Nephrotic Syndrome

Group 57

Introduction

Nephrotic syndrome is a nonspecific disorder in which the kidneys are damaged, causing them to leak large amounts of protein (proteinuria at least 3.5 grams per day per 1.73 m2body surface area) from the blood into the urine. Other symptoms include hypoalbuminemia (decrease in albumin in the blood), edema, hypercholesterolemia (high serum cholesterol), and normal renal function.

* The most common sign is excess fluid in the body. This may take several forms:  o Puffiness around the eyes, characteristically in the morning.  o Edema over the legs which is pitting (i.e., leaves a little pit when the fluid is pressed out, which resolves over a few seconds).  o Fluid in the pleural cavity causing pleural effusion. More commonly associated with excess fluid is pulmonary edema.  o Fluid in the peritoneal cavity causing ascites.  

 The following are baseline, essential investigations

  

 •

* Urine sample shows proteinuria (>3.5g per 1.73 m2 per 24 hour). * Comprehensive metabolic panel (CMP) shows Hypoalbuminemia: albumin level ≤2.5g/dL (normal=3.5-5g/dL). * High levels of cholesterol (hypercholesterolemia), specifically elevated LDL, usually with concomitantly elevated VLDL * Electrolytes, urea and creatinine (EUCs): to evaluate renal function.

Causes:
Nephrotic syndrome has many causes and may either be the result of a disease limited to the kidney, called primary nephrotic syndrome, or a condition that affects the kidney and other parts of the body, called secondary nephrotic syndrome. Primary causes of nephrotic syndrome are usually described by the histology, i.e., minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS) and membranous nephropathy (MN), sickle cell disease, diabetes mellitus and malignancy such as leukemia. Secondary causes of nephrotic syndrome occurs after an infectious disease, such as infection with group A beta-hemolytic streptococci, syphilis, malaria, tuberculosis, or viral infections, including varicella, hepatitis B, HIV, and infectious mononucleosis.

Epidemiology:
 Nephrotic syndrome is often described as a disease of children and is relatively rare. It is 15 times more common in children than in adults. The reported annual incidence rate is 2 to 5 per 100,000 children younger than 16 years. The cumulative prevalence rate is approximately 15.5 per 100,000 individuals. Nephrotic syndrome prevalence is difficult to establish in adults, because the

Case Study Format I. PATIENT DEMOGRAPHIC DATA
Name: Rose Nina Francisco Home Address: Cogon, Pardo

Age/Sex: 14/Female Nationality: Filipino

Status: Single Religion: Roman Catholic Occupation: N/A

II. HEALTH HISTORY PROFILE A. Past Medical History 1. Pediatric and Adult Illness
Date NONE Illness NONE Medication NONE Remarks NONE

2. Immunization
Immunization BCG DPT OPV Doses 1 3 3 Dates Can’t Recall Can’t Recall Can’t Recall Remarks Complete Complete Complete

3. Hospitalization
Date/Year 2007 2008 Hospital Cebu City Medical Center Cebu City Medical Center Diagnosis Nephrotic Syndrome Nephrotic Syndrome Duration 1 week 1 week

4. Injuries and Accidents- The patient did not experience any injuries and accidents. 5. Transfusions- The patient did not undergo any transfusions such as blood transfusion. 6. Allergies(specify)- The patient has no any allergies . B. Family History

Rodrigo Francisco Legend: Father Mother Patient Rose Nina Francisco

Nelia Francisco

C. Social and Personal History

1.Occupation-N/A 2.Number of Children-N/A 3.Military experiences, foreign travel-N/A 4.Habits (tobacco, alcohol, non-prescription drugs, others)-N/A 5.Diet-fruits, vegetables, pork chop, dried fish 6.Type of Family-Extended Family 7.Cultural and Religious Beliefs-N/A 8.Brief description of average day:

5:30 am-wake up 6:00 am-breakfast 7:00-9:00 am-class hours 9:15-9:30 am-recess 9:30-12:00 am-class hours 12:00-1:00 pm-lunch 1:00-5:00 pm-class hours 5:30 pm-do homework 6:00 pm-dinner 7:00-8:00 pm-watch T.V 8:00 pm-sleeping time

D. Review System (for the past 6 months). Physical Assessment
General
Weight loss Fatigue Anorexia Night sweats Chills Fever Weakness The patient experienced fever due to cough and colds. The patient experienced fatigue due to illness and lack of sleep. The patient experienced weakness due to fatigue. Itch NONE Rash Bleeding Lesions Bruising Color change

Skin

Eyes

Pain Discharge Itch Vision loss Excessive tearing Glasses/Contact lens NONE Earaches NONE Discharges Tinnitus

Diplopia Date of last exam

Ears Nose Throat and Mouth Neck and Head Chest

Hearing loss

Obstruction NONE Sore throats NONE Swelling NONE

Discharges

Epistaxis

Bleeding gums

Toothache

Dentures

Dysphagia

Hoarseness

Cough Sputum: Amount and Character Hemoptysis Wheeze Pain on respiration Dyspnea The patient experienced dyspnea due to obstruction of the airway.

