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Table of Contents

I. Introduction
A. Background of the study
B. Rationale for Choosing the Case
C. Significance of the Study
D. Scope and Limitation
II. Clinical Summary
A. General Data
B. Chief Complaint
C. Nursing History
a. History of Present Illness
b. Past Medical History
c. Familial History
d. Social History
D. Physical Assessment
F. Laboratory and Diagnostic Exams
G. Impression/Diagnosis
III. Clinical Discussion of Disease
A. Anatomy and Physiology
B. Pathophysiology
C. Drug Studies
IV. Nursing Process
A. Problem List
B. Nursing Care Plan
C. Long Term Objective
D. Discharge Planning

A. Background of the Study
This is a case of a 30 y/o, G1P0 who came in due to left back pain. Present
complaint started 1 day PTA when Px experienced left back pain radiating to the
lumbosacral area and difficulty of breathing usually after coughing. Persistent coughing
and back pain, Px was advised and was admitted in our institution.
B. Rationale for Choosing the Case
The case was studied for the following reasons:
1. to know the anatomy and physiology of the lungs
2. to know the pathophysiology of pulmonary edema
3. to know the appropriate nursing intervention in handling Px with pulmonary
4. to know the appropriate medical management in caring for patient with
pulmonary edema
C. Significance of the Study
This study will be able to help students, specially nursing students to know
everything about pulmonary edema, thus being able to render proper nursing care and
intervention to patients with pulmonary edema. This, if implemented, will make it easier
for patients to restore their health. This study may also help student nurses to be more
effective nurses.
D. Scope and Limitation
This study only engage in the following topics:
1. anatomy and physiology of the lungs
2. pulmonary edema

A. General Data
Name: Rosario S. Banaag
Address: B11 116 PH2 Kawal, Dagat-dagatan, Caloocan City
Date of Birth: 12/18/1976
Age: 29 y/o
Sex: Female
Civil Status: Single
Nationality: Filipino
B. Chief Complaint
Difficulty of breathing
C. Nursing History
a. History of Present Illness
Admitting a case of a 30 y/o, G1P0 who came in due to left back pain.
Present complaint started 1 day PTA when Px experienced left back pain radiating to the
lumbosacral area and difficulty of breathing usually after coughing. Nebulization with
Salbutamol was done affording temporary relief. Persistence prompted consult at
Puericulture where she was advised to consult at a tertiary hospital. 16 hours PTA,
persistence of left back pain associated with DOB prompted consult at Jose Reyes
Memorial Medical Foundation where CBC, UA, UTS and x-ray was requested. She was
advised admission however went on HAMA. Persistence forced consult at our institution
and was subsequently admitted.
b. Past Medical History
(+) suicide attempt – 1990, drug intoxication with anti-TB, confined at
(+) allergy to food – chicken
(-) allergies to drugs
(+) HPN, Dx: Oct. 2006, on Aldomet 250 mg TID, HBP: 160/100

HBP: 160/100

UBP: 120/90

(+) asthma, Dx 1 week ago at Puericulture, on Ventolin 2 mg tablet q 60
no DM, no PTB
c. Familial History
(+) HPN, both parents

(+) asthma - father

(+) DM – mother

(+) heart problem – mother

(-) cancer
d. Social History
♣ HS graduate
♣ presently unemployed
♣ living – in for 1 year to 30 y/o computer engineer, Palestinian, whom
she met 2 years ago at Dubai
♣ non-smoker, non-alcoholic beverage drinker
♣ menarche – 14 y/o with regular monthly interval lasting 3-4 days
consuming 2-3 pads/day

D. Physical Assessment
Date of Assessment: 11-22-06
Vital Signs:

Temp.: 36.60C

RR: 28 bpm

PR: 120 beats/min

BP: 150/100

General Survey: Px is conscious, coherent, tachycardia, tachypnea
Parts to be Assessed

Technique Used
palpation, inspection
inspection, palpation

Deviation from Normal
(+) crackles, R midlung


(+) edema on both LE

E. Patterns of Functioning
♣ Activity/Rest
Ability to engage to necessary activities of life, but is having difficulty
having adequate sleep.
♣ Circulation
Inability to transport oxygen necessary to meet cellular needs.
♣ Elimination
Ability to excrete waste products.
♣ Food / Fluid
Ability to maintain intake and utilize nutrients and liquids to meet
physiologic needs.
♣ Hygiene
Ability to perform daily hygienic activities.
♣ Neurosensory
Impaired perception, integration, and respond to internal and external
♣ Pain / Discomfort
Inability to control internal / external environment to maintain comfort.
♣ Respiration
Inability to provide and use oxygen to meet physiologic needs.
♣ Safety
Ability to provide a safe growth-promoting environment.
♣ Sexuality
Ability to meet requirements and characteristics of female role.
♣ Social Interaction
Ability to establish and maintain relationship among others.
F. Laboratory and Diagnostic Examination
Date: 11-21-06


