Introduction Anasarca is an accumulation of serous fluid in various tissues and cavities of the body.

It is different form edema in which it is defined as accumulation of fluid in the intercellular space of subcutaneous tissue or in body cavities. Here also is the difference between anasarca and edema --- Anasarca is different from slight swelling or edema that occurs mostly in the feet. In anasarca, the person looks like bloating and when the person is pinched, the skin will not go back to its normal condition right away. Anasarca refers to a diffuse generalized edema of multiple organ systems due to effusion of fluid into the extracellular space. Anasarca is very common in patients with kidney failure and heart failure because there is a loss of protein in the urine and the kidney cannot function well as a result water and other toxins are retained in the body while with heart failure there is a poor cardiac function so there is lesser blood volume that is pumped by the heart to be delivered in the other parts of the body. As a result, the kidney will be alarmed that there is a decreased blood volume in the body. To compensate for that problem, the kidney will retain salt and water thus, edema happens. Usually anasarca indicates severe illness and may often be seen in the serious condition. It is usually caused by cirrhosis of the liver or renal failure and increases over a short period of time. (http://symptomscausestreatment.com, 4 Feb 2012, Web.) Here are some symptoms of anasarca: vomiting, cramps, shortness of breath, weakness in body, swelling of the ankle and feet, anemia, unable to sleep at night, stretched out skin, burnished skin, loss of appetite, changes in blood pressure and insomnia. There are also some precautions to be followed in person who is suffering from anasarca and these are avoid chocolates, alcohol drink, exercise regularly, avoid water pills and salt, eat high fiber diet, take protein food like egg, broiled white fish, cottage cheese which can help to reduce edema but some of this precautions may be disregard by the attending physician. Patient who is suffering from anasarca may have an underlying cause of hypoproteinemia. This condition refers to a disorder characterized by a decrease in the amount of protein in the blood to an abnormally low level accompanied by edema, nausea, vomiting, diarrhea, and abdominal pain. It may be caused by an inadequate dietary supply of protein, by intestinal lymphangiectasia, or by renal failure. One common cause of hypoproteinemia is the kidney failure where in damaged kidneys start leaking proteins into the urine, causing proteinuria. This happens because of the plasma protein that causes the fluid to be pulled back into the capillary's from the tissue spaces. This is also called the capillary colloidal osmotic pressure or the pressure needed to pull back the fluid back into the vascular space. So plasma proteins act as regulators in keeping the capillary pressure in harmony. When there is a decrease in plasma proteins, this pressure is decreased and fluid starts to build up in the tissue spaces. Plasma proteins are derived from the liver. The liver cannot synthesize these plasma proteins without certain amino acids which can only be achieved by dietary intake. With malabsorbtion, there is insufficient intake of these amino acids and it results in Edema.

There is also a relation between anasarca and pleural effusion. First, pleural effusion is an abnormal collection of fluid in the pleural space resulting from excess fluid production or decreased absorption. Too much fluid impairs the ability of the lung to expand and move. According to some article, pleural effusion is an indicator of an underlying disease process that may be rule out as pulmonary or non-pulmonary in origin and may be acute or chronic. Since a pleural effusion is a manifestation of another illness, the risk factors are those of the underlying disease. It is nice to know that pleural effusions are usually seen in adults and less commonly in children. There are possible symptoms that can be seen in patient who have pleural effusion and these are shortness of breath which is the most common symptom of a pleural effusion. It happens when the effusion grows larger with more fluid, the harder it is for the lung to expand and the more difficult it is for the patient to breathe, Chest pain occurs because the pleural lining of the lung is irritated. According to study, the pain is usually described as pleuritic which define as a sharp pain, worsening with a deep breath. As the pleural effusion increases in size, the pain may increase. These two symptoms are the primarily seen in patient with pleural effusion. Objectives

a) General Objectives: During the course of the study, the patient and specific others shall have acquired knowledge on the risk factors that have contributed to anasarca, severe anemia, hypoproteinemia and peural effusion with its signs and symptoms and its therapeutic management. To gain understanding and show compliance on the treatment and management rendered by the health care team to and to be aware for its several effects that can potentially happen over again.

b) Specific Objectives: • To make a trusting, cooperative and supporting relationship between the nurse researchers and the other members of the health care team to become united. To gain knowledge on the definition of anasarca, severe anemia, hypoproteinemia and peural effusion, its signs and symptoms, underlying causes, how it affect each disease and its relation to one another and lastly, medical and nursing care management. To give and received the best possible medical and nursing care that can help the individual to have a feeling of security, comfort and good development of the condition.

