ࡱ> ` 5bjbjss .- $$$$$$$8???8??\8 4A4A4A4A4ABBB'))))))$hM$BBBBBM$$4A4AbGGGBj$4A$4A'GB'GG$$4A(A \+P?yEoN;x0^ȲFxȲȲ$ BBGBBBBBMMGRBBBBBBB888$\#$888\#888$$$$$$ Nursing Process Focus: Patients Receiving Chlorothiazide (Diuril) Assessment Prior to administration: Obtain complete health history including allergies, drug history and possible drug interactions Assess for presence/history of serious kidney dysfunction, hypokalemia, decreased liver function, diabetges mellitus, decreased liver function Lab values for CBC, BUN, creatinine, electrolytes, uric acid, blood glucose Obtain vital signs Assess for peripheral edema Obtain body weightPotential Nursing Diagnoses Comfort, impaired, nausea/vomiting, related to effects of chlorothiazide Falls, risk for, related to orthostatic hypotension secondary to medication Knowledge, deficient, related to effects of thiazide diuretics Fluid volume, deficient, related to excessive dose of chlorothiazide Noncompliance, recommended medication regime, related to unpleasant side effects, misunderstanding of need to take medication exactly as orderedPlanning: Patient Goals and Expected Outcomes Patient will Take medication as ordered, without increasing or decreasing unless recommended by health care provider Experience no side effects or adverse reactions Experience increased urinary output, decreased blood pressure Demonstrate knowledge of mechanisms of action of chlorothiazide Demonstrate knowledge of eating potassium-rich diet or of taking potassium supplement, but not both unless specifically recommended by health care providerImplementation Interventions and (Rationales) Patient Education/Discharge PlanningObtain history of drug allergies. (Chlorothiazide is a sulfonamide, so it patient is sensitive to one sulfa drug, he/she will not be able to take it.)Instruct patient to report all allergies to the health care provider. Monitor renal function. (Chlorothiazide cannot be given to patient with severe renal dysfunction or anuria.)Instruct patient to monitor intake and output and report changes in urine amount to health care provider.Monitor potassium levels. (Chlorothiazide decreases potassium levels, patient must be monitored closely for normal levels throughout therapy.)Instruct patient to: Recognize signs and symptoms of hypokalemia, including leg cramps, nausea, vomiting, cardiac dysrhytmias. Report symptoms to health care provider Add potassium rich foods to diet such as citrus fruit and melonsMonitor blood sugar levels if patient is diabetic or pre-diabetic. (Chlorothiazide may cause hyperglycemia and glycosuria. Patient may need dosage adjustments of hypoglycemic drugs.)Instruct patient to: Monitor blood glucose closely. Report consistent hyperglycemia to the health care providerMonitor for gout. (Patient with gout may experience hyperuricemia without symptoms, secondary to chlorothiazides interference with uric acid excretion.)Instruct patient to report worsening of symptoms of gout to the health care provider. Monitor intake and output for equality between intake and output in a 24-hour period. (Excessive diuresis, or oliguria, can lead to electrolyte imbalances.) Instruct patient to report either oliguria or extreme diuresis immediately.Provide safe environment. (Chlorothiazide