TRACE COLLEGE

Traceville Subdivision, El Danda Street, Los Baños, Laguna

COLLEGE OF NURSING
Bachelor of Science in Nursing

In partial fulfillment of the course requirement in

Nursing Care Management 102 with RLE

NURSING CASE STUDY
Acute Tonsillopharyngitis

Submitted by: Joel Ian D. Espenilla BSNII – 1N

Date Submitted: February 11, 2010

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CHAPTER 1 INTRODUCTION
Last February 5, 2010, a group of students with nine members were assigned to Mrs. Julie Anne Paullete A. Onte at Los Baños Doctor’s Hospital and Medical Center to complete their affiliation and to gain lots of new knowledge, and develop their skills and passion on the field of nursing. Each members of the group were required to submit an individual nursing case study. We are told that we will be assigned on the 3rd floor medical ward and will handle all patients hospitalized on that ward. What interests me to take Ms. JCBP’s case to be studied is that with all of the patients that I had handled, hers is further the most complicated case. I had handled mild cases and they are all on discharged. Tonsillopharyngitis is an acute infection of the pharynx or the palatine tonsils or both. Symptoms may include sore throat, dysphagia, cervical lymphadenopathy, and fever. Diagnosis is clinical, supplemented by culture or swoft antigen test. Treatment is dependent on symptoms.

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CHAPTER 2 OBJECTIVES

General Objectives: My general objective is to understand what Acute Tonsillopharyngitis is. Specific Objectives: Specifically: 1.) To know what causes to have Acute Tonsillopharyngitis. 2.) To know the anatomy and physiology of the body organ involved in Acute Tonsillopharyngitis. 3.) To understand the pathophysiology of Acute Tonsillopharyngitis. 4.) To relate my patient chief complaint on her condition having Acute Tonsillopharyngitis. 5.) To improve myself on formulating Nursing Care Plans. 6.) To relate the medications and medical procedures done to Ms. RR on her condition of having Acute Tonsillopharyngitis.

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CHAPTER 3 HEALTH HERTORY
i. PATIENT’S DATA
Patient's Name: “Ms. JCBP” Hospital Case No.: 0067310 Address: Jubileeville, Masaya, Bay, Laguna Birth Date: 06/29/91 Placeof Birth: San Pablo City, Laguna, Ph Age: 1Y7M6D Insurance: n/a Sex: Female Date & Time Admitted: 02-03-2010/11:50AM Ordinal Rank (if pedia patient): n/a Ward/Room No./Bed No.: Rm. 306A Nationality: Filipino Inclusive Date of Confinement: --Civil Status: Single Discaharge Date&Time: --Religion: Catholic Attending Physician: Dr. M, MD Occupation: Student Educational Background: 4th yr. College Payment Source for Discharges: Self/Family: Mrs. CBP Employer/Union (give name): Public Agency (give name): Others (pls. specify): Private Insurance (pls. specify name of insurance company): Admitted per: Ambulatory: Stretcher:  Responds to Verbal:  Responds to Pain: Easily Aroused: Wheelchair: 

Level of Consciousness upon Admission:   Alert: Oriented: * Drowsy: Lethargic: Chief Complaint/s: Sore throat Impression/ Admitting Diagnosis: Acute Tonsillopharyngitis Final Diagnosis: Acute Tonsillopharyngitis Disoriented: Asleep:

Unresponsive: Confused:

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ii. PAST HEALTH HERTORY Ms. JCBP verbalized that she had not been hospitalized in her life. She completed her vaccines but cannot enumerate the vaccines. She had chickenpox when she was 8 years old. iii. PRESENT HEALTH HERTORY Nine days prior to admission, she had experienced cough and colds. Two days prior to admission, she had an on and off fever. She also experienced sore throat. iv. ADMISSION HERTORY The patient was admitted last February 3, 2010 around 11:50am with the chief complaint of sore throat. She was admitted under the service of Dr. M, MD with the admitting impression of Acute Tonsillopharyngitis. Consent for admission was secured. The doctor ordered administration of IVF D5LR 1L x 80. the doctor also ordered to monitor her VS q40 and record it. Her diet was DAT. The doctor also ordered the lab results of CBC and urinalysis. With the administration of the following drugs: Biogesic 500g/tab q40 pn for fever; Arcoxia 90mg 1 tab OD; Difflam gargle TID; Zinacef 750mg IV q80 ANST(-).

