COLLEGE OF NURSING

November 29, 2020

Thursday

Level 3 Section A

INDANAN, MA. CHARIS ANNE M.

Anecito Alkuino

___________________________________________
Clinical Instructor

1
Name of Institution assigned: Southwestern University- Medical Center____________
Area of assignment: 4th Floor – IM Ward Dates of Assignment: November 26-27, 2020

Concept: CARE OF CLIENTS WITH PROBLEMS OF OXYGENATION, FLUID AND

ELECTROLYTE BALANCE, INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC
RESPONSE, CELLULAR ABBERATIONS- ACUTE AND CHRONIC

Name of Clinical Instructor: Anecito Alkuino Rotation Grade: _______

General Objectives

After 2 days exposure at ____Southwestern University- Medical Center___ being aided

with a concept of Care of clients with problems of oxygenation, fluid and electrolyte
balance, infectious, inflammatory and immunologic response, cellular aberrations- acute
and chronic, the student nurses will be able to gain knowledge about the health and well-
being of the patient, enhance the skills in improving and identifying the problems and
show positive attitude to the patient as well as towards other people.

Specific Objectives

After two weeks exposure at Southwestern University- Medical Center, I will:

1. Be oriented to the physical setup, rules and policies and the staff in the hospital;
2. Exhibit professionalism in the performance of all functions in the clinical area;
3. Display respect during all interaction with the client and towards the staff nurse
and clinical instructor
4. Establish rapport with the client and significant others;
5. Render nursing care and information to the client through the application of skills
taught in the classroom;
6. Boost my knowledge and skills relating to real life health care setting and nursing
practices;
7. Boost confidence in facing and providing care towards the client;
8. Add experience for real life health situations and problems;
9. Research on and apply additional information on nursing techniques; and
10. Prepare in dealing with patients in the actual clinical setting in the future.

2
 HISTORY

Biographic Data:

Name: Allan M. Bernardos Occupation: N/A

Gender: Male Nationality: Filipino
Birth Date: June 12, 1943 Religion: Roman Catholic
Birth Place: Cebu City Source of Data: Tricia Bernardos
Age: 77 Date & Time of Admission: August 13, 2020
Address: Lawaan, Talisay Attending Physician: Dr. Quijano
Educational Level: N/A Diagnosis: CVD Bleed, HCVD, Type 2 DM,
Marital Status: Married CICD Stage 5 sec to hypersensitive
Nephrosclerosis vs Urate Nephropathy

Chief Complaint:

L sided weakness, slurring of speech.

Vital signs: BP: 160/100 HR: 89_RR: 38_Temp: 36.7_O2Sat: 97%_

DEFINITION OF DISEASE

WHAT IS CVD?

Cerebrovascular disease refers to a group of conditions, diseases, and disorders that

affect the blood vessels and blood supply to the brain. If a blockage, malformation, or
hemorrhage prevents the brain cells from getting enough oxygen, brain damage can
result. Cerebrovascular disease can develop from a variety of causes, including
atherosclerosis, where the arteries become narrow; thrombosis, or embolic arterial blood
clot, which is a blood clot in an artery of the brain; or cerebral venous thrombosis, which
is a blood clot in a vein of the brain.

SIGNS AND SYMPTOMS

sudden severe headache

vision changes
loss of balance or coordination
becoming unable to move
numbness in an arm or leg
seizures
loss of speech or difficulty understanding speech
confusion or loss of alertness
nausea and vomiting
loss of consciousness

3
ANATOMY AND PHYSIOLOGY

Cerebrovascular Disease (Hemorrhagic Stroke)

Blood from an artery begins bleeding into the brain due to a weakened blood vessel that
bursts and bleeds into the surrounding brain. Pressure from the leaked blood damages
brains cells, and, as a result, the damaged area is unable to function properly.

There are two main types of hemorrhagic stroke:

 Intracerebral hemorrhage: The bleeding occurs inside of the brain. This is the
most common type of hemorrhagic stroke.
 Subarachnoid hemorrhage: The bleeding occurs between the brain and the
membranes that cover it.

4
Pathophysiology

Smoking,
Age, gender, sedentary
heredity, race lifestyle, drug
abuse
A blood vessel penetrating
the
brain weakens

Blood vessel ruptures

At this stage,
visualization
Ruptured vessel bleeds into
Sudden severe studies could
the
headache already detect
brain
accumulation if
they are visible
enough.
Blood accumulates and
compresses surrounding
brain
tissue

Affected cells have impaired

functioning

vision changes, loss of

balance, seizures, loss of
speech, loss of
consciousness, paralysis

DEFINITION OF DISEASE

WHAT IS HCVD?

Hypertensive heart disease refers to a constellation of changes in the left ventricle, left
atrium and coronary arteries as a result of chronic blood pressure elevation. Hypertension
increases the workload on the heart inducing structural and functional changes in the
myocardium. These changes include hypertrophy of the left ventricle, which can progress
to heart failure.

5
SIGNS AND SYMPTOMS

chest pain (angina)

tightness or pressure in the chest
shortness of breath
fatigue
pain in the neck, back, arms, or shoulders
persistent cough
loss of appetite
leg or ankle swelling

ANATOMY AND PHYSIOLOGY

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.

6
Pathophysiology

DEFINITION OF DISEASE

WHAT IS DM?