may cause Orthostatic hypotension placing patient at risk for falls.)Teach patient/caregivers: Measures to decrease falls if orthostatic hypotension occurs To change position slowly, rise slowlyEvaluation of Outcome Criteria Evaluatge the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning). Nursing Process Focus: Patients Receiving SPIRONOLACTONE (Aldactone) Assessment Prior to administration: Obtain complete health history including allergies, drug history and possible drug interactions. Vital signs Serum, electrolytes, creatinine, CBC, ABGs, BUN) Obtain body weight Assess for presence/history of decreased liver or kidney functionPotential Nursing Diagnoses Body image, disturbed (gynecomastia in males, hirsutism in females) related to anti-estrogen effects of spironolactone Diarrhea, related to side effects of medication Fluid volume, deficient, risk for, related to excessive doses of spironolactone Knowledge, deficient, related to no effects of medicationPlanning: Patient Goals and Expected Outcomes The patient will: Experience increased diuresis. Exhibit decreased or absent edema or crackles. Demonstrate blood pressure and potassium values within normal limits Demonstrate knowledge of mechanisms of action of spironolactone, side effects and adverse reactions Mainatain absence of diarrhea Implementation Interventions and (Rationales) Patient Education/Discharge PlanningMonitor renal function. (Spironolactone cannot be used if anuria, worsening decreased kidney function, or acute renal insufficiency is present. Use cautiously if BUN is 40 or above.)Instruct patient to report changes in urinary output to the health care provider. Monitor serum potassium levels results for impending hypokalemia or hyperkalemia. (The patient is at risk for cardiac dysrhytmias.) Advise patient regarding signs and symptoms of hypokalemia or hyperkalemia including leg cramps, nausea, vomiting, irregular heart rhythm. Monitor daily weight and intake and output (to determine fluid loss). Instruct patient/caregivers to: Weigh daily or on schedule recommended by health care provider, and record, and report changes of >3 pounds if doing daily weights, or >5 pounds if once weekly weights Weigh at same time every day, same scale, and in same amount of clothing, in order to get most accurate weight possibleMonitor for symptoms of metabolic acidosis.Instruct patient caregivers to monitor for drowsiness, restlessness.Monitor diet for food high in potassium (may lead to hyperkalemia).Instruct patient to: Avoid foods with high potassium content (bananas, oranges, orange juice, dried apricots, Sanka, etc.) Avoid use of potassium-based salt substitutes, and to get permission of health care provider before using any salt substituteMonitor for side effects/adverse reactions.Advise patient/caregiver to be aware of and report: nausea/vomiting, diarrhea, burning of tongue, lethargy, confusion, headache, dizziness, drowsiness, gout, rash, or urticariaMonitor for sexual changes. (Patient may experience decreased libido, hirsutism in females, gynecomastia and/or impotence in males, irregular menses or possibly amenorrhea, post-menopausal bleeding, or deepening of the voice in females.)Instruct patient/caregiver to report changes to