Normal Values


38-0.0% 3. Impression Cardiomegaly with pulmonary edema noted bilaterally. Interstitial infiltrates are likewise Both hemidiaphragms & sulci are obscured.58 mmol/L 0.519 mmol/L 0.4% Normal Values 60-70 g/L 23-35 g/L 60-70 secs 100% Interpretation Date: 11-24-06 Components hemoglobin erythrocytes Results 1.5 g/L 35.47 mmol/L Interpretation Date: 11-23-06 Radiological Report There is a prominence of the pulmonary vascularity.0 secs 81.Monocytes Eosinophils Platelet 4.5% 522 x 109 L 1.00 mmHg 35-45 mmHg respiratory alkalosis HCO3 12.0% 150-450 x 109 L Components Results Normal Values pO2 85 mmHg 80-100 mmHg mild hypoxemia pCO2 21. There is haziness in both mod & lower lungfields.33 mmol/L Normal Values 1.8% 1. Heart appear markedly enlarged.0 g/L 22. . G.86-2.70 mmol/L 22-26 mmol/L metabolic acidosis results: mild hypoxemia with respiratory alkalosis and metabolic acidosis Date: 11-22-06 Components total protein globumin PTT PT Results 58.

The airways that bring air into the lungs (the trachea and bronchi) are made of smooth muscle and cartilage. Anatomy and Physiology The lungs are paired cone-shaped organs in the thoracic cavity. As a result. They are made of spongy. should trauma cause one lung to collapse.CLINICAL DISCUSSION OF DISEASE A. elastic tissue that stretches and constricts as you breathe. the other may remain expanded. They are separated from each other by the heart and other structures in the mediastinum which separates the thoracic cavity into two anatomically distinct chambers. Our lungs are located within our chest cavity inside the rib cage. allowing the airways to .

The lungs and airways bring in fresh. pulmonary blood vessels. the base. oxygen-enriched air and get rid of waste carbon dioxide made by your cells. which contains a small amount of lubricating fluid secreted by the membranes. allowing them to slide easily over one another during breathing. collectively called the pleural membrane. The apex of the lungs lies superior to the medial third of the clavicle and is the only area that can be palpated.constrict and expand. a phenomenon called surface tension. They also help in regulating the concentration of hydrogen ion (pH) in our blood. in which the heart lies. The narrow superior portion of the lung is the apex. excess fluid accumulates in the pleural space known as pleural effusion. Due to the space occupied by the heart. the costal surface. the visceral pleura. Separate pleural cavities surround the left and right lungs. may in its early stages cause pain due to friction between the parietal and visceral layers of the pleura. Inflammation of the pleural membrane. The base of the lungs extends from . the deep layer. is concave and fits over the convex area of the diaphragm. If the inflammation persists. the left lung also contains a concavity. The mediastinal (medial) surface of each lung contains a region. Pleural fluid also causes the two membranes to adhere to one another. nerves enter and exit. The broad inferior portion of the lung. lateral. enclose and protect each lung. accommodating the liver that lies inferior to it. and posterior surfaces of the lungs lie against the ribs. it is also somewhat shorter than the left lung because the diaphragm is higher on the right side. Although the right lung is thicker and broader. This fluid reduces friction between the membranes. the pleural cavity. the hilus. The superficial layer lines the wall of the thoracic cavity and is called the parietal pleura. called pleurisy or pleuritis. the left lung is about 10% smaller than the right lung. These structures are held together by the pleura and connective tissue and constitute the root of the lung. Two layers of serous membrane. Between the visceral and parietal pleurae is a small space. covers the lungs themselves. The anterior. the cardiac notch. The lungs almost fill the thorax. matches the rounded curvature of the ribs. lymphatic vessels. Medially. through which bronchi. The lungs extend from the diaphragm to just slightly superior to the clavicles and lie against the ribs anteriorly and posteriorly. The surface of the lung lying against the ribs.