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v. GENOGRAM

SPDP 82y/o

CS DP 78y/ o

ASB 79y/o

SSB 80y/ o

HPL 52y/ o

DP E 48y/ o

BRDP 40y/o

AR BP 41y/ o

AJSB 35y/o

Legend: - heart attack - asthma - diabetes

BJBP 20y/o

JCB P 18y/ o

DBBP 10y/o

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CHAPTER 4 PHYSICAL ASSESSMENT
I General Survey Patient’s mobility was not limited, with slow and she has a coherent speech. She is conscious but looks drowsy and weak on the first day of my care. Dress appropriately on the condition of her room (specifically the room temperature): Vital Signs results are: • Temperature: 36.6 oC • Pulse Rate: 85 bpm • Respiratory Rate: 24 cpm • Blood Pressure: 100/60 mmHg II Skin, Hair and Nails

The color of her hair is black. Her skin is smooth, intact and warm to touch without any rashes, bruises nor cuts. Her nails are intact, cut, clean and with three seconds capillary perfusion. III Head, Neck and Lymph Nodes

Neck and lymph nodes palpation is not done. IV Nose and Sinuses

She had signs of colds. V Mouth and Throat

Lips look pale in color. Patient verbalized itchiness on throat and difficulty on clearing her throat. Teeth are clean with whitish color. VI Eyes

Patient has normal eyesight of 20/20. she doesn’t wear any contact lens nor glasses. Her reaction to light is normal. VII Ears

Assessment not done.

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VIII

Respiratory System

Upon auscultation, I heard a wheezing breath sound. Percussion was not done. Use of accessory muscles while coughing was noted. The patient verbalized that she sometimes feels difficulty on breathing. IX Cardiovascular System

She is not hypertensive with BP of 100/60 mmHg during our shift. The patient doesn’t feel any chest pain during my shift. X Breasts

Assessment not done. XI Gastro-Intestinal System

Assesment not done. XII Urinary System

Patient’s urinated twice. Amount of urine depends on the amount of fluid intake. XIII Reproductive System

Assessment not done. XIV Nervous System

Assessment not done. XV Musculoskeletal System

Patient is but shows weakness on doing activities like walking and changing positions. XVI Endocrine System

Assessment not done. GORDON’S FUNCTIONAL HEALTH PATTERN A. HEALTH PERCEPTION – HEALTH MANAGEMENT PATTERN Whenever she is sick she buy OTC drugs, then if symptoms persists, that’s the time she’ll go to her doctor and have check-up.

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B. NUTRITIONAL – METABOLIC PATTERN She eats whatever she wants to eat. She loves to eat fatty foods. She verbalized that she’s not eating street foods. C. ELIMINATION PATTERN As she verbalized, she defecated normally and she also urinated normally. D. ACTIVITY – EXERCISE PATTERN As a student, she always go to school riding jeepneys. She seldom exercise. her everyday walking is her means of exercise. E. SLEEP – REST PATTERN On the past few days, she had few amount of sleep hours. She is catching thesis and project on deadline. F. COGNITIVE – PERCEPTUAL PATTERN She is coherent and answers my questions directly. G. SELF– PERCEPTION PATTERN/SELF – CONCEPT PATTERN The patient is conscious but shows loneliness and boredom. H. ROLE – RELATIONSHIP PATTERN She verbalized that all the members of the family were close with each other. And she’s happy with how her relationship with her family goes. I. SEXUALLY – REPRODUCTIVE PATTERN She refused to answer questions in this pattern. J. COPING STRESS TOLERANCE PATTERN Whenever she’s bored or sad, she takes rest and sleeps. She is not that fond of watching TV. K. VALUES/BELIEF PATTERN Their whole family religion is Catholic. They do not believe in hilot and faith healers.

