MMSU College of Health Sciences

MARIANO MARCOS
STATE UNIVERSITY

NCM 116b:
Simulated Clinical Duty Scenario
Hypertension

DADIZ, KARL RENZO V.

Group 1, BSN- III A

MARVIN R. LUTRANIA
Clinical Instructor
 MMMHMC-N-QP-012 Form 1-Rev.0 – Doctor’s Order Sheet

MARIANO MARCOS MEMORIAL HOSPITAL AND MEDICAL CENTER

Batac, Ilocos Norte

Hosp. No. _0655201__

DOCTOR’S ORDER SHEET
Reminder: Always indicate DATE & TIME
Use GENERICS always
SIGN all orders
SOAP/PROBLEM BASED patient management

PATIENT’S CONDITION/ NURSES TIME/ RN

DOCTOR’S ORDER
PROGRESS NOTES ACTION SIGN
10/04/2020 12:00pm Admit to medical ward C 12:00pm/KRVD
Secure consent for admission C 12:00m/KRVD
TPR, I&O q shift & record C/E 12:10pm/KRVD
Low salt and low fat diet C 12:10pm, 6:00/KRVD
On low-fowlers position C 12:02pm/KRVD
O2 inhalation at 4LPM per nasal cannula C 12:03pm/KRVD
Dxtics:
CBC R 12:20pm/KRVD
Urinalysis R 12:20pm/KRVD
Chest X-ray R 12:20pm/KRVD
ECG R 12:20pm/KRVD
Pulse oximetry, ABG R 12:20pm/KRVD
FBS, lipid profile, creatinine and BUN determination R 12:20pm/KRVD
Txtics:
D5LR 1 L X 16hrs; IVF TF: D5LR 1 L for 12 hrs. A/E 12:05pm/KRVD
Furosemide 10mg IV q 12 hrs. with BP precaution A/E 12:20pm/KRVD
Amlodipine 10mg, 1 tab BID A/E 12:20pm/KRVD
Captopril 25 mg, 1 tablet OD A/E 1:20pm/KRVD
Diclofenac K 50 mg IV q 6 hrs PRN for pain A/E 12:07pm/KRVD
Monitor V/S q 4hrs and record 12:10pm, 4:00pm,
C/E 8:00pm /KRVD
Monitor Wt. OD and record C/E 12:10pm/KRVD
CBR with BRP’s C 12:10pm/KRVD
Range of motion exercises C 2:00pm/KRVD
Refer C/E 8:00pm/KRVD
John Dwight, M.D. Karl Renzo V. Dadiz/Marvin R. Lutrania/Mimi Y. Uh
MMSU-SN Clinical Instructor NOD

Name Juan P. Kennedy Age 65 Sex M Ward ER Rm. No.1

Nurses Action Legend:
C – Carried A – Administered R – Requested E – Endorsed D– Discontinue
 MARIANO MARCOS MEMORIAL HOSPITAL AND MEDICAL CENTER
Batac, Ilocos Norte

Name: Juan P. Kennedy Ward: ER__________ Age: _65___ HN: 0655201____

Address: _North Carolina, USA Attending Physician: John Dwight, M.D.

VITAL SIGNS

DATE CR BP PR RR Temperature
10/04/2020 120 180/110 120 25 37.5 oC
12:10pm
4:00pm 99 130/90 99 20 37.2 oC
8:00pm 92 120/80 92 18 37 oC
 MARIANO MARCOS MEMORIAL HOSPITAL AND MEDICAL CENTER
Department of Pathology and Laboratories
City of Batac, Ilocos Norte, Philippines
Contact Details: Direct Line: (077)6000105; Trunk Line: (077)7923133 loc. 102: Email:mmmh.lab@gmail.com
CLINICAL LABORATORY REQUEST
Note:
REQUESTING PHYSICIAN MUST PROVIDE TO PATIENT CORRECT PRE-ANALYTIC INSTRUCTIONS PRIOR RO LABORATORY EXAMINATION. USE SEPARATE RESPECTIVE REQUESTS FOR THE
FOLLOWING: BACTERIOLOGY LABORATORY REQYEST, CROSS-MATCHING, SURGICAL PATHOLOGY, PAPS, FNAB, PERIPHERLA BLOOD SMEAR.
STAT REQUEST WILL NO BE PROCESSED UNLESS JUSTIFIED BY THE REQUESTING PHYSICIAN AND SHALL BE CHARGED ACCORDINGLY.