Terminal bronchioles subdivide into microscopic branches called respiratory broncdhioles. and inferior (lobar) secondary bronchi. thus forming a middle lobe. middle. The segment of the lung tissue that each tertiary that each tertiary bronchus supplies is called a bronchopulmonary segment. whereas the inferior part of the oblique fissure separates the inferior lobe from the middle lobe. The pleura extends about 5 cm below the base from the sixth costal cartilage anteriorly to the twelfth rib posteriorly. The oblique fissure in the left lung separates the superior lobe from the inferior lobe. Removal of excessive fluid in the pleural cavity can be accomplished without injuring lung tissue by inserting the needle posteriorly through the seventh intercostal space. Lobes. Thus. the epithelial lining changes from simple cuboidal to simple squamous. and Lobules One or two fissure divide each lung into lobes. Fissures. the secondary bronchi give rise to the tertiary (segmental) bronchi. a procedure termed thoracentesis. each of which is wrapped in elastic connective tissue and contains a lymphatic vessel. Each bronchopulmonary segment of the lungs has many small compartments called lobules. the right lung also has a horizontal fissure. a venule. the lungs do not completely fill the pleural cavity in this area. an arteriole.the sixth costal cartilage arteriorly to the spinous process of the tenth thoracic vertebra posteriorly. The horizontal fissure of the right lung subdivides the superior lobe. and a branch froma terminal bronchiole. which are constant in both origin and distribution – there are ten tertiary bronchi in each lung. As the respiratory bronchioles penetrate more deeply into lungs. Respiratory . the right primary bronchus gives rise to three secondary bronchi called the superior. Both lungs have an oblique fissure. which extends inferiorly or anteriorly. Bronchial and pulmonary disorders that are localized in a bronchopulmonary segment may be surgically removed without seriously disrupting the surrounding lung tissue. whereas the left primary bronchus gives rise to superior and inferior (lobar) secondary bronchi. Each lobe receives its own secondary bronchus. the superior part of the oblique fissure separates the superior lobe from the inferior lobe. In the right lung. Within the substance of the lung. Thus.

The thin type I alveolar cells are the main sites of gas exchange. Surfactant lowers the surface tension of alveolar fluid. The respiratory passages from the trachea to the alveolar ducts contain about 25 orders of branching. a complex mixture of phospholipids and lipoproteins. wandering phagocytes that remove fine dust particles and other debris in the alveolar spaces. which are rounded or cuboidal epithelial cells whose free surface between the cells and the air moist. On the outer surface of the alveoli. also called septal cells. Type I alveolar cells. branching – from the trachea into primary bronchi (first order braching) into secondary bronchi (second order branching) and so on down to the alveolar ducts – occurs about 25 times. which reduces the tendency of alveoli to collapse. subdivide into several alveolar ducts. The walls of the alveoli consist of two types of alveolar epithelial cells. An alveolus is a cup-shaped outpouching lined by simple squamous epithelium and supported by a thin elastic basement membrane. that is. an epithelial basement membrane underlying the alveolar wall . The exchange of O2 and CO2 between the air spaces in the lungs and the blood takes place by diffusion across the alveolar and capillary walls. are simple squamous epithelial cells that form a nearly continuous lining of the alveolar wall. Associated with the alveolar walls are alveolar macrophages (dust cells). Extending from the alveolar air space to blood plasma. are fewer in number and are found between type I alveolar cells. Alveoli Around the circumference of the alveolar ducts are numerous alveoli and alveolar sacs. an alveolar sac consists of two or more alveoli that share a common opening.bronchioles. the predominant cells. the lobule’s arteriole and venule disperse into a network of blood capillaries that consist of a single layer of endothelial cells and basement membrane. the respiratory membrane consists of four layers: 1. Underlying the type I alveolar cells is an elastic basement membrane. Included in the alveolar fluid is surfactant. Type II alveolar cells. which together form the respiratory membrane. Type II alveolar cells. Also present are fibroblasts that produce reticular and elastic fibers. a layer of type I and type II alveolar cells and associated alveolar macrophages that constitutes the alveolar wall 2. in turn.