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CHAPTER 5 DEFINITION OF COMPLETE MEDICAL DIAGNOSIS
Acute Tonsillopharyngitis is an acute infection of the pharynx or palatine tonsils or both. Symptoms may include sore throat, dysphagia, cervical lymphadenopathy, and fever. Diagnosis is clinical, supplemented by culture or swift antigen test. Treatment is dependent on symptoms and, within the case of GABHS, involves antibiotics. Tonsillopharyngitis is usually viral, most regularly caused by the adjectives cold viruses (adenovirus, rhinovirus, influenza, coronavirus, respiratory syncytial virus), but occasionally by Epstein-Barr virus, herpes simplex virus, cytomegalovirus, or HIV. In in the region of 30% of cases, the cause is bacterial. Group A β-hemolytic streptococcus (GABHS) is most adjectives (see Gram-Positive Cocci: Streptococcal Diseases), but Staphylococcus aureus, Streptococcus pneumoniae, Mycoplasma pneumoniae, and Chlamydia pneumoniae are sometimes involved. Rare causes include pertussis, Fusobacterium, diphtheria, syphilis, and gonorrhea. Tonsillopharyngitis of adjectives varieties constitutes nearly 15% of all department visits to primary supervision physicians. GABHS occurs most commonly between ages 5 and 15 and is singular before age 3. Symptoms and Signs Pain next to swallowing is the hallmark and is often referred to the ears. Very youthful children who are not able to complain of sore throat habitually refuse to guzzle. High fever, malaise, headache, and GI upset are adjectives, as are halitosis and a muffled voice. A scarlatiniform or nonspecific rash may also be present. The tonsils are swollen and red and recurrently have purulent exudates. Tender cervical lymphadenopathy may be present. Fever, adenopathy, palatal petechiae, and exudates are somewhat more adjectives with GABHS than near viral tonsillopharyngitis, but there is much overlap. GABHS usually resolves inside 7 days. Untreated GABHS may lead to local suppurative complications (eg, peritonsillar abscess or cellulitis) and sometimes to rheumatic disorientation or glomerulonephritis. Diagnosis Pharyngitis itself is easily traditional clinically. However, its cause is not. Rhinorrhea and cough usually indicate a viral explanation. Infectious mononucleosis is suggested by posterior cervical or generalized adenopathy, hepatosplenomegaly, fatigue, and malaise for > 1 wk; a full neck near petechiae of the soft palate; and thick tonsillar exudates. A dirty gray, gummy, tough membrane that bleeds if peeled away indicates diphtheria .

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CHAPTER 6 ANATOMY AND PHYSIOLOGY
The Upper Respiratory Tract and tonsil The upper respiratory tract refers to the following parts of the respiratory system:
• • •

nose and paranasal sinuses oral cavity (also part of the digestive system) throat o pharynx  nasopharynx  oropharynx  laryngopharynx o larynx (The larynx can be considered part of the upper respiratory tract or the lower respiratory tract depending on the source. Some specify that the glottis (vocal cords) is the defining line between the upper and lower respiratory tracts; others make the line at the cricoid cartilage.)

Unlike the trachea and bronchi, the upper airway is a collapsible, compliant tube. As such, it has to be able to withstand suction pressures generated by the rhythmic contraction of the diaphragm that sucks air into the lungs. This is accomplished by the rhythmic contraction of upper airway muscles, such as the genioglossus (tongue) and the hyoid muscles. In addition to rhythmic innervation from the respiratory center in the medulla oblongata, the motoneurons controlling the muscles also receive tonic innervation that sets a baseline level of stiffness and size. The tonsils are areas of lymphoid tissue on either side of the throat. An infection of the tonsils is called tonsillitis. Most commonly, the term "tonsils" refers to the palatine tonsils that can be seen in the back of the throat.