Cardiovascular

Precordialpain Palpitation Dyspneaon exertion Orthopnea Dyspnea Paroxysmal nocturnal Edema Heart murmur Claudication Thrombophlebitis NONE Heartburn Nausea Vomiting Diarrhea Food intolerance Excessive gas or indication Constipation Jaundice Bloating Change in Bowel movement Melena Hemorrhoids Hernia NONE Heartburn Nausea Vomiting Diarrhea Food intolerance Excessive gas or indication Constipation Jaundice Bloating Change in Bowel movement Melena Hemorrhoids Hernia NONE Joint pains Edema Varicose veins Claudication Stiffness Deformities Back pain

Gastrointestinal

Genitourinary

Extremities

The patient experienced edema due to illness which is nephrotic syndrome.

Endocrine

Hot flashes Polydipsia NONE

Hair loss Goiter

Temperature intolerance

Neurology

Numbness Tingling Tremor Headaches Muscle weakness Ataxia Memory loss Dizziness The patient experienced headaches due to fever.

Fainting Seizure

Unconsciousness

Paralysis/Paresis

Psych

Anxiety Nightmares NONE NONE

Depression

Sexual problems

Insomnia

Others

III. CURRENT HEALTH PROFILE

A.Presenting complaints and medical diagnosis to include intervention done prior to hospitalization. Rosa Nina Francisco was diagnosed for Nephrotic Syndrome. She Complain of difficulty in breathing. B. Application of the Nursing Process 1. Assessment Finding (Head –to-Toe)
Skin Hair Nails Head Uniform skin color, no jaundice, cyanosis Skin is evenly distributed over scalp Hair intact Skin color blackdry thin Hair warm and and Color pink, well groomed ad convex, smooth and firm No lesions or pediculosis midline Normocephallic, erect and Head symmetrical, no masses, nontender

Face Ears Eyes

Facial expression appropriate, no abnormal movements or lesions Facial bones smooth, intact,symmetrical,nontender Ears aligned with eyes, symmetrical, no redness, lesions or drainage Eyes clear and bright, equal parallel alignment Eyelids color consistent with clients complexion Eyelashes evenly distributed, no excessive tearing or dryness Nose midline, symmetrical, no deviation, no flaring No deformities or nasal tenderness Sinuses clear, nontender Lips pink, moist, no lesions Oral mucosa pink, moist, no lesions, intact Teeth complete Tongue pink, moist,midline Neck symmetrical, skin intact, no masses Skin color uniform; no erythema, edema Skin color consistent, no lesions, rashes, scars or discoloration. Hair distribution appropriate for client’s age and gender. Abdomen flat and symmetrical, no bulges or hernias Umbilicus midline Abdomen soft, nontender, no masses Leg hair evenly distributed; color uniform; no edema or lesions

Nose Sinuses Mouth

Neck Upper Extremities Abdomen

Lower Extremities

Laboratory/Diagnostic Results
Date 09-01-09 Lab Exam Protein to Creatinine ratio Patient Results 1.55 Normal Findings Interpretation/Significant 0.5-0.9 Suggests the presence of nephrotic range proteinuria.

Serum albumin

0.9g/dl

3.4-5.4g/dl

Hypoalbuminemia can be caused by Excess excretion by the kidneys.

Human anatomy

KIDNEY

Parts of the human kidney

• NORMAL KIDNEY SIZE The normal kidney size of an adult human is about 10 to 13 cm (4 to 5 inches) long and about 5 to 7.5 cm (2 to 3 inches) wide. It is approximately the size of a conventional computer mouse. • NORMAL KIDNEY COLOR - The kidneys are dark-red, bean-shaped organs. One side of the kidney bulges outward (convex) and the other side is indented (concave) • NORMAL KIDNEY LOCATION  - towards the back of the abdominal cavity, just

above the waist. One kidney is normally located just below the liver, on the right side of the abdomen and the other is just below the spleen on the left side.

