I.

INTRODUCTION

Our client XXY is a 50 years old resident of Purok 5 - Balulang, Cagayan de Oro. He was a
former mechanic and welder. He worked there at 32 years and stopped on year 2000 because he
was hospitalized at Northern Mindanao Medical Center and was diagnosed of having COPD. He is
living with his beloved wife and siblings. He is a cigarette smoker and uses a pack or 20-30 sticks of
cigarette a day.

The Global Initiative for Chronic Obstructive Lung Disease(GOLD) has defined chronic
obstructive pulmonary disease (COPD) as “a preventable and treatable disease with some
significant extrapulmonary effects that may contribute to the severity in individual patients. Its
pulmonary component is characterized by airflow limitation is usually progressive and associated
with an abnormal inflammatory response of the lung to noxious particles or gases”(GOLD,2008,p.2).
This updated definition is a broad description that explains COPD and its signs and symptoms.
Although previous definitions have categorized emphysema and chronic bronchitis as a types of
COPD, this was often confusing because most patients with COPD, present with overlapping signs
and symptoms of these two distinct disease processes.

People with COPD commonly become symptomatic during the middle adult years, and the
incidence of the disease increases with age. Although certain aspects of lung function normally
decrease with age-for example, vital capacity and forced expiratory volume in second (FEV1), COPD
accentuates and accelerates these physiologic changes.

This case study aims to learn more and gain knowledge about COPD so we will be able to
develop and improve the client’s condition through the use of nursing process, nursing
management and different nursing intervention.

II. BIOGRAPHIC DATA

Name of Patient: PATIENT XXY

Address: Balulang, Cagayan de Oro City
Gender: Male Age: 50 years old Civil Status: Married
Date of Birth: November 10, 1960 Place of Birth: Manolo Fortitch, Bukidnon
Educational Attainment: High School Graduate Occupation: Former mechanic and welder
Religion: Roman Catholic Chief Complaint: Difficulty of breathing
Primary Medical Diagnosis: Exacerbation Of COPD Physician:
Date of Admission: September 8, 2011 at around 3:45pm

III. HEALTH HISTORY

A. History of Present Illness

It was Tuesday afternoon when the client experience difficulty of breathing. He was brought
at Northern Mindanao Medical Center on September 8, 2014 at exactly 3:45pm. He was pale, weak
and irritable. His respiration ranges from 27-30cpm. He was dyspneic with production and
secretion of sputum with productive cough.
B. Past Health History
On 2010 he was diagnosed of having PTB and successfully treated within 6 months. On the year
2012 was first time our client hospitalized at Polymedic General Hospital and diagnosed of
having COPD. He was stopped in working. According to our client he is always brought to the
hospital several times per year. But this year (2014) it is his third time to be hospitalized at
Northern Mindanao Medical Center and he was diagnosed to have exacerbation of chronic
obstructive pulmonary disease. From year 2012-2014 he only consumes 5-10 sticks of
cigarettes per day.
C. Family History
There is no history of COPD but there is a history of stroke.
IV. PSYCHOLOGICAL HEALTH

A. Coping Pattern
Whenever the client has problems, his family is always there to support her if there are
problems encountered regarding financial and conflicts.

Analysis:

Coping may be described as dealing with changes successfully or unsuccessfully. It is cognitive and
behavioral effort to manage external or internal demands that are approved as exceeding resources
of the person.(Fundamentals of Nursing Kozier& Erb pg. 1068)

Interpretation:

The client has a good relationship to his families and friends.

B. Interaction Patterns
The client expresses his feelings and thoughts to his wife and friends. For him it is essential
it is increase trust and bonding and for them to know his feelings. He is a kind of person
who does not blame others whatever happens.

Analysis:

This includes the ways of exposing affection of love, sorrow, anger, to note significant
family members in person’s life and openness of communication within a family member.
(Fundamentals of Nursing Kozier pg. 193)

Interpretation:
The client is open and very close to his family and friends. This is essential to improve
social life.

C. Emotional Pattern
If the patient gets angry he tells it frankly to his family and relatives in good manner in
order to maintain good relationship to them.

Analysis: Emotional pattern includes thoughts and actions that relieve emotional distress. It does
not improve the situation, but the person often feels better. (Fundamentals of Nursing Kozier pg.
147)

Interpretation: Good relationship to his family is very important to him: He believed that doing
good communication is the best way to have good relationship to them.

