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CHAPTER I THE PROBLEM AND ITS SCOPE INTRODUCTION Rationale of the Study Myocardial infarction is a common presentation of ischemic heart disease. Defined as death or necrosis of myocardial cells, It is a diagnosis at the end of the spectrum of myocardial ischemia or acute coronary syndromes. Myocardial infarction occurs when myocardial ischemia exceeds a critical threshold and overwhelms myocardial cellular repair mechanisms designed to maintain normal operating function and hemostasis. Ischemia at this critical threshold level for an extended period results in irreversible myocardial cell damage or death.
(www.clevelandclinic.com) World Health Organization estimated that in 2002, 12.6 percent of deaths worldwide were from ischemic heart disease. Ischemic heart disease is the leading cause of death in developed countries, but third to AIDS and lower respiratory infections in developing countries. According to the Centers for Disease Control and Prevention (CDC), annual mortality rates in the United States from all causes in the pediatric population
range from 22 deaths per 100,000 population in children aged 514 years to 756 deaths per 100,000 population in infants younger than 1 year. (Compare this to 90 deaths per 100,000 in persons aged 15-24 y and 2,538 deaths 100,000 in individuals aged 65-74 y.2) The CDC also reports that the mortality rate from acute myocardial infarction is 0.2 deaths per 100,000 population in persons aged 15-24 years and fewer than 0.2 deaths per 100,000 in infants younger than 1 year. (Compare this to 1.4 deaths per 100,000 population in persons aged 25-34 y and 262 deaths per 100,000 population in individuals aged 6574 y.2) (www.emedicine.medscape.com) Every hour, nine Filipinos die of cardiovascular or heart diseases. In fact, cardiovascular diseases remain the No. 1 cause of death in the Philippines. About one out of four deaths in the country are traced to cardiovascular diseases, according to the Department of Health. The DOH is promoting a massive information and education campaign to increase awareness of cardiovascular diseases. Surveys made by the DOH show that Central Luzon had the highest cases of cardiovascular diseases (225 per 100,000 population). Metro Manila registered the highest mortality rate (99 per 100,000) while the lowest was in
Central Mindanao (16 per 100,000). One out of 20 adults (40 years and older) suffers from coronary/ischemic heart disease. And one out of 10 adults (15 years and older) suffers from hypertension, or high blood pressure. Five out of 100 adults suffer from coronary artery disease (www.philstar.com). The researcher is a graduate of Bachelor of Nursing Degree. She has been assigned to many different hospitals while she was a student nurse and previously worked as a volunteer nurse for 3 months at Cebu Peuriculture and Maternity House Inc. She has been exposed in obstetric ward, labor and delivery room, assisting obstetricians during delivery and labor watch, and operating room assisting the surgeon in minor and major operations. Presently the researcher is a Clinical Instructor at Southwestern University College of Nursing where she is
assigned at Medical Surgical Ward and Emergency Room. The interest of the researcher in conducting the study was due to the death of a close relative from myocardial infarction. The researcher, have acquired learning on Orem’s Self-Care Theory and on the disease process of Myocardial Infarction. The researcher is aware of the scope of this disease and its impact on the patient and his family. Having such knowledge matched
4 with skills on rendering health care. Theoretical Background This study was anchored on Dorothea Orem’s Self-Care Theory. implementing and at the same time. evaluating nursing care plans for a patient with Myocardial Infarction using Orem’s Self-care Theory as its bases. which is composed of three interrelated . the researcher conduct this study with an aim of assessing a case of Myocardial Infarction. Orem developed the Self-Care Deficit Theory of Nursing (her general theory). planning.
In this philosophy. Orem views nurses as agents of selfempowerment.5 theories: (1) the theory of self-care. In many ways. In this notion. nursing is not so much about caring for people but rather empowering and guiding people to . (2) the theory of self-care deficit. teaching and guiding or directing selfcare. or even a contractual relationship in order to receive the assistance that one requires. One of the most important contributions of Orem’s work is her redefinition of the role of nurses in society. and (3) the theory of nursing systems. because she sees individuals as capable of guiding their own self-care. Orem views people as having ‘health-associated limitations’ and having the need for assistance in order to promote their self-care agency. she does not promote the notion of submitting to someone else’s care but rather engaging in a partnership. nurses provide assistance relative to the person’s needs at the time. Thus. Nurses have the ultimate role of facilitating and increasing a person’s abilities to engage in their own self-care. First and foremost. They are not meant to take over for someone’s ability to provide their own self-care but to facilitate one’s ability to perform this function. This could be education and support (physical and/or psychological).
the condition is the inability of the parent (or guardian) associated with the child’s health state to maintain continuously for the child the amount and quality of care that is therapeutic (George. in recovering from disease or injury. The outcome of this study may help the researcher in coming up with a proposed self-care guide for clients with Myocardial Infarction.com) This study seeks to come up with effective nursing care that will be beneficial for the client in performing self-care activities while maintaining as much independence as possible.nursingplanet. According to Marjorie A. She states her general theory as follows: the condition validates the existence of a requirement for nursing in an adult is the health-associated absence of the ability to maintain continuously that amount and quality of self-care that is therapeutic in sustaining life and health. or in coping with their effects. Isenberg (2005).6 understand how they can best care for themselves. 2008) . This would serve as a basis in client health teaching. This does not imply that nurses do not provide care. but rather a far different model of care and what that means in a practical sense. (www. With children.
health care system factors (i. gender. These basic conditioning factors age. self-care requisites and therapeutic selfcare demand.e. 2004).. environmental factors. development state. 2004). and resource adequancy and availability. Self-care is human endeavor. family system factors.7 The self-care theory is based on the four concepts: selfcare. This ability is affected by basic conditioning factors. (Kozier et al. Orem defined self-care as “the practice of activities that individuals initiate and perform on their own behalf in maintaining life. It consists of two agents: a self-care agent (an individual who performs self-care independently) and a dependent care agent (a person other than the individual who provides care) (Kozier et al. health and well being” (Udan. pattern of living (e. sociocultural factors . activities regularly engaged in). self-care agency. Self-care is produced as individual engage in action to care for themselves by influencing internal and external factors to regulate their own internal . 2004).g. diagnostic and treatment modalities). learned behavior that has the characteristics of deliberate actions. Self-care agency is the human’s acquired ability or power to engage in self-care.
Self-care has a purpose. the maintenance of a balance between activity and rest .nursing. It is an action that has a pattern and sequences and when it is effectively performed contributes in specific ways to human structural integrity. human functioning. the maintenance of the integrity of human structure and functioning.gr). Three types of self care requites are identified: Universal self-care requisites are associated with life processes. women and children are as follows: the maintenance of a sufficient intake of air. human functioning and human well-being . the maintenance of a sufficient intake of water. the maintenance of sufficient intake of food. A common term for these requisites is the activities of daily living (George. Self-care requisites must be known before they can serve as the purpose of self-care (www. The purposes to be attained through the kinds of action termed self-care are named self-care requisites. the prevention of hazards to human life. and human development. the provision of care associated with elimination processes and excrements. 2008). the maintenance of a balance between solitude and social interaction.8 functioning and development. and with general well-being. The eight self-care requisites common in men.
(2) maintain human structure and human functioning within a normal range. 2008). When these three types of requisites are effectively met. they are productive of human and environmental conditions that (1) support life processes. (5) contribute to the regulation or . Developmental self-care requisites are associated with human development processes and with conditions and events occurring during those various stages of the life cycle (e.g. The following are actions to be undertaken that will provide developmental growth: provisions of conditions that promote development. Health-deviation self-care requisites are associated with genetic and constitutional defects and human structural and functional deviations (George. (4) prevent injury and pathological states. Examples would be adjusting to a new job or adjusting to body changes such as a facial lines or hair loss. prematurity. (3) support development in accord with the human potential. 2008)..9 and the propmotion of human functioning and development (Octaviano and Balita. 2008). engagement in selfdevelopment and prevention of the effects of human condition that threatens life (Octaviano and Balita. pregnancy) and events that can adversely affect development.
nursing. supporting. Nursing is required when adults (or in the case of a dependent. This theory explains not only when nursing is needed but also how people can be assisted through five methods of helping: Acting or doing for. She has identified three classifications of nursing systems to meet the self-care requisites of the patient (George. (6) contribute to the cure or regulation of pathological processes. In Orem’s third theory of nursing systems. guiding and directing. 2004). and (7) promote general well-being (www. the parent or guardian) are incapable of or limited in their ability to provide continuous effective self-care. actions to maintain health and well-being (Kozier et al. the patient or both. 2008). she outlines how the patient’s self-care needs will be met by the nurse.gr). 2008). The theory of self-care deficit is the basic element of Orem’s general theory because it delineates when nursing is needed.10 control of the effects of injury and pathology. . providing and maintaining an environment that support personal development and teaching (George. or in other words. The therapeutic self-care demand refers to all self-care activities required to meet existing self-care requisites.
diet. who is very short of breath. exercise regimen and medication are considered important education for this patient.bellaonline. A pneumonia patient. such as an acute stroke patient. The third of Orem’s system is the Educative-Development system.11 The Compensatory system is when the nurse provides total care for the patient. 2008). This patient cannot do anything for themselves but they are not limited to activities of daily living and ambulation. The patient who has high cholesterol may fit into this category. assist in ADL’s and ambulation. the nurse assist with education and promoting safe health practices. This patient is totally dependent of the nurse for survival. oxygen saturations. The nurse should teach the patient how to properly maintain good health practices (www.com) . The nurse must assist in the care of the patient but the patient and family can assist as well. may require the nurse to monitor the vital signs. The patient has primary control over his health. The second of Orem’s system is the Partial Compensatory. The patient will be able to resume their own care when they are better but need the assistance and education a nurse can provide at this time (George.
The nursing process offers the adaptation of interventions to the patient’s individual needs. She believes that individuals have the potential to be developed and learned (Octaviano and Balita.12 According to Orem. Its use associated with a theory may result in a more effective assistance. Humans can reflect upon events. Orem’s theory emphasizes the importance of a patient’s reflection to self-care. and Cure Theory. 2008). One of the major concepts of . human beings are very much different from other living things in terms of their capacity. They can symbolize experiences that they have been through by using words or ideas. 2008). themselves and their environment. his perceptions and attitudes towards others. For this. Core. it is fundamental to understand the patient’s reflection and development habits. Another theory that supports this study is Lydia Eloise Hall’s Care. with conditions for the patient to participate in the care planning (Octaviano and Balita. She believes the attainment of something beneficial to them. Such symbols could be used creatively in guiding and communicating in their efforts towards the attainment of something beneficial to them. feelings and emotions demonstrated in the most diverse situations.
The nurse functions in this role as investigator and potential cause of pain related to skills such as injections and dressing changes (Tomey and Alligood. From Hall’s perspective. Cure is the aspect of nursing involved with administration of medications and treatment.13 her theory is self-awareness which refers to the state of being that nurses endeavor to help their patients achieve. and Cure are the central concept of Hall’s Theory. patient achieve their maximal potential through a learning process. 2004). The more self-awareness persons have their feelings. therefore. Rehabilitation is a process of learning to . the nurse and patient develop a close relationship representing the teaching-learning aspects of nursing. Care alludes to the “hands-on”. helps the patient clarify motives and goals. Nursing circles of Care. through the use of reflective technique. Core. Core involves the therapeutic use of self in communicating with the patient. the chief therapy they need is teaching. intimate bodily care of the patient and implies a comforting. nurturing relationship. While intimate physical care is provided. the more control they have over their behavior (Tomey and Alligood. facilitating the process of increasing the patient’s self awareness. 2004). The nurse.
but a prerequisite is learning about oneself as a person.arizona.edu). and 3) Health professionals constitute a part of the interpersonal environment. There are many assumptions within the context of the HPM. Physical and mental skills must be learned. 2) individuals seek to actively regulate their own behavior. The Health Promotion Model uses a wellness orientation in order to explain health-promoting behavior. 2004). Nola Pender’s Health Promotion Model (HPM) also supports this study.nursing . which exerts influence on persons throughout their lifespan (www.14 live within limitations. Pender’s model integrates nursing and behavioral science with factors that influence people’s ability to engage in and/or change health behaviors. There are two . and clarifying motivations (Tomey and Alligood. For the purpose of this study. including assessment of their own competencies. This model has been used to guide the exploration of biopsychosocial processes that influence one’s decisions to engage in health behaviors and as a framework to predict health-promoting lifestyle as well. becoming aware of feelings and behaviors. there are three applicable assumptions: 1) Persons have the capacity for reflective self-awareness.