Diabetes mellitus, commonly known as diabetes, is a metabolic disease that causes high
blood sugar. The hormone insulin moves sugar from the blood into your cells to be stored
or used for energy. With diabetes, your body either doesn’t make enough insulin or can’t
effectively use the insulin it does make.

SIGNS AND SYMPTOMS

The symptoms of diabetes are related to high blood glucose levels. They include:
Excessive urination, thirst and hunger
Weight loss
Increased susceptibility to infections, especially yeast or fungal infections

ANATOMY AND PHYSIOLOGY

TYPE 2 DIABETES MELLITUS

Type 2 diabetes is a chronic disease. It is characterized by high levels of sugar in the

blood. Type 2 diabetes is also called type 2 diabetes mellitus and adult-onset diabetes.
That's because it used to start almost always in middle- and late-adulthood. However,

7
more and more children and teens are developing this condition. Type 2 diabetes is much
more common than type 1 diabetes, and is really a different disease. But it shares with
type 1 diabetes high blood sugar levels, and the complications of high blood sugar. Type
2 diabetes occurs when your body's cells resist the normal effect of insulin, which is to
drive glucose in the blood into the inside of the cells. This condition is called insulin
resistance. As a result, glucose starts to build up in the blood.

Pathophysiology

8
 DEFINITION OF DISEASE

WHAT IS CKD?

Chronic kidney disease is a slowly progressive decline in the kidneys’ ability to filter
metabolic waste products from the blood. Chronic kidney disease means your kidneys
are damaged and can’t filter blood the way they should. The disease is called “chronic”
because the damage to your kidneys happens slowly over a long period of time. This
damage can cause wastes to build up in your body. CKD can also cause other health
problems.

HYPERTENSIVE NEPHROSCLEROSIS

Hypertensive arteriolar nephrosclerosis results when long-standing (chronic)

hypertension damages tissue in the kidneys, including small blood vessels, glomeruli,
renal tubules, and interstitial tissues. As a result, progressive chronic kidney disease
develops.

SIGNS AND SYMPTOMS

loss of appetite
nausea
vomiting
itching
sleepiness or confusion
weight loss
unpleasant taste in the mouth

URATE NEPHROPATHY

Uric acid nephropathy is a health condition that involves damage to the kidneys that result
from excess uric acid in the body. Uric acid nephropathy is caused by high levels of uric
acid in the body, which may result from either overproduction of urate or reduced uric acid
excretion.

SIGNS AND SYMPTOMS

Uric acid nephropathy is usually asymptomatic until it leads to significantly reduced

kidney function or failure. Signs of this may include:

Reduced urine output

Nausea and vomiting
Lethargy
Seizures
Abdominal pain
Painful urination
Hematuria

9
 ANATOMY AND PHYSIOLOGY

CHRONIC KIDNEY DISEASE

With CKD, the kidneys usually do not fail all at once. Instead, kidney disease often
progresses slowly over a period of years. This is good news because if CKD is caught
early, medicines and lifestyle changes may help slow its progress and keep you feeling
your best for as long as possible

10
Pathophysiology

LABORATORY AND DIAGNOSTIC

CLINICAL CHEMISTRY

TEST RESULT NORMAL RANGE

Blood Urea Nitrogen 45.1 mg/dL 6-20

(BUN)

Blood Uric Acid (BUA) 9.20 mg/dL 2.4-5.7

Blood Glucose (HGT) 253 mg/dL

HBA1C 7.50% Normal: <5.70%

Pre-Diabetes: 5.70%-
6.40%

Diabetes: >/=6.50%

ALT (SGPT) 6.10 U/L 0-41

Creatinine 3.66 mg/dL 0.51-1.95 mg/dL

Potassium 3.70 mEq/L 3.5-5.1 mEq/L

Sodium 138 mEq/L 136-145 mEq/L

Clinical Chemistry

The patient’s Blood Urea Nitrogen (BUN) has increased with a result of 45.1 mg/dL
(ref. range: 6.0-20.0) where it indicates kidney injury or disease is present. Kidney
damage can be caused by diabetes or high blood pressure that directly affects the

11
kidneys. The Blood Uric Acid (BUA) has also increased with a result of 9.20mg/dL (ref.
range: 2.4-5.7) this means that the patient’s kidneys don't eliminate uric acid efficiently.
Things that may cause this slow-down in the removal of uric acid includes being
overweight, having diabetes or taking certain diuretics. The Blood Glucose (HGT) of the
patient has a result of 253 mg/dL which indicates hyperglycemia. Patient’s hemoglobin
A1c level is above the normal range which is 7.50% this means that the patient has
diabetes. The ALT/SGPT of the patient is elevated 6.10 U/L this indicates liver damage
or injury. Creatinine is also elevated which means that the patient’s kidneys aren't working
well. While the sodium and potassium of the patient is within normal range.

COMPLETE BLOOD COUNT

TEST RESULT NORMAL RANGE

WBC 13.1 4-10.50

RBC 3.64 4.70-6

Hemoglobin 10.8 g/dL 14.0-17.5

Hematocrit 32.8 41.5-50.4

Increase level of white blood cells and decrease level of red blood cells. Decrease
level of both Hemoglobin and Hematocrit.