a capillary basement membrane that is often fused to the epithelial basement membrane 4. it has been estimated that the lungs contain 300 million alveoli.5 µm thick. however. deliver oxygenated blood to the lungs. Deoxygenated blood passes through the pulmonary trunk. Connection exist between branches of the bronchial arteries and branches of the pulmonary arteries. and returns to the heart via the superior vena cava. Blood Supply to the Lungs The lungs receive blood via sets of arteries. the respiratory membrane is very thin – only 0. however.3. providing an immense surface area of 70 m2 – about the size of a handball court – for the exchange of gases. This blood mainly perfuses the walls of the bronchi and bronchioles. This phenomenon is known as ventilationperfusion coupling because the perfusion (blood flow) to each area of the lungs matches the extent of ventilation (airflow) to alveoli in that area. Moreover. A unique feature of pulmonary blood vessels is their constriction in response to localized hypoxia (low O2 level). drains into bronchial veins. which drain into the left atrium. Some blood. Breathing Pattern . vasoconstriction in response to hypoxia diverts pulmonary blood from poorly ventilated areas to well-ventilated regions of the lungs. branches of the azygos system. hypoxia causes dilation of blood vessels. which branch from the aorta. about one-sixteenth the diameter of a red blood cell. Bronchial arteries. however. the endothelial cells of the capillary Despite having several layers. Return of the oxygenated blood to the heart occurs by way of the four pulmonary veins. This thinnes allows rapid diffusion of gases. In all other body tissues. which divides into a left pulmonary artery that enters the left lung and a right pulmonary arter that enters the right lung. pulmonary arteries and bronchial arteries. which serves to increase blood flow to a tissue that is not receiving adequate O2. In the lungs. and most blood returns to the heart via pulmonary veins.

This expansion lowers the pressure in the chest cavity below the outside air pressure. the purpose of breathing is to keep the oxygen concentration high and the carbon dioxide concentration low in the alveoli so this gas exchange can occur! B. the diaphragm and intercostal muscles relax and the chest cavity gets smaller. The concentration of carbon dioxide is high in the pulmonary capillary. At the beginning of the pulmonary capillary. The carbon dioxide then leaves the alveolus when you exhale and the oxygen-enriched blood returns to the heart. the hemoglobin in the red blood cells has carbon dioxide bound to it and very little oxygen. Pathophysiology of Pulmonary Edema Pulmonary edema is excess water in the lung. The cycle then repeats with each breath. Air then flows in through the airways (from high pressure to low pressure) and inflates the lungs. surfactant lining the alveoli repels water. helping fluid from entering the alveoli. capillary oncotic pressure. The normal lung contains very little water. Thus. This exchange of gases occurs rapidly (fractions of a second). As we breathe air in through our nose or mouth. Air from the lungs (high pressure) then flows out of the airways to the outside air (low pressure). so carbon dioxide leaves the blood and passes across the alveolar membrane into the air sac. The oxygen binds to hemoglobin and the carbon dioxide is released. the oxygen concentration is high.When we inhale. From the bronchi. In addition. it goes past the epiglottis and into the trachea. air passes into each lung. so oxygen passes or diffuses across the alveolar membrane into the pulmonary capillary. Within each air sac. It continues down the trachea through your vocal cords in the larynx until it reaches the bronchi. The decrease in volume of the cavity increases the pressure in the chest cavity above the outside air pressure. It is kept dry by lymphatic drainage & a balance among capillary hydrostatic pressure. & capillary permeability. . When you exhale. the diaphragm and intercostal muscles (those are the muscles between your ribs) contract and expand the chest cavity. Carbon dioxide is also released from sodium bicarbonate dissolved in the blood of the pulmonary capillary. The air then follows narrower and narrower bronchioles until it reaches the alveoli.

overdoing of activities .(+) asthma history – intoxication of anti-TB .(+) heart problem respiratory and cardiac distress disrupted lung architecture .Modifiable Non-modifiable lifestyle – crowded environment genetics – (+) HPN .

suctioning. if not treated fibrosis medical treatment development of complications healing .increased permeability increased force of LV contraction increased LV O2 demand LV hypoxia decreased forc of LV contraction increased LV preload pulmonary edema flooded alveoli increased pulmonary vascular resistance compliance (stiff lungs) RV failure hypoxemia increased RV preload if treated oxygenation.

involvement of all system recovery compromiseimmune system shock death .

> monitor increasing Na inhibitors or loop hyperkalemia electrolyte level. and H2O diuretics excretion I & O. absorption aldosterone in hyperaldosteronism acute or > protect drug the distal >heart failure as progressive renal from light tubules. Drug Study Classification Action drugs for fluid potassium- and electrolyte sparing diuretic. balance antagonizes Available Form tablets – 25 mg Indication Contraindication Adverse Effects Nursing > edema >hypersensitivity Consideration > give drug with .C. & BP > inform the laboratory that the Px is taking the drug because it may interfere with tests that measure digoxin level > maximum .100 mg > diuretic-induced > Px with anuria.50 mg > hypertension to the drug meal to enhance . adjunt to ACE insufficiency.

antihypertensive respone may be delayed for up to 2 weeks > watch for hyperchloremic metabolic acidosis > instruct Px to take drug in morning to prevent need to urinate at night > warn Px to avoid excessive ingestion of potassium-rich foods to avoid hyperkalemia > caution Px to avoid .