These phases are the decision making phase and action phase. Worldwide. The decision phase involves seven cognitive or perceptual elements that constitute motivational mechanisms for acquiring and maintaining health-promoting behavior as well as five modifying circumstances that indirectly influence patterns of health behavior. 2004). This theory relates to this study because this model portrays the multifaceted nature of persons interacting with their interpersonal and physical environment. The action phase involves obstacles and prompts to action which stimulates activity in health promoting behavior (Polit and Beck. cardiovascular disease is estimated to be the leading cause of death and loss of disability-adjusted life . The promotion of self-care in Myocardial Infarction patient has increasingly attracted attention due to increasing incidence of such disease. Not to be forgotten is the influence of family and environment on arriving at health related decisions (Polit and Beck.15 phases that comprises it. the individuals participating in this study had undertaken a course of action that they believe will improve their overall health and functioning. Anatomy and Physiology of Myocardial Infarction. Obviously. 2004). There are many ramifications to their decision.
(www.com. rates of cardiovascular disease have risen greatly in low-income and middle-income countries. Although age-adjusted cardiovascular death rates have declined in several developed countries in past decades.com) .wikipedia. occurs when the blood supply to part of the heart is interrupted causing some heart cells to die.medicinageriatrica.16 years. if left untreated for a sufficient period of time. Effective prevention needs a global strategy based on knowledge of the importance of risk factors for cardiovascular disease in different geographic regions and among various ethnic groups. commonly known as a heart attack. The resulting ischemia (restriction in blood supply) and oxygen shortage. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque. which is an unstable collection of lipids (like cholesterol) and white blood cells (especially macrophages) in the wall of an artery. (www. with about 80% of the burden now occurring in these countries.ar) Myocardial infarction (MI or AMI for acute myocardial infarction). can cause damage and/or death (infarction) of heart muscle tissue (myocardium).
which results in coronary artery blood flow occlusion. Plaque erosion may occur because of the actions of metalloproteases and the release of other collagenases and proteases in the plaque. which result in thinning of the overlying fibromuscular cap. If such an occlusion persists long enough (20 to 40 minutes). The loss of structural stability of a plaque often . The development of atherosclerotic plaque occurs over a period of years to decades. The initial vascular lesion leading to the development of atherosclerotic plaque is not known with certainty. The action of proteases. can lead to a disruption of the endothelium and fissuring or rupture of the fibromuscular cap.17 Myocardial Infarction are caused by a disruption in the vascular endothelium associated with an unstable atherosclerotic plaque that stimulates the formation of an intracoronary thrombus. The degree of disruption of the overlying endothelium can range from minor erosion to extensive fissuring. The two primary characteristics of the clinically symptomatic atherosclerotic plaque are a fibromuscular cap and an underlying lipid-rich core. irreversible myocardial cell damage and cell death will occur. which results in an ulceration of the plaque. in addition to hemodynamic forces applied to the arterial segment.
but may also radiate to the lower jaw. a site otherwise known as the plaque's “shoulder region. (www. . although a prospective observational study showed that it had a poor positive predictive value. neck.” Disruption of the endothelial surface can cause the formation of thrombus via platelet-mediated activation of the coagulation cascade. right arm. or squeezing. MI can result.18 occurs at the juncture of the fibromuscular cap and the vessel wall. in which the patient localizes the chest pain by clenching their fist over the sternum. Pain radiates most often to the left arm. Levine's sign. over several minutes.com) The onset of symptoms in myocardial infarction (MI) is usually gradual. has classically been thought to be predictive of cardiac chest pain. pressure. Chest pain due to ischemia (a lack of blood and hence oxygen supply) of the heart muscle is termed angina pectoris. Chest pain is the most common symptom of acute myocardial infarction and is often described as a sensation of tightness. If a thrombus is large enough to occlude coronary blood flow completely for a sufficient period. back. and rarely instantaneous.eMedicine. and epigastrium. where it may mimic heartburn.
weakness.8 symptoms in men).19 Shortness of breath (dyspnea) occurs when the damage to the heart limits the output of the left ventricle. and dyspnea have been reported as frequently occurring symptoms which may manifest as long as one month before the actual clinically manifested ischemic . causing left ventricular failure and consequent pulmonary edema. weakness. Loss of consciousness (due to inadequate cerebral perfusion and cardiogenic shock) and even sudden death (frequently due to the development of ventricular fibrillation) can occur in myocardial infarctions. and fatigue. Other symptoms include diaphoresis (an excessive form of sweating). sleep disturbances. nausea. light-headedness. Women and older patients experience atypical symptoms more frequently than their male and younger counterparts. Fatigue. vomiting. The most common symptoms of MI in women include dyspnea. and palpitations. These symptoms are likely induced by a massive surge of catecholamines from the sympathetic nervous system which occurs in response to pain and the hemodynamic abnormalities that result from cardiac dysfunction. Women also have more symptoms compared to men (2.6 on average vs 1.
aortic dissection. Approximately one fourth of all myocardial infarctions are silent.com) . pericardial effusion causing cardiac tamponade. These cases can be discovered later on electrocardiograms or at autopsy without a prior history of related complaints. in patients with diabetes mellitus and after heart transplantation. A silent course is more common in the elderly. (www.20 event. Approximately half of all Myocardial Infarction patients have experienced warning symptoms such as chest pain prior to the infarction. The differential diagnosis includes other catastrophic causes of chest pain. Any group of symptoms compatible with a sudden interruption of the blood flow to the heart is called an acute coronary syndrome. such as pulmonary embolism. autonomic neuropathy. In diabetics.wikipedia. differences in pain threshold. and psychological factors have been cited as possible explanations for the lack of symptoms. chest pain may be less predictive of coronary ischemia than in men. tension pneumothorax. probably because the donor heart is not connected to nerves of the host. without chest pain or other symptoms. In women. and esophageal rupture.
Repeat in-depth patient education and counseling not only improve compliance with medical therapy but also reduce cardiovascular risk factors. and prescription to continue its use after hospital discharge.com). with the possible additions of thrombolytics. beta-adrenergic blocking agents. Therefore. health care professionals should also promote a healthy lifestyle and preventive strategies to decrease the prevalence of Cardiovascular Disease in the general population (www.emedicine. and antiplatelet agents. which means one has to . analgesics. throughout the hospitalization. earlier detection. Patients should receive a beta-blocker initially. and angiotensin-converting enzyme (ACE) inhibitors. a long-term commitment to lifestyle modification and pharmacological therapy is required. For this disease. For optimal control. lifestyle changes are the first line of prevention and treatment. (Black and Hawk 2005) A comprehensive study for reduction of mortality and morbidity from Myocardial Infarction must include prevention strategies. calcium channel blockers.21 The Patient with suspected acute myocardial infarction needs immediate treatment which includes oxygen receives nitroglycerin. and adequate treatment.
The foundation of this case study which is anchored on the interrelated concepts of the three theories given by Dorothea Orem will definitely benefit a patient with myocardial infarction since this patient has a certain degree of self care deficit and is in definite need of the nurse’s care and attention. consumption of food high in saturated fat. tobacco use. .22 keep a tight rein of the major risk factors which include high blood pressure. obesity. and diabetes. The principles of the theory will also be able to address efficiency the needs of the patient. lack of physical activity. elevated blood cholesterol.
What are the needs of the patient in terms of following selfcare requisites: 1. 1.3 1.2 1.23 THE PROBLEM Statement of the Problem: This study determined the effectiveness of nursing care utilizing Orem’s theory to a patient with Myocardial Infarction. The outcomes of the study served as bases for a proposed health teaching care guide. universal. and health deviation? What nursing diagnosis and desired outcomes are identified and formulated? .1 1. developmental .
mainly heart attack and stroke. What health teaching guide for self care can be proposed based on the findings? Significance of the Study Death from heart disease ranks first as cause of death in the Philippines. In turn.24 2. this is almost guaranteed that every family will be affected by this disease. This study will make the patients aware of the nature of their condition and the importance of compliance to . 3. This will impact not only these individuals but their families as well. while disabling hundreds of millions more often individuals in the prime of their lives. Thus. this study will benefit the following: Patients. How effective is the nursing care plan formulated and implemented utilizing Orem’s theory. the researcher felt the need to conduct this study to address these concerns. With almost one in three adults diagnosed with the disease. Cardiovascular Diseases. kill more than 16 million people worldwide.
and psychological support. They are the patient’s significant provider of emotional. the family of the patient’s will be able to acknowledge the appropriate measures on how to care for their Myocardial Infarction member. The patient can enhance their self-care activities to certain measures pertinent to his condition. Community. Through this study. The family can help the patient develop healthy life style and behavior pattern which eventually will result to higher levels of health not only to the patient but also the family members. The result of this study will serve as a good motivation for them to assume the task of being actively involved in carrying out specific care practices geared towards control of myocardial infarction and prevention of complications. Awareness of the facts discovered in this study would make the general public understand that myocardial infarction control be achieved solely by the efforts of the health team. . physical. This research would make everyone cognizant of the relevance of health education in the practice of desirable self-care skills for promotion of health.25 self-care measures. Significant others. Management of the condition demands much participation from the patient and family.
on Knowing self-care that patient’s are participation measures essential. health care providers will have to focus more on giving social support during the entire regimen. . Clinical Instructors. They will also develop a positive attitude towards rendering health care in various clinical settings. the Clinical Instructors will be able to share this learning to their students. Necessary assessment and follow-up on the patient’s compliance should be done from time to time. effective care management will be achieved. Having the knowledge about the importance of maintaining self-care principles in the care of Myocardial Infarction patients. Student Nurses awareness of nursing management on Myocardial Infarction will enable them to provide appropriate interventions and health teachings to their future clients. thus. Hospital Administrators. This study will serve as a guide for hospital administrators to come up with effective staffing patterns and standardized health teachings and interventions to be done in handling patients with Myocardial Infarction. Health cooperation Care and Providers.26 Student Nurses.
This study will be a guide for the researcher to further enhance their competencies in handling patients with Myocardial infarction using Orem’s Self-Care Theory. Research Environment The study was conducted at Sacred Heart Hospital. Future Researchers. It will serve as an added reference for future researchers in developing their research problems and in designing their research study using the same variable or research locale. intensive care unit.27 Researcher.. emergency services. These include various wards and private rooms. diabetes clinic. Cebu City. hemodialysis unit. It is a tertiary health care institution located at Urjello St. public- . RESEARCH METHODOLOGY Research Design The study utilized the case study method to determine the effectiveness of Dorothea Orem’s Self-Care Theory in the care of a Myocardial Infarction patient. diagnostic laboratories. The hospital offers a variety of health services. operating room. a 150 total bed capacity.