04. 2013 B. hypoproteinemia. HEALTH HISTORY A. C. Patient A added also that she is not comfortable when she feels any pain.According to the patient. Albay Marital (Civil) Status: Single Nationality: Filipino Religion: Roman Catholic Address and Telephone Number: Brgy. (+) difficulty of breathing • . staff nurses and the family is also a source for information. pleural efusión R&L lung S/P preterm delivery Jan. Alima Bacoor. I. FPOGS Final Diagnosis: Anasarca secondary to severe anemia. Rizalina C. Patient’s chart. The patient’s father. Upon asking the severity of pain she is experiencing she answered 4 with a pain scale of 1-3 – mild | 4-6 – moderate | 7-10 – severe.• • To demonstrate and promote compliance on each treatment and management. July 15. 1991. she felt pain on her chest every time she breath. Private Clinic Admission Date: 01/26/2013 Time Admitted: 8:50 pm Attending Physician: Dr. Source and Reliability of Information • • • The patient itself seems reliable. Cula who seems also reliable. Demographic (Biographical) Data • • • • • • • • • • • • • • Client’s Name or Initial: Patient A Gender (Sex) : Female Age. Birthdate and Birthplace: 21 years old. Reason for Seeking Care • (+) chest pain . To demonstrate independence or self-care and home management upon discharge. Bunyi OB-GYNE. Cavite Educational Background: College Graduate Occupation: Travel Agent Usual Source of Medical Care: Baranggay Health Center. Mr.

Past Medical History The patient had an episode of asthma attack during her childhood years. And the last hospitalization was only this year January 04. Patient doesn’t look that she has a hard time coping with the lost of her supposed to be first baby. Afterwards. a 21 years old single woman was been admitted at St. The first attack was experienced when she was 6 years old. patient doesn’t remember any other injuries that she acquired.• Patient experience difficulty in breathing in which it aids to increase the pain in her chest. 2013 patient went to a preterm delivery and unfortunately it is still birth. According to her. due to preterm delivery. Dominic Medical Center last January 26. And as of now. And according to her. Patient also had cough for only 3 days which is productive. Patient A added that when she was 18 years old was been hospitalized because of urinary tract infection. 04. According to the patient. History of Present Illness Patient A. January 4. the mild injury that she would never forget was when she fell down in her own bike during her 6th year of age. E. The patient verbalized “lalo akong nahihirapan huminga kasi may nararamdaman akong sakit sa dibdib ko”. Few days PTA. . She remembers that last asthma attack that she experienced when she was already 15 years old. Patient doesn’t acquire any accidents when she was a child up to the present but she got only mild injuries when she was a child like scratch from falling at stair. Patient A also suffered from having a chicken pox at age of 10. According to her. Patient added that she was been confined only for 3 days. 2013. 2 weeks PTA. she doesn’t take any medication instead she increases her fluid intake. she always had cough and colds during that time. And according to patient A. she first notices her edema on her both feet until it ascends to her upper extremeties. There is no evidence of postpartum depression symptoms that is visible to the patient. she was been hospitalized because of her asthma but as the time goes by and she gets older she notices that she doesn’t experienced it anymore. 2013 with chief complaints of chest pain. patient had difficulty of breathing and chest pain hence consults in St. patient noted edematous legs ascending to the trunk and upper extremities ascending to face. - D. At first she experienced fever accompanied by headache and after 2 days she noticed a red spots on her skin. In addition.The patient is experiencing edema since Jan. difficulty in breathing and generalized edema. (+) generalized edema . she consulted a general physician and it was been confirmed that she has chicken pox. it was her first baby and expecting to be delivered alive. 2013. that was the first time she was admitted to a hospital and that was when she was 6 years old. And according to her. Dominic Medical Center leading to subsequent admission.

she always experience a skip of one month in her LMP. Immunization: BCG: // at birth / / school entrance DPT: // 1st dose // 2nd dose // 3rd dose OPV: // 1st dose // 2nd dose // 3rd dose TT: // 1st dose / / 2nd dose / / 3rd dose / / 4th dose / / 5th dose Hepa B vaccine: // 1st dose // 2nd dose // 3rd dose Allergies:  Foods (chicken) F. Patient stated that she is not using any family planning method. Patient’s brother doesn’t have any family yet and stays with them. On her father side. She usually consumed 3 soaked pads during day time and 1 soaked adult pampers at night. According to the patient. there is a history of heart illnesses in which her grandfather died from stroke. His father has 2 siblings and he was the youngest. He doesn’t acquire any inherited illness from her father and mother’s inherited health conditions. According to her. LEGEND: . T0P0A1L0. she doesn’t remember any alleviated health conditions on the side of his father. her grandmother died from hypertension.Patient A menarche at age of 11. Her mother’s side has a history of hypertension. Each period usually last for 3 – 5 days and the blood flow is normal. In fact. After 1 year of menarche patient experience dysmenorrhea. Family History • • • The patient is the young among sibling. Next to her is a 23 year old male who is healthy according to patient’s point of view. Patient’s LMP (last menstrual period) July 08. 2013. irritable and sometimes she experience blackout. Patient’s usual cycle of menstruation is irregular. OB SCORE: G1P0. Patient’s mother is the young among her 2 siblings.