Kidney anatomy and excretion
• The most basic structures of the kidneys, are nephrons. They are responsible for filtering the blood. • The renal artery delivers blood to the kidneys each day. Over 180 liters (50 gallons) of blood pass through the kidneys every day. When this blood enters the kidneys it is filtered and returned to the heart via the renal vein. • The process of separating wastes from the body fluids and eliminating them, is known as excretion . The urinary system is one of the organ systems responsible for excretion. The kidneys are the main organs of the urinary system.

Kidney anatomy and blood vessels
• The kidney is full of blood vessels. Every function of the kidney involves blood, therefore, it requires a lot of blood vessels to facilitate these functions. • Together, the two kidneys contain about 160 km of blood vessels. •

Renal capsule
• is a tough fibrous layer surrounding the kidney and covered in a thick layer of adipose tissue. It provides some protection from trauma and damage

Renal cortex
• is the outer portion of the kidney between the renal capsule and the renal medulla. In the adult, it forms a continuous smooth outer zone with a number of projections (cortical columns) that extend down between the pyramids. • ultrafiltration occurs.

Renal medulla
• is the innermost part of the kidney • split up into a number of sections, known as the renal pyramids • contains the structures of the nephrons responsible for maintaining the salt and water balance of the blood • is hypertonic to the filtrate in the nephron and aids in the reabsorption of water. •

Renal pyramids
 are cone-shaped tissues of the kidney  made up of 8 to 18 of these conical subdivisions  The broad base of each pyramid faces the renal cortex, and its apex, or papilla, points internally  The base of each pyramid originates at the corticomedullary border and the apex terminates in a papilla, which lies within a minor calyx, made of parallel bundles of urine collecting tubules

Minor calyx
• surrounds the apex of the malpighian pyramids. Urine formed in the kidney passes through a papilla at the apex into the minor calyx then into the major calyx. • Peristalsis of the smooth muscle originating in pace-maker cells originating in the walls of the calyces propels urine through the pelvis and ureters to the bladder. •

Major calyx
• surrounds the apex of the malpighian pyramids. Urine formed in the kidney passes through a papilla at the apex into a minor calyx then into major calyx before passing through the renal pelvis into the ureter. • Peristalsis of the smooth muscle originating in pace-maker cells originating in the walls of the calyces propels urine through the pelvis and ureters to the bladder. •

Renal papilla
• is the location where the Medullary pyramids empty urine into the renal pelvis

Renal column
• is a medullary extension of the renal cortex in between the renal pyramids. It allows the cortex to be better anchored. • Each column consists of lines of blood vessels and urinary tubes and a fibrous material.

Renal pelvis
• is the funnel-like dilated proximal part of the ureter in the kidney. • It is the point of convergence of two or three major calyces. Each renal papilla is surrounded by a branch of the renal pelvis called a calyx. • The major function of the renal pelvis is to act as a funnel for urine flowing to the ureter. •

Ureter

are muscular ducts that propel urine from the kidneys to urinary bladder. In the adult, the ureters are usually 25– 30 cm (10–12 in) long.

Pathophysiology:
• Nephrotic syndrome results from damage to the kidney’s glomeruli, the tiny blood vessels that filter waste and excess water from the blood and send them to the bladder as urine. They consist of capillaries that are fenestrated, that is, have small openings, which allow fluid, salts, and other small solutes to flow through but normally not proteins. Damage to the glomeruli from diabetes, glomerulonephritis, or even prolonged hypertension, causes the membrane to become more porous, so that small proteins, such as albumin, pass through the kidneys into urine. As protein continues to be excreted, serum albumin is decreased, which in turn decreases the serum osmotic pressure. Capillary hydrostatic fluid pressure becomes greater than capillary osmotic pressure, which results in generalized edema. As fluid is lost into the tissues, the plasma volume decreases, stimulating secretion of aldosterone to retain sodium and water, which decreases the glomerular filtration rate to retain water. This additional water also passes out of the capillaries into the tissue, leading to even greater edema.

NURSING CARE PLAN Name of Patient: Rose Nina Francisco Age: 14 yrs. old Sex: Female Occupation: N/A Date of Admission: September 1, 2009 Status: Single Religion: Roman Catholic
Needs/Nsg. Diagnosis/Cues Physiologic Imbalanced Nutrition, less than body requirements related to poor appetite, restricted diet, and protein loss Cues:
 

Patient’s Health Profile: Received the patient lying in bed with Dopamine 67ml at 31 gtts/min, unconscious, uncoherent and afebrile. Initial Complaint: dyspnea Diagnosis/Impression: Nephrotic Syndrome
Nursing Problem/ Interventions Assess and monitor food/fluid ingested. Monitor weight daily at same time, same clothing and same scale.

