Arcipe Iccu Case 5

SOUTHWESTERN UNIVERSITY
__________________________________________________
PHINMA
COLLEGE OF NURSING
December 10, 2020

Thursday
Level 3 Section A
Arcipe, Nathaniel Dean G.
Dr. Adriel Arman V. Pizarra, DHCM, MAN, RN

___________________________________________
Clinical Instructor
INTRODUCTION
CKD is a condition in which the kidneys are damaged and cannot filter blood
as well as they should. Because of this, excess fluid and waste from blood
remain in the body and may cause other health problems, such as
heart disease and stroke. One Filipino develops chronic renal failure every
hour or about 120 Filipinos per million in the population per year. More than
5,000 Filipino patients are presently undergoing dialysis and approximately
1.1 million people worldwide are on renal replacement therapy.
DEFINITION OF DISEASE
CHRONIC KIDNEY DISEASE

Chronic kidney disease includes conditions that damage your kidneys
and decrease their ability to keep you healthy by fulfilling their functions. If
kidney disease gets worse, wastes can build to high levels in your blood and
make you feel sick. You may develop complications like high blood pressure,
anemia (low blood count), weak bones, poor nutritional health and nerve
damage. Also, kidney disease increases your risk of having heart and blood
vessel disease. These problems may happen slowly over a long period of time.
Chronic kidney disease may be caused by diabetes, high blood pressure and
other disorders. Early detection and treatment can often keep chronic kidney
disease from getting worse. When kidney disease progresses, it may
eventually lead to kidney failure, which requires dialysis or a kidney transplant
to maintain life.
The two main causes of chronic kidney disease are diabetes and high
blood pressure, which are responsible for up to two-thirds of the cases.
Diabetes happens when your blood sugar is too high, causing damage to many
organs in your body, including the kidneys and heart, as well as blood vessels,
nerves and eyes. High blood pressure, or hypertension, occurs when the
pressure of your blood against the walls of your blood vessels increases. If
uncontrolled, or poorly controlled, high blood pressure can be a leading cause
of heart attacks, strokes and chronic kidney disease. Also, chronic kidney
disease can cause high blood pressure.
Nephrosclerosis Involvement
Nephrosclerosis is basically the hardening of the walls of the small
arteries and arterioles (small arteries that convey blood from arteries to the
even smaller capillaries) of the kidney. This condition is caused by
hypertension (high blood pressure).
Hypertensive nephrosclerosis (HN) is defined as chronic kidney
disease caused by nonmalignant hypertension (HTN). HN is the presumed
underlying disease in 10–30% of patients with end-stage renal disease
worldwide. HN typically presents without proteinuria or any abnormalities in
the urine sediment.
ASSESSMENT OF SIGNS AND SYMPTOMS
The disease process of CKD first has renal involvement. However, as the
disease progresses, a lot of other symptoms may already involve different
organ systems of the body. Chronic kidney disease (CKD) can progress silently
over many years, with no signs or symptoms or with ones that are too general
for a person to suspect as related to kidney function. Routine lab tests done
during a health examination can help detect early warning signs of kidney
disease such as:
 Hematuria
 Proteinuria
 Decreased estimated glomerular filtration rate (eGFR)
 Elevated creatinine and urea (blood urea nitrogen or BUN)
Other signs and symptoms may include:
 Swelling or puffiness, particularly around the eyes or in the face, wrists,

abdomen, thighs or ankles
 Urine that is foamy, bloody, or coffee-colored
 A marked decrease in the amount of urine
 Problems urinating, such as a burning feeling or abnormal discharge
during urination, or a change in the frequency of urination, especially at
night
 Mid-back pain (flank), below the ribs, near where the kidneys are located
 High blood pressure (hypertension)
As kidney disease worsens, additional signs and symptoms may include a

combination of the following:
 Feeling itchy
 Tiredness, loss of concentration
 Loss of appetite, nausea and/or vomiting
 Numbness in hands and feet
 Darkened skin
 Muscle cramps
 Gout
Acute kidney injury (AKI) is a sudden loss of kidney function and can be
fatal. It requires prompt treatment. Symptoms may include:
 Urinating less frequently

 Fluid retention, causing swelling in the legs, ankles or feet
 Drowsiness, fatigue
 Shortness of breath
 Nausea
 Confusion
 Seizures or coma
 Chest pain
Most people may not have any severe symptoms until their kidney disease is
advanced. However, you may notice that you:
 feel more tired and have less energy

 have trouble concentrating
 have a poor appetite
 have trouble sleeping
 have muscle cramping at night
 have swollen feet and ankles
 have puffiness around your eyes, especially in the morning
 have dry, itchy skin
 need to urinate more often, especially at night.
Predisposing Factors:
 Family History of Kidney Failure
 Inherited Kidney Abnormality
 Age
 Race
Precipitating Factors:
 Diabetes
 Hypertension
Complications:
 Gout
 Anemia
 Metabolic Acidosis
 Bone Disease
 Hyperphosphatemia
 Hyperkalemia
 Fluid buildup
Assessment
► Assessment of patient’s health status
► Screen people at risk for CKD, including those with

► Diabetes mellitus type 1 or type 2
► Hypertension
► Cardiovascular disease (CVD)
► Family history of kidney failure
► Assessment of renal function
► Monitoring of vital signs
LABORATORY A ND DIAGNOSTIC STUDIES
 Blood Test for GFR

o A blood test checks how well your kidneys are filtering your
blood, called GFR. GFR stands for glomerular filtration rate. Your
health care provider will use a blood test to check your kidney
function. The results of the test mean the following:
 A GFR of 60 or more is in the normal range. Ask your
health care provider when your GFR should be checked
again.
 A GFR of less than 60 may mean you have kidney disease.
Talk with your health care provider about how to keep
your kidney health at this level.
 A GFR of 15 or less is called kidney failure. Most people
below this level need dialysis or a kidney transplant. Talk
with your health care provider about your treatment
options.
 Creatinine Test
o Creatinine is a waste product from the normal breakdown of
muscles in your body. Your kidneys remove creatinine from your
blood. Providers use the amount of creatinine in your blood to
estimate your GFR. As kidney disease gets worse, the level of
creatinine goes up.
 Urine Test for Albumin
o A urine test checks for albumin. If you are at risk for kidney
disease, your provider may check your urine for albumin.
Albumin is a protein found in your blood. It can pass into the
urine when the kidneys are damaged. A healthy kidney doesn’t
let albumin pass into the urine. A damaged kidney lets some
albumin pass into the urine. The less albumin in your urine, the
better. Having albumin in the urine is called albuminuria. A
health care provider can check for albumin in your urine in two
ways:
 Dipstick test for albumin. A provider uses a urine
sample to look for albumin in your urine. You collect the
urine sample in a container in a health care provider’s
office or lab. For the test, a provider places a strip of
chemically treated paper, called a dipstick, into the urine.
The dipstick changes color if albumin is present in the
urine.
 Urine albumin-to-creatinine ratio (UACR). This test
measures and compares the amount of albumin with the
amount of creatinine in your urine sample. Providers use
your UACR to estimate how much albumin would pass into
your urine over 24 hours. A urine albumin result of:
 30 mg/g or less is normal
 more than 30 mg/g may be a sign of kidney disease
 Imaging techniques
o If a structural problem or blockage is suspected, imaging of the
kidneys can be helpful. Imaging techniques such as an
ultrasound, CT scan (computed tomography), isotope scan, or
intravenous pyelogram (IVP) may be used.
 Kidney biopsy
o A biopsy is sometimes used to help determine the nature and
extent of structural damage to a kidney. Analyzing a small piece
of kidney tissue, obtained using a biopsy needle and diagnostic
imaging equipment, can sometimes be useful when disease of
the glomeruli (or sometimes the tubules) is suspected.
 Tests for biomarkers of acute kidney injury
o Several biomarkers are gaining attention as early indicators of
acute kidney injury (AKI). Studies suggest that blood or urine
tests for these biomarkers can detect acute kidney damage
earlier than currently used kidney function tests, such as serum
creatinine. Early detection of AKI is critical because injury occurs
rapidly over a period of hours to days. AKI biomarkers are still
being studied and may become more widely available in the
future.
PATIENT’S LAB RESULTS
TEST: CLINICAL CHEMISTRY
Test Result Unit Reference Range
Creatinine 7.18 mg/dL 0.51 – 0.95
Sodium 134.0 mmol/L 136 – 145
Potassium 6.30 mmol/L 3.5 – 5.1
Calcium (Ionized) 1.09 mmol/L 1.13 – 1.31
Phosphorus 12.24 mmol/L 2.4 – 4.5
Blood Urea Nitrogen 143.30 mg/dL 6.0 – 20.0

(BUN)
Blood Uric Acid (BUA) 9.90 mg/dL 2.7 – 7.3
Albumin 2.19 mg/dL 3.97 – 4.94
ALT/SGPT 12 U/L < 34
eGFR: 6 (Normal: >90)

Explanation:
Clinical chemistry uses chemical processes to measure levels of chemical

components in body fluids and tissues. The most common specimens used in
clinical chemistry are blood and urine. Many different tests exist to detect and
measure almost any type of chemical component in blood or urine.
A lot of the patient’s lab results shown are abnormal. The only one that is
normal is the ALT/SGPT which indicates that the liver is functioning normally.
The patient’s levels of creatinine, sodium, potassium, phosphorus, BUN, and
BUA are elevated, indicating kidney problems. The low level of albumin
substantiates this diagnosis. Meanwhile, the patient’s ionized calcium is low
which suggests that the patient might be suffering from hypoparathyroidism.
The patient’s eGFR number is very low, again, indicating kidney problems.
TEST: ULTRASOUND
SONOGRAPHIC REPORT
IMPRESSION:
1. NORMAL-SIZED LIVER WITH MILD DIFFUSE FATTY CHANGES DEMONSTRATED

2. MASSIVE AMOUNT ASCITES
3. THICKENED GALLBLADDER WALL LIKELY DUE TO ASCITES
4. SMALL-SIZED ECHOGENIC KIDNEYS AS DESCRIBED. CONSIDER CHRONIC
INTRINSIC RENAL PARENCHYMAL DISEASE, BILATERAL.
5. SIMPLE SMALL RENAL CORTICAL CYST, LEFT
6. NORMAL SONOGRAM OF THE PANCREAS AND SPLEEN
7. NORMAL SONOGRAM OF THE URINARY BLADDER WITH SIGNIFICANT AMOUNT
RESIDUAL URINE VOLUME DEMONSTRATED. Clinical correlation is suggested.
8. NORMAL-SIZED ANTEVERTED UTERUS.
Explanation:
An ultrasound scan uses high-frequency sound waves to make an image of a
person's internal body structures. Doctors commonly use ultrasound to study
a developing fetus (unborn baby), a person's abdominal and pelvic organs,
muscles and tendons, or their heart and blood vessels.
The patient’s sonographic impressions have a lot of normal findings. However,
some of them show abnormalities. These are most noted in the impressions
that stated that a “small renal cortical cyst” is present as well as the possibility
of an “intrinsic renal parenchymal disease” might be considered, which brings
us to our patient’s CKD diagnosis.
TEST: BLOOD GAS ANALYSIS
Test Result Unit Reference

Range
pH 7.234 -- 7.350 – 7.450
pCO2 37.9 mmHg 35.0 – 45.0
pO2 219.7 mmHg 80.0 – 100.0
HCO3- 15.9 mmol/L 22.0 – 26.0
BE(ecf) -11.70 mEq/L ±2.0
O2 Sat 99.2 % >95.0
Temperature: 36.5°C
Remarks: SPECIMEN SENT TO LABORATORY
Written: metabolic acidosis
Explanation:
A blood gas test provides a precise measurement of the oxygen and carbon
dioxide levels in your body. This can help your doctor determine how well your
lungs and kidneys are working. This is a test that is most commonly used in
the hospital setting to determine the management of acutely ill patients.
The patient’s results in this test show the occurrence of an abnormality in this
aspect. The pH is low, meaning that there is acidosis present. The high level
of pO2 indicates respiratory compensation, which leads us to the written
remark of metabolic acidosis, which can be connected to kidney failure, as the
urinary system is involved in maintaining the body’s pH balance.
TEST: URINALYSIS
Test Result Reference Range
MACROSCOPIC EXAMINATION
Color LIGHT YELLOW -

Volume 60ml -
Transparency CLOUDY
Specific Gravity 1.010 1.003 – 1.035
CHEMICAL EXAMINATION
Albumin 3+ -
pH 6.0 5.0 – 8.0
Ketone NEGATIVE -
Blood TRACE -
Glucose 2+ -
Nitrite NEGATIVE -
Bilirubin NEGATIVE -
Urobilinogen NORMAL -
MICROSCOPIC EXAMINATION
WBC TNTC/HPF 0-5/HPF

RBC 3-5/HPF 0-3/HPF
Epithelial Cells ABUNDANT -
Mucus Threads RARE -
Bacteria MODERATE -
Calcium Oxalates RARE -
Remarks: TNTC – TOO NUMEROUS TO COUNT
Explanation:
A urinalysis is used to detect and manage a wide range of disorders, such as
urinary tract infections, kidney disease and diabetes. A urinalysis involves
checking the appearance, concentration and content of urine. Abnormal
urinalysis results may point to a disease or illness.
A lot of the parameters in the patient’s urinalysis point towards an
abnormality, specifically involving the kidneys. The presence of albumin,
blood, and other substances indicate that the kidneys are not functioning
properly. Moreover, glucose in the urine indicates diabetes, and increased
WBC suggests an infection.
TEST: HEMATOLOGY
Blood Type: “O”
Rh: Positive
Reticulocyte Count 5.3 % Adult: 0.5 – 1.5
Newborn: 2.5 – 6.5
Explanation:
A reticulocyte count is a test your doctor can use to measure the level of
reticulocytes in your blood. It is also known as a retic count, corrected
reticulocyte count, or reticulocyte index. It can help your doctor learn if your
bone marrow is producing enough red blood cells.
The patient’s reticulocyte count is higher than the normal adult range. This
indicates that anemia is present, which is a complication of CKD.
Pathophysiology
Predisposing Factors: Precipitating Factors
 Genetic Predisposition
 Family History of Kidney
Disease
Diabetes Hypertension
 Race
Legend
 Part of Pathological Process

 Decreased nitric oxide ↑RBF and
 Disease
 Increased RAS Glomerular Sodium retention
 Diagnostic Tests
 Complications  Insufficient HIF activation Hyperfiltration
 Signs and Symptoms  Decreased AMPK
 Explanation  Tubulointerstitial injury
 Treatment  Microvascular rarefaction
 Increased tubular reabsorption

Drug Side Effects
Glomerulosclerosis
 Nursing Diagnosis
Increased oxygen consumption
The following diagnostic studies

will show abnormal results at
this point:  Hematuria
 Blood Test for GFR Tissue hypoxia  Proteinuria
 Creatinine Test  Edema
 Urine Test for Albumin  Decreased urine
 Imaging Techniques output
 Kidney Biopsy  Urination problems
 Biomarker Test Chronic Kidney Disease
 Mid-back pain
Gout Anemia Hyperkalemia Fluid Buildup
Imbalanced Nutrition: Imbalanced Nutrition:

Less than body More than body Fluid Volume Excess
Acute Pain requirements requirements
Drug Therapy: Drug Therapy: Drug Therapy:

Colchicine Erythropoietin Furosemide
 Diarrhea  High blood

 Thirst
 Nausea pressure
 Dry mouth
 Cramping  Swelling
 Headaches
 Abdominal  Fever
 Confusion
pain  Dizziness
 Dizziness
 Vomiting  Nausea
 Muscle cramps
 Pain at
injection site
Explanation:
A number of predisposing factors as well as precipitating conditions influence the occurrence of