Socio-Economic 21 y/o Diagnosis: Anasarca secondary to severe anemia.Male Female Patient Deceased Died from stroke Hypertensive Alive & Well Heart attack Alive & Well Alive & Well Alive & Well Alive & Well Alive & Well Alive & Well 5 years old Menopause baby Alive and Well 23 y/o Alive & Well G.000 • The patient worked at travel agency located at Quirino wherein she works for 7 months. . hypopreteinemia. 04. 2013 FAMILY MEMBER Patient itself OCCUPATION SOURCE OF INCOME Travel agent MONTHLY INCOME Php 8. leural efusión s/p preterm delivery Jan.

But she added that if there is an occasion she can attend to that without no limitations even though if it is a night party. Even if they already have their own families their still have physical and emotional connection. Isolation (Young Adulthood. Patient has a tight relationship with her family and she is making a point that she will value what she had now. the one who will love her strength and weakness and will never leave her during the ups and downs of her life. support. Patient is well committed to her life now. She is still bonded with them even they have now their own families and priorities in life. Patient rent a bed space near her work place in which she spends her 5 days there and return to Cavite after her work. Developmental History • Erick Erickson’s Psychosocial Development Theory . She is very contented and feels secured with her family but still finding someone who can be her partner in life. Patient A doesn’t smoke and drinks alcohol. But still in this stage. Cavite wherein they lived for almost 10 years since they left their province. They have enough resources to support their daily needs and expenses. Review of Systems . Patient is also building a God-centered and trusting relationship to her family that can help them to increase their faith which can aid them out in times of trouble. I. She expresses her unconditional love to her family and a wholehearted care. They continue to develop and boost there feelings of friendship to one another. 20-35 years old) The patient starts family at an early age with no other issues except being pregnant in an early age but unfortunately she was been left by her partner after knowing that she is pregnant. H. Even though patient experienced failure in her relationship. comfort and trust to each other.Stage: Intimacy vs. love.• • • • They owned a house located at Bacoor. Patient still communicates with her friends from grade school up to college. patient continuously develop herself in expressing emotions to each family members. She added that she is not fun of going out to a night party or clubbing with her friends. she still focuses her feelings and emotions to her family.

sniff with each nostrils and a thoracic breather. cerumen is yellow in color. There are no signs of deformities. Patient doesn’t expose to any environmental noise. Upper and lower eyelids were able to meet together and close easily. It is held upright and still in midline of the spinal column. The scalp is clean and dry without visible dandruff. According to the patient. No birthmark was found on the patient’s skin. It is 20/20 vision which signifies a normal distant visual acuity and can read prints at 12 inches without any difficulty.System  General  Integumentary  Head  Eyes  Ears  Nose & Sinuses 1. Dry skin is noted upon assessment. Patient’s nostrils are not deformed and have both equal in size and shape. There is 160 degree angle between the nail base and the skin. no mass was been palpated and no evidence of head injury seen in patient’s head upon assessment. As of this time. Upon further assessment. Auricle’s skin is smooth without any presence of lesions. There is no lesion visible. No changes of vision manifested by the patient. soft and moist with no evidences of any other discharge like pus. BP: 140/90 mmHg PR: 95 bpm RR: 20 cpm T: 36. firm and elastic. No obstruction seen during observation . Regional Examination – January 29. Patient doesn’t use eyeglasses but she sometimes put contact lenses on her eyes for accessory purpose only. Pupils are easily reacted to light upon examination. Patient can breathe normally. Its color is same with the complexion on the patient’s face.5oC (afebrile) Wt: 75 kg (165 lbs) Nails are cleaned. Ears are line parallel to one another. down. Black is the natural hair color of the patient and hair strands are equally distributed with smooth in texture. smooth and firm with slightly curve. left. Skin is intact with no redness noted. There is no discoloration noted on the patient’s external nose. It is hard and basically immobile. The eye movement is smooth and symmetric throughout the 6 directions from up. oblique left and oblique right. Skin surface is cool to touch. flat. No hair loss is noted. It is moist with no presence of inflammation and abnormal discharge was been noted upon observation. There is visible edematous noted all over the patient’s face. lumps or nodules. It is even and rough to touch with stretch marks and healed scars but without lesions seen. Ear lobes are attached to the skin. Nasal structure is smooth and symmetric without any tenderness felt upon palpation. When skin pinches it doesn’t returns immediately to its original position and doesn’t rebound easily when pressure is released. patient doesn’t experience headache or any disturbances in her head. The patient’s head is symmetric and round. The ears are bilaterally equal in size and both auricles are also same in size with no deformities observed and aligned in the corner of each eye. there was no presence of swelling and redness on patient’s both eye. And there is no evidence that patient has problem with her sense or hearing. right. 2013 Actual Findings The current weight of the patient is 75 kg (165 lbs) and stands 5’ tall. Nail plate is firmly attached to nailbed with capillary refill less than 3 seconds. Based on the BMI categories she is said to be obese . Eyes are located in a proper placed and in line with each other. Face is symmetric and round.