Scientific Analysis

Objective

Rationale

Evaluation

Nephrotic syndrome is a After 8 hours of nursenonspecific disorder in patient interaction, the which the kidneys are patient will be able to: damaged, causing them to Identify the appropriate leak large amounts of diet for her condition. protein from the blood (Low-sodium diet) into the urine. Damage to b.Follow the diet  the glomeruli causes the prescribed. S: “Wala koy gana membrane to become c.Verbalize realization of mukaon.”, as verbalized more porous, so that the importance of proper by the patient. small proteins, such as diet. O: protein-creatinine ratio albumin, pass through the of 1.55 kidneys into urine. Serum albumin of 0.9g/dl (Rick Daniels, Contemporary MedicalSurgical Nursing, Thomson Learning Asia, volume 2, 2007, page 1784)

Identifies nutritional Goals met. After 8 hours deficits/ therapy needs. of nurse-patient To assess the health interaction, the patient status of patient. Same was able to: clothing, same time and a.Identify the appropriate  same scale makes the diet for her condition.  weight equal/fair than (Low-sodium diet)  yesterday. b.Follow the diet Smaller portions may prescribed. Recommend small, enhance intake. c.Verbalize realization of This electrolyte can frequent meals. the importance of proper Restrict sodium as quickaccumulate, causing diet. indicated, and limit fluid fluid retention, and intake to 100ml. weakness.  Replaces vitamin/mineral deficits resulting from Administer malnutrition. multivitamins, as indicated.

Needs/Nsg. Diagnosis/Cues

Scientific Analysis Objective Because of the leaking proteins from the blood to the urine, the nutrients needed in her body are being excreted. This causes her to lose the nutrients in the body, making her nutrition less than body requirements.

Nursing Problem/ Interventions Administer medications as appropriate. Monitor laboratory studies

Rationale Reduces stimulation of the vomiting center. To assess development and status.

Evaluation

NURSING DIAGNOSIS SCIENTIFIC ANALYSIS

OBJECTIVES

NURSING INTERVENTIONS Record accurate intake and output of the patient

RATIONALE

EVALUATION

Excess fluid volume Nephrotic syndrome is a After 8 hrs of related to compromised clinical disorder of nursing regulatory mechanism unknown cause interventions, the with changes in characterized by patient will display hydrostatic or oncotic proteinuria, stable weight, vital vascular pressure and hypoalbuminemia, edemasigns within increased in activation of and hyperlipidemia. This patient’s normal rennin angiotensin conditions result from range, and nearly aldosterone system excessive leakage of absence of edema. S: “murag nanghupong plasma proteins into the aq anak sa iya bitiis” as urine because of the verbalized by the mother impairment of the O: edema, glomerular capillary weight gain, membrane. changes in vital signs

Accurate intake and output is After 8 hrs of necessary for determining the renal nursing  function and fluid replacement needs interventions, the and reducing risk of fluid overload patient was able to Monitor urine specific gravity  Measures the kidneys ability to display stable Weight daily at same time of concentrate urine. weight, vital signs the day, on same scale, with Daily body weight is the best within patient’s same equipment and clothing monitor of fluid status. A weight gain normal range, and Assess skin, face, dependent of more than 0.5 kg/day suggest fluid nearly absence of areas of edema retention. edema.  Edema occurs primarily in dependent tissues of the body. It will Monitor heart rate and blood serve as a parameter the severity of pressure. fluid excess
  

Tachycardia and hypertension can occur because of failure of the kidneys to excrete urine

NEEDS/NSG SCIENTIFIC DIAGNOSIS/CU ANALYSIS ES

OBJECTIVE

NURSING PROBLEM/ INTERVENTIONS

RATIONALE

EVALUATION

Assess level of May reflect consciousness: fluid shifts and investigate electrolyte changes in imbalances mentation, presence of restlessness.