D. Family Copping Pattern

When he encountered problems he tells it to his wife.

Analysis: The families have functions that are important in how individual family members meet
their needs and maintain their health. The family provides the individual with the necessary
environment for development and social interactions. (Lippincott Williams and Wilkins of Nursing
page 30)

Interpretation: Being open to his wife is a good quality to solve any problems.
E. Cognitive Pattern
The client finished elementary and high school. He was attentive in school. He can speak
and understand English and Filipino.
Analysis: The families have functions that are important in how individual family members meet
their needs and maintain their health. The family provides the individual with the necessary
environment for development and social interactions. (Lippincott Williams and Wilkins of Nursing
page 30)

Interpretation: The client can read and understand Filipino and English.

F.Self Concept
He loves and accepts who he is physically.

Analysis: Self-concept involves all of the perception that is appearance, values, beliefs that
influence behavior and that are referred to when using the word I or me. It is over mental image of
oneself. (Fundamentals of Nursing, kozier and Erb’s page 957)

Interpretation: He accepts things easily.

G. Sexuality
He is contended of being a male and accepts responsibility of being a father.

Analysis: Sexuality is an individually expressed and highly personal phenomenon whose meaning
evolves from life experiences. Satisfying or normal sexual expression can generally be described as
whatever behaviors give pleasure and satisfaction to the adults involved, without treat of coercion
or injury to self or others (Kozier & Erb’s Fundamentals of Nursing page 1029)

Interpretation: He is satisfied with what he had now.

V. Socio-cultural Health

A. Cultural Pattern
The client instructed his siblings to obey or respect elders and everyone. They have family reunion
yearly. They love eating Filipino foods.

Analysis: Cultural Pattern refers to cultural beliefs that we are practicing. Culture is a non physical
trait such as beliefs, attitudes and customs that is shared by a group. (Kozier and Erb’s
Fundamentals of Nursing page206)

Interpretation:Their family believes that respecting others is a good quality that Filipinos must
have. They love eating Filipino dishes.

B. Significant Relationship
The patient significant others give their best to support and give his strength to face his
problem.

Analysis: Significant relationship is the client’s support systems in times of stress what affects the
client illness has on the family and whether family problems are affecting the client. (Kozier and
Erb’s Fundamentals of Nursing page 268)

Interpretation: His significant others serve as his backbone in every moment of his life especially
his family.
C. Recreation
The patient loves playing softball and billiards and he spend most of his times by smoking at
least 10-30 sticks of cigarettes per day. Doing these made him more relaxed and it became his
hobby. He also loves drinking liquors occasionally.

Analysis: Recreation or hobbies are an exercise activity and tolerance hobbies and other interest
and vocations. (Kozier and Erb’s Fundamentals of Nursing page 263)

Interpretation: Clients recreation and hobbies are not good for his health even though it decreases
stress. Those hobbies are risk factors for developing much kind of diseases.

D. Environment:
The client live in a simple but a clean house together with his beloved family. They have dogs. They
can move freely and comfortably in their house.
Analysis: Environment is all of the conditions, circumstances and influences surrounding and
affecting the development of a person. Physical environment consider the natural boundaries, sizes
and population density, types of dwells and incidence of crime and vandalism. (Kozier and Erb’s
Fundamentals of Nursing page 201)

Interpretation: He is living in a healthy place. They love pets.

E. Economic
He has enough salary for his family. He is prioritizing foods.

Analysis: Economic status identifies the client’s ability to pay or afford medical care or health care
in order to ensure his or her own health stability.

Interpretation:They have slightly enough money to buy and support basic needs.

VI. SPIRITUAL HEALTH

A. Religious Beliefs & Practices

He is a Roman Catholic. They attend mass occasionally and he prays every night.

Analysis: Spiritual and religious belief can signifies that affect health behavior. It also refers to that
part of being human that seeks meaningfulness through intra, inter, and transpersonal connection.
Spirituality generally involves a belief in a relationship with some higher power, creative, divine
being or infinite source of energy. (Kozier and Erb’s Fundamentals of Nursing page 1042)

Interpretation: The client has faith in God.

B. Value & Valuing

He valued most and keeps treasured all the things he received from others. He also valued
of taking care of his family.

