SAINT LOUIS UNIVERSITY COLLEGE OF NURSING BAGUIO CITY

NCP (CASE STUDY)

SUBMITTED BY: FERRER, Tristan GALINATO, Michael RABARA, Romuel ALMEROL, Bernalyn BLANCO, Catherine BOADO, Andrienne DAMASCO TY, Mikaella LAGUINDAY, Michelle MEJIA, Camille PARAS, Mary Margarette SARMIENTO, Ellaine Joyce URAYENZA, Aira Joyce SUBMITTED TO: Ma’am Shiela Adversalo

I. Demographic Data Full Name: Jesus Carlota Tan Jr. Age: 59 years old Birthdate: August 18, 1950 Birthplace: Cebu City Address: 214 Naguilian Road, Baguio City Civil Status: Married Religion: Roman Catholic Nationality: Filipino Highest Educational Attainment: Military Graduate Occupation: Retired military officer (Major) Date Admitted: August 25, 2009 Time of Admission: 4:30 pm Chief Complaint: Right flank pain Impression Diagnosis:Massive pleural effusion right parapneumonic vs. malignant pleural effusion II. History of Present Illness 2 weeks prior to admission, patient has difficulty of breathing with associated cough and chest pains. No head ache, no fever and no nausea and vomiting. No medical consultations were done. 1 week prior to admission, after lifting a heavy object, client felt right flank pain described as shooting in character. No fever, head ache or nausea and vomiting noted. The patient sought consult to his private physician and was given Arcoxia and Myonal affording slight relief. The patient’s right flank pain persisted in the next few days even having Arcoxia and Myonal. The patient had DOB when sleeping and lying flat on bed. He was relieved when he was doing right lateral decubitus position. Patient’s flank pain persisted despite the medications and when the pain was already severe, the patient was brought to the institution for further management and evaluation; hence, admission. III.Past Medical History Patient has no known allergies to food and drugs. No major operations were done and no trauma noted. Immunizations were unrecalled. The patient has been diagnosed with CVD, RMCA on 2006 and his last admission was July 2009 due to removal of boil. The patient was a known hypertensive and diabetic. Maintenance drugs include Norises, Lifezar, Aspilet, Metformin and Plavix with good compliance.

IV. Family History The patient claims to have a history of heredofamilial diseases such as DM and HPN and denied any history of CAD, asthma, cancer, CVD, goiter and kidney diseases. V. A. Course of Confinement This is the case of Jesus Tan, a 59 yr old male, married, Filipino, Roman Catholic, born in Cebu City on September 18, 1950, currently residing at 214 Naguilian Road Baguio City. He was admitted for the 2nd time in this institution on August 25, 2009, with a chief complaint of right flank pain. He was given an IVF of Plain NSS upon admission. VI. B. Diagnostics August 27, 2009 WBC Results 10.0 10e9/L 58.6% N 30..0 % L 8.61 % M 1.68 % E 1.13 % B 4.95 10e12/L 140 g/L 0.421 L/L 8.51 fL 331 g/L Platelet: Comments: RBCs Normal Values 5.00-10.00 45.0-70.0% N 20.0-40.00 % L 0.00-12.00 % M 0..00-8.00 % E 0.00-2.00 % B 4.50-6.00 120-170 0.40-0.54 76.0-96.0 320-360 adequate Normocytic, normochromic

RBC HGB HCT MCV MCH

• Massive pleural effusion. such as chemotherapy and radiation.0-32.2 pg 27.MCHC 28. X-Ray Report August 25. right • Atherosclerotic aortic knob . It is also used to diagnose and/or monitor bleeding and clotting disorders through platelet count and to evaluate bleeding and clotting disorders and to monitor anticoagulation (anti-clotting) therapies through prothrombin time.This test was done to determine the existence of an infection and to determine if blood components are within normal levels. Intact left hemidiaphragm and costrophrenic angle.0 Interpretation: This test is used to aid in diagnosing anemia and other blood disorders and certain cancers of the blood. Cardiac shadow cannot be evaluated. to monitor blood loss and infection. 2009 Chest PA and Thoracolumbar Vertebrae Chest There is homogeneous opacity seen in the right lung field. The tracheal air column and mediastinal structures are directed to the right. Atherosclerotic aortic knob. All findings in the examination are within the normal range. to monitor a patient's response to cancer therapy. An increase in the WBCs in indicative of infection whereas a decrease in the HGB or HCT indicates the possibility that the blood may not be able to adequately supply body’s demands for oxygen. Observing the right hemidiaphragm and costophrenic angle.

Client has been given an impression diagnosis of massive pleural effusion. but are also useful for detecting some disease processes in soft tissue. a chest x-ray has been performed. Results convey that there is massive pleural effusion at the right lung pleura and reveals atherosclerosis of the abdominal aorta which means that there are increased cholesterol deposits at the wall of the abdominal aorta which may obstruct blood flow. 2009 Follow up chest study since August 25. 2009 reveals minimal clearing of the previously seen right sided pleural effusion. The left lung field is still unremarkable The tracheal air column and mediastinal structure now appear midline Cardiac shadow still could not be evaluated properly A CTT tube is seen in the right peripheral hemithorax No interval change noted Interpretation: . In order to confirm the diagnosis. X-Ray Report August 26.Thoracic and Lumbar Osteophytic lippings are seen in the articulatory margins of the thoracic and lumbar spine No evident fracture or listhesis Line of gravity is physiologic Intact pedicle and disc spaces Lumbarized S1 vertebral body Atherosclerotic abdominal aorta • Degenerative disease of the thoracic and lumbar spine • Lumbarized S1 Interpretation: X-rays are especially useful in the detection of pathology of the skeletal system.

the number of white blood cells will be elevated. number. The lung is still unremarkable No internal changes noted Interpretation: X-rays are especially useful in the detection of pathology of the skeletal system. 2009 Follow up study since 08-26-09 shows further clearing of the previously seen right sided pleural effusion. and maturity of the different blood cells in a specific volume of blood. The use of this test is . 2009 Blood Type: Rhesus Factor: “O” positive (+) Normal Value: Normal Value: 1-7 minutes 5-15 minutes Bleeding Time: 3 minutes Clotting Time: 7 minutes Interpretation: A complete blood cell count is a measurement of size.After the insertion of a CTT to drain pleural fluid.X-rays are especially useful in the detection of pathology of the skeletal system. A complete blood cell count can be used to determine many abnormalities with either the production or destruction of blood cells. x-ray reveals minimal clearing of the right pleural effusion which means that there is minimal decrease in the pleural volume found at the right lung. X-Ray Report August 27. The result reveals further clearing of the right pleural effusion which means that the CTT is effective in draining pleural secretions.This x-ray is done as a follow up of the recent x-ray. or maturity of the blood cells can be used to indicate an infection or disease process. This x-ray has been done as a follow up to the previous x-ray in order to determine the progress of the condition and to check the placement of the CTT at the same time. size.. Variations from the normal number. but are also useful for detecting some disease processes in soft tissue. This is to determine whether the pleural fluid has been reduced. Hematology August 25. but are also useful for detecting some disease processes in soft tissue. Often with an infection.

