SOUTHWESTERN UNIVERSITY

                     __________________________________________________________

PHINMA

COLLEGE OF NURSING
 

November 20, 2020

Thursday

Level 3 Section A

Labrador, Ericka Ysa

Lozano, Princess Lyn
Macion, Queenie
Nabua, Katherine Kate
Noval, Glezelle Joyce
Naol, Kristine

Anecito Alkuino

___________________________________________

Clinical Instructor
 
 GENERAL OBJECTIVES

   After 1 to 2 hours of case presentation with a concept of Care of Family and Family
Heath, the student nurses will be able to gain knowledge about the health and well-being of
the patient, enhance the skills in improving and identifying the problems and show positive
attitude to the patient as well as towards other people.

Specific Objectives

   After two weeks exposure at ____Southwestern Medical Center____, I will :

1. Have an overview of the Demographic data including patient's name, age, date of birth and
others.

2. Discuss the patient’s present medical history that includes the chief complaint and admitting
diagnosis, and psychosocial history will be followed.

3. Discuss the assessment of the patient based from the assessment findings.

4. Explain the anatomy and physiology of the affected organ system according to the diagnosis
of the patient and provide a brief discussion on its function

5. Explain the Anatomy and Physiology to trace the disease process of the patient’s diagnosed
condition.

6. Identify five nursing problem and provide its justification for each problem.

7. Formulate a nursing care plan based on the assessment findings of the patient.

8. Discuss the discharge planning of the patient using the METHODS.

9. Have further readings about the news and updates related to the diagnosis or management of
the patient.
 INTRODUCTION

DEFINITION OF DISEASE

COVID-19

Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered

coronavirus. Most people who fall sick with COVID-19 will experience mild to moderate
symptoms and recover without special treatment. The virus that causes COVID-19 is mainly
transmitted through droplets generated when an infected person coughs, sneezes, or exhales.
These droplets are too heavy to hang in the air, and quickly fall on floors or surfaces. You can be
infected by breathing in the virus if you are within close proximity of someone who has COVID-
19, or by touching a contaminated surface and then your eyes, nose or mouth.

Most common symptoms:

Fever

Dry cough

Tiredness

Less common symptoms:

Aches and pains

Sore throat

Diarrhea

Conjunctivitis

Headache

Loss of taste or smell

A rash on skin, or discoloration of fingers or toes

Serious symptoms:

Difficulty breathing or shortness of breath

Chest pain or pressure

Loss of speech or movement

 
Anatomy &Physiology  (This will show a drawing of the organ affected related to the diagnosis of the

patient.)

Since both SARS-CoV and SARS-CoV-2 have the same cell entry mechanism, the pathogenesis of both
viruses could be the same, or at least very similar [12]. ACE2 is the common factor that binds to the
superficial S glycoprotein on the envelope of the virus. It seems that this binding is sensed (essentially) by
Toll-like receptor-7 (TLR-7), which is present in endosomes, and which then leads to the secretion of
inflammatory cytokines . ACE2 is highly expressed in some organs, like lung epithelial cells, especially
type II pneumocytes, and in cells of the heart, kidneys, gastrointestinal tract, liver, and bladder. Therefore
these organs constitute the main target for the virus. Following entry of SARS-CoV-2 into the cell, the
viral RNA genome is transferred from the envelope into the cytoplasm and the translation process begins.
After replication of the RNA new viral particles are formed, by incorporating part of the host cell
membrane in the new viral envelope. Although, SARS-CoV-2 buds from the infected cell, it does not lyse
it directly. Infected lung epithelial cells produce interleukin IL-8 which acts as a chemo attractant for
neutrophils and T lymphocytes. The innate immune response is initially triggered by lung epithelial cells,
alveolar macrophages and neutrophils. In the next stage, adaptive immune responses are triggered
involving T and B lymphocytes to complete the complete immune response. Virus particles containing
single-stranded ssRNA, act as pathogen-associated molecular patterns (PAMPs), and provoke a strong
innate immune response after recognition by Toll-like receptor 7 (TLR7), which is expressed on
monocyte-macrophages and dendritic cells (DC). TLR7 can activate several signaling pathways and
transcription factors, such as Janus kinase transducers (JAK/STAT), nuclear factor κB (NF-κB), activator
protein 1 (AP-1), interferon response factor 3 (IRF3), and IRF7. This signaling cascade leads to increased
secretion of pro-inflammatory cytokines, like IL-1, IL-6, monocyte chemo attractant protein-1 (MCP-1),
MIP-1A, tumor necrosis factor α (TNF-α) and ultimately interferon 1 (IFN1) . Furthermore, neutrophils
are rapidly recruited to sites of infection, where they kill viruses by an oxidative burst, defensin secretion,
and neutrophil extracellular traps (NETs) . Along with these events, antigen presentation subsequently
stimulates the body's specific adaptive immunity (both humoral and cellular immunity) which culminates
in approximately 7–14 days after infection. Following the representation of antigens by APCs to the
CD4+ and CD8+ T-cells, pro-inflammatory cytokines are produced via the NF-κB signaling pathway.
Activated B cells secrete virus-specific antibodies, while antigen-specific T cytotoxic cells kill virus-
infected cells. Additionally, Th17 cells, neutrophils, and granulocytes secrete IL-17, which in turn
stimulates production of IL-1, IL-6, IL-8, MCP-1, Gro-a, G-CSF, GM-CSF, TNF-α, and PGE2. All these
mediators can increase the recruitment of neutrophils, monocytes, and other immune cells. Besides, it has
been reported that IL-17 expression is correlated with several inflammatory respiratory diseases. All these
immune signaling pathways are designed to create an inflammatory environment with the goal of
eradicating SARS-CoV-2.

 The immune system response

The pathology of SARS-CoV-2 is not yet completely understood; most of our knowledge has been based
on research into SARS-CoV and MERS, which previously caused epidemics of acute respiratory
syndromes. In this short duration of the present pandemic, studies have shown that SARS-CoV-2 has
several defense mechanisms, which makes its eradication more difficult. The SARS-CoV-2 envelope
includes attached proteins like M (membrane), S (spike), E (envelope), and N (nucleocapsid). Similar to
other coronaviruses, the N protein of SARS-CoV-2 inhibits IFN1 by regulating IFN-β synthesis and
signaling. On the other hand, the effectiveness of the innate immune response against viral infection
depends mainly on IFN1 production and its downstream signaling that results in controlling viral
replication and induction of an adequate adaptive immune response . However the virus could avoid this
attack due to the complex immune dysregulation caused by this infection. Chronic stimulation of T cells,
resulting in a cytokine storm and T cell exhaustion, weakens the overall body defenses and puts the
patient in a dangerous situation. High-grade chronic viral infections result in CD8+ T cell exhaustion
(Tex) leading to a decreased effector function and lower proliferative capacity. Tex leads to over-
expression of inhibitory receptors, including CD279 (PD-1), a lymphoid cell surface protein of the Ig
superfamily, and a member of the extended CD28/CTLA-4 family of T cell regulators, which act as a
mature T cell checkpoint for the modulation of apoptosis. PD-1 can bind to either of its ligands (PD-
L1[CD274] and PD-L2[CD273]) both members of B7 family of T cell co-receptors. This binding causes
significant suppression of the immune system by affecting T cells, as well as B cells and NK cells [7, 20,
24, 25]. Another important observation is the strong correlation between inflammatory markers, including
ESR, CRP and IL-6, and the relevant subset of lymphocytes. Overall, general lymphopenia is seen in
COVID-19 patients, especially in severe cases.

 
Coronaviruses are a large family of viruses, some of which infect humans. The coronavirus at the root of
COVID-19 is the newest known member of this family. And like other coronaviruses that infect people,
the new coronavirus causes respiratory disease, among other symptoms. At their core, coronaviruses
contain a genetic blueprint called RNA, similar to DNA. The single-stranded RNA acts as a molecular
message that enables production of proteins needed for other elements of the virus. Bound to this string of
RNA are nucleoproteins—proteins that help give the virus its structure and enable it to replicate.
Encapsulating the RNA genome is the viral envelope, which protects the virus when it is outside of a host
cell. This outer envelope is made from a layer of lipids, a waxy barrier containing fat molecules. As well
as protecting the precious genetic cargo, this layer anchors the different structural proteins needed by the
virus to infect cells. Envelope proteins embedded in this layer aid the assembly of new virus particles
once it has infected a cell. The bulbous projections seen on the outside of the coronavirus are spike
proteins. This fringe of proteins gives the virus its crown-like appearance, from which the Latin name
corona is derived. The spike proteins act as grappling hooks that allow the virus to latch onto host cells
and crack them open for infection. Like all viruses, coronaviruses are parasites that are unable to thrive
and reproduce outside of a living host.