In fact. Patient’s favorite fruits are banana. According to her. Patient is very lenient in following doctor’s prescription and order. she doesn’t eat any foods that are bad for her health. She was very conscious about her health in fact. She also has knowledge about her families medical problem in each side (mother and father).J. According to the patient before this condition happen she can perform her duties well in the family and outside the house like going to work. According to patient A. Patient is aware with the current trends of medicine and the medication she is currently taking and its function in her body. The common food intake of the patient is fruits and vegetables but when it comes to pork and beef she only eats that occasionally and patient has an allergy to poultry products most especially chicken. she loves to eat different kinds of fresh fruits and vegetables and can really manage her life style choice that cannot affect her health status. • Nutritional and Metabolic Pattern Patient A regularly eats meal 3 times a day with 2 snacks (occasionally). In fact. Kaya nagtataka ako kung bakit ganito yung kalusugan ko”. Dominic Medical Center. Functional Assessment • Health Perception and Health Management Patient is not happy with his current health because she feels something wrongs. she eats whenever she is hungry. Bihira lang ako bumili ng lutong ulam o kumain sa fast foods. The patient doesn’t have any problems with regards on financing her health care because she her mother was the one who is supporting her hospital needs. Patient doesn’t have any idea how she got that illness. Patient doesn’t have any activities that will improve her health only eating fruits and vegetables in substitute with rice but patient added that she usually exercise every morning for 60 minutes. she loves fruits and vegetables. She doesn’t follow any diet that she knows but she maintains her normal weight. Patient A has knowledge about links between lifestyle choice and health. she verbalized “Masusustansyang pagkain nga ang aking kinakain at ako pa mismo ang nagluluto. She takes multivitamins daily as life time supplements prescribe by her doctor. mango and . Patient doesn’t take actions by herself to alleviate her health instead she decided to consult at St.

firm and elastic. There are no skins problems observed and noted during physical examination. Patient weight and height is not proportional to one another. Body temperature is normal (36. She also added that she doesn’t have any hemorrhoids. “Hindi ako nahihirapang dumumi. Patient doesn’t have any problem with regards to defecation. Patient urinates normally without any hesitance and pain during urination but there is a problem on her urine out. Water is the only beverages taken last 24hr. Saglit lang ako sa banyo kapag dumumi hindi katulad ng iba na madami pang seremonya ang gingawa”. clean and the nailplate is firmly attached to the nailbed. • Elimination Pattern Patient A has a regular bowel and bladder movement. According to BMI categories. Nails are firm. Patient verbalized. She doesn’t see any crystals or blood in her urine. No diseases are present in patient’s digestive and urinary system. Patient skin is dry and clammy without any implication of dehydration. smooth to touch. It is still intact with presence of massive edema. Patient doesn’t eat rice but during morning she does. “Sa umaga ako kumakahin ng rice para may lakas ako sa buong araw. Basta kapag nakaramdam ako ng tawag ng kalikasan pumupunta na kaagad ako sa banyo maghihintay ng saglit at lalabas na. Patient stated. Patient drinks water more than 8 glasses a day. According to the patient upon palpation. patient is said to be obese. It is functioning well base on the assessment. According to her. she is not into soda but pineapple juice is her choice with regards to beverages. she doesn’t palpated any palpable mass in her anus and its surrounding areas. it is insufficient to compensate her daily fluid intake. . The hair is not dry. Patient is on diet as tolerated ordered by her doctor. The patient skin condition is dry and rough with no rash and redness is seen but it is cool to touch.grapes. Heavy breakfast lagi ang hinahanda ko kasi mas healthy iyon”. one at early morning and the other before bedtime. There are no disturbances and changes noted by the patient itself.5oC). She added that she only urinates 3 times a day and its characteristic is light yellow in color. According to her. she defecates twice a day. She can live in a day without eating rice.

they eat breakfast. watch movies and anything else that will boost their bond with each other. According to her. There are some changes felt by the patient during the time the illness arises. they all go to church to hear God’s message. And in fact. Patient feels that her body is too bloated because of massive edema. After Sunday service. She is also frustrated with her body and she really wants to become sexy like Anne Curtis. almost every day she tries to perform morning exercise for about 60 minutes of combine running and walking. She thinks that her body is too big for her height. Patient is thankful to God because she has this asset with no deformities and hindrances that can affect her life. • Activities Tolerance – Exercise Pattern The patient usually performs morning exercise at their compound. buy some stuff for each other. They spend all the time of Saturdays together.s image that can affect her capabilities. The patient doesn’t have any regrets with her appearance and she is happy and enjoying it.• Self-perception and Self-concept Pattern The patient perceives herself as an individual created by GOD with his own image and likeness. Patient’s description about her physical appearance is medium in height but not proportion in weight. Patient spends most of her time during Saturdays and Sundays with her family. Patient verbalized “Mataba na nga ako tapos buong katawan ko pa manas kaya hindi na ako komportable sa itsura ko”. But patient pushes her dedication to compensate her bad thoughts by merely getting adequate exercise and thinking how to become healthy and fit. lunch and dinner together. Patient A added that sometimes she feels not good with herself because she is chubby. According to patient A. “Kahit ano pa ang itsura ko hinding-hindi ako magsusubok magparetoke kahit naniniwala ako na lahat ng nilika ng Diyos ay magaganda”. patient with her family will eat lunch . those people who always replica herself and get envy will never succeed because every one is unique. During Sundays. She is comfortable and contented for whatever she had in her body from head down to foot. She repeated that she is happy and contented for what God has given her. Patient verbalized. she has the capacity to do and performs whatever she wants to do. Their no noticeable problem with patient. They would go to mall. There are some negative feelings were been felt by the patient with her appearance but still she is satisfied with that. During Saturdays.