NURSING CARE PLAN
Name: Rose Nina Francisco Age: 14 Sex: Female Date of Admission: September 1, 2009 Occupation: N/A Status: Single Religion: Roman Catholic Needs/Nursing Diagnosis Self- Actualization Cues Knowledge deficit related to chronic illness Scientific Analysis Objectives Patient’s Health Profile: Received the patient lying in bed with Dopamine 67ml @ 31 gtts/min, unconscious, uncoherent, and a febrile. Initial complaint: Dyspnea Diagnosis: Nephrotic Syndrome

Assess readiness to Nephrotic Syndrome After 4 hours of is a set of symptoms nurse-patient and learn. that are caused by significant others many different interaction, the problems, most patient and the commonly significant others glomerulonephritis or will be able to: Assess ability to some systemic Identify disorder such as perform desired diabetes or lupus interferences to health-related care. erythematosus. The learning and specific symptoms are heavy actions to deal with loss of protein in the it. urine, resulting in

Nursing Interventions

Rationale
To facilitate successful learning, it is important to assess readiness to learn.

Evaluation

Goal was met. The patient and the significant others were able to identified the interferences to Physical limitations learning and made or cognitive specific actions to limitations must be deal with it. And identified and they were to considered when performed necessary establishing procedures correctly treatment plan. and they explained the

Environment should reasons for the hypoalbuminemia Perform necessary Provide an and massive edema. procedures correctly environment that is be free of actions they made. There may also be a and explain reasons conducive to distractions and And they were able high blood for the actions. learning. noise. to initiated necessary cholesterol level. lifestyle changes and Provide written Reinforces learning participated in Medical-Surgical Initiate necessary Nursing information/guidelin process, allows treatment regimen Philadelphia/London lifestyle changes and es and self-learning client to proceed at by allowing them to /Toronto participate in modules for client to own pace. practice and W.B Saunders treatment regimen. refer to as necessary. demonstrate the Company treatment regimen. Allow practice and Vol.1, 1974 To ensure accurate Page 728 demonstrations. learning and Knowledge deficit accurate evaluation result when an of ability to perform individual desired skills, repeat experiences an demonstrations need inability to state or to be observed. explain information or demonstrate a required skill related to health care measures necessary to maintain or improve wellness.

Nursing Diagnosis in Critical Practice United States of America Delmar Publishers /, Inc 1992 Pages 339-342

DRUG STUDY Name of patient : Rose Nina Francisco Age: 14 years old Sex: Female Occupation: none Date of admission: September 1 ,2009 Status: single Religion: Catholic Name of drug: generic name brand name Captopril (NuCapto) Classification Patient’s health profile: Received patient lying in bed with dopamine 67 ml at 31 gtts/min unconscious, uncoherent and afebrile. Initial Complaint : dyspnea Diagnosis: Nephrotic Syndrome Contraindication Route and dosage Side effects Nursing responsibilities

Mechanism of action Competitive inhibitor of angiotensinconverting enzyme (ACE); prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor; results in lower levels of angiotensin II which causes an increase in plasma renin activity and a reduction in aldosterone secretion

Antihypertensive, inhibitor of angiotensin synthesis

Hypersensitivity to 50 mg captopril or any component of the formulation; angioedema related to previous treatment with an ACE inhibitor; idiopathic or hereditary angioedema; bilateral renal artery stenosis; pregnancy (2nd or 3rd trimester)

Dermatologic: >Do not discontinue rash with pruritus without the and occasionally providers consent. fever, Stevens>obtain baseline Johnson Syndrome hematologic and CV: MI, CVA, CHF, renal finction test. cardiac arrest, >observe for bronchospams, precipitous drop in pulmonary BP within 3 hr after embolism, initial dose if client pulmonary has been on diuretic infarction. therapy and a lowHematologic: salt diet. aplastic or >take 1 hr before hemolytic anemia meals, on an empty stomach; food interferes with drug absorption. >report any fever, skin rash, sore throat, mouth sores.

Name of drug: generic name brand name

Classification

Mechanism of action

Contraindication

Route and dosage

Side effects

Nursing responsibilities

Ranitidine GASTROINTESTI Competitive >Hypersensitivity to 50 g IVTT q 8 Zantac, Zantac NAL AGENT; inhibition of ranitidine or any EFFERdose, Zantac ANTISECRETORY histamine at H2component of the GELdose, Zantac- (H2-RECEPTOR receptors of the formulation 75 ANTAGONIST) gastric parietal cells, which inhibits gastric acid secretion, gastric volume, and hydrogen ion concentration are reduced. Does not affect pepsin secretion, pentagastrinstimulated intrinsic factor secretion, or serum gastrin.

allergic reaction: >Potential toxicity hives; difficulty results from breathing; swelling decreased clearance of your face, lips, (elimination) and tongue, or throat. therefore prolonged >chest pain, fever, action; greatest in feeling short of the older adult breath, coughing up patients or those green or yellow with hepatic or renal mucus; dysfunction. >easy bruising or >Lab tests: Periodic bleeding, unusual liver functions. weakness; fast or Monitor creatinine slow heart rate; clearance if renal problems with your dysfunction is vision; present or >fever, sore throat, suspected. When and headache with a clearance is <50 severe blistering, mL/min, peeling, and red manufacturer skin rash; or n recommends >nausea, stomach reduction of the pain, low fever, loss dose to 150 mg of appetite, dark once q24h with urine, clay-colored cautious and gradual stools, jaundice reduction of the (yellowing of the interval to q12h or skin or eyes). less, if necessary.

