. Brown’s drug regimen. It is said that Phenytoin can increase the effects of anticoagulants. â€Å"The hydantoins displace the anticoagulants and aspirin, causing more free drug and increasing their activity† (Kee Hayes, 2006, p. 342). Still, it is important to check on the prothrombin time (PT), phenytoin level and prothrombin time of the patient during the administration of both drugs. â€Å"Signs of an active bleed include coughing up blood in the form of coffee grinds (hemoptysis), gum bleeding, nose bleeds, cola- or tea-colored urine (hematuria), and black, tarry stools (hemoccult positive)†. Brown should be observed and notified to the physician. It is also said that the use of phenytoin can lead to â€Å"increased hepatotoxicity with acetaminophen† (Karch, 2007, p. 952). Lithium interacting with Phenytoin â€Å"may either increase or decrease the effectiveness of lithium or increase or decrease the effectiveness of the drug† (Raber, 2010). Phenytoin level and lithium serum level should be checked frequently to monitor the effectiveness of these drugs. Warfarin (Coumadin). Aside from the drug interactions of warfarin to both Metronidazole and Phenytoin, there is an existing interaction between Metformin and Warfarin. It is said that Metformin â€Å"oral hypoglycemic drugs for diabetes can displace warfarin or dicumarol from the protein-bound site, causing more free-circulating anticoagulant† (Kee Hayes, 2006, p. 663). Due to this possible interaction, it is important to monitor the blood glucose level and prothrombin time (PT). The patient should be informed of the signs and symptoms of hypoglycemia and bleeding so that she could report it to the health care team immediately. Warfarin also interacts with paracetamol (acetaminophen); it said that â€Å"some investigators advise that the hypothrombinemic response to warfarin can increase when acetaminophen is taken in a dosage of more than 2 g per day for longer than one week† (Ament, Bertolino Liszewski, 2000). Since Mrs. Brown has a prescription of 1000mg to be taken four times a day, her dosage is more than 2g per day. â€Å"If acetaminophen therapy is needed, the dosage should be as low as possible, and the drug should be taken for only a short period. In addition, the INR should be monitored closely† (Ament et al. 2000). Metformin (Glucophage) Meformin has moderate drug interaction with the drug Phenytoin. It is said to diminish the efficacy of oral diabetic agents and insulin. â€Å"These drugs may interfere with blood glucose control because they can cause hyperglycemia, glucose intolerance, new-onset diabetes mellitus, and/or exacerbation of preexisting diabetes† (Drugs. com, 2 010). There should be close monitoring of Mrs. Brown’s blood glucose level in order to observe hypoglycemia in the patient. Lithium (Eskalith) Lithium has drug interactions with Metronidazole and Phenytoin. It is also established that lithium may diminish the therapeutic effects of insulin and oral anti-diabetic agents. â€Å"In one study, 10 psychiatric patients treated with lithium carbonate for 2 weeks demonstrated elevated blood glucose levels and impaired glucose tolerance tests. There have also been isolated case reports of hyperglycemia, impaired glucose tolerance, or diabetes mellitus in patients on lithium, although a causal relationship has not been established† (Drugs. com, 2010). The blood glucose level should be checked frequently after starting or discontinuing lithium therapy. Drug to Food, Drug to Herbal, Drug to OTC drugs Interactions Metronidazole Metronidazole has a significant interaction with ethanol. â€Å"Use of alcohol or products containing alcohol during nitroimidazole therapy may result in a disulfiram-like reaction in some patients† (Drugs. com, 2010). Necessary precautions should be made in relation to use of ethanol and ethanol-containing products. Mrs. Brown should be instructed not to take alcohol beverages and alcohol-containing products. It is said that â€Å"alcohol beverages should not be consumed for at least a day after completion of metronidazole therapy† (Drugs. om). Metronidazole has an interaction to the herb milk thistle. â€Å"Milk thistle has been reported to protect the liver from harm caused by some prescription drugs. While milk thistle has not yet been studied directly for protecting people against the known potentially liver-damaging actions of metronidazole, it is often used for this purpose† (Morazz oni Bombardelli, 1995). Phenytoin Phenytoin has moderate interaction with alcohol and food. The effects of alcohol on the therapeutic level of Phenytoin depend on the duration of its consumption. â€Å"Acute consumption of alcohol may increase plasma phenytoin levels. Chronic consumption of alcohol may decrease plasma phenytoin levels† (Drugs. com, 2010). Phenytoin (oral drug) could be given with or without food in a consistent manner. Give with food if patient complains of GI upset ( Karch, 2007). The bioavailability of Phenytoin is said â€Å"to decrease to