CKD, which is a product of renal dysfunction. When renal function is impaired, the kidneys are not
able to properly maintain fluid and electrolyte balance. The decline of urine concentration ability
would then be apparent followed by decrease in ability to excrete excess phosphate, acid, and
potassium, causing various complications.
DRUG STUDIES
DRUG NAME MECHANISM OF INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

ACTION
GENERIC NAME: Resotres body’s Metabolic acidosis;  CNS: headache, irritability, BEFORE
Sodium Bicarbonate buffering capacity; urinary alkalization; confusion, stimulation,  Explain the drug and rationale
(NaHCO3) neutralizes excess renal tubular acidosis; tremors, twitching, of administration to the
acid. antacid hyperreflexia, weakness patient.
 CV: irregular pulse, edema  Assess the patient for
BRAND NAME:
 GI: gastric distention, conditions in which the drug is
Neut
contraindicated.
belching, flatulence, acid
CLASSIFICATION: reflux
DURING
Alkalinizer,  GU: renal calculi
 For IV use, infuse at
Antacid  Metabolic: hypokalemia, fluid
prescribed rate using
retention, hypernatremia
DOSAGE: controlled infusion device.
 Respiratory: slow and shallow
650mg/tab  Do not give concurrently with
respirations
calcium or catecholamines.
 Other: weight gain, pain and
ROUTE:  When giving IV, closely
inflammation at IV site
Oral monitor arterial blood gas
results and electrolyte levels.
FREQUENCY:  Stay alert for signs and
TID symptoms of metabolic
alkalosis and electrolyte
TIMING: imbalances.
8AM – 1PM – 6PM
Source:  Monitor fluid intake and
Schull, P.D., (2013). output.
McGraw – Hill  Assess for fluid overload.
Nurse’s Drug
Handbook 7th Edition.
The McGraw – Hill AFTER
Companies, Inc.  Tell patient using drug as
antacid that too much sodium
bicarbonate can cause
systemic problems.
 Advise patient not to take oral
form with milk.
CONTRAINDICATION ADVERSE EFFECTS
 As appropriate, review all
other significant and life-
Hypocalcemia;  CNS: seizures of alkalosis,
threatening adverse reactions
metabolic or respiratory tetany
alkalosis; and interactions.
 CV: cardiac arrest
hypernatremia;  GI: paralytic ileus
hypokalemia; severe  Metabolic: hyperosmolarity
pulmonary edema; (with overdose), metabolic
seizures; vomiting
alkalosis
resulting in chloride
 Respiratory: cyanosis, apnea
loss; diuretic use
resulting in
hyochloremic alkalosis;
acute ingestion of
mineral acids (oral
form)
ACTION
GENERIC NAME: Ferrous sulfate is an Prevention and  CNS: headaches, dizziness BEFORE
Ferrous Sulfate essential mineral treatment of iron-  GI: nausea, vomiting,  Explain the drug and rationale
(FeSO4) + B-Complex found in hemoglobin, vitamin and dietary diarrhea, constipation, dark of administration to the
+ Folic Acid myoglobin, and many deficiency anemia; stools, stomach pain patient.
enzymes. Enters the used in anemia due to  GU: urine discoloration  Observe proper dosage of
BRAND NAME: bloodstream and is blood loss during  Other: pain at IM site medication.
Foralivit transported to the menstruation,  Note other drugs patient is
organs of the infections, surgery, taking to avoid possible
CLASSIFICATION: reticuloendothelial delivery, intoxications, interactions.
Mineral supplement, system (liver, spleen, parasitic infections, or
Anti-anemic bone marrow), where other causes and DURING
it is separated out anemias during  Administer drug 1 to 2 hours
DOSAGE: and becomes part of pregnancy before meals for maximum
450mg/cap iron stores. absorption.
Moreover, B-complex  Administer drug with a full
ROUTE: is a group of water- glass of water or orange juice.
Oral soluble vitamins that  Instruct patient not to crush
are found especially or chew enteric-coated tablets
FREQUENCY: in yeast, seed germs, and not to open capsules.
BID eggs, liver and flesh,  Monitor patient’s blood
and vegetables that studies.
TIMING: have varied  Assess patient’s bowel
8AM – 6PM metabolic functions function.
and include
coenzymes and CONTRAINDICATION ADVERSE EFFECTS
growth factors. Folic
acid helps to make Hemochromatosis,  CNS: seizures AFTER
red blood cells and is hemosiderosis, or  CV: hypertension, hypotension  Encourage patient to avoid
found in many food other evidence of iron  GI: gastrointestinal using antacids, coffee, tea,
sources. overload; anemias not perforation, gastrointestinal and dairy products within 1
due to iron deficiency obstruction hour after administration.
 Inform patient about dark or
Source: black stools to avoid panic.
Hodgson, B.B., &
Kizior, R.J. (1998).
Saunders nursing
drug handbook.
and interactions.
Philadelphia:
Saunders.
ACTION
GENERIC NAME: Decreases serum uric Long-term  CNS: dizziness BEFORE

Febuxostat acid level. management of  GI: nausea  Explain the drug and rationale
hyperuricemia in  Hepatic: liver function of administration to the
BRAND NAME: patients with gout abnormalities patient.
Uloric  Musculoskeletal: arthralgia  Observe proper dosage of
 Skin: rash medication.
CLASSIFICATION:  Note other drugs patient is
Anti-gout taking to avoid possible
interactions.
DOSAGE:
40mg/tab DURING
 Administer drug with or
ROUTE: CONTRAINDICATION ADVERSE EFFECTS without food.
Oral  Monitor patient for signs and
Concomitant use of  CNS: nonfatal cerebrovascular symptoms of MI or CVA.
FREQUENCY: azathioprine, accident (CVA)  Be aware that gout flares may
OD mercaptopurine  CV: cardiovascular occur. To prevent such flares,
thromboembolic events provide concurrent
TIMING: (nonfatal myocardial infarction prophylactic treatment with a
8AM [MI], deaths) non-steroidal anti-
inflammatory drug or
colchicine, as prescribed.
 Monitor liver function tests 2
months and 4 months after
starting therapy and
periodically thereafter.
Source:
Schull, P.D., (2013). AFTER
McGraw – Hill  Instruct patient to
Nurse’s Drug immediately report
Handbook 7th Edition. cardiovascular symptoms or
The McGraw – Hill stroke-like symptoms.
Companies, Inc.  Tell patient to inform
prescriber of increased gout
symptoms or rash.
and interactions.
ACTION
GENERIC NAME: Erythropoietin (EPO) Treatment of anemia  CNS: headache, dizziness, BEFORE
Erythropoietin interacts directly with due to chronic kidney insomnia, depression  Explain the drug and rationale
the EPO receptor on disease (CKD) in  CV: hypertension of administration to the
BRAND NAME: the red blood cell patients on dialysis and  GI: nausea, vomiting, patient.
Espogen (RBC) surface, not on dialysis; stomatitis, dysphagia  Assess patients for presence
triggering activation treatment of anemia of conditions in which the
 Respiratory: cough
CLASSIFICATION: of several signal due to zidovudine in drug is contraindicated.
 Skin: pruritus, rash, urticaria
Erythropoiesis- transduction patients with HIV-  Visually inspect parenteral
 Musculoskeletal: arthralgia,
stimulating Agent pathways, resulting infection; treatment of products for particulate
myalgia, bone pain
(ESA) in the proliferation anemia due to the matter and discoloration prior
 Hematologic: leukopenia to administration whenever
and terminal effects of concomitant
DOSAGE: differentiation of myelosuppressive  Metabolic: vitamin B6 solution and container permit.
4,000 units erythroid precursor chemotherapy; deficiency, hyperglycemia,
cells and providing reduction of allogeneic hypokalemia DURING
ROUTE: protection from RBC RBC transfusions in  Other: fever, injection site  Protect vials from light.
SQ precursor apoptosis. patients undergoing reaction, weight loss, chills,  Do not shake or freeze.
elective, noncardiac, infection  Do not dilute.
FREQUENCY: nonvascular surgery  Do not administer with other
OD drug solutions in general
 Evaluate patient’s response to
TIMING: drug therapy.
8AM  Watch out for occurrence of
adverse reactions.
AFTER
CONTRAINDICATION ADVERSE EFFECTS  Encourage patient to report
adverse effects immediately.
Patients with serious  CNS: seizures, stroke  As appropriate, review all
allergic reactions, such  CV: heart failure, myocardial other significant and life-
as anaphylactic infarction, thromboembolism, threatening adverse reactions
reactions, angioedema, thrombosis and interactions.
bronchospasm, skin  Respiratory: pulmonary
Source: rash, and urticaria, to embolism, bronchospasm
Hodgson, B.B., & the product; red cell
 Hematologic: anemia,
Kizior, R.J. (1998). aplasia; hypertension
phlebitis, red cell aplasia
Saunders nursing
 Skin: edema, erythema,
drug handbook.
erythema multiforme,
Philadelphia:
Saunders. angioedema, toxic epidermal
necrolysis
 Other: antibody formation,
Stevens-Johnson syndrome,
anaphylactoid reactions
ACTION
GENERIC NAME: Reduces gastric acid Erosive esophagitis caused  CV: chest pain BEFORE
Pantoprazole secretion and by gastroesophageal reflux  EENT: rhinitis  Explain the drug and rationale
increases gastric disease (GERD); pathologic  GI: abdominal pain, of administration to the patient.
BRAND NAME: mucus and hypersecretory conditions dyspepsia  Question patient about history
Pantoloc bicarbonate  Metabolic: of hypersensitivity reactions to
production, creating hyperglycemia drug.
CLASSIFICATION: protective coating on
 Musculoskeletal: hip,
Proton Pump Inhibitor gastric mucosa. DURING
wrist, spine fractures
 Be aware that oral granules
(with long-term use)
DOSAGE: may be mixed with applesauce
 Skin: rash, pruritus or apple juice and given 30
40mg/cap
 Other: injection site minutes before a meal. Once
ROUTE: reaction mixed, give drug within 10
Oral minutes.
 Assess for symptomatic
FREQUENCY: improvement.
Hypersensitivity to drug or  Skin: itching, swelling  Monitor blood glucose level in
OD
any substituted  CNS: severe dizziness diabetic patient
benzimidazole  Respiratory: trouble  Tell patient to swallow delayed-
TIMING:
8AM breathing release tablets whole without
 Renal: kidney damage crushing, chewing, or splitting.
AFTER
 Tell patient they may take
tablets with or without food.
 Explain that antacids do not
affect drug absorption.
Source:  Instruct diabetic patients to
Schull, P.D., (2013). monitor blood glucose level
McGraw – Hill carefully and stay alert for signs
Nurse’s Drug and symptoms of
Handbook 7th hyperglycemia.
Edition.  As appropriate, review all other
The McGraw – Hill significant adverse reactions
Companies, Inc. and interactions.
ACTION
GENERIC NAME: Increases serum Hypocalcemic  CNS: headache, weakness, BEFORE