Patient’s developmental stage and maturational crisis presumes lack of knowledge about his situation. 2009 due to mild myocardial infarction. Research Subject The research subject of this study was a 79 year old. 3 days prior to admission he was able to manage doing things at . History of Present Illness: Five months prior to admission patient noted difficulty in breathing when carrying heavy objects. 79 years old. admitted for the first time at Sacred Heart Hospital last August 03. Chief Complaints: “I have difficulty in breathing when I carry heavy objects”. of Bulacao Cebu City. I. According to the patient. widower. male. Roman Catholic. T. male. V. as verbalized by the patient. Situational Appraisal: A case of Mr. who was diagnosed of Myocardial Infarction. The medical ward wherein the case study was conducted receives an average of 15-20 patients/day.28 private mixed directly observed treatment short course chemotherapy (DOTS) clinic as well as a reproductive health clinic. Filipino.
The assessment tools were also translated to vernacular for the patient’s convenience. Another letter asking permission to conduct a study was sent to the Chief of Hospital of Sacred Heart Hospital. a transmittal letter was sent to the Dean of the Graduate School asking permission to conduct a case study method research at Sacred Heart Hospital. condition was tolerated until condition worsened and the patient decided to seek consultation at 1:18 pm and was advised for admission. as well as a thorough physical assessment utilizing the IPPAO method and the Gordon’s Functional Health Patterns in obtaining a comprehensive health history based on Dorothea Orem’s model. The researcher then started conducting the case study.29 home like watering his plants. Research Procedure Data Gathering Before the actual data gathering. explained the purpose and emphasized the significance of the . and the Chief Nurse. The Patient experienced chest pain at around 12:30 in the afternoon. Research Instruments A researcher-made tool was used for data collection and assessment. The researcher asked permission from the patient.
may result from medical measures required to correct illness or injury.30 study and benefits he can have. stating that the former is informed and has agreed to participate in the study and assured of utmost confidentiality. Health Deviation Self-Care Requisites is the care needed by individuals who are ill or injured. A consent form was signed by the patient and by a witness. . the following words are defined operationally: Developmental Self-Care Requisites are maintaining conditions to support life and development or to provide preventive care for adverse conditions that affect development of the patient with myocardial infarction. Definition of Terms To fully understand the terms used in this study. Myocardial Infarction refers to a medical condition that affects the human heart of the patient. In this cardiac disorders.
Self-Care Deficit is the inability of the patient with myocardial infarction to carry out all necessary self-care activities. Partially Compensatory Nursing System is a situation in which both nurse and patient perform care measures or other actions involving manipulative tasks or ambulation. . Nursing care is needed if there is a problem that prevents a person from reaching their optimal health. self-care activities.31 inadequate amount of oxygenated blood reach the cardiac muscles thereby causing pain in the chest and weakening of the pumping action of the heart. usually in collaboration with and after instruction by a health professional. health and well-being. This condition is commonly know as heart attack. It identifies when and how much a nurse is needed in the care of the patient. but not all. It refers to the personal and medical care performed by the patient. This system is designed for individuals who are unable to perform some. Self-Care is the practice of activities that the patient with myocardial infarction personally initiate and perform on their own behalf to maintain life.
during some period. to meet self-care requisites. . associated with life processes and the integrity of human structure and function. Therapeutic Self-Care Demand is the sum or total of selfactions needed. also called self-care needs. are measures or actions taken to provide self-care. This system is required for individuals who are unable to control and monitor their environment and process information. Universal Self-Care Requisites are those requisites common to all throughout life. Wholly Compensatory Nursing System is a situation in which the patient has no active role in the performance of selfcare.32 Self-Care Requisites.
developmental . Needs of the patient Universal Self-Care Requisites Assessment • Patient’s 24 hour Diet Recall ➢ Before Admission: Meal Time 06:00 AM Food 3 pieces of bread. I. 1 banana Beverage 1 cup of coffee approx.33 CHAPTER II RESULTS AND DISCUSSION This chapter discussed about the needs of a Myocardial Infarction patient based on Orem’s Self-Care requisites in terms of following self-care requisites: universal. and health deviation. .
• Food supplements: The patient is not taking any food supplements. chicken soup.34 240 cc 12:00 noon 2 pieces of bread. The family utilizes a stove fueled by an LPG (liquid petroleum gas) tank in cooking. He likes to eat vegetables like during meal time and eat any leftover bread for his snacks. 240 cc 1 glass of approx. Their primary food storage is in the refrigerator. 1 piece fried fish 1 cup of coffee approx. • Food preparation: Their food at home is prepared by her daughter. . 1 cup bowl of vegetables with soup Beverage Water 250 ml Water 250 ml Water 250 ml Water 250 ml • Patient’s food preferences: When patient wakes up early in the morning he likes to eat bread with coffee or juice. 1 piece fried fish 1 cup rice. The foods prepared are different for each member of the family. 240 cc water 07:00 PM ➢ During Admission Meal Time 05:00 AM 10:00 AM 12:00 noon 6:00 PM Food 1 cup rice. 1 pack of crackers 1 cup of rice. and 1 banana 2 pieces bread and 1 pack crackers 1 cup of rice.
it is yellow to brown but he ca not account as to how much. As to color. • Utilization of other aids to facilitate elimination: Patient’s daughter buys laxative like Dulcolax or Docusate from a pharmacy in front of their house to help facilitate his elimination. The family does not have any food restrictions with regards to their cultural or religious beliefs. The patient eats first because he has a different meal than the others. their table is too small to accommodate them all that’s why they do not usually eat together. When he gets bored he goes out of their house and walks around their compound or chat .35 • Factors that influence patient’s dietary modifications: Since they are an extended family. • Usual activity patterns: Patient likes to watch television and read the newspaper. He urinates 3-5 times in a day with pale yellow color about 50 cc per episode. • Usual elimination pattern in terms of frequency. amount and usual habits: Patient defecates once a day.
He is also fun of planting vegetables and fruit trees in their backyard. His only means of exercise is when he walks around their compound. He takes his usual afternoon nap around 1-2 pm. • Adherence to a regular exercise regimen: Patient do not have a regular exercise regimen. he prefers to stay in bed as he experience body weakness and shortness of breath. neighbors and . He has good relationship with his children. • Attitude towards self and others: Patient said he is a very hardworking and responsible father. Patient has also mentioned feeling of sadness and loss whenever he thinks of his wife who passed away. • Time and duration of patient’s usual sleep pattern: Patient usually sleeps around 9 in the evening and wakes up at around 4 in the morning.36 with friends. His children and grandchildren are his source of inspiration. grandchildren. He believes that things happen for a reason and he can surpass it all. He is a very fun loving and energetic person. During patient’s hospital admission and course of illness.
• Environmental factors: Patient lives in a healthy environment that is pollution-free. He maintains good health by eating nutritious food like fruits and vegetables. Due to his 1st hospitalization last 2003 at Miller Hospital due to epistaxis and elevated BP of 150/90 he decided to stop all his vices. • Nursing Diagnosis . has clean surroundings and proper waste disposal. Now for the last 6 years till present the patient doesn’t adhere to any vices. He neither drinks nor smokes. He takes his medicine every day. His daughter said that they have not encountered any conflicts with their neighbors. • Patient’s lifestyle: He was an alcoholic and smoker for 48 years. He also said that his daughter would prepare fresh calamansi juice for him whenever he has cough or colds. He does not have much exercise since he gets tired easily.37 has not had any conflicts with them. • Health practices: Patient regularly takes a bath and changes into clean clothes every day. He enjoys having chats with their neighbors and friends.
Now he just stays at home and sometimes watches the house while his children are at work. Activity intolerance related to imbalanced oxygen supply and demand as evidenced by verbal reports of fatigue and shortness of breath. • Perception and satisfaction on the said role: Patient is happy and contented with the responsibilities he is carrying and does his best to fulfill his duties as well. Developmental Self-Care Requisites • Role in the family and community: Patient used to be the breadwinner of the family when he was still working as a carpenter.38 Sedentary lifestyle related to lack of interest in accomplishing a physical exercise regimen. • Problems with relationship to others: None . Deficient diversional activity related to physical limitations as evidenced by verbal reports of fatigue shortness of breath.
He is mindful is mindful of his prescribed medication and takes it on time. Patient always observes proper hygiene practices such as taking a bath everyday and changing into clean clothes. • Experienced any of the following for the past 6 months: √ loss of family member (nephew) × loss of possessions or occupation . pulse and temperature measurements. • Knowledge of the importance of self-examination: Patient does not have knowledge on taking one’s blood pressure. He claimed that he is particular when it comes to cleanliness in their home and surroundings. He no longer eat what is bad for him or what is restricted for him to eat.39 • Patient’s consciousness and awareness of his own health: Patient is aware of his own health and strictly follows his diet. He is aware of the importance of health care practices. Patient is conscious about what is happening to his body and tells his daughter whenever he feels something unusual.
40 × change of residency into an unfamiliar environment × any hazardous accident or health threat √ CAP MR and Hypocalemia NURSING DIAGNOSIS: Ineffective Family Coping: risk for compromised related to prolonged disease/disability progression that exhausts the supportive capacity of family members.0 °C Respiratory Rate: 35 cpm Pulse Rate: 62 bpm Blood Pressure: 130/90 Heredo familial disease present in both parent’s family: Hypertension and diabetes are present on both sides of the patient’s family Current laboratory results or diagnostic tests findings . HEALTH DEVIATION SELF-CARE REQUISITES Patients vital signs (upon assessment) Temperature: 37. Ineffective coping related to situational crisis.
• August 03. It consists of the following tests: red blood cell (RBC) count. . classification of white blood cells (WBC differential). and calculation of hematocrit and red blood cell indices. It is a noninvasive recording produced by an electrocardiographic device.41 ECG Date performed: is a transthoracic interpretation of the electrical activity of the heart over time captured and externally recorded by skin electrodes. and platelet count. measurement of hemoglobin and mean red cell volume. white blood cell (WBC) count. 2009 AF MVR Acute Ant MR CRBB Complete Blood Count: A complete blood count (CBC) is a series of tests used to evaluate the composition and concentration of the cellular components of blood.
Date Taken August 03.7 0.00/0.0 mEq/L 0.0/34. 2009 Laboratory Procedure WBC RBC HGB HCT MCV MCH MCHC RDW PLT MPV LYM% MON% NEU% EOS% BAS% Result 5.48 Normal Value 135-145 mEq/L 3.42 Date Taken August 03.3 87.00 37.6 3.0/50.00/4.1 9.9 33.0 2.00/0.80 0.0 150/450 6.0/16.6-1.0/2.0 4.548 .00 0.4/35. to detect and evaluate mild to severe heart injury.20 Significance Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Serum Enzyme: This test measures the amount of an enzyme called angiotensin-converting enzyme in blood.067 Normal Value 4.0/80.00/8.0 1.7 0.0 80/90 26.906 .5 10.1 176 7.4/11.50/5.5-5.7 15.40 0.9 25.0/18.6 46.225 .49 5.0 33.0/0.6 29.92 . and to distinguish chest pain that .10 11.5 0.28 15. 2009 Laboratory Procedure Na+ K+ Creatinine CK-MB Result 140.10/1.225 .16 1.0 35.0/9.0/0.0/54.36mg/dl 0 – 18 u/L Significance Normal Normal Normal Normal Troponin T (Quantitative ) It is used to help diagnose a heart attack.
and microscopic examination of a urine sample (specimen).03 ng/ml 2. chemical. In patients who experience heartrelated chest pain.3 126. Date Taken August 03. 67-142% 0.82-1. It is an important part of hemostasis (the cessation of blood loss from a damaged vessel). the troponin test will still be positive if the symptoms are due to heart damage. wherein a damaged blood vessel wall is covered by a platelet and fibrin-containing clot to stop bleeding and begin repair of the damaged vessel. Between 0. Disorders of coagulation can lead to an increased risk of bleeding (hemorrhage) or clotting (thrombosis).1 ng/ml 3.05 ng/ml August 03. ➢ 0. 2009 PT % activity INR Laboratory Procedure Result 10.43 may be due to other causes. or other symptoms and do not seek medical attention for a day or more. .2% 0.79 Normal Value 10-14 sec. > 2. discomfort.0 ng/ml 4.2 Significance Normal Normal Bleeding time URINE ANALYSIS: Urinalysis is a diagnostic physical. Between 0.0 ng/ml Rationale Low Cardiac Risk Medium Cardiac Risk (Possible Myocardial damage) High Risk (Myocardial damage detected) Massive Myocardial damage has been detected COAGULATION: It is a complex process by which blood forms clots.03 ng/ml & 0.1 ng/ml & 3. < 0. 2009 Interpretation of Results 1.