Analysis: Values are freely chosen enduring belief or attitude about the worth of a person, object
idea or action. It is important because it influences decision and actions including nurse’s ethical
decision making. (Kozier and Erb’s Fundamentals of Nursing page 69)

Interpretation: He appreciates all the things that he receives from his friends and family.
 VII. ACTIVITIES OF DAILY LIVING

Activities of Before During Analysis Interpretation

Daily Living Hospitalization Hospitalization

1. Nutrition The patient eats 3x a During Nutrition is the The client’s intake
day and he usually eats hospitalization his sum of all was lessen because
rice, meat, vegetables food and water interaction of problem of
and fish and drinks intake was lessen. between hospitalization.
1.5L of water a day. organism and
the food it
consumes.
(FON pg.1232)

2. Elimination He experienced 5-6x His urine output is Defecation The client has no
urination and defecates 30ml/hr. He refers to the problem when it
once a day or six to defecates once a emptying of comes to urination
seven times in one day. large intestines. and defecation.
week. Urination is
emptying the
urinary
bladder.

(Kozier and
Erb’s FON
pg.1340)
pg.1291)

3. Hygiene He takes a bath daily He was not able to Cleanliness and The client has
and brushed his teeth do hygienic grooming slightly good hygiene.
every after meal. practices so his promote
family was the one physical and
who provides psychiatric
general hygiene for well-being.
him. Improved
personal
hygiene
practices
reduce illness
rates.

4.Exercise He has no extraneous He doesn’t have any Active exertion He doesn’t have
activities. From year exercise and is of muscles enough exercises for
2000-2011 he was always lying in bed. involving the his body.
suffered from COPD But the relatives contraction and
and he has lack of provide massage relaxation of
exercise. and stretching to his muscle group.
extremities.

5.Rest and The client sleeps 6-8 The client sleeps 6-7 Rest connotes a The client has a
Sleep hours per day. hours per day. condition in normal sleep pattern.
which the body
is in a
decreased state
of activity, with
the consequent
feeling of being
 refreshed.
Sleep is a state
of rest
accompanied
by altered
consciousness
and relative
inactivity. The
average
amount of
sleep required
is 8 hrs.

6. Substance He consumes 1 pack of N/A Substance He has no substance

Abuse cigarette or 20- abuse is a abuse during
30sticks a day and major threat to hospitalization.
drinks alcoholic the health of
beverages occasionally. young adult.
Prolonged use
can lead to
physical and
physiologic
dependency
and subsequent
health
problems.

VII. Physical Assessment

Vital Signs
Measurements Findings Normal Findings Interpretation

Blood Pressure 110/70mmHg 90/60-120/80 Normal

mmHg

Respiratory 27bpm 12-20cpm He is experiencing DOB

and trying to
compensate enough
oxygen.

Pulse/Heart Rate 100bpm 60-100bpm Normal

Body Temperature 36.5 C 36.6C-37.5 C Normal

 Head to Toe Physical Assessment

Body Part Findings Norms Interpretation

Skin Dry skin Normally skin is a uniform Due old age

whitish, pink or brown,
depending on the client’s
race. No skin lesions should
be present except for
freckles, birthmarks or
moles which may be flat or
elevated. Skin should
normally feel smooth, even,
firm except where there is
significant hair growth. A
certain amount of
roughness is normal.

Skull Smooth and non-tender Normal skull is smooth, Normal

non-tender and without
masses or depression.

Scalp No lesions and masses The scalp should be shiny, Normal

found intact and without lesions
or masses.

Hair Dry hair, and the color is Hair varies from dark black Normal
black to gray to pale brown.

Face Around shape no nodules The shape of the face can be Normal
and masses oval, round or slightly
square. There should be no
edema, disproportionate
structures or involuntary
movements. Should be
smooth and uniform in
consistency. Absence of
nodules and masses.

Eyes moves smoothly and Both eyes should move Is in good

symmetrical smoothly and symmetrical. condition

Eyebrows Symmetrical and evenly Eyebrows are symmetrical Normal

distributed above the and evenly distributed
eyelids above the eyelids.

Eyelashes Spaced along the lid
margins and curve outward
to protect the eye by
filtering particles of dirt and
dust from the external
environment.
Evenly spaced along the lid Normal
margins and curve outward
to protect the eye by
filtering particles of dirt and
dust from the external
environment.