NAME OF DRUG

CLASSIFICATION & INDICATION AND MECHANISM OF DOSAGE ACTION

CONTRAINDICATIO SIDE-EFFECTS/ N ADVERSE REACTIONS

NURSING RESPONSIBILITIES

>Be alert for early signs of hepatotoxicity (though low and thought to be a hypersensitivity reaction): jaundice (dark urine, pruritus, yellow sclera and skin), elevated transaminases (especially ALT) and LDH. >Long-term therapy may lead to vitamin B12 deficiency.

Name of drug: generic name brand name Furosemide Fumide , Furomide , Lasix, Luramide

Classification

Machanism of action Inhibits reabsorption of sodium and chloride in the ascending loop of Henle and distal renal tubule, interfering with the chloride-binding cotransport system, thus causing increased excretion of water, sodium, chloride, magnesium, and calcium

Contraindication

Route and dosage

Side effects

Nursing responsibilities

ELECTROLYTIC AND WATER BALANCE AGENT; LOOP DIURETIC

>Hypersensitivity 30 g IVTT q 12 to furosemide, any component, or sulfonylureas; anuria; patients with hepatic coma or in states of severe electrolyte depletion until the condition improves or is corrected

allergic reaction: >Take this hives; difficulty medication exactly breathing; swelling as it was prescribed of your face, lips, for you. Do not take tongue, or throat. the medication in dry mouth, thirst, larger amounts, or nausea, vomiting; take it for longer feeling weak, than recommended drowsy, restless, or by your doctor. light-headed; fast or Follow the uneven heartbeat; directions on your muscle pain or prescription label. weakness; urinating >Avoid becoming less than usual or dehydrated. Follow not at all; easy your doctor's bruising or instructions about bleeding, unusual the type and weakness; a red, amount of liquids blistering, peeling you should drink skin rash; hearing while you are loss; or nausea, taking furosemide. stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

NAME OF DRUG

CLASSIFICATION & INDICATION AND MECHANISM OF DOSAGE ACTION

CONTRAINDICATIO SIDE-EFFECTS/ N ADVERSE REACTIONS

NURSING RESPONSIBILITIES

>It is important that patients be closely followed for hypokalemia, hypomagnesemia, and volume depletion because of significant diuresis. If given the morning of surgery, it may render the patient volume depleted and blood pressure may be labile during general anesthesia.

Name of drug: generic name brand name

Classification

Mechanism of action

Contraindication

Route and dosage

Side effects

Nursing responsibilities

Prednisone hormones and >Decreases >Hypersensitivity to 10 mg 6 OD Apo-Prednisone , synthetic substitutes; inflammation by prednisone or any Deltasone, adrenal suppression of component of the Meticorten, Orasone, corticosteroid; migration of formulation; serious Panasol, Prednicen- glucocorticoid polymorphonuclear infections, except M, Sterapred, leukocytes and tuberculous Winpred reversal of increased meningitis; systemic capillary fungal infections; permeability; varicella suppresses the immune system by reducing activity and volume of the lymphatic system; suppresses adrenal function at high doses. Antitumor effects may be related to inhibition of glucose transport, phosphorylation, or induction of cell death in immature lymphocytes. Antiemetic effects are thought to occur due to blockade of cerebral innervation of the emetic center via inhibition of

allergic reaction: >Establish baseline hives; difficulty and continuing data breathing; swelling regarding BP, I&O of your face, lips, ratio and pattern, tongue, or throat. weight, and sleep problems with your pattern. Start flow vision; swelling, chart as reference for rapid weight gain, planning feeling short of individualized breath; severe pharmacotherapeutic depression, unusual patient care. thoughts or behavior, seizure >Check and record (convulsions); BP during dose bloody or tarry stabilization period stools, coughing up at least 2 times daily. blood; pancreatitis Report an ascending (severe pain in your pattern. upper stomach >Report symptoms spreading to your of GI distress to back, nausea and physician and do not vomiting, fast heart self-medicate to find rate); low potassium relief. (confusion, uneven heart rate, extreme thirst, increased urination,