2 Fasting Blood Sugar Lipid Profile: A fasting blood test is a blood sample taken from a person who has not eaten for 9 to 12 hours.6 mg/dL Adhere to the prescribed treatment : Currently adhering to the appropriately to his prescribed medications Nursing Diagnoses: Risk for decreased cardiac output related to increased after load secondary to Myocardial Infarction. 2009) ➢ Macroscopic Exam: Color: Yellow Volume: 60 ml ➢ Chemical Exam: Albumin: +1 PH: 6.0 Ketone: Negative ➢ Microscopic Exam: WBC: 1. Date Taken August 04. 2009 Laboratory Procedure Glucose Uric Acid Cholesterol Triglycerides Direct HGL LDL VDRL Result 63 mg/dL Normal Value 74 – 106 2.025 Blood: +1 Glucose: Negative RBC: 1.5 – 6.2 Transparency: clear Specific Gravity: 1. normal Atherosclerosis increased normal normal 176 mg/dL 173 mg/dL 28 mg/dl 113.44 Specimens can be obtained by normal emptying of the bladder (voiding) or by a hospital procedure called catheterization. (August 03. .4 mg/dL 34.2 0 – 200 0 – 150 40 – 60 60 – 180 25 – 50 Significance Hypoglycemia Hyperuricemia. the blood sample is taken early in the morning. Usually.
or potential tissue damage and mediated by specific nerve fibers to the brain where its conscious appreciation may be modified by . LIST OF NURSING DAIGNOSES WITH DESIRED OUTCOMES Nursing Diagnosis: Alteration in comfort: acute pain related to increased cerebrovascular pressure 2 ° to myocardial infarction.45 Ineffective evidenced breathing by client’s pattern related to of fatigue feelings as of verbalization breathlessness. Knowledge Deficient regarding therapeutic regimen. II. Readiness for enhanced therapeutic regimen related to minimal knowledge regarding disease process 2° Myocardial Infarction. Expected Scientific Basis Outcome After 4-6 hours of Pain has been defined as “an unpleasant sensory rendering and emotional experience associated with actual appropriate nursing interventions. present condition and potential complications of illness related to lack of information.
Present time problems such as heart . (http://www.46 the be patient will various factors. rendering appropriate and nursing interventions.nlhep. sore throats. Expected Outcome Scientific Basis After 4-6 hours of Shortness of breath can stem directly indirectly from many sources. occasionally life-threatening disease. 0-no pain and chest generates far greater concern because it 10-severe pain). and muscle stitches. The new onset of chest pain and what it may connote provokes anxiety and fright. the message being sent by the oxygen-deprived heart is clear and needs to be listened to. and all persons experienced unpleasant but innocent decrease in pain have from 8 to 5 (in a headaches. pain that seems to originate in the 10. pain are transmitters. may announce the presence of severe.” Pain follows the bumps and verbalize bruises encountered in daily life. it is one of the symptoms most likely to cause the victim to seek prompt medical attention. In given scale of 0. both in terms of its frequency and in terms of its diagnostic Even and therapeutic the implications. The pain of myocardial ischemia is described first because of its clinical importance. chemical not well though receptors. and sensory pathways that mediate cardiac understood. consequently.contrast.org) Nursing Diagnosis: Ineffective breathing pattern related to fatigue as evidenced by verbalization of feelings of breathlessness 2 ° to Myocardial Infarction.
or find coping extremely exciting can as well take our away of cause degree . asthma. whom you are afraid of. over-tight clothing.47 the patient will be attacks.com) demonstrate appropriate behaviors in case of breath possible recurrence. stress. as poor posture. to and even pictures of people we do not like. prescription drug side effects. . obesity. Expected Scientific Basis Outcome After 3-4 hours of Inadequate blood pumped by the heart to rendering meet the metabolic demands of the body. Poor physical absence of tachpnea. edge and able to establish a suffocation are comparatively easy to Learning health respiratory pattern as practitioners realize there may be many evidenced the aspects to shortness of breath that may Science. (http://www. by junk food. or and exacerbate individual shortness of breath. recent appropriate diet and surgery. by lung disease. normal & effective observe. toxic environment. Nursing Diagnosis: Risk for decreased cardiac output related to decreased after load as evidenced by blood pressure elevation 2 ° to Myocardial Infarction.breathing. recurrent lung infections. unresolved emotional an issues. SOB is largely a matter susceptibility. not be considered by much of Western will be able to initiate Medical changes evidenced adhering be to able the needed lifestyle conditioning.
Patients and be able to do may have acute. fluid to electrolyte imbalance. drug effects. overload. When the . This care plan focuses on the acute management. decreased fluid pulmonary volume. reduces control causes pressure contractility and cardiac output. and be disease. temporary problems or decreased cardiac output. Nursing Diagnosis: Alteration in thermoregulation: Hyperthermia related to increased metabolic rate 2 ° to Myocardial Infarction.48 appropriate nursing interventions patient able demonstrate ways blood to will Common causes of reduced cardiac output include myocardial infarction. valvular heart disease. hypertension. congenital heart disease. Expected Outcome After 4-6 hours Scientific Basis rendering nursing of Hyperthermia is an elevated body temperature due to failed appropriate thermoregulation. Hyperthermia occurs when the body produces or absorbs more intervention. debilitating effects of living (ADLs). Geriatric patients are especially at risk because the aging process reduced which compliance further of the ventricles. heat than it can dissipate. or home care setting. arrhythmias. Patients may be managed in an acute. (http://nursingcareplan.blogspot.com) Activities of daily experience chronic. ambulatory care. cardiomyopathy.
The presence of other signs and symptoms related to hyperthermia syndromes. or by dysfunction of the . Heart failure can be caused by weakness of the heart muscle. are also considered in making the diagnosis.49 the patient’s elevated body temperatures are sufficiently high.5 ˚C. then hyperthermia is excluded. Scientific Basis Heart failure is the result of poor cardiac function and is reflected by a decreased volume of blood pumped out by the heart. If fever-reducing drugs lower the body temperature. Expected Outcome After 3-4 hours of rendering appropriate nursing interventions patient will be able response to interventions and teaching and actions performed.8 ˚C Hyperthermia is generally diagnosed in the to 37. humid environment (heat stroke) or that was taking a drug for which hyperthermia is a known side effect (drug-induced hyperthermia). and the absence of signs and symptoms more commonly related to infection-related fevers. presence of an unexpectedly high body temperature and a history that suggests hyperthermia instead of a fever.com/Hyperthermia. called cardiac output. even if the temperature does not return entirely to normal.wikepedia. hyperthermia is a medical emergency temperature will and requires immediate treatment to prevent disability and death. Most commonly this means that the elevated temperature has appeared in a person that was working in a hot. such as the extrapyramidal symptoms that are characteristic of neuroleptic malginant syndrome. (http://www. which pumps blood out through the arteries to the entire body.) Nursing Diagnosis: Risk for fluid volume excess related to excess in fluid intake 2 ° to Myocardial Infarction. decrease from 38.
Because of the decreased volume of blood pumped out by the heart (decreased cardiac output). Medicine. As a result.50 heart valves. The diminished volume of blood pumped out by the heart (decreased cardiac output) is responsible for a decreased flow of blood to the kidneys. the kidneys sense that there is a reduction of the blood volume in the body. the kidneys are fooled into thinking that the body needs to retain more fluid volume when. which regulate the flow of blood between the chambers of the heart. This accumulation of fluid in the lung is called pulmonary edema. Expected Outcome Scientific Basis After 3-4 hours of administering appropriate nursing interventions. At the same time. the volume of blood in the arteries is also decreased. To counter the seeming loss of fluid. In this instance. the body already is holding too much fluid. despite the actual increase in the body's total fluid volume. This edema occurs because the build-up of blood in the veins of the legs causes leakage of fluid from the legs' capillaries (tiny blood vessels) into the interstitial spaces (http://www. This fluid increase ultimately results in the buildup of fluid within the lungs. in fact. which causes shortness of breath. It reflects a combination of biochemical changes in the body. accumulation of fluid in the legs causes pitting edema.net). the kidneys retain salt and water. Nursing Diagnosis: Anxiety related to change in health and socioeconomic status 2 ° to Myocardial Infarction. An associated increase in the amount of fluid in the blood vessels of the lungs causes shortness of breath because the excess fluid from the lungs' blood vessels leaks into the airspaces (alveoli) and interstitium in the lungs. patient Anxiety is a multisystem response to a perceived threat or danger. the patient's personal history .
people would not have the "raw materials" of anxiety (http://www. and memory. anxiety is a uniquely human experience. that animals do not appear to have. Moreover.51 will be able to verbalized reduction of anxiety and identified causes and contributing factors.com).”. a large portion of human anxiety is produced by anticipation of future events. to use memory and imagination to move backward and forward in time. . as verbalized by the patient. but human anxiety involves an ability. As far as we know. Without a sense of personal continuity over time. NURSING CARE PLANS Day 1 Nursing Diagnosis: Alteration in comfort: acute pain related to increased cerebrovascular pressure 2 ° to myocardial infarction. The anxiety that occurs in post-traumatic syndromes indicates that human memory is a much more complicated mental function than animal memory. and the social situation.answer. Other animals clearly know fear. Defining Characteristics Subjective Cues: “ Sakit man akong dughan.
Davis Company) 2. R – 36 cpm. Marilynn. Mary Frances Moorhouse. as verbalized by the patient.(Doenges. Mary Frances Moorhouse.A. Philadelphia:F.A. Evaluate pain regularly 1.A. restricts movement. (Doenges. Evaluation: The patient verbalized lessening of intensity level of pain from 8 as severe to 6 as moderate. appeared to be relaxed. Alice Geissler-Murr (2000). 6. May differentiate current pain from preexisting patters as well as identify complications. awake. pain related at scale from 1-10 is 8. Schedule adequate rest periods. nasal flaring noted.A. Alice Geissler-Murr (2000). Mary Frances Moorhouse. Marilynn. using of accessory muscles when breathing . restlessness. & intensity on a 0-10 scale. able to sleep and rest well.(Doenges. Nursing Care Plans. Nursing Care Plans. calm activities. Davis Company) 4. Philadelphia:F. Marilynn. Philadelphia:F.(Doenges. Nursing Care Plans. Objective Cues: received patient sitting on bed.52 Objective Cues: facial grimace noted. 5. Delay in reporting of pain hinders pain relief. tachypnea noted. Mary Frances Moorhouse. Day 2 Nursing Diagnosis: Ineffective breathing pattern related to fatigue as evidenced by verbalization of feelings of breathlessness 2 ° to Myocardial Infarction. Provides information about need for or noting characteristics.A.4 ˚C. Davis Company) 3. Defining Characteristics Subjective Cues: Kutasan ku dayun basta maglihok-lihok ko”. Mary Frances Moorhouse. Alice Geissler-Murr (2000). Marilynn. Marilynn. Helpful in decreasing perception to pain. location effectiveness of interventions. Nursing Care Plans. review history of previous MI pain 2. Davis Company) 4. P – 65 bpm.(Doenges. with the following vital signs:T – 36. Instruct patient to report pain immediately. Nursing Care Plans. Decrease external stimuli which may aggravate anxiety and cardiac strain. BP – 130/60 mmHg Interventions Rationale 1. Davis Company) 6. Prevents fatigue and conserves energy for healing. Philadelphia:F. Philadelphia:F. (Doenges. 3.A. conscious & coherent. Nursing Care Plans. shows guarding or distraction behaviors. Alice Geissler-Murr (2000). Davis Company) 5. Assist in relaxation techniques like deep breathing. Provide quiet environment. and discomfort measures. Marilynn. Philadelphia:F. Alice Geissler-Murr (2000). Mary Frances Moorhouse. Alice Geissler-Murr (2000).