Patient regularly took a bath and sometimes she bathe 3 times a day most the days during summer season. Most of the time upon waking. Siguro dahil ito sa nararamdaman ko”. if she has a time to sleep in the afternoon or anytime during the day. During the time that the patient was been hospitalized.together in their own house. she shared that she is not comfortable staying in the hospital that’s why every time she woke up in the morning she looks lethargic. Patient is very hygienic and making a point that every time she went to toilet she has her own tissue or wipes. she maximized it to sleep so that at least half of her energy will restore. And during day time. Patient added that if ever her off in work falls on weekdays she stills try make things and activities that will bond their family more. The sleep-wake up cycle of the patient is waking early in the morning to for morning exercise and usually sleeps early at night. As far as now. • Cognitive – Perception Pattern . “Maaga akong nakakatulog at maayos naman din akong gumising kaya lang nanlalambot ako pag-gigising ko. According to patient A. • Sleep – Rest Pattern The patient pattern of sleep is somewhat good because can be able to sleep whatever time she wants. patient is satisfied in her sleep and she looks well relaxed and rested. She always utilized all of her time with her family. Patient A can perform her task well without any problem in her body and perceived ability for full self care. And she added that there are no environmental factors that trigger the patient’s pattern of sleep. she spends a lot of time to her job but sometimes if there is no client and no pending paper works she tries to take a nap for a while so that she gain back some of her energy. patient seems that she doesn’t suffer from any sleeping disorder. Upon assessment. patient is well groomed. Patient A verbalized. Patient doesn’t have any factors that distract her sleeping pattern.

Base on the ways the patient answers the questions. Patient’s both palms can grasp and hold things for a period of time without any presence of shaking or tingling. She can also see things clearly even if it is 12 inches far from her and can differentiate one object to another. Patient still has a father and mother who are doing all the roles. She only has one sibling. As she can tolerate the pain she wouldn’t take any medicine except if it is prescribe by her doctor. Patient can hears words clearly and can answer question correctly during the interview. Patient A is very aware when it comes to touch. She can differentiate sounds and repeat sentences that was been whispered softly in her ears. According to patient. During the interview. She can also tell the difference between each scent. Next to her is a 23 year old male who is healthy according to patient’s point of view.According to the patient. Patient identifies pain as a tolerable feeling because according to her she had a wide pain threshold. she doesn’t have any new significant roles in her life but she added that before she had a preterm delivery she is expecting for a big changes of role in her life and this is to become a good . There is no possible problem in patient sensory of smell because she can identify immediately the difference with each other. It is also not numb because patient can feel the pain when I gently pinch her palms. But according to patient A. sometimes if the object is too big she has a hard time to hold it because of swelling in her both hands. sour. Currently. She can easily feels something like if you dump the cotton slowly and softly on her skin. patient can express her feelings and thoughts clearly and logically. fruit and etc. Patient A can distinguish different kinds of taste (sweet. when it comes to vision and other sensory organ it is functioning well without any procedure done since she was been born and doesn’t experience any problem with her sensory modes. • Role – Relationship Pattern The patient is the young in the family. Patient’s vision is 20/20 and categories as normal. patient doesn’t have any problem in regards to sense of taste. she pain is suffering from mild pain due to her condition. She was very sensitive to it. Patient is a college graduate She seems that she doesn’t have any problem with his mental and sensory function. salty and bitter) from one another without any doubled thoughts. Upon assessment. Patient can smell different scent of perfumes. she can be automatically judge of acquiring a highly educated person. She can differentiate hot. According to her. she can read writings even though it is written in font 12. warm and cold from the other.

God and family centered. Manners are well taught according to her because patient believes that if you have good manners it simply signifies that your parents mold you in a very nice manner. Even though her mother was the one who gives everything still patient wants to help. spiritual beliefs is one of her guide in life most especially when it comes to lifestyle choice and decision making. She is an intelligent. “Naniniwala ako sa kakayanan ng ating Panginoon na siya ang gagabay sa aming pamilya. bright and down to earth person. She is friendly and nice person and in fact. At higit sa lahat alam ko na hindi kami pababayaan ng Panginoon dahil malakas ang pananampalataya naming sa kanya”. she still performing my role as a good daughter to my parents and sibling. Patient doesn’t have any regret or bad feeling with my role and in fact. Patient A was also helping their family in financing their daily need. tight. Her perspective to health is already modern in which only doctor with the guidance of God is the one can cure and everything that happens in our life is God’s perfect choice and plan for our family. According to the patient. K.mother but unfortunately it doesn’t happen because the outcome was still birth. because she knows that they don’t have the capabilities to cure disease. They both expressing their love from one another and continuously gaining enough affection from them. she is satisfy and enjoying her role in the family. Personal / Social History Patient is the youngest in the family. liar. The patient doesn’t put any trust on what we called “Albularyo” when it comes to health. Being the youngest and the girl in the family she was assigned in many task in household chores. social climber and . Patient doesn’t have any significant relationship at this moment instead she focuses on her own relationship with her family. during her elementary up to college days she had plenty of real friends but according to her she only consider 4 best friends of hers. Now. back fighter. The patient doesn’t want people who are stabber. • Values – Belief Pattern The patient had learned the values and beliefs that were been introduce to her by her mother were all important during her childhood years and until now she is conveying it. Patient verbalized. The patient’s relationship to her family is very close. Most of the values that the patient learned from her parents are still present and she used to act upon it.