Conjunctiva Shiny, moist pink in color Shiny, moist, salmon pink in Good condition

Sclera Whitish in color with some
superficial vessels
Pupils Equally round and reactive
to light and accommodation
Eye Movements Intact and can move 6
cardinal directions
Peripheral
Vision
Visual Acuity Able to see.
Nose Symmetry in the midline of
the face, no swelling,
bleeding , lesions and
masses that found
Internal nares Clean with a few cilia
Septum Located in midline
Ears Match to the color of the
body, centrally positioned
and proportioned to head,
no foreign bodies,
deformities and lesions
Hearing Acuity Can able to repeat words. ??
Lips The lips and membranes
pink, no inflammation or
lesion
Gums Pale-red stipple surface, no
color
Sclera should be white with No deformities
some small, superficial found
vessels.
Pupils equal round reactive Normal
to light and
accommodation. Average
pupil size 3-7 mm.
EOM is intact; can move I 6 In good
cardinal directions condition
Able to see the fields,
stimulus at about 60۫
superiorly, 90۫ temporally,
70۫ inferiorly and 50۫ nasally
Able to see and read Normal
newspaper’s headline, by
lines, detailed newsprint.
Normal vision is 20/20
The shape of the external No deformities
nose can vary greatly
among individuals. Located
symmetrically in the
midline of the face and is
without swelling, bleeding
lesions and masses.
Patent, clean and with a few Normal
cilia
Septum is located midline Normal
The ears should match the Normal
flesh color of the rest of the
body and should be
positioned centrally and in
proportion to the head.
Cerumen should be moist
and not obstruct the
tympanic membrane. There
should be no foreign bodies,
redness, drainage,
deformities, nodules or
lesions.
The patient is able to repeat
words whispered from a
distance of 5 feet
The lips and membranes In a good
should be pink and moist condition
with no evidence of
inflammation or lesion
In light-skinned individuals, Is in good
 bleeding or swelling found
Teeth Incomplete teeth
Tongue Symmetry and moves
freely, the color is slightly
pink, moist, rough w/ lesion
Frenulum It locate to the floor of the
mouth, is in the midline and
moist
Buccal Mucosa Moist, smooth and free of
lesion
Neck Can able to move from side
to side and freely movable
Thorax symmetrical from side to
side
Abdomen Same color to the body, no
presence of lesions, masses
and tenderness. Absence of
bowel sounds <5x/min.
Upper *******
Extremities
Hands Compete fingers in each
hand and able to do ROM
Nails Normally nails have pink
cast. the capillary refill
return to normal w/ in 2- 3
seconds
Lower *******
the gums have a pale-red appearance
stipple surface. The gums
should have no bleeding or
swelling.
32 permanent teeth (adult) Due to aging
process
The dorsum of the tongue Is in good
should be pink, moist, rough condition
and without lesion. The
tongue should be
symmetrical and moves
freely.
Located at the floor of the Normal
mouth, interiorly, midline,
moist
The buccal mucosa should Normal
be moist, smooth and free of
lesion.
Able to move from side to Normal
side, freely movable
Although no individual is Good condition
absolutely symmetric in
both hemispheres, most
individual are reasonably
similar form side to side.
The normal depth of
inspiration is non
exaggerated and effortless
Should have the same color, Client has
as the rest of the body, no irregular
presence of lesion, masses defecation.
and tenderness, liver should
not be palpable. Bowel
sounds are usually high
pitched occurring at 5-30
times/minute.
********* ********
There are five fingers in Normal
each hand. Able to do ROM.
Normally, the nails have a Due to her
pink cast for light-skinned disease process
individuals. The capillary
refill may vary with age but
color should return to
normal within 2-3 seconds.
********* *******
Extremities

Legs Knees are in align and able
to flex and extend the legs
with no audible clicks will
be heard during joint
movement
Knees are in alignment with Normal
each other. The foot is in
alignment with the lower
leg. The patient will be able
to flex and extend the legs
with no audible clicks will
be heard during joint
movement

Nails The nails have pink cast
capillary refill may vary
color should return to
normal w/in 2-3 seconds
Normally, the nails have a Good condition
pink cast for light-skinned
individuals. The capillary
refill may vary with age but
color should return to
normal within 2-3 seconds.