PATHOPHYSIOLOGY
Pathogenesis
 Coronavirus disease 2019 (COVID-19) is caused by, SARS-CoV-2, a novel coronavirus named
for the similarity of its symptoms to those caused by the severe acute respiratory syndrome.
 Unlike SARS-CoV, transmission of COVID-19 takes place during the prodromal period when
those infected are mildly ill and are carrying on with their usual activities. This contributes to the
spread of infection.
 The virus infects epithelial cells of the lung alveoli by receptor ‐mediated endocytosis via the
angiotensin‐converting enzyme II (ACE-II) as an entry receptor.
Tropism
 The virus also relies on the ACE-II receptor not only for host cell entry but also for subsequent
viral replication.
 High viral loads have been detected in the lower respiratory tract, suggesting that the virus might
have a higher affinity for the epithelium of the lower respiratory tract and indicating a need for
repeat testing of the upper or lower respiratory tract samples in the setting of an initial negative
result of nasopharyngeal or throat swab in a suspected case.
 ACE-II receptors' presence in the extrapulmonary tissues (heart, kidney, endothelium, and
intestine) could also explain the multi-organ dysfunction observed in patients.
 ACE-II receptors are also expressed in the oral cavity with a higher level of expression in the
tongue than the buccal or gingival tissues. This indicates oral cavity as potentially high risk for
SARS-CoV-2 infectious susceptibility.
 ACE-II receptors' high expression on the luminal surface of intestinal epithelial cells suggests that
the intestine might also be a major entry site for the virus and that the infection might have been
initiated by consuming food from the Wuhan market (the assumed site of the outbreak).
Activation of Host Immune Reponses
  SARS-CoV2 is known to cause a delayed-type I interferon response during the initial phases of
infection.
 Infection and viral replication lead to an activation of neutrophils, macrophages, and monocytes.
Th1/Th17 induced specific antibodies are produced.
 RNA viruses such as SARS-CoV and MERS are recognized pathogen associated molecular
patterns by endosomal RNA receptors, TLR3 and TLR7 and the cytosolic RNA sensor, RIG-
I/MDA5.
 This leads to downstream activation of NF-KB signaling cascade and nuclear translocation of
transcription factors, which in turn leads to the production of type 1 interferon pro-inflammatory
cytokines.
 Coronavirus Nucleocapsid Inhibits Type I Interferon Production by Interfering with TRIM25-
Mediated RIG-I Ubiquitination.
 The main pathogenesis of COVID-19 is severe pneumonia, RNAemia, combined with the
incidence of ground-glass opacities, and acute cardiac injury.
As evident from the autopsies of those infected by the SARS-CoV, the extensive lung damage may be
caused by multiple factors, such as:
 High initial virus titers
 Increased monocyte, macrophage, and neutrophil infiltration in the lungs
 Elevated levels of serum proinflammatory cytokines and chemokines
Transmission and Infectivity
 The fact that large number of infected people were exposed to the wet animal market in Wuhan
City where live animals are routinely sold, it is suggested that COVID-19 is likely of zoonotic
origin.
 Initial reports identified two species of snakes that could be the culprit reservoir of COVID-19.
However, there is no consistent evidence of coronavirus reservoirs except mammals and birds.
 Genomic sequence analysis of SARS-CoV-2 has shown 88% identity with two bat-derived
SARS-like coronaviruses, indicating mammals as the most likely link between the virus and
humans.
 Between the two types of the virus (L and S), the L type is more prevalent (~70%) than the S type
(~30%).
 The L type, derived from the SARS-CoV-2 ancestral S type, is found to have a higher
transmission rate than the S type and has accumulated a significantly higher number of derived
mutations. This hints towards a more aggressive nature of the L type.
 The rapid spread of the disease and the occurrence of cases among people who did not visit the
wet animal market in Wuhan hint at the fact that person-to-person transmission is actively taking
place.
 Person-to-person transmission occurs primarily via direct contact or through droplets spread by
coughing or sneezing from an infected individual.
 A recent pilot study has shown that some patients' stool specimens tested positive to SARS-CoV-
2 and some patients who tested positive to rectal swabs had detectable virus in the gastrointestinal
tract, saliva, or urine.
 The epidemic can double in the number of affected individuals every 7 days and every patient can
infect 2.2 other individuals on average (R0).
 The mean R0 ranges from 2.2 to 3.58. With mitigation measures and transmission precautions,
the R0 may be decreased.

Transmission through Gastrointestinal Route

  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been detected in non-
respiratory specimens, together with stool, blood, ocular secretions, and semen. However, the role
of those sites in the transmission is unsure.
 Several reports are evident for the detection of SARS-CoV-2 RNA from a stool sample, even
after no viral RNA is detected from the upper respiratory sample.
 According to studies, the SARS-CoV-2 antigen is detected in gastrointestinal epithelial cells of a
biopsy sample.
 Live SARS-CoV-2 is also cultured from stool samples in rare cases, providing the evidence that
SARS-CoV-2 has the possibility of fecal-oral transmission.
 According to a recent investigation, Researchers adopt the method of control volume-based
computational fluid dynamics (CFD) to inspect fluid flow characteristics during toilet flushing.
Researchers illustrate through computer simulation that toilet flushing can produce plenty of
turbulence and vortices above the toilet bowl. These vortices can create a cloud of live virus-
containing aerosol droplets that can climb up to 106.5 cm from the ground. These virus-
containing droplets can be inhaled and settle onto surfaces. The toilet flushing effect has been
studied before for the spread of other diseases. However, the World Health Organization and US
Center for Disease Control and Prevention have not verified the transmission of SARS-CoV-2
through this route.
 In spite of the fact that it is hard to affirm, fecal-oral transmission has not been clinically
depicted, and as indicated by a joint WHO-China report, didn't have all the earmarks of being a
noteworthy factor in the spread of infection. 
Incubation Period
 Based on the observational data, the mean incubation period is found to be 5 days.
 The median incubation period is 3 days (range: 0 - 24 days).

LABORATORY AND DIAGNOSTIC STUDIES

BLOOD GAS ANALYSIS

Test Result Unit Reference Range

pH 7.460 - 7.350-7.450
Pco2 27.7 mmHg 35.0-45.0
Po2 62.0 mmHg 80.0-100.0
HCO3 20.0 Mml/L 22.0-26.0
BE(ecf) -4.00 mEq/L +2.0
-
O2 Sat 94.0 % >95.0
Temperature 35.6 oC
:

IMMUNOLOGY

Test Result Method

IgG Antibody POSITIVE Immunoassay
IgM Antibody POSITIVE Immunoassay

SARS-COV2 VIRAL RNA DETECTION TEST (PCR) 8/1/2020

Test Result: SARS-COV-2 (Causative Agent of COVID 19) viral RNA detected
Interpretation Positive for SARS CoV2 viral RNA
:

CT-SCAN REPORT (BRAIN/CRANIAL PLAIN) 7/30/2020

Multiple axial tomographic sections of the head, without contrast, were obtained.
The brain parenchyma is intact, with no focal mass lesion nor abnormal calcification seen.
There is no parenchyma hemorrhage nr acute infarction seen.
Small CSF-like hypodensities are seen in the right anterior periventricular white matter and left
lentiform nucleus with no mass effect.
The cortical sulci and ventricles are widened.
There is normal gray-white matter demarcation. The midline structures are undisplaced.
The brainstem and cerebellar hemispheres are unremarkable.
The visualized sellar/suprasellar regions, orbits, paranasal sinuses and mastiods are intact.
The calvarium and basal skull structure are unremarkable.

IMPRESSION: CHRONIC LACUNAR INFARCTS IN THE RIGHT ANTERIOR

PERIVENTRICULAR WHITE MATTER AND LEFT LENTIFORM NUCLEUS. AGE-
COMPATIBLE-CEREBELLAR VOLUME LOSS.
 DRUG NAMES MECHANISM OF INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES
ACTION

GENERIC NAME ➣ Allergy symptoms caused  dry mouth, nose, and throat ● Advise patient to avoid alcohol
by histamine release and other depressants such as
Diphenhydramine Interferes with histamine (including anaphylaxis,  nausea sedatives while taking drug.
effects at histamine1-receptorseasonal and perennial
hydrochloride sites; prevents but doesn’t  vomiting ● Caution patient to avoid driving
allergic rhinitis, and allergic
BRAND NAME reverse histamine-mediated dermatoses); nausea; vertigo  increased chest congestion and other hazardous activities until
response. Also possesses CNS he knows how drug affects
Benandryl depressant and anticholinergic ➣ Cough  muscle weakness concentration and alertness.
properties.
➣ Dyskinesia; Parkinson’s  nervousness ● Monitor cardiovascular status,
CLASSIFICATION disease especially in patients with
cardiovascular disease.
Antihistamine ➣ Mild nighttime sedation
● Supervise patient during
DOSAGE CONTRAINDICATION ADVERSE EFFECTS
ambulation. Use side rails as
50 mg CNS: drowsiness, dizziness, headache, necessary
paradoxical stimulation (especially in
● Hypersensitivity to drug ● As appropriate, review all other
children)
ROUTE significant adverse reactions and
Source: ● Alcohol intolerance CV: hypotension, palpitations, interactions, especially those related
IVTT tachycardia to the drugs, tests, herbs, and
Saunders (2014). Nursing ● Acute asthma attacks
behaviors mentioned above.
drug hand book. EENT: blurred vision, tinnitus
FREQUENCY ● MAO inhibitor use within
past 14 days GI: diarrhea, constipation, dry mouth
OD
● Breastfeeding GU: dysuria, urinary frequency or
TIMING
● Neonates, premature retention
infants
 8AM Skin: photosensitivity

Other: decreased appetite, pain at I.M.

injection site

DRUG NAMES MECHANISM OF ACTION INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

GENERIC NAME ➣ Moderate to severe active  Instruct patient or caregiver about

Tocilizumab Binds specifically to both
soluble and membrane-bound
BRAND NAME IL-6 receptors (sIL6R and
mIL-6R), and has been shown
Actemra to inhibit IL-6–mediated
signaling through these
CLASSIFICATION
receptors; decreases levels of
Immunomodulators C-reactive protein to within
normal range; decreases
DOSAGE rheumatoid factor, erythrocyte
sedimentation rate, serum
400 mg amyloid A; increases
hemoglobin
ROUTE
IV
rheumatoid arthritis in patients
who have had inadequate
response to one or more tumor
necrosis factor (TNF)
antagonists
➣ Active systemic juvenile
idiopathic arthritis (SJIA)
CONTRAINDICATION
Hypersensitivity to drug
 a cough or sore throat,
blocked or runny nose
 weight gain or swollen ankles
 skin rashes, infections or
itching
 Instruct patient to immediately seek
ADVERSE EFFECTS
 Instruct patient or caregiver of
CNS: headache, dizziness
CV: hypertension
EENT: nasopharyngitis
GI: gastroenteritis, diverticulitis,
mouth ulcerations, upper
importance of telling prescriber
about known infections before
starting drug. ● Tell patient or
caregiver that TB test will be done
before start of therapy and tests for
blood counts and liver function will
be done frequently.
medical attention if hives, rash,
throat swelling, or difficulty
breathing occurs.
importance of immediately
contacting prescriber if severe,
persistent abdominal pain; change in
bowel habits; infection (fever, chills,
cough, or burning on urination); or
other new signs and symptoms occur.
● Instruct patient or caregiver that
patient shouldn’t receive live
 FREQUENCY Source: abdominal pain, gastritis, vaccines during therapy.
 Advise female patient of
OD Saunders (2014). Nursing drug GI perforation childbearing age to inform prescriber
hand book. if she becomes pregnant during
GU: urinary tract infection
TIMING therapy.
Hematologic: neutropenia,
 Advise breastfeeding patient that she
8AM decreased platelets
should decide whether to discontinue
Hepatic: abnormal liver function breastfeeding or discontinue drug,
test results, increased lipids taking into account importance of
drug for her treatment.
Musculoskeletal: bacterial
arthritis

Respiratory: upper respiratory

tract infection, pneumonia,
bronchitis Skin: cellulitis, rash

Other: herpes zoster

exacerbation, other serious and
opportunistic infections, sepsis,
malignancies, infusion reactions,
hypersensitivity reactions
including anaphylaxis

Drug Names Mechanism of Action Indication Side Effects Nursing Responsibilities

Generic Name: Inhibits human Treatment of HIV infection in 1. Assess neurologic status closely. Stay
immunodeficiency combination with other antiretroviral Diarrhea, nausea, vomiting, heartburn, alert for depression.
Lopinavir/Ritonavir virus (HIV) non-nucleoside agents. stomach pain, dizziness, tiredness,
reverse weakness, changes in taste, or 2. Monitor vital signs and watch for
transcriptase by binding tingling/numbness of mouth area may syncope.
Brand Name: directly to occur. If any of these effects persist or
reverse transcriptase and worsen, tell your doctor or pharmacist 3. Closely monitor nutritional and hydration
Norvir blocking promptly. status.
RNA-dependent and DNA-
dependent polymerase 4. Advise patient to take with meals to
Classification: activity. increase absorption.