BP – 150/90 mmHg . with Oxygen @ 2L/min via nasal prong. Investigate sudden changes or continued alterations in mentation e.A. productive cough noted. BP – 140/90 mmHg Interventions Rationale 1. Defining Characteristics Subjective Cues: “Nalipong-lipong ko”.5 ˚C. Marilynn. (Doenges. and systemic emboli. Objective Cues: received sitting on bed awake. Alice Geissler-Murr (2000). Philadelphia:F. Cerebral perfusion is directly related to cardiac output and is also influenced by electrolyte/ acid-base variations. Davis Company) 3. Maintain the patency of oxygenation therapy. Mary Frances Moorhouse. Nursing Care Plans. weakness noted. Philadelphia:F. Philadelphia:F. breathing. lethargy. Monitor respirations. Alice Geissler-Murr (2000). To help relieve difficulty in breathing exercise. Cardiac pump failure and/ or ischemic pain may precipitate respiratory distress. Mary Frances Moorhouse. cool/clammy skin. Davis Company) 2. Nursing Care Plans. (Doenges. Mary Frances Moorhouse. conscious and coherent. R – 34 cpm. Mary Frances Moorhouse. as verbalized by the patient. and mottling. confusion. Note strength of peripheral pulse.A. Day 3 Nursing Diagnosis: Risk for decreased cardiac output related to decreased after load as evidenced by blood pressure elevation 2 ° to Myocardial Infarction. P – 63 bpm. stupor.(Doenges. Nursing Care Plans. Assess. 2.A. sudden/ continued dyspnea may indicate thromboembolic pulmonary complications. R -42 cpm.8 ˚C. Systemic vasoconstriction resulting from diminished cardiac output may be evidenced by decreased skin perfusion and diminished pulses. however. Alice Geissler-Murr (2000). Alice Geissler-Murr (2000). Nursing Care Plans. document & report to 1. P – 60 bpm. Marilynn. Inspect pallor. with the following vital signs: T – 36.g. 5. Nursing Care Plans. 6. Davis Company) Evaluation: Patients RR has decreased from 42cpm to 35 cpm & verbalized understanding of the importance of performing deep breathing exercise. Can be used as a guide for activity the physician on abnormal prescription and a basis for patient health breath sound and taught deep management. To provide oxygen needed by the physiologic need of the body. hypoxia. anxiety. Marilynn. clammy skin noted.A.(Doenges.53 noted. Marilynn. Philadelphia:F.(Doenges. Alice Geissler-Murr (2000). verbalized reports of headaches and dizziness. Davis Company) 3.A. cyanosis. Philadelphia:F. with the following vital signs: T – 36. note work of breathing. Mary Frances Moorhouse. 6. Marilynn. Davis Company) 5.
Help reduce sympathetic stimulation. Nursing Care Plans. restful surroundings. Maintain activity restrictions. Instruct in relaxation techniques. bedrest/chair rest. 4. Day 4 Nursing Diagnosis: Alteration in thermoregulation: Hyperthermia related to increased metabolic rate 2 ° to Myocardial Infarction.A. Alice Geissler-Murr (2000). Marilynn. Objective Cues: received patient lying in bed . Philadelphia:F.(Doenges.(Doenges. Davis Company) Evaluation: Patient was able to demonstrate ways to control blood pressure like following his diet low salt and low fat. Reduces physical stress and tension that affect blood pressure and the course of hypertension. Can reduce stressful stimuli. Alice Geissler-Murr (2000).g. assist client with self-care activities as needed. Davis Company) 3.A. Philadelphia:F. Philadelphia:F. e. with the following vital signs: T – 38. Nursing Care Plans.skin warm to touch.g.g. Mary Frances Moorhouse. P – 65 bpm.A. schedule periods of uninterrupted rest. 3. Defining Characteristics Subjective Cues: “Init akong paminao”. elevation of head. bedrest/chair rest. Davis Company) 2.A. Nursing Care Plans.(Doenges.8˚C. e. Nursing Care Plans. Interventions 1. R – 35 cpm. Marilynn.A. Davis Company) 4. Rationale 1. Alice Geissler-Murr (2000). flushed skin noted. 5. Provide comfort measures. Reduces physical stress and tension that affect blood pressure and the course of hypertension. guided imagery. assist client with self-care activities as needed. Limit the number of visitors and length of stay. Marilynn. BP – 130/90 mmHg Interventions Rationale . Provide calm. Marilynn. Mary Frances Moorhouse. promotes relaxation.54 1.(Doenges. Maintain activity restrictions. Davis Company) 5. distractions. Alice Geissler-Murr (2000). Philadelphia:F. Mary Frances Moorhouse. Decreases discomfort and may reduce sympathetic stimulation. Alice Geissler-Murr (2000). back and neck massage. Marilynn.(Doenges. promotes relaxation. Mary Frances Moorhouse. schedule periods of uninterrupted rest. e. Philadelphia:F. Nursing Care Plans. minimize environmental activity/noise. as verbalized by the patient. Mary Frances Moorhouse. 2.
(Doenges. Instructed the significant others not to let the client wear tight clothing.A. clammy skin noted. Marilynn. Nursing Care Plans.A. Marilynn. Philadelphia:F. Marilynn. (Doenges.55 1. Mary Frances Moorhouse. Davis Company) 2.5˚C. Decreases discomfort and may reduce sympathetic stimulation. (Doenges. (Doenges. To facilitate heat loss through evaporation and conduction. Mary Frances Moorhouse. Alice Geissler-Murr (2000). To provide proper knowledge and to empower the SO in taking care of the –patient to slow down the patient metabolism. R – 35 cpm. Davis Company) 5. Nursing Care Plans. BP – 130/90 mmHg . Objective Cues: received sitting on bed awake. Davis Company) 2. with the following vital signs: T – 36. Demonstrated performance of TSB. Marilynn. Philadelphia:F. Davis Company) 4. 4.8 to 37. Philadelphia:F. Davis Company) 3.A. limit fluid to 1L/day as ordered . Nursing Care Plans. Nursing Care Plans. Day 5 Nursing Diagnosis: Risk for fluid volume excess related to excess in fluid intake 2 ° to Myocardial Infarction. Philadelphia:F. Encouraged periods. as verbalized by the patient. Alice Geissler-Murr (2000). Defining Characteristics Subjective Cues: “ki ohaw gyud ko. Instructed the SO to keep the patient rested. 6. signs 1. Mary Frances Moorhouse. (Doenges. Alice Geissler-Murr (2000). Monitored vital especially temperature. anxiety noted. ganahan ko mu inom daghan tubig”.7 ˚C and seen sleeping comfortably.A. Have a baseline data and be alert for sudden changes in the temperature. Alice Geissler-Murr (2000).A. To prevent impairment of blood flow. adequate rest 3. Philadelphia:F. (Doenges. Marilynn. shortness of breath noted. Mary Frances Moorhouse. Performed tepid sponge bath. proper 5. Alice Geissler-Murr (2000).A. P – 65 bpm. Aid in lowering down the temperature. Mary Frances Moorhouse. Nursing Care Plans. 6. Davis Company) Evaluation: Patient’s temperature has reduced from 38. Nursing Care Plans. conscious and coherent restless noted. Philadelphia:F. Alice Geissler-Murr (2000). Mary Frances Moorhouse. Marilynn.
Philadelphia:F. Marilynn. 4. Alice Geissler-Murr (2000). restlessness noted. Philadelphia:F. Mary Frances Moorhouse. lack of initiative noted. To promote wellness. Day 6 Nursing Diagnosis: Anxiety related to change in health and socioeconomic status 2 ° to Myocardial Infarction. Nursing Care Plans. AND REDUCED URINE OUTPUT. Marilynn. Marilynn. Alice Geissler-Murr (2000). Objective Cues: received patient sitting on bed. Meets normal adult body fluid requirements. Evaluate for any edematous extremities. Philadelphia:F. Decreases discomfort and may reduce sympathetic stimulation. Marilynn. Marilynn. Davis Company) 5. (Doenges. Discuss the importance of fluid restrictions. Mary Frances Moorhouse. Davis Company) 3. (Doenges. Seen monitoring his intake to 1L/day only. Promote early mobilization. Philadelphia:F. Nursing Care Plans. Davis Company) 2. Nursing Care Plans. Mary Frances Moorhouse. Mary Frances Moorhouse. To prevent fluid excess and edematous on extremities. Nursing Care Plans.A. Defining Characteristics Subjective Cues: “maayu pakaha ko aning akong sakit?”. Philadelphia:F. (Doenges. DECREASED CARDIAC OUTPUT RESULTS IN IMPAIRED KIDNEY PERFUSION.A. Nursing Care Plans. Alice Geissler-Murr (2000).A. 5. noting decrease in output. BP – 140/90 mmHg . R – 42 cpm. To prevent impairment of blood flow. Stress the need mobility and frequent position changes. concentrated appearance. Measure I&O. expressions of concern about current and future events.5 °C. but may require alteration/restriction in presence of cardiac decompensation. Rationale 1. (Doenges. Mary Frances Moorhouse. as verbalized by the patient. (Doenges. with the following vital signs: T – 36. passivity noted. Mary Frances Moorhouse. Alice Geissler-Murr (2000). Davis Company) 2. Davis Company) Evaluation: Patient understood the importance of restricting fluid intake and complied with doctor’s orders.A.A. Nursing Care Plans. Maintain total fluid intake at 1000 mL/24 hr within cardiovascular tolerance. Philadelphia:F. P – 60 bpm. Calculated fluid balance. Alice Geissler-Murr (2000). facial tension noted. Davis Company) 4. Marilynn. 3.56 Interventions 1.A. Alice Geissler-Murr (2000). 6. 6. (Doenges. SODIUM/WATER RETENTION.
peripheral resistance. Philadelphia:F. Nursing Care Plans. One way of releasing tension and assessing the level of anxiety. Davis Company) 2. Instructed significant others to schedule visiting others. Nursing Care Plans. To identify client’s problem regarding the situation. Marilynn.57 Interventions 1. Alice Geissler-Murr (2000). Mary Frances Moorhouse. Marilynn. Alice Geissler-Murr (2000). BID Brand Name Generic Name Classification Action Pt. (Doenges. and depressed renin secretion 50 mg 1 tab. Philadelphia:F. decreases cardiac output . Mary Frances Moorhouse. Nursing Care Plans. Alice Geissler-Murr (2000). Provided a less stressful environment. Davis Company) 4. dosage ordered by . Encouraged client to express feelings. 5. (Doenges. Philadelphia:F. 4.A. Philadelphia:F. (Doenges. Philadelphia:F. Davis Company) 5. Davis Company) 3. To prevent client from an environment that could trigger stress. Diverted client’s attention through listening to a soothing music. Nursing Care Plans. Alice Geissler-Murr (2000).A.A. Evaluation: Patient appeared relaxed and reported anxiety is reduced to manageable level as evidenced by talking to his daughter. 3. This will help client divert her attention for the time being. Listened attentively concerning client’s feelings. Nursing Care Plans. Rationale 1. Decreases discomfort and may reduce sympathetic stimulation. Mary Frances Moorhouse. and cardiac oxygen consumption.A. • Medication or therapy used Metoprolol Lopressor Antihypertensives A selective beta blocker that selectively blocks beta1 receptors. Marilynn. (Doenges. Marilynn. Mary Frances Moorhouse. Marilynn. Mary Frances Moorhouse. Davis Company) 2. (Doenges.A. Alice Geissler-Murr (2000).