IX. Laboratory Findings/ Diagnostic Examination

Tests 8-26-11 Normal Interpretations
Findings

Hbg 133.4g/L 120 – 170 g/L Normal

Hct 0.407 0.37 - 0.45 Normal

WBC MPV 8 5.10 x 10 g/L Normal

MCV 83.90 80-96 fl Normal

MCH 27.48 27-31pg Normal

MCHC 33 33-36g/dl Normal

Neutrophils 0.778 0.54 - 0.75 increase

Lymphocyte 1.160 0.35 – 0.45 increase

Monocytes 0.048 0.01 – 0.06 normal

Eosinophils 0.011 0.01 – 0.04 normal

 Thrombocytes 349 150 - 400 normal

glucose 9.16mmol/L 4.10 – 5.90 increase

BUN 4.52 2. 1 -7.1 increase

Creatine 85.52 53 – 106 normal

Cholesterol 5.53 Up 5.2 increase

LDL 3.80 Up 2.47 increase

HDL 1.14 0.78 –2.21 normal

Triglycerides 1.31 0.68 – 1.88 normal

Sodium 8- 27-11

147.7 135- 148 normal

8-26-11

145.7 normal

XII. Anatomy and Physiology

Raises
High blood
blood
sugar
sugar

Promotes
insulin
release
 Glucagon
Stimulates
breakdown of
glycogen
Glycogen-glucose

Insulin
Stimulate formation of
glycogen

Promote glucose release

Lower
tissue cells
blood
sugar
low blood
sugar

XIII. Pathophysiology (Flow Chart Format)

Modifiable
Non-modifiable
 Obesity- 93kg BMI-34.96
 Lifestyle-smoking, drinking
liquor, sedentary
 Diet-high fat, cholesterol,  Age -49y/o
CHO,CHON,
 I

Poor production of Beta cells

Impaired insulin secretions

Insulin Resistance

Intravascular:
Intracellular: failure of
Metabolic syndrome increase glucose in
glucose to enter in ICS blood
(Prevent build-up of
glucose in the blood)

Hypergylcemia Systemic blood

(9.16mmol/L) Viscosity
Hypertension Hypercholesterolemia

Sluggish circulation
ECF/ICF dehydration Cell Starvation

Increase Osmotic
pressure in renal tubules
Beta cells cannot
keep up with the Polydipsia Polyphagia
increase of glucose A

Polyuria

Hyperglycemia

Diabetes
Mellitus Type II

Scale for ranking health conditions and problems according to priorities

Hyperthermia
Criteria Weight
1. Nature of the condition or problem presented
Scale
 Wellness state
 Health deficit 3/3 x 1 1
  Health threat
 Foreseeable crisis
2. Modifiability of the condition or problem
Scale :
 Easily modifiable 1/2 x 2 1
 Partially modifiable
 Not modifiable
3. Preventive potential
Scale:
 High 3/3 x 1 1
 Moderate
 Low
4 .Salience
Scale:
 A condition or problem needing immediate 2/2 x 1 1
attention
 A condition or problem not needing immediate
attention
 Not perceived as a problem or condition
needing change
ANSWER=5

Hypertension
1. Nature of the condition or problem presented
Scale
 Wellness state
 Health deficit 2/3 x 1 0.67
 Health threat
 Foreseeable crisis
2. Modifiability of the condition or problem
Scale :
 Easily modifiable 2/2 x 2 1
 Partially modifiable
 Not modifiable
3. Preventive potential
Scale:
 High 2/3 x 1 0.67
 Moderate
 Low
4 .Salience
Scale:
 A condition or problem needing immediate 2/2 x 1 1
attention
 A condition or problem not needing immediate
attention
 Not perceived as a problem or condition
needing change

Answer = 3.34

Constipation
1. Nature of the condition or problem presented
Scale
 Wellness state
 Health deficit 2/3 x 1 1
 Health threat
 Foreseeable crisis
2. Modifiability of the condition or problem
 Scale :
 Easily modifiable
 Partially modifiable 1/2 x 2 1
 Not modifiable
3. Preventive potential
Scale:
 High
 Moderate 2/3 x 1 0.67
 Low
4 .Salience
Scale:
 A condition or problem needing immediate
attention 1/2 x 1 0.5
 A condition or problem not needing immediate
attention
 Not perceived as a problem or condition
needing change
Answer=3.17

XII. Prioritization of the Problems

Nursing Diagnosis#1:

HYPERTHERMIA

Interaction:

“mainitaangpakiramdamko”

Cues/Clues:

,skin is warm to touch, weak, irritable

Nursing Diagnosis#2:

HYPERTENSION

Interaction:

“nahihiloaq at sumasakitangbatokko”

Cues/Clues:

BP=140/90 increased blood pressure

Nursing Diagnosis#3:

CONSTIPATION

Interaction:

“tatlongarawnasiyahindidumidumi”

Cues/Clues:

Absence of bowel movement

Nursing Analysis Goal & Objectives Nursing Rationale Evaluation
Diagnosis Intervention
Hyperthermia Goal:
related to After 8 hours of The goal was :
increased continuous __met
__partially met
metabolic rate intervention the
 Unmet
client’s temperature
I – “mainit ang will be lessen or gain
pakiramdam within normal range. Because the client feels
ko”. comfortable but not
Objectives:  Established  To have the decreased the
temperature.
O – increase in  After 3 hours of rapport cooperation of
body rendering care, the client
temperature the client will
-flushed skin state increased  Maintained
-warm to touch comfort, calm voice on
through either
M– verbal reports  Applied cold  To lower the
T -39.5 ®c or behavior compress over body
BP- 140/100 the fore head. temperature
Output – 760 cc  Monitor body
 temperature  To evaluate
every 4 hours. effectiveness of
the
temperature

 Performed
tepid sponge’s
bath.  To lower the
body
 Advised the temperature
 client to
maintain  To reduce
adequate rest metabolic
demands
 After 3 hours of  Discuss
health teachings precipitating
the client and factors w/  To develop
relatives will patient if recommendati
demonstrate known ons for keeping
the behavior in cool and
monitoring and avoiding heat
promoting related illness.
 normothermia.