5. Tell patient to swallow tablets whole and

Antiretroviral Agent not to chew, break, or crush them.

6. Tell patient drug may cause numbness,

Dosage: tingling, weakness, and other CNS effects
that increase his injury risk. Urge him to use
200 mg appropriate safety precautions.
Contraindications Adverse Effects
7. Instruct patient to report depression.
Route: Hypersensitivity to drug or its CNS: headache, dizziness, depression,
components insomnia, drowsiness, asthenia,
PO ● Concurrent use of alfuzosin, paresthesia, syncope, malaise
amiodarone, cisapride, CV: vasodilation, prolonged PR
dihydroergotamine, interval
Frequency: ergonovine, ergotamine, flecainide, EENT: pharyngitis
lovastatin, methylergonovine, oral GI: nausea, vomiting, diarrhea,
BID midazolam, pimozide, propafenone, constipation, dyspepsia, flatulence,
quinidine, sildenavir (Revatio, when abdominal pain, anorexia, pancreatitis
Timing: used for pulmonary arterial Musculoskeletal: myalgia
hypotension), simvastatin, triazolam, Skin: diaphoresis, mild skin eruptions,
8am, 6pm voriconazole, or St. John’s wort Stevens-Johnson syndrome (rare)
Respiratory: bronchospasm
Other: abnormal taste, fever, pain,
 allergic reactions including anaphylaxis
(rare), immune reconstitution
syndrome

DRUG NAMES MECHANISM OF ACTION INDICATION SIDE EFFECTS NURSING

GENERIC NAME Unclear. Pain relief may result
Paracetamol from inhibition of prostaglandin
synthesis in CNS, with
subsequent blockage of pain
impulses. Fever reduction may
BRAND NAME
result from vasodilation and
Tylenol increased peripheral blood flow
in hypothalamus, which
dissipates heat and lowers body
➣ Mild to moderate pain caused
by headache, muscle ache,
backache, minor arthritis,
common cold, toothache, or
menstrual cramps or fever
RESPONSIBILITIES
 nausea,  Caution parents or other
 stomach pain, caregivers not to give
 loss of appetite, acetaminophen to children
 itching, younger than age 2 without
consulting prescriber first.
 rash,
● Tell patient, parents, or
 headache, other caregivers not to use
 dark urine, drug concurrently with other
acetaminophen-containing
CLASSIFICATION  clay-colored stools, products or to use more than
Analgesic 4,000 mg of regular-strength
acetaminophen in 24 hours.
● Inform patient, parents, or
other caregivers not to use
DOSAGE CONTRAINDICATION ADVERSE EFFECTS extra-strength caplets in
500 mg dosages above 3,000 mg (six
● Hypersensitivity to drug caplets) in 24 hours because
Hematologic: thrombocytopenia, of risk of severe liver
ROUTE damage.
PO hemolytic anemia, neutropenia,
Source: Schull, P.D., (2013). leukopenia, pancytopenia ● Advise patient, parents, or
McGraw – Hill Nurse’s Drug Hepatic: jaundice, other caregivers to contact
Handbook 7th Edition. hepatotoxicity prescriber if fever or other
FREQUENCY The Mc-Graw – Hill Companies, Metabolic: hypoglycemic coma symptoms persist despite
Q4 Inc.. Skin: rash, urticaria taking recommended amount
Other: hypersensitivity reactions of drug.
(such as fever) ● Inform patients with
chronic alcoholism that drug
TIMING
may increase risk of severe
8-12-4-8-12-4
liver damage.
● As appropriate, review all
other significant and life-
threatening adverse reactions
and interactions, especially
those related to the drugs,
tests, and behaviors
mentioned above.
DRUG NAME MECHANISM OF INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES
ACTION
GENERIC NAME: Inhibits accumulation of Acute exacerbations of Inhalation: Cough, dry - Monitor I&O, daily weight.
Dexamethasone acetate, inflammatory cells at chronic allergic disorders, mouth, hoarseness, throat - Assess for edema.
Dexamethasone sodium inflammation sites, cerebral edema, conditions irritation. Intranasal: - Evaluate food tolerance.
phosphate phagocytosis, lysosomal treated by Burning, mucosal dryness. - Monitor daily pattern of bowel activity, stool
enzyme release and immunosuppression, Ophthalmic: Blurred consistency.
BRAND NAME: synthesis, and/or release of inflammatory conditions, vision. Systemic: - Report hyperacidity promptly.
 Decadron, Dexasone, mediators of inflammation otitis externa, ophthalmic Insomnia, facial - Check vital signs at least twice a day.
Diodex, Hexadrol, conditions (corneal injury, edema (cushingoid - Be alert to infection (sore throat, fever, vague
Maxidex inflammatory conditions, appearance [“moon face”]), symptoms).
allergic conjunctivitis). moderate abdominal
- Monitor serum electrolytes, esp. for hypercalcemia
CLASSIFICATION: distention,
(muscle twitching, cramps), hypokalemia
Long-acting glucocorticoid indigestion, increased
(weakness, muscle cramps, paresthesia [esp. lower
appetite, nervous-
extremities], nausea/vomiting, irritability), Hgb,
ness, facial flushing,
occult blood loss.
diaphoresis
- Assess emotional status, ability to sleep.
DOSAGE:
6mg - Do not change dose/schedule or stop taking drug.
ROUTES: Source: - Must taper off gradually under medical
IVTT Saunders (2014). Nursing supervision.
drug hand book. - Notify physician if fever, sore throat, muscle
aches, sudden weight gain, edema, exposure to
FREQUENCY: measles/chickenpox occurs.
OD - Severe stress (serious infection, surgery, trauma)
may require increased dosage.
TIMING: - Inform dentist, other physicians of dexamethasone
8am therapy now or within past 12 mos.
- Avoid alcohol, limit caffeine
CONTRAINDICATION ADVERSE EFFECTS

Hypersensitivity; active Long-term therapy: Muscle

untreated infections; wasting (esp. arms, legs),
ophthalmic use in viral, osteoporosis, spontaneous
fungal disease of the eye. fractures, amenorrhea,
 cataracts, glaucoma, peptic
ulcer disease, CHF.
Ophthalmic: Glaucoma,
ocular hypertension,
cataracts. Abrupt
withdrawal following long-
term therapy: Severe joint
pain, severe headache,
anorexia, nausea, fever,
rebound inflammation, fa-
tigue, weakness, lethargy,
dizziness, orthostatic
hypotension.

DEFINING NURSING SCIENTIFIC GOAL OF CARE INTERVENTION RATIONALE EVALUATION

CHARACTERISTICS DIAGNOSIS ANALYSIS

SUBJECTIVE: Ineffective Airway Coronavirus Disease After 8 hours of Nursing Independent After 8 hours of Nursing
Clearance related to (Covid-19) is an interventions patient will be able  Establish rapport to  To establish/elicit Care patient was able to;
“Maglisodkougginhawa, gahi failure to avoid infectious disease caused to; the patient patients trust and  Normalize vital
kayo oglisodpudugpagubo’’ as pathogen secondary by newly discovered  Monitor and document cooperation signs
verbalized by the patient. to expose to Covid- coronavirus. Most people  Attain normal lab vital signs  For baseline of data  Verbalize
19 infected will develop values and vital signs  Assess general health  Covid-19 can cause understanding
OBJECTIVE; mild to moderate  Understand the status inflammation to the regarding the Covid-
illnesssuch as fever, dry causative of the diseases  Auscultate the lungs, airway leading to 19 and its
Vital signs; cough and tiredness. and its therapeutic note any unusualities obstruction and complications
T- 36.2 management and on its rate, rhythm and difficulty breathing  Apply behaviors
PR- 93 medications depth of respiration  Identify abnormal such as deep
RR- 30 bpm  Demonstrate behaviors breath sounds findings breathing
Temp- 36.2 to achieve airway  Discuss the nature of  It is important to techniques
O2Sat- 94% clearance the disease educate the patient ,evaluation of bed,
 Display effective  Elevate the head of about the new disease increase hydration
 Pt. shows shallow breathing and optimal bed, change position  Increase and effective
breathing with the use gas exchange with frequently, teach pt. comfortability and hydration and
of accessory muscles. breathing and optimal deep breathing aids in breathing effective coughing
 Ineffective coughing gas exchange with leading to an
  Non-productive cough breathe sounds clearing exercise and effective  Deep breathing increase hydration
Reference: and absence of dyspnea coughing exercise helps to and effective
 Establish measures to  Illustrate and adequate gas coughing leading to
www.who.int.com prevent spread demonstrate health exchange an increase of
infection. protocols  Covid-19 disease is a airway patency
Dependent highly contagious  Use required
 Administer disease that can infect knowledge in safety
medications as many people and infection control
prescribed protocols
 Refer for any
unusuality
Collaborative

 Follow up for
Diagnostic 2 lab tests

Defining Characteristics Nursing Scientific Analysis Goal of Care Intervention Rationale

Diagnosis
Subjective Cues Infection related to Coronavirus disease 2019 (COVID-19) Short Term: Independent
failure to avoid is a contagious
“I have been experiencing pathogen respiratory and vascular disease caused   1. Monitor V/S closely 1. Infection usually begins with a high
difficulty in breathing and secondary to by severe acute respiratory syndrome temperature. Monitor the patient’s O2
cough,” as verbalized by the -Identify interventions to 2. Monitor Respiratory Status. saturation because respiratory
exposure to coronavirus (SARS-CoV-2). Common
patient. prevent/reduce risk/ spread compromise results in hypoxia.
COVID-19 symptoms of COVID-19 include fever, 3. Demonstrate and encourage good hand-
of/ secondary infection.
cough, fatigue, breathing difficulties, washing technique. 2. Monitor the respiratory rate of the
and loss of smell and taste.
patient as shortness of breath is
OBJECTIVE: 4. Institute isolation precautions as
another common symptom.
-Achieve timely resolution individually appropriate.
  of symptoms without  3. To reduce or prevent the
Symptoms begin one to fourteen days 5. Perform proper suctioning technique as
complications. transmission of the virus.
 Diarrhea after exposure to the virus. While most appropriate.
 Dyspnea people have mild symptoms, some   4. SARS-CoV-2 spreads by close
 Tachypnea people develop acute respiratory 6. Encourage adequate rest balanced with
contact as do other respiratory
 Hypoxia distress syndrome (ARDS). COVID-19 Long term: moderate activity.
illnesses. It is spread most rapidly
 (+) SARS- CoV2 mainly spreads through the air when
   Dependent: through droplet transmission in which
Viral RNA people are near each other long
Detection Test the infected particles are large and can
enough, primarily via small
(PCR) After 7 days of nursing 7. Administer medications as ordered. travel only about 3 feet. But the virus
droplets or aerosols, as an infected
 Memory Loss intervention, the patient can also spread by touching a surface
person breathes, coughs, sneezes, sings, 8.Provide Oxygen Therapy as ordered
 Change in will be able to: contaminated by the droplets, and
sensorium or speak
then touching one’s mouth, nose, or
 Body malaise reduce the risk to spread of 9. Assess client’s nutritional status. Schedule
eyes.
infection consultation with dietitian to restructure meal
SOURCE: plan and evaluate food choices. 5. Duration should be limited to
V/S as follows: maintain the absence of reduce hazard of hypoxia, damage
Coronavirus Disease 2019 (COVID- respiratory symptoms Collaborative:
airway mucosa and impair cilia
BP 100/80 19). (n.d.). Retrieved November 18,
10. Consult a respiratory therapist for chest action.
2020, from
HR:93 https://www.cdc.gov/coronavirus/2019- physiotherapy as ordered.
6. Facilitates healing process and
ncov/index.html enhances natural resistance.
RR:30

Temp:36.2 11. Collect and monitor diagnostic results.  