Calcium Carbonate calcium level through emergency; dizziness, syncope,  Explain the drug and rationale
direct effects on hypocalcemic tetany; paresthesia of administration to the
bone, kidney, and GI cardiac arrest;  CV: mild blood pressure patient.
BRAND NAME:
tract. Decreases magnesium decrease  Assess patients for presence
Calcimate
osteoclastic intoxication; exchange of conditions in which the
 GI: nausea, vomiting,
osteolysis by transfusions; drug is contraindicated.
CLASSIFICATION: diarrhea, constipation,
reducing mineral hyperphosphatemia in
Dietary Supplement, epigastric pain or discomfort
release and collagen patients with end-stage DURING
Electrolyte  GU: urinary frequency, renal
breakdown in bone. renal disease; dietary  When infusing IV, do not
Replacement Agent calculi
supplement exceed a rate of
 Metabolic: hypercalcemia 200mg/minute.
DOSAGE:  Musculoskeletal: joint pain,  Administer oral doses 1 to ½
650mg/tab back pain hours after meals.
 Respiratory: dyspnea  Know that IM or subcutaneous
ROUTE: administration is never
 Skin: rash
Oral recommended.
 Other: altered or chalky
taste, excessive thirst,  Be aware that IV route is
FREQUENCY: preferred in children.
allergic reactions
TID  Evaluate patient’s response to
drug therapy.
TIMING:  Monitor calcium levels
8AM – 1PM – 6PM frequently, especially in
elderly patients.
AFTER
Hypersensitivity to  CV: bradycardia,  Keep patient supine for 15
Source: drug; ventricular arrhythmias, cardiac arrest minutes after IV
Schull, P.D., (2013). fibrillation;  Other: anaphylaxis administration.
McGraw – Hill hypercalcemia and  Instruct patient to consume
Nurse’s Drug hypophosphatemia; plenty of milk and dairy
Handbook 7th Edition. cancer; renal calculi; products during therapy.
The McGraw – Hill pregnancy or  Refer patient to dietitian for
Companies, Inc. breastfeeding help in meal planning and
preparation.
and interactions.
ACTION
GENERIC NAME: Unclear. Thought to Acute pulmonary  CNS: dizziness, headache, BEFORE
Furosemide inhibit sodium and edema; edema caused vertigo, weakness, lethargy,  Explain the drug and rationale
chloride reabsorption by heart failure, hepatic paresthesia, drowsiness, of administration to the
BRAND NAME: from ascending loop cirrhosis, or renal restlessness, light- patient.
Lasix of Henle and distal disease; hypertension headedness  Question patient about history
renal tubules. of hypersensitivity reactions
 CV: hypotension, orthostatic
CLASSIFICATION: Increases potassium to drug.
hypotension, tachycardia,
Diuretic, excretion and plasma
volume depletion
Antihypertensive volume, promoting DURING
 EENT: blurred vision,
renal excretion of  Watch for signs and
xanthopsia, hearing loss,
DOSAGE: water, sodium, symptoms of ototoxicity.
40mg/tab chloride, magnesium, tinnitus
 Monitor CBC, BUN, and
hydrogen, and  GI: nausea, vomiting,
electrolyte, uric acid, and CO2
ROUTE: calcium. diarrhea, constipation,
levels.
Oral dyspepsia, oral and gastric
 Monitor blood pressure, pulse,
irritation, cramping, anorexia,
fluid intake and output, and
FREQUENCY: dry mouth
weight.
OD  GU: excessive and frequent
 Assess blood glucose levels in
urination, nocturia,
patients with diabetes
TIMING: glycosuria, bladder spasm
mellitus.
8AM  Hematologic: anemia,
 Monitor dietary potassium
purpura
intake. Watch for signs and
 Hepatic: jaundice
symptoms of hypokalemia.
 Metabolic: hyperglycemia,
hyperuricemia, dehydration,
hypokalemia, AFTER
hypomagnesemia,  Caution patient to avoid
hypocalcemia driving and other hazardous
 Musculoskeletal: muscle pain, activities until he knows how
muscle cramps drug affects concentration and
 Skin: photosensitivity, rash, alertness.
Source: diaphoresis, urticaria,  Instruct patient to move
Schull, P.D., (2013).
pruritus, exfoliative slowly when rising, to avoid
McGraw – Hill
dermatitis dizziness from sudden blood
Nurse’s Drug
 Other: fever, transient pain at pressure decrease.
I.M. injection site  Encourage patient to discuss
The McGraw – Hill
Companies, Inc. need for potassium and
CONTRAINDICATION ADVERSE EFFECTS magnesium supplements with
prescriber.
Hypersensitivity to drug  CV: necrotizing angiitis,  Caution patient to avoid
or other sulfonamides; thrombophlebitis, alcohol and herbs while taking
anuria arrhythmias this drug.
 GI: acute pancreatitis  Inform patient that they will
 GU: oliguria, interstitial undergo regular blood testing
nephritis during therapy.
 Hematologic: leukopenia,  As appropriate, review all
thrombocytopenia, hemolytic other significant and life-
anemia threatening adverse reactions
 Metabolic: hypochloremic and interactions.
alkalosis
 Skin: erythema multiforme
DRUG NAME MECHANISM OF INDICATION SIDE EFFECTS NURSING REPONSIBILITIES
ACTION
GENERIC NAME: It combines the anti- Inflammatory infection  EENT: mild BEFORE
Chamomile Extract + inflammatory, deodorant of the buccal and mucosal irritation  Explain drug and rationale of
Methyl Salicylate + and accelerated wound pharyngeal cavity; administration to patient.
Natural Oil Extract healing properties of parodontosis; acute  Observe proper drug dose.
chamomile with the gingivitis; pain after  Assess patient for conditions in
BRAND NAME: bacteriostatic and tooth extraction and which the drug is
Kamillosan fungistatic effects of the during 2nd dentition; contraindicated.
essential oils. It is mucosal irritation
CLASSIFICATION: therefore suited for the caused by dental DURING
Oral Ulceration and relief of inflammatory plates; tonsillary  Do not spray directly into the
Inflammation Preparation infection of the buccal angina; canker sores nose.
and pharyngeal cavity. and bad breath  Apply two sprays of Kamillosan
DOSAGE: into patient’s mouth three times
400mg/ml (spray) CONTRAINDICATION ADVERSE EFFECTS a day after meals.
Hypersensitivity to drug  Respiratory:  Evaluate patient’s response to
ROUTES: and anethole difficulty breathing drug therapy.
Oral Spray  EENT: swelling of
throat AFTER
FREQUENCY:  Encourage patient to report
TID occurrence of adverse effects
immediately.
TIMING: Source:  Encourage patient to adhere to
8AM – 1PM – 6PM Hodgson, B.B., & Kizior, medication regimen.
R.J. (1998). Saunders  Store at temperatures not
nursing drug handbook. exceeding 30°C.
Philadelphia: Saunders.  As appropriate, review all other
significant and life-threatening
adverse reactions and
interactions.
ACTION
GENERIC NAME: Inhibits the enzyme Acute bacterial  CNS: dizziness, headache, BEFORE
Levofloxacin DNA gyrase in exacerbation of chronic insomnia  Explain the drug and rationale
susceptible gram- bronchitis; community-  CV: chest pain, palpitations, of administration to the
BRAND NAME: negative and gram- acquired pneumonia; hypotension patient.
Levox positive aerobic and acute bacterial sinusitis  EENT: photophobia, sinusitis,  Question patient about history
anaerobic bacteria, caused by S. of hypersensitivity reactions
pharyngitis
interfering with pneumoniae, H. to drug.
CLASSIFICATION:  GI: nausea, vomiting,
bacterial DNA influenzae, or
Antibiotic diarrhea, constipation,
synthesis Moraxella catarrhalis; DURING
abdominal pain, dyspepsia,
complicated urinary  Check vital signs, especially
flatulence blood pressure. Too-rapid
DOSAGE: tract infections; acute
500mg/tab pyelonephritis caused  GU: vaginitis infusion can cause
by E. coli  Metabolic: hyperglycemia hypotension.
ROUTE:  Musculoskeletal: back pain,  Closely monitor patients with
Oral tendon rupture, tendinitis renal insufficiency.
 Skin: photosensitivity  Monitor blood glucose level
FREQUENCY:  Other: altered taste, reaction closely in diabetic patients.
OD and pain at IV site,  Assess for severe diarrhea,
hypersensitivity reactions which may indicate
TIMING: pseudomembranous colitis.
8AM  Watch for hypersensitivity
reaction. Discontinue drug
immediately if rash or other
signs or symptoms occur.
Source: CONTRAINDICATION ADVERSE EFFECTS  Watch for signs and
Schull, P.D., (2013). symptoms of tendinitis or
McGraw – Hill Hypersensitivity to  CNS: seizures tendon rupture.
Nurse’s Drug drug, its components,  GI: pseudomembranous colitis
Handbook 7th Edition. or other quinolones  Hematologic: lymphocytopenia AFTER
The McGraw – Hill  Metabolic: hypoglycemia  Tell patient to stop taking
Companies, Inc.  Other: Stevens-Johnson drug and contact prescriber if
syndrome he experiences signs or
symptoms of hypersensitivity
 Instruct patient not to take
with milk, yogurt,
multivitamins containing zinc
or iron, or antacids containing
aluminum or magnesium.
and interactions.
ACTION
GENERIC NAME: Prevents protein and Insulin-dependent  CNS: confusion, loss of BEFORE
Dextrose 50% In nitrogen loss; hypoglycemia; calorie consciousness  Explain the drug and rationale
Water (D50W) promotes glycogen replacement  CV: hypertension, phlebitis of administration to the
deposition and  GU: glycosuria, osmotic patient.
BRAND NAME: ketone accumulation diuresis  Assess patient for presence of
Insta-Glucose (through osmotic conditions in which the drug is
 Metabolic: hyperglycemia,
diuretic action). contraindicated.
hypervolemia, hypovolemia,
CLASSIFICATION:
electrolyte imbalances
Carbohydrate Caloric DURING
 Skin: flushing, urticaria
Nutritional  Use aseptic technique when
 Other: chills, fever, preparing solution. Bacteria
Supplement
dehydration, injection site thrive in high-glucose
DOSAGE: reaction, infection environments.
0.5g/ml  Infuse concentrations above
10% through central vein.
ROUTE:  Do not infuse concentrated
IVTT solution rapidly, because
doing so may cause
FREQUENCY: hyperglycemia and fluid shifts.
STAT  Never stop infusion abruptly.
 Monitor infusion site
TIMING: frequently to prevent
Now irritation, tissue sloughing,
necrosis, and phlebitis.
CONTRAINDICATION ADVERSE EFFECTS  Check blood glucose level at
regular intervals.
Source: Hypersensitivity to  CV: venous thrombosis, heart  Monitor fluid intake and
Schull, P.D., (2013). drug; hyperglycemia, failure output.
McGraw – Hill diabetic coma;  Metabolic: hyperosmolar coma  Weigh patient regularly.
Nurse’s Drug hemorrhage; heart  Respiratory: pulmonary edema  Assess patient for confusion.
Handbook 7th Edition. failure
The McGraw – Hill AFTER
Companies, Inc.  Teach patient how to
recognize signs and symptoms
of hypoglycemia and
hyperglycemia.
 Provide instructions on
glucose self-monitoring.
and interactions.
ACTION
GENERIC NAME: Increases serum Hypocalcemic  CNS: headache, weakness, BEFORE

Calcium Gluconate calcium level through emergency; dizziness, syncope,  Explain the drug and rationale
direct effects on hypocalcemic tetany; paresthesia of administration to the
BRAND NAME:
bone, kidney, and GI cardiac arrest;  CV: mild blood pressure patient.
Kalcinate
tract. Decreases magnesium decrease  Assess patients for presence
osteoclastic intoxication; exchange of conditions in which the
osteolysis by transfusions; drug is contraindicated.
Dietary Supplement, diarrhea, constipation,
reducing mineral hyperphosphatemia in
Electrolyte epigastric pain or discomfort
release and collagen patients with end-stage DURING
Replacement Agent  GU: urinary frequency, renal
breakdown in bone. renal disease; dietary  When infusing IV, do not
calculi exceed a rate of
supplement
DOSAGE:  Metabolic: hypercalcemia 200mg/minute.
10ml  Musculoskeletal: joint pain,  Administer oral doses 1 to ½
back pain hours after meals.
ROUTE:  Respiratory: dyspnea  Know that IM or subcutaneous
IV administration is never
 Skin: rash
 Other: altered or chalky recommended.
FREQUENCY:  Be aware that IV route is
taste, excessive thirst,
STAT preferred in children.
allergic reactions
 Evaluate patient’s response to
TIMING: drug therapy.
Now  Monitor calcium levels
frequently, especially in
elderly patients.
AFTER
Hypersensitivity to  CV: bradycardia,  Keep patient supine for 15
Source: drug; ventricular arrhythmias, cardiac arrest minutes after IV
Schull, P.D., (2013). fibrillation;  Other: anaphylaxis administration.
McGraw – Hill hypercalcemia and  Instruct patient to consume
Nurse’s Drug hypophosphatemia; plenty of milk and dairy
Handbook 7th Edition. cancer; renal calculi; products during therapy.
The McGraw – Hill pregnancy or  Refer patient to dietitian for
Companies, Inc. breastfeeding help in meal planning and
preparation.
and interactions.
ACTION
GENERIC NAME: Increases osmotic Test dose for marked  CNS: dizziness, headache BEFORE
Mannitol pressure of plasma in oliguria or suspected  CV: chest pain, hypotension,  Explain the drug and rationale
glomerular filtrate, inadequate renal hypertension, tachycardia of administration to the
BRAND NAME: inhibiting tubular function; to prevent  EENT: blurred vision, rhinitis patient.
Renimax reabsorption of water oliguria during  GI: nausea, vomiting,  Observe proper dosage of
and electrolytes. cardiovascular and medication.
diarrhea, dry mouth
These actions other surgeries; acute
CLASSIFICATION:  GU: polyuria, urinary retention
enhance water flow oliguria; to reduce DURING
Diuretic  Metabolic: dehydration, water
from various tissues intercranial pressure  Withhold drug until adequate
intoxication, hypernatremia,
and ultimately and brain mass; to renal function and urinary
DOSAGE: hyponatremia, hypovolemia,
decrease intracranial reduce intraocular output are established.
100ml hypokalemia
and intraocular pressure; to promote  When administering for drug
pressures; serum diuresis in drug  Skin: rash, urticarial toxicity, give fluids and
ROUTE:  Other: chills, fever, thirst, electrolytes to match fluid
sodium level rises toxicity; irrigation
IV edema, extravasation with loss.
while potassium and during transurethral
blood urea levels fall. resection of prostate edema and tissue necrosis  Be aware that at low
FREQUENCY: temperatures, solution may
Also protects kidneys
PRN crystallize. If crystals form,
by preventing toxins
from forming and warm bottle in hot-water bath
TIMING: or dry-heat oven or autoclave,
blocking tubules.
As needed then cool to body temperature
or lower before giving.
 Do not give electrolyte-free
mannitol solutions with blood.
CONTRAINDICATION ADVERSE EFFECTS  Know that drug may be given
as continuous or intermittent
Active intracranial  CNS: seizures IV infusion.
bleeding (except  CV: thrombophlebitis, heart  Monitor IV site carefully to
during craniotomy); failure, vascular overload avoid extravasation and tissue
anuria secondary to  GU: osmotic nephrosis necrosis.
severe renal disease;  Monitor renal function tests,
 Metabolic: hyperkalemia,
progressive heart urinary output, fluid balance,
metabolic acidosis
failure, pulmonary central venous pressure, and
congestion, renal electrolyte levels.
damage, or renal
dysfunction after AFTER
mannitol therapy  Teach patient about
begins; severe importance of monitoring
pulmonary congestion exact urinary output.
or pulmonary edema;  Tell patient drug may cause
severe dehydration thirst or dry mouth.
Source: Emphasize that fluid
Schull, P.D., (2013). restrictions are necessary, but
McGraw – Hill that frequent mouth care
Nurse’s Drug
should ease these symptoms.
The McGraw – Hill
Companies, Inc.
and interactions.
NCP
DEFINING NURSING SCIENTIFIC NURSING

PLAN OF CARE RATIONALE EVALUATION
CHARACTERISTICS DIAGNOSIS ANALYSIS INTERVENTIONS
SUBJECTIVE: Excess Fluid Excess fluid SHORT TERM: Independent Independent SHORT TERM:
Volume related to volume is
“I do not know why I’m After 8 hours of 1. Be aware of risk 1. To understand the After 8 hours of
fluid buildup referred to as
having a hard time nursing intervention, factors etiology of patient’s nursing intervention,
secondary to the increase in
breathing especially the patient will: 2. Note amount/rate condition the patient was able
parenchymal isotonic fluid
when I lay down. I’m of fluid intake from 2. To assess progress of to:
kidney retention. The ⮚ Stabilize fluid
anxious about this,” as all sources patient’s condition
dysfunction as patient has CKD volume as  Show signs of fluid
verbalized by the 3. Review intake of 3. To assess patient’s
evidenced by which has effects evidenced by volume stability as
patient.
orthopnea on the body’s balanced I/O and sodium and protein risks for fluid evidenced by a
fluid volume. respiratory rate 4. Auscultate patient’s retention balanced I/O as
Often, it is within client’s breath sounds 4. To note presence of well as normal
problems with normal range (RR: 5. Measure patient’s crackles/congestion respiratory rate
the kidneys that 12 – 20) abdominal girth 5. To note for changes (RR: 17 cpm)
cause ⮚ List signs that that may indicate
OBJECTIVE: hypervolemia. (Goal Met)
require further increasing fluid
This is because evaluation such as
▪ Swelling of the retention  Identify signs
the kidneys polyuria, insomnia,
extremities noted involving kidney
normally balance and edema Collaborative Collaborative
▪ Patient’s intake disease that require
the amount of
exceeds output as further evaluation
salts and fluids in LONG TERM: 1. Restrict sodium and 1. To control the
documented such as polyuria,
your body. When fluid intake as progression of fluid
▪ Patient observed to insomnia, and
they retain salt, After 2 weeks of indicated retention
be restless edema
they increase the nursing intervention, 2. Administer the 2. To promote
▪ Increased body’s total the patient will: appropriate diuresis/treat (Goal Met)
respiratory rate sodium content,
 Verbalize medications as underlying conditions
noted (RR: 23 cpm) which increases LONG TERM:
understanding of indicated 3. To incorporate
your fluid interdisciplinary After 2 weeks of
individual
content. Fluid nursing intervention,
dietary/fluid
overload is a restrictions 3. Consult with approach to health the patient was able
major including a low-salt, dietitian as needed care to:
presentation in low-fat diet and a
 Verbalize
late CKD patients low amount of fluid
understanding of
and is frequently intake
individual
present in mild  Demonstrate
dietary/fluid
to moderate CKD behaviors to
restrictions
cases. monitor fluid status
including a low-salt,
and reduce
low-fat diet and a
recurrence of fluid
low amount of fluid
excess such as
intake
monitoring of
intake and output (Goal Met)
and adhering to
dietary/fluid  Demonstrate
restrictions behaviors to
monitor fluid status
and reduce
recurrence of fluid
excess such as
monitoring of
intake and output
Reference: and adhering to
Doenges, E., dietary/fluid
Moorhouse, F. M., & Reference: Reference: restrictions
Murr A. 2010.
Nursing Care Plans: Doenges, E., Moorhouse, F. Doenges, E., Moorhouse, F. M., (Goal Met)
Guidelines for M., & Murr A. 2010. Nursing & Murr A. 2010. Nursing Care
Individualizing Client Care Plans: Guidelines for Plans: Guidelines for
Care Across the Life Individualizing Client Care Individualizing Client Care
Span Across the Life Span Across the Life Span
INTRODUCTION
Acute coronary syndrome (ACS) refers to a spectrum of clinical presentations
ranging from those for ST-segment elevation myocardial infarction (STEMI) to
presentations found in non–ST-segment elevation myocardial infarction
(NSTEMI) or in unstable angina. It is almost always associated with rupture
of an atherosclerotic plaque and partial or complete thrombosis of the infarct-
related artery.
Acute coronary syndrome (ACS) can be divided into subgroups of ST-segment

elevation myocardial infarction (STEMI), non-ST-segment elevation
myocardial infarction (NSTEMI), and unstable angina. ACS carries significant
morbidity and mortality and the prompt diagnosis, and appropriate treatment
is essential. STEMI diagnosis and management are discussed elsewhere.
NSTEMI and unstable angina are very similar, with NSTEMI having positive
cardiac biomarkers. The presentation, diagnosis, and management of NSTEMI
are discussed below.
The median age at the time of presentation for ACS in the United States is 68
years. Males outnumber females by a 3:2 ratio. The incidence of ACS in the
United States is over 780,000, and of those, approximately 70% will have
NSTEMI.
ACUTE CORONARY SYNDROME - NSTEMI
Acute coronary syndrome is a term used to describe a range of

conditions associated with sudden, reduced blood flow to the heart. One such
condition is a heart attack (myocardial infarction) — when cell death results
in damaged or destroyed heart tissue. Even when acute coronary syndrome
causes no cell death, the reduced blood flow changes how your heart works
and is a sign of a high risk of heart attack. Acute coronary syndrome often
causes severe chest pain or discomfort. It is a medical emergency that
requires prompt diagnosis and care. The goals of treatment include improving
blood flow, treating complications and preventing future problems.
The term acute coronary syndrome (ACS) refers to any group of clinical
symptoms compatible with acute myocardial ischemia and includes unstable
angina (UA), non—ST-segment elevation myocardial infarction (NSTEMI), and
ST-segment elevation myocardial infarction (STEMI). NSTEMI stands for non-
ST segment elevation myocardial infarction, which is a type of heart attack.
Compared to the more common type of heart attack known as STEMI, an
NSTEMI is typically less damaging to your heart.
As a summary, NSTEMI is a type of heart attack. NSTEMI stands for