According to her. Drainage is well maintained and clean without any bad odor. OB SCORE: G1P0. The place has security that roams around especially at midnight care of the baranggay counsel. She usually consumed 3 soaked pads during day time and 1 soaked adult pampers at night. She also doesn’t want a person who always talks about nonsense topic instead she wants interesting and knowledgeable subject. The streets are cleaned and maintained by the street kipper and only some homeowners who still really do burning of trash. M. Laboratory Studies and Diagnostics HEMATOLOGY . Patient usually works out every morning and she is having fun every time she performs it. Patient also loves to eat in a buffet which only cost not that much. All of the bad vibes were lessen if she does it including listening to radio and playing music. T0P0A1L0. 2013. She spends some of her money buying stuff for their house and for herself. Patient loves and like going to different destination but there was a hindrance with her finances. OB-GYNE History Patient A menarche at age of 11. Patient’s usual cycle of menstruation is irregular. Each period usually last for 3 – 5 days and the blood flow is normal. Patient stated that she is not using any family planning method. Environmental History Patient is currently residing at Bacoor. Patient added that there are lots of trees in there area and it looks refreshing. According to the patient. There is no sports was been played by the patient. she always experience a skip of one month in her LMP. irritable and sometimes she experience blackout. her place was peaceful and safe but sometimes it is noisy because of some occasions like birthdays. L. II. Cavite. According to patient A. The patient usually prefers to have a healthy life style but still she is trying to achieve it most especially in performing exercise. After 1 year of menarche patient experience dysmenorrhea. wedding reception. She doesn’t feel anything about how much money she spends for a one day in buying some stuff. Their own house was been surrounded by plenty of neighbors. There are streetlights and warning device posted in some accident prone areas. whenever she was stress she was into singing and cooking. fiestas and etc but most of the time it is a quiet place. She doesn’t have fan of any sports but she loves watching movies with her friends while eating pop corn and have some pep talk as well.boastful. and family. Patient’s LMP (last menstrual period) July 08.

40-0.01-0.25 5-15 10^g/L 10^g/L  Neutrophile Eosiphile Basophile Lymphocyte Monocyte Reticulocyte Platelet Count Blood Typing Bleeding Time Clotting Time MVC MCH MCHC MPV 0.60 Mins Mins fL PG g/L f/l I.00 0.01 0.00-0.50 %  Decreased impaired erythropoeisis.Examination Hemoglobin Results 106 Reference 125-160 Value g/L  Significance Decrease in adequate tissue oxygenation Hematocrit 0. Decreased numbers are seen in disorders involving in impaired erythropoeisis excessive blood cell destruction (ex: hemolytic anemia) and blood loss and in chronic inflammatory diseases.06 0.5 150-350 2-4 7-15 86-100 26-31 310-370 9.02-0.08 0.5-5.00 386 5-10 0. Malignancies) 75 24. Viral.13 % % % % % 10^4/L  Increase Infection ( Bacterial.00 0.40 0. RBC Unit WBC Unit 4. Pathophysiology .9 331 9.38-0.54 0.20-0.38 0.32 0.25 4.08 4.60 0.

within the blood vessels (blood) or lymphatic vessels (lymph or lymphatic fluid). Fluid is pushed away from an area of high hydrostatic pressure but is pulled into an area of high osmotic pressure. Hydrostatic pressure is the force that pushes fluid from an area of high pressure to low pressure. This fluid is not just water but there are also cells. This allows for the exchange of nutrients. Fluid within the tissue spaces also have a hydrostatic force but this is usually smaller than the pressure within the vessels so very little fluid flow from the tissues spaces into the vessel due to hydrostatic pressure. Concept Mapping . This is due to the pumping heart that pushes the blood with force within the vessels. Blood does not just ooze out of the vessels unless the vessel wall becomes permeable and allows it to exit. gases and wastes. Usually fluid from the tissue spaces enters the blood vessel due to a difference in osmotic pressure. Therefore the blood vessels which have a higher hydrostatic and a higher osmotic pressure will push out some fluid into the tissue spaces and draw other fluids from the tissue spaces. Osmotic pressure is the force that draws fluid from an area of low electrolyte concentration to one of a higher electrolyte concentration. within the tissue space between cells (interstitial fluid). The lymphatic system also plays an essential part here as the interstitial fluid is pulled from the tissue spaces into the lymphatic vessels which then empties into the blood vessels. Fluids within our blood vessels are at a higher pressure than the fluid in the tissue spaces. II.Fluid in the body exists within cells (intracellular fluid). Two forces are responsible for maintaining the fluid in specific areas or ‘pulling’ and ‘pushing’ fluid into other areas. These forces are known as hydrostatic pressure and osmotic pressure. nutrients. electrolytes and waste products existing with water in these areas.