This test most often detects breast cancer. to monitor blood loss and infection. lung cancer. and lymphoma. 2009 Physical Description Pleural fluid submitted for study Volume: Apperance: Color: 22 mL turbid red Microscopic Description Smears Few atypical cells with medium-sized to large oval nuclei. occasionally with prominent nucleoli. or when cancer is suspected. Since the patient is a diabetic and needs to undergo an invasive procedure. It is also important to determine the patient’s blood type and Rh factor to prepare for Blood transfusion if in case bleeding persists and is uncontrolled during the procedure. In an abnormal test. to monitor a patient's response to cancer therapy. malignant (cancerous) cells are present and may indicate a cancerous tumor. The result reveals the presence of atypical . his clotting and bleeding time should be known in order to determine whether the procedure can be pursued. scanty to moderate amount of cytoplasm seen singly in small clusters Few lymphocytes and occasional macrophages Few mesothelial cells Some erythrocytes Interpretation: The test is performed to determine the cause of fluid accumulation in the pleural space (pleural effusion).To aid in diagnosing anemia and other blood disorders and certain cancers of the blood. Pleural Fluid Examination August 25. such as chemotherapy and radiation. Pleural fluid from the CTT drain has to be examines in order to determine whether there is a presence of infection at the pleural area.

: Interpretation: The prothrombin time is the time it takes plasma to clot after addition of tissue factor (obtained from animals).cells with few lymphocytes and occasional macrophages indicating the presence of an infectious process. 2009 Source of Specimen: Examination Desired: Results: Patient’s plasma: Control plasma: Reference Value: Prothrombin Activity: I. Prothrombin is converted to thrombin during clotting. The prothrombin time is the time it takes plasma to clot after addition of tissue factor (obtained from animals).2 mg/dL Normal Value: 0.1% 1. 2009 1.07 . The prothrombin value is quite high indicating that the patient has good clotting capacity. Plasma Examination September 2.N.R. This test has been performed to determine effectiveness of client’s clotting capacity. This measures the quality of the extrinsic pathway (as well as the common pathway) of coagulation.7 seconds 97.8-12. Creatinine G September 4. This measures the quality of the extrinsic pathway (as well as the common pathway) of coagulation.3 mg/dL Interpretation: citrated plasma Prothrombin time and activity 12.5 seconds 9.6-1.3 seconds 11. with the body’s defenses trying to combat infection by the release of phagocytic cells.

The most common causes of longstanding kidney disease in adults are high blood pressure and diabetes mellitus. which is taken out of your blood by the kidneys and then passed out of your body in urine. Creatinine is made at a steady rate and is not affected by diet or by normal physical activities.162 8:00AM .108 6:00AM – 153 Interpretation: CBG consisting in measuring the glucose (sugar) content in the blood is done on a regular basis in diabetes patients to determine their glucose level (Normal = 90 120). If your kidneys are damaged and cannot work normally. collecting a blooddrop (capillary blood) on a chemical strip. the amount of creatinine in your urine goes down while its level in your blood goes up. Creatine is broken down into another substance called creatinine.117 11:30 AM – 137 4:50PM – 83 6:20PM . The result appears in a LED.2 mg/dL which revealed that kidneys are not damaged or deficient and did not lead to sudden rise in the blood levels.6 to 1.Creatinine tests measure the level of the waste product creatinine in your blood and urine.2 milligrams (mg) per deciliter (dl) in adult males and 0.The purpose is to find out if the dosis of medecine which the patient is taking is correct and if his diet is right or if corrections should be made.5 to 1. It is done in general from one to various times a week. which is introduced in a glucosemeter. Normal levels of creatinine in the blood are approximately 0. These tests tell how well your kidneys are working. Drug Study . It consists in making a pinprick with a sterile throwaway lancet in a fingertop. The cretainine level of the patient is 1.1 milligrams per deciliter in adult females. CBG (September 4. 2009) 12:00AM – 199 4:00AM . The substance creatine is formed when food is changed into energy through a process called metabolism. VII.

It blocks the Angiotensin II AT1 receptors and decreases arterial BP by decreasing vasoconstriction and systemic vascular resistance. Instruct to report if any adverse effects are experienced. Nursing Considerations: Check BP before each dose. 2nd degree AV block. Instruct to take drug regularly Generic Name: Metformin HCl Brand Name: Neoform . gout. muscle cramps. symptomatic hypotension. anxiety disorder. oral or IV digoxin. Losartan did not affect the pharmacokinetics and pharmacodynamics of warfarin. when used concomitantly led to a reduction of about 20% in the AUC of losartan and that of its active metabolite. Contraindications: Hypersensitivity. diarrhea. migraine. Losartan and phenobarbital. nervousness Interactions: Co-administration of losartan and cimetidine led to an increase of about 18% in AUC of losartan but did not affect the pharmacokinetics of its active metabolite. arrhythmia. Observe for interactions when administering other drugs that may decrease the drug’s effect such as adrenergics. Fever. angina pectoris. dry mouth.Generic Name: Losartan Potassium Brand Name: Lifezar General Classification: Anti-hypertensive. and ketoconazole. anemia. Angiotensin II Antagonist Indication: HPN Mechanism of Action: Blocks the strong BP raising effect of angiotensin II by competing with angiotensin II for tissue binding sites and prevent angiotensin II from combining with its receptors in the body tissues. renal artery stenosis Side Effects: Facial edema. hepatic impairment. arthritis.

nausea and metallic taste Interactions: Reduction in metformin HCl dosage may be required in patients receiving metformin HCl and cimetidine concomitantly to reduce the risk of lactic acidosis. amylase) in the GI tract and thereby delay digestion of complex carbohydrates into glucose and other simple sugars. Some of the metabolites are absorbed systemically and excreted in the urine. recent MI. chronic low back pain. gout . Ideally administer at the beginning of a meal so the drug will be present at the GIT with food and be able to block the digestion of CHOs. conditions likely to predispose to lactic acidosis Side Effects: Diarrhea. Alpha-Glucosidase Inhibitor Indications: NIDDS Type 2. psoriatic arthritis. ketoacidosis. It is metabolized in the GI by digestive enzymes and intestinal bacteria.General Classification: Metabolic/Endocrine Drug. Instruct to report any side effects Generic Name: Etoricoxib Brand Name: Arcoxia General Classification: Analgesic-Antipyretic. ankylosing spondylitis. As a result. patients no longer responding to sulphonylureas. Contraindications: Cardiac failure. inadequately controlled by proper dietary management and exercise especially in obese diabetic patients. acute or chronic alcoholism. chronic liver disease. plasma concentrations are increased in the presence of renal impairment. osteoarthritis. acute pain. cox-2 Inhibitor Indications: rheumatoid arthritis. either alone or in combination with other drugs Mechanism of Action: Inhibits alpha-glucosidase enzymes (sucrose. anorexia. glucose absorption is delayed and there is small increase in blood glucose levels following a meal. maltase. Muscle Relaxant. abdominal pain. Nursing Considerations: Assess changes in blood sugar levels (400 mg/100ml is dangerous). lactic acidosis.