health care provider immediately, but not to abruptly discontinue taking spironolactone unless recommended by health care provider. Evaluation of Outcome Criteria Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning). NURSING PROCESS FOCUS: Patients Receiving SODIUM BICARBONATE Assessment Prior to administration: Obtain complete health history including allergies, drug history and possible drug interactions Assess for presence/history of metabolic acidosis or alkalosis, cardiovascular disease, decreased renal function, peptic ulcer disease Obtain vital signs Monitor ABGsPotential Nursing Diagnoses Gas exchange, impaired, related to acidosis or alkalosis Fluid volume excess, related to bicarbonate Knowledge, deficient, related to proper use of sodium bicarbonatePlanning: Patient goals and Expected Outcomes Patient will: Demonstrate reversal of symptoms of acidosis or alkalosis Demonstrate pH between 3.5-5.3, and sodium level between 135-145 Demonstrate understanding of proper uses/application of sodium bicarbonate productsImplementation Interventions and (Rationales) Patient Teaching/Discharge PlanningMonitor for alkalosis. (Indicates drug effectiveness.) Advise patient and caregiver regarding symptoms of alkalosis: irritability, confusion, cyanosis, slow respirations, irregular pulse, muscle twitching.Monitor for metabolic acidosis. (Sodium bicarbonate is used to neutralize acidosis.)Advise patient and caregiver regarding symptoms of acidosis: sleepiness, coma, disorientation, dizziness, headache, seizures, hypoventilation.Monitor respirations, pulse, lung sounds, fluid balance, pH, ABGs.Advise patient that frequent vital signs checks and lab studies will be performed.Monitor for decreased renal function. (Drug will not be excreted, leading to metabolic alkalosis.)Advise patient that intake and output balance, pH of urine, daily weight will be done.Monitor for hyponatremia: elevated blood pressure, cold, clammy skin, anorexia, vomiting, diarrhea, abdominal cramps lethargy, fatigue, confusion, headache, seizures, coma, tremorsAdvise patient regarding symptoms of hyponatremia and to notify health care provider/health care provider if he/she notes any of symptoms listed in previous columnMonitor for hypokalemia.Advise patient regarding symptoms of hypokalemia including muscle cramps, nausea, irregular heart rhythm and to report symptoms to health care providerEvaluation of Outcome Criteria Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning). NURSING PROCESS FOCUS: Patients Receiving POTASSIUM CHLORIDE Assessment Prior to administration: Obtain complete health history including allergies, drug history and possible drug interactions. Assess for presence/history of severe renal disease, hypokalemia, hyperkalemia, dehydration, acidosis or alkalosis, cardiac dysrhythmias Potential Nursing Diagnosis Falls, risk for, R/T adverse reactions to medication Knowledge, deficient, proper use of medication, R/T no previous exposure Skin integrity, impaired, risk for, R/T extravasation at IV site Therapeutic regimen management, ineffective, R/T lack of understanding regarding other medication/food use Urinary elimination, impaired, decreased urinary output, R/T medication usePLANNING: PATIENT GOALS and EXPECTED