Non-ST-elevation myocardial infarction. Sometimes an NSTEMI is known as a
non-STEMI. A myocardial infarction is the medical term for a heart attack. ST
refers to the ST segment, which is part of the EKG heart tracing used to
diagnose a heart attack.
The sudden occurrence of an ACS-NSTEMI primarily causes cardiac

involvement. However, since the heart is the organ that promotes blood
circulation towards other body parts, systemic effects soon emerge. These
signs and symptoms include:
 Pressure, tightness, or discomfort in your chest
 Pain or discomfort in your jaw, neck, back, or stomach
 Dizziness
 Lightheadedness
 Nausea
 Sweating
Predisposing Factors:
 Gender
 Family History of Heart Disease
 Family History of Stroke
 Smoking
 Sedentary Lifestyle
 Hypertension
 Hypercholesterolemia
 Diabetes
 Obesity
Complications:
 Disturbance of rate, rhythm and conduction
 Cardiac rupture
 Heart failure
 Pericarditis
 Ventricular septal defect
 Ventricular aneurysm
 Ruptured papillary muscles
 Dressler's syndrome
ASSESSMENT:
► Assessment of patient’s health status
► Physical assessment with emphasis on cardiovascular system
► Evaluation of signs and symptoms of ACS-NSTEMI
► Screening for predisposing and precipitating factors
► Monitoring of vital signs especially blood pressure
LABORATORY AND DIAGNOSTIC STUDIES
 ECG
o ECG should be performed as soon as possible in patients
presenting with chest pain or those with a concern for ACS. A
normal ECG does not exclude ACS and NSTEMI. ST-elevation or
anterior ST depression should be considered a STEMI until
proven otherwise and treated as such. Findings suggestive of
NSTEMI include transient ST elevation, ST depression, or new T
wave inversions. ECG should be repeated at predetermined
intervals or if symptoms return. An ECG will show the following
characteristics for an NSTEMI:
 Depressed ST wave or T-wave inversion
 No progression to Q wave
 Partial blockage of the coronary artery
 TROPONIN TEST
o Cardiac troponin is the cardiac biomarker of choice. Troponin is

more specific and more sensitive than other biomarkers and
becomes elevated relatively early in the disease process.
A troponin test measures the levels of troponin T or troponin I
proteins in the blood. These proteins are released when the
heart muscle has been damaged, such as occurs with a heart
attack. The more damage there is to the heart, the greater the
amount of troponin T and I there will be in the blood.
 CREATININE KINASE – MB (CK-MB) TEST
o Creatine kinase-MB (CK-MB) is a form of an enzyme found

primarily in heart muscle cells. This test measures CK-MB in the
blood. CK-MB is one of three forms (isoenzymes) of the enzyme
creatine kinase (CK). CK is found in the heart, muscles, and
other organs. These include the small intestine, brain, and
uterus. When high levels of CK-MB are present, it usually means
that there is damage in the heart muscle.
TEST: X-RAY
EXAMINATION: CHEST PA OR AP
X-RAY REPORT
There are nodulohazy opacities in both inner lung zones extending towards the left lung base,
obscuring the left lower cardiac border, left hemidiaphragm and costophrenic sulcus. Heart is
magnified. The central pulmonary vascular markings are slightly accentuated. Aorta is tortuous
and sclerotic. The tracheal air column is at the midline. The right hemidiaphragm and
costophrenic sulcus are intact. The visualized osseous structures are unremarkable. A right-
sided jugular catheter is noted with its tip seen at the level of the right atrium.
IMPRESSION:
MAGNIFIED CARDIAC SILHOUETTE WITH PULMONARY CONGESTIVE CHANGES. A

SUPERIMPOSED INFLAMMATORY PROCESS IN THE LEFT LUNG BASE IS NOT
EXCLUDED.
CONSIDER MINIMAL LEFT PLEURAL EFFUSION.
ATHEROSCLEROSIS OF THE THORACIC AORTA.
RIGHT-SIDED JUGULAR CATHETER IN PLACE.
Explanation:
An X-ray is an imaging test that uses small amounts of radiation to produce
pictures of the organs, tissues, and bones of the body. When focused on the
chest, it can help spot abnormalities or diseases of the airways, blood vessels,
bones, heart, and lungs.
The patient has problems in the organs of her chest, especially the heart. This
is manifested by the impression of the presence of atherosclerosis in the
thoracic aorta of the patient, which puts the patient at a high risk for a
myocardial infarction.
TEST: TROPONIN-I TEST
Test Result Unit
Troponin-I (High Sensitivity) 264.90 ng/L
Reference Range:
< 19.0 ng/L = NEGATIVE
19 – 99 ng/L = OBSERVATIONAL ZONE
100 ng/L & Above = POSITIVE
Explanation:
A troponin test measures the levels of troponin T or troponin I proteins in the
blood. These proteins are released when the heart muscle has been damaged,
such as occurs with a heart attack. The more damage there is to the heart,
the greater the amount of troponin T and I there will be in the blood.
The patient’s troponin level is extremely high, indicating that there is damage
in the patient’s heart muscle, suggestive of a heart attack.
TEST: RADIOGRAPHY
RADIOGRAPHIC REPORT
The right costophrenic angle is blunted. The rest of the lung fields are clear. The trachea is
in the midline. The heart is enlarged with a cardiothoracic ratio of 0.70. There is fullness noted in
both hilar regions with cephaladization of pulmonary vessels demonstrated. The retrosternal and
retrocardiac spaces are intact. The thoracic aorta is tortuous. The left hemidiaphragm is distinct.
The osseous thoracic cage reveals no significant bony abnormality.
IMPRESSION:
1. CARDIOMEGALY WITH BILATERAL PULMONARY CONGESTION

2. CONSIDER MINIMAL AMOUNT OF PLEURAL EFFUSION AND/OR THICKENING,
RIGHT
3. ATHEROSCLEROSIS OF THE THORACIC AORTA
Explanation:
Radiography is an imaging technique using X-rays, gamma rays, or similar
ionizing radiation and non-ionizing radiation to view the internal form of an
object. To create an image in conventional radiography, a beam of x-ray is
produced by an x-ray generator and is projected toward the object.
In this test, the patient’s results show issues regarding her heart as
cardiomegaly and atherosclerosis of the thoracic aorta are notable findings.
TEST: ECHOCARDIOGRAPHY
Summary of Interpretation
DOPPLER STUDY:
= Tricuspid regurgitation, mild
= TR jet velocity= 2.96 cm/sec
= Tricuspid regurgitation jet pressure gradient= 35 mmHg.
= Pseudonormal mitral E/A ratio= 1.65 ; E velocity= 99 cm/sec
= Reverse tricuspid E/A ratio
= Septal e’ = 2.6 cm/sec
= Lateral e’ = 6 cm/sec
= Reverse septal and lateral e’/a’ ratio by tissue Doppler imaging
= E/e’ = 26.6
= Mild pulmonary hypertension (systolic pulmonary artery pressure= 45 mmHg by TR jet)
2D ECHO:
= Concentric left ventricular hypertrophy (left ventricular mass index= 133 gm/m 2:
relative wave 0.45) with adequate wall motion and contractility.
= Normal right ventricular dimension with adequate wall motion and contractility
= Dilated left atrial dimension (4.66 cm) with abnormal left atrial volume index = 52.6
ml/m2
= Normal right atrial dimension
= Structurally normal mitral valve, aortic valve, tricuspid valve and pulmonic valve with
good closing motion.
= Normal main pulmonary artery and aortic root dimension.
CONCLUSIONS:
= Concentric left ventricular hypertrophy (left ventricular mass index= 133 gm/m 2:
relative wave 0.45) with adequate wall motion and contractility and systolic function
(ejection fraction= 5) and dysfunction grade 2 (reduced compliance); E/e’ = 26.6
suggestive of elevated left ventricular filling pressure.
= Dilated left atrial dimension (4.66 cm) with abnormal left atrial volume index = 52.6
ml/m2
= Normal right ventricular dimension with adequate systolic function (TAPSE= 2.12 cm; S’
velocity= 13 cm/sec) but with diastolic dysfunction.
= Tricuspid regurgitation, mild.
= Mild pulmonary hypertension (systolic pulmonary pressure = 45 mmHg by TR jet)
Explanation:
Echocardiography is a test that uses sound waves to produce live images of
your heart. The image is called an echocardiogram. This test allows your
doctor to monitor how your heart and its valves are functioning. The images
can help them get information about blood clots in the heart chambers.
The patient’s results reflected in the conclusions show that there are
abnormalities especially with the left ventricle as there is hypertrophy in that
area. Moreover, the left atrium is also dilated and there is tricuspid
regurgitation as well as mild pulmonary hypertension. These are issues
regarding the heart, subjecting it to a higher risk of a heart attack.
TEST: PRO BNP TEST
Test Result Unit
PRO BNP > 25,000 pg/ml
REMARKS:
*NT PRO-BNP DIAGNOSTIC REFERENCE RANGES:
RULE OUT HEART FAILURE

ACUTE PATIENT:
< 300 pg/ml
NON ACUTE PATIENT:

< 125 pg/ml (<75 Y.O)
< 450 pg/ml (>75 Y.O)
RULE IN HEART FAILURE

> 450 pg/ml (<50 Y.O)
Explanation:
A BNP test or NT-proBNP test can be used, along with other cardiac biomarker
tests, to detect heart stress and damage and/or along with lung function tests
to distinguish between causes of shortness of breath. Chest x-rays and an
ultrasound test called echocardiography may also be performed.
According to the patient’s result, heart failure should be ruled in because the
PRO BNP level is very high. This means that the cause of the patient’s
shortness of breath is an intrinsic cardiac dysfunction.
Pathophysiology
ACUTE CORONARY SYNDROME – NSTEMI
 Smoking
Predisposing Factors:  Hypertension
 Dyslipidemia
 Gender  Diabetes
 Age  Obesity
 Heredity  Psychosocial Stress
 Sedentary Lifestyle
 Unhealthy Diet
Legend Inflammation in coronary arteries

 Disease
Drug Therapy:
Atherosclerotic coronary arteries Atorvastatin
 Complications
 Signs and Symptoms
 Explanation
Plaque rupture/erosion  Diarrhea
 Treatment
 Runny nose
 Drug Side Effects  Joint pain
 Insomnia
 Nausea
Atherothrombosis  Loss of appetite
Coronary artery partially blocked

 Chest discomfort
 Pain in jaw, neck,
Myocardial hypoperfusion
back, or stomach
 Dizziness The following
 Lightheadedness diagnostic tests will
 Nausea show abnormal results:
 Sweating
Acute Coronary Syndrome – Non-  ECG
ST Segment Elevation Myocardial  Troponin Test
Infarction  CK – MB Test
Cardiac Injury Heart Failure Pericarditis Ventricular Aneurysm
Decreased Cardiac Ineffective Tissue

Acute Pain
Output Perfusion
Drug Therapy:
Drug Therapy: Drug Therapy:
Benazepril
Morphine Aspirin
 Dizziness
 Miosis  Dizziness
 Lightheadedness
 Orthostatic  Mental
 Drowsiness
hypotension disturbance
 Headache
 Respiratory  Diarrhea
 Dry cough
depression  Headache
 Nausea  Nausea
 Sedation  Vomiting
Explanation:
The disease process of ACS NSTEMI starts with the presence of different predisposing and
precipitating factors which leads to atherosclerosis and its effects, leading to hypoperfusion. This
decreases the blood flow to the heart, making it ischemic and therefore causing myocardial
infarction. Since it is an NSTEMI, the blockage is not total, but partial.
DRUG STUDIES