OD qHS To reduce risk of death from CV disease and CV events in patients at high-risk for coronary events. Respiratory: upper respiratory tract infection Use drug only after diet and other non-drug therapies prove ineffective. GI: Abdominal pain. CNS: Asthenia. Skin: rashes Always check patient’s apical pulse rate before giving drug. Diarrhea. initially 100 mg P. heart failure. Take drugs exactly as prescribed with meals. CV: hypotension.cholesterolemia. edema. Beta selectively is lost at higher doses. Inform the Health provider before procedures or surgery Alert. taper dose for 1-2 weeks. then up to 100 mg to 450 mg daily divided in two or three doses. Respiratory: dyspnea. taper off beta blocker to avoid thyroid storm. CNS: fatigue. In patients with suspected thyrotoxicosis. To reduce total and LDL cholesterol levels in patients with homo-zygous familial hyper. Obtain liver function test results at start of therapy and then periodically. dizziness. if have a shortness of breath occurs Notify the prescriber. once daily. When stopping therapy. GI: nausea. Davis’s Drug Guide for Nurses 9th Edition 2005 Simvastatin Zocor Antilipemics Inhibits HMG-CoA reductase. Patient should follow a standard low-cholesterol diet during therapy. bradycardia. Beta blockers may mask tachycardia caused by hyperthyroidism. dosage ordered by Physician Indication Hypertension.58 Physician Indication Adverse reaction Nursing consideration Source Brand Name Generic Name Classification Action Pt. AV block. if you stop taking medication.O. Avoid driving and other task requiring mental alertness. Constipation. Monitor blood pressure frequently. Musculoskeletal: Myalgia. an early (and rate-limiting) step in cholesterol biosynthesis. Headache. 40 mg 1 tab. Watch for peripheral side effects. depression. A liver biopsy maybe performed if enzyme elevations persist. Nausea. diarrhea. Adverse reaction Nursing consideration .
vomiting Metabolic: hyperkalemia Respiratory: dry.to report swelling of the face. that lightheadedness is possible especially during first few days therapy Advise pt.food in GI tract may reduce absorption Inform pt. dry mouth. nonproductive cough. anorexia. maculopapular rash. Wilkins Kalium Durules Potassium Chloride Pt.59 Source 40 mg daily significantly reduces risk of death from coronary heart disease. non fatal MIs. decreasing aldosterone secretion. fatigue. CV: tachycardia. OD Left ventricular ventricular dysfunction after acute MI CNS: dizziness. fever. alopecia Other: angioedema Before: Check pt. preventing conversion of angiotensin I to angiotensin II. Davis’s Drug Guide for Nurses 9th Edition 2005 Brand Name Generic Name Classification Action Captopril Capoten Antihypertensives Inhibits ACE. take the medication Observe for any adverse reactions Assess the pt. which reduces sodium and water retention and lower blood pressure. nausea. if there is a result of some adverse reactions After: Instruct pt. and revascularization procedures. headache. persistent. which reduces secretion. hypotension. fainting. constipation. angina pectoris Hematologic: abdominal pain. diarrhea. adverse reaction occur. to take drug 1 hour before meals. 25 mg 1 tab. take drug with meals proper dietary management of cholesterol and triglycerides inform patients. stroke. particularly muscles aches. Less angiotensin II decrease peripheral arterial resistance. malaise. dyspnea Skin: urticarial rash. pruritis.Williams. for signs and symptoms of infection such as fever and sore throat Urge pt. dosage ordered by Physician Indication Adverse reaction Nursing consideration Source Brand Name Generic Name . dysgeusia. difficulty breathing Nursing2008 Drug Handbook by Lippincott. chart for the doctors order Take baseline V/S Explain the need for medication Discuss the existing adverse reaction During: Give the medication on its specific site of administration Ensure that the pt. a potent vasoconstrictor.
CV: post infusion phlebitis. hot flushes. listlessness. wasting diuretics to maintain potassium levels. 30 mg 1 tab OD Prophylactic treatment of angina pectoris. flaccid paralysis.60 Classification Action Pt. an active metabolite of isosorbide dinitrate. and tell patient to notify prescriber if they occur.diarrhea. cardiac arrest. Metabolic: Hyperkalemia Respiratory:Respiratory paralysis Before: Make sure powders are completely dissolved before giving. The effect of the treatment is dependent on the dose. arrhythmias. After: Teach patient signs and symptoms of hyperkalemia. insertion site. resulting in peripheral pooling of blood.I. Nursing 2008 Drug Handbook 28th Edition page: 885-886 Philadelphia Wolters Kluwer Health / Lippincott Williams & Wilkins Imdur Isosorbide Mononitrate (ISMN) Anti-anginal Drug The principal pharmacological action of isosorbide -5mononitrate. G. chest pain. Body as a Whole: asthenia. Autonomic Nervous System Disorders: dry mouth. edema. with the latter effect predominating. Many averse reactions may reflect hyperkalemia. fatigue. Treatment of post myocardial infarction (MI) anginal attacks. hypotension. dosage ordered by Physician Indication Adverse reaction Electrolytes and replacement solutions Replace potassium and maintains potassium level. confusion. dosage ordered by Physician Indication Adverse reaction . Low plasma concentrations lead to venous dilata-tion. ECG changes.: nausea. Drug is commonly use with potassium. weakness or heaviness of limbs. is relaxation of vascular smooth muscle produ -cing vasodi latation of both arteries and veins.V. vomiting abdominal pain. High plasma concentrations also dilate the arteries reducing systemic vascular resistance and arterial pressure leading to a reduction in cardiac afterload. During: Monitor ECG and electrolyte levels during therapy. Tell patient to report discomfort at I. back pain. 1 tab TID x 3days To prevent hypolealemia CNS: paresthesla of limbs. Nursing consideration Source Brand Name Generic Name Classification Action Pt. decreased venous return and reduction in left ventricular end diastolic pressure (preload). heart block.
paresthesia. paresis. diarrhea. loose stools. flatulence. nausea. anaphylaxis.61 fever. malaise. OD infection of the sinuses. Store drug in a cool place. headache. Central and Peripheral Nervous System Disorders: dizziness. ears. diarrhea. melena. & away from light. neuritis. seizure. myasthenia gravis Pt. gastric ulcer. vertigo. in a tightly close container. Explain the action and possible effects of the drug Observe 5 Rights After: Stay with the patient Observe reaction of the patient During: Source Brand Name Generic Name Classification Action Monitor blood pressure & intensity & duration of drug response Drug may cause headache. rigors. tympanic membrane perforation. vomiting. abdominal pain. atrial fibrillation. hemorrhagic gastric ulcer. hives. flu-like symptoms. hypertension. hypotension. Gastrointestinal System Disorders: abdominal pain. skin. gastritis. Hearing and Vestibular Disorders: earache. tinnitus. it may cause spasm of coronary arteries Tell patient to minimize dizziness upon standing up by changing to upright position slowly. arrhythmia atrial. Davis’s Drug Guide for Nurses 9th Edition 2005 Levox Levofloxacin Quinolone inhibit bacterial DNA gyrase (main target in gram -ve bacteria) and topoisomerase IV (main target in gram +ve bacteria)although this major mechanism of action requires cell division quinolones also have other mechanisms of action which result in them being active against bacteria that are not actively replicating 500 mg 1 tab. constipation. vomiting. Heart Rate and Rhythm Disorders: arrhythmia. tendonitis. Cardiovascular Disorders. treat it with aspirin or acetaminophen Advise patient not to stop taking drug abruptly. General: cardiac failure. dosage ordered by Physician Indication Adverse reaction . and joints caused by susceptible bacteria urinary tract infections prostatitis Nausea. lungs. bradycardia. hypoesthesia. Nursing consideration Before: Assess condition of the patient. migraine. bones. hemorrhoids. dyspepsia. glossitis. airways.
AFTER: Tell to take this medication until the full-prescribed amount is finished even if symptoms disappear after a few days. also enhances the diffusion of NH3 from the blood into the gut where conversion to NH4+ occurs. DURING: Encourage patient to drink plenty of fluids while taking this medication. DURING: Monitor blood pressure. Davis’s Drug Guide for Nurses 9th Edition 2005 Plavix. diarrhea. Note for any adverse effects. AFTER: Record the intake and output data of the patient. produces an osmotic effect in the colon with resultant distention promoting peristalsis 30cc OD portal-systemic Encephalopathy treatment of chronic constipation Flatulence. Observe patient for any adverse reactions to drug. Platexan clopidogrel bisulfate Cardiovascular System Drug Inhibits the binding of adenosine diphospate (ADP) to its platelet receptor. Pt.62 Nursing consideration BEFORE: Source Brand Name Generic Name Classification Action Administer medication at least 2 hours before or 2 hours after taking any medications containing magnesium or aluminum. Observe patient for any adverse reactions. Monitor fluid status. impeding ADP-mediated activation and subsequent platelet aggregation. Davis’s Drug Guide for Nurses 9th Edition 2005 Lilac Lactulose Laxative inhibits the diffusion of NH3 into the blood by causing the conversion of NH3 to NH4+. Clopidogrel irreversibly modifies the platelet ADP receptor. Refer any unusuality seen. dosage ordered by Physician Indication Adverse reaction Nursing consideration Source Brand Name Generic Name Classification Action . drug may be given with fruit juices or milk. vomiting. nausea. Monitor bowel movement patterns. hypokalemia BEFORE: Ask patient if he has a diabetes mellitus. To improve taste. cramping.
Tell patient to refrain from activities in which trauma and bleeding may occur. Check patients chart.fatigue. Record and document procedure and patient’s reaction to medication. Inform patient that drug may be taken without regards to meal. Refer for any unusualities. that he is taking drug. headache.epistaxis. including dentists.63 Pt. including those receiving drugs and those having percutaneous coronary intervention(with or without stent) or coronary artery bypass graft (CABG).constipation. Instruct patient to notify prescriber if unusual bleeding or bruising occurs.abdominal pain. Davis’s Drug Guide for Nurses 9th Edition 2005 Adverse reaction Nursing consideration Source . AFTER: Reassess patient’s vital signs.hemorrhage. dizziness. PC Lunch to reduce thrombotic events in patients with atherosclerosis documented by recent stroke. Check for rights in medication administration. DURING: Advise patient it may take longer than usual to stop bleeding. Check patient’s vital signs. dosage ordered by Physician Indication 75 mg OD.edema. Tell patient to inform all health care providers. MI. before undergoing procedures or starting new drug therapy.ulcers BEFORE: Assess patient for drug hypersensitivity. or peripheral arterial disease to reduce thrombotic events in patients with acute coronary syndrome(unstable angina and non-Q-wave MI).
2.64 PROPOSED HEALTH TEACHING GUIDE FOR PATIENTS WITH MYOCARDIAL INFARCTION Rationale This health teaching guide is intended to guide patients with myocardial infarction. control or minimize its ill effect. Obtain a functional knowledge on myocardial infarction. Gather information on the different risk factors that can contribute or trigger the occurrence of myocardial . those who are at risk and even those who are not currently experiencing the said illness and to make them aware on the proper measures to prevent. Objectives: This health teaching program would encourage patients with myocardial infarction to: 1.