Complete Blood Count

The patient has leukocytosis which means the WBC is elevated. While the RBC,
Hemoglobin and Hematocrit is low and this level is considered anemic.

PROTHROMBIN TIME

TEST RESULT NORMAL RANGE

Patient 12.1 seconds 9.2-13.2

Control 9.2 Seconds -

INR 1.32 0.84-1.11

% Activity 76.03 % 83-143

Prothrombin Test

The International Nationalized Ratio (INR) of the patient result, reported that it
takes 1.32 seconds for the blood to clot, which is a little longer than the normal range.

BLOOD GAS ANALYSIS

TEST RESULT NORMAL RANGE

pH 7.250 7.350-7.450

12
 pCO2 46.4 mmHg 35-45

pO2 120.7 mmHg 80-100

HCO3 20.1 mmol/L 22-26

BE (ecf) -7.10 mEq/L +2

O2 Sat 97.5% >95

Metabolic Acidosis

Blood Gas Analysis

Patient’s Blood Gas Analysis has a result of decreased 7.250 in pH (normal value:
7.350-7.450) and an increased pCO2 level of 46.4mmHg (normal value: 35-45), pO2 was
also increased 120.7mmHg (normal value: 80.0-100.0) and HCO3 was decreased
20.1mmHg (normal range: 22.0-26.0) this indicates that the patient is in metabolic
acidosis.

IMMUNOLOGY

TEST RESULT NORMAL RANGE

IgG Antibody NEGATIVE

IgM Antibody NEGATIVE

No antibodies present

Immunology

Patient’s Immunology examination has a result of negative which means there's

no antibodies present.

URINALYSIS

TEST RESULT NORMAL RANGE

Color Light Yellow Yellow

Transparency Hazy Clear or Cloudy

pH 6 5-8

Glucose 2+ Negative

Bilirubin Negative Negative

Blood 2+ Negative

Leucocytes Negative Negative

Nitrite Negative Negative

13
 Urobilinogen Normal Normal

RBC 20-25 0-3

WBC 2-5 0-5

Epithelial Cells RARE RARE

Bacteria FEW RARE

Mucus Threads RARE RARE

Urine Analysis

Patient’s urinalysis reported a Glucose of 2+ which pt.’s urine contains more sugar
or glucose. The Blood also reported 2+ which more blood in the urine or also called
hematuria that can indicate a serious disorder. The RBC reported 20-25/HPF that could
be an indicator that infection has reached the kidney or bladder, putting patient more at
risk for serious complications.

Problem List

Number of Focus / Nursing Diagnosis

Priority
1
Impaired Physical Mobility related to neuromuscular impairment
secondary to hemorrhagic stroke

3
Fatigue related to decreased metabolic energy production

4
Impaired Urinary Elimination related to decrease in glomerular
filtration rate secondary to chronic kidney disease

5
Activity Intolerance related to imbalance between oxygen supply and
demand

14
 1 FDAR

Date Focus Time DAR

11/26/2 Activity Intolerance 8am D : Received patient lying on bed, conscious, afebrile,
0 showing discomfort through facial expressions, with
PNSS 1L @ 20gtts/min, with O2 @ 2-3LMP via NC, V/S
are BP: 160/100, PR: 89bpm, RR: 38cpm, Temp:
36.7oC, O2 sat: 97%.---------------------------------------------
A : NSS rounds done, established rapport, assessed
health status, anticipated needs, raised bedside rails,
observed and monitored sleeping pattern, Assess the
need for ambulation aids for ADLs, Observe and
document response to activity, encouraged
1pm verbalization of feelings and concerns, monitored for
any signs of complications, afforded rest and
comfort, needs attended.-------------
R: Patient is stable, afebrile, conscious, V/S taken and
charted, endorsed.//------------------------------------------------
----------------------------

15
 DRUG NAME MECHANISM OF ACTION INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

GENERIC NAME ●Test dose for marked CNS: dizziness, headache,  Monitor I.V. site carefully to avoid
mannitol Increases osmotic pressure oliguria or suspected seizures  extravasation and tissue necrosis.
of plasma in glomerular inadequate renal function GI: nausea, vomiting, diarrhea, dry  In comatose patient, insert indwelling
BRAND NAME filtrate, inhibiting tubular ●To prevent oliguria mouth urinary catheter as ordered to monitor
Osmitrol reabsorption of water and during cardiovascular and Skin: rash, urticaria urine output.
electrolytes (includingother surgeries Other: chills, fever, thirst, edema,  Monitor renal function tests, urinary
sodium and potassium). ●Acute oliguria extravasation with edema and
 output, fluid balance, central venous
These actions enhance ●To reduce intracranial tissue
CHARACTERISTIC water flow from various pressure and brain mass necrosis  pressure, and electrolyte levels
Diuretic tissues and ultimately●To reduce intraocular (especially sodium and potassium).
decrease intracranial and pressure  Watch for excessive fluid loss and
intraocular pressures; ●To promote diuresis in  signs and symptoms of hypovolemia
DOSAGE serum sodium level rises drug toxicity  and dehydration.
200 cc while potassium and blood  Assess for evidence of circulatory
urea levels fall. Also CONTRAINDICATION ADVERSE EFFECTS  overload, including pulmonary
protects kidneys by ●Active intracranial CV: chest pain, hypotension, edema, water intoxication, and heart
preventing toxins bleeding (except hypertension, tachycardia, failure.
from forming and blocking during
ROUTE craniotomy) thrombophlebitis, heart failure,  Patient teaching
tubules.
IV vascular overload  Teach patient about importance of
● Anuria secondary to  monitoring exact urinary output.
severe renal disease EENT: blurred vision, rhinitis  Advise patient to report pain at
 infusion site as well as adverse
FREQUENCY ● Progressive heart GU: polyuria, urinary retention,
reactions, such as increased
Q4 failure, pulmonary osmotic nephrosis
congestion, renal shortness of breath or pain in back,
TIMING damage, or renal
Metabolic: dehydration, water legs, or chest.
8 am, 12 nn, 4 pm, 8 Patricia D. Schull (2013), dysfunction after mannitol
intoxication, hypernatremia,  Tell patient drug may cause thirst or
pm, 12 am, 4 am Nurse’s therapy begins
hyponatremia, hypovolemia,  dry mouth. Emphasize that fluid
Drug Handbook, McGraw- hypokalemia, hyperkalemia,  restrictions are necessary, but that
Hill Education, LLC. ● Severe pulmonary metabolic acidosis  frequent mouth care should ease
congestion or pulmonary these