O2 Sat:94% Source: Title of the book, author, page no.,

 Source: Title of the book, author, page edition, volume 7. There is no known treatment
no., edition, volume directed at the SARS virus.

8. To improve oxygenation.
Doenges, M. Nurse’s Pocket Guide, pg.427-
432, 14th Ed. 9. Facilitates healing process and
enhances natural resistance.

 
www.nurseslabs.com

https://nurseslabs.com/hyperthermia

10. Chest physiotherapist includes

techniques of postural drainage and
chest percussion.

11.Follows progress and effects of

disease process

Defining Characteristics Nursing Scientific Analysis Goal of Care Intervention Rationale

Diagnosis
Subjective: Deficient Fluid
“Walakokasabotsaakonggibati. Volume Related to Fluid volume deficit (FVD)
Nag sigekogadtoug cr. Diarrhea as evidence or hypovolemia is a state or
Mgakaupatna.Sakitkaayoakong by Covid-19 Positive condition where the fluid
tiyan.” As verbalized by the output exceeds the fluid
patient. intake. It occurs when the
body loses both water and
Objective: electrolytes from the ECF in
-Restlessness similar proportions.
-Irritability Common sources of fluid
-Dry skin loss are the gastrointestinal
tract, polyuria, and
VITAL SIGNS: increased perspiration. Risk
P: 59 bpm factors for FVD are as
R: 24 cpm follows: vomiting, diarrhea,
Bp: 100/70 GI suctioning, sweating,
decreased intake, and
nausea, inability to gain
access to fluids, adrenal
insufficiency, osmotic
diuresis, hemorrhage,
coma, third-space fluid
shifts, burns, ascites, and
liver dysfunction. Fluid
volume deficit may be an
acute or chronic condition
managed in the hospital,
outpatient center, or home
setting
COVID-19 is a respiratory
disease caused by a new
form of the coronavirus that
was discovered in
December 2019.
Coronavirus is a family of
viruses that causes several
Short Term:
After 2-3 hours of
nursinginterventions,
the pt. will be able to:
Gain knowledge about
Diarrhea related to Covid 19
symptoms.
Verbalize awareness of
causative factors and
behaviors essential to
correct fluid deficit.
Maintain good skin turgor
LONG TERM
After 1-2 days of nursing
interventions, the patient
will be able to:
Reestablish and maintain
normal pattern of bowel
functioning.
Maintain fluid volume at a
functional level as evidence
by individually adequate
urinary output with normal
specific gravity, stable vital
signs, moist mucous.
Patient explains measures
INDEPENDENT
-Review causative factors and appropriate
interventions.
-Urge the patient to drink prescribed amount of
fluid.
-Emphasize importance of oral hygiene.
-Assess skin turgor and oral mucous membranes
for signs of dehydration.
DEPENDENT
-Administer parenteral fluids as prescribed.
-Stop fluid loss as prescribed.
COLLABORATIVE:
Collaborate with MedTech’s, Infection control
health workers, indicating need for emergent or
further evaluation and follow up.
To prevent recurrence.
-Oral fluid replacement is indicated for
mild fluid deficit and is a cost-effective
method for replacement treatment.
-Fluid deficit can cause a dry, sticky
mouth. Attention to mouth care
promotes interest in drinking and
reduces discomfort of dry mucous
membranes.
- Signs of dehydration are also detected
through the skin. Skin of elderly patients
losses elasticity, hence skin turgor
should be assessed over the sternum or
on the inner thighs. Longitudinal furrows
may be noted along the tongue.
-Fluids are necessary to maintain
hydration status. Determination of the
type and amount of fluid to be replaced
and infusion rates will vary depending
on clinical status.
-Administer medication to stop vomiting,
diarrhea.
-This promotes timely intervention.
human diseases, including that can be taken to treat or Doenges, M, (et. Al). (2012). Nurses Pocket
the common cold, Middle prevent fluid volume loss. Guide (14thed). F.A. Davis Company.
East respiratory syndrome
(MERS), and severe acute Demonstrate behaviors or
respiratory syndrome lifestyle changes to prevent
(SARS). development of fluid volume
Many people with COVID-19 deficit.
experience gastrointestinal
symptoms such as nausea,
vomiting or diarrhea,
sometimes prior to having
fever and lower respiratory
tract signs and symptoms.

Less common symptoms

include headache,
hemoptysis, nausea,
vomiting, and diarrhea.8
Although
initially found in a small
percentage of cases, an
increasing
number of patients present
with diarrhea.9 Diarrhea is a
frequent symptom in
coronavirus infections; it
was
detected in up to 30% of
patients with MERS-CoV
and
10.6% of patients with
SARS-CoV.

Kanwal (2020). Diarrhea

During COVID-19 Infection:
Pathogenesis,
Epidemiology, Prevention,
and
Managementhttps://www.c
ghjournal.org/article/S1542
-3565(20)30481-X/pdf

Wayne (2020). Deficient

Fluid Volume.
https://nurseslabs.com/defi
cient-fluid-volume/
 INTRODUCTION

DISEASE DEFINITION

COMMUNITY ACQUIRED PNEUMONIA (CAP)

Community-acquired pneumonia is defined as pneumonia that is acquired outside the hospital.

The most commonly identified pathogens are Streptococcus pneumoniae, Haemophilus influenzae,
atypical bacteria (ie, Chlamydia pneumoniae, Mycoplasma pneumoniae, Legionella species), and viruses.
Symptoms and signs are fever, cough, sputum production, pleuritic chest pain, dyspnea, tachypnea, and
tachycardia. Diagnosis is based on clinical presentation and chest x-ray. Treatment is with empirically
chosen antibiotics. Prognosis is excellent for relatively young or healthy patients, but many pneumonias,
especially when caused by S. pneumoniae, Legionella, Staphylococcusaureus, or influenza virus, are
serious or even fatal in older, sicker patients.

SIGNS AND SYMPTOMS

 Shortness of breath
 Coughing
 Heavy sputum
 Fever and chills
 Chest pain that is worse when you breathe or cough
 Nausea and vomiting (less common)

ASSESSMENT:

 Assess respiratory symptoms. 

 Assess clinical manifestations.
 Physical assessment. 
 Assessment in elderly patients. 

LABORATORY AND DIAGNOSTIC STUDIES

COMPLETE BLOOD COUNT

Test Result Unit Reference Range
WBC 9.5 109/L 4.00-1.050
RBC 4.48 1012/L 4.70-6.00
Hemoglobin 139 g/L 13-180
Hematocrit L 0.40 0.42-0.52
Mean Corpuscular Volume 83 Fl 78-100
Mean Corpuscular Hb 29 Pg 27-31
Mean Corpuscular Hb Conc. 0.35 0.32-0.36
RBC Distribution Width 11.8 % 11.0-16.0
Platelet Count 170 109/L 150-450
Diff. Count (Relative)
Segementers/Neutrphils H 79.9 % 50.0-70.0
Lymphocytes L 1.11 % 18.0-42.0
Monocytes 8.7 % 2.0-11.0
Eosinphils 0.2 % 0.0-6.0
Basinophils 0.1 % 0.0-2.0
Bands 0.00 % 0.0-5.0
Diff. Count (Absolute)
Absolute Seg/Neutro Count H 7.59 109/L 1.30-6.00
Absolute Lymphcyte Count L 1.06 109/L 1.50-3.50
Absolute Monocyte Count 0.83 109/L <1.00
Absolute Eosinophil Count 0.02 109/L <0.70
Absolute Basophil Count 0.01 109/L <0.10
Absolute Band Count 0.00 109/L <1.0

URINE ANALYSIS

Macroscopic COLOR: Yellow TRANSPARANCY: Clear

Examination
Chemical Examination SPECIFIC 1.015
GRAVITY:
pH: 6.0 PROTEIN: +2
GLUCOSE: NEGATIVE BILIRUBIN: NEGATIVE
BLOOD: NEGATIVE LEOCOCYTES: NEGATIVE
NITRITE: NEGATIVE UROBILINOGEN: <1mg/dL
KETONE: NEGATIVE
Microscopic RBC: 3-5/hpf WBC: 1-3/hpf
Examination
EPITHELIAL RARE BACTERIA: RARE
CELLS:
MUCUS RARE FINE GRANULAR 3-5/lpf
THREADS: CAST:

IMMUNOLOGY

Test Result Unit Reference Range

QCRP >160 Mg/dL <10

X-RAY REPORT
EXAMINATION: CHEST PA OR AP
There are hazy opacities in both upper lobes. The rest of the lungs are clear. Heart is magnified.
Aorta is tortuous and sclerotic. The right hemidiaphragm is elevated. The tracheal air column is
at the midline. The left hemidiaphragm and both costophrenic sulci are intact. The visualized
osseous structures are unremarkable.
IMPRESSION:
INFLAMMATORY PROCESS IN BOTH UPPER LOBES. FOLLOW UP STUDY IS
SUGGESTED.
MAGNIFIED CARDIAC SILHOUETTE WITH NO SIGNS OF PULMONARY
CONGESTION.
ATHEROSCLEROSIS OF THE THRACIC AORTA.
ELEVATED RIGHT HEMIDIAPHRAGM. THIS MAY RELATE TO EVENTRATION
VERSUS CHANGES SECONDARY TO LIVER PATHOLOGY.
 DRUG NAME MECHANISM OF INDICATION SIDE EFFECTS
ACTION
GENERIC NAME: It is a macrolide antibiotic -pertussis Systemic: nausea, -
 Azithromycin used for the treatment of -penicillin allergic rheumatic vomiting, diarrhea,
respiratory and skin fever prophylaxis abdominal pain.
BRAND NAME: infection. It inhibits the -campylobacter
Zithromax ribosomal synthesis of the -uncomplicated genital Ophthalmic: eye irritation -
bacteria. It is a broad- infections
CLASSIFICATION: spectrum antibiotic with -drug resistant enteric fever Rare: systemic: headache,
Macrolide Antibiotics increased action against -chlamydial Trachomatis dizziness, allergic reaction.
the gram-negative Infection -
bacteria. -mycoplasma pneumonia -
DOSAGE:
500mg/tab
-