Ducene. Diazepam Intensol.performing hazardous activities if adverse CNS rxns occur DIAZEPAM Antenex. Vinol . Diastat. DMS-Diazepam. Apo-Diazepam. Valium. Novo-Dipam. Diazemuls.

5 mg > in pregnant paradoxical > dilute oral . or amnesia. hypotension. headache.5 mg intoxication insomnia.20 mg > children minor changes in giving younger than age EEG patterns > monitor 6 mos.Classification anxiolytics CNS drugs Action unknown Available Form Indication Contraindication Adverse Effects Nursing capsule – 15 mg > anxiety > Px > CNS – Considerations > use diastat injection – 5 > pre-op hypersensitive to drowsiness. more than one rectal gel – acute alcohol ataxia. receiving blurred vision. concentrate sol. specially anxiety. . fatigue. & collapse. days . – 5mg/5ml . rectal gel to treat mg/ml ssedation drug or soy dysarthria. repeated or oral sol. episode every 5 2. no more than 5 > cardioversion protein slurred speech. coma. CV renal. > CV – periodic hepatic. transient month & no shock.15 mg first trimester hallucinations.5mg/ml tablets – 2 mg . episodes per > Px experiencing tremor.10 mg .10 mg women. hematopoeitic bradycardia fxn studies in Px EENT – diplopia.5 mg . just before .

therapy constipation. > warn Px to diarrhea with avoid activities rectal form that require GU – alertness & good incontinence. coordination urine retention > tell Px to avoid HEPATIC – alcohol while jaundice taking drug RESP. withdrawal phlebitis at symptoms may injection site occur > warn woman . apnea decrease drug’s SKIN – rash effectiveness OTHER – altered > warn Px not to llibido. physical abruptly stop or psychological drug because dependence. – > notify Px that respiratory smoking may depression.nystagmus prolonged GI – nausea. pain.

to avoid use during pregnancy AMIKACIN SULFATE Amikin Classification Action Available Form Indication Contraindication Adverse Effect Nursing Considerations .

azotemia.aminoglycoside inhibits protein synthesis by injection – 50 mg/ml > serious > Px > CNS – > obtain infections caused hypersensitive to neuromuscular specimen for blockade C&S before binding directly . during therapy if Klebsiella. > GU – hearing before & bactericidal coli. or nephrotoxicity. E.arthralgia first dose avium complex > RESP.SKELETAL studies before >mycobacterium . he will be Staphylococcus possible increase receiving drug > uncomplicated in urinary longer than 2 UTI caused by excretion of weeks organism not casts > weight Px & susceptible to >MUSCULO review renal fxn less toxic drugs . Proteus.5 mg/ml in strains of > EENT – giving first dose Pseudomonas ototoxicity > evaluate Px’s subunit. aeuroginosa.250 mg/ml by sensitive to the 30S . – apnea > correct ribosomal NSS drug dehydration before therapy > monitor renal fxn > watch for s/s .

Capoten. Nursing Considerations > monitor Px’s . Novo-Captopril Classification antihypertensive Action inhibits ACE. Available Form tablets – Indication > hypertension Contraindication Adverse Effects > Px > CNS – dizziness.of superinfection > if no response occurs after 3-5 days. stop therapy & obtain new specimens for C&S > instruct Px to promptly report adverse rxn > encourage Px to maintain adequate fluid intake CAPTOPRIL Acenorm. Enzace.

dysgeusia. hypotension. q 2 weeks for secretion.5mg > left hypersensitive to fainting.100 mg . dry vascular dse decrease mouth. > monitor WBC less angiotensin angina pectoris & differential II decrease > GI – abdominal counts in Px with peripheral pain. angioedema vasoconstrictor.25 mg ventricular angiotensin I to . > instruct Px to thrombocytopenia take drug 1 hour >METABOLIC – ac taking hyperkalemia > inform Px that conversion of . therapy. anorexia. thereafter anemia. periodically pancytopenia.50 mg dysfunction angiotensin II. vomiting Tx. frequently fever > assess Px for > CV – signs of potent tachycardia. which >HEMATOLOGIC the first 3 mos of reduces Na & – leucopenia. a . fatigue. fxn or collagen resistance. headache. impaired renal arterial constipation.cardiovascular system drug preventing 12. BP & PR the drug malaise. before starting aldosterone nausea. diarrhea. & H2O agranulocytosis.