thus alleviating stiffness and spasticity. angioneurotic oedema. The drug inhibits the vicious cycle of myotonia by decreasing pain. ischaemia. improvement of circulation. improvement of muscular hypertonic symptoms in conditions such as cervical syndrome. spinocerebellar degeneration. This reduces the generation of prostaglandins (PGs) from arachidonic acid. their role in the inflammation cascade should be highlighted. Among the different functions exerted by PGs. and hypertonia in skeletal muscles. Instruct client to report any untoward effects Generic Name: Eperisone Brand Name: Myonal General Classification: Antispasmodic. and facilitating muscle Contraindications: Eperisone is contraindicated in patients with known hypersensitivity to the drug . postoperative sequelae (including from cerebrospinal tumour). and suppression of the pain reflex.Mechanism of Action: Inhibits isoform 2 of cyclo-oxigenase enzyme (COX-2). urticaria Side Effects: Immune system disorders. or active GI bleeding. periarthritis of the shoulder. cerebral palsy.g. cervical spondylosis. and demonstrates a variety of effects such as reduction of myotonia. sequelae to trauma (e. spastic spinal paralysis. Observe for decrease in the severity of pain. as demonstrated in several large clinical trials performed with different COXIB Contraindications: Hypersensivity. cardiac disorders. This reduced activity is the cause of reduced gastrointestinal toxicity. Skeletal Muscle Relaxant Indications: Spastic paralysis in conditions such as cerebrovascular disease. acute rhinitis. spinal trauma or head injury). nasal polyps. COX-2 selective inhibitor (aka "COXIB") showed less marked activity on type 1 cycloxigenase compared to traditional non-steroidal anti-inflammatory drugs (NSAID). acute peptic ulceration. respiratory and thoracic mediastinal disorders Nursing Responsibilities: Administer with full glass of fluid during or after meals to decrease gastric irritation. and lumbago Mechanism of Action: Eperisone acts by relaxing both skeletal muscles and vascular smooth muscles. nervous system disorders. amyotrophic lateral sclerosis. spinal vascular diseases and other encephalomyelopathies. bronchospasm.

itching. Administer the drug after meals to decrease gastric irritation Generic Name: Bisacodyl Brand Name: Dulcolax General Classification: Laxative—stimulant Indications: Treatment of constipation. . abdominal pain. nausea or vomiting. alters fluid and electrolyte transport producing fluid accumulation in the colon. insomnia. May decrease the absorption of other orally administered drugs because of increased motility and decreased transit time. Nursing Implication: Assess patient for abdominal distention. Assess color. itching.Side Effects: Shock and Anaphylactoid reactions: In the event of symptoms such as redness. Other side effects: anaemia. Contraindication: Hypersensitivity. Nursing Considerations: Caution the patient on the possible side effects of the drug. ocular congestion or stomatitis. sleepiness. Monitor for signs of psychological hypofunction during treatment. Patients should be carefully observed. particularly when associated with prolonged bed rest. oedema of the face and other parts of the body. abdominal pain. pruritus. urinary retention or incontinence. CNS side effects: Depletion of Myelin Sheath of Nerves. Oculo-muco-cutaneous syndrome (Stevens Johnson Syndrome) and Toxic Epidermal Necrolysis: Serious dermatopathy such as oculo-muco-cutaneous syndrome (Stevens-Johnson syndrome) or toxic epidermal necrolysis may occur. consistency. headache. abdominal cramps Interactions: Antacids may remove enteric coating of tablets. treatment should be discontinued and appropriate measues taken. dyspnoea etc. obstruction. etc. urticaria. diarrhoea. and usual pattern of bowel function. and amount of stool produced. in the event of symptoms such as fever. treatment discontinued and appropriate measures taken. blistering. rash. presence of bowel sounds. especially when associated with fever or other signs of an acute abdomen A/R and S/E: Nausea. constipation. evacuation of the bowel prior to radiologic studies or surgery Mode of Action: Stimulates peristalsis. nausea ang vomiting. erythema. anorexia.

carbamazepine. Its weak anti-inflammatory activity is related to inhibition of prostaglandin synthesis in the CNS. It produces antipyresis by inhibiting the hypothalamic heat-regulating centre.Generic Name: Paracetamol Brand Name: Alaxan General Classification: Analgesic Antipyretic Indications: Mild and moderate pain and fever Mode of Action: Paracetamol exhibits analgesic action by peripheral blockage of pain impulse generation. skin rashes. Side Effects: Nausea. Generic Name: Cefotaxime Na Brand Name: Zefocent General Classification: Cephalosporins . hydantoins. allergic reactions. Interactions: Reduced absorption of cholestyramine within 1 hr of admin. Paracetamol may increase effect of warfarin. Nursing Implications: Assess patient for signs and symptoms of infection. Accelerated absorption with metoclopramide. acute renal tubular necrosis. rifampicin and sulfinpyrazone. G6PD deficiency. Assess patients pain characteristics. Contraindication: Renal or hepatic impairment. Decreased effect with barbiturates. alcohol-dependent patients.

muscle spasms. Obtain specimen for culture and sensitivity. septic arthritis. Nursing Implications: Assess patient for infection. cellulitis. Mode of Action: Inhibits protein synthesis of the bacteria Contraindications: Hypersensitivity to cephalosporins. meningitis. Vit deficiencies & alteration in bacterial flora. Monitor intake and output and daily weight to assess hydration status and renal function Generic Name: Diazepam Brand Name: General Classifications: Anxiolytics. acute narrow angle glaucoma. sedative. septicemia. gonorrhea. muscle relaxant and amnestic properties. Anti convulsants Indications: Short term treatment for anxiety. endometritis. Contraindications: Hypersensitivity. anxiolytic. UTI. adnexitis. Interactions: Aminoglycosides & diuretics eg furosemide. severe hepatic impairment. wound & post-op infections. preexisting CNS depression or coma. hematologic. tonsillitis. peritonitis. hypersensitivity reactions.Indications: Serious & life-threatening infections due to susceptible gm+ve & gm-ve bacteria. Post-injury. It increases neuronal membrane permeability to chloride ions by binding to stereospecific benzodiazepine receptors on the postsynaptic GABA neuron within the CNS and enhancing the GABA inhibitory effects resulting in hyperpolarisation and stabilisation. prostitis. seizures. cholecystitis. sleepwalking. penicillins & local anesth eg lidocaine (in IM use Side Effects: Shock. resp infections. acute pulmonary insufficiency or sleep apnoea. Mode of Action: Diazepam is a long-acting benzodiazepine with anticonvulsant. bacterial endocarditis. renal & hepatic disturbances. Pneumonia. pregnancy and lactation. . insomia. parametritis. children < 6 mth. burns. respiratory depression. Osteomyelitis. Digestive & resp effects. cholangitis.