16
edema Respiratory: pulmonary congestion  symptoms.
 As appropriate, review all other
● Severe dehydration significant and life-threatening
adverse
 reactions and interactions, especially
 those related to the drugs and tests
 mentioned above.

17
 DRUG NAME MECHANISM OF ACTION INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES
GENERIC NAME ● Cerebrovascular GI: Diarrhea, epigastric discomfort,  Obtain baseline laboratory studies
citicholine Citicoline is a naturally disorders stomach pain including CBC, before starting
occurring endogenous ● Head injury therapy and periodically thereafter
nucleoside involved in the ● Parkinson’s disease CNS; Dizziness, headache  Instruct patient to take the
BRAND NAME biosynthesis of lecithin. It ●Cognitive disorder medication as prescribed.
Cholinerv increases the synthesis of  Teach the patient that citicoline
phosphatidylcholine (main may be taken with or without food.
neuronal membrane
 Monitor for adverse effects;
phospholipid) and
CHARACTERISTIC instruct patient to report
enhances acetylcholine
Peripheral Vasodilators production. It is also claimed immediately if he/she develops
that it increases blood flow chest tightness, tingling in mouth
and oxygen consumption in and throat, headache, diarrhea
the brain. and blurring of vision
DOSAGE  The supplement should not be
1 gm taken in the late afternoon or at
CONTRAINDICATION ADVERSE EFFECTS night because it can cause
Hypertonia of the CV: Bradycardia, tachycardia, difficulty sleeping.
parasympathetic nervous Hypotension  Women who are pregnant or trying
ROUTE system. to become pregnant should consult
IV Skin: Rashes, Hives with their doctor before taking the
supplements. Not enough is known
Patricia D. Schull (2013), about the use of Citicoline during
Nurse’s
pregnancy and breast-feeding.
Drug Handbook, McGraw-
FREQUENCY Stay on the safe side and avoid
Hill Education, LLC.
Q8 use.
 Contact the physician immediately
if allergic reaction such as hives,
TIMING
rash, or itching, swelling in your
3 am, 11 am, 7 pm
face or hands, mouth or throat,
chest tightness or trouble
breathing are experienced.

18
 Provide patient with a clean and
well-ventilated environment


19
 DRUG NAME MECHANISM OF ACTION INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES
GENERIC NAME ● Adjunct to diet for GI: nausea, vomiting, diarrhea,  Monitor patient for signs and
atorvastatin calcium Inhibits HMG-CoA controlling, total constipation, abdominal cramps, abdominal symptoms of allergic
reductase, which cholesterol, apo-lipoprotein or biliary pain, colitis, indigestion, response.
BRAND NAME catalyzes first step in B, and triglyceride levels dyspepsia, flatulence, stomach ulcers,
 Evaluate for muscle weakness
Lipitor cholesterol synthesis; this and to increase HDL levels gastroenteritis, melena, tenesmus, glossitis,
in patients with primary mouth sores, dry mouth, dysphagia, (a
CHARACTERISTIC action reduces  symptom of myositis and
hypercholesterolemia and esophagitis, pancreatitis, rectal hemorrhage
Lipid-lowering agent concentrations of serum GU: hematuria, nocturia, dysuria, urinary
mixed dyslipidemia possibly rhabdomyolysis).
DOSAGE cholesterol and low-density ● Adjunct to other lipid- frequency or urgency, urinary retention,  Be aware that reduction in
80 mg lipoproteins (LDLs), linked to lowering treatments in cystitis, nephritis, renal calculi, abnormal dosage and periodic
increased risk of coronary patients with homozygous ejaculation, decreased libido, erectile
artery disease (CAD). dysfunction, epididymitis monitoring of creatine kinase
familial
hypercholesterolemia Hematologic: anemia, level may be considered for
Also moderately increases ● Prevention of stroke and thrombocytopenia patients taking drugs that may
concentration of high- myocardial infarction in Hepatic: jaundice, hepatic failure, increase, atorvastatin level.
density lipoproteins (HDLs), patients with type 2 hepatitis  Monitor liver function test
associated with decreased diabetes who have multiple Metabolic: hyperglycemia, hypoglycemia results
risk factors for CHD but
risk of CAD.  and blood lipid levels.
without clinically evident
CHD  Tell patient he may take drug
CONTRAINDICATION ADVERSE EFFECTS with or without food.
● Hypersensitivity to CNS: amnesia, abnormal dreams,  Advise patient to immediately
ROUTE drug or its emotional lability, headache, report allergic response,
P.O components hyperactivity, poor coordination, irregular heartbeats, unusual
● Active hepatic disease malaise, paresthesia, peripheral bruising or bleeding, unusual
or unexplained, neuropathy, drowsiness, syncope, tiredness, yellowing of skin or
Patricia D. Schull (2013),
persistent serum weakness eyes, or muscle weakness.
FREQUENCY Nurse’s
transaminase CV: orthostatic hypotension, Caution patient to avoid
OD Drug Handbook, McGraw-
elevations palpitations, phlebitis, vasodilation, driving and other hazardous
Hill Education, LLC.
● Pregnancy or arrhythmias activities until he knows how
breastfeeding EENT: amblyopia, altered refraction, drug affects concentration,
TIMING alertness, and vision.