ROUTES: -
P.O
-
CONTRAINDICATION ADVERSE EFFECTS
Source:
FREQUENCY: Saunders (2014). Nursing
OD Hypersensitivity to other Antibiotic-associated -
drug hand book. macrolide antibiotics. colitis, other super
TIMING: History of cholestatic infections (abdominal -
8am jaundice/hepatic dysfunction cramps, sever watery
associated with prior diarrhea, fever) may result
azithromycin therapy. from altered bacterial
balance. Acute interstitial
nephritis, hepatoxicity -
occur rarely.
Name of the Drug Mechanism of Action Indication/s Side Effects/Adve
Reactions
 Levofloxacin is a NS: seizures
Inhibits the enzyme DNA fluoroquinolone antibacterial
Generic Name: gyrase insusceptible gram- indicated in adults (≥18 years GI: pseudomembr
negative and gram-positive of age) with infections Colitis
Levofloxacin aerobic and anaerobic caused by designated,
bacteria, interfering with susceptible bacteria. Hematologic:
Brand Name: bacterial DNA synthesis. lymphocytopenia
Pneumonia
Loxeva Metabolic: hypoglyce
Chronic bacterial prostatitis
Classification: Other: Steven-Jo
Inhalational Anthrax syndrome
Fluoroquinolone;
Anti-Infective Acute Bacterial Exacerbation
of Chronic Bronchitis
Dosage:
Acute Bacterial Sinusitis
750mg/tab

Route:
Contraindication/s
PO May exacerbate muscle
weakness in patients with
Frequency: myasthenia gravis or with
history.
OD
Blood circulation problems,
Timing: aneurysm, narrowing or
hardening of the arteries;
8AM heart problems, high blood
pressure.

DRUG NAME MECAHNISM OF INDICATION SIDE EFFECT

ACTION
GENERIC NAME: - Diarrhea
Piperacillin Antibacterial combination Nosocomial - Nausea
product consisting of the Pneumonia - Vomiting
BRAND NAME: semisynthetic piperacillin
Piptaz and the beta-lactamase
inhibitor tazobactam.
CLASSIFICATION: Tazobactam component
does not decrease the
anti-infective; beta-lactam activity of the piperacillin
antibiotic; component against
antipseudomonal penicillin susceptible organisms.

DOSAGE:
4.5 mg CONTRAINDICATION ADVERSE EFFEC

CNS: headache, inso

ROUTES:
- Hypersensitivity to agitation, dizz
IVTT
penicillin’s, cephalosporins, anxiety, let
imipenem’s, or beta hallucinations, depre
FREQUENCY:
lactamase inhibitors twitching, coma, seiz
Q6
-Neonates
CV: hypertension,
TIMING:
pain, tachycardia E
8 am- 2 pm
rhinitis, glossitis
2pm- 8 am
nausea, vomiting, dia
constipation, dysp
abdominal
pseudomembranous c

GU: prote
hematuria, v
candidiasis, vag
oliguria, inte
nephritis,
glomerulonephritis

Hematologic: an
increased bleeding,
marrow depre
leukopenia,
thrombocytopenia

Metabolic: hypoka
hypernatremia Respir
dyspnea
 DRUG NAMES MECHANISM OF ACTION INDICATION

GENERIC NAME  Symptomatic management of dry

upper gastrointestinal nau
Domperidone  Domperidone is a peripheral motility disorders associated hyp
dopamine-receptor blocker. It with chronic and sub-acute whi
increases esophageal peristalsis, gastritis and diabetic gala
BRAND NAME
lower esophageal sphincter gastroparesis. gyn
Motilium pressure, gastric motility and  May also be used to prevent men
peristalsis, and enhances gastrointestinal symptoms
gastroduodenal coordination, associated with the use of
CLASSIFICATION thereby facilitating gastric dopamine agonist anti
emptying and decreasing small parkinsonian agents
Prolactin releaser
bowel transit time.

DOSAGE CONTRAINDICATION

10mg Prolactin-releasing pituitary Sign

tumor (prolactinoma), existing hyp
QTc interval prolongation, ana
significant electrolyte neu
disturbances (e.g. hypokalemia, effe
ROUTE hypomagnesaemia,
hyperkalaemia), underlying
PO cardiac disease (e.g. CHF), Eye
gastrointestinal haemorrhage, Gas
mechanical obstruction or diar
FREQUENCY
perforation. Moderate to severe
TID hepatic impairment. Concomitant Gen
use with QT-prolonging drugs, con
TIMING and potent CYP3A4 inhibitors
e.g. ketoconazole, macrolide
8- 1- 6 Imm
(e.g. erythromycin), protease
inhibitors, or nefazodone.

Inve

Ner
mig
Psy
agit
som

Ren
rete

Rep
diso
tend

Skin
diso
 INTRODUCTION

DISEASE DEFINITION

CVD INFARCT

A cerebral infarction is an area of necrotic tissue in the brain resulting from a blockage or
narrowing in the arteries supplying blood and oxygen to the brain. The restricted oxygen due to the
restricted blood supply causes an ischemic stroke that can result in an infarction if the blood flow is not
restored within a relatively short period of time. The blockage can be due to a thrombus, an embolus or an
atheromatous stenosis of one or more arteries. Which arteries are problematic will determine which areas
of the brain are affected (infarcted). These varying infarcts will produce different symptoms and
outcomes. About one third will prove fatal.

ASSESSMENT OF SIGNS AND SYMPTOMS

 Dizziness, nausea, or vomiting

 Unusually severe headache
 Confusion, disorientation or memory loss
 Numbness, weakness in an arm, leg or the face, especially on one side
 Abnormal or slurred speech
 Difficulty with comprehension
 Loss of vision or difficulty seeing
 Loss of balance, coordination or the ability to walk

ASSESSMENT:

During the acute phase, a neurologic flow sheet is maintained to provide data about the following
important measures of the patient’s clinical status:

 Change in level of consciousness or responsiveness.

 Presence or absence of voluntary or involuntary movements of extremities.
 Stiffness or flaccidity of the neck.
 Eye opening, comparative size of pupils, and pupillary reaction to light.
 Color of the face and extremities; temperature and moisture of the skin.
 Ability to speak.
 Presence of bleeding.
 Maintenance of blood pressure.
During the post-acute phase, assess the following functions:

 Mental status (memory, attention span, perception, orientation, affect, speech/language).

 Sensation and perception (usually the patient have decreased awareness of pain and temperature).
 Motor control (upper and lower extremity movement); swallowing ability, nutritional and
hydration status, skin integrity, activity tolerance, and bowel and bladder function.
 Continue focusing nursing assessment on impairment of function in patient’s daily activities.
 LABORATORY AND DIAGNOSTIC STUDIES

PROTHROMBINE TIME

Test Result Unit Reference Range

PATIENT 13.0 Seconds 9.2-13.2

CONTROL 12.0 Seconds -

INR 1.08 - 0.84-1.11
% ACTIVITY 92.31 % 83-143

HEMATOLOGY

BLOOD TYPING
Blood Type: “O” Rh: POSITIVE

Test Result Reference Range

BLEEDING TIME 2 MINUTES & 23 SECONDS 2 T 6 MINS

CLOTTING TIME 7 MINUTES & 17 SECONDS 5 TO 15 MINS

D-DIMER

Test Result Reference Unit

D-DIMER 1.020 <0.5 UgFEU/ML

TUMOR MARKER

Test Result Reference Unit

FERRITIN (HCA, HD) 2922 30 - 00 ng/mL

 DRUG NAME
Generic Name: Famotidine
Brand Name: Pepcid
Classification: gastrointestinal
agent; antisecretory agent (h
2-receptor antagonist)
Dosage/ Route/ Frequency/
Timing:
MECHANISM OF ACTION INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES
Famotidine competitively blocks -Short-term treatment and maintenance of CNS: Dizziness, headache,
histamine H2-receptors thus duodenal ulcer confusion, depression Assess patient for abdominal pain. Look
reducing basal, nocturnal and for blood in emesis, stool or gastric
stimulated gastric acid secretion. -Short-term treatment of benign gastric GI: Constipation, diarrhea aspirate
Pepsin secretion is reduced resulting ulcer
in decreased peptic activity. It Skin: Rash, acne, pruritus, dry skin, Oral suspension must be reconstituted and
effectively heals duodenal and -Treatment of pathologic hypersecretory flushing shaken before use.
gastric ulcers and prevents conditions (eg, Zollinger-Ellison
recurrence. syndrome) Hematologic: Thrombocytopenia  Take this drug at bedtime (or in
the morning and at bedtime).
-Short-term treatment of GERD, Urogenital: increases in BUN and Therapy may continue for 4–6
esophagitis due to GERD serum creatinine weeks or longer. Place rapidly
disintegrating tablet on tongue
OTC: Relief of symptoms of heartburn, and swallow with or without
acid indigestion, sour stomach water.
 Have regular medical follow-up
CONTRAINDICATION ADVERSE EFFECT while on this drug to evaluate
your response.
 Contraindicated to patient with:  Take over-the-counter drug 1
DOSAGE: kidney disease; confusion, hallucinations, agitation, hour before eating to prevent
20mg/tab, 2 tabs lack of energy; indigestion. Do not take more
liver disease; than two per day.
ROUTES: a seizure;  You may experience these side
P.O cancer stomach; or effects: Constipation or diarrhea;
fast or pounding heartbeats, sudden loss of libido or impotence
FREQUENCY: long QT syndrome (in you or a family dizziness (like you might pass out); (reversible); headache (adjust
OD member) or lights, temperature, noise levels).