NAME OF DRUG

CLASSIFICATION & INDICATION AND MECHANISM OF DOSAGE ACTION

CONTRAINDICATIO SIDE-EFFECTS/ N ADVERSE REACTIONS

NURSING RESPONSIBILITIES

prostaglandin synthesis.

leg discomfort, muscle >Take drug as prescribed and weakness or limp do not alter dosing regimen or feeling); or dangerously stop medication without high blood pressure consulting physician. (severe headache, >Be aware that a slight weight blurred vision, buzzing gain with improved appetite is in your ears, anxiety, expected, but after dosage is confusion, chest pain, stabilized, a sudden slow but shortness of breath, steady weight increase [2 kg (5 uneven heartbeats, lb) per wk] should be reported seizure). to physician.

Name of drug: generic name brand name Ampicillin Unasyn

Classification

Machanism of action

Contraindication

Route and dosage

Side effects

Nursing responsibilities

antiinfective; antibiotic; aminopenicillin

>Inhibits bacterial >Hypersensitivity to 1500 g q 6 ANST cell wall synthesis ampicillin, any by binding to one or component of the more of the formulation, or other penicillin binding penicillins proteins (PBPs); which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.

allergic reaction: >Determine hives; difficulty previous breathing; swelling hypersensitivity of your face, lips, reactions to tongue, or throat. penicillins, fever, sore throat, cephalosporins, and and headache with a other allergens prior severe blistering, to therapy. peeling, and red skin >Lab tests: Baseline rash; diarrhea that is C&S tests prior to watery or bloody; initiation of therapy; fever, chills, body start drug pending aches, flu results. symptoms; easy >Report promptly bruising or bleeding, unexplained unusual weakness; bleeding (e.g., urinating less than epistaxis, purpura, usual or not at all; ecchymoses). agitation, confusion, >Monitor patient unusual thoughts or carefully during the behavior; or seizure first 30 min after (black-out or initiation of IV convulsions). therapy for signs of hypersensitivity and anaphylactoid reaction (see Appendix F).

NAME OF DRUG

CLASSIFICATION & INDICATION AND MECHANISM OF DOSAGE ACTION

CONTRAINDICATIO SIDE-EFFECTS/ N ADVERSE REACTIONS

NURSING RESPONSIBILITIES Serious anaphylactoid reactions require immediate use of emergency drugs and airway management. >Observe for and report symptoms of superinfections (see Appendix F). Withhold drug and notify physician. >Monitor I&O ratio and pattern. Report dysuria, urine retention, and hematuria.

Name of drug: generic name brand name

Classification

Machanism of action

Contraindication

Route and dosage

Side effects

Nursing responsibilities

Nifedipine cardiovascular >Inhibits calcium Adalat, Adalat CC, agent; calcium ion from entering Procardia, Procardia channel blocker; the "slow channels" XL antiarrhythmic or select voltage(class iv); nonnitrate sensitive areas of vasodilator. vascular smooth muscle and myocardium during depolarization, producing a relaxation of coronary vascular smooth muscle and coronary vasodilation; increases myocardial oxygen delivery in patients with vasospastic angina

] >Hypersensitivity to 10mg tab TID nifedipine or any component of the formulation; immediate release preparation for treatment of urgent or emergent hypertension; acute MI

>an allergic reaction >Keep a record of (difficulty nitroglycerin use breathing; closing and promptly report of the throat; any changes in swelling of the lips, previous pattern. tongue, or face; or Occasionally, hives); unusually people develop fast or slow increased frequency, heartbeats; severe duration, and dizziness or severity of angina fainting; psychosis; when they start yellowing of the treatment with this skin or eyes drug or when (jaundice); or dosage is increased. swelling of the legs >Monitor BP or ankles. carefully during titration period. Patient may become severely hypotensive, especially if also taking other drugs known to lower BP. Withhold drug and notify physician if systolic BP <90.

NAME OF DRUG

CLASSIFICATION & INDICATION AND MECHANISM OF DOSAGE ACTION

CONTRAINDICATIO SIDE-EFFECTS/ N ADVERSE REACTIONS

NURSING RESPONSIBILITIES >Monitor blood sugar in diabetic patients. Nifedipine has diabetogenic properties. >Monitor for gingival hyperplasia and report promptly. This is a rare but serious adverse effect (similar to phenytoin-induced hyperplasia).