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CHAPTER 7 PATHOPHYSIOLOGY

VIRAL  Influenza  Para-influenza  Herpes simplex  Measles  Chickenpox  Cytomegalovirus  Rhinovirus

BACTERIAL  Streptococcus (Group A beta hemolytic)  Diphtheria  Gonococcus

FUNGAL  Candida

MISCELLANEOUS  Toxoplasma (parasite)  Chlamydia

Mild Infections: • • • • Discomfort in throat Malaise Low grade fever Congested pharynx but no lymphadenopathy. Moderate to Severe Infections: • • • Pain in throat Dysphagia Headache

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CHAPTER 8 LABORATORY AND DIAGNOSTIC EXAMINATIONS
NURSING CONSIDERATIONS BEFORE AND AFTER THE PROCEDURES

DATE ORDERED

DIAGNOSTIC EXAMINATIONS WITH DEFINITIONS

NORMAL FINDINGS
Hemoglobin

ACTUAL RESULTS

CLINICAL SIGNIFICANCE (RATIONALE)
Within normal range Within normal range Within normal range high

02/03/10

HEMATOLOGY/CBC – the most commonly performed blood test which is a basic evaluation of the cellular components of blood.

13 – 18 gms Hematocrit 40 - 54 vol % RBC Count 4.5 – 5.5 M/ml WBC Count • 5,000-10,000 cumm Differential WBC Count Segmented Neutrophils: 55 - 65% •

• • •

13.8 43 % 4.8 M/ml 15,600/μl

88% 12%

high low
---


• 3 - 7%

Lymphocytes: 25 - 35% Monocytes: Eosinophils: 0 - 5% Basophils:

1. Instruct family about the requirements or instructions 2. Inform the mother/family about the time period before the results will be available. 3. Document teachings. Include the client’s responses.


• 0 - 3%

-----

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02/03/10

Urinalysis – the chemical analysis of urine sample

Appearance: • Clear Color: • yellow Odor : • aromatic Transparency: Specific Gravity : • 1.005 - 1.030 Glucose : • negative Casts : • none WBC : • 0-4 RBC :

Clear Yellow Not specified turbid 1.010 Negative
No albumin trace

Urinalysis To measure and detect the level of a variety of substances in the urine.

2 – 3/cast 0-1

Obtaining a clean catch urine sample: The head of the man’s penis or opening of a woman’s urethra is cleansed, usually with a small pad that contains an antiseptic substance. A few drops of urine are allowed to flow into the toilet washing out the urethra. Urination is resumed and a sample is collected from the stream into a sterile cup.
Always wash your hands before and after holding your patient.

<2

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CHAPTER 9 MEDICAL MANAGEMENT
DOCTOR’S ORDER
Feb. 3, 2010

• • • • • • • • •

Admit to ROC under Dr. M Secure consent pls. Inform BP once admitted Monitor OS CL (temp.) q shift (BP, RR, PR) DAT IVF D5LR; 1L x 8 hrs Dx – CBC w/ PH Urinalysis Refer accordingly Dr. M

Feb 4, 2010

• • • • • •

Dx – Zinacef 750mg IVT q 8 ANST Biogesic 500mg PO q4 for fever Difflam gargle TID Arcoxia 90mg OD PO IVF D5NM; 1L x 8 hrs Refer accordingly Dr. M

Feb. 5, 2010

• •

IVF D5NM; 1L x 8 hrs Px may go home Dr. M

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CHAPTER 10 NURSING CARE MANAGEMENT
NURSING CARE PLAN
Assessment 02/04/10 Cues: S>”Masakit ang lalamunan ko,” as verbalized O> received patient asleep lying in bed w/ an IVF of D5LR 1L @ 100 cc lvl running at 31.25 gtts/min to run for 8 hrs infusing well @ the L metacarpal vein > (+) redness @ neck area >(+) pain and swelling @ neck area >(+) cough and colds Scientific Rationale Redness and pain is caused by the inflammation of the tonsil. Diagnosis Ineffective Airway Clearance r/t inflammation of tonsils Planning Nursing Intervention At the end of > Give due shift, the patient meds. as will show signs ordered orally of relief after a (Zertin and satisfactory relief Difflam gargle) measure Rationale Evaluation > the patient will report that there is no more swelling and pain in her neck. Upon assessment, the neck area will have no redness. She will also report no signs of coughing.