OUTCOMES Patient will: Remain free of physical injury Demonstrate knowledge of drug therapy, side effects, and adverse reactions Maintain intact skin integrity Demonstrate understanding of possible drug interactions Maintain urinary elimination within normal rangeImplementation Interventions and (Rationales) Patient Teaching/Discharge PlanningMonitor serum potassium levels (indicates effectiveness of therapy) Instruct patient to be aware of symptoms of hyperkalemia: nausea, abdominal cramping, oliguria, weakness, changes in heart rate, numbness or tingling of arms or legsMonitor kidney function. (Damaged kidneys are unable to excrete normal amounts of potassium, leading to hyperkalemia.)Advise patient and caregiver regarding the importance of kidney function tests and of complete disclosure of past medical history.Monitor diet for excessive foods containing potassium. (There is a risk for hyperkalemia resulting in cardiac dysrhythmias. Patient receiving potassium supplements should avoid use of salt substitute since most use potassium in place of sodium.)Instruct patient to: Avoid use of salt substitute without approval of health care provider Avoid increasing potassium rich foods while taking a potassium supplement, including bananas, oranges, orange juice, broccoli, carrots, brussel sprouts, etc.Monitor for overdose. (Patient is at risk for cardiac dysrhythmias.) Advise patient and caregiver that frequent blood studies will be done so early hyperkalemia will be identified.Evaluation of Outcome Criteria Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning).     DOW f  *+STEF01? #$@t,"$""""""m##$0$$$%%ʼжХ h/KZh|@CJOJQJaJ h|aJh|5CJ\ h|5 h|CJh|CJOJQJaJ h|5\h|CJOJQJh|h|5CJOJQJ\aJADOhW  J  $$ & Fd$Ifa$ & F d$If  & F $If$ & F d$Ifa$ d$If$If $$$d1$a$55 Q p____N$$ & F d$Ifa$$$ & Fd$Ifa$dxx$Ifgd/KZ $d$Ifa$skd$$Ifl0d "^^0"64 la 90 d$If`kd$$Ifld ""0"64 la$If`kd$$Ifld ""0"64 la v]I$ d$If^a$$ & F d$If^a$$ & F d$Ifa$skd$$Ifl0d "^^0"64 la$IfH|c$ & F d$If^a$$ & F d$Ifa$skd $$Ifl0d "^^0"64 laBW*|lSSS$ & F d$If^a$$Nd$If^Na$$ & F d$Ifa$skd$$Ifl0d "^^0"64 la*+S|hNN$ & F hd$If^a$$ hNd$If^Na$$ & F d$Ifa$skd8$$Ifl0d "^^0"64 laSTDE|bH$ hd$If^`a$$ & F hd$If^a$$ & F d$Ifa$skd$$Ifl0d "^^0"64 laEF0|b$ & F hd$If^a$$ & F d$Ifa$skdP$$Ifl0d "^^0"64 la01|lSS$ & F d$If^a$$Nd$If^Na$$ & F d$Ifa$skd$$Ifl0d "^^0"64 la ?z$If $d$Ifa$skdh$$Ifl0d "^^0"64 la  1vfY & Fd$If$ & Fd$Ifa$ d$If$If $$$d1$a$ $$d1$d`kd$$Ifld ""0"64 la $@8s$$ & Fd$Ifa$$If  & F$If & Fd$If$ & Fd$Ifa$stIveeeTT$$ & Fd$Ifa$$$ & Fd$Ifa$ xx$Ifgd/KZ $$Ifa$skdx$$Ifl0n"L0"64 la6- d$If`kd$$Ifln""0"64 la $$Ifa$`kd $$Ifln""0"64 la,-67mT@$ d$If^a$$ & F d$If^a$$ & F ""d$If^"a$skd $$Ifl0n"L0"64 la$If78HIsZF$ d$If^a$$ & F d$If^a$$ & F ""d$If^"a$skd$$Ifl0n"L0"64 laIJYs_O66$ & F d$If^a$$0d$If^0a$$ ""d$If^"a$$ & F ""d$If^"a$skd5 $$Ifl0n"L0"64 laCsZ$ & F d$If^a$$ & F ""d$If^"a$skd $$Ifl0n"L0"64 laCDscJJ$ & F d$If^a$$0d$If^0a$$ & F ""d$If^"a$skd_ $$Ifl0n"L0"64 la` sZ$ & F d$If^a$$ & F ""d$If^"a$skd $$Ifl0n"L0"64 la` a O!""sZZ$ & F d$If^a$$ & F ""d$If^"a$skd $$Ifl0n"L0"64 la""$""}$If d$Ifskd $$Ifl0n"L0"64 la""""""" #m##$$0$||||$ & Fd$Ifa$ d$If$a$d`kd $$Ifln""0"64 la 0$i$$$$%%O%%%{ul[[[$$ & F d$Ifa$ d$If$Ifskd2 $$Ifl0H$0J%64 la$$ & Fd$Ifa$ %%%%!