fatigue. paradoxical excitation. hypotension. sedation. Mode of Action: Oral hypoglycemic agent. confusion. Generic Name: Glimepiride Brand Name: Norizec General Classification: Antidiabetic Indications: Adjunct to diet and exercise to lower blood glucose in patients with type 2 diabetes mellitus as monotherapy and in combination with metformin or insulin when diet and exercise plus the single agent do not result in adequate glycemic control. changes in libido. drowsiness. Interactions: Increased clearance of diazepam when used with phenytoin.7% . Caution the patient on the possible side effects of the drug. GI disturbances. Monitor for signs of psychological hypofunction during treatment. incontinence. Glimepiride also provides overall glycemic control by increasing sensitivity of peripheral tissues to insulin. Combination with lithium may produce hypothermia. It lowers blood glucose primarily by stimulating the release of insulin from functioning pancreatic β-cells.9-1. Contraindications: Known hypersensitivity to glimepiride. mental changes. carbamazepine and phenobarbital. ataxia. Side Effects: Hypoglycemia (blood glucose values <60 mg/dL): 0. Glimepiride is a sulfonylurea antidiabetic agent. jaundice. changes in salivation. pain and thrombophloebitis at Inj site (IV).Side Effects: Psychological and physical dependence with withdrawal syndrome. Reversible deterioration of parkinsonism may occur when given together with levodopa. visual disturbances. vertigo. depression. constipation. slurring of speech and dysarthria. amnesia. Diabetic ketoacidosis with or without coma. tachycardia. headache. muscle weakness. elevated liver enzyme values. Nursing Implications: Assess patients general status. Treat this condition with insulin.

nausea: 1. ibuprofen. Nasal polyps. Hypovolaemia or dehydration. lactation. headache: 1. As prophylactic analgesic before surgery.5%. sympathomimetics and isoniazid tend to produce hyperglycemia and may lead to loss of glycemic control. bronchospasm. cerebrovascular bleeding. hemolytic anemia. 22% and 15%. there is no evidence of clinically significant adverse interactions with uncontrolled concurrent administration of aspirin and other salicylates. Allergic skin reactions eg.6%. Do not give postoperatively to patients with high risk of haemorrhage. diclofenac. maculopapular reactions (<1%). . Co-administration of aspirin (1 g 3 times a day) and glimepiride leads to a 34% decrease in the mean AUC and 4% decrease in the mean Cmax of glimepiride. angioedema. Nursing Implications: Assess patient for signs and symptoms of hypoglycemia. thyroid products. agranulocytosis. Potential interactions of glimepiride with other drugs metabolized by cytochrome P-450 2C9 also include phenytoin. probenecid. naproxen and mefenamic acid. increase in liver enzymes. Thiazides and other diuretics. corticosteroids. phenothiazines. oral contraceptives. Assess patient for any change in blood glucose. urticaria. phenytoin. Closely observe the patient on glimepiride for loss of glycemic control when these drugs are coadministered. asthma. Generic Name: Ketorolac Brand Name: Ketomed General Classification: NSAIDS Indications: Short term management of moderate to severe pain Mode of Action: Ketorolac inhibits prostaglandin synthesis by decreasing the activity of the cyclooxygenase enzyme. Potential interactions between oral miconazole and oral hypoglycemic agents have been reported. sulfonamides and highly protein-bound drugs eg. Contraindications: Hypersensitivity to aspirin or other NSAIDs. respectively. Moderate to severe renal impairment. pruritus. Labour.1%. Concomitant administration of propranolol (40 mg 3 times a day) and glimepiride significantly increases Cmax. gastrointestinal pain and diarrhea (<1%). monoamine oxidase inhibitors and β-blockers can potentiate the hypoglycemic action of glimepiride and sulfonylureas. However. AUC and t½ of glimepiride by 23%. GI bleeding. asthenia: 1. aplastic anemia and pancytopenia have been reported with sulfonylureas. Pregnancy. estrogen. History of peptic ulcer or coagulation disorders. coumarins. Leukopenia.7%. Vomiting. erythema. Interactions: Nonsteroidal anti-inflammatory drugs (NSAIDs). salicylates. rarely.Adverse events occurring in >1% of glimepiride patients: Dizziness: 1. nicotinic acid. thrombocytopenia. chloramphenicol.

Head injury. fever. Increased risk of renal toxicity with ACE inhibitors. vomiting. Generic Name: Nalbuphine Brand Name: Nalphine General Classifications: Analgesic Indications: Management of Pain Mode of Action: Nalbuphine is a phenanthrene derivative opioid analgesic with mixed opioid agonist and antagonist activity. Renal or hepatic impairment. urinary urgency. speech difficulty. Interactions: Additive CNS depressant effects may occur with other CNS depressants e. nausea. ACE inhibitors or angiotensin II receptor antagonists). anaesthetics. hypotension. TCAs and antipsychotics .g. liver function changes. severe infection. dizziness. blurred vision. Pregnancy and lactation. dizziness. cyanosis. Contraindications: May impair ability to drive or operate machinery. alprazolam. altering the perception of and response to pain by binding to opiate receptors in the CNS. signs of dizziness. pallor. headache. Hallucinations may occur when used with fluoxetine. nervousness and GI disturbances. anxiolytics. It also produces generalised CNS depression. headache. Interactions: May reduce effects of antihypertensives (e. chest pain. oedema. bradycardia. closely monitor these patients during long-term therapy. uraemia.Side Effects: GI ulcer. Medicine should be taken after meals. It inhibits the ascending pain pathways. warmth. vertigo. MI patients who exhibit nausea and vomiting and in those about to undergo biliary tract surgery. psychosis. bronchial asthma. hypnotics. respiratory obstruction. miosis. drowsiness. Transient stinging and local irritation (ophthalmic). Side Effects: Sedation. urticaria. rash. bronchospasm. clamminess. Emotionally unstable patients or patients with history of opiate abuse. asthma. bleeding and perforation. alcohol. Respiratory depression. sweating. flushing. dry mouth. intracranial lesions or pre-existing increased intracranial pressure. Increased adverse effects with aspirin or other NSAIDs. Elderly and debilitated patients. thiothixene. diuretics. Impaired respiration due to other drugs. dyspnoea.g. burning. itching. Nursing Implications: Assess patient’s pain. dry mouth.