>Zertin is indicated to treat tonsillitis and Difflam gargle is used to temporarily relief the pain in the throat > Assess > Signs of relief effectiveness of indicates tht Difflam gargle the drug is after 30 mins. effective; no change in condition indicates drug is not effective > Render health >Hot and cold teaching to compress is patient: use of applied to the hot/cold swelling/painful compress area to lessen methods to the pain relieve pain

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CHAPTER 11 DRUG STUDY
A. INTRAVENOUS THERAPY IV fluid Classification/ Type Hypertonic Solution Indications Mechanisms Of Action Normosol-M and 5% Dextrose Injection provides water and electrolytes (with dextrose as a readily available source of carbohydrate) for maintenance of daily fluid and electrolyte requirements, plus minimal carbohydrate calories. Adverse Reaction/ Side Effects Reactions which may occur because of the solution or the technique of administration include febrile response, infection at the site of injection, venous thrombosis or phlebitis extending from the site of injection, extravasation and hypervolemia. If an adverse reactiondoes occur, discontinue the infusion, evaluate the patient, institute appropriate therapeutic countermeasures and save the Nursing Responsibilities

D5NM Or NormosolM in 5% Dextrose

Normosol-M and 5% Dextrose Injection (Multiple Electrolytes and 5% Dextrose Injection Type 1, USP) is indicated for parenteral maintenance of routine daily fluid and electrolyte requirements with minimal carbohydrate calories from dextrose. Magnesium in the formula may help to prevent iatrogenic magnesium deficiency in patients receiving prolonged parenteral therapy.

Solutions containing sodium ions should be used with great care, if at all, in patients with congestive heart failure, severe renal insufficiency and in clinical states in which there exists edema with sodium retention. Solutions which contain potassium should be used with great care, if at all, in patients with hyperkalemia, severe renal failure and in conditions in which potassium retention is present. In patients with diminished renal function, administration of solutions containing sodium or potassium ions may result in sodium or potassium retention. Solutions containing acetate should be used with great care in patients with metabolic or respiratory alkalosis, and in those conditions in which there is an increased level or an impaired

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remainder of the fluid for examination if deemed necessary.

utilization of acetate, such as severe hepatic insufficiency. Administration of ther solution can cause fluid and/or solute overloading resulting in dilution of serum electrolyte concentrations, overhydration, congested states or pulmonary edema. The risk of dilutional states is inversely proportional to the electrolyte concentrations of administered parenteral solutions. The risk of solute overload causing congested states with peripheral and pulmonary edema is directly proportional to the electrolyte concentrations of such solutions.

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IV fluid

Classification/ Type

Indications

Mechanisms Of Action

Adverse Reaction/ Side Effects

Nursing Responsibilities

D5LRS Or Lactated Ringer’s Solution in 5% Dextrose

Lactated Ringer’s and 5% Dextrose Injection, USP is indicated as a source of water, electrolytes and calories or as an alkalinizing agent.

Lactated Ringer’s Allergic reactions and 5% Dextrose or anaphylactoid Injection, USP has symptoms such value as a source as localized or of water, generalized electrolytes, and urticaria and calories. It is pruritus; capable of inducing periorbital, facial, diuresis depending and/or laryngeal on the clinical edema, condition of the coughing, patient. sneezing, and/or Lactated Ringer’s difficulty with and 5% Dextrose breathing have Injection, USP been reported produces a during metabolic administration of alkalinizing effect. Lactated Ringer’s Lactate ions are and 5% Dextrose metabolized Injection, USP. ultimately to The reporting carbon dioxide and frequency of water, which these signs and requires the symptoms is consumption of higher in women hydrogen cations. during pregnancy. Reactions which may occur