20
8 am glaucoma, eye hemorrhage, dry eyes,  Inform patient taking hormonal
hearing loss, tinnitus, epistaxis, contraceptives that drug
sinusitis, pharyngitis increases estrogen levels.
Instruct her to tell all
prescribers she’s taking drug.
 Tell men that drug may cause
erectile dysfunction and
abnormal ejaculation.
Encourage them to discuss
these issues
 with prescriber.

 Tell patient he’ll undergo

regular
 blood testing during therapy.

21
 DRUG NAME MECHANISM OF ACTION INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES
GENERIC NAME ●Erosive esophagitis CNS: dizziness, headache Patient monitoring
pantoprazole sodium Reduces gastric acid caused by GI: vomiting, diarrhea, abdominal  Assess for symptomatic
secretion and increases gastroesophageal reflux pain, dyspepsia improvement.
gastric mucus and disease (GERD) Metabolic: hyperglycemia  Monitor blood glucose level in
bicarbonate production, Skin: rash, pruritus diabetic patient.
BRAND NAME creating protective coating ●Pathologic Other: injection site reaction  Patient teaching
Protonix on gastric mucosa. hypersecretory conditions  Tell patient to swallow delayed
release tablets whole without
●Erosive esophagitis
crushing, chewing, or splitting.
 Tell patient he may take tablets
CHARACTERISTIC with
GI agent  or without food.
 Explain that antacids don’t
DOSAGE affect drug absorption.
40 mg  Instruct diabetic patients to
monitor
CONTRAINDICATION ADVERSE EFFECTS  blood glucose level carefully
● Hypersensitivity to drug CV: chest pain and stay
ROUTE or any substituted  alert for signs and symptoms of
IV benzimidazole EENT: rhinitis hyperglycemia.
 As appropriate, review all other
FREQUENCY Patricia D. Schull (2013), Musculoskeletal: hip, wrist, spine
Nurse’s  significant adverse reactions
STAT, Q24 fractures (with long-term daily use)
Drug Handbook, McGraw- and
Hill Education, LLC.  interactions, especially those
related
TIMING
8 am  to the drugs and tests
mentioned
 above.

22
 DRUG NAME MECHANISM OF ACTION INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES
GENERIC NAME ●Chronic stable angina, CNS: dizziness, headache,  Assess vital signs and
nicardipine hydrochloride Inhibits calcium transport into given alone GI: nausea, dyspepsia, dry mouth cardiovascular
myocardial and vascular or with beta-adrenergic Skin: flushing  status.
smooth muscle cells, causing blockers  Monitor fluid intake and output.
cardiac output and ●Hypertension, given alone Assess for signs and symptoms
BRAND NAME myocardial contractions to or with other of heart failure.
Cardene decrease antihypertensives
 Patient teaching
●Short-term treatment of
 Tell patient he may take
hypertension when oral
therapy isn’t feasible or immediate release capsules
CHARACTERISTIC
desirable without regard to meals. If GI
Calcium channel blocker upset occurs, advise him to
take them with food, but not
with grapefruit or grapefruit
juice.
DOSAGE  Tell patient not to open, crush,
break, or chew sustained-
10 mg release capsules.
CONTRAINDICATION ADVERSE EFFECTS  Instruct him to take them with
● Hypersensitivity to drug asthenia, drowsiness, paresthesia meals,
ROUTE Patricia D. Schull (2013), ● Advanced aortic stenosis CV: hypotension, peripheral edema,  but not with high-fat meals,
IV DRIP Nurse’s chest pain, increased angina, grapefruit,
Drug Handbook, McGraw- palpitations, tachycardia  or grapefruit juice.
Hill Education, LLC. Musculoskeletal: myalgia  Tell patient to monitor blood
FREQUENCY pressure and report abnormal
OD findings.
 Advise patient to immediately
report chest pain or blood
TIMING pressure drop.
8am  Instruct patient to consult
prescriber before drinking

23
 alcohol or taking herbs or over-
the-counter drugs (especially
cold remedies).
 As appropriate, review all other
significant adverse reactions
and interactions, especially
those related to the drugs,
foods, herbs, and behaviors
mentioned above.

