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Case Study Final Najud
Case Study Final Najud
__________________________________________________________
PHINMA
COLLEGE OF NURSING
Thursday
Level 3 Section A
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
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.
9. Have further readings about the news and updates related to the diagnosis or management of
the patient.
INTRODUCTION
DEFINITION OF DISEASE
COVID-19
Fever
Dry cough
Tiredness
Sore throat
Diarrhea
Conjunctivitis
Headache
Serious symptoms:
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 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.
IMMUNOLOGY
Test Result: SARS-COV-2 (Causative Agent of COVID 19) viral RNA detected
Interpretation Positive for SARS CoV2 viral RNA
:
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.
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
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
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
DISEASE DEFINITION
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:
URINE ANALYSIS
IMMUNOLOGY
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.
DOSAGE:
4.5 mg CONTRAINDICATION ADVERSE EFFEC
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
DOSAGE CONTRAINDICATION
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:
During the acute phase, a neurologic flow sheet is maintained to provide data about the following
important measures of the patient’s clinical status:
PROTHROMBINE TIME
HEMATOLOGY
BLOOD TYPING
Blood Type: “O” Rh: POSITIVE
D-DIMER
TUMOR MARKER
Generic Name: Famotidine 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
Brand Name: Pepcid 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
Classification: gastrointestinal the morning and at bedtime).
agent; antisecretory agent (h -Short-term treatment of GERD, Urogenital: increases in BUN and Therapy may continue for 4–6
2-receptor antagonist) 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
Dosage/ Route/ Frequency/ CONTRAINDICATION ADVERSE EFFECT while on this drug to evaluate
Timing: 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)
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
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.
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 Headache Stress that atorvastatin is an adjunct to not
HMG-CoA reductase, the enzyme heart attack in type 2 diabetes a substitute for low-cholesterol diet
Generic Name: that catalysis the conversion of patients without evidence of heart Flatulence
Atorvastatin HMG-CoA to mevalonic acid. This disease but with other CV risk
results in the induction of the LDL factors, and revascularization Diarrhea Tell patient to take drug at the same time
Brand Name: receptors, leading to lowered LDL- procedures in patients without each day to maintain its effects
cholesterol concentration. evidence of coronary heart disease Nausea
Lipitor
(CHD) but with multiple risk
Classification: factors other than diabetes Vomiting
Instruct patient to take a missed dose as
(smoking, HTN, low HDL-C,
Statins soon as possible. If it’s almost time for his
family history of early Anorexia
next dose, he should skip the missed dose.
CHD)Patients with CHD, to reduce
Dosage:
risks of MI, revascularization Xerostomia
40mg/tab procedures, hospitalization for
CHF, and angina Angio edema Advise patient to notify prescriber
Route: immediately if he develops unexplained
Myalgia muscle pain, tenderness, or weakness,
PO
especially if accompanied by fatigue or
Frequency: Rash/pruritus fever
Contraindication/s
DO Hypersensitivity, active liver
disease or unexplained persistent Alopecia
Timing: elevations of serum transaminase,
porphyria, pregnancy, lactation Allergy
8AM Infection
Chest pain
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
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 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:
CLINICAL CHEMISTRY
GPT/ALT+
URIC ACID + L 3.80 mg/dL M: 4.0 - 8.5 225.0 umol/L M:237 – 503
BLOOD GLUCOSE
Pre-diabetes: 5.70%-6.40%
Diabetes: >/=6.50%
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
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.
Frequency:
GI: Vomiting, severe diarrhea, severe
OD constipation
8am
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
PO
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:
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.
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 Humulin 70/30 is a fixed ratio premix -Injection site reactions (pain redness, -Monitor patient response to therapy
Isophane Insulin stimulating peripheral glucose uptake by recombinant human insulin formulation irritation) (stabilization of blood glucose levels).
skeletal muscle and fat and by inhibiting indicated to improve glycemic control in -Diarrhea
hepatic glucose production. Insulin inhibit adult patient’s diabetes mellitus -back pain -Monitor for adverse effects
lipolysis and proteolysis and enhance -Headache (hypoglycemia, ketoacidosis, injection-site
protein synthesis. -Body fat redistribution irritation)
BRAND NAME: -Low blood sugar including sweating,
Humulin R, 70/30 tremors, irritability, fainting or seizure. -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
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