PATIENT’S COMPLETE NAME (FIRST NAME, MIDDLE NAME, LAST NAME) Please print AGE SEX DATE OF BIRTH DATE AND TIME
JUAN P. KENNEDY 65 M REQUESTED:
HOSPITAL NUMBER COMPLETE ADDRESS: PATIENT’S CONTACT NUMBER (IF AVAILABLE) 10/04/2020
0655201 North Carolina, USA 12:20pm
REQUESTING PHYSICIAN:
JOHN DWIGHT, M.D.
REQUEST PREPARED BY:
Karl Renzo V. Dadiz
CLINICAL DIAGNOSIS
T/C Stage III Hypertension ߛ  ROUTINE 󠇯ߛ STAT
(SIGNATURE OVER PRINTED NAME) (SIGNATURE OVER PRINTED NAME) JUSTIFIATION:
LOCATION ____ OPD DEPARTMENT: ____ MEDICINE ____ ENT _____ OPTHALMOLOGY MSS CLASSIFICATION
__ ER ___ SURGERY ____ PEDIATRICS _____ HEMODIALYSIS
____ IN-PATIENT WARD/ROOM/BED NO.1 ____ ORTHOPEDICS ____ OB-GYN _____ FAMILY MEDICINE
********* FOR LABORATORY USE ONLY *********
DATE AND TIME REQUEST REQUEST RECEIVED BY CHARGE SLIP PREPARED BY/ DATE AND TIME SPECIMEN SPECIMEN COLLECTED/ RECEIVED PATEINT’S ENTRY NO.
RECEIVED CHARGE SLIP NO. COLLECTED/ACCEPTED BY