5 0C Key Problem #3 High risk damage to skin integrity related to circulatory and neurologic changes III.Key Problem #1 Ineffective breathing pattern related to decrease lung expansion (accumulation of air and liquid) Key Problem #2 Ineffective tissue perfusion related to vasoconstriction of blood volume Key Demographic Data: Clients initial: Patient A Age: 21 y/o Gender: Female Assessment of Patient: Chest pain. Massive edema Key Assessments: BP: 140/ 90 mmHg RR: 20 cpm PR: 95 bpm Temp: 36. Problem List Key Problem #4 Fluid volume excess related to water retention secondary to decreased renal perfusion and cardiac output . Shortness of breathing.

Ineffective tissue perfusion related to vasoconstriction of blood volume 3. Patient blood pressure decreased from 140/90 to 120/80 after a 4 hour nursing intervention. High risk damage to skin integrity related to circulatory and neurologic changes Patient maintain and improve ambulation with performs normal daily activities. Ineffective breathing pattern related to decrease lung expansion (accumulation of air and liquid) Patient will indicate normal and effective breathing pattern within her normal range. 5. 4. 2. Fluid volume excess related to water retention secondary to decreased renal perfusion and cardiac output Patient demonstrates stabilized fluid volume with balanced intake and output. .ACTUAL or active Problem No. evidenced of reduced fatigue and weakness. Problem Remarks 1. Activity intolerance related to imbalance between oxygen supply and demand Patient achieved measurable increase in activity tolerance.

noting rapid or shallow respirations. the patient participated in treatment regimen. Evaluation GOAL MET. IV is intact and on oxygen therapy. 1L to run for 8 hours. Dependent: • Administer supplemental oxygen as ordered by the physician. • Observe skin and mucous membranes for signs of cyanosis. respiratory rate and effort and the use of accessory muscles. Promote a calm and restful environment. In addition. • Encourage adequate rest and limit activities within client’s level of tolerance. • Evaluate respiratory function. dyspnea and changes in vital signs. Within 4 hour of nursing care. • Assess lung sounds.IV. Ineffective breathing pattern related to decrease lung expansion (accumulation of air and liquid) Assessment S: “Nahihirapan pa din akong huminga kahit na may nakalagay na oxygen sa ilong ko pero kumpara ngayon mas medyo nakakahinga ako ng maayos kesa dati na walang oxygen” as verbalized by the patient. • Monitor vital signs. Intervention Independent: • Identify etiology or precipitating factors. the patient will establish a normal and effective breathing pattern within her normal range. At mas maayos na din ang aking paghinga”. Conscious and coherent Ambulatory Cool to touch (+) dry lips and skin (+) skin pallor (+) massive edema grade: ++++ (+) facial grimace (+) guarding behaviour BP: 140/ 90 PR: 95 bpm RR: 20 cpm Temp: 36. the patient stated “ Maginhawa na ang pakiramdam ko ngayon hindi katulad nung nakaraan araw. Nursing Care Plan a.5 0C Diagnosis Ineffective breathing pattern related to decrease lung expansion (accumulation of air and liquid) Planning After 4 hour of nursing interventions. Vital signs are within normal range. . O: Received patient lying on bed with on going D5LR.

Administer with food to prevent Mechanism Of Action Ferrous sulfate facilitates O2 transport via haemoglobin. Contraindicated in clients with hemolytic anemia.• Administer medications as prescribed by the physician. It is used as iron source as it replaces iron found in Side Effect Adverse Reaction • GI irritation • abdominal pain • cramps • nausea and vomiting • constipation . Medical – Surgical Management a. Pharmacotherapeutic b. GN (BN) Classification Stock Ferrous Sulfate (Iberet Active) Classification: Iron preparation Indication (Client Specific) Dosage & Frequency Indication: Prevention and treatment for iron deficiency anemia and dietary supplement for iron. 2. Nursing Responsibilities includes Health Teaching and Implications 1. peptic ulcer and ulcerative colitis. V.