&F&6-- d$If`kdF$$Ifl$J%0J%64 la d$If`kd $$Ifl$J%0J%64 la%%%G&~&''''((N)O)**[+{++>,b,,L-M-i-../0J0o0p0\1]1W2X2G4H44555555555555555ǿ۲ۥjh|U h|6h|CJOJQJ\aJh|5\] h|5]h|5CJOJQJ\h|CJOJQJaJh| h|aJh|5CJOJQJ\aJ4F&G&~&&'yiP$ & F! hhd$If^ha$$ld$If^la$ & F" $If^skd$$Ifl0H$0J%64 la''l''sZ$ & F! hhd$If^ha$$ & F" d$If^a$skdZ$$Ifl0H$0J%64 la''@((sZ$ & F! hhd$If^ha$$ & F" d$If^a$skd$$Ifl0H$0J%64 la(((N)sZ$ & F! hhd$If^ha$$ & F" d$If^a$skd$$Ifl0H$0J%64 laN)O)**sc$ & Fd$Ifa$$ & F" d$If^a$skd$$Ifl0H$0J%64 la***[+sc$ & Fd$Ifa$$ & F" d$If^a$skd$$Ifl0H$0J%64 la[+\+{++z$If $d$Ifa$skdC$$Ifl0H$0J%64 la++,>,I,b,,M-i---vp__$$ & Fd$Ifa$$If $ & F$If$ & Fd$Ifa$$If$da$`kd$$Ifl$J%0J%64 la -(....//$$Ifl0H$0J%64 la55555555555555d`kd$$Ifl$J%0J%64 la ,1/ =!"#$% $$If!vh5^5^#v^:V l0"65^4a$$If!vh5"#v":V l0"65"4a$$If!vh5"#v":V l0"65"4a$$If!vh5^5^#v^:V l0"65^4a$$If!vh5^5^#v^:V l0"65^4a$$If!vh5^5^#v^:V l0"65^4a$$If!vh5^5^#v^:V l0"65^4a$$If!vh5^5^#v^:V l0"65^4a$$If!vh5^5^#v^:V l0"65^4a$$If!vh5^5^#v^:V l0"65^4a$$If!vh5^5^#v^:V l0"65^4a$$If!vh5"#v":V l0"65"4a$$If!vh5L5#vL#v:V l0"65L54}$$If!vh5"#v":V l0"65"4}$$If!vh5"#v":V l0"65"4$$If!vh5L5#vL#v:V l0"65L54$$If!vh5L5#vL#v:V l0"65L54$$If!vh5L5#vL#v:V l0"65L54$$If!vh5L5#vL#v:V l0"65L54$$If!vh5L5#vL#v:V l0"65L54$$If!vh5L5#vL#v:V l0"65L54$$If!vh5L5#vL#v:V l0"65L54$$If!vh5L5#vL#v:V l0"65L54}$$If!vh5"#v":V l0"65"4$$If!vh55#v#v:V l0J%6554}$$If!vh5J%#vJ%:V l0J%65J%4}$$If!vh5J%#vJ%:V l0J%65J%4$$If!vh55#v#v:V l0J%6554$$If!vh55#v#v:V l0J%6554$$If!vh55#v#v:V l0J%6554$$If!vh55#v#v:V l0J%6554$$If!vh55#v#v:V l0J%6554$$If!vh55#v#v:V l0J%6554$$If!vh55#v#v:V l0J%6554}$$If!vh5J%#vJ%:V l0J%65J%4$$If!vh55#v#v:V l0J%6554}$$If!vh5J%#vJ%:V l0J%65J%4}$$If!vh5J%#vJ%:V l0J%65J%4$$If!vh55#v#v:V l0J%6554$$If!vh55#v#v:V l0J%6554$$If!vh55#v#v:V l0J%6554$$If!vh55#v#v:V l0J%6554$$If!vh55#v#v:V l0J%6554}$$If!vh5J%#vJ%:V l0J%65J%4P@P Normal$$da$OJQJ_HmH sH tH Z@Z Heading 1$$$d@&a$5CJ OJQJ\aJZ@Z Heading 2$$$d@&a$5CJOJQJ\aJV@V Heading 3$$d@&a$5CJOJQJ\aJR@R Heading 4$<@&5CJOJQJ\aJN@N Heading 5 <@&56CJ\]aJ@@@ Heading 6$$@&a$5\N@N Heading 7$d@&5CJOJQJaJDAD Default Paragraph FontVi@V  Table Normal :V 44 la (k@(No List 0O0 KWB*CJOJQJkH4@4 Header  !4 @4 Footer  !H"H  Balloon TextCJOJQJ^JaJJB@2J Body Text$da$CJOJQJaJ-DOhWJQHBW* +  S T D E F 0 1  ?  1$@8stI,-678HIJYCD`aO$ m0iO!FG~l@ N!O!""""[#\#{###$>$I$b$$M%i%%%(&&&&''<''''((( (J(o(p((\)]))W*X*N+c++G,H,,,,-----------0000 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 00 0 0000000 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0  0  00 0  0  00 0  00 0 0 0 0  0  0 0  0 0 0 0 0  0  0 0  0  0 0 0 00 0 000000 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 " 00 ! 0 0 " 0 ! 0 0 " 0 ! 0 0 " 0 ! 0 0 " 0  0 0 " 0  0 0 00 0 0000 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 $ 0 # 0 0 $ 0 # 0 0 $ 0 0 0 0 0 $ 00 # 0 0 00 0 00h00h00h00h00h00t DOhWJQHBW* +  S T D E F 0 1  ?  1$@8stI,-678HIJYCD`aO$ m0iO!FG~l@ N!O!""""[#\#{###$>$I$b$$M%i%%%(&&&&''<''''((( (J(o(p((\)]))W*X*N+c++G,H,,,,-----------0h0h0h0h0h0h0h0h0h0h0h0h0h0h0h0\h0h00h0h0h0h0h0h0h0h0A$Dh0h0h0h0"h0""[M"[h0%h0%h0%h0%h0%tth0+h0+h0+h0+!tth0-h0-h0-MMMMh0/h0/,OHOdOOh01h01h01h01PPPQh03h03?@ABCDEFGH58@0(  B S  ?,:<B*3pz;I -?Ewo }    " L Z ? H  Wcnw)7zFTgmmx|yV_: > [!g!)"5"""""$%%%?