Name: ALEXIS S.

CIDER Age: 50

DOB: January 4, 1971 Weight: 61 kg

BMI: 
Gender: Male Height: 168 cm 

Nationality: Filipino Religion: Roman Catholic

Allergies: NKDA

Family History: + HTN (paternal side)

Past Medical History: DM Type II, Hypercholesterolemia, Liver cirrhosis (2020)

Primary Diagnosis: UGIB bleeding secondary to liver cirrhosis

Social History: Alcoholic beverage drinker 

Surgeries/Procedures: NONE

Current Medications Omeprazole 40 mg/IV

Tranexamic 500mg/NGT q8h
Lactulose 40ml/NGT q4
Neomycin 500mg/tab, 1 tab BID
Propranolol 10mg/tab, 1 tab q12

History of present illness:

Patient AC, a known case of liver cirrhosis, is admitted yesterday due to melena. 1 week PTA, experienced episodes of fainting,
did not seek consultation. Few days PTA, verbalized disturbance in sleep-wake pattern. Few hours PTA, experienced epigastric
pain and passage of black stools. Working diagnosis upon admission is UGIB secondary to liver cirrhosis. Admitted at Medical
Surgical Unit for monitoring management.

1 week PTA - episodes of fainting (no consult)

 Few days PTA - disturbance in sleep-wake pattern

Few hours PTA - epigastric pain & passage of black stools

ASSESSMENT UPON ER ADMISSION: 

 Conscious, coherent
 Abdominal pain (7/10)
 Enlarged abdomen
 Icteric Sclerae

 BP 140/90

MEDS DRUG CLASS/ INDICATION MOA NURSING CONSIDERATIONS

OMEPRAZOLE 40 DRUG CLASS: Omeprazole is a proton pump inhibitor.  Monitor for signs and
mg/IV Proton-pump inhibitors Basically prevents proton pumps from symptoms of gastroesophageal
working properly, by reducing the reflux disease (GERD) and
Works by decreasing the amount of acid the stomach makes. peptic ulcer disease: 
amount of acid made in the  Regurgitation (food
stomach comes back into your
mouth from esophagus)
 Heartburn
 Coughing
 Chest pain
 Problem swallowing
 Vomiting
 Sore throat and
hoarseness

REPORT IF THERE IS:

 Any pain or discomfort
associated with
 urination, or blood in
urine.
 Report severe diarrhea;
drugs may need to be
discontinued.

TRANEXAMIC DRUG CLASS: Tranexamic acid works by blocking the WHEN TO TAKE:
500mg/NGT q8h Antifibrinolytics breakdown of blood clots, which helps to Given 3-4x each day: morning,
prevent prolonged bleeding. early afternoon, evening. You
Indicated for the treatment of can take tablets with or without
hereditary angioedema food.

Controls bleeding and improves Monitor vital signs:  blood

blood clotting pressure, pulse, and respiratory
status as indicated by severity
of bleeding.

Monitor neurologic status ---

GCS

Monitor platelet count and

clotting factors

Instruct patient to notify the

nurse immediately if bleeding

LACTULOSE DRUG CLASS:  Drugs are broken down through the
40ml/NGT q4 Ammonia-reducing drug
Prevention and treatment of
portal-systemic encephalopathy
(PSE), including both the
hepatic pre-coma and coma
variations.
Indicated for use as a laxative:
 To treat chronic
constipation in adults
NEOMYCIN DRUG CLASS:
500mg/tab, 1 tab Aminoglycoside antibiotics
BID
colon into products that pull water out
from the body and into the colon. This
water softens stools. 
Lactulose is also used to reduce the
amount of ammonia in the blood of
patients with liver disease.
Stool softening; laxative
Neomycin works by inhibiting bacterial
protein synthesis leading to its
bactericidal effect.
recurs
Caution patient to make
position changes slowly to
avoid orthostatic hypotension.
WHEN TO TAKE: Lactulose
can be taken with or without
food
Contraindicated with allergy to
lactulose, low galactose diet
If syrup, give with juice, water
or milk to increase palatibility
Dont use other laxatives
Monitor serum ammonia levels
Monitor CBG if diabetic
Side effects: flatulence,
abdominal fullness, belching to
severe belching
WHEN TO TAKE:
This medicine may be taken on
a full or empty stomach.

Neomycin is used to help lessen
the symptoms of hepatic coma,
a complication of liver disease
by reducing ammonia-forming
bacteria in the intestinal tract.
Stops growth of bacteria in the
intestines
 Prevent or treat skin
infections caused by
bacteria
PROPRANOLOL DRUG CLASS:
10mg/tab, 1 tab Beta blockers
q12
Indicated to treat hypertension
Relaxes blood vessels and
slows heart rate to improve
blood flow and decrease blood
pressure
It inhibits bacterial ribosomes by binding
to the 30S ribosomal subunit of Contraindicated in:
susceptible bacteria. Hypersensitivity to neomycin or
other aminoglycosides;
Intestinal obstruction.
Monitor signs of
hypersensitivity reactions:
 Tightness in throat and
chest, wheezing, Cough
dyspnea
 Rash, pruritus, ulticaria
Adverse Reactions:
CNS - Sore Mouth
GI - Anorectal pain, diarrhea,
mouth irritation, nausea, rectal
irritation, vomiting
Propranolol is a type of medicine called WHEN TO TAKE:
a beta blocker. It works by changing the Should be taken at bedtime
way your body responds to some nerve with or without food.
impulses, including in the heart. It slows
down your heart rate and makes it easier Contraindicated in:
for your heart to pump blood around your Do not give if patient has
body. asthma
Monitor signs of peripheral
vasoconstriction
 Extreme coldness in
hands, feet, cyanosis,
 muscle cramping
 Notify physician of
severe or prolonged
signs of
vasoconstriction.

Assess symptoms of
bronchospasm (wheezing,
coughing, tightness in chest)

MED PREPARATION

 Elevate HOB 
 Check VS ulit haha
o BP: 120/80
o Temp: 36.2
o PR: 90
o 02: 88
 Deep breathing ns
o Ilong, bibig
 If may masakit sa IV 
 9am MEDS:
o Omeprazole IV
 Mababa acids sa tiyan
 Lessen abd pain
o Neomycin tablet =
 1mg/tab NGT 
 Elevate head of bed, Check NGT placement 
 Crush tablet
 2x a day → ittake ngayong umaga and mamayang gabi ulit