achieved 6–9 h postural following oral doses. Prevention: 200 mg daily. therapeutic flushing effectiveness. or at the time of dosage increase. Report Abdominal pain. Monitor adverse reaction. bradycardia. Monitor BP for Palpitations. diuretics are added. 2. 20-30% absorption in those with inadequate iron stores.Dosage & Frequency: Adult: Treatment: 400600 mg daily in divided doses. postural hypotension. Excessive lowering of blood pressure during initiation of amlodipine treatment can occur. reduction is greatest peripheral or facial after peak levels of edema. sloughing of the intestinal mucosa and menstruation. blocking calcium transport relaxes artery muscles and dilates coronary arteries and other arteries of the body. sweat. myoglobin and other enzymes. constipation. Monitor for S&S of dose-related CNS: peripheral or facial Light-headedness. 6-12 yr: >22 kg: 200 mg daily. In rare CV: 1. vomiting. By relaxing coronary arteries. These medications block the transport of calcium into the smooth muscle cells lining the coronary arteries and other arteries of the body. Excretion: Via urine. 4. This phenomenon usually occurs when first starting amlodipine. antihypertensives or flatulence. frequently when dyspepsia. Absorption: Duodenum and upper jejunum: 10% absorption after oral admin in persons with normal serum iron stores. especially in patients already taking another blood pressure lowering medication. 3. diarrhea. syncope. Monitor more constipation. amlodipine are chest pain. anorexia. amlodipine can increase the frequency and severity of angina or actually cause a heart attack on rare occasions. Child: Treatment: <6 yr or <22 kg: Not recommended. headache. epigastric pain and refer to attending nurse upon occurrence for management. Onset: Oral: 3-10 days. hypotension. Monitor BP with postural GI: changes. BP tachycardia. nausea. edema fatigue. 4. Since calcium is important in muscle contraction. Inform clients of side effects like nausea and vomiting. additional dysphagia. amlodipine is useful in preventing chest pain (angina) resulting from coronary artery • diarrhea • dark stool • discoloration of urine heartburn GI upset. 3. diarrhea. >44 kg: 200 mg bid >66 kg: 200 mg tid hemoglobin. Urogenital: . Amlodipine (Norvasc) Classification: • Cardiovascular agent • Calcium channel blocker • Antihypertensive agent Indication: In patients with severe coronary artery disease.

nocturia.5 mg. other:Arthralgia. Dosage & Frequency: Hypertension Adult: PO 5–10 mg once daily Geriatric: start with 2. and feel confused. . Relaxing the muscles lining the arteries of the rest of the body lowers the blood pressure. .Urinate very little or not at all.Gain weight for no known reason . which reduces the burden on the heart as it pumps blood to the body. frequency. Reducing heart burden lessens the heart muscle's demand for oxygen.Urinate more than usual.5 mg.  Instruct the patient to: . Respiratory: Dyspnea. Discharge Health Teaching  Advice patient to return upon occurrence of symptoms listed below: . cramps.Lips and nail beds are very white or blue. . I. Sexual dysfunction.Fever . . Skin: Flushing.New or increased swelling in your legs or feet. usually in patients already on a beta blocker. .Heart feels like it skips a beat or flutters. sweating.Limit your liquids as directed: Follow your primary healthcare provider or pulmonologist's directions about how much liquid . . adjust dose at intervals of not less than 2 wk Renal Impairment Start with 2. and further helps to prevent angina in patients with coronary artery disease. congestive heart failure has been associated with amlodipine.instances. myalgia. adjust dose at intervals of not less than 2 wk spasm. rash.Breathing very fast.Chest pain or trouble breathing that is getting worse.

Ask if you need to eat low-salt or low-fat foods. A CASE STUDY ABOUT “Anasarca secondary to severe anemia. low-fat dairy products. I gave her health teaching and advices with regards to her condition. whole-grain breads. hypoproteinemia. You may have trouble breathing when you are lying down. 2013” . and fish. the need for rest and delay of another pregnancy until the client fully recovers. Healthy foods may decrease your symptoms and help you have more energy.Eat a variety of healthy foods: Healthy foods include fruits. She was diagnosed with Anasarca secondary to severe anemia. As a student nurse. 2013 . you should drink each day. I. 04. vegetables. Too much liquid can increase your risk for fluid buildup. 2012 with a chief complaint of chest pain. The patient was suffering from different illnesses with accompanying signs and symptoms of possible other diseases. pleural efusión R&L lung S/P preterm delivery Jan. lean meats. hypoproteinemia. Offer anticipatory guidance relative to expected recovery. On-going Appraisal The patient was admitted last January 26. The device should not bend your body at the upper back or neck. On the same day. she was been on observation for further assessment and diagnosis. This may help you breathe easier while you are resting or sleeping. I told her to use of and assist with non pharmacological approaches to pain management relaxation and breathing exercise. Use foam wedges or elevate the head of your bed. pleural efusión R&L lung S/P preterm delivery Jan. The physician ordered to insert D5LR 1L with normal gtts/min and prescribed drugs to help her condition becomes better with the help of oxygen therapy. . . shortness of breath and massive edema. or bend your body at the waist. beans. and do more each day. Use a device that will tilt your whole body. 04.Rest as needed: Return to activities slowly. Promoting comfort and emotional support for the client is one of my primary objectives to relieve or reduce patient’s problem.

PRESENTED TO THE SCHOOL OF HEALTH SCIENCE PROFESSION In Partial Fulfillment of the Requirement for Related Learning Experience Second Semester AY 2012 – 2013 Submitted By: Alyxzza U. Group 2A Submitted to: Mr. Paul John Carvajal RN Clinical Instructor 13 February 2013 . Gandia BSN 2A.

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