%K%&&(( ))))****1,8,~,,,,-------------e p &. ##-------------33333%/[eIS NX\g##h%h%p(p(((((])])))X*X*^+a+c+d+++H,H,,,-----------------$}fxZ(HtH[d4r=? Vp$9) >Ҏ&G%A(D~TAOC\@e@F-*JOTaEQlSTQ /lXdCi]vfƁ}qaiP{t}j\%Y xpO'wqӪ% yd0m_y&=axl}hh ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo( hh^h`OJQJo( ^`OJQJo(o ^`OJQJo(   ^ `OJQJo(   ^ `OJQJo(o PP^P`OJQJo(   ^ `OJQJo( ^`OJQJo(o ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo( hh^h`OJQJo( ^`OJQJo(o ^`OJQJo(   ^ `OJQJo(   ^ `OJQJo(o PP^P`OJQJo(   ^ `OJQJo( ^`OJQJo(o ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(h   ^ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h | | ^| `OJQJo(h LL^L`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo( ^`OJQJo( ^`OJQJo(o pp^p`OJQJo( @ @ ^@ `OJQJo( ^`OJQJo(o ^`OJQJo( ^`OJQJo( ^`OJQJo(o PP^P`OJQJo( hh^h`OJQJo( ^`OJQJo(o ^`OJQJo(   ^ `OJQJo(   ^ `OJQJo(o PP^P`OJQJo(   ^ `OJQJo( ^`OJQJo(o ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo( ^`OJQJo( ^`OJQJo(o pp^p`OJQJo( @ @ ^@ `OJQJo( ^`OJQJo(o ^`OJQJo( ^`OJQJo( ^`OJQJo(o PP^P`OJQJo( ^`OJQJo( ^`OJQJo(o pp^p`OJQJo( @ @ ^@ `OJQJo( ^`OJQJo(o ^`OJQJo( ^`OJQJo( ^`OJQJo(o PP^P`OJQJo( ^`OJQJo( ^`OJQJo( pp^p`OJQJo( @ @ ^@ `OJQJo( ^`OJQJo(o ^`OJQJo( ^`OJQJo( ^`OJQJo(o PP^P`OJQJo(h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo( hh^h`OJQJo( ^`OJQJo(o ^`OJQJo(   ^ `OJQJo(   ^ `OJQJo(o PP^P`OJQJo(   ^ `OJQJo( ^`OJQJo(o ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo( hh^h`OJQJo( ^`OJQJo(o ^`OJQJo(   ^ `OJQJo(   ^ `OJQJo(o PP^P`OJQJo(   ^ `OJQJo( ^`OJQJo(o ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo( hh^h`OJQJo( ^`OJQJo(o ^`OJQJo(   ^ `OJQJo(   ^ `OJQJo(o PP^P`OJQJo(   ^ `OJQJo( ^`OJQJo(o ^`OJQJo( hh^h`OJQJo( ^`OJQJo(o ^`OJQJo(   ^ `OJQJo(   ^ `OJQJo(o PP^P`OJQJo(   ^ `OJQJo( ^`OJQJo(o ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo( hh^h`OJQJo( ^`OJQJo(o ^`OJQJo(   ^ `OJQJo(   ^ `OJQJo(o PP^P`OJQJo(   ^ `OJQJo( ^`OJQJo(o ^`OJQJo( hh^h`OJQJo( ^`OJQJo(o ^`OJQJo(   ^ `OJQJo(   ^ `OJQJo(o PP^P`OJQJo(   ^ `OJQJo( ^`OJQJo(o ^`OJQJo( hh^h`OJQJo( ^`OJQJo(o ^`OJQJo(   ^ `OJQJo(   ^ `OJQJo(o PP^P`OJQJo(   ^ `OJQJo( ^`OJQJo(o ^`OJQJo($Ci]}do>S,? ('wqqaijC}je@FEQxl}G%A% y xpm#s)0io.lXm_yo.TA9) *JvfEDtxH)[dH$$                                                                        q                          q                                            q        q                          q        q        q                 q                 q                          q        q                 q        q        q        /KZ|DHB* + S T E F 0 1  $st,-78IJCD`aO!FGl@ N!O!""""[#\###>$M%&&((( (J(o(p((\)]))W*X*N+G,H,,,----@####-P@UnknownGz Times New Roman5Symbol3& z Arial;" HelveticagB Frutiger BoldTimes New Roman5& zaTahoma?5 z Courier New;Wingdings"1h^&ʣJx#'Y#'Y!Nj4d,, 2qHP ?/KZ2(PROTOTYPE DRUG: Chlorothiazide (Diuril) Elena Mauceri TSI Graphics$                           ! " # Oh+'0$ <H h t  ,PROTOTYPE DRUG: Chlorothiazide (Diuril)Elena Mauceri Normal.dotTSI Graphics5Microsoft Office Word@[@㬝^@lbO@L P#'՜.+,0, hp   EMM Editorial & Consulting SvceY, )PROTOTYPE DRUG: Chlorothiazide (Diuril) Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIKLMNOPQRSTUVXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root Entry F \+PData JR1TableWdWordDocument.SummaryInformation(DocumentSummaryInformation8CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q