Hypersensitivity; lactation. Unexplained muscle pain, Store reconstituted oral suspension below
tenderness, or weakness especially 86oF (30oC). Discard after 30 days.
if you also have fever, unusual
tiredness, and dark colored urine. Avoid drinking alcohol.
 Name of the Drug Mechanism of Action Indication/s Side Effects/Adverse Reactions Nursing Responsibilities

Generic Name: Inhibits the action of histamine at Occasional (2%): Diarrhea Instruct patient not to take new medication
theH2 receptor site located w/o consulting physician
Ranitidine primarily in gastric parietal cells, Treatment and prevention Rare (1%): Constipation, headache
resulting in inhibition of gastric of heartburn, acid indigestion, and (may be severe)  
acid secretion. sour stomach.
Instruct patient to take as directed and do
Brand Name: not increase dose
Reversible hepatitis, blood dyscrasias
Zantac
Has some antibacterial action   occur rarely.
against Pylori Prophylaxis of GI hemorrhage from Allow 1 hour between any other antacid
Classification: stress ulceration. and ranitidine

H2 Blockers   
Contraindication/s Assess patient for epigastric or abdominal
Pregnancy pain and frank or occult blood in the stool,
Dosage: emesis, or gastric aspirate

150mg/tab
Lactation (excreted in breastmilk)
Nurse should know that it may cause false-
positive results for urine protein; test with
Route:
sulfosalicylic acid
Geriatric patients (more susceptible
PO
to adverse CNS reactions)  

Inform patient that it may cause drowsiness

Frequency: or dizziness
Renal impairments
1tab BID Inform patient that increased fluid and
fiber intake may minimize constipation
Cirrhosis

Timing:
Advise patient to report onset of black,
tarry stools; fever, sore throat; diarrhea;
8AM-6PM dizziness; rash; confusion; or
hallucinations to health care professional
promptly

Inform patient that medication may

temporarily cause stools and tongue to
appear gray black.
 Name of the Drug Mechanism of Action Indication/s Side Effects/Adverse Reactions Nursing Responsibilities

 A low molecular weight heparin Prevent pulmonary embolism and deep Contraindicated in pork hypersensitivity.
derivative that accelerates formation of vein thrombosis after hip or knee Hemorrhage
Generic Name: anti-thrombin III-thrombin complex and replacement surgery, abdominal surgery. Monitor for signs of bleeding.
deactivates thrombin, preventing Thrombocytopenia
Enoxaparine sodium conversion of fibrinogen to fibrin. Has Patients with acute illness who are at Administer in subcutaneous tissue.
higher anti-factor XatoantifactorIIa increased risk because of decreased mobility. Local reactions (Small local hematoma)
Brand Name: activity ratio. DO NOT eject air bubble prior to injection.
To prevent ischemic complications of Exceptional cases of skin necrosis
Clexane unstable angina and non-Q-wave MI with DO NOT aspirate or massage site.
oral aspirin therapy. Rarely cutaneous or systemic allergic reaction
Classification: Monitor pregnant women using the drug
Increase liver enzymes
Anticoagulants Instruct patient and family to watch for signs of
bleeding or abnormal bruising and to notify
Dosage: prescriber immediately if any occur.

0.6 cc Tell patient to avoid OTC drugs containing aspirin

or other salicylates unless ordered by physician.
Route:
Contraindication/s
SC Conditions with high risk of uncontrolled
hemorrhage including major bleeding
Frequency: disorders.

Q2h

Timing:
Name of the Drug Mechanism Of Action Indication/s Side Effects/Adverse Reactions Nursing Responsibilities

Atorvastatin competitively inhibits Reduction of risk of stroke and
HMG-CoA reductase, the enzyme heart attack in type 2 diabetes
Generic Name: that catalysis the conversion of patients without evidence of heart
Atorvastatin HMG-CoA to mevalonic acid. This disease but with other CV risk
results in the induction of the LDL factors, and revascularization
Brand Name: receptors, leading to lowered LDL- procedures in patients without
cholesterol concentration. evidence of coronary heart disease
Lipitor
(CHD) but with multiple risk
Classification: factors other than diabetes
(smoking, HTN, low HDL-C,
Statins
family history of early
CHD)Patients with CHD, to reduce
Dosage:
risks of MI, revascularization
40mg/tab procedures, hospitalization for
CHF, and angina
Route:
PO
Frequency:
Contraindication/s
Headache Stress that atorvastatin is an adjunct to not
a substitute for low-cholesterol diet
Flatulence
Diarrhea Tell patient to take drug at the same time
each day to maintain its effects
Nausea
Vomiting
Instruct patient to take a missed dose as
soon as possible. If it’s almost time for his
Anorexia
next dose, he should skip the missed dose.
Xerostomia
Angio edema Advise patient to notify prescriber
immediately if he develops unexplained
Myalgia muscle pain, tenderness, or weakness,
especially if accompanied by fatigue or
Rash/pruritus fever
 DO
Timing:
8AM
DRUG NAME MECHANISM OF ACTION
Generic Name:Citicholine Citicoline consumption
promotes brain metabolism by
restoring phospholipid content
Brand Name:
in the brain and regulation of
Cholinerv neuronal membrane
excitability. It also influences
Cholinerv injection the mitochondria or energy
factories of the brain cells and
found to improve memory
Hypersensitivity, active liver
disease or unexplained persistent
elevations of serum transaminase,
porphyria, pregnancy, lactation
INDICATION
 Cerebrovascular diseases –
e.g. from ischaemia due to
stroke, where Citicoline
accelerates the recovery of
consciousness and
overcoming motor deficit.
 Head Trauma of varying
severity: In a clinical trial,
Alopecia
Allergy
Infection
Chest pain
SIDE EFFECTS NURSING RESPONSIBILITIES
 Body temperature elevation
 Restlessness
 Headaches  Citicoline may be taken with or without
 Nausea and vomiting food. Take it with or between meals.
 The supplement should not be taken in
 Diarrhea
 Low or high blood pressure the late afternoon or at night because it
 Tachycardia can cause difficulty sleeping.
 Sleeping troubles or  Women who are pregnant or trying to
insomnia become pregnant should consult with
 Blurred vision their doctor before taking the
Classification: Nootropics &
Neurotronic
Neurotrophic
Peripheral Vasodilators
Cerebral Activators
Dosage/ Route/ Frequency/
Timing:
function. After several clinical Citicoline accelerated the  Chest pains supplements. Not enough is known
trials, Citicoline has been recovery from post-traumatic Central Nervous system about the use of Citicoline during
shown to raise the amount of coma and the recuperation of disorders: Dizziness, headache. pregnancy and breast-feeding. Stay on
walking ability, achieved a the safe side and avoid use.
acetylcholine in the brain.
better final functional result  Special attention should be paid for
and reduced hospital stay. administration in the neonate,
 Cognitive disorders of diverse premature and children.
etiology – e.g. senile  Contact the physician immediately if
cognitive impairment which allergic reaction such as hives, rash, or
is secondary to degenerative itching, swelling in your face or hands,
diseases (e.g. Alzheimer’s mouth or throat, chest tightness or
disease). Citicoline improves trouble breathing are experienced.
scores on cognitive evaluation  Citicoline therapy should be started
scales and slowed the within 24 hours of a stroke. The
progression of Alzheimer’s physician will prescribe the correct
disease. dosage and the length of time it should
 Parkinson’s disease – be taken for a medical condition.
Citicoline has also been
shown to be effective as co-
therapy for Parkinson’s
disease. Beneficial
neuroendocrine,
neuromodulator, and
neurophysiological effects
have been described.
CONTRAINDICATION ADVERSE EFFECT
Hypersensitivity

Adult: PO Cerebrovascular Patients with hypertonic of the Cardiac disorders: Bradycardia,

disorders; Head injury; parasympathetic tachycardia.
Parkinson’s disease;
Cognitive disorder As tab:
Gastrointestinal
500 mg once daily or bid, or
disorders: Diarrhea, epigastric
1,000 mg once daily. As discomfort, stomach pain
solution: 100-200 mg bid or
tid.  IV/IM Cerebrovascular
General disorders and admin site
disorders; Head injury;
conditions: Fatigue.
Parkinson’s disease;
Cognitive disorder 500-1,000
mg/day. Skin and subcutaneous tissue
disorders: Rashes.
Dosage Details

Intramuscular, Intravenous
Vascular disorders: Hypotension.
Cerebrovascular disorders,
Cognitive disorder, Head
injury, Parkinson's disease

Adult: 500-1,000 mg daily
given via IM inj or slow IV inj
over 3-5 minutes, or infused at
a rate of 40-60 drops/minute.

Oral
Cerebrovascular disorders,
Cognitive disorder, Head
injury, Parkinson's disease

Adult: As tab: 500 mg once

daily or bid, or 1,000 mg once
daily. As solution: 100-200 mg
bid or tid.
 DRUG NAME
Generic Name: Colchicine
Brand Name: Mitigare
Classification: anti-gout agents
Dosage/ Route/ Frequency/ Timing:
 of inflammation. Adverse rxn:  Hypersensitivity to the active Blood and lymphatic system
solution):
o For prevention of gout
attacks:
 Adults—0.6
milligram (mg) (5 milliliters
[mL]) 1 or 2 times a day.
Your doctor may increase
your dose as needed.
However, the dose is usually
not more than 1.2 mg per
day.
 Children—Use
MECHANISM OF ACTION
Colchicine’s effectiveness as a Colchicine capsules are indicated for Gastrointestinal
treatment for prophylaxis of gout flares in adults. disorders
Gout has been postulated to be
due to its ability to block
neutrophil-mediated
inflammatory responses
induced by monosodium rate
crystals in synovial fluid.
■ Disrupts the polymerization
of Β-tubulin into microtubules,
thereby preventing the
activation, degranulation, and
migration of neutrophils to sites
Gastrointestinal disorders
INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES
system  Store at room temperature protected
from light. Store in a dry place. Do
Common: abdominal pain, not store in a bathroom.
nausea, vomiting and diarrhea.  Keep lid tightly closed.
 Keep all drugs in a safe place. Keep
all drugs out of the reach of children
and pets.
 Throw away unused or expired
drugs. Do not flush down a toilet or
pour down a drain unless you are
told to do so. Check with your
CONTRAINDICATION ADVERSE EFFECT pharmacist if you have questions
about the best way to throw out
drugs. There may be drug take-back
substance or to any of the excipients disorders programs in your area.
listed in section 6.1 Not known: bone marrow  If a dose of colchicine capsules is
depression with
• Patients with blood dyscrasias missed, advice the patient to take
agranulocytosis, aplastic
the dose as soon as possible and
anemia and thrombocytopenia.
• Pregnancy then return to the normal dosing
Nervous system disorders schedule. However, if a dose is
• Breastfeeding skipped, the patient should not
Not known: peripheral neuritis,
double the next dose.
• Women of childbearing potential neuropathy.
unless using effective contraceptive Hepatobiliary disorders
measures
Not known: hepatotoxicity
 and dose must be
determined by your doctor.