The two primary characteristics of the clinically symptomatic atherosclerotic plaque are a fibromuscular cap and an underlying lipid-rich core. reason for avoiding them and measures on how to avoid them. Plaque erosion may occur because of the actions of metalloproteases and the release of other collagenases and proteases in the plaque.65 infarction. The initial vascular lesion leading to the development of atherosclerotic plaque is not known with certainty. Myocardial Infarction Myocardial Infarction are caused by a disruption in the vascular endothelium associated with an unstable atherosclerotic plaque that stimulates the formation of an intracoronary thrombus. irreversible myocardial cell damage and cell death will occur. which result in . which results in coronary artery blood flow occlusion. The development of atherosclerotic plaque occurs over a period of years to decades. If such an occlusion persists long enough (20 to 40 minutes). 3. Acquire practical measures to promote health and enjoy life free from any further complications of myocardial infarction.
66 thinning of the overlying fibromuscular cap.( http://www. can lead to a disruption of the endothelium and fissuring or rupture of the fibromuscular cap.” Disruption of the endothelial surface can cause the formation of thrombus via platelet-mediated activation of the coagulation cascade. If a thrombus is large enough to occlude coronary blood flow completely for a sufficient period.medicinageriatrica. The degree of disruption of the overlying endothelium can range from minor erosion to extensive fissuring. MI can result.com) Risk Factors: • Atherosclerosis with occlusive or partially occlusive thrombus formation • Nonmodifiable risk factors for atherosclerosis ○ Age ○ Sex . in addition to hemodynamic forces applied to the arterial segment. The action of proteases. The loss of structural stability of a plaque often occurs at the juncture of the fibromuscular cap and the vessel wall. which results in an ulceration of the plaque. a site otherwise known as the plaque's “shoulder region.
67 ○ Family history of premature coronary heart disease • Modifiable risk factors for atherosclerosis ○ Smoking or other tobacco use ○ Diabetes mellitus ○ Hypertension ○ Dyslipidemia ○ Obesity • New and other risk factors for atherosclerosis ○ Elevated homocysteine levels ○ Male pattern baldness ○ Sedentary lifestyle and/or lack of exercise ○ Psychosocial stress ○ Presence of peripheral vascular disease ○ Poor oral hygiene • Nonatherosclerotic causes ○ Vasculitis ○ Coronary emboli .
A patient should start with activity that lasts 3 minutes. lowered blood pressure and edurance. or hyperthyroidism ○ Factors that decrease oxygen delivery. The Patient should have moderate physical activity. Exercise is critical for successful weight loss. patients should begin with a 5-minute warm-up period to stretch to . Weight loss is encouraged. fever. such as parking farther from a building to increase the walking time. such as hypoxemia of severe anemia Lifestyle Modifications ○ Weight Reduction. If the patient’s body mass index (BMI) is 25 or higher. such as heavy exertion. For sustained activity.68 ○ Congenital coronary anomalies ○ Coronary trauma ○ Coronary spasm ○ Drug use (cocaine) ○ Factors that increase oxygen requirement.
Patient’s are instructed to stop or limit alcohol intake to no more than 1 ounce of ethanol ( 2 ounces of liquor. ○ Moderate of Alcohol Intake. ○ Smoking Cessation. if they cannot have a conversation. the oxygen carrying component of blood. lightheadedness. Stop any activity if experiencing chest pain. or 24 ounces of beer) daily. to combine more readily with carbon . causing hemoglobin. they should slow down and switch to a less intensive activity. dizziness. shortness of breath. They should end the exercise with a 5-minute cool-down period in which they gradually reduce the intensity of the activity to prevent sudden decrease in the cardiac output. 8 ounces of wine. They should also be taught to exercise to an intensity that does not preclude their ability to talk. Excessive alcohol consumption may elevate arterial blood pressure and can add “empty” calories.69 prepare the body for exercise. or nausea. unusual chest pain. The inhalation of smoke can increases the blood carbon monoxide level.
leading to a higher probability of thrombus formation.70 monoxide than with oxygen.Calorie restriction in individuals with hypertension is recommended. Otherwise normal individuals need the daily-recommended calorie according to the age. A decreased amount of available oxygen may decrease the heart’s ability to pump. The use of tobacco also causes a detrimental vascular response and increase platelet adhesion. It is better to avoid high intake of . The Dietary Approaches to Stop Myocardial Infarction ➢ Encouraged the patient and instructed the significant others to prepare foods that are: ○ Low calorie . sex and physical activity. ○ Low fat It is advisable to reduce the fat consumption since hypertension has greater risk of arteriosclerosis. People who stop smoking reduce their risk of heart disease by 30% to 50% within the first year. which raise the heart rate and blood pressure. Nicotine acid in tobacco triggers the release of catecholamines. and the risk continues to decline as long as they refrain from smoking.
lean meats. by eating a high protein diet loaded with high protein foods. The dietary fats should consist of vegetable oil like corn oil. beef and fish and egg whites. ○ High fiber. ○ High protein – Most high protein foods are extremely low in carbohydrates and extremely low in saturated fat. eating low carbohydrates and eating little or no saturated fat is a must. The cholesterol rich foods such as liver. in order to lose weight and lose fat. olive oil and sunflower oil. organ meat. Chicken. lobster. Therefore. meat. . There are even types of fiber that will help reduce the risk of colon cancer. at the same time you'd end up eating low carbohydrates foods and low saturated fat foods.71 animal fat or hydrogenated oils. crab and prawns should be minimized in the diet.Not only does a high fiber diet aid in healthy bowel movements but also research has shown that it also lowers cholesterol. which contain saturated fatty acids. if you didn't already know. egg yolk. And.
Moderate sodium restriction 2. abdominal pain. Potassium intake should be increased.72 ○ Low sodium and high potassium diet. Hypertensive patients with kidney disease should avoid a high intake of potassium as it puts an excessive load on the kidney. tomato. watermelon. Food sources of potassium should be increased to patients who are on diuretics.Help to lower high blood pressure. (Lippincott Williams and Wilkins. such as spicy products this is to minimize gastrointestinal disorder. and potato should be included in the daily diet since they contain low sodium and high potassium.3 gm per day decreases diastolic blood pressure 6. ○ Instructed the significant others to avoid gastric irritant foods. banana. CNS disorder like dizziness. such as nausea and vomiting. 2004) . For example apricots. headache.10 mmHg and enhances the blood pressure lowering effect of diuretic therapy. leafy vegetables.
it was found out that the patient has self-care requisite in the three categories of Universal. Summary of Findings Using the researcher-made assessment tool guide that was based on Orem’s Self-Care Theory. . and recommendation. Developmental and Health Deviation. conclusion. CONCLUSION AND RECOMMENDATIONS This chapter presents the summary of findings.73 CHAPTER III SUMMARY OF FINDINGS.
it was found out that a possible factor of the onset of his illness was due primarily to the loss of his wife and feeling of worthless because of his illness. In the Developmental Self-Care Requisite category.74 In the Universal Self-Care Requisite category. In the Health Deviation Self-Care requisite. patient’s . The selected patient of this study was found out to have the diagnosis of Myocardial Infarction due to the following factors: heredo familial history of essential hypertension and diabetic history on both sides of the patient’s family.05 ng/ml which were positive indicators Medium Cardiac Risk Possible Myocardial damage. the patient demonstrated no problems with regards to his nutritional intake of foods high in fat and sodium and regular physical activity due to his reports of weakness and shortness of breath. His laboratory and diagnostic reports also showed Troponin T(Quantitative) of 0. patient’s elevated blood pressure level was also caused by potential hazards to his health related to a family history of hypertension on both paternal and maternal sides. The patient demonstrates an imbalance between his activity and rest because he only performs minimal exercise and most of the time engaged in a sedentary lifestyle.
CHF III C. a current diagnosis of HCVD. non-adherence to a particular physical exercise regimen. . Utilization of Health teaching guide. 3. in order to prevent and control the progression of the disease. 4. MI Killip CRBB. AF MVR. Conclusion It was concluded that Orem’s Self-Care Theory is effective in the care of patient’s with Myocardial Infarction. These findings imply the need to teach the patient to prevent further complications. high fat intake diet. everyone is advised to relent to adhere to appropriate lifestyle modifications. That the proposed health teaching guide for patient with myocardial infarction be handed out & implemented. Acute Ant. CAP-MR.75 body mass index of 28 which falls in the category of overweight. Hypokalemia & high salt. That anyone who has a great propensity of experiencing heart attacks due to unmodified risk factors such as age & a heredo familial history should be vigilant in adhering to their repetitive health management. Recommendations Based on the findings of the study. 2. the following are suggested: 1. That.
11th edition. Davis’s Drug Guide for Nurses. • Lifestyle Management Practices of Patients with Myocardial Infarction. and Jane Hokanson Hawks (2005). The future researchers will delve further into the following related studies: • An evaluation of the Effects of the Health Teaching Guide on Selected Clients with Myocardial Infarction. Nurse’s Pocket Guide.I (2008). (2007). Philadelphia: W. Marilyn E. Murr. B et al (2008). 6th edition. Joyce M. Philadelphia:Lippincott-Williams & Wilkins Black.. Pensylvania: F. and Velerand. Saunders Company. A. Philadelphia: F. • Risk Factors Affecting Compliance to Lifestyle Modification of Patients with Myocardial Infarction.B. J. Doenges. Deglin. MedicalSurgical Nursing Clinical Management for Positive Outcome. Davis Company.A. BIBLIOGRAPHY BOOKS Bare..A. Davis . Brunner and Suddarth’s Textbook of Medical-Surgical Nursing.76 5. Mary Frances Moorhouse and Alice C.
Nursing Theorists and Their Work. Kozier. Metro Manila. 5th edition. Mastering Fundamentals of Nursing. Nursing: Concepts of Practice. and Cheryl Tatano Beck (2004) Nursing Research Principles and Methods. Udan.77 Company George. St. (2001). 7th edition. Josie Q. 6th edition. Nursing Theories: The Base for Professional Nursing Practice. JOURNALS AND PERIODICALS . 5th edition. Lippincott Manual(2007). 5th edition. Nursing & Health Professions(2006). (2004). 7th Ed. Barbara et al (2004).Surgical Nursing. Williams and Wilkins. Singapore: Person Education South Asia Pte. 10th edition Philadelphia: Lipincott. Ltd. Singapore: Elsevier Pte. Balita (2008). 1st edition Philippines:Guiani Prints House. . Octaviano. Ltd. Philadelphia: Lippincott. Process and Practice. Brunner and Suddarth’s Textbook of Medical. Ann Marriner and Martha Raile Alligood (2004). Suzanne and Brenda Bare (2004). Singapore: Pearson Education South Asia Pte. (2008). Louis: Mosby. Tomey. Theoretical Foundations of Nursing: The Philippine Perspective . and Carlito E. Eufemia f. Denise F. Fundamental of Nursing: Concepts. Philippines: Ultimate Learning Series. Mosby’s Pocket Dictionary of Medicine. Dorothea E. Orem. Ltd. Smeltzer. Ltd. Julia B. Williams & Wilkins. Polit. Singapore: Elsevier Pte. Philadelphia: Lippincott Williams and Wilkins.