or difficulty breathing . dry. or mouth. lips. – light-headedness dyspnea. is possible persistent. pruritus. notify prescriber alopecia if pregnancy > OTHER – occurs angioedema > urge Px to promptly report swelling of the face. > tell Px to use nonreproductive caution in hot cough H2O & during > SKIN – rash. exercise maculopapular > advise Px to rash.> RESP.

Nu-Cephalex Classification Action Available Form Indication Contraindication Adverse Effects cephalosporins first generation (hydrochloride) > respiratory > in Px anti-infective cephalosporin tablets – 500mg tract. Biocef. Novo-Lexin. Keflex.CEPHALEXIN (hydrochloride) Keftab (monohydrate) Apu-Cephalex. fatigue. hypersensitive to Nursing > CNS – dizziness. GIT. post rxns to . skin. Considerations > ask Px about headache.

500 mg infections & hallucinations therapy before promoting oral susp. nausea. pseudomembrane- > ontain instability. > monitor Px for dyspepsia. vomiting.netropenia. or penicillin synthesis. . therapy is anal pruritus. – otitis media > GI – giving first dose osmotic 125mg/5ml caused by E. oral > treat group A candidiasis beta-hemolytic > GU – genital streptococcus pruritus. cell-wall capsules-250mg the drug agitation.that inhibits (monohydrate) soft tissue. specimen for anorexia. C&S before .500mg diarrhea. prescribed even . prolonged tenesmus. minimum of 10 vaginitis.250 mg/5ml coli ous colitis. gastritis. superinfection if abdominal pain. . & joint confusion. days interstitial nephritis > tell Px to take usually bactericidal tablets – 250mg >HEMATOLOGIC drug exactly as . infections for a candidiasis. cephalosporins bone. giving first dose -1g glossitis.

serum sickness. better thrombocytopenia > instruct Px to >MUSCULO – take drug with SKELETAL – foodor milk arthritis.eosinophilia. develop irticaria > OTHER – hypersensitivity rxns. anaphylaxis . after feeling anemia. asthralgia. > tell Px to notify joint pain prescriber if rash > SKIN – or s/s of maculopapular & superinfection erythematus rashes.

nephrofer. feostat. novofumas. black constipation component in the formation of 100 mg/5 ml tablets – 63mg . ircon. peptic diarrhea.6 ml > as a hemochromatosis epigastric pains doses are an essential oral susp. 0. hemocyte. vitron – C Classification hematinics Action Available Form Indication Contraindication Adverse Effects Nursing provides drops – 45mg / > iron deficiency > Px with primary > GI – nausea. palafer. preferable during hemolytic constipation. > check for pregnancy anemia. Considerations > between meal elemental iron. palafer pediatric drops. vomiting. – supplement or hemosiderus.FERROUS FUMARATE Femiron.

hemoglobin . anorexia.324 mg regional enteritis. > tell Px to take .325 mg or ulcerative temporarily or water but not . stools. > OTHER – tablets with juice .350 mg colitis stained teeth with milk or > Px receiving from suspension antacids repeated blood & drops > tell Px to take tablets – 100mg transfusion suspension with straw & place drops at back of throat > caution Px not to crush talets > advice Px not to substitute 1 iron salt for another .200 mg ulcer dse.

fatigue. > arrange for Nonsteroidal inhibits anti- prostaglandin’s inflammatory synthesis.500 mg . drug with milk moderate pain inflammation of dizziness. > pregnancy insomnia. or food to possesses anti- the GIT somnolence.MEFENAMIC ACID Ponstan. decrease Gi inflammatory. upset antipyretic. Ponstel Classification Action Available Contraindication Adverse Effects Nursing > short term > ulceration > CNS – Considerations > tell Px to take relief of mild to > chronic headache. analgesic Form capsule -250mg Indication . & > children under tinnitus.

eosinophilia. only the flatulence prescribed > RESP. GI long term pain. > tell Px to take constipation. prescriber if platelet inhibition adverse rxn with higher doses. – dosage dyspnea. occur neutropenia. therapy vomiting. examination for dyspepsia.bleeding. . occur rhinitis > instruct Px to > d/c drug & HEMATOLOGIC consult . drowsiness or pharyngitis. dizziness can brocnhospasm. diarrhea. > inform Px that hemoptysis.analgesic effects 14 y/o ophthalmologic periodic > hypersensitivity effects opthalmogic to the drug > GI – nausea.

leukopenia. dry mucous membrane. renal impairment > SKIN –rash. menorrhagia > GU – dysuria. enaphylactoid rxns to fatal . bone marrow depression. stomatitis > OTHER – peripheral edema. sweating. granulocytopenia. thrombocytopenia. decreased Hcb or Hct. pruritus. agranulocytis. aplastic anemia. pancytopenia.