24
 DRUG NAME MECHANISM OF ACTION INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES
GENERIC NAME Temporary reduction off CNS: headache  Do not exceed the recommended
Paracetamol Produce analgesia by ever, of minor aches and Hypersensitivity: rash, fever dosage.
blocking generation of pain pains caused by common  Reduce dosage with hepatic
impulses, probably by cold and influenza, impairment.
BRAND NAME inhibiting prostaglandin headache, sore throat,  Assess patient’s fever or pain: type
Biogesic synthesis in the CNS or the toothache, backache, of pain, location, intensity,
synthesis or action of other menstrual cramps, etc. duration, temperature, and
substances that sensitize diaphoresis.
pain receptors to  Assess allergic reactions: rash,
CHARACTERISTIC mechanical or chemical urticarial; if these occur, drug may
Analgesic (Non-opioid) stimulation. It is thought to have to be discontinued
Antipyretic relieve fever by central  Give drug with food if GI upset
action in the hypothalamic occurs
DOSAGE heat-regulating center.  Discontinue drug if hypersensitivity
500 mg reactions occur.
CONTRAINDICATION ADVERSE EFFECTS
● Hypersensitivity to the CV: chest pain, dyspnea,
drug
ROUTE ●Use cautiously with GI: hepatic toxicity and failure,
IV impaired hepatic function, jaundice
Patricia D. Schull (2013), chronic alcoholism,
Nurse’s pregnancy, lactation GU: acute renal failure, renal
Drug Handbook, McGraw- tubular necrosis
FREQUENCY Hill Education, LLC.
PRN Hematologic: hemolytic anemia,
leukopenia, neutropenia,
pancytopenia, thrombocytopenia.
TIMING

25
 DRUG NAME MECHANISM OF ACTION INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES
GENERIC NAME  Assess patient’s electrolyte levels.
Ketoanalogue It allows the intake of Prevention and therapy of Nausea  Explain therapeutic value of drug.
essential amino acids while damages due to faulty or Vomiting  Assess allergy to the drug.
minimizing the amino- deficient protein  Verify patient’s identity.
BRAND NAME nitrogen intake. Following metabolism in chronic  Administer with food to prevent
Ketobest ingestion, the renal insufficiency in gastrointestinal upset.
ketoanalogues are connection with limited  Advise to swallow the tablet whole.
transaminated by taking protein food of ≤40g/day  Monitor vital signs.
nitrogen from non-essential (for adults)
CHARACTERISTIC  Document administration of drug.
amino acids, thereby
Supplement  Monitor calcium levels.
decreasing the formation of
urea by re-using the amino  Monitor for signs of hypercalcemia
group. and electrolyte levels

DOSAGE
600/tab
CONTRAINDICATION ADVERSE EFFECTS

Hypercalcemia, disturbed Hypercalcemia.

ROUTE Schull, P.D., (2013).
Oral McGraw – Hill Nurse’s
Drug Handbook 7th
Edition. The McGraw – Hill
Companies, Inc.
FREQUENCY
TID
amino acid metabolism; in
case of hereditary
phenylketonuria, it has to
be taken into account that
ketoanalogue contains
phenylalanine; disturbed
amino acid metabolism

TIMING
8 AM – 1 PM – 6PM

26
 DRUG NAME MECHANISM OF ACTION INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES
GENERIC NAME ●Adjunctive treatment of GI: nausea, vomiting, anorexia  Measure temperature and watch for
levetiracetam Unknown. Thought to partial onset seizures in Respiratory: cough signs and symptoms of infection.
prevent seizures by patients with epilepsy Other: infection, pain  Monitor neurologic status. Report
inhibiting nerve impulses in ●Myoclonic seizures in signs that patient is dangerous to
BRAND NAME hippocampus of brain. patients himself or others.
Keppra Chemically unrelated to with juvenile myoclonic  Evaluate nutritional status. Report
other anticonvulsants. epilepsy signs of anorexia.
●Primary generalized
 Patient teaching
tonic-clonic
CHARACTERISTIC seizures  Tell patient to take with or without
Anticonvulsant food.
 Instruct patient to swallow extended
release tablets whole and not to chew,
 break, or crush them.
DOSAGE
500 mg/tab  Advise family to contact prescriber
 if patient poses a danger to himself or
CONTRAINDICATION ADVERSE EFFECTS
others.
● Hypersensitivity to drug CNS: aggression, anger, irritability,
 Caution patient not to stop taking drug
or its components mental or mood changes, asthenia,
abruptly, because doing so may
ROUTE ataxia, dizziness, drowsiness,
somnolence, fatigue, nervousness, increase seizure activity.
NGT
depression, anxiety, amnesia,  Teach patient and family about
hostility, coordination difficulties, adverse CNS reactions, and tell them
Patricia D. Schull (2013), headache, paresthesia, vertigo to report these promptly. Urge them to
Nurse’s take safety measures to prevent
FREQUENCY
Drug Handbook, McGraw- EENT: diplopia, pharyngitis, rhinitis, injury.
BID
Hill Education, LLC. sinusitis  Instruct patient to avoid activities that
require mental alertness until CNS
TIMING Hematologic: neutropenia, reactions are known.
8 am, 6 pm leukopenia  Inform patient that he’ll undergo
periodic blood testing during therapy.