Lactated Ringer’s and 5% Dextrose Injection, USP should be used with great care, if at all, in patients with congestive heart failure, severe renal insufficiency, and in clinical states in which there exists edema with sodium retention. Lactated Ringer’s and 5% Dextrose Injection, USP should be used with great care, if at all, in patients with hyperkalemia, severe renal failure, and in conditions in which potassium retention is present. Lactated Ringer’s and 5% Dextrose Injection, USP should be used with great care in patients with metabolic or respiratory alkalosis. The administration of lactate ions should be done with great care in those conditions in which there is an increased level or an impaired utilization of these ions, such as severe hepatic insufficiency. Lactated Ringer’s and 5% Dextrose Injection, USP should not be administered

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because of the solution or the technique of administration include febrile response, infection at the site of injection, venous thrombosis or phlebitis extending from the site of injection, extravasation, and hypervolemia. If an adverse reaction does occur, discontinue the infusion, evaluate the patient, institute appropriate therapeutic countermeasures , and save the remainder of the fluid for examination if deemed necessary.

simultaneously with blood through the same administration set because of the likelihood of coagulation. The intravenous administration of Lactated Ringer’s and 5% Dextrose Injection, USP can cause fluid and/or solute overloading resulting in dilution of serum electrolyte concentrations, overhydration, congested states, or pulmonary edema. The risk of dilutional states is inversely proportional to the electrolyte concentrations of the injection. The risk of solute overload causing congested states with peripheral and pulmonary edema is directly proportional to the electrolyte concentrations of the injection. In patients with diminished renal function, administration of Lactated Ringer’s and 5% Dextrose Injection, USP may result in sodium or potassium retention. Lactated Ringer’s and 5% Dextrose Injection, USP is not for use in the treatment of lactic acidosis.

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B. MEDICATIONS Generic Name Paracetamol Brand Name: Biogesic Dosage/Route/ Frequency: 500mg PO q4o Indication Fever Mechanisms Of Action Paracetamol has long been suspected of having a similar mechanism of action to aspirin because of the similarity in structure. That is, it has been assumed that paracetamol acts by reducing production of prostaglandins, which are involved in the pain and fever processes, by inhibiting the cyclooxygenase (COX) enzyme as aspirin does. Contraindication If the patient is allergic to paracetamol or any ingredient in the product. • Avoid longterm use of paracetamol in patients with anemia or with heart, lung, kidney, or liver disease.

Adverse Effects Skin rashes and minor stomach and intestinal disturbances

Nurisng Considerations • Watch out for overdosage, Paracetamol causes hapatotoxicity • Do not use with any other medicine containing Paracetamol. Do not use medicine if the patient has liver disease and if patient is taking warfarin, a blood thinning medicine.

Generic Name

Indication

Mechanisms of Action

Contraindication

Adverse Effects

Nursing Considerations

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Etoricoxib Brand Name: Arcoxia Dosage/Route/ Frequency: 90mg PO OD

Relief of acute pain

Arcoxia reduces pain and inflammation by blocking COX-2, an enzyme in the body.

Patient hypersensitive to drug and to hypertensive patients. Also contraindicated to patients who will undergone major surgery that may increase risk of coronary artery disease

feeling sick (nausea), vomiting • heartburn, indigestion, uncomfortable feeling or pain in the stomach • diarrhoea • swelling of the legs, ankles or feet • high blood pressure • dizziness • headache

• Arcoxia can be given to pregnant women during their late stages pregnancy. • Do not administer if there is an allergic reaction to any other antiinflammatory drugs. • Do not administer if the patient has allergic reaction to any other substance such as food preservative or dyes. • Inform the physician if the patient has a history of stroke or mini stroke

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Generic Name Difflam Gargle Dosage/Route/ Frequency: 1 cup PO gargle TID

Indication Relief of painful conditions of the mouth & throat including tonsillitis, sore throat, radiation mucositis, aphthous ulcers, post-orosurgical & periodontal procedures. Helps to reduce the development of plaque & gingivitis during the period of treatment when the usual oral hygiene measures are interrupted.