Name of drug: generic name brand name Cephalexin Cefanex, Ceporex_A, Keflet, Keflex, Keftab, Novolexin_A

Classification

Machanism of action

Contraindication

Route and dosage

Side effects

Nursing responsibilities

antiinfective; antibiotic; firstgeneration cephalosporin

>Inhibits bacterial >Hypersensitivity 75 g q 8 ANST cell wall synthesis to cephalexin, any by binding to one or component of the more of the formulation, or penicillin-binding other proteins (PBPs) cephalosporins which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.

allergic reaction: >Determine history hives; difficulty of hypersensitivity breathing; swelling reactions to of your face, lips, cephalosporins and tongue, or throat. penicillin and diarrhea that is history of other watery or bloody; drug allergies seizure before therapy is (convulsions) initiated. fever, sore throat, >Lab tests: and headache with aEvaluate renal and severe blistering, hepatic function peeling, and red periodically in skin rash; patients receiving pale or yellowed prolonged therapy. skin, dark colored >Monitor for urine, fever, manifestations of confusion or hypersensitivity weakness; (see Signs & easy bruising or Symptoms, bleeding, unusual Appendix F). weakness; Discontinue drug and report their appearance promptly.

NAME OF DRUG

CLASSIFICATION & INDICATION AND MECHANISM OF DOSAGE ACTION

CONTRAINDICATIO SIDE-EFFECTS/ N ADVERSE REACTIONS

NURSING RESPONSIBILITIES

confusion, agitation, hallucinations (seeing things that are not there); or urinating less than usual or not at all.

>Take medication for the full course of therapy as directed by physician. >Keep physician informed if adverse reactions appear.

S: O: A: Knowledge deficit related to chronic illness P: After 4 hours of nurse-patient and significant others interaction, the patient and the significant others will be able to: Identify interferences to learning and specific actions to deal with it. Perform necessary procedures correctly and explain reasons for the actions. Initiate necessary lifestyle changes and participate in treatment regimen.

SOAPIE

I:Assessed readiness to learn. Provided an environment that is conducive to learning. Provided written information/guidelines and self-learning modules for client to refer to as necessary. Allowed practice and demonstrations. E: Goal was met. After 4 hours of nurse-patient and significant others interaction, the patient and the significant others will be able to identified the interferences to learning and made specific actions to deal with it. And they were to performed necessary procedures correctly and they explained the reasons for the actions they made. And they were able to initiated necessary lifestyle changes and participated in treatment regimen by allowing them to practice and demonstrate the treatment regimen.

SOAPIE
S- “Wala koy gana mukaon.”, as verbalized by the patient. O- : protein-creatinine ratio of 1.55 Serum albumin of 0.9g/dl A- Imbalanced Nutrition, less than body requirements related to poor appetite, restricted diet, and protein loss. P- After 8 hours of nurse-patient interaction, the patient will be able to: a.Identify the appropriate diet for her condition. (Lowsodium diet) b.Follow the diet prescribed. c.Verbalize realization of the importance of proper diet.

I- Assessed and monitored food/fluid ingested and calculate caloric intake. •Monitored weight daily at same time, same clothing and same scale. •Recommended small, frequent meals. •Restricted sodium as indicated, and limited fluid intake to 100ml •Administered multivitamins, as indicated. •Administered medications as appropriate. •Monitored laboratory studies. E- Goals met. After 8 hours of nurse-patient interaction, the patient was able to identify the appropriate diet for her condition. (Low-sodium diet). Follow the diet prescribed. Verbalize realization of the importance of proper diet.

S- “Murag nanghupong akong anak sa iya bitiis.”, as verbalized by the mother. O- Edema, weight gain, changes in vital signs A- Excess fluid volume related to compromised regulatory mechanism with changes in hydrostatic vascular pressure and increased activation of rennin angiotensin aldosterone system. P-After 5 hrs of nursing interventions, the patient will be able to: display stable weight vital signs within patient’s normal range nearly absence of edema.

SOAPIE

I-Record accurate intake and output of the patient Monitor urine specific gravity Weight daily at same time of the day, on same scale, with same equipment and clothing Assess skin, face, dependent areas of edema Monitor heart rate and blood pressure Assess level of consciousness: investigate changes in mentation, presence of restlessness. E-Goals were fully met. After 5 hrs of nursing interventions, the patient was able to display stable weight, vital signs within patient’s normal range, and nearly absence of edema.

Sign up to vote on this title
UsefulNot useful