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VII.

DIAGNOSTIC TEST RESULTS & SIGNIFICANCE NAME OF TEST Complete Blood Count Purpose: CBC is ordered to aid in the detection of anemias; hydration status; and as part of routine hospital admission test. The differential WBC is necessary for determining the type of infection. NORMALVALUE RBC: 4-6 x 10/L Hct: 0.37- 0.47 Hgb: 110- 160 gm/L WBC: 5-10 x 10 /L Lymphocytes:0.25-0.35 Segmenters: 0.50-0.65 Eosinophil: 0.01-0.06 RESULTS 4.28 0.36 111 11.3 0.25 0.74 0.01 SIGNIFICANCE Increased segmenters (mature neutrophils) reflect a bacterial infection since this are the body’s first line of defense against acute bacterial invasion. Lymphocytes are decreased during early acute bacterial infection and only increase late in bacterial infections but continue to function during the chronic phase.

VI. DRUG STUDY

Generic/ Brand Name Salbutamol

Mechanism of Action Stimulates beta-2 receptors of bronchioles by increasing levels of cAMP which relaxes smooth muscles to produce bronchodilatation. Also cause CNS stimulation, cardiac stimulation, increase dieresis, skeletal muscle tremors, and increased gastric acid secretion. Longer acting than isoproterenol. Immediately and completely converted to active prednisolone in the liver. The antiinflammatory effects maybe due to inhibition of prostaglandin synthesis. It also inhibits the migration of leukocytes and macrophages to the site of inflammation as well as inhibits phagocytosis and lososomal enzyme release. Glucocorticoid with anti inflammatory effect because of its ability to inhibit prostaglandin synthesis, inhibit migration of macrophages, leukocytes, and fibroblasts at sites of inflammation, phagocytosis and lysosomal enzyme

Indication/ Classification -Bronchodilators -Relief of bronchospasm in bronchial asthma, chronic bronchitis, emphysema and other reversible, obstructive pulmonary diseases. Also useful for treating bronchospasm in patients with coexisting heart disease of hypertension.

Adverse Reaction Fast, irregular, pounding, or racing heartbeat or pulse, shakiness in the legs, arms, hands, or feet, trembling or shaking of the hands or feet

Nursing Responsibility Assessment Assess cardiorespiratory function: BP, heart rate and rhythm and breath sounds Determine history of previous medication and ability to self medicate to prevent additive. Monitor for evidence of allergic reaction and paradoxical bronchospasm. Assessment Obtain baseline weight, BP, and electrolyte levels and monitor periodically during therapy. Assess patient’s condition before therapy and regularly thereafter to monitor drug effectiveness. Monitor for possible drug induced adverse reactions. Monitor plasma cortisol levels during long term therapy. Assess patient’s condition before starting therapy and reassess regularly. Monitor patients weight, BP, glucose and electrolyte levels. Monitor weight, input and output ratio, urine output and increasing edema. Assess carefully for

Prednisone

-Steroids -Allergic and inflammation conditions, i.e., in bronchial asthma and skin disorders, ophthalmic diseases, rheumatic disorders, organ transplant, neoplastic GI and nervous disorders. In conditions responsive to glucosesteroid therapy, as in adrenocortical insufficiency. The topical corticosteroids constitute a class of primarily synthetic steroids used as antiinflammatory and antipruritic agents.

problems with your vision; swelling, rapid weight gain, feeling short of breath; severe depression, unusual thoughts or behavior, seizure (convulsions); bloody or tarry stools, coughing up blood.

Hydrocortisone

burning, itching, irritation, dryness, folliculitis, hypertrichosis, acneiform eruptions, hypopigmentatio n, perioral dermatitis, allergic contact dermatitis,

VIII. NURSING CARE PLAN (ACTUAL) CUES/DATA Subjective: “ Ubo ako ng ubo at hindi makahinga ng maayos.”, as verbalized by the client. Objective: (+) dyspnea (+) facial grimace Pain scale: 7/10 Respiratory Rate: 13 bpm NURSING DIAGNOSIS Ineffective breathing pattern related to painful / ineffective cough. SHORT/LONG TERM OBJECTIVES After 8 hours of Nursing Intervention, the patient’s breathing pattern is effectively maintained as evidenced by: 1) eupnea 2) minimal/no complaints of dyspnea INTERVENTION -Monitor vital signs -Avoidance of irritants; smoking allergens, and industrial chemicals -Increased based fluid intake -Deep breathing exercise -position the client with proper alignment for optimal breathing pattern -encourage the patient to clear her own secretions with effective coughing. RATIONALE -to serve as a baseline data -to prevent further irritation. EVALUATION Goals are partially met. After 8 Hours of Nursing interventions, the patient’s breathing pattern was improved as evidenced by eupnea and minimal complaints of dyspnea

-to thin mucus and make it easier to expectorate. -to improve air circulation and breathing. -if not indicated, a sitting position allows for good lung excursion and chest expansion -this promotes airway patency

Interdependent: -Use of Meds: Bronchodilators, expectorants & liquifying agents. NURSING CARE PLAN (POTENTIAL) CUES/DATA Objective: (+) inability to perform or begin activity (+)Abnormal Heart Rate (+) Exertional discomfort or dyspnea NURSING DIAGNOSIS Risk foe Activity Intolerance r/t imbalance between oxygen supply and demand SHORT/LONG TERM OBJECTIVES After 8 hours of nursing intervention, the client will be able to maintain activity level within capabilities as evidenced by: 1) normal heart rate 2) absence of shortness of breath, weakness and fatigue. 3) Patient verbalizes and uses energyconservati on techniques INTERVENTION -Observe and document response to activity -Refrain from performing nonessential procedures -establish guidelines and goals of activity with the patient and caregiver -encourage adequate rest periods -encourage physical activity consistent with the patient’s RATIONALE -close monitoring serves as a guide for optimal progression of activity. -patients with limited activity intolerance need to prioritize tasks -motivation is enhanced if the patient participates in goal setting. -provides energy conservation and recovery. -this promotes a sense of autonomy while being realistic about EVALUATION n/a

needs. -encourage verbalization of feelings regarding limitations

capabilities. acknowledgemen t that living with activity intolerance is both physically and emotionally difficult aids coping