Mechanisms Of Action Gives temporarily relief to inflammation of tonsils and pharynx

Contraindication Patient hypersensitive to dru. Also contraindicated to patients with hepatic or renal impzairment.

Adverse Effects Oral numbness, burning or stinging sensation, dryness or thirst, tingling, warm feeling in mouth, altered sense of taste, nausea, vomiting, retching, GI disorders, dizziness, headache, drowsiness.

Cefuroxime Brand Name: Zinacef Dosage/route Frequency: 750mg IVT q8o ANST

Injectable form is used for treatment of serious infections of the lower respiratory tracts.

Inhibits cell-wall synthesis, promoting osmotic instability; usually bactericidal

Hypersensitivity to cefuroxime, any component. Or other cephalosporin

Pseudomembranou s colitis, hypersensitivity, reactions, serum sickness, anaphylaxis

Nurisng Considerations • Always remind that the drug used for gargle purposes; watch if the patient drinks the medication. • Must have special consideration to pregnant clients and to clients below 6 years old. • If sore throat is caused or complicated by a bacterial infection, appropriate bacterial therapy should be considered in the addition to use Difflam gargle. Assess for previous history of reactions to other cephalosporin or penicillin.

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CHAPTER 12 PROGNOSIS/EVALUATION

Criteria Duration of Illness Onset of Illness Precipitating Factors

Poor

Fair

Good 

Justification
Duration of illness is good because her illness heals. Onset of illness is fair because it is immediately attended. Precipitating factors were fair because of her present living. Her status of being a student may cause her tonsillitis back. She is willing to take her medications and doesn’t have any difficulty on swallowing tablets and capsules. Compliance to treatment was good because she is willing to do whatever her doctor told him so. Age as criteria is fair because she is not too old and not too young to develop such illness. Environment as criteria is poor because she is exposed on pollutions especially when traveling. Family Support as criteria is good because there is always someone in her family that stays with her at the hospital.

 

Willingness to take medicines Compliance to treatment regimen Age Environment  Family Support 

 

Prognosis of the patient is good. She can overcome the disease if she knows how to prevent being exposed on its predisposing factors and prevent being sick, especially acquiring cough and colds. Family Support is also a big help for her recovery.

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CHAPTER 13 DISCHARGE PLAN
• MEDICATION Difflam gargle TID until total relief. EXERCISE • Be sure to get enough rest and sleep on a daily basis. TREATMENT • If you do not smoke, don’t start. • Avoid stress, fatigue, sudden changes in temperature and excessive alcohol intake, all of ther lowers resistance to pneumonia. HYGIENE • Take bath daily. • Promote frequent oral hygiene. DIET • Drink plenty of water (at least 8 glasses every day), especially during warm weather. • Eat a healthy, balanced diet and take in a sufficient amount of non-alcoholic fluids each day.

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BIBLIOGRAPHY
Beers, M. H., et al. The Merck Manual of Medical Information (2nd Home Ed.). NY, USA. Merck & Co., Inc. 2003 Comer, S. R. Delmar’s Critical Care: Nursing Care Plans (2nd edition). Singapore. Thomson Learning Asia Pte. Ltd. 2005 CWAnswer. Acute Tonsillopharyngitis. CWAnswer. http://www.cwanswers.com/8921/Acute Tonsillopharyngitis Department of Health. Health Indicators: Morbidity. (2006). Department of Health. http://www.doh.gov.ph/kp/statistics/morbidity Department of Health. Health Indicators: Mortality. (2006). Department of Health. http://www.doh.gov.ph/kp/statistics/mortality Doenges, M.E., et al. Nurses’ Pocket Guide (ed. 10). Philadelphia, Pennsylvania. F.A. Davis Co. 2006
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Ther is a property of College of Nursing – TRACE College. No part of ther manuscript may be reproduced or transmitted in any form or by any means. Please obtain permission from the College of Nursing – TRACE College.