27
 As appropriate, review all other
significant and life-threatening
adverse reactions and interactions,
especially those related to the herbs
mentioned above.

28
 DRUG NAME MECHANISM OF ACTION INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES
GENERIC NAME ●Metabolic acidosis Respiratory: slow and shallow  When giving I.V., closely monitor
sodium bicarbonate Restores body’s buffering ●Urinary alkalization respirations, cyanosis, apnea  Arterial blood gas results and
capacity; neutralizes ●Renal tubular acidosis electrolyte levels.
excess acid. Antacid Other: weight gain, pain and  Stay alert for signs and symptoms
BRAND NAME inflammation at I.V. site  of metabolic alkalosis and electrolyte
Citrocarbonate  Imbalances.
 Monitor fluid intake and output.
 Assess for fluid overload.
CHARACTERISTIC  Avoid rapid infusion, which may
Alkalinizer, antacid  Cause tetany.
 Watch for inflammation at I.V. site.
 Patient teaching
DOSAGE  Tell patient using drug as antacid
200 mg  that too much sodium bicarbonate
CONTRAINDICATION ADVERSE EFFECTS
can
● Hypocalcemia CNS: headache, irritability,
 cause systemic problems. Urge him to
● Metabolic or respiratory confusion, stimulation, tremors,
alkalosis twitching, hyperreflexia, weakness  use only the amount approved by
ROUTE
● Hypernatremia seizures of alkalosis, tetany  prescriber.
P.O
● Hypokalemia CV: irregular pulse, edema, cardiac  Advise patient not to take oral form
Patricia D. Schull (2013), ● Severe pulmonary arrest  with milk. Caution him to avoid the
Nurse’s edema GI: gastric distention, belching,  herb oak bark.
FREQUENCY Drug Handbook, McGraw- ● Seizures flatulence, acid reflux, paralytic  Tell patient sodium bicarbonate
STAT Hill Education, LLC. ● Vomiting resulting in ileus  interferes with action of many
chloride loss GU: renal calculi common drugs. Instruct him to notify
● Diuretic use resulting in Metabolic: hypokalemia, fluid all
TIMING hypochloremic alkalosis retention, hypernatremia, hyper-
 prescribers if he’s taking oral sodium
● Acute ingestion of osmolarity (with overdose),
mineral acids metabolic alkalosis  bicarbonate on a regular basis.
(with oral form)

29
 ● As appropriate, review all other
significant and life-threatening
adverse
 reactions and interactions, especially
 those related to the drugs, tests, and
 herbs mentioned above.

30
 DRUG NAME MECHANISM OF ACTION INDCATION SIDE EFFECTS NURSING INTERVENTION

GENERIC NAME: Humulin R lowers blood glucose Humulin 70/30 is a fixed ratio  Injection site reactions  Monitor patient response
Isophane Insulin by stimulating peripheral glucose premix recombinant human (pain redness, irritation) to therapy (stabilization
uptake by skeletal muscle and fat insulin formulation indicated to  Diarrhea of blood glucose levels).
and by inhibiting hepatic glucose improve glycemic control in  back pain
production. Insulin inhibit lipolysis adult patient’s diabetes mellitus  Headache
BRAND NAME: and proteolysis and enhance  Monitor for adverse
 Body fat redistribution
Humulin N, 70/30 protein synthesis. effects (hypoglycemia,
 Low blood sugar
ketoacidosis injection-
including sweating,
site irritation)
tremors, irritability,
fainting or seizure.
CLASSIFICATION:
Antidiabetic Drugs  Evaluate patient
understanding on the
drug therapy by asking
the patient name the
drug, its indication, and
adverse effects to watch
DOSAGE: CONTRAINDICATION ADVERSE EFFECTS
5 units for
Reference;
https;//www.rxlist,com/humulin- Humulin 70/30 is Allergic Reactions
70/30-druug.htm contraindicated during the Peripheral Edema
ROUTE:
Subcutaneous episodes of hypoglycemia (see Lipodystrophy
precautions and warnings) and Weight gain
in patients who had
hypersensitivity reactions to
FREQUENCY: OD humilin 70/30 or any of its
excipients (see precautions
TIMING: 8AM and warnings)

31
 DEFINING NURSING SCIENTIFIC GOAL OF CARE INTERVENTION RATIONALE EVALUATION
CHARACTERISTICS DIAGNOSIS ANALYSIS
SUBJECTIVE After 8 hours of nursing  Assess the  Provides baseline After 8 hours of nursing
Insufficient intervention the patient physical activity information for intervention the patient
“Way gana ilihok miss Activity physiologic or will be able to: level and mobility formulating was able to:
oy, kapoy. ”as Intolerance psychological of the patient. nursing goals
verbalized by the energy to endure  Participate in during goal  Participate in
related to
patient. or complete necessary/desired setting. necessary/desired
generalized
required or activities.  Sleep deprivation activities. Goal
weakness 
desired daily  Use identified Observe and
and difficulties was met.
OBJECTIVE activities. techniques to monitor the  Use identified
during sleep can
● Exertion a dyspnea enhance activity patient’s sleep
affect the activity techniques to
● weak looking Related to tolerance. pattern and the
level of the patient enhance activity
● drowsy generalized amount of sleep
 Report a  Assistive devices tolerance. Goal
● withdrawn weakness and achieved over the
measurable enhance the was met.
debilitation from past few days.
increase in activity mobility of the
acute or chronic  Assess the need
VITAL SIGNS tolerance. patient by helping
illnesses. for ambulation  Report a
 Demonstrate a him overcome
aids (e.g., cane, measurable
T – 37.3 °axilla decrease in limitations.
walker) for ADLs. increase in activity
P – 95 bpm physiological signs  Motivation and
R – 16 cpm of intolerance. tolerance. Goal
cooperation are
BP – 100/80 mmHg  Display comfort was met.
enhanced if the
O2 – 99% and safety.  Demonstrate a
 Establish patient
Doengers, decrease in
guidelines and participates in goal
physiological
Marilynn et. al. goals of activity setting.
signs of
(2006). Nurse’s with the patient  Helps in
intolerance. Goal
Pocket Guide. and/or SO. increasing the
was met.
C&E Publishing, tolerance for the
F.A Company. activity.