subtherapeutic levels when the suspension is given concomitantly with enteral feedings† (Drugs. com, 2010). Antacids containing calcium may decrease the blood level of phenytoin while aspirin (more than 1500 mg/dl) may increase the blood level of phenytoin (Epilepsy. om, 2010). Phenytoin also will lower the blood levels of other types of medication like acetaminophen (Epilepsy. com, 2010). Warfarin Patients taking Warfarin should not take Vitamin K-rich foods like â€Å"liver, broccoli, brussels sprouts, spinach, Swiss chard, coriander, collards, cabbage, and other green leafy vegetables† (Drugs. com). There are also particular medicines that should not be taken for they m ay cause serious bleeding problems in the stomach and intestines and alterations in blood clotting. These particular medicines are as follows: â€Å"acetaminophen (Tylenol), aspirin, and NSAIDs including celecoxib (Celebrex), diclofenac (Voltaren), ibuprofen (Motrin, Advil), indomethacin, naproxen (Aleve, Naprosyn),and others† (Drugs. com, 2010). It is also said that the patient should â€Å"avoid eating cranberries, drinking cranberry juice, or taking cranberry herbal products† (Drugs. com, 2010). Warfarin can interact with the following herbal products: â€Å"garlics, gingko biloba, ginseng or St. John’s wort†. (Drugs. com, 2010). Metformin Drugs that can raise the blood sugar affecting the use of Metformin include medicines to treat colds and allergies while drugs that lower blood sugar include some nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, and sulfa drugs (Bactrim)† (Drugs. com, 2010). Alcohol should also not be taken concomitantly with this drug. â€Å"Alcohol lowers blood sugar and may increase the risk of lactic acidosis while taking this drug† (Drugs. com, 2010). There could be increased risk for hypoglycemia if the drug is taken with â€Å"juniper berries, ginseng, garlic, dandelion root and celery† (Karch, 2007, p. 58). Lithium Patients taking lithium carbonate should â€Å"avoid drinking large amounts of coffee, tea, or cola, which can cause dehydration through increased urination† (Drugs. com, 2010). Besides having interactions with other drugs in the patient’s regimen, lithium also interacts with over-the-counter drugs. â€Å"If Eskalith is taken with certain other drugs, the effects of either could be increased, decreased, or altered such as nonsteroidal anti-inflammatory drugs† (Drugs. com, 2010). â€Å"Patients being treated with lithium should be encouraged not to use the herbal therapy psyllium. If combined with lithium, the absorption of the lithium may be blocked and the patient will not receive therapeutic level† (Karch, 2006, p. 333) Possible Adverse Reactions and Nursing Interventions Metronidazole â€Å"Convulsive seizures have been reported in patient treatment with metronidazole† (DailyMed, 2009). Necessary seizure precautions should be implemented. Mrs. Brown has a history of seizure; this is why the healthcare team should take necessary adjustments to the dosage of metronidazole. Aside from this major adverse reaction, the patient can develop â€Å"unpleasant metalic taste, nausea, vomiting and diarrhea† (Karch, 2007, p. 86). Nursing care for strange metallic taste should be â€Å"frequent mouth care, sucking sugarless candies†, and for nausea, vomiting and diarrhea, the patient should be advised to â€Å"eat frequent small meals† (Karch, 2007, p. 786). In the case of Mrs. Brown, complains of discomfort in her buttocks, pain in per ineal area and offensive odor could mean that she developed cadidiasis as â€Å"known or previously unrecognized candidiasis may present more prominent symptoms during therapy with metronidazole† (DailyMed, 2009). Treatment with candidicidal agent should be instituted to the patient. Other adverse effect can be â€Å"disulfiram-like interaction with alcohol† (Karch, 2007, p. 786). The patient should be always reminded of precautions on ingesting alcohol and alcohol-containing products. Phenytoin â€Å"Nausea,vomiting, diarrhea, constipation and gingival hyperplasia† (Karch, 2009, p. 951) could be present in patients taking Phenytoin. The nurse should â€Å"arrange instruction in proper hygiene technique for long-term patients to prevent development of gum hyperplasia†, â€Å"take drug with food, eat frequent small meals† (Karch, 2007, p. 953). Among the other common adverse effects are â€Å"dizziness ,drowsiness, confusion and headache†. The patient should be advised to â€Å"avoid performing tasks requiring alertness and visual acuity† (Karch, 2007, p. 953). Warfarin The common adverse effects of Warfarin are â€Å"nausea, vomiting, abdominal cramping, diarrhea and hemorrhage† (Karch, 2007,p. 1216). Nurse should advise the patient to â€Å"avoid any situations in which she could be easily injured. † Necessary care should be provided to avoid bleeding in the patient like â€Å"not giving any IM injections† (Karch, 2007, p. 1217). The patient should also be asked to â€Å"report unusual bleeding (from brushing teeth, excessive bruising), black