ACTION
GENERIC NAME: Inhibits HMG-CoA Adjunct to diet for  CNS: amnesia, BEFORE
Atorvastatin reductase, the controlling LDL, total headache, drowsiness  Explain the drug and rationale
enzyme that cholesterol, apo-lipoprotein  CV: orthostatic of administration to the patient.
BRAND NAME: catalyzes the early B, and triglyceride levels hypotension,  Question patient about history
Lipitor step in cholesterol and to increase HDL levels palpitations, phlebitis of hypersensitivity reactions to
synthesis; this action in patients with primary  EENT: glaucoma, drug.
reduces hypercholesterolemia and
CLASSIFICATION: hearing loss, tinnitus
concentrations of mixed DURING
Antihyperlipidemic  GI: nausea, vomiting,
serum cholesterol dysbetalipoproteinemia in  Give drug with or without food.
diarrhea, constipation  Do not give drug with grapefruit
and low-density patients unresponsive to
 GU: hematuria, dysuria, juice or antacids.
DOSAGE: lipoproteins (LDLs), diet alone; adjunct to diet
80mg/tab linked to increased to reduce elevated renal calculi  Monitor patient for signs and
risk of coronary triglyceride levels; adjunct  Hematologic: anemia symptoms of allergic response.
 Hepatic: jaundice  Evaluate for muscle weakness.
ROUTE: artery disease (CAD). to other lipid-lowering
 Metabolic:  Be aware that reduction in
Oral Also moderately treatments in patients with
dosage and periodic monitoring
increases homozygous familial hyperglycemia
of creatinine kinase level may
FREQUENCY: concentration of hypercholesterolemia;  Musculoskeletal: be considered for patients
OD high-density prevention of bursitis, gout, joint pain taking drugs that may increase
lipoproteins (HDLs), cardiovascular disease in  Respiratory: dyspnea atorvastatin level.
TIMING: associated with patients without clinically  Skin: alopecia, acne,  Monitor liver function test
8PM decreased risk of evident CHD but with eczema results and blood lipid levels.
CAD. multiple CHD risk factors;
prevention of stroke and AFTER
myocardial infarction in  Other: taste loss, fever,  Tell patient he may take drug
patients with type 2 DM gingival bleeding with or without food.
 Advise patient to immediately
CONTRAINDICATION ADVERSE EFFECTS report allergic response,
Source: irregular heartbeats, unusual
Schull, P.D., (2013). Hypersensitivity to drug or  CV: arrhythmias bleeding or bruising, unusual
its components; active tiredness, and others.
McGraw – Hill Nurse’s  GI: rectal hemorrhage
 As appropriate, review all other
Drug Handbook 7th hepatic disease or  Hematologic:
significant adverse reactions
Edition. unexplained, persistent thrombocytopenia and interactions.
The McGraw – Hill serum transaminase  Hepatic: hepatic failure,
Companies, Inc. elevations; pregnancy or hepatitis
breastfeeding
 Metabolic:
hypoglycemia
 Musculoskeletal:
rhabdomyolysis
 Skin: toxic epidermal
necrolysis
 Other: Steven-Johnson
syndrome
ACTION
GENERIC NAME: Relaxes smooth To prevent and relieve  CNS: dizziness, headache, BEFORE
Salbutamol muscles by bronchospasm in insomnia  Explain the drug and rationale
stimulating beta2- patients with reversible  CV: dizziness, excitement, of administration to the
BRAND NAME: receptors, thereby obstructive airway headache, hyperactivity, patient.
Ventolin causing disease; to prevent insomnia  Question patient about history
bronchodilation and exercise-induced  CV: hypertension, palpitations of hypersensitivity reactions
vasodilation. bronchospasm to drug.
CLASSIFICATION: tachycardia, chest pain
Anti-asthmatic,  EENT: conjunctivitis, dry and
DURING
Bronchodilator irritated throat, pharyngitis
 Give extended-release tablets
 GI: nausea, vomiting,
whole; do not crush or mix
DOSAGE: anorexia, heartburn,
with food.
2.5mg/neb gastrointestinal distress, dry
 Follow manufacturer’s
mouth
directions supplied with
ROUTE:  Metabolic: hypokalemia
inhalation drugs.
Inhalation  Musculoskeletal: muscle
 Administer solution for
cramps
inhalation by nebulization over
FREQUENCY:  Respiratory: cough, dyspnea,
5 to 15 minutes, after diluting
Q6 wheezing
0.5ml of 0.5% solution with
 Skin: pallor, urticaria, rash,
TIMING: 2.5 ml of sterile normal saline
angioedema, flushing,
8AM – 2PM – 8PM – solution.
sweating
2AM  Stay alert for hypersensitivity
 Other: tooth discoloration,
reactions and paradoxical
increased appetite
bronchospasm. Stop drug
immediately if these occur.
Source: Hypersensitivity to  Respiratory: paradoxical  Monitor serum electrolyte
Schull, P.D., (2013). drug bronchospasm levels.
McGraw – Hill  Other: hypersensitivity
Nurse’s Drug reaction AFTER
Handbook 7th Edition.  Advise patient to limit intake
The McGraw – Hill of caffeine-containing foods
Companies, Inc. and beverages and to avoid
herbs unless prescriber
approves.
 Caution patient to avoid
driving and other hazardous
activities until drug effects are
known.
and interactions.
ACTION
GENERIC NAME: Inhibits platelet Recent myocardial  CNS: depression, dizziness, BEFORE
Clopidogrel aggregation by infarction (AMI) or fatigue, headache  Explain the drug and rationale
blocking binding of stroke or established  CV: chest pain, hypertension of administration to the
BRAND NAME: adenosine peripheral arterial  EENT: epistaxis, rhinitis patient.
Clopidra diphosphate to disease; acute  GI: diarrhea, abdominal pain,  Question patient about history
platelets, thereby coronary syndrome dyspepsia, gastritis of hypersensitivity reactions
preventing thrombus (ACS) to drug.
CLASSIFICATION:  Metabolic:
formation.  Note other drugs patient is
Antiplatelet hypercholesterolemia, gout
taking to avoid possible
 Musculoskeletal: joint pain,
interactions.
DOSAGE: back pain
75mg/tab  Respiratory: cough, dyspnea, DURING
bronchitis, upper respiratory  Give drug with or without
ROUTE: tract infection food.
Oral  Skin: pruritus, rash,  Know that drug may need to
angioedema be discontinued 5 days before
FREQUENCY: surgery.
 Other: hypersensitivity
OD  Monitor haemoglobin and
reactions
haematocrit periodically.
TIMING:  Monitor patient for unusual
8AM bleeding or bruising.
 Assess for occult GI blood loss
if patient is receiving
naproxen concurrently with
clopidogrel.
AFTER
Hypersensitivity to  GI: gastrointestinal bleeding  Tell patient to take tablets
drug; active pathologic  Hematologic: bleeding, with or without food.
bleeding neutropenia, thrombotic  Advise patient to minimize
thrombocytopenic purpura adverse GI effects by eating
 Other: anaphylactic reactions small, frequent meals or
Source: chewing gum.
Schull, P.D., (2013).
McGraw – Hill
Nurse’s Drug
and interactions.
The McGraw – Hill
Companies, Inc.
ACTION
GENERIC NAME: Inhibits Treatment of mild to  GI: abdominal distention, BEFORE

Aspirin prostaglandin moderate pain, fever; cramping, heartburn, mild  Explain the drug and rationale
synthesis, acts on reduces inflammation nausea of administration to the
BRAND NAME: the hypothalamus related to rheumatoid  Respiratory: bronchospasm patient.
Aspen heat-regulating arthritis (RA), juvenile  Skin: pruritus, urticaria  Question patient about history
center, interferes arthritis, osteoarthritis, of hypersensitivity reactions
with production of rheumatic fever; as to drug.
CLASSIFICATION:
thromboxane A, a platelet aggregation  Note other drugs patient is
Anticoagulant, Anti-
substance that inhibitor in the taking to avoid possible
inflammatory
stimulates platelet prevention of transient interactions.
aggregation. ischemic attacks
DOSAGE:
(TIAs), cerebral DURING
80mg/tab
thromboembolism, MI  Monitor for loss of tolerance to
or reinfarction; aspirin.
ROUTE:  Review Lab tests: frequent PT
adjunctive treatment
PO and IRN with concurrent
of Kawasaki’s disease
anticoagulant therapy; more
FREQUENCY: frequent fasting blood glucose
OD levels with diabetes.
 Monitor for salicylate toxicity.
TIMING:  Do not give aspirin to children
8AM or teenagers with symptoms
of varicella (chickenpox) or
influenza-like illnesses
because of association of
CONTRAINDICATION ADVERSE EFFECTS aspirin usage with Reye's
syndrome.
Hypersensitivity to  CNS: headache, dizziness,  Use enteric-coated tablets,
salicylates, NSAIDs; restlessness, seizures, coma extended release tablets,
asthma, rhinitis, nasal  CV: flushing, tachycardia buffered aspirin, or aspirin
polyps; inherited or administered with an antacid
 EENT: tinnitus
acquired bleeding to reduce GI disturbances.
 GI: thirst, gastrointestinal
disorders; use in bleeding, gastric mucosal
children for viral
lesions AFTER
infections; pregnancy
 Respiratory: hyperventilation,  Encourage patient to adhere
Source:
abnormal breathing patterns, to medication regimen.
Schull, P.D., (2013).
respiratory failure  As appropriate, review all
McGraw – Hill
Nurse’s Drug  Skin: diaphoresis other significant and life-
Handbook 7th Edition.  Other: hyperthermia threatening adverse reactions
The McGraw – Hill and interactions.
Companies, Inc.
ACTION
GENERIC NAME: Promotes peripheral Treatment and  CNS: dizziness, headache, BEFORE
Isosorbide Dinitrate vasodilation and prophylaxis in apprehension, asthenia,  Explain the drug and rationale
reduces preload and situations likely to syncope of administration to the
BRAND NAME: afterload, decreasing provoke acute angina patient.
 CV: orthostatic hypotension,
Isordil myocardial oxygen pectoris; prophylaxis of  Assess patient for presence of
tachycardia, paradoxical
consumption and angina pectoris conditions in which the drug is
bradycardia, rebound
increasing cardiac contraindicated.
CLASSIFICATION: hypertension
output. Also dilates
Antianginal  EENT: sublingual burning
coronary arteries, DURING
increasing blood flow  GI: nausea, vomiting, dry  Have patient wet sublingual
DOSAGE:
and improving mouth, abdominal pain tablet with saliva before
5mg/tab placing it under tongue.
collateral circulation.  Skin: flushing
 To avoid tingling sensation,
ROUTE: have patient place tablet in
Sublingual buccal pouch.
 Monitor ECG and vital signs
FREQUENCY: closely, especially blood
PRN pressure.
 In suspected overdose, assess
TIMING: for signs and symptoms of
As needed increased intracranial
pressure.
 Monitor arterial blood gas
values and methemoglobin
levels.
CONTRAINDICATION ADVERSE EFFECTS AFTER

Source: Hypersensitivity to  CNS: lightheadedness  Instruct patient to move
Schull, P.D., (2013). drug; severe anemia;  CV: worsening angina, slowly when sitting up or
McGraw – Hill acute myocardial dysrhythmias, pounding standing, to avoid dizziness or
Nurse’s Drug infarction; angle- heartbeats, fluttering in chest light-headedness from sudden
Handbook 7th Edition. closure glaucoma; blood pressure decrease.
The McGraw – Hill concurrent sildenafil  Inform patient that drug may
Companies, Inc. therapy
cause headache.
 Advise patient to treat
headache as usual and not to
alter drug schedule.
and interactions.
ACTION
GENERIC NAME: Trimetazidine is an Stable angina  CNS: asthenia BEFORE

Trimetazidine anti-ischemic  CV: arterial  Explain the drug and rationale
metabolic agent, hypotension, orthostatic of administration to the patient.
BRAND NAME: which improves hypotension  Assess patient for presence of
Lavtrim myocardial glucose  GI: abdominal pain, conditions in which the drug is
utilization through dyspepsia, diarrhea, contraindicated.
CLASSIFICATION: inhibition of long-
nausea, vomiting
Antianginal chain 3-ketoacyl CoA DURING
 Skin: pruritus, urticaria
thiolase activity,  Administer drug with food.
 Other: movement
DOSAGE: which results in a  Observe proper dosage when
disorders administering medication.
35mg/tab reduction of fatty
acid oxidation and a  Ensure that the patient’s
ROUTE: stimulation of treatment course is completed.
Oral glucose oxidation.  Do not stop the use of the drug
Parkinson’s disease;  Skin: edema in the face,
High fatty acid without consulting the doctor.
parkinsonian symptoms; eyes, and lips
FREQUENCY: oxidation rates are  Evaluate patient’s response to
tremors; restless leg  Respiratory: difficulty
BID detrimental during drug therapy.
syndrome; other breathing
ischemia due to an  Be alert for occurrence of
movement-related  Skin: rashes
TIMING: inhibition of glucose adverse effects.
disorders; severe renal
8AM – 6PM oxidation leading to
impairment; lactation
uncoupling of AFTER
glycolysis and an  Encourage patient to adhere to
increase in proton medication regimen.
production, which as  As appropriate, review all other
the potential to significant adverse reactions
accelerate sodium and interactions.
and calcium overload
in the heart. This
leads to an
exacerbation of
ischemic injury and
decreased cardiac
efficiency during
reperfusion.
Source:
Hodgson, B.B., &
Kizior, R.J. (1998).
Saunders nursing
drug handbook.
Philadelphia:
Saunders.
NCP

SUBJECTIVE: Ineffective Ineffective SHORT TERM: Independent Independent SHORT TERM:

Cardiac Tissue cardiac tissue
“I am experiencing After 8 hours of 1. Determine factors 1. To have a deeper After 8 hours of
Perfusion related perfusion is
chest pain as well as nursing intervention, related to individual understanding nursing intervention,
to arterial defined as the
difficulty in breathing. I the patient will: situation about patient’s the patient was able
interruption of decrease in
feel as though 2. Investigate reports condition to:
blood flow oxygen resulting ⮚ Demonstrate
something bad is going of chest pain and 2. To evaluate
secondary to in the failure to increased perfusion  Demonstrate
to happen to me,” as note precipitating characteristics of
atherosclerosis as nourish the through increased
verbalized by the
evidenced by cardiac tissues at normalization of factors patient’s perfusion as
patient. Patient dysrhythmia and the capillary vital statistics such 3. Monitor vital signs, condition evidenced by vital
reported a pain score
dyspnea level. Tissue as RR, PR, and hemodynamics, 3. To assess statistics within
of 8/10. perfusion capillary refill time heart sounds, and progress and normal range (RR:
problems can ⮚ Report that pain cardiac rhythm characteristics of 18, PR: 91,
exist without and discomfort has 4. Encourage quiet, condition capillary refill
decreased been time: < 3 seconds)
restful atmosphere 4. To reduce
cardiac output. relieved/controlled
OBJECTIVE: 5. Caution client to oxygen demand (Goal Met)
However, there with a new pain avoid activities that 5. To prevent
▪ Capillary refill may be a score of <5 increase cardiac exacerbation of  Report that pain
longer than 3 relationship
workload condition and discomfort
seconds noted between cardiac
have been relieved
▪ Increased output and tissue LONG TERM:
Collaborative Collaborative with a new pain
respirations noted perfusion. In the
After 2 weeks of score of 2
(25 cpm) case of the 1. Review baseline 1. To have a
nursing intervention,
▪ Tachycardia noted patient, the ABGs, electrolytes, baseline for (Goal Met)
the patient will:
(111 bpm) heart is not and cardiac comparative
receiving enough LONG TERM:
 Verbalize enzymes analysis
blood supply to understanding of 2. Review specific After 2 weeks of
fully function. condition, therapy nursing intervention,
dietary
regimen such as changes/restrictions 2. To enforce the patient was able
medications, with client dietary aspect of to:
surgical procedures, 3. Review medical therapy
 Verbalize
and diagnostic regimen and 3. To utilize
understanding of
monitoring appropriate safety pharmacological condition, therapy
 Demonstrate measures therapy regimen such as
behaviors/lifestyle
medications,
changes to improve
surgical
Reference: circulation including
procedures, and
physical exercise
Doenges, E., diagnostic
and proper diet
Moorhouse, F. M., & Reference: monitoring
Murr A. 2010.
Nursing Care Plans: Reference: Doenges, E., Moorhouse,
(Goal Met)
Guidelines for F. M., & Murr A. 2010.
Individualizing Client Doenges, E., Moorhouse, F. Nursing Care Plans:
 Demonstrate
Care Across the Life M., & Murr A. 2010. Nursing Guidelines for
Span Care Plans: Guidelines for Individualizing Client Care behaviors/lifestyle
Individualizing Client Care Across the Life Span changes to
Across the Life Span improve circulation
including physical
exercise and
proper diet
(Goal Met)
INTRODUCTION
Hypertensive heart disease involves the heart conditions caused by high blood
pressure or hypertension. The heart working under increased pressure causes
some different heart disorders. Hypertensive heart disease includes heart
failure, thickening of the heart muscle, coronary artery disease, and other
conditions. Incidence of CVD in the Philippines based on the Philippine Heart
Association survey among hospital-based population showed hypertension as
the highest, followed by stroke, CAD, and heart failure.
DISEASE DEFINITION
Hypertensive Cardiovascular Disease
Hypertensive cardiovascular disease is a major world-wide health problem.