32
 Have the patient  Display comfort
perform the and safety. Goal
activity more  Prevents was met.
slowly, in a longer orthostatic
time with more hypotension.
rest or pauses, or
with assistance if
necessary.
 This helps the
patient to cope.
 ● Dangle the legs Acknowledgment
from the bed side that living with
for 10 to 15 activity intolerance
minutes. is both physically
and emotionally
difficult.
 Encourage
verbalization of  Knowledge
feelings promotes
regarding awareness to
limitations. prevent the
complication of
overexertion.
 Teach the patient
and/or SO to
recognize signs
of physical
overactivity or
overexertion.

33
 DEFINING NURSING SCIENTIFIC GOAL OF CARE INTERVENTION RATIONALE
CHARACTERISTICS DIAGNOSIS ANALYSIS
SUBJECTIVE After 8 hours of  Monitor pulse, respiratory  Indicates physiological levels of
Fatigue related to Refers to a mental or nursing intervention rate, and BP before and tolerance.
“Kapoy man mandae Decreased physical state of the patient will be after activity.
oy. Kapoy mag lihok.” metabolic energy extreme tiredness able to:  Alternate activity with
as verbalized by the production and lack of energy. periods of rest and  To prevent excessive fatigue.
patient. evidenced by ● Verbalize increase uninterrupted sleep.
Overwhelming lack A feeling of constant in energy level.  Discuss with patient the
of energy tiredness or  Education may provide
need for activity. Plan motivation to increase activity
OBJECTIVE weakness and can ● Display improved
schedule with patient and
● lack of energy be physical, mental ability to participate level even though patient may
identify activities that lead
● restlessness or a combination of in desired activities. feel too weak initially.
● Sleepy both to fatigue.  Increases confidence level, self-
● withdrawn behavior ● Identify factors that  Increase patient esteem and tolerance level.
improve health. participation in ADLs as  Response to an activity can be
tolerated. evaluated to achieve desired
VITAL SIGNS ● Participate on the  Assess response to level of tolerance.
health care regimen. activity.  To determine the level of
T – 37.8 °axilla activity.
P – 90 bpm ● Maintain
R – 18 cpm engagement in
BP – 100/80 mmHg Doengers, Marilynn desired activities.  Assess muscle strength of
O2 – 97% et. al. (2006). patient and functional level
Nurse’s Pocket of activity.  Interventions should be directed
Guide. C&E at delaying the onset of fatigue
Publishing, F.A and optimizing muscle
Company.  Perform activities slowly
efficiency.
with frequent rest periods.
 For proper oxygenation.
 Helps promote relaxation.

 Provide adequate
ventilation.

34
 Instruct patient to perform  To be free from injury during
deep breathing exercises. activity.
 To provide proper ventilation.

 Provide comfort and safety

measures.
 Administer oxygen as
ordered.

35
 BIBLIOGRAPHY

Drug Handbook, McGraw-Hill Education, LLC

Doengers, Marilynn et. al. (2006). Nurse’s Pocket Guide. C&E Publishing, F.A
Company.

https;//www.rxlist,com/humulin-70/30-druug.html

https://www.scribd.com/doc/81195677/NCP-of-Activity-Intolerance

https://nurseslabs.com/fatigue/

https://www.healthline.com/health/rbc-in-urine

https://medlineplus.gov/lab-tests/prothrombin-time-test-and-inr-
ptinr/#:~:text=A%20prothrombin%20time%20(PT)%20test,as%20clotting%20(coagulatio
n)%20factors.

https://www.medicalnewstoday.com/articles/319457#:~:text=Here's%20our%20process.
,of%20symptoms%20and%20health%20complications.

https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-
Management/534207/all/Interpretation_of_Arterial_Blood_Gases

https://www.unilab.com.ph/biogesic/learn/articles/paracetamol-(biogesic)-care-and-
relief-from-headaches-fever-and-minor-pain-
undefined?ef_id=EAIaIQobChMInMKn_KOd7QIVia-WCh2p-
gcFEAAYASAAEgKbivD_BwE:G:s&gclid=EAIaIQobChMInMKn_KOd7QIVia-WCh2p-
gcFEAAYASAAEgKbivD_BwE

https://www.mayoclinic.org/tests-procedures/complete-blood-count/about/pac-20384919

Patricia D. Schull (2013), Nurse’s

36