Interactions: Celecoxib metabolism is predominantly mediated via cytochrome P-450 2C9 in the liver . Nursing Implications: Assess patient’s pain. Mode of Action: Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID) that exhibits anti-inflammatory. nausea. Reduce the number of adenomatous colorectal polyps in familial adenomatous polyposis (FAP). nervousness and GI disturbances. and at therapeutic concentrations in humans. endoscopic surveillance surgery). headache. flatulence. Generic Name: Celecoxib Brand Name: Celcoxx General Classification: NSAID Indications: For the relief of the signs and symptoms of osteoarthritis and rheumatoid arthritis in adults. Co-administration of celecoxib with drugs that are known to inhibit 2C9 should be done with caution. Severe. . The mechanism of action of celecoxib is believed to be due to inhibition of prostaglandin synthesis. heart failure and inflammatory bowel disease. Management of acute pain in adults especially in postoperative pain. as an adjunct to usual care (eg. Assess for signs of dizziness. Patients with renal impairment associated with creatinine clearance of <30 mL/min. Side Effects: Abdominal pain. signs of dizziness. primarily via inhibition of cyclooxygenase-2 (COX-2). Contraindications: Patients with known hypersensitivity to celecoxib and those who have demonstrated allergic-type reactions to sulfonamide. urticaria. or allergic-type reactions after taking acetyl salicylic acid (ASA) or other NSAIDs including other COX-2 specific inhibitors. diarrhea. anaphylactic-like reactions to NSAIDs have been reported in such patients. nausea and vomiting. Medicine should be taken after meals. Patients who have experienced asthma. analgesic and antipyretic activities. Patients who are known or suspected to be P-450 2C9 poor metabolizers based on a previous history should be administered celecoxib with caution as they may have abnormally high plasma levels due to reduced metabolic clearance. rarely fatal.Nursing Implications: Assess pain characteristics. celecoxib does not inhibit the cyclooxygenase-1 (COX-1) isoenzyme. dyspepsia. Treatment of dysmenorrhea. Patients who have previously had a myocardial infarction (MI) or stroke and in the peri-operative period undergoing cardiac or major vascular surgery. Patients with severe hepatic impairment (Child-Pugh Class C).

lamotrigine. phenobarbital. Mode of Action: Alpha2-delta ligand modulator (Anti-neuropathic pain/Anticonvulsant/Antiepileptics). In vitro studies show that pregabalin binds to an auxiliary subunit (α2-δ protein) of voltage-gated calcium channels in the central nervous system. pregabalin reduces the release of several neurotransmitters. In addition.Generic Name: Pregabalin Brand Name: Lyrica General Classification: Anticonvulsants Indications: Treatment of neuropathic pain in adults. Similarly. carbamazepine. constipation. tiagabine and topiramate. population pharmacokinetic analysis indicated that the commonly used drug classes. oxycodone or ethanol. In addition. or be subject to. vertigo. does not inhibit drug metabolism in vitro. valproic acid. phenytoin. including glutamate. somnolence. had no clinically significant effect on pregabalin clearance. Side Effects: Increased appetite. gabapentin. Blurred vision. vomiting. diuretics and insulin. Monitor for signs of psychological hypofunction during treatment. Caution the patient on the possible side effects of the drug. valproic acid. undergoes negligible metabolism in humans (<2% of a dose recovered in urine as metabolites). pregabalin is unlikely to produce. diplopia. Two lines of evidence indicate that binding pregabalin to the α2-δ site is required for analgesic and anticonvulsant activity in animal models: (1) Studies with the inactive R-enantiomer and other structural derivatives of pregabalin and (2) Studies of pregabalin in mutant mice with defective drug binding to the α2-δ protein. these analysis indicated that pregabalin had no clinically significant effect on Nursing Implications: Assess patients general status. . The significance of these effects for the clinical pharmacology of pregabalin is not known. lorazepam. lamotrigine. and is not bound to plasma proteins. pharmacokinetic interactions. Accordingly in in vivo studies no clinically relevant pharmacokinetic interactions were observed between pregabalin and phenytoin. Dizziness. oral antidiabetics. carbamazepine. flatulence Interactions: Since pregabalin is predominantly excreted unchanged in the urine. noradrenaline and substance P. Dry mouth. and the commonly used antiepileptic drugs. Contraindications: Hypersensitivity to pregabalin or to any of the excipients of Lyrica. potently displacing [3H]-gabapentin.

peptic ulcer or intracranial hemorrhage. in combination with ASA in medically treated patients eligible for thrombolytic therapy. abdominal pain. Severe liver impairment. ischemic stroke (from 7 days until <6 months) or established peripheral arterial disease. Antiplatelets & Fibrinolytics (Thrombolytics) Indications: Prevention of atherothrombotic events in: Patients suffering from myocardial infarction (from a few days until <35 days). surgery or other pathological conditions that receive concomitant glycoprotein IIb/IIIa inhibitors . Active pathological bleeding eg.) Mode of Action: Platelet aggregation inhibitors excluding heparin. and the subsequent ADP-mediated activation of the GPIIb/IIIa complex. Side Effects: GI bleeding.Generic Name: Clopidogrel Brand Name: Norvasc General Classification: Anticoagulants. Diarrhea. platelets exposed to clopidogrel are affected for the remainder of their lifespan and recovery of normal platelet function occurs at a rate consistent with platelet turnover Contraindications: Hypersensitivity to clopidogrel or any component of Plavix. (See Pharmacology under Actions. Pharmacodynamics: Clopidogrel selectively inhibits the binding of adenosine diphosphate (ADP) to its platelet receptor. Clopidogrel acts by irreversibly modifying the platelet ADP receptor. ATC Code: BO1AC/04. dyspepsia Interactions: Warfarin: The concomitant administration of clopidogrel with warfarin is not recommended since it may increase the intensity of bleedings. Glycoprotein IIb/IIIa Inhibitors: Clopidogrel should be used with caution in patients who may be at risk of increased bleeding from trauma. in combination with ASA. Patients suffering from acute coronary Non-ST segment elevation acute coronary syndrome (unstable angina or non-Q-wave myocardial infarction) including patients undergoing a stent placement following percutaneous coronary intervention. ST segment elevation acute myocardial infarction. Biotransformation of clopidogrel is necessary to produce inhibition of platelet aggregation. Clopidogrel also inhibits platelet aggregation induced by other agonists by blocking the amplification of platelet activation by released ADP. Consequently. thereby inhibiting platelet aggregation.