*****Instruction: PLEASE CROSS OUT THE LEFT BOX BESIDE THE DESIRED TEST

HEMATOLOGY Total Cell Count PANCREATIC PROFILE HEPATITIS C

× Complete Blood Count Differential Count Amylase Anti-HCV Screening
Hemoglobin Glucose Lipase Anti-HCV ECLIA/EIA
Hematocrit Protein LIPID PROFILE THYROID FUNCTION TEST
Platelet count LDH × Total Cholesterol T3
Clotting Time CLINICAL CHEMISTRY × Triglyceride T4
Bleeding Time BONE/ JOINT ARTHRITIS TEST × HDL- Cholesterol FT3
Clot Retraction Time Blood Uric Acid × LDL – Cholesterol FT4
ABO-Rh Typing Rheumatoid Factor LIVER FUNCTION PROFILE TSH
COAGULATION STUDIES CARDIAC MARKERS Total Protein TUMOR MARKERS
Prothrombin Time AST/SGOT Albumin AFP
APTT CK-MB Direct Bilirubin Beta-HCG
Fibrinogen Trop-T quantitative Total Bilirubin CEA
ANEMIA WORK UP Trop-I quantitative TEST FOR LIVER INJURY CA 19-9
Iron DIABETIC PROFILE AST/SGOT PSA
Total Iron Binding Capacity × Fasting Blood Sugar/ FBS ALT/ SGPT CA 125
Unsaturated Iron Binding Capacity Random Blood Sugar/ RBS Alkaline Phosphatase/ALP SLE WORK-UP
Folate OGTT _____75 g _____100 g LDH Anti-Nuclear Antibody
Ferritin OGCT _____ 50g _____75 g SEROLOGY/ IMMUNOLOGY SYPHILIS WORK UP
BLOOD BANKING HbA1C DENGUE WORK UP Anti T. pallidum rapid test
Direct Coomb’s test 2-HR Post-Prandial Blood Sugar DENGUE NS1 Antigen TPHA
Indirect Coob’s test Insulin Dengue IgG/IgM
DRUG TESTING LABORATORY Urine Ketone HIV TESTING OTHER TEST AVAILABLE
Cannabinoids ELECTROLYTES Anti-HIV-1/ HIV-2 Screening/Rapid Complement3 (C3)
Methamphetamine Sodium Anti-HIV-1/ HIV-2 EIA C-Reactive Protein
A.U.B.F./ PARASITOLOGY Potassium HEPATITIS VIRUS INFECTION MARKERS Anti-streptolysin O (ASO)
24-h Urine HCG Titer ___Ionized/ ____Total Calcium HEPATITIS A Salmonella IgG/IgM
Pregnancy test Chloride × Chest X-ray
Routine stool examination Magnesium × ECG
× Routine Urinalysis Phosphorous × Pulse oximetry
× ABS
× Creatinine and BUN determination
PURPOSES LABORATORY AND DIAGNOSTICS PROCEDURES RELATED
CBC- tests for the amount blood components, elevated hemoglobin and hematocrit assessing the relationship of cells to
fluid volume (viscosity), and anemia caused by chronic renal disease
Urinalysis- to test electrolytes (concentration of sodium), presence of blood, glucose and possible kidney damage or
disease
Chest X-ray- provide a visualization of the heart for possible enlargement
ECG (Electrocardiogram)- measures the electrical activity, rate and rhythm of heart
Pulse oximetry- measures heart rate and amount of oxygen in the blood
ABG (Arterial Blood Gas)- determines the level of oxygen in the arterial blood and acid-base balance
FBS (Fasting Blood Sugar)- determines level of blood glucose in relation to possible diabetes associated with
hypertension
Lipid profile- to determine levels of cholesterol (triglyceride, LDL and HDL cholesterol)
Creatinine and BUN (Blood Urea Nitrogen) determination- to assess kidney involvement and renal function
 MMMHMC-N-QP-030 Form 2-A-Rev.0 – Intravenous Medications

MARIANO MARCOS MEMORIAL HOSPITAL AND MEDICAL CENTER

Batac, Ilocos Norte

MEDICATION AND TREATMENT SHEET

SURNAME AGE HOSPITAL NUMBER
Kennedy________________ 65_ _0655201_____
GIVEN NAME M.I. SEX WARD BED NO.
Juan_________ _P M_ ER___ ___1_____

Intravenous Medications
Date 10/04/2020
MED. DOSAGE
DATE/TIME
FREQUENCY
Ordered Sig Sig
SHIFT Hr Sig. Hr Sig. Hr Hr Hr Sig.
. .
10/04/2020 Furosemide 10mg IV q 12:2
7–3 KRVD
12:00pm 0
12 hrs. with BP
3 – 11
precaution
11 – 7
Diclofenac K 50 mg IV q 12:0
7–3 KRVD
7
6 hrs PRN for pain
3 – 11
11 – 7
7–3
3 – 11
11 – 7
7–3
3 – 11
11 – 7
7–3
3 – 11
11 – 7
7–3
3 – 11
11 – 7
Treatments
7–3
3 – 11
11 – 7
Breakfast
Lunch Low salt and
DIET low fat
Dinner Low salt and
low fat

Code: R-Refused PO-Including Meds. DC-Discontinued P-Prescribed OP-Out-on-Pass E-Emesis

 MMMHMC-N-QP-030 Form 2-A-Rev.0 – Oral Medications

MARIANO MARCOS MEMORIAL HOSPITAL AND MEDICAL CENTER

Batac, Ilocos Norte

MEDICATION AND TREATMENT SHEET

SURNAME AGE HOSPITAL NUMBER
Kennedy________________ 65_ _0655201_____
GIVEN NAME M.I. SEX WARD BED NO.
Juan___________ P_ M_ __ER__ ___1_____