With high blood pressure, there is a greater risk of stroke, heart attack, heart
failure, kidney disease, and renal failure.
Types of hypertensive heart disease
 Narrowing of the arteries

o Coronary arteries transport blood to your heart muscle. When high
blood pressure causes the blood vessels to become narrow, blood
flow to the heart can slow or stop. This condition is known as
coronary heart disease (CHD), also called coronary artery disease.
 Thickening and enlargement of the heart

o High blood pressure makes it difficult for your heart to pump
blood. Like other muscles in your body, regular hard work causes
your heart muscles to thicken and grow. This alters the way the
heart functions. These changes usually happen in the main
pumping chamber of the heart, the left ventricle. The condition is
known as left ventricular hypertrophy (LVH).
Congestive Heart Failure Involvement

Heart failure, a condition where your heart is unable to provide enough
blood to the body, can take years to develop inside your body. The narrowing
and blocking of blood vessels caused by high blood pressure (HBP or
hypertension) increases your risk of developing heart failure.
 High blood pressure adds to your heart’s workload: Narrowed

arteries that are less elastic make it more difficult for the blood to travel
smoothly and easily throughout your body — causing your heart to work
harder.
 Over time, a higher workload leads to an enlarged heart: In order

to cope with increased demands, the heart thickens and becomes larger.
While it is still able to pump blood, it becomes less efficient. The larger
the heart becomes, the harder it works to meet your body's demands
for oxygen and nutrients.
The usual body system that is involved in this disease the cardiovascular
system – the heart and blood vessels. With this, various signs and symptoms
include those that are associated with the cardiovascular system due to
increased workload or worse, damage to tissues.
Symptoms vary depending on the severity of the condition and progression of

the disease. You may experience no symptoms, or your symptoms may
include:
 Chest pain (angina)

 Tightness or pressure in the chest
 Fatigue
 Pain in the neck, back, arms, or shoulders
 Persistent cough
 Loss of appetite
 Leg or ankle swelling
Precipitating Factors
 Being overweight
 Sedentary lifestyle
 Smoking
 Eating foods high in fat and cholesterol
Predisposing Factors
 Age
 Gender
 Heredity
Complications
 Heart failure
 Arrhythmia
 Ischemic heart disease
 Heart attack
 Sudden cardiac arrest
 Stroke and sudden death
ASSESSMENT:
 Physical Assessment
 Health History Taking
 Vital Signs Monitoring with emphasis on BP
 Exercise Stress Test

o A stress test involves working out on a treadmill or exercise bike
while hooked up to heart and blood pressure monitors. Results
demonstrate heart function during physical activity.
 Nuclear Stress Test
o Uses radioactive dye and an imaging machine to create pictures
showing the blood flow to your heart.
 Electrocardiogram (ECG)
o An ECG records the electrical activity of your heart at rest.
 Echocardiogram
o Although echocardiography is the second-line study in the evaluation
of hypertensive patients, it gives many clues suggesting bad
prognosis associated with hypertension.
 Coronary Angiography
o Examines the flow of blood through your coronary arteries.
TEST: CLINICAL MICROSCOPY
Test Result
Fecal Occult Blood NEGATIVE
Explanation:
The fecal occult blood test (FOBT) is a lab test used to check stool samples
for hidden (occult) blood. Occult blood in the stool may indicate colon cancer
or polyps in the colon or rectum – although not all cancers or polyps bleed.
The patient shows a negative result in this test, indicating that the patient
has no problems in this aspect.
TEST: COMPLETE BLOOD COUNT
Test Result Unit Range

WBC 6.6 103/mm3 4.4 – 11.0
% # % #
NEU 79.6 5.27 37.0 – 80.0 1.8 – 7.8
LYM 8.1 0.54 10.0 – 50.0 1.0 – 4.8
MON 11.0 0.73 0.0 – 12.0 0.2 – 1.0
EOS 1.2 0.08 0.0 – 7.0 0.0 – 0.5
BAS 0.1 0.01 0.0 – 2.5 0.0 – 0.2
Test Result Unit Range

RBC 3.06 10 /mm
6 3
4.5 – 5.1
HGB 8.6 g/dl 12.3 – 15.3
HCT 26.3 % 35.9 – 44.6
MCV 86 µm3 80 – 96
MCH 28.1 pg 27.5 – 33.2
MCHC 32.6 g/dl 32.0 – 36.0
RDW 14.6 % 11.6 – 14.8
PLT 191 103/mm3 150 – 450
MPV 7.4 µm3 6.0 – 11.0
Suspected Pathology:
LEUKO: lymphopenia, nrbcs
ERYTHRO: anemia
THROMBO: platelet aggregate
Explanation:
A complete blood count is a commonly performed blood test that is often
included as part of a routine checkup. Complete blood counts can be used to
help detect a variety of disorders including infections, anemia, diseases of the
immune system, and blood cancers.
The patient’s results notably show a low level of red blood cells. This is
indicative of anemia. Since this is a concern of the circulatory system, the
patient’s HCVD diagnosis may be affected by this finding.
PATHOPHYSIOLOGY
Precipitating Factors: sedentary

Predisposing Factors: age, heredity, lifestyle/physical inactivity, poor diet
gender, race (high fat, high cholesterol),
hypertension
These laboratory tests will
show abnormal results from
this point onwards:
Vasoconstriction
 Exercise Stress Test
 Nuclear Stress Test
 Electrocardiogram (ECG)
 Echocardiogram
 Coronary Angiography
Endothelial Injury Increased
afterload
Atherosclerosis Left ventricular hypertrophy
Increased myocardial
Vascular lumen demand and
Worsening of
narrowing and occlusion decreased diastolic
hypertension
coronary flow
Drug
Therapy:
Coronary heart disease Captopril
Myocardial ischemia
 Dizziness 
Legend Pain in the neck  Chest pain
 Lightheadedness
 Loss of taste
 Fatigue  Tightness or presure
 Dry cough  Leg or ankle in the chest
 Disease swelling  Shortness of breath
 Complications
 Explanation
 Treatment
Hypertensive
 Drug Side Effects
Cardiovascular Disease
Arrhythmia Heart Failure Ischemic Heart Heart Attack

Disease
Decreased Cardiac
Output Acute Pain
Drug Therapy: Drug Therapy:

Amlodipine Morphine
 Edema  Miosis
 Headache  Orthostatic hypotension
 Fatigue
 Palpitations  Respiratory depression
 Dizziness  Nausea
 Nausea
 Flushing  Sedation
Explanation:
The occurrence of HCVD in a person is influenced by the presence of risk factors which
first causes vasoconstriction. However, different effects of vasoconstriction towards
various parts of the body – specifically towards the cardiovascular system – would lead to
more damage and complications, which would worsen the condition of the patient and
even add to their health problems.
DRUG STUDIES

ACTION
GENERIC NAME: Inhibits Hypertension;  CNS: dizziness, fatigue, BEFORE

Telmisartan vasoconstricting cardiovascular risk headache  Explain the drug and rationale
effects and blocks reduction  CV: chest pain, hypertension, of administration to the
BRAND NAME: aldosterone- peripheral edema, intermittent patient.
Telday-20 producing effects of claudication  Question patient about history
angiotensin II at  EENT: sinusitis, pharyngitis of hypersensitivity reactions
various receptor to drug.
sites, including  Correct volume deficits as
Antihypertensive diarrhea, dyspepsia,
vascular smooth appropriate before therapy
abdominal pain starts.
muscle and adrenal
DOSAGE:  GU: urinary tract infection
glands.
40mg/tab  Musculoskeletal: myalgia, back DURING
and leg pain  Do not remove tablet from
ROUTE:  Respiratory: cough, upper blister pack until just before
Oral respiratory infection giving.
 Skin: ulcer  Know that drug may be used
FREQUENCY: alone or with other
 Other: pain, flue or flulike
OD antihypertensives.
symptoms, hypersensitivity  Monitor blood pressure
TIMING: frequently and watch for signs
8AM
Hypersensitivity to  CNS: faintness and symptoms of
drug or its components  CV: hypotension hypotension.
 GU: kidney disease  Closely monitor patient with
impaired hepatic or renal
 Respiratory: trouble breathing
function.
 Skin: rash  Monitor fluid intake and
 Other: unexplained weight output and creatinine level
gain, allergic reaction during therapy.
AFTER
 Tell patient to take 1 hour
before or 2 hours after meals.
 Advise patient to report
Source:
swelling or chest pain.
Schull, P.D., (2013).
 Teach patient to measure
McGraw – Hill
Nurse’s Drug blood pressure regularly and
Handbook 7th Edition. report significant changes.
The McGraw – Hill  As appropriate, review all
Companies, Inc. other significant and life-
and interactions.
ACTION
GENERIC NAME: Stimulates alpha- Mild to moderate  CNS: drowsiness, dizziness, BEFORE
Clonidine adrenergic receptors hypertension; severe nervousness, nightmares  Explain the drug and rationale
in CNS, decreasing pain in cancer patients  CV: hypotension, palpitations of administration to the
BRAND NAME: sympathetic outflow, unresponsive to  GI: nausea, vomiting, patient.
Catapres inhibiting opioids alone constipation, dry mouth  Question patient about history
vasoconstriction, and  GU: urinary retention, of hypersensitivity reactions
CLASSIFICATION: ultimately reducing to drug.
nocturia, erectile dysfunction
Antihypertensive blood pressure. Also
 Skin: rash, sweating, pruritus,
prevents DURING
dermatitis
DOSAGE: transmission of pain  To minimize sedative effects,
 Other: weight gain, withdrawal
75mcg/tab impulses by give largest portion of
inhibiting pain phenomenon
maintenance PO dose at
ROUTE: pathway signals in CONTRAINDICATION ADVERSE EFFECTS
bedtime.
NGT brain.  Monitor patient for signs and
Hypersensitivity to  CNS: depression
symptoms of adverse
FREQUENCY: drug; hypersensitivity  CV: bradycardia, arrhythmia
cardiovascular reactions.
Q6 to components of  Metabolic: hypernatremia
adhesive layer  Frequently assess vital signs,
(transdermal form); especially blood pressure and
TIMING:
infection at epidural pulse.
8AM – 2PM – 8PM –
2AM injection site, bleeding  Monitor patient for drug
problems (epidural tolerance and efficacy.
use); concurrent  Assist patient in mobilization
anticoagulant therapy when CNS effects are in
effect.
AFTER
 Instruct patient to move
slowly when sitting up or
standing, to avoid dizziness or
light-headedness caused by
Source: orthostatic hypotension.
Schull, P.D., (2013).  Caution patient not to stop
McGraw – Hill
taking drug abruptly.
Nurse’s Drug
The McGraw – Hill
Companies, Inc.
and interactions.
ACTION
GENERIC NAME: Faktu has multiple External and internal  Skin: burning sensation, BEFORE
Policresulen + actions hemorrhoids itching  Explain the drug and rationale
Cinchocaine predominantly associated with  Other: mild local discomfort of administration to the
Hydrochloride attributable to inflammatory patient.
policresulen. It symptoms or  Assess patient for presence of
BRAND NAME: arrests bleeding by superficial bleeding; conditions in which the drug is
Faktu coagulating blood anal fissures and contraindicated.
protein and inducing rhagades; incised or
the muscle fibers of spontaneously DURING
CLASSIFICATION:
small blood vessels perforated perianal  Ointment should be used after
Local Anesthetic
to contract. The thrombosis; anitis; emptying the bowel.
coagulating cryptitis; anal eczema;  Keep in mind that patient’s
DOSAGE: clothes may be stained, as the
properties and the pruritus and
60mg/g (ointment) ointment melts at body
acid pH brings out postoperative wound
the antimicrobial treatment following temperature.
ROUTE:  Have the patient wear the
action against proctological
Topical cartridge to prevent staining
Escherichia coli, operations
of clothes.
staphylococci and  Apply ointment as long as the
FREQUENCY:
streptococci, physician recommends it.
BID
Pseudomonas  Evaluate patient’s response to
aeruginosa, Proteus drug therapy.
TIMING:
vulgaris, candida and  Monitor patient for adverse
8AM – 6PM
other bacteria. Thus, CONTRAINDICATION ADVERSE EFFECTS reactions.
the wound is
protected against Hypersensitivity to  Skin: angioneurotic edema, AFTER
infection. soya or peanut laryngeal edema, urticaria  Encourage patient to adhere
Cinchocaine has local  Other: anaphylaxis to medication regimen.
anesthetic action  Encourage patient to report
which relieves pain occurrence of adverse
and itching. reactions immediately.
Source:
and interactions.
Schull, P.D., (2013).
McGraw – Hill
Nurse’s Drug
The McGraw – Hill
Companies, Inc.
ACTION
GENERIC NAME: Clinical investigations Treatment and  Hematologic: leukopenia BEFORE

Silver Sulfadiazine have shown that prevention of infected  Musculoskeletal: back pain, leg  Explain the drug and rationale
Flamazine, because burn wounds; pain of administration to the
BRAND NAME: of its bacteriostatic treatment of infected  GI: stomach pain patient.
Flamazine and bactericidal skin lesions  Skin: intense itching  Assess patient for presence of
activity, is a very conditions in which the drug is
effective therapy in contraindicated.
CLASSIFICATION:
the treatment of local
Antibiotic
infections caused by DURING
both gram-positive  Do not use drug if the tube or
DOSAGE:
and especially gram- jar has been opened or shows
10mg/g (ointment) signs of tampering before first
negative
microorganisms like application.
ROUTE:  Reserve one jar or tube for
Pseudomonas,
Topical one patient.
Klebsiella and
 Follow all directions given by
Enterobacter.
FREQUENCY: doctor and pharmacist
BID carefully.
 Ointment should be applied by
TIMING: means of a sterile spatula or
8AM – 6PM by hand, covered with a
sterile glove.
 Apply ointment at about the
same time every day.
Hypersensitivity to  Skin: rash, photosensitivity, AFTER
sulfonamides; liver general body swelling,  Encourage patient to adhere
Source: damage; oliguria blistering, peeling, loosening to medication regimen.
Hodgson, B.B., & of skin, skin discoloration  Tell patient to report
Kizior, R.J. (1998).  Other: fever, chills perceived effectivity of drug.
Saunders nursing  As appropriate, review all
drug handbook. other significant and life-
Philadelphia:
Saunders.
and interactions.
ACTION
GENERIC NAME: Inhibits influx of Management of  CNS: headache, dizziness, BEFORE

Amlodipine extracellular calcium hypertension, coronary drowsiness, light-headedness,  Explain the drug and rationale
ions, thereby artery disease (chronic fatigue, weakness, lethargy of administration to the
BRAND NAME: decreasing stable angina,  CV: angina, bradycardia, patient.
Norvasc myocardial vasospastic palpitations  Question patient about history
contractility, relaxing [Prinzmetal’s or of hypersensitivity reactions
 GI: nausea, abdominal
CLASSIFICATION: coronary and variant] angina). to drug.
discomfort
Antihypertensive vascular muscles,
 Musculoskeletal: muscle
and decreasing DURING
cramps, muscle pain
DOSAGE: peripheral resistance.  Be aware that this drug may
 Respiratory: shortness of
10mg/tab be given alone or with other
breath, dyspnea, wheezing
drugs to relieve hypertension
ROUTE:  Skin: rash, pruritus, urticaria,
or angina.
Oral flushing
 Monitor BP for therapeutic
effectiveness.
FREQUENCY:  Monitor for signs and
OD
symptoms of dose-related
peripheral or facial edema
TIMING:
that may not be accompanied
7AM
by weight gain.
 Monitor BP with postural
changes. Report postural
hypotension.
 Monitor heart rate.
AFTER
Hypersensitivity to  CNS: syncope  Encourage patient to report
amlodipine  CV: excessive peripheral significant swelling of face or
vasodilation, peripheral extremities.
Source: edema, marked hypotension  Support patient when
Schull, P.D., (2013). with reflex tachycardia standing and walking due to
McGraw – Hill possible dose-related light-
Nurse’s Drug
headedness/dizziness.
The McGraw – Hill
Companies, Inc.
and interactions.
ACTION
GENERIC NAME: Blocks stimulation of Hypertension; heart  CNS: dizziness, fatigue, BEFORE
Carvedilol cardiac beta1- failure caused by anxiety, depression,  Explain the drug and rationale of
adrenergic receptor ischemia or insomnia administration to the patient.
BRAND NAME: sites and pulmonary cardiomyopathy; left  CV: orthostatic  Question patient about history of
Carvid beta2-receptor sites. ventricular dysfunction hypotension, peripheral hypersensitivity reactions to
Shows intrinsic following myocardial vasoconstriction, angina drug.
CLASSIFICATION: sympathomimetic infarction  Assess vital signs and
pectoris
Antihypertensive activity, causing cardiovascular status.
 EENT: blurred vision, dry
slowing of heart rate,
eyes, stuffy nose, rhinitis,
DOSAGE: decreased DURING
sinusitis  Ensure that patient is
25mg/tab myocardial
excitability, reduced  GI: nausea, diarrhea, hemodynamically stable and fluid
ROUTE: cardiac output, and constipation retention has been minimized.
Oral decreased renin  GU: urinary tract infection,  Give immediate-release form
release from kidney. hematuria, erectile with food to slow absorption.
FREQUENCY: dysfunction  Give extended-release form in
OD  Hematologic: bleeding the morning with food and
 Metabolic: hypovolemia, instruct patient to swallow
TIMING: hypervolemia, capsule whole.
8AM  For patients who cannot swallow
hyperglycemia,
capsules whole, carefully open
hyponatremia, gout
capsules and sprinkle contents
 Musculoskeletal: arthralgia,
on applesauce.
back pain, muscle cramps  Watch for signs and symptoms of
 Respiratory: wheezing, hypersensitivity reaction.
dyspnea
 Skin: pruritus, rash
 Other: weight gain, viral  Assess baseline CBC and kidney
infection and liver function test results.
CONTRAINDICATION ADVERSE EFFECTS AFTER