Chest expansion is symmetrical with no adventitious lung sounds but with decreased breath sounds on the right lung. In the case of fever. He has no edematous extremities and skeletal deformities and has good capillary refill of 2 seconds. V. There is no tenderness noted on his abdominal area. common dishes include ginataang kalabasa. the patient has an input of approximately 420 cc during the 7-3 shift. Nutritional-Metabolic Pattern Patient eats a balanced diet. nystagmus or ataxia observed. place and persons. He does not feel any numbness or tingling sensation at present. Hearing is slightly impaired on his left ear but he does not use a hearing aid. Assess vital signs especially the cardiac rate. He loves condiments especially bagoong but has avoided such since he has suffered mild stroke in 2006. His preference is fish with a few vegetables and avoids meat. There is no nasal congestion and the patient has a patent airway. The patient doesn’t take in antibiotics or any other drug that has not been prescribed by the physician. conscious and oriented to time. labong and pinakbet. He complies strictly with his therapeutic regimen and takes all drugs prescribed by the doctor. except for Paracetamol. Patient is awake. He has a cardiac rate of 80 bpm and has been diagnosed to have adynamic pericardium. His taste sensation is normal but tongue movement is slightly altered due to the mild stroke he experienced in 2006. Whenever the patient experiences sore throat.Nursing Implications: Assess for signs of GI bleeding. At the hospital. gargling with bactidol. There are no discharges from the ears. Health-Perception-Health-Management Pattern Whenever the patient or anyone in the family gets sick. At home. There are no masses on his neck and no palpable lymph nodes. His average water intake at home ranges from 6-8 glasses a day. At present. He drinks milk. . orahex or warm water with salt is done. Assess for abdominal distention. b. coffee and coke zero occasionally. If in case the condition is not relieved by home management. There are no tremors. self-medication of Paracetamol is done to decrease body temperature. Physical Examination a. The patient has regular goes for regular monthly check ups to his private doctor for the management of his DM. he is at risk of infection related to traumatized tissue secondary to the CTT insertion and the VATS he underwent on September 4. home management is done initially. the patient seeks for medical assistance. He has a positive perception of his health and believes that his condition will go back to normal after hospitalization. Patient’s pupillary size and reaction to light are normal on both eyes.

He has experienced DOB with associated cough and chest pains 2 weeks PTA but has normal diaphragmatic breathing at present. sitting and supine positions. e. He has no known allergies to food and drugs and was able to return to his usual eating pattern at the hospital. At the hospital. He has undergone hemorrhoidectomy in 2004 and does not experience any difficulty in voiding and defecating at home or at the hospital. eating pattern has been affected because of the pain he feels when assuming a sitting position during meals. He does not perform gross mechanical activities at home and was placed on CBR without BRPs since admission in this institution. He did not experience any sleeping problems before he complained for flank pain. He did not pass stools during the 7-3 shift and urinated 1 during the shift. d. He voids approximately 6 times per day with yellow to dark yellow urine. His usual bowel movement is once a day with semi-solid to hard stools of usually brown color. He has a CTT tube placed on the right chest draining a dark red discharge. Activity-Exercise Pattern His usual activities at home include reading the newspaper. He has an RR of 20 cycles per minute a day before the surgery and 16 cycles per minute when he was brought back to the surgical ward after the VATS. watching TV and sweeping the backyard occasionally. He does not perform any physical exercise at home and has a sedentary lifestyle in general. He does not climb the stairs going to the second floor of their house but believes that he can do so. He has limited ROM with stooping noted when walking. His condition persisted even during the first days of his stay at the hospital. He was initially on NPO before the VATS has been performed but was informed that he can resume his usual and regular diet after the surgery as long as tolerated. He also used to be a chronic alcohol beverage drinker but has stopped smoking and drinking 9 years ago. He has been a smoker since 15 years old consuming 5 packs per day. c. he was given a diabetic diet with low cholesterol and low saturated fat.Since patient has experienced flank pain 1 week prior to admission. He is able to perform ADLs without assistance and no longer experiences any difficulty in changing bed positions and is able to tolerate standing. Elimination Pattern Patient has normal bowel sounds with no abdominal tenderness. He is also able to perform DBE on his own to relieve pain and facilitate breathing. . He has refrained from taking in rice and viand and preferred eating bread with ham and egg. that he can eat even on a supine position. Sleep-Rest Pattern Patient sleeps approximately 6-8 hours at night and takes a nap for about 2 hours in the afternoon. He is able to go back to sleep immediately whenever he wakes up to void at night. His total output is approximately 455 cc with 315 cc from bladder and 140 cc from the pleural fluid. he has preferred lateral decubitus postion and has experienced difficulty in changing bed position and standing on his own. Since he has felt right flank pain a week before admission.

his marital relationship with his wife is still intact. He denies any anxiety in relation to the upcoming invasive procedures to be done to him. Teresa 17 y/o stays in Manila for her College education. He manifests obstinacy towards health care providers as manifested by his attempts to remove the oxygen mask placed on him after the VAST. Angelo 29 y/o and Augusto 27 y/o. The pain was rated as 5/10. Self-Perception-Self-Concept Pattern Patient is a retired military officer and projects a good self image. Verbal messages are very minimal. He is alert but irritable at times due to the pain that he feels at the site of the CTT insertion. After the surgery. Because of the sense of superiority that he feels for himself. Cognitive-Perceptual Pattern He is oriented to time. He is however. Patient has narrowed focus accompanied with reduced interaction with people and is not conversant. f.At the hospital. He does not experience any body image disturbance or sense of powerlessness even after his stroke. Facial grimacing and guarding behaviors have been observed. Pain has however been relieved when Arcoxia has been administered. characterized as pricking and non-radiating. Their family is intact. h. No diaphoresis has been observed. There are no signs of confusion. disorientation or disturbed thought processes. characterized as pricking. exacerbated when changing bed positions and performing gross movements. James 30 y/o. Despite this. . his wife is very submissive to his opinions and ideals. It is felt whenever he wakes up in the morning and whenever he changes bed positions. and their youngest. Role-Relationship Pattern Patient is irritable at times and his interaction with others including his wife and HW is affected. radiating to the entire right chest up to the right hypochondriac region. He feels a sense of superiority over the others including his wife and HWs. His 3 children. Since he was given Arcoxia. He voice becomes louder whenever he insists on a point which he believes is right. he has resumed his usual sleep pattern. patient rated post-operative pain as 7/10. Some of his relaxation techniques at home include watching TV and reading newspapers. He is coherent and knowledgeable about his condition and is able to comprehend and understand the treatment and invasive diagnostic procedures that he needs to undergo. he experienced sleep disturbances due to the pain he feels secondary to the insertion of the CTT. g. irritable at times. are currently living with them. place and persons.