Oral Medications
Date 10/04/2020
MED. DOSAGE
DATE/TIME
FREQUENCY
Ordered Sig
SHIFT Hr Sig. Hr Sig. Hr Hr Sig. Hr Sig.
.
10/04/2020 Amlodipine 10mg, 1tab 7–3 12:20 KRVD
12:00pm 3 – 11
BID
11 – 7
Captopril 25 mg, 1 7–3 1:20 KRVD

tablet OD 3 – 11
11 – 7
7–3
3 – 11
11 – 7
7–3
3 – 11
11 – 7
7–3
3 – 11
11 – 7
7–3
3 – 11
11 – 7
7–3
3 – 11
11 – 7
Treatments
7–3
3 – 11
11 – 7
Breakfast
DIET Lunch
Dinner

Code: R-Refused PO-Including Meds. DC-Discontinued P-Prescribed OP-Out-on-Pass E-Emesis

 MARIANO MARCOS MEMORIAL HOSPITAL AND MEDICAL CENTER
Batac City, Ilocos Norte

INTRAVENOUS FLUID FLOW SHEET

Surname Age Hospital Number

Kennedy___________________________________ ___65_____ ______0655201__________
Given Name MI Sex Ward Bed. No.
Juan_________________ ___F____ _____M ___F _____ER____ ___1____

Type of
I.V. Type of
Nurse’s Drug Cannulae
Fluid Date & Time I.V. Fluid Flow Rate / Date & Time Nurse’s
Signatur Additiv /Needle & Remarks
Bottle Started & Infusion Device Consumed Signature
e es Location of
. No. Volume
Insertion
1 10/04/202 KRVD D5LR Gauge 18 20-21gtts/min
1L
Right
0 dorsum of
the hand
12:05pm

TEMPLATE FOR MEDICATION CARDS

Medication card No. 1

FRONT:
RM110/04/2020

Juan P. Kennedy
Furosemide 10mg IV q 12 hrs. with BP precaution
BACK:

Signed: KARL RENZO V. DADIZ

MMSU- CHS- SN

Signed: MARVIN R. LUTRANIA

Clinical Instructor

Medication card No. 2

FRONT:
RM110/04/2020

Juan P. Kennedy
Diclofenac K 50 mg IV q 6 hrs PRN for pain

BACK:

Signed: KARL RENZO V. DADIZ

MMSU- CHS- SN

Signed: MARVIN R. LUTRANIA

Clinical Instructor

Medication card No. 3

FRONT:
RM110/04/2020

Juan P. Kennedy
Amlodipine 10mg, 1tab BID

BACK:
 Signed: KARL RENZO V. DADIZ
MMSU- CHS- SN

Signed: MARVIN R. LUTRANIA

Clinical Instructor

Medication card No. 4

FRONT:
RM110/04/2020

Juan P. Kennedy
Captopril 25 mg, 1 tablet OD

BACK:

Signed: KARL RENZO V. DADIZ

MMSU- CHS- SN

Signed: MARVIN R. LUTRANIA

Clinical Instructor

MEDICATIONS

Furosemide 10mg IV q 12 hrs. with BP precaution

Stock dose: Furosemide 10mg/ml

desired dose
× diluent=¿
stock dose

10 m g
× 1ml=¿
10 m g

1 ×1 ml=1ml

Amlodipine 10mg, 1tab BID

Stock dose: Amlodipine 10mg/tab

desired dose
=¿
stock dose
10 mg
=¿1tab
10 mg

Captopril 25 mg, 1 tablet OD

Stock dose: Captopril 25 mg/tab

desired dose
=¿
stock dose

25 mg
=¿ 1tab
25 mg

Diclofenac K 50 mg IV q 6 hrs PRN for pain

Stock dose: Diclofenac K 25mg/ml

desired dose
× diluent=¿
stock dose

50 mg
×1 ml=¿
25 mg

2 ×ml=2 ml

IV FLUID REGULATION

D5LR 1 L X 16hrs

volume of IV fluid ¿ infuse∈ml × drop factor ¿ =¿

h ours of infusion ×60 min

1000 ml ×20 gtts/min

=¿ 20.63 or 20-21gtts/min
16 hrs × 60 min

volume of IV fluid ¿ infuse∈ml ¿

hours of infusion =volume/hour

1000 ml
=62.5∨62−63 ml /hr
16 hrs

IVF TF: D5LR 1 L for 12 hrs.