or bloody stools, cloudy or dark urine† (Karch, 2007, p. 1218). Metformin The most significant possible adverse effects of this drug are â€Å"hypoglycemia and lactic acidosis† (Karch, 2007, p. 758). The nurse should â€Å"monitor blood for glucose and ketones† or â€Å"should ask the client any sign of hypo- or hyperglycemic reactions† (Karch, 2007, p. 758). There could also be â€Å"signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat† (Drugs. om, 2010). In this case, it is necessary to â€Å"stop the medication and report to the physician† (Drugs. com, 2010). Lithium The common side effects of Lithium involves CNS manifestions such as â€Å"lethargy, slurred speech, muscle weakness and fine hand tremor; GI manifestions such as nausea, vomiting , diarrhea, thirst; GU effect is polyuria† (Karch, 2007, p. 704). It is important to instruct the client to â€Å"report any signs of toxicity such as diarrhea, vomiting, tremor, drowsiness, muscle weakness† (Karch, 2007, p. 705). The patient should also be prohibited or â€Å"avoid driving or performing tasks requiring alertness† and should be instructed to â€Å"eat frequent small meals† (Karch, 2007, p. 705). Health Education Metronidazole It is impotant to instruct the client to â€Å"not drink alcohol (beverages or preparations containing alcohol, cough syrups)† (Karch, 2007, p. 786). The nurse should also mention to the client that she may experience â€Å"urine with darker color , dry mouth with strange metallic taste, nausea, vomiting and diarrhea† (Karch, 2007, p. 786). Intervention to relieve these side effects should be taught like â€Å"frequent mouth care, sucking sugarless candies for dry mouth; eating frequent small meals for nausea, vomiting and diarrhea† (Karch, 2007, p. 786). Phenytoin Patients taking Phenytoin should be advised to â€Å"take this drug exactly as prescribed with food to reduce GI upset or without food — but maintain the consistency† (Karch, 2007, p. 953). Mrs. Brown should be advised to â€Å"not discontinue this drug abruptly or change dosage, except on advice of health care provider† (Karch, 2007,p. 953). Since Mrs. Brown has diabetes, it should be advised that she should â€Å"monitor blood or urine sugar regularly, and report any abnormality to health care provider† (Karch, 2007, p. 953). She should be advised that she should â€Å"maintain good oral hygiene to prevent gum disease and arrange frequent dental checkups† (Karch, 2007, p. 953). Warfarin It should be advised to the patient to â€Å"not start or stop taking any medication without consulting her health care provider† (Karch, 2007, p. 1217). She should â€Å"carry or wear a medical ID tag to alert emergency medical personnel about the drug† (Karch, 2007, p. 218). She should be instructed to â€Å"avoid situations that may cause injury and have periodic blood tests to check on drug action† (Karch, 2007, p. 1218). Lastly, the patient should be instructed to â€Å"report unusual bleeding, black or bloody stools and cloudy or dark urine† (Karch, 2007, p. 1218). Metformin Some of the instructions t hat should be given to the patient are â€Å"not to discontinue the medication without consulting health care provider and avoid using alcohol while taking the drug† (Karch, 2007, p. 758). She should also be advised to â€Å"monitor blood for glucose and ketones and report any hypo-or hyperglycemia reactions† (Karch, 2007, p. 758). Lithium Health teaching about this drug should include the following: â€Å"take the drug exactly as prescribed, after meals or with food or milk; eat a normal diet with normal salt intake and maintain adequate fluid intake and arrange for frequent checkups including blood tests† (Karch, 2007, p. 705). Mrs. Brown has numerous risk factors and health conditions that may produce drug interactions that may worsen her health. It is known that Metronidazole can produce seizures as its side effect. Considering this, safety precautions should be made since she has a history of seizure. This drug can also impair the clearance of the drug Phenytoin in her system and potentiate the anticoagulant effects of Warfarin. These things should be monitored by the healthcare team for them to make necessary adjustments. Phenytoin can also increase the anticoagulant effect of Warfarin and may either increase or decrease the efficacy of lithium. Necessary drug dosage adjustments should be made to minimize these interactions. Daily blood glucose monitoring should be done and symptoms of hypo- or hyperglycemia should be reported. This is necessary because Warfarin can increase the effects of oral diabetic agents such as Metformin. However, Phenytoin and Lithium can diminish the efficacy of this drug. Thus, it is really important to monitor the client’s clinical status and the possible adverse effects of the drug regimen. It is also important to â€Å"offer support and encouragement to help the patient cope with the drug regimen† (Karch, 2006, p. 334). How to cite Written Critique of Drug Therapy in Nursing Practice, Papers