Despite this. He has no history of penile bleeding or any other sexual problems or STDs of any kind. He has no alterations in terms of desired sex role and there are no conflicts with regards to his sexual orientation and variant preferences. He does not experience any fear. barang. Whenever their family is faced with problems requiring major decisions. powerlessness. He is brave and outgoing. He does not believe that being a smoker since he was 15 years old has any relation to his current respiratory problems. His verbal communication is affected by his altered speech pattern caused by his stroke. he is still able to communicate his feelings and concerns in a manner that can be understood by others. kulam etc. hopelessness. Sexuality-Reproductive He has no history of prostate problems but does not undergo regular prostate exams. grooming and action. anxiety. He believes that the health team is the only reliable source of treatment. i. The wife verbalized that he has no social activities and does not go to church. The patient has 4 children and has intact marital status with his wife. k. Elizabeth Tan.He denies any impact of the change of his health condition to his role and relationship pattern. He does not believe is usog. sadness or depression is relation to this hospitalization. He believes that all diseases are results of pathogenic invasion or part of the degenerative/aging process that everyone undergoes in life. He is masculine in appearance. j. Coping-Stress-Tolerance Pattern Patient copes well to his condition primarily due to the effectiveness of his support systems and his positive outlook and viewpoint of his present condition. He is not anxious about the invasive procedures to be done to him. List of Identified Problems o Impaired Gas Exchange r/t accumulation of fluids at the pleural cavity secondary to pleural effusion . he acts as the head of the family and the primary decision maker. conflicts and problems with regards to the patient’s sexuality. He believes in the existence of supernatural beings but does not believe that these can affect his health. Value-Belief Pattern The patient is a Roman Catholic but does not go to church. He does not consider going to an albularyo as a substitute for medical assistance. There are no concerns.

Failure to engage in recreational activities may result to a feeling of boredom. Since then. breathing will not be possible.-This is an overt problem and is of primary importance in accordance to the concept of ABC( Airway. Breathing. If the patient's airway is blocked. In the case of our patient. and oxygen cannot reach the lungs and be transported around the body in the blood. This problem is 4th in rank since it has lesser bearing than the previously identified problems and can be managed by performing independent nursing interventions o Impaired physical mobility r/t post-operative pain secondary to VATS This problem is ranked 5th because gross movements are avoided in the case of the client since these movements can aggravate pain. the client has not engaged in any leisure or recreational activities. he felt flank pain which is associated to accumulation of fluids in the pleural cavity therefore interefering lung expansion resulting in decreased oxygen inhalation. Circulation). This is of lesser importance compared to the previously identified problems since the client’s physical mobility will most probably go back to normal once the pain is relieved and once the wound heals o Deficient diversional activity r/t situational problem secondary to stroke Since the husband suffered stroke in 2006. It should also be monitored since post operative pain is also a concern for the HW. he has refrained from going out on family outings and no longer goes to church. Compared to the previously identified problems. - Impaired tissue integrity r/t tissue trauma secondary to VATS and CTT insertion This is an overt problem and is of tertiary importance since the break in the skin caused by the procedures done to the patient may result to complications such as infection. lack of interest and enjoyment or dissatisfaction in life. - - - - Impaired verbal communication r/t speech problems secondary to stroke Verbal communications play an essential role in every individual’s day-to-day living. he experienced DOB 2 weeks PTA. This problem if not managed may result to social problems since recreational activities are also helpful in increasing the client’s social interaction and providing a sense of enjoyment and satisfaction. In the case of the client. this o . this problem does not pose a threat to life and is thus ranked as 6th. A problem concerning verbal communication may lead to further problems such as inability to convey message in an understandable way or inability to interact with other people effectively. One week PTA. which will result in hypoxia and cardiac arrest o Acute pain r/t tissue trauma secondary to VATS It has been rated as 7/10 by the patient and needs to be attended to in order to prevent pain from interfering with the client’s rest and relaxation. o o Sleep deprivation r/t discomfort secondary to post-operative pain Sleep and rest are essential elements for the recovery of a post-operative patient.

this problem may also be resolved. In his case. This however is least likely to take place since the client has significant volumes of CTT drains. the client has been given prophylactic doses to prevent infection therefore. - - Risk for imbalanced fluid volume r/t accumulation of secretions secondary to pleural effusion The client’s problem with regards to the accumulation of fluid has already been addressed by the insertion of the CTT. hence this problem is of lesser bearing than the 7th. o Risk for infection r/t traumatized tissue secondary to VATS All post-operative clients are at risk for infection. capacity to verbalize is still superior over ability to effectively interact with people. o . This problem is of least importance since it may only take place if management has not been effective in reducing/draining accumulated fluid. This problem is of lesser bearing compared to the previously identified problems since it is only a risk factor which has not yet taken place. o Impaired social interaction r/t communication barrier secondary to stroke This problem rose as a result of the 7th problem. Also. if the 7th problem is attended to. Also.problem is not yet of major importance since he is still capable of verbalizing his concerns in a manner that can be understood by others. Also. this problem may or may not take place. it does not pose a risk to his life and is therefore ranked as 7th.

” as verbalized by the patient.NCP PROPER P > Impaired gas exchange related to accumulation of fluids at the pleural cavity secondary to pleural effusion S > ”Nahihirapan akong huminga lalo na kapag nakahiga ako ng diretso. Dapat nakatagilid ako parati.8 °C via axilla Pulse Rate: 80 beats per minute regular.  “May ubo pa rin siya pero wala naming plema” as verbalized by the wife O > Vital signs are as follows: Temperature: 35. +2 amplitude Respiratory Rate: 16 cycles per minute regular Blood Pressure: 130/90 mmHg at the right arm  Capillary refill of 1-2 seconds  Difficulty in breathing  Irritable at times  Needs assistance in performing ADLs  Dry cough noted  With crackles heard on right lower lobe  With intact and patent CTT draining dark-red discharges to a one-way bottle  Restlessness noted .

Maintains acceptable activity level e. NURSING RATIONALE CRITERIA OF THE EVALUATION .Goal: After 3 days of nursing interventions. Adequate Gas Exchange depends on an adequate ventilation-perfusion ratio. The finding of a transudative effusion generally implies that the pleural membrane are not diseased. Verbalizes information about smoking correctly. the pleural space contains a small amount of fluid (5 – 15 ml). A pneumothorax is a collection of gas in the pleural space that result in collapse of the lung/s. usually results from inflammation by bacterial products or tumors involving the pleural space. usually by imbalances in hydrostatic or oncotic pressures. A transudate occurs when factors influencing the formation and reabsorption of pleural fluid are altered. benefits of quitting. Injuries to the chest are often life-threatening and result in one or more of the following pathologic conditions: Hypoxemia for disruption of the airway. injury to the lung parenchyma. This almost always has a pathologic significance. resulting in hypoxia. or it can be bloody of pulurent. risks of continuing. the patient will have an adequate oxygenation and absence of respiratory distress STO: After a day of nursing interventions. rib cage. Ventilation and perfusion imbalance causes shunting of blood. Understands the rationale for activities and medications Explanation of the problem: Impaired Gas Exchange is the excess or deficit in oxygenation or CO2 elimination at the alveoli-capillary membrane. Pleural Effusion. and perfusion is the filling of pulmonary capillaries with blood. is rarely a primary disease process but is usually secondary to other diseases. Practices and uses pursed lip and diaphragmatic breathing c. The most common cause of a transudative effusion is heart failure. a collection of fluids in the pleural space. Paces self to avoid fatigue and dyspnea d. massive hemorrhage. and respiratory musculature. collapse and pneumothorax Ventilation is the flow of gas in and out of the lungs. The effusion can be composed of a relatively clear fluid. An effusion of clear fluid may be a transudate or exudates. techniques to optimize cessation efforts b. In certain disorders. An exudates. the patient will be able to: a. fluid may accumulate in the fluid space to a point where it becomes clinically evident. Normally.