Lanoxicaps. activated .0. cardiac fibrillation. or headache.2 mg > Px with digitalis weakness.0. Considerations > before giving – potassium – 0. about use of ventricular hallucinations. glycosides Inotropics Inhibits sodium Cardiovascular system drugs triphosphate. Digoxin.05 mg > tachycardia hypersensitivity generalized loading dose. agitation.05 mg/ml injection – . promoting movement of elixir – 0. Lanoxin Classification Action Available Form Indication Contraindication Adverse Effects Nursing capsule – > heart failure > Px with > CNS – fatigue.1 mg to the drug muscle obtain baseline adenosine . data and ask Px induced toxicity.anaphylactic shock DIGOXIN Digitex.

0. take diplopia apical-radial > GI – anorexia. within the extracellular to . pulse for a nausea. > before giving photophobia.125 mg > CV – usually divided myocardial . dose given in the bulrred vision. drug.0. weeks heart failure paresthesia > loading dose is cytoplasm and tablets – strengthening 0.0.calcium from 0.25 mg/ml unless caused by vertigo. first dose light flashes.1 mg/ml tachycardia dizziness.05mg/ml ventricular malaise. > monitor diarrhea potassium level contraction carefully . previous 2-3 intracellular .25mg arrythmias over the first 24 > EENT – hours with yellow-green approximately halos around half the loading visual images. stupor. minute vomiting.

and Available Form Indication Contraindication Adverse Effects Nursing > Px Considerations > CNS – fatigue. > Monitor BP degree heart heart failure.200 mg greater than 1st hypotension. > always check 1 mg/ml in 5- hypersensitive to dizziness.METOPROLOL TARTRATE Apo-Metoprolol. Apo-Metoprolol Type L. Nu-Metop Classification Action antihypertensive decreases cardiovascular cardiac output. Lopresor SR. Minax. AV frequently . Novo-Metoprolol. bradycardia. Px’s apical pulse ml ampules the drug depression > monitor > Px with sinus > CV – glucose level injection – tablets – 50mg > hypertension cardiac oxygen .100 mg bradycardia. Betaloc Durules. system drug peripheral resistance. Betaloc. closely consumption . Lopresor.

– > tell Px to take it dyspnea with meals > SKIN – rash > caution Px to avoid driving if taking the drug > tell Px to alert prescriber if shortness of breatn occurs . block > store drug at cardiogenic > GI – nausea. or overt vomiting temperature cardiac failure > RESP. room shock.block.


parenteral and emotional nervousness.NALBUPHINE HYDROCHLORIDE Nubain Classification Action Available Form Contraindication Adverse Effects > moderate to > Px > CNS – Considerations > reassess Px severe pain hypersensitive to headache. circulatory & crying. . least 15 & 30 altering dizziness. mins. level of pain at the drug sedation.l respiratory status opiod analgesics binds with injection- central nervous opiate receptors 10 mg/ml system drug in the CNS. after perception of vertigo. administration response to pain depression.20 mg/ml Indication Nursing . > monitor restlessness.

dry mouth > GI – cramps. walking hallucinations. > caution Px hostility. dyspepsia. bradycardia > EENT – blurred vision. delusions > CV – hypertension. tachycardia. about getting out confusion. bitter taste. hypotension. speech disturbance. nausea. of bed or unusual dreams. constipation .euphoria. vomiting.

urticaria.> GU – urinary urgency > RESP. pulmonary edema > SKIN – pruritus. asthma. burning. – respiratory depression. clamminess. dyspnea. diaphoresis .