o For prevention of gout
attacks:
 Adults—0.6
milligram (mg) 1 or 2 times
a day. Your doctor may
increase your dose as needed
and tolerated. However, the
dose is usually not more
than 1.2 mg per day.
 Children—Use
and dose must be
determined by your doctor.
o For treatment of gout
attacks:
 Adults—1.2
milligrams (mg) at the first
sign of a gout attack,
followed by 0.6 mg after 1
hour. The dose is usually 1.8
mg over a 1-hour period.
• Patients with severe renal Musculoskeletal and
impairment connective tissue disorders
Not known: myopathy and
• Patients with severe hepatic
rhabdomyolysis.
impairment
Renal and urinary disorders
• Colchicine should not be used in
Not known: renal damage.
patients undergoing hemodialysis
since it cannot be removed by
dialysis or exchange transfusion.
• Colchicine is contraindicated in
patients with renal or hepatic
impairment who are taking a P-
glycoprotein (P-gp) inhibitor or a
strong CYP3A4 inhibitor (see section
4.5)
 DEFINING NURSING SCIENTIFIC OBJECTIVES INTERVENTION RATIONALE EVALUATION
CHARACTERISTIC DIAGNOSIS ANALYSIS
S

SUBJECTIVE: Ineffective Inspiration At the end of the INDEPENDENT:  To promote harmonious After the treatment the patient:
breathing and/or treatment the patient relationship with the pt.’s
“Maglisod kog pattern related to expiration that must:  Establish rapport to the and SO
ginhawa” as verbalized elevation patient  Baseline data
of does not provide  Monitor vital signs  Response of interventions
by the patient  Establish  To see if there`s an
hemidiaphragm adequate  Assess and record alteration in the pattern are performed
normal
as evidenced by ventilation. effective respiratory rate and of breathing to detect  Pt. can now establish
difficulty in respiratory depth. early signs of respiratory normal respiratory pattern
OBJECTIVE: breathing. pattern as  Evaluate skin color, compromise  ABG of the pt. are now in
evidenced by temperature, capillary  Lack of oxygen will normal range
 X-ray report absence of refill; observe central cause blue/cyanosis to  Pt can now perform ADLs
shows right cyanosis and versus peripheral the inside of the mouth is w/out experiencing
hemidiaphragm other signs cyanosis a medical emergency difficulty of breathing
is elevated and symptoms  Place pt. w/ proper body  Pts hemidiaphragm are in
SOURCE:
 VITAL SIGNS: of hypoxia alignment for maximum  A sitting expansion normal
BP:100/80 Nurse`s Pocket  Verbalize breathing pattern permits maximum long
HR:93 Guide 13th Ed. causative excursion and chest
RR:30 Marlynn E. factors expansion
TEMP:36.2 Doenges, Mary  ABG within DEPENDENT:
O2SAT:94% clients normal  Provide oxygenation
Frances  Administer oxygen as
or acceptable
ordered
 DEFINING NURSING SCIENTIFIC NURSING
PLAN OF CARE RATIONALE EVALUATION
CHARACTERISTICS DIAGNOSIS ANALYSIS INTERVENTIONS
SUBJECTIVE: Ineffective It is defined as the SHORT TERM: Independent Independent After 8 hours of nursing
“I can’t speak properly,” Cerebral Tissue decrease in oxygen After 8 hours of 1. Determine factors 1. To have a more intervention, the patient was
as verbalized by the Perfusion related resulting in the nursing intervention, related to individual comprehensive idea able to demonstrate proper
patient. to interruption of failure
Moorhouse, to nourish the
rangethe patient will: Medicatesituation
w/ analgesics as about patient’s condition mental alertness and improved
blood flow Alice C. tissues
Murr at  the Pt`s  carries
Demonstrate ordered2. Look for presence 2. ToTo assess of speech pattern. Patient also
severitydeeper
promote
P167 capillary13th level.
out increased  Ambulate
ADL`s of pt. as tolerated
visual, respiration and healing reported relief of discomfort.
patient’s condition
Tissue perfusion
breathingperfusion as sensory/motor
w/ doctor’s order 3. To determine if patient
edition
problems can exist pattern evidenced  by changes,intubation
Endotracheal headache,  isAmbulation
experiencingcan further(Goal Met)
transient
OBJECTIVE: without decreased
remains mental alertnessand ventilation
dizziness,
as neededand ischemic
break-upattacks
and move
 Patient has altered cardiac output;  Have improved
normal altered mental 4. To secretions promote
mental status however, there may Normal mentation and status  circulation/venous
To provide or permits air
 Speech abnormalities be a relationship speech pattern
hemidiaphrag 3. Note history of drainage
to pass freely to and from
observed between m  Be
cardiac free of intermittent periods 5. To decrease tension
the lungs
 Patient is restless output and tissue anxiety and of level
 Vital signs taken as perfusion. discomfort blackout/confusion
follows: 4. Elevate head of bed
 Temp: 37.3°C and maintain
 PR: 93 bpm head/neck in
 RR: 30 cpm midline or neutral
 B/P: 120/80 position
mmHg 5. Encourage use of
 O2Sat: 94% relaxation
LONG TERM: techniques
After 2 weeks of Collaborative
nursing intervention, 1. To help alleviate
the patient will: symptoms and manage
 Verbalize condition
understanding of 2. To facilitate patient
condition, readiness for surgery
therapy regimen, Collaborative aimed to treat condition
Reference: drug side effects, 1. Review regimen 3. To improve overall
Doenges, E., and when to seek and administer health and minimize risk
Moorhouse, F. M., medical help drugs as appropriate
&Murr A. 2010.  Demonstrate 2. Prepare client for
Nursing Care Plans: lifestyle changes surgery as indicated Reference:
Guidelines for to improve 3. Review specific Doenges, E., Moorhouse, F.
Individualizing circulation dietary changes M., &Murr A. 2010.
Client Care Across with client Nursing Care Plans:
the Life Span Guidelines for
Individualizing Client Care
Reference: Across the Life Span
 INTRODUCTION

DISEASE DEFINITION

TYPE 2 DIABETES MELLITUS

Type 2 diabetes is a chronic disease. It is characterized by high levels of sugar in the blood. Type 2 diabetes is
also called type 2 diabetes mellitus and adult-onset diabetes. That's because it used to start almost always in middle- and
late-adulthood. However, more and more children and teens are developing this condition. Type 2 diabetes is much more
common than type 1 diabetes, and is really a different disease. But it shares with type 1 diabetes high blood sugar levels,
and the complications of high blood sugar. Type 2 diabetes occurs when your body's cells resist the normal effect of
insulin, which is to drive glucose in the blood into the inside of the cells. This condition is called insulin resistance. As a
result, glucose starts to build up in the blood.

ASSESSMENT OF SIGNS AND SYMPTOMS

 Increased thirst  Blurred vision

 Frequent urination  Slow-healing sores
 Increased hunger  Frequent infections
 Unintended weight loss  Areas of darkened skin, usually in the armpits
and neck
 Fatigue

ASSESSMENT:

 Assess the patient’s history.   Perform examination of foot, skin, nervous

system and mouth.
 Assess physical condition. 
 Laboratory examinations. 
 Assess the body mass index and visual acuity of
the patient.

LABORATORY AND DIAGNOSTIC STUDIES

CLINICAL CHEMISTRY

Test Result Unit Reference Range

FBS Mg/dL 70-100

CHOLESTEROL 184.5 Mg/dL 0-200

TRIGLYCERIDES 127.1 Mg/dL 25-148

HDL 22.62 Mg/dL 35-88

LDL 136.4 Mg/dL 0-150

VLDL 25.4 Mg/dL 0-42

LDH & BUN

 Test Result Unit Reference Range

BLOOD UREA 11.17 Mg/dL 6.0 – 20.0

NITROGEN (BUN)

LACTATE 609.36 U/L <480

DEHYDRGENASE (LDH)

GPT/ALT+

CHEMISTRY CONVENTIONAL UNITS SI UNITS

GPT /ALT 23 U/L <42 23.00 U/L <42

URIC ACID + L 3.80 mg/dL M: 4.0 - 8.5 225.0 umol/L M:237 – 503

BLOOD GLUCOSE

SPECIMEN: WHOLE BLOOD

Test Results & Unit

HGT 175 mg/dL

CAPILLARY BLOOD SUGAR

Test Result w/ Unit Reference Range

CAPILLARY BLOOD SUGAR +

Chemistry Conventional Units SI Units

CAPILLARY BLOOD SUGAR 142.00 mg/dL

CREATININE 0.93 mg/dL (0.60-1.20) 82.12 umol/L (53.04-106.08)

FASTING BLOOD SUGAR H 141.50 mg/gL (70-100) 7.84 mmol/L (3.88-5.54)

(Patient fasted for 10 hours)

HBA1c (IE-HPLC) 7.20 % Normal: <5.70%

Pre-diabetes: 5.70%-6.40%
 Diabetes: >/=6.50%

POTASSIUM 4.51 meq/L (3.5-5.0) 4.51 mmol/L (3.5-5.0)

SODIUM L 131.00 meq/L (135.00-148.00) 131.00 mmol/L (135.00-148.00)

 DRUG NAMES MECHANISM OF ACTION INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

GENERIC NAME  Type 1 (insulin-dependent)  Low blood sugar. Symptoms may  Instruct patient how to administer
diabetes mellitus and type 2 insulin subcutaneously
Insulin glargine (rDNA origin) Long-acting insulin form. include:
(non-insulin dependent)  Advise patient to rotate subcutaneous
Promotes glucose transport, diabetes mellitus in patients o hunger injection sites and keep a record of
which stimulates carbohydrate who need long-acting insulin sites used.
BRAND NAME o nervousness
metabolism in skeletal and  Conversion from another  Teach patient how to monitor and
cardiac muscle and adipose insulin type in patients with o shakiness
Lantus record blood glucose level and, if
tissue. Also promotes type 1 diabetes mellitus who o sweating indicated, urine glucose and ketone
phosphorylation of glucose in need long-acting insulin o chills levels.
CLASSIFICATION liver, where it’s converted to  Type 2 diabetes mellitus in  Inform patient that changes in diet,
glycogen. Directly affects fat and patients receiving oral o clamminess activity, and stress level can affect
Pancreatic Hormone
protein metabolism, stimulates hypoglycemics Adults: o dizziness blood glucose level and insulin
protein synthesis, inhibits release Dosage highly individualized requirements.
o fast heart rate
of free fatty acids, and indirectly based on glucose levels and  Advise patient to wear medical
response o lightheadedness identification stating that he is diabetic
decreases phosphate and
potassium. o sleepiness and takes insulin.
o confusion  As appropriate, review all other
significant and life-threatening
o blurred vision adverse reactions and interactions,
o headache especially those related to the drugs,
tests, herbs, and behaviors mentioned
o feeling confused or not
above.
like yourself, and
irritability
 Unexplained weight gain
  Swelling in your arms, legs, feet,
or ankles (edema)
 Reactions at the injection site.
Symptoms may include:
o a small indent in your skin
(lipoatrophy)
o increase or decrease in
fatty tissue under the skin
from using the injection
site too much
o red, swollen, burning, or
itchy skin
DOSAGE CONTRAINDICATION ADVERSE EFFECTS

15 units
 Hypersensitivity to drug or Metabolic: rebound hyperglycemia
its components (Somogyi effect), hypoglycemia
ROUTE
 Hypoglycemia Skin: urticaria, rash, pruritus, redness,
SQ stinging, or warmth at injection site

FREQUENCY Other: edema, lipodystrophy, lip

hypertrophy, allergic reactions including
HS anaphylaxis

TIMING
 Drug Names Mechanism of Action Indication Side Effects Nursing Responsibilities

Generic Name: Vitamin C (ascorbic acid) and -This supplement may be given to prevent or •GI: Upset stomach or throwing up, 1. Avoid taking more than one multivitamin
zinc are two essential treat certain deficiencies caused by poor Diarrhea, Constipation. product at the same time unless your doctor
Vitamin C + Zinc micronutrients that play nutrition, different diseases, medications, or tells you to. Taking similar products
important functional roles in pregnancy. together can result in an overdose or serious
nutrition, immune support and side effects.
maintenance of health. Vitamin C
Brand Name: is a cofactor for several enzymes
involved in the biosynthesis of -Reduce the severity of symptoms associated
VitaCinc collagen, carnitine and with the common cold or to promote overall 2.Avoid the use of salt substitutes in your
neurotransmitters. wellness. diet if your multivitamin and mineral
contain potassium. If you are on a low-salt
diet, ask your doctor before taking a vitamin
Classification: or mineral supplement.