 Auscultate chest breath sounds  Review laboratory and diagnostic results  Assess for changes in behavior and mentation  Monitored patency CTT . decreased or absent breath sounds may indicate pneumothorax or hemothorax  It aids in diagnosis of microscopic and molecular abnormalities not detected by plain assessment  Restlessness is an early sign of hypoxia. The client will be able to participate in every intervention done. He will be able to correctly adopt practicing pursed lip and diaphragmatic breathing every day. Chronic hypoxemia may result in cognitive changes such as memory changes  To make sure that the tube is intact and continuously flowing EVALUATION  Goal is fully met if the patient will attain the optimal gas exchange by being able to breathe normally without any signs of respiratory distress.INTERVENTION Dx:  Monitor vital signs  Tachypnea . He will be able to verbalize willingness / interest to gradually decrease the number of cigarettes per day. Tachychardia and Dyspnea may indicate Pnuemothorax for  Crackles indicate pulmonary congestion.

and facilitating lung expansion and ideally improve gas exchange  Even simple activities such as bathing can cause fatigue and increase oxygen consumption  Kinking. or interfere with the patient’s movement Edx:  Explain the need to restrict and pace activities  Teach the patient appropriate breathing techniques  To facilitate adequate air exchange and secretion clearance  Goal not met if no improvement or willingness occurred. and therefore may actually improve oxygenation  Aids in keeping airway patent. preventing atelectasis. loop. looping. He will be able to correctly practice pursed lip breathing and diaphragmatic breathing but not daily.Tx:  Keep the patient in an upright/semi-fowler’s position  Semi-fowler’s position allows for a better much of ventilation and perfusion. He will be able to verbalize willingness to minimize cigarette smoking but with a little doubt.  Assist in performing the correct technique for BDE and pursed lip breathing  Pace activities and schedule rest periods to prevent fatigue  Ensure that the drainage tubing does not kink. or pressure on the drainage tubing can produce backpressure. His condition will stay the same. He will do pursed lip and . which may force fluid back into the pleural space or impede its drainage  To decrease consumption oxygen  Goal is partially met if the patient will be able to breathe normally but with a little respiratory difficulties.

characterized as pricking. PR=80 bpm and RR=16 cycles per minute facial grimacing noted guarding behavior observed no teeth clenching noted narrowed focus accompanied with reduced interaction with people .” pointing to incision site at the right chest.  Encourage patient the use of oral substitutes for smoking like sugarless gum P: S: O:         Acute pain r/t tissue trauma secondary to CTT insertion “Masakit dito.8 degrees Celsius. radiating to the entire right chest up to the right hypochondriac region pain is exacerbated when changing bed positions and performing gross movements no diaphoresis noted elevated BP of 160/80 mmHg and normal T=35. He will not participate from any nursing intervention done. Limit visitors indicated as  Reduces likelihood of exposure to other infectious pathogens  Smoking causes permanent damage to the lung and diminishes the lungs’ protective mechanisms  Oral gratification reduces the urge to smoke  Educate regarding hazards of smoking diaphragmatic breathing incorrectly or will totally not adopt the exercise taught. pain rated as 7/10 (1 as the lowest and 10 as the highest).

Monitoring vital signs and noting for changes serves as baseline data for evaluating effectiveness of interventions. He is able to report a noticeable decrease in the severity of pain. throbbing and persistent pain. This is the pain that is continuously perceived by the patient. This tissue trauma is sensed by the neurons which transmits pain signals passing through the spinal cord to the brain. After 3 days of nursing interventions. the C-fibers are activated after the A-delta fibers which transmits a vague. 2. The A-delta fibers are responsible for immediate yet short-lived pain perceived as pricking at the site of injury. Explanation of the Problem Incision during the CTT insertion creates a break in the skin tissue of the chest wall. Perform deep breathing exercises without assistance. The feedback consists of reflexive involuntary muscle contractions perceived as pain. On the other hand. Injury activates two kinds of nociceptors namely the A-delta fibers and the C-fibers. INTERVENTIONS RATIONALE CRITERIA EVALUATION FOR EVALUATION *Dx > Monitor v/s and note for * Increase in temperature may changes indicate progress of infection. Neurons transmit the impulses to the brain and the brain in response. Rate pain as less than 6/10. generates a feedback to the site of injury. 4. After 1 day of nursing interventions. the client will report a significant decrease (2 pts or more) in the severity of pain. not conversant LTO: STO: 1. the patient will: Adhere strictly to pharmacologic regimen. Any abnormal changes implies Goal fully met if the client reports a significant decrease in the severity of pain. He will take all the drugs prescribed by . Other feedbacks may also manifest in the form of increased temperature and diaphoresis. Obtain adequate rest and sleep. 3.

He obtains adequate rest and sleep. this may serve as a sympathetic stimulus that may increase the body’s vital functions such as an increase in PR and RR. * Proper assessment of pain will help to determine proper interventions to perform to address the problem the physician. If the client rates the pain as 5 or less >Observed non-verbal cues * Observation may/ may not be congruent with verbal reports indicating needs for further evaluation for possible >Assess insertion site for *This indicate swelling. When client perceives pain. He is able to perform DBE correctly without assistance. > Assess PQRST of pain *Presence of known/unknown complication may make the pain more severe. bleeding and infection dislocation of the tube *Tx> Provide measures >Place in a comfort *This will help in nonpharmacological pain Goal is partially met if the management like relaxation client takes some of the drugs prescribed by the physician. If semi-fowler’s *A semi-fowler’s position the client needs assistance in .abnormality and problem.

> Periodically position the patient (flat position) * Flat position may relieve the pressure exerted in the abdominal area. If the client is not able to rest at all.position permits residual air in the pleural space rise to upper portion of pleural space and be removed via the upper chest catheter. If the client rates the pain as 6. If the client refuses to perform DBE with/without the nurse’s assistance. If the client still rates the pain as 7 out of 10 > Encourage verbalization * Verbalization of feelings will of feelings about pain help validates the objective data gathered and to know the proper intervention to address the problem > Encourage the client to take * Rest allows the body time to . > Administer analgesics as prescribed * Medication orders will ensure that the client receives the adequate doses of medicine for more effective pain management. *Ed >Encourage activities divertional *Helps the patient divert his attention thus reduce tension Goal not met if no decrease in the severity of pain is and relaxation promotion reported. performing DBE. If the client refuses to take all the drugs prescribed by the physician. If the client is able to obtain rest for a while.

adequate rest period heal itself and prevent the increase in the severity of the condition > Teach client to perform Deep *Deep breathing provides good Breathing Exercises. . oxygenation to the body making it more relaxed.

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