Source:  Caution patient not to stop
Schull, P.D., (2013). Hypersensitivity to  CV: bradycardia, heart taking drug abruptly, because
McGraw – Hill drug; uncompensated failure, atrioventricular serious reactions may occur.
Nurse’s Drug heart failure; block  Advise patient to use soft-
Handbook 7th Edition. pulmonary edema;  GU: renal dysfunction bristled toothbrush and electric
The McGraw – Hill cardiogenic shock;  Hematologic: purpura, razor to avoid gum and skin
Companies, Inc. bradycardia or heart thrombocytopenia injury.
block; severe hepatic  As appropriate, review all other
 Metabolic: hypoglycemia
impairment; bronchial significant and life-threatening
 Respiratory:
asthma, brochospasm adverse reactions and
bronchospasm, pulmonary
interactions.
edema
 Other: anaphylaxis
ACTION
GENERIC NAME: Promotes glucose Type 1 (insulin-  Metabolic: BEFORE
Human Regular transport, which dependent) diabetes hypokalemia, sodium  Explain the drug and rationale of
Insulin (HRI) stimulates carbohydrate mellitus; type 2 (non- retention administration to the patient.
metabolism in skeletal insulin-dependent)  Skin: urticaria, rash,  Question patient about history of
BRAND NAME: and cardiac muscle and diabetes mellitus pruritus hypersensitivity reactions to
Humulin R adipose tissue. Also unresponsive to diet and  Other: edema, drug.
promotes oral hypoglycemics; lipodystrophy,
phosphorylation of diabetic ketoacidosis lipohypertrophy, DURING
CLASSIFICATION: glucose in liver, where erythema, warmth,  Be aware that insulin is a high-
Hypoglycemic it is converted to stinging at injection alert drug.
glycogen. Directly site, allergic reactions  Do not give insulin IV (except
affects fat and protein
non-concentrated regular
DOSAGE: metabolism, stimulates
12 units protein synthesis, insulin).
inhibits release of free  When mixing two types of
fatty acids, and insulin, draw up regular insulin
ROUTES: indirectly decreases into syringe first.
IV phosphate and  Rotate subcutaneous injection
potassium. sites to prevent lipodystrophy.
 Administer mixtures of regular
FREQUENCY:
Q6 and NPH or regular and lente
insulins within 5 to 15 minutes of
TIMING: mixing.
8AM – 2PM – 8PM –  Monitor glucose level frequently
2AM to assess drug efficacy and
appropriateness of dosage.
 Monitor for glycosuria.
AFTER
Hypersensitivity to drug  Metabolic:  Teach patient how to administer
or its components; hypoglycemia, rebound insulin subcutaneously as
hypoglycemia hyperglycemia appropriate.
(Somogyi effect)  As appropriate, review all other
 Other: anaphylaxis significant and life-threatening
Source: interactions.
Schull, P.D., (2013).
McGraw – Hill Nurse’s
Drug Handbook 7th
Edition.
The McGraw – Hill
Companies, Inc.
NCP

SUBJECTIVE: Activity Patients with SHORT TERM: Independent Independent SHORT TERM:
Intolerance Hypertensive
“I have this feeling After 8 hours of 1. Note presence of 1. To have a better After 8 hours of
related to Cardiovascular
of weakness and I nursing intervention, factors contributing understanding of nursing intervention,
imbalance Disease have
couldn’t do activities the patient will: to fatigue patient’s the patient was able
between alterations in
because of it,” as 2. Evaluate current condition to:
oxygen cardiac output ⮚ Report measurable
verbalized by the limitations 2. To provide
supply and and side effects increase in activity  Report that activity
patient. 3. Assess comparative
demand as of tolerance tolerance has
evidenced by antihypertensive ⮚ Participate willingly cardiopulmonary baseline increased
unwillingness medications, in response to 3. To assess
to perform causing physical activity severity of (Goal Met)
necessary/desired
activities insufficient activities in the 4. Plan care with rest patient’s  Participate in
physiological treatment plan periods between condition desired activities
OBJECTIVE: energy to ⮚ Demonstrate a activities 4. To reduce fatigue willingly and
complete daily decrease in
▪ Dyspnea upon 5. Promote comfort 5. To enhance successfully
activities. physiological signs
exertion noted measures and ability to
of intolerance such (Goal Met)
▪ ECG changes provide for relief of participate in
as normalized PR pain activities
noted  Display decrease
and BP
▪ Abnormal heart of physiological
rate noted (110 Collaborative Collaborative signs of
LONG TERM:
bpm) 1. Note treatment- 1. To identify intolerance as
▪ Increased BP After 2 weeks of evidenced by
related factors, precipitating
recorded (140/110 nursing intervention, normal statistics
such as side effects factors of
mmHg) the patient will: such as PR (93
of drugs condition
bpm) and BP
 Identify negative 2. Provide 2. To supplement
supplemental (110/80 mmHg)
factors affecting oxygen needs
activity intolerance oxygen and (Goal Met)
and treat
such as low fitness medications as underlying LONG TERM:
level, acute fatigue, indicated conditions
After 2 weeks of
and a non- 3. Provide referral to 3. To provide
therapeutic psychological emotional
the patient was able
environment and counseling as support to to:
eliminate or reduce appropriate patient
their effects when  Identify negative
Reference:
possible factors affecting
Doenges, E.,  Use identified activity intolerance
Moorhouse, F. M., &
techniques to Reference:
Murr A. 2010. such as low fitness
Nursing Care Plans: enhance activity Doenges, E., Moorhouse, level, acute
Guidelines for tolerance such as F. M., & Murr A. 2010. fatigue, and a non-
Individualizing Client meditation, proper Nursing Care Plans:
therapeutic
Care Across the Life Guidelines for
diet, and proper Reference: environment and
Span Individualizing Client Care
resting schedule. Across the Life Span eliminate or
Doenges, E., Moorhouse, F.
M., & Murr A. 2010. Nursing reduce their
Care Plans: Guidelines for effects when
Individualizing Client Care
possible
Across the Life Span
(Goal Met)
 Use identified
techniques to
enhance activity
tolerance such as
meditation, proper
diet, and proper
resting schedule
(Goal Met)
INTRODUCTION
A stroke is an emergency situation. This happens when the blood perfusion to

an area of the brain is blocked or cut off. In this incident, the brain cells are
deprived of nutrients and oxygen which causes cell death. There are two types
of stroke namely ischemic stroke (CVD infarct) and hemorrhagic stroke (CVD
bleed). Stroke is the second leading cause of death in the Philippines. It has
a prevalence of 0.9%; ischemic stroke comprises 70% while hemorrhagic
stroke comprises 30%. That is why it is important for people to know more
about this condition. In this case study, we will be focusing on ischemic stroke
(CVD infarct), specifically the chronic type in this section.
CHRONIC CVD INFARCT
Also called an ischemic stroke, a cerebrovascular disease (CVD) infarct,

is a type of stroke caused by cutoff or blockage of blood flow to the brain.
Stroke is the Philippines' second leading cause of death. Ischemic stroke
comprises 70% while hemorrhagic stroke comprises 30% of all stroke cases
in the Philippines.
Ischemic stroke is one of three types of stroke. It’s also referred to as

brain ischemia and cerebral ischemia. This type of stroke is caused by a
blockage in an artery that supplies blood to the brain. The blockage reduces
the blood flow and oxygen to the brain, a condition called cerebral
hypoperfusion, leading to damage or death of brain cells. If circulation isn’t
restored quickly, brain damage can be permanent. Approximately 87 percent
of all strokes are ischemic stroke incidences.
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.
What makes a CVD Infarct chronic?
This type of CVD infarct follows the same disease process that occurs
in acute stroke. 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. However, the main characteristic that distinguishes a chronic CVD
infarct is the duration of the incidence of clinical manifestations, which can
take weeks or even more.
The following signs and symptoms have a major cerebral involvement in

their occurrence. This is because of the nature of the condition, which results
in the death of cells in the brain due to oxygen starvation. The clinical
manifestations of chronic CVD infarct are similar to those of acute CVD
infarct.
 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
Predisposing factors:
 Age
 Heredity
 Gender
 Race
Precipitating factors:
 Sedentary lifestyle/physical inactivity
 Poor diet (high fat, high cholesterol)
 Hypertension
Complications:
 Permanent disability
 Loss of cognitive functions
 Partial paralysis in some limbs
 Speech difficulties
 Memory loss
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 has 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.
 Blood Tests
o You may have several blood tests, including tests to check how
fast your blood clots, whether your blood sugar is too high or
low, and whether you have an infection.
 Computerized Tomography (CT) Scan
o A CT scan uses a series of X-rays to create a detailed image of

your brain. A CT scan can show bleeding in the brain, an
ischemic stroke, a tumor or other conditions. Doctors may inject
a dye into your bloodstream to view your blood vessels in your
neck and brain in greater detail (computerized tomography
angiography).
 Magnetic Resonance Imaging (MRI)
o An MRI uses powerful radio waves and magnets to create a

detailed view of your brain. An MRI can detect brain tissue
damaged by an ischemic stroke and brain hemorrhages. Your
doctor may inject a dye into a blood vessel to view the arteries
and veins and highlight blood flow (magnetic resonance
angiography or magnetic resonance venography).
 Carotid Ultrasound
o In this test, sound waves create detailed images of the inside of

the carotid arteries in your neck. This test shows buildup of fatty
deposits (plaques) and blood flow in your carotid arteries.
 Cerebral Angiogram
o In this uncommonly used test, your doctor inserts a thin, flexible

tube (catheter) through a small incision, usually in your groin,
and guides it through your major arteries and into your carotid
or vertebral artery. Then your doctor injects a dye into your
blood vessels to make them visible under X-ray imaging. This
procedure gives a detailed view of arteries in your brain and
neck.
 Echocardiogram
o An echocardiogram uses sound waves to create detailed images

of your heart. An echocardiogram can find a source of clots in
your heart that may have traveled from your heart to your brain
and caused your stroke.
TEST: LIPID PROFILE
FBS 52.53 mg/dL 70 – 100
Cholesterol 149.7 mg/dL 0 – 200
Triglycerides 150.4 mg/dL 25 – 148
HDL 34.93 mg/dL 35 – 88
LDL 84.7 mg/dL 0 – 150
VLDL 30.1 mg/dL 0 – 42
Explanation:
A complete cholesterol test is also called a lipid panel or lipid profile. Your
doctor can use it to measure the amount of “good” and “bad” cholesterol and
triglycerides, a type of fat, in your blood. Cholesterol is a soft, waxy fat that
your body needs to function properly.
The patient’s lipid profile results are not very alarming. However, the level of
triglycerides is quite high, which indicates high fatty content in the blood.
This is coupled by a low level of HDL, which supposedly lowers the risk of
hypercholesterolemia.
PATHOPHYSIOLOGY
Predisposing factors: Precipitating factors:

 Age  Sedentary lifestyle/physical
 Heredity inactivity
 Gender  Poor diet (high fat, high
 Race cholesterol)
 Hypertension
Blood tests detect risk factors such as

increased clotting activity, high blood
sugar, and presence of infections at Atherosclerosis
any point but they can be conducted
from this point onwards.
Buildup of plaque deposits in walls of

Transient ischemic attack
blood vessels Diagnostic studies to visualize
blockage will show positive
results at this point:
 Nausea
Drug Therapy:  CT Scan
 Diarrhea Thrombosis
 Fever Enoxaparin  MRI
 Edema  Carotid Ultrasound
 Pain at injection
site  Cerebral
Angiogram
Blocked blood vessel  Echocardiogram
Brain involvement causes Cerebral hypoperfusion

Legend
some symptoms to occur:
 Dizziness  Part of Pathological Process
 Nausea  Disease
 Vomiting Impaired oxygen and nutrient  Diagnostic Tests
 Confusion  Complications
delivery to brain
 Explanation
 Treatment
Tissue hypoxia and cellular  Drug Side Effects

Ischemia brings forth more  Nursing Diagnosis
severe symptoms:
starvation
 Numbness
 Weakness
 Slurred speech Cerebral ischemia (stroke)
 Loss of vision
 Loss of balance
and coordination
Chronic CVD Infarct
Loss of Cognitive Memory Loss Paralysis Speech Difficulties

Functions
Impaired Physical Impaired Verbal

Disturbed Thought Impaired Memory Communication
Mobility
Processes
Management: Management:
 Physical  Speech Therapy
Drug Therapy:  Speech Exercises
Therapy
Citicoline
 Occupational
Therapy
 Use of mobility
aids
 Insomnia  Use of
 Headache
supportive
 Diarrhea
 Nausea devices
 Blurred vision
 Chest pain
Explanation:
Several predisposing and precipitating factors influence the incidence of a
CVD infarct. Once the conditions are severe enough to foster the propagation
of the condition, the cardiovascular system – more focused on the brain –
gets involved with the presence of clots or any entity that would block blood
flow. Once this occurs, and the brain’s supply of blood is blocked, cerebral
tissues starve and eventually become damaged, causing cerebral function
impairment.
DRUG STUDIES
DRUG NAME MECHANISM OF INDICATION SIDE EFFECTS NURSING REPONSIBILITIES