Vitamins and Minerals

3.Do not take this medicine with milk, other

dairy products, calcium supplements, or
Dosage: antacids that contain calcium. Calcium may
Contraindications Adverse Effects make it harder for your body to absorb
1 tab certain minerals.
-Hypersensitivity to any of the component of Anaphylactic Reaction: rash; hives; itching;
the formulation red, swollen, blistered, or peeling skin with
- Active peptic ulcer or without fever; wheezing; tightness in the
Route: 4.Use Vitamin C Plus Zinc exactly as
- Severe hypotension chest or throat; trouble breathing,
directed on the label, or as prescribed by
PO swallowing, or talking; unusual hoarseness;
your doctor. Do not use in larger or smaller
or swelling of the mouth, face, lips, tongue, amounts or for longer than recommended.
or throat.

Frequency:
GI: Vomiting, severe diarrhea, severe
OD constipation

MS: Muscle weakness, numbness and

tingling
Timing:

8am

Drug Names Mechanism of Action Indication Side Effects Nursing Responsibilities

Generic Name: The B- complex vitamins act as Used for Vit B complex deficiencies - Headache 1. Monitor vital signs.
coenzyme and are essential for neuritis, polyneuritis, neuralgia, lumbalgia,
Vitamin B Complex the metabolism of proteins intercostal and trigeminal neuralgia. -Paresthesia
carbohydrates and fatty acids.
-Blurred vision 2.Determine reticulocyte count, hct, Vit.
B12, iron, folate levels before beginning
Brand Name: - Rashes therapy.

Aduvit -Wheezing

-Diarrhea 3.Obtain a sensitivity history before

Classification: -Flatulence administration.

Therapeutic Anti-anemics, - Nausea and Vomiting

Food supplement
-Irritation 4.Avoid IV administration because faster
Pharmacological Multi systemic elimination will reduce
vitamins effectiveness of the vitamin.

Dosage: 5.Don’t give large doses of Vitamin B12

routinely, drug is lost through excretion.
1 tab

6.Don’t mix parenteral preparation in same

Route: syringe with other drugs.

PO

Contraindications Adverse Effects

Sensitivity to any of the ingredients included CNS: Headache, dizziness, insomnia,

in the medication fatigue, tiredness, Derma, Rash, pruritus,
Frequency: sweating, dry MM, stomatitis
OD
GI: dyspepsia, GI pain, diarrhea, vomiting

GU: Dysuria renal impairment

Timing:

8am
Drug Names Mechanism of Action Indication Side Effects Nursing Responsibilities
Generic Name: Inhibits DPP-4 and slows
inactivation of incretin  upset stomach
Sitagliptin hormones, helping to regulate  diarrhea
1. Monitor renal function periodically.
glucose homeostasis through  stomach pain
increased insulin release and  upper respiratory infection 2. Measure patient’s weight and body mass
Brand Name: decreased glucagon levels. Adjunct to diet and exercise to  stuffy or runny nose and sore throat index periodically during therapy.
improve glycemic control in type 2 diabetes  headache
Januvia mellitus.
3. Monitor blood glucose and
hemoglobin A1c levels periodically
during therapy.
Classification:
4. Monitor patient for signs and symptoms
DPP-4 inhibitors (gliptins).
of hypersensitivity reactions and
CLINICAL: Antidiabetic
immediately stop drug and institute
agent
emergency measures if such reactions
occur.
Dosage:
5. Check for diabetes signs and symptoms
Contraindications Adverse Effects and disease progression routinely.
50mg
CNS: headache 6. Be aware of post marketing reports of
History of serious hypersensitivity to acute pancreatitis, including fatal and
Route:
drug (such as anaphylaxis or nonfatal hemorrhagic or necrotizing
EENT: nasopharyngitis
angioedema) pancreatitis. If pancreatitis is suspected,
PO
promptly discontinue drug.
GI: abdominal pain, nausea, vomiting,
diarrhea, pancreatitis
Frequency:

OD GU: acute renal failure

Respiratory: upper respiratory tract

Timing: infection

8am
Other: hypersensitivity reactions (including
anaphylaxis, angioedema, exfoliative skin
conditions such as Stevens-Johnson
syndrome)
 Name of the Drug Mechanism Of Action Indication/s Side Effects/Adverse Reactions Nursing Responsibilities

Generic Name: Linagliptin belongs to a group of Indicated as an adjunct to diet and Nasopharyngitis -Before taking linagliptin, assess if the
medicines called exercise to improve glycemic client has allergies to medication.
Linagliptin dipeptidylpeptidase-4 inhibitors control in adults with type 2
(DPP-4 inhibitors) or gliptins. It's diabetes mellitus. Hyperlipidemia (with pioglitazone)
used to treat type 2 diabetes, which -Before using this medication, tell your
Brand Name: is caused by problems with a doctor about your medical history,
hormone in your body called
Tradjenta Cough (with metformin and especially of disease of the
insulin. Gliptins help your body pancreas(pancreatitis).
sulfonylurea)
make more insulin.

Classification:
Hypertriglyceridemia (with -You may experience blurred vision,
dizziness, or drowsiness due to extremely
Antidiabetics Contraindication/s sulfonylurea) low or high blood sugar levels.

Dosage: Weight gain (with pioglitazone)

5mg/tab Hypersensitivity-Type 1 diabetes Hypoglycemia -Do not drive, use machinery, or do any
mellitus-Diabetic ketoacidosis. activity that requires alertness or clear
Incidence similar to placebo with mono vision until you are sure you can perform
therapy or combined with metformin or such activities.
Route: pioglitazone.
PO

Frequency:

OD

Timing:

8AM
 DRUG NAME MECHANISM OF ACTION INDCATION SIDE EFFECTS NURSING INTERVENTION

GENERIC NAME: Humulin R lowers blood glucose by
Isophane Insulin stimulating peripheral glucose uptake by
skeletal muscle and fat and by inhibiting
hepatic glucose production. Insulin inhibit
lipolysis and proteolysis and enhance
protein synthesis.
BRAND NAME:
Humulin R, 70/30
Humulin 70/30 is a fixed ratio premix -Injection site reactions (pain redness,
recombinant human insulin formulation irritation)
indicated to improve glycemic control in -Diarrhea
adult patient’s diabetes mellitus -back pain
-Headache
-Body fat redistribution
-Low blood sugar including sweating,
tremors, irritability, fainting or seizure.
-Monitor patient response to therapy
(stabilization of blood glucose levels).
-Monitor for adverse effects
(hypoglycemia, ketoacidosis, injection-site
irritation)
-Evaluate patient understanding on the
drug therapy by asking the patient name
the drug, its indication, and adverse effects
to watch for

CLASSIFICATION:
Antidiabetic Drugs

DOSAGE: Reference; CONTRAINDICATION ADVERSE EFFECTS

5 units https;//www.rxlist,com/humulin-70/30-
druug.htm
Humulin 70/30 is contraindicated during Allergic Reactions
the episodes of hypoglycemia (see Peripheral Edema
precautions and warnings) and in patients Lipodystrophy
who had hypersensitivity reactions to Weight gain
ROUTE: Humulin 70/30 or any of its excipients (see
Subcutaneous precautions and warnings)
FREQUENCY:
OD

Date Focus Time DAR

11/19/20 Watery stools 8am D : “Nagsigera gyudlutawiyanghunahuna day nyaikapilananisiyanalibang” as verbalized by the
SO.----------------------------------------------

F : Received patient sitting on bed, exhausted, conscious, and afebrile with ongoing IVF of PNSS 1L @4Occ/hr,
infusing well, O2 @ 4L/hr. via NC, exhibits body malaise and memory loss, passes out foul-smelling, watery
stools approx. 5x a day, with the following vital signs BP: 100/80mmHg, TEMP: 36.2 oC, PR: 93 bpm, RR: 30
bpm& O2 sat @ 94%.----------------------------------------------------------------------

A: Placed patient in a position of comfort, Assessed the degree of dehydration, monitored vital signs and
charted, increased oral fluid intake, Encouraged patient to eat food high in sodium but still strictly follow low
salt low fat & full diabetic diet with SAP given by physician, monitored color, frequency, consistency, amount
of stools, and monitored IVF and regulated to its desired rate.------------

R: Patient regained normal frequency and consistency of stool, conscious and alert, afebrile, with O 2decreased
to3-4 LMP via NC, V/S q2 with O 2 sat, I/O q4. Patient for transfer to other institution, Provide copy of labs prior
to transfer.------------------------------------------

1pm
References

https://nurseslabs.co
m/ineffective-breathing-pattern/
www.nurseslabs.com

https://nurseslabs.com/hyperthermia

https://www.who.int/health-topics/coronavirus#tab=tab_1

https://www.mayoclinic.org/diseases-conditions/coronavirus/symptoms-causes/syc-20479963
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266583/
https://www.wikidoc.org/index.php/COVID-19_pathophysiology
Kizior, R. (2014). Saunders Nursing Drug Handbook. Pg.79-81

Nursing 2019 drug handbook pp.188-191 (Wolters kluwer)

Nursing 2019 drug handbook pp.1252-1254
Nurse`s Pocket Guide 13th Ed. Marlynn E. Doenges, Mary Frances Moorhouse, Alice C. Murr P167 13th edition
Saunders (2014). Nursing drug hand book.
Schull, P.D., (2013). McGraw – Hill Nurse’s Drug Handbook 7th Edition.
The Mc-Graw – Hill Companies, Inc
www.scibd,com