Problem Nursing Scientific Objective Nursing Rationale Evaluation Rationale disrupted lung At the end of the Intervention INDEPENDENT architecture nursing shift.: verbalized by the interstitium breathing optimal alveolar > normal rate. helps loosen breath sounds compliance hypoxemia client At the end of the . as evidencedof difficulty of Diagnosis Ineffective breathing breathing pattern Subjective Cues: r/t lung “medyo compliance as a nahihirapan nga result of akong huminga. as pulmonary difficulty which promotes the ff. accumulation of lalo na pag fluid in the nauubo ako”. the Px will be able to semi to high allow increased Px was able to experience fowler position if diaphragmatic experience adequate not excursion & adequate respiratory fxn. contraindicated maximum lung respiratory fxn. the > place Px in a > this position nursing shift. expansion. ventilation rhythm & depth > instruct & > frequent of respiration Objective Cues: assist Px to repositioning > improved > (+) crackles change position.

> abnormal chest Coughing or x-ray result huffing mobilizes secretions & facilitates removal of these secretions from the respiratory tract > implement > a Px with pain measures to often guards reduce pain – respiratory . deep breathe.>rapid. shallow. & secretions & > (-) crackles irregular cough or “huff” promotes a more > blood gases respiration every 1-2 hours effective cough. within normal > use of It also promotes ranges accessory maximum lung > Px verbalizes muscles when expansion & relief from coughing stimulates difficulty of > abnormal surfactant breathing blood gases production.

splint incision efforts – pain with pillow reduction during coughing enables the client & deep breathing to breathe more deeply which enhances alveolar veltilation & O2/CO2 DEPENDENT exchange > implement > excessive measures to secretions and facilitate inability to clear removal of secretions from pulmonary the respiratory secretions – tract lead to suction – as stasis of orderes secretions > maintain O2 > supplemental therapy as O2 increases the ordered concentration of .

oxygen in the alveoli. which increases the diffusion of O2 across the alveolar – capillary membrane > administer > medication meds that may therapy is an be ordered to integral part of improve Px’s treating many respiratory status respiratory condition .


kasi sabi ng doctor may dizziness Objective Nursing At the end of the Interventions INDEPENDENT nursing shift. the > encourage > verbalization nursing shift. pattern kaya pakiramdam ko feeling of tuloy parang ang anxiety sama-sma ng Rationale Evaluation At the end of the . response to & understanding respond to call requests provide of the medical signal as soon as a sense of procedures high blood daw ako. the Px will be able to verbalization of of feelings & Px will be able to experience a feelings & concerns helps experience a reduction of fear concerns client identify reduction of fear factors that are as evidenced by causing anxiety the ff: > assure Px that > close contact > verbalization staff members & a prompt of decreased fear are nearby.Problem Nursing fear Diagnosis Fear r/t Subjective Cues: persistent “natatakot nga headache Scientific Rationale pre-eclampsia altered BP ako eh. eh lagi pa disturbed sleep kong nahihilo.

fear possible security & Hindi pa ko facilitates the makatulog ng development of maayos trust. disease uncertainty condition.pakiramdam ko. treatment plan & prognosis > implement > improvement measures to of respiratory reduce distress status helps relieve anxiety . thus kakaisip”. as reducing the verbalized by the client’s anxiety client > reinforce > factual Objective Cues: physician’s information & an > disturbed sleep explanations & awareness of pattern clarify what to expect > weak misconceptions help decrease the appearance the Px has about anxiety that the diagnostic arises from tests.

associated with the feeling of not being able to breathe DEPENDENT > administer > helps reduce prescribed the Px”s anxiety antianxiety agents if indicated .

heart dse.Problem Nursing potential Diagnosis potential complications of complications of heart failure heart failure r/t Subjective Cues: acute pulmonary “Hindi kaya edema d/t matuloy to sa accumulation of puso. as heart distress complications Px Objective Cues: complications of heart failure Evaluation Interventions INDEPENDENT pulmonary verbalized by the Rationale At the end of the position evidenced by the DEPENDENT ff. the Px will measures to reduce shift. the Px was be able to have improve cardiac pulmonary able to have mild mild to moderate output vascular to moderate congetion prognosis from > to improve pulmonary lung expansion edema as prognosis from > place Px in a kaming sakit sa further lung & edema to prevent high fowler puso”. kasi meron fluid in the lungs Scientific Rationale Hx of hypertension. pulmonary edema Objective Nursing At the end of the whole nursing > implement > in order to whole nursing shift.” > maintain O2 > to improve O2 >(-) crackles therapy intake > normal result .

diuretics accumulation in .blood gas result the lungs within normal > development of crackles > chest x-ray showing pulmonary edema > worsening blood gases range .> Hx of heart dse > administer > to reduce fluid of x-ray > hypertension’ meds .