volume of IV fluid ¿ infuse∈ml × drop factor ¿ =¿
h ours of infusion ×60 min

1000 ml ×20 gtts/min

=27.5∨27−28 gtts /min
12hrs × 60 min

volume of IV fluid ¿ infuse∈ml ¿ =volume /hour

hours of infusion

1000 ml
=83.33∨83−84 ml /hr
12hrs

MARIANO MARCOS MEMORIAL HOSPITAL AND MEDICAL CENTER

Batac City, Ilocos Norte

RECORD OF FLUID INTAKE AND OUTPUT

V-VOIDED
C-CATHETER
L.T. –LAVIN TUBE
L.Q. – LIQUID STOOL
E.N. – EMESIS
INC – INCONTINENT
NAME: Juan P. Kennedy_______________ WARD NO: _ER______ BED. NO. _1_________________
 SECRE VOMITU
DATE SHIFT CLYSIS BLOOD ORAL TOTAL URINE OTHERS TOTAL
TIONS S
10/04/202 7-3 500cc 600cc 1100cc 800cc 100cc 900cc
0 (12-8)

TOTAL

TOTAL

TOTAL

TOTAL

TOTAL

TOTAL

TOTAL

TOTAL

MMMHMC-N-QP-030 Form 5-A-Rev.0 – NURSES PROGRESS NOTES

MARIANO MARCOS MEMORIAL HOSPITAL AND MEDICAL CENTER

Batac, Ilocos Norte

NURSE PROGRESS NOTES

Surname Age Hospital Number

__Kennedy______________ ____65___ __0655201__________
Given Name MI Sex Ward Bed No.
___Juan___________ _F__ ___M __F _ER__ ___1____
Date/time Focus Data Action Response
10/04/2020
12:00pm Acute pain >with
12:07pm progressive nape >administered Diclofenac K 50 mg >nape pain scale
pain of 8/10 and through IV as per Doctor’s order decreased from 8/10
severe headache >provided non-pharmacologic to 5/10 with
accompanied by measures for relief such as cool cloth to controlled
dizziness, forehead, back and neck rubs, headaches
blurring of relaxation techniques like guided
vision, easy imagery, distraction, and diversional
fatigability, activities
nausea and >assisted with ambulation
vomiting and >promoted a well-lit room with good
anorexia, BP of ventilation and calm environment
180/110 mmHg, >encouraged bed rest
CR of 120 bpm, >health teaching imparted: >adhered to the
12:30pm RR of 25 brpm, - to eliminate vasoconstricting interventions and
and O2 Sat of activities like bending over, straining understands the
93% the stool and prolonged coughing instructions from
- to report adverse effects of the the health teaching
medication
- to continue diversional activities
12:10 Overweight >with weight of >assisted for appropriate food selection >verbalized
80kg , height of such as diet rich fruits, vegetables, and understanding on
5’7” and BMI of low-fat dairy food the health teachings
26.8, past health >established a realistic weight imparted, “Masapol
history of reduction plan with atleast 1lb weight unay nga agdyeta
obesity, and fond loss per week nak tapnu bumaba
of eating salty >health teaching imparted: iti timbang ko.”
and fatty foods, -encouraged a low fat and low salt diet
cigarette -instructed to limit alcohol intake in
smoking and moderation and encouraged to stop
alcohol drinking smoking
>referred to a dietitian as indicated

Karl Renzo V. Dadiz/Marvin R. Lutrania/Mimi Y. Uh

MMSU-SN Clinical Instructor NOD