ACTION
GENERIC NAME: Citicoline is a naturally Cerebrovascular  GI: diarrhea, BEFORE
Citicoline occurring endogenous disorders; head injury; epigastric  Explain drug and rationale of
nucleoside involved in Parkinson’s disease; discomfort, administration to patient.
BRAND NAME: the biosynthesis of cognitive disorders stomach pain  Observe proper drug dose.
Cholinerv lecithin. It increases the  CNS: dizziness,  Assess patient for conditions in
synthesis of headache which the drug is
CLASSIFICATION: phosphatidylcholine contraindicated.
Nootropic, Cerebral (main neuronal
Activator membrane phospholipid) DURING
and enhances  Monitor for adverse effects;
DOSAGE: acetylcholine production. instruct patient to report
500mg/cap It is also claimed that it immediately if he/she develops
increases blood flow and chest tightness, tingling in
oxygen consumption in mouth and throat, headache,
ROUTES: the brain. diarrhea and blurring of vision.
PO  Instruct patient to take
the medication as prescribed.
FREQUENCY:  The supplement should not be
BID taken in the late afternoon or at
night because it can cause
TIMING: difficulty sleeping.
8AM – 6PM  Women who are pregnant or
trying to become pregnant
should consult with their doctor
before taking the supplements.
Hypertonia of the  CV: bradycardia,  Teach the patient that citicoline
parasympathetic tachycardia, may be taken with or without
nervous system hypotension food.
 Skin: rashes, hives AFTER
Source:  Contact the physician
Hodgson, B.B., & Kizior, immediately if
R.J. (1998). Saunders allergic reaction such as hives,
nursing drug handbook. rash, or itching, swelling in your
Philadelphia: Saunders. face or hands, mouth or throat,
chest tightness or trouble
breathing are experienced.
interactions.
ACTION
GENERIC NAME: Inhibits thrombus Patients at risk for  CNS: dizziness, headache, BEFORE
Enoxaparin and clot formation by thromboembolic insomnia, confusion  Explain the drug and rationale of
blocking factor Xa complications due to  CV: edema, chest pain administration to the patient.
BRAND NAME: and factor IIa. This severely restricted  GI: nausea, vomiting,  Question patient about history of
Clexane inhibition accelerates mobility during acute constipation hypersensitivity reactions to
formation of illness; prevention of  GU: urinary retention drug.
CLASSIFICATION: antithrombin III- pulmonary embolism
 Hematologic: anemia
Anticoagulant thrombin complex (a and deep-vein DURING
 Skin: bruising, pruritus, rash,
coagulation thrombosis (DVT)  Be aware that enoxaparin is a
urticaria
DOSAGE: inhibitor), thereby after abdominal high-alert drug.
 Other: fever, pain, irritation,  Use tuberculin syringe with
0.6ml deactivating surgery; prevention
thrombin and of pulmonary or erythema at injection site multi-dose vial to ensure
ROUTE: preventing embolism and DVT accurate dosage.
SQ conversion of after hip or knee  Do not expel air bubble from
fibrinogen to fibrin. replacement surgery; syringe before administering.
FREQUENCY: prevention of  Inject drug deep subcutaneously
OD ischemic with patient in supine position.
complications of Alternate left and right
TIMING: unstable angina or anterolateral and posterolateral
8AM non-Q-wave abdominal wall sites.
myocardial  Don’t rub injection site.
infarction;  Do not give drug by IM or IV
hospitalized patients route.
with acute DVT with  Monitor CBC and platelet counts.
or without pulmonary Watch for signs and symptoms of
embolism (PE) (given bleeding or bruising.
with warfarin
sodium); Outpatients  Monitor fluid intake and output.
with acute DVT Watch for fluid retention and
Source: without PE (given edema.
Schull, P.D., (2013). with warfarin
McGraw – Hill sodium) AFTER
Nurse’s Drug CONTRAINDICATI ADVERSE EFFECTS  If patient will self-administer
Handbook 7 Edition.
th
ON drug, teach proper injection
The McGraw – Hill technique.
Hypersensitivity to  CNS: cerebrovascular  Teach patient safety measures to
Companies, Inc.
drug, heparin, accident avoid bruising or bleeding.
sulfites, benzyl  CV: atrial fibrillation, heart  Advise patient to weigh self
alcohol, or pork failure regularly and to report gains.
products;  Hematologic: bleeding  As appropriate, review all other
thrombocytopenia; tendency, thrombocytopenia, significant and life-threatening
active major bleeding adverse reactions and
hemorrhage
 Metabolic: hyperkalemia interactions.
ACTION
GENERIC NAME: Unclear. Pain relief Mild to moderate pain  Hepatic: jaundice BEFORE
Acetaminophen may result from caused by headache,  Skin: rash, urticaria  Explain the drug and rationale of
inhibition of muscle ache,  Other: hypersensitivity administration to the patient.
BRAND NAME: prostaglandin backache, minor reactions (such as  Question patient about history of
Tylenol synthesis in CNS, arthritis, common cold, fever) hypersensitivity reactions to drug.
with subsequent toothache, or
blockage of pain menstrual cramps or DURING
CLASSIFICATION:
impulses. Fever fever;  Be aware that although most
Analgesic, Antipyretic
reduction may result patients tolerate drug well, toxicity
from vasodilation and can occur with a single dose.
DOSAGE: increased peripheral  Know that acetylcysteine may be
500mg/tab blood flow in ordered to treat acetaminophen
hypothalamus, which toxicity, depending on patient’s
ROUTE: dissipates heat and blood drug level. Activated charcoal
Oral lowers body Hypersensitivity to  Hematologic:
drug thrombocytopenia, is used to treat acute, recent
temperature.
hemolytic anemia, acetaminophen overdose (within 1
FREQUENCY:
neutropenia, hour of ingestion).
TID
leukopenia,  Determine overdose severity by
TIMING: pancytopenia measuring acetaminophen blood
8AM – 1PM – 6PM  Hepatic: hepatotoxicity level no sooner than 4 hours after
 Metabolic: hypoglycemic overdose ingestion (to ensure that
coma peak concentration has been
reached).
 Observe for acute toxicity and
overdose.
AFTER
 Tell patient, parents, or other
caregivers not to use drug
concurrently with other
Source: acetaminophen-containing products
Schull, P.D., (2013). or to use more than 4,000 mg of
McGraw – Hill regular-strength acetaminophen in
Nurse’s Drug
24 hours.
 Inform patient, parents, or other
The McGraw – Hill
caregivers not to use extra-strength
Companies, Inc.
caplets in dosages above 3,000 mg
(six caplets) in 24 hours because of
risk of severe liver damage.
 Advise patient, parents, or other
caregivers to contact prescriber if
fever or other symptoms persist
despite taking recommended amount
of drug.
 Inform patients with chronic
alcoholism that drug may increase
risk of severe liver damage.
adverse reactions and interactions.
ACTION
GENERIC NAME: Interferes with Allergy symptoms  CNS: drowsiness, dizziness, BEFORE
Diphenhydramine histamine effects at caused by histamine headache, paradoxical  Explain the drug and rationale
histamine1-receptor release (including stimulation (especially in of administration to the
BRAND NAME: sites; prevents but anaphylaxis, seasonal children) patient.
Benadryl doesn’t reverse and perennial allergic  Question patient about history
 CV: hypotension, palpitations, of hypersensitivity reactions
histamine-mediated rhinitis, and allergic
tachycardia to drug.
response. Also dermatoses); nausea;
CLASSIFICATION:  EENT: tinnitus
possesses CNS vertigo; cough;
Antihistamine
depressant and dyskinesia; Parkinson’s  GI: diarrhea, constipation, dry DURING
anticholinergic disease; mild nighttime mouth  For IV use, check
DOSAGE: properties. sedation  Skin: photosensitivity compatibility before mixing
50mg  Other: decreased appetite, with other drugs.
pain at I.M. injection site  Discontinue drug 4 days
ROUTE: before allergy skin testing to
IVTT avoid misleading results.
 Do not give within 14 days of
FREQUENCY: MAO inhibitors.
PRN
 Monitor cardiovascular status,
especially in patients with
TIMING:
cardiovascular disease.
As needed
 Supervise patient during
ambulation. Use side rails as
CONTRAINDICATION ADVERSE EFFECTS necessary
Hypersensitivity to  EENT: blurred vision AFTER
drug; alcohol  GU: dysuria, urinary frequency  Advise patient to avoid alcohol
Source: intolerance; acute or retention and other depressants such as
Schull, P.D., (2013). asthma attacks; MAO sedatives while taking drug.
McGraw – Hill inhibitor use within  Caution patient to avoid
Nurse’s Drug past 14 days; driving and other hazardous
Handbook 7th Edition. breastfeeding; activities until he knows how
The McGraw – Hill neonates, premature
drug affects concentration and
Companies, Inc. infants
alertness.
and interactions.
ACTION
GENERIC NAME: Thought to produce Mild pain or fever  CNS: headache BEFORE
Paracetamol analgesia by  Explain the drug and rationale
inhibiting of administration to the
BRAND NAME: prostaglandin and patient.
Ifimol IV other substances that  Question patient about history
sensitize pain of hypersensitivity reactions
CLASSIFICATION: receptors. Drug may to drug.
Analgesic relieve fever through
central action in DURING
DOSAGE: hypothalamic heat  Do not exceed the
300mg regulating center. recommended dosage.
 Reduce dosage with hepatic
CONTRAINDICATION ADVERSE EFFECTS impairment.
ROUTE:
IV  Avoid using multiple
Hypersensitivity to  CV: chest pain, dyspnea, preparations containing
FREQUENCY: drug myocardial damage when acetaminophen. Carefully
PRN doses of 5-8g/day are ingested check all OTC products.
daily for several weeks or  Give drug with food if GI
TIMING: when doses of 4g/day are upset occurs.
As needed ingested for 1yr  Discontinue drug if
 GI: hepatic toxicity and failure, hypersensitivity reactions
jaundice occur.
 Treatment of overdose:
 GU: acute renal failure, renal
Monitor serum levels
tubular necrosis
regularly, N-acetylcysteine
 Hematologic:
should be available as a
methemoglobinemia- specific antidote; basic life
cyanosis; hemolytic anemia- support measures may be
hematuria, anuria; necessary.
neutropenia, leukopenia,
Source: pancytopenia, AFTER
Hodgson, B.B., & thrombocytopenia,  Encourage patient to adhere
Kizior, R.J. (1998). hypoglycemia to medication regimen.
Saunders nursing  As appropriate, review all
 Other: rash, fever
drug handbook. other significant and life-
Philadelphia: threatening adverse reactions
Saunders. and interactions.
NCP

SUBJECTIVE: Impaired A SHORT TERM: Independent Independent SHORT TERM:

Physical Mobility cerebrovascular
“I cannot move my After 8 hours of 1. Ascertain client’s 1. To have a basis After 8 hours of
related to infarct causes
limbs,” as verbalized nursing intervention, perception of in creating nursing intervention,
neuromuscular damage to the
by the patient. the patient will: activity/exercise individualized the patient was able
impairment cerebral tissue.
needs activity/exercise to:
secondary to When it reaches ⮚ Verbalize
cerebral the motor willingness to and 2. Determine degree routine  Report and show
ischemia as centers of the demonstrate of immobility of 2. To evaluate willingness and
evidenced by brain which are participation in patient severity of participate in
inability to responsible for activities 3. Instruct client to patient’s activities
OBJECTIVE: move limbs movement of ⮚ Verbalize use siderails, condition
skeletal muscles, (Goal Met)
understanding of overhead trapeze, 3. To aid in position
▪ Patient has limited their function is situation, risk and roller pads changes or  Verbalize
range of motion impaired, leading factors such as age, 4. Support affected transfers understanding of
▪ Slowed movement to an individual’s gender, and body parts using 4. To maintain situation, risk
of the patient inability to move genetics, and pillows/pads position of factors such as
noted the affected treatment regimen 5. Schedule activities function and age, gender, and
▪ Patient engages in area/s. This including drug genetics, and
substitutions for with adequate rest reduce risk of
causes limitation therapy, physical
movement i.e. periods during the pressure ulcers treatment regimen
in independent, therapy, and
controlling day 5. To reduce fatigue including drug
purposeful speech therapy
behavior therapy, physical
physical
Collaborative Collaborative therapy, and
movement of the LONG TERM:
speech therapy
body. 1. Administer 1. To permit
After 2 weeks of
medications prior to maximal effort or (Goal Met)
the patient will: activity as needed involvement in
for pain relief activity
 Demonstrate 2. Assist with 2. To reduce, if not
techniques and treatment of eradicate, the
behaviors that underlying LONG TERM:
enable resumption condition causing cause of After 2 weeks of
of activities such as dysfunction immobility nursing intervention,
increased activity the patient was able
tolerance and to:
improved mobility
 Demonstrate
 Maintain position of
techniques and
function and skin
behaviors that
integrity as
Reference: enable resumption
Reference: evidenced by
of activities such
absence of Reference: Doenges, E., Moorhouse,
Doenges, E., as increased
Moorhouse, F. M., & contractures, F. M., & Murr A. 2010.
Doenges, E., Moorhouse, F. Nursing Care Plans: activity tolerance
Murr A. 2010. footdrop, and M., & Murr A. 2010. Nursing Guidelines for and improved
Nursing Care Plans: pressure ulcers Care Plans: Guidelines for Individualizing Client Care mobility
Guidelines for Individualizing Client Care Across the Life Span
Individualizing Client Across the Life Span
Care Across the Life (Goal Met)
Span
 Maintain position
of function and
skin integrity as
evidenced by
absence of
contractures,
footdrop, and
pressure ulcers
(Goal Met)
PATIENT’S OTHER LAB RESULTS
TEST: IMMUNOLOGY
Test Result
HBsAg (Qualitative) NONREACTIVE
Anti-HCV (Qualitative) NONREACTIVE
Explanation:
The OnSite HBsAg/HCV Ab Rapid Test is a lateral flow chromatographic
immunoassay for the qualitative detection and differentiation of hepatitis B
surface antigen (HBsAg) and anti-hepatitis C virus antibodies (IgG, IgM, IgA)
in human serum, plasma or whole blood.
The patient’s result in this test signifies that the patient is not suffering from
hepatitis C.
TEST: RT PCR TEST
TEST PERFORMED: SARS-CoV2 RNA Detection Test (PCR)
TEST RESULT: SARS-CoV2 Viral RNA Not Detected
INTERPRETATION: Negative for SARS-CoV2 Viral RNA
Explanation:
This test assesses if the patient is infected with SARS-CoV2, the pathogen
responsible for COVID-19.
The patient’s result shows that the she is not COVID-19 positive.

Arcipe Iccu Case 5

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Arcipe Iccu Case 5

Uploaded by

Copyright:

Available Formats

SOUTHWESTERN UNIVERSITY

December 10, 2020

Arcipe, Nathaniel Dean G.

Dr. Adriel Arman V. Pizarra, DHCM, MAN, RN

CHRONIC KIDNEY DISEASE

ASSESSMENT OF SIGNS AND SYMPTOMS

Other signs and symptoms may include:

 Swelling or puffiness, particularly around the eyes or in the face, wrists,

As kidney disease worsens, additional signs and symptoms may include a

 Urinating less frequently

 feel more tired and have less energy

► Screen people at risk for CKD, including those with

LABORATORY A ND DIAGNOSTIC STUDIES

 Blood Test for GFR

Test Result Unit Reference Range

Creatinine 7.18 mg/dL 0.51 – 0.95

Sodium 134.0 mmol/L 136 – 145

Potassium 6.30 mmol/L 3.5 – 5.1

Calcium (Ionized) 1.09 mmol/L 1.13 – 1.31

Phosphorus 12.24 mmol/L 2.4 – 4.5

Blood Urea Nitrogen 143.30 mg/dL 6.0 – 20.0

Blood Uric Acid (BUA) 9.90 mg/dL 2.7 – 7.3

Albumin 2.19 mg/dL 3.97 – 4.94

ALT/SGPT 12 U/L < 34

eGFR: 6 (Normal: >90)

Clinical chemistry uses chemical processes to measure levels of chemical

1. NORMAL-SIZED LIVER WITH MILD DIFFUSE FATTY CHANGES DEMONSTRATED

TEST: BLOOD GAS ANALYSIS

Test Result Unit Reference

Test Result Reference Range

Color LIGHT YELLOW -

WBC TNTC/HPF 0-5/HPF

Test Result Unit Reference Range

Reticulocyte Count 5.3 % Adult: 0.5 – 1.5

Newborn: 2.5 – 6.5

Predisposing Factors: Precipitating Factors

 Part of Pathological Process

Increased oxygen consumption

The following diagnostic studies

Gout Anemia Hyperkalemia Fluid Buildup

Imbalanced Nutrition: Imbalanced Nutrition:

Drug Therapy: Drug Therapy: Drug Therapy:

 Diarrhea  High blood

A number of predisposing factors as well as precipitating conditions influence the occurrence of

DRUG NAME MECHANISM OF INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

GENERIC NAME: Decreases serum uric Long-term  CNS: dizziness BEFORE

GENERIC NAME: Increases serum Hypocalcemic  CNS: headache, weakness, BEFORE

GENERIC NAME: Increases serum Hypocalcemic  CNS: headache, weakness, BEFORE

DEFINING NURSING SCIENTIFIC NURSING

Acute coronary syndrome (ACS) can be divided into subgroups of ST-segment

Acute coronary syndrome is a term used to describe a range of

As a summary, NSTEMI is a type of heart attack. NSTEMI stands for

The sudden occurrence of an ACS-NSTEMI primarily causes cardiac

 Depressed ST wave or T-wave inversion

 Partial blockage of the coronary artery

o Cardiac troponin is the cardiac biomarker of choice. Troponin is

 CREATININE KINASE – MB (CK-MB) TEST

o Creatine kinase-MB (CK-MB) is a form of an enzyme found

MAGNIFIED CARDIAC SILHOUETTE WITH PULMONARY CONGESTIVE CHANGES. A

CONSIDER MINIMAL LEFT PLEURAL EFFUSION.

ATHEROSCLEROSIS OF THE THORACIC AORTA.

RIGHT-SIDED JUGULAR CATHETER IN PLACE.

Test Result Unit