GENERIC CLASSIFICATION ACTION INDICATION DOSAGE CONTRAINDICATION NURSING CONSIDERATION

NAME/BRAND
NAME
PHENYTOIN CNS drug Limits seizure activity Tonic-clonic and 300g q12 x 3 Sinus bradycardia, SA  Assess patient’s
by stabilizesneuronal psychomotor doses block, AV blocks ll & lll condition before
membranes of hyper seizures therapy
excitable cells through  Assess seizure
decreasing influx of  Assess for and report
sodium during action allergic reactions
potential  Monitor drug level
RANITIDINE GI drug 50 mg q8 IV hypersensitivity  Assess eye problems
Used in management during and after
Inhibits histamine at of various GI therapy
h2 receptors site in the disorders such as
gastric parietal cells, dyspepsia  Assess potential for
which inhibits gastric interactions with other
secretion. pharmacological
agents patient might be
AMLODIPINE Anti- 10g 1tab OD 2nd degree or 3rd degree taking
hypertensive AV block
drug Hypertension  Monitor AST, ALT,
serum creatinine
Inhibits influx of
CEFTRIAXONE calcium ion across cell
Anti-effectives membranes to produce 1g IV q12 –
relaxation of coronary (ANST) Hypersensitivity to
vascular smooth Treatment of penicillin  Assess
muscle, deceaseBP susceptible infections cardiorespiratory
status
 Assess hydration and
Inhibits bacterial cell fluid volume status
wall synthesis,  Monitor liver function
rendering cell wall
 osmotically unstable,
leading to cell death  Assess patient’s
previous sensitivity
CLINDAMYCIN reaction to penicillin or
Anti-infective 300mg 2tab QID Hypersensitivity to other cephalosporins
lincosamides, severe  Assess patient for signs
Serious anaerobic and hepatic and symptoms of
infections, impairment infection before or
duringtreatment
 Obtain C&S before
beginning drug therapy
Inhibits bacterial  Monitor hematologic,
MANNITOL protein synthesis by electrolyte & hepatic
(fluid and binding the 50s status
electrolytes) subunit of the 100cc q4 Hypersensitivity,
 ribosome’s severe dehydration
Reduction of
increased
intracranial pressure  Assess for signs and
associated with symptoms of infection
cerebral edema  Assess complete C&S
 Assess patient with
Increase the osmotic poor renal function
pressure of glomerular  Assess for allergic
OMEPRAZOLE filtrate, which inhibits reactions
tubular reabsorption of 40mg IV q12  Monitor urine
GI drug water & electrolyte & output/blood
increase urinary Hypersensitivity, studies/bleeding
output combination therapy  Assess bowel
ACETAZOLAMIDE Short term treatment with clarithromycin movement pattern
 of active duodenal 250mg IV BID should not be used in daily/overgrowth of
Cardiovascular ulcer, GERD patients with hepatic infection
drug impairment
 Assess patient’s
Hypersensitivity to condition before
Adjunctive treatment sulfonamides, therapy
Suppress gastric of chronic electrolyte imbalance
secretion by inhibiting simple(open angle)  Assess for possible
hydrogen/potassium glaucoma & drug induced adverse
CLONIDINE ATpase enzyme system secondary glaucoma drug interaction
in the gastric parietal 750 mg SL
cell  Monitor manifestations
Cardiovascular of electrolyte
drug Inhibits carbonic imbalance
LOSARTAN anhydrase activity
 100 mg 1tab OD Hypersensitivity to  Assess BP before and
clonidine during therapy with
Management of all patient lying, standing
LACTULOSE Cardiovascular grades of and sitting orthostatic
drug hypertension hypotension can occur
300 OD HS rapidly
Hypersensitivity
GI drug
Treatment of HPN  Assess GI system
Stimulates central  Monitor hepatic
alpha- adrenergic Patient who require a enzyme
receptors to inhibit low lactose diet  Monitor therapeutic
Dexamethasone sympathetic cardio effectiveness and
accelerator& Constipation 4mg IV q 12 adverse reaction
vasoconstrictor centers
 Hormones & Selectively blocks the  Assess neurologic
related drugs binding of angiotensin status when using drug
2 to receptors sites in for seizures
many tissue Systemic fungal  Assess for eye pain,
Ticlodipine infections change in vision when
Testing of adrenal using drug for
Causes an influx of corticol 750 mg tab TID intraocular pressure
fluid in the intestinal hyperfunction  Assess fluid volume
tract by increasing the status
Cardiovascular osmotic pressure  Assess BP before and
drugs within the intestinal during therapy
lumen  Monitor glucose level
in diabetic patients
Presence of
Paracetamol hematopoietic
Reduction of risk of 500 mg IV disorders
thrombotic stroke in 300mg RTC
Synthetic glucorticoid patient who have
with marked anti- experienced stroke  Assess pain/BP &
Insulin Antipyretic, inflammatory precursors apical pulse before
analgesic initial dose/symptoms
Subcutaneous of CHF,note allergic
reactions
Hypersensitivity,
alcohol, table sugar
Antidiabetic
drugs Relief of mild-to-  Assess BP/hydration
Irreversibly inhibits moderate pain; status/monitor
ADP induced platelet- treatment of fever possible adverse drug
 fibrinogen binding & Hypoglycemia diabetic interaction
platelet-platelet coma, IV  Obtain baseline of liver
interactions administration of & kidney function
Diazepam Management of type insulin suspension,
2 DM which cannot insulinoma  Assess patient
be controlled by STAT condition
diet ,exercise or
weight reduction  Monitor for possible
alone adverse GI reaction
CNS drugs Decreases fever
 Monitor for fluid &
electrolyte status

 Monitor for increase

Decrease blood glucose Hypersensitivity glucose levels in
 dependence in other diabetes mellitus
substances including
alcohol  Obtain patients history
of underlying
Basal sedations conditions before
before stressful therapy
therapeutic  Monitor patient weight
measures of & glucose level
intervention  Monitor cardiac status
 Assess carefully for
infection because drug
can mask infection
Facilitates, potentiates,  Monitor renal status
the inhibitory activity  Assess mental status
of the CABA at the
limbic system &
reticular formation  Assess patients
condition
 Obtain baseline liver
function
 Monitor for allergic
reaction
 Assess patients fever
or pain

 Assess allergic
reactions

 Monitor liver & renal

functions

 Obtain history
 Monitor FBG (2 hrs
.after meals)
 Assess for
 hypoglycemic reaction
 Monitor body weight
periodically
 Observe injection sites
for signs and
symptoms of
hypersensitivity
 Assess for
hyperglycemia three
Ps, fatigue, flushed, dry
skin, lethargy
 Obtain history
 Monitor seizures
 Assess foe alcohol
withdrawal symptoms
 Monitored vital signs
 Assess for mental
status