John and Bergenson. Fulcher. (2006 October) “Alcohol consumption and risk for Coronary Heart Disease in men with healthy lifestyle”. Volume 296. No. The American Journal of Cardiology. The Medical Journal of Australia. No. No. Gantt. The Journal of American Medical Association. 8 Clark. ( 2003 September) “ Lowering blood pressure in 2003”. Judith C. Houck. Unpublished Master of Arts in . No. Applied Nursing Research Volume. (2003 October) “ Heart failure: How can we prevent epidemic?” The Medical Journal of Australia. Volume 179.M. and Lan. et al (2004 August)” Heart Failure Patient learning needs after hospital discharge”. Virginia M. Volume 96 Kaplan N. Volume 32. Leonard F. Martin. and Riggs (2005 July) “ Relation of atmospheric pressure changes and the occurrence of Acute Myocardial Infarction and Stroke”. and Chalmers. Nursing Management. Steven (2006 December) “ A system Approach to Patient-Centered Care”. Theresa (2003 May) “ How Heart failure complicates care”.(2000) “ Evidence in Favor of Moderate Dietary Sodium Reduction” American Journal of Hypertension. 23 Dehner. No. Volume 166. no. Archives of Internal Medicine. (2008). Lethen. and ( 2003 August) “ Prevention of Cardiovascular disease: an evidence based clinical aid”. K. Chulou H.78 Amerena . 3 Dean.J. Arnolda. “Dorothea Orem’s Theory on the Client with Hemothorax”. 19 UNPUBLISHED THESES Penales. 6 Campbell. 5 Mukamal. Duncan J. John P. 17. Conner. The Medical Journal of Australia Volume. 176.
htm (retrieved 29 June 2009) “Optimal Breathing” from http://www.com (retrieved 10 June 2009) “Dorothea Orem's Self-Care Requisites” from http://www.wikipedia. Philippines.asp (retrieved 13 June 2009) “Hypertension” from http://www.ph/ (retrieved 29 June 2009) “Hypertension” from http://en.answer.com/articles/art57906.blogspot.HTM (retrieved 29 June 2009) “High Blood Pressure” from http://www.79 Nursing thesis.com/high_blood_pressure/article. INTERNET SOURCES Southwestern University. “Orem’s Theory” from http://www.com/med/TOPIC1106.emedicine.breathing.bellaonline.medicinenet.com (retrieved 10 June 2009) “Dorothea Orem” from http://www. Cebu City.com (retrieved 10 June 2009) “NCP Anorexia Nervosa” from http://nursingcareplan.philstar.org/wiki/Hypertension (retrieved 29 June 2009) .com.
1984 Cebu City Single Roman Catholic Nurse Educational Background Postgraduate : Master’s of Arts in Nursing: Medical Surgical Nursing Southwestern University Villa Aznar. Urgello Street Cebu City 2007-present .80 CURRICULUM VITAE Personal Data Name Date of Birth Place of Birth Civil Status Religion Profession : : : : : : Cherry Joy Hermoso Datan September 21.
2007. 2007 APPENDICES . Guadalupe. Cebu City Secondary : Intermediate : Work Experiences Clinical Instructor : Nurse Volunteer : Southwestern University (SWU) April 10.81 College : Bachelor of Science in Nursing Southwestern University Villa Aznar.. Urgello Street Cebu City 2002-2006 University of San Carlos – Girls High School P. November 15.Present Cebu Puericulture & Maternity House Inc. del Rosario Street Cebu City 1998-2002 Guadalupe Elementary School 1997-1998 Bethany Christian School 1990-1997 Buena Hills Subd. 2006 – February 15.
Longinos Dean. Urjello St.82 APPENDIX A TRANSMITTAL LETTER TO THE DEAN OF THE GRADUATE SCHOOL AND PEDAGOGY SOUTHWESTERN UNIVERSITY Dr. Rouel A. Graduate School Southwestern Uiniversity Villa Aznar. Cebu City Dear Dr. Longinos: Greetings! ..
M. may I humbly ask permission from your good office to allow me to conduct this study. Cebu City Thru: Mrs. may I ask permission to go on duty in the Cebu City Medical Center at 8 hours per shift for 6 days (total of 48 hours) as part of this study.N. Datan. In line with this. Researcher/Student Noted by: Jill Marie C.. I am currently undertaking a research entitled: Orem’s Self-Care Theory on Patient with Myocardial Infarction.83 I a student of Southwestern University enrolled in Masters of Arts in Nursing. Adviser APPENDIX B TRANSMITTAL LETTER TO THE MEDICAL DIRECTOR SACRED HEART HOSPITAL July 01. Fermo Chief Nurse .. Hermogenes.N. R. Vicente Gabriel Balbuena Sacred Heart Hospital Urjello St.A. Cherry Joy H. Kirsten A.N. R. I look forward with great gratitude your kind approval of this request. Respectfully yours. 2009 Dr. Furthermore.
Ph.84 As a graduate School student of Southwestern University taking up Master of Arts n Nursing major in Medical-Surgical Nursing. I am presently working a research entitled: Orem’s Self-Care Theory on Patient with Myocardial Infarction. single/married/widowed. do hereby give my consent without the influence of any person. CHERRY JOY H. In connection with this. Graduate School APPENDIX C-1 CONSENT TO SERVE AS A SUBJECT IN RESEARCH To whom it may concern: Be it known. _____________________. Thank you very much. Respectfully yours.D. MAN Adviser ROUEL A. RN. LONGINOS. I hope that this letter merit your approval. that I. HERMOGENES.D. Ed. _____ years of age. Dean. RN Researcher/Student Noted: JILL MARIE C. to participate and cooperate in the interventions done upon me by researcher as a . DATAN. may I humbly ask permission from your good office to allow me to go on duty in the Medical Ward as a part of my case study.
____ anyos ang pangedarun. The nature and general purpose of the research procedure have been explained to me. Signature: _______________________ (Patient. si ____________________.85 subject in their research entitled: Care of a Patient with Myocardial Infarction utilizing Orem’s Self-Care Theory. na mu-apil ug mu-hatag sa ako tabang sa ihayang pagbuhat sa mga . The researcher is authorized to proceed on the understanding that I may terminate my service as a subject in this research at any time I so desire. Guardian or Person giving the consent or his thumb mark) Witness: ___________________ APPENDIX C-2 CONSENT TO SERVE AS A SUBJECT IN RESEARCH (VERNACULAR) Kung kinsa dapat mahibalo: Mahibalo nga ako. ulitawo/minyo/biyudo. 2009. naghatag sa akong pagsugot. nga wala’y impluwensya ni bisang kinsa. In witness thereof. I have herewith set my signature this ____ day of _____.
Pirma: ______________________ (Pasyente.Health Perception – Health Management Pattern Patient defines health as “kanang walay sakit”. Ako mi-pirma sa adlaw nga ___________.86 pamaagi nga pag-atiman sa ako-a bahin sa ako-ang sakit. Taga-bantay o ang taw nga naghatag ani nga pagsugot o ang thumb mark sa pasyent) Witness: ___________________ APPENDIX D GORDON’S FUNCTIONAL HEALTH PATTERN I. He maintains good health by eating . Ang mahitungod ani nga research kai gi-isplikar na kanako. Patient related health as 10. Patient verbalized that health is very important. isip usa ka subject para sa iyahang research na: Care of a Patient with Myocardial Infarction utilizing Orem’s Self-Care Theory. Ang estudyanteng researcher nasayud na nga pwede nako undangun ang ako-a pagka-subject sa ilahang research bisan kanus-a nako gusto. 2009. for when you are not healthy you can’t function well and can’t perform your daily work. where 10 as very important and 1 as least important.
Patient has not undergone vaccination since during their time vaccines where not yet available during their time. He also claims that he doesn’t take any vitamin supplements.87 nutritious foods and through regular exercise by just walking around in their compound. Patients usually seek consultation on health matters with a physician. He is aware of the importance of health care practices. He has no known allergies to food and drugs. Patient is admitted for the first time at Sacred Heart Hospital due to Myocardial Infarction. Patient always observes proper hygiene practices such as taking a bath everyday and changing into clean clothes. Patient has no knowledge in performing self-examination such as: BP taking. Patient verbalized that his daughter would prepare fresh calamansi juice for him whenever he has cough or colds. He considers the environment as a major risk factor that influences his health practices. He claimed that he is particular when it comes to cleanliness in their home and surroundings. During admission. Patient does not smoke nor drinks alcohol. patient is taking . Patient doesn’t take any medication unless issued a prescription from his physician. Patient does not take herbal supplements or any maintenance drugs. pulse and temperature measurements.
88 prescribed medications such as Metoprolol 50 mg 1 tab. patient usually drinks around 6-7 glasses of water a day from a regular size of glass approximately 240 cc. soft drinks and hot drinks like coffee.Nutritional – Metabolic Pattern Fluid: Before admission. and Plavix 75 mg OD PC Lunch. Food: Before admission usually eats 3 times a day. Imdur 30 mg 1 tab OD. Levox 500 mg 1 tab. Simvastatin 40 mg 1 tab. lunch and dinner and he seldom take snacks. BID. Remark: Ineffective health maintenance related to inability to take responsibility for meeting basic health practices during hospitalization as evidenced by verbalization of body weakness and shortness of breath. He also drinks juice. breakfast. He is very weak and doesn’t want to communicate with the people around him. patients’ oral fluids are limited to 1 liter per day. II. OD qHS. Lilac 30cc OD. During admission. Captopril 25 mg 1 tab. OD. OD. Kalium Durules 1 tab TID x 3days. He usually eats the .
1 piece fried fish 1 cup rice. diet for five days. 1 banana 2 pieces of bread. less than body requirement related to decrease appetite for foods.89 food prepared by his daughter. Patient has verbalized that he has decreased appetite since he doesn’t like hospital foods. 1 banana 2 pieces of bread. lunch and dinner). 240 cc 1 glass of water approx. 1 piece fried fish Beverage 1 cup of coffee approx. He eats together with his family. I pack of crackers 1 cup of rice. low fat. During admission. 24-hour Diet Recall Remark: Risk for altered nutrition. 240 cc Meal Time 05:00 AM 10:00 AM 12:00 noon 6:00 PM Food 3 pieces of bread. 1 cup bowl of vegetables with soup Beverage 1 cup of coffee 240 cc 1 cup of coffee 240 cc 1 glass of water 240 cc 1 glass of water 240 cc approx. 240 cc 1 cup of coffee approx. He still eats three times a day (breakfast. approx. patient was on low salt. III.Nutritional – Metabolic Pattern . 1 pack of crackers 1 cup of rice. approx. Typical Dietary Intake Meal Time 06:00 AM 12:00 noon 07:00 PM Food 3 pieces of bread. He enlisted pork and roasted chicken as his favorite foods. approx.
He voids 5-6 times in a day but he can’t account as to how much. patient has lost his appetite. During admission. patient usually starts his daily routine at 6 am. Remark: Risk for constipation related to poor eating habits as evidenced by decrease frequency in defecation. he just drinks water for relief or his daughter would buy laxatives from a pharmacy near their house. As to color. He takes his siesta at 1 pm and wakes up around 3 pm to take his snacks. When it occurs. But there are times that he can’t defecate for 2 days. He urinates 6-7 times in a day with pale yellow color about 120 cc per episode.Activity-Exercise Pattern Before admission. Sometimes he experiences difficulty in defecating. eats breakfast and whiles the time by watching television shows or reading the newspaper. He takes a bath. patient defecates once a day. 11 am is the time when he usually eats his lunch with his family. He only defecates once during the first three days of admission with dark hard stool.90 Before admission. . IV. Patient’s skin is intact and returns immediately when pinched. it is yellow to brown and he can’t account as to how much.
watching television and chatting with his neighbors. After eating he resumes watching the television.91 Dinner is served at 7 pm wherein he eats together with his family. He is unable to perform his daily routine such as taking a bath. During admission. During admission. He just lay in bed the entire day. His activity according to him is limited during his hospitalization because he feels weak and tired whenever he attempts to stand up. patient wakes up around 8 am to take his breakfast & take his prescribed medications. patient usually sleeps around 10 pm and wakes up at 5 am. He retires to is bed around 10 pm. He claimed . Sleep – Rest Pattern Before admission. Remark: Activity intolerance related to generalized weakness secondary to myocardial infarction V. He said that he can’t sleep well because he is not used to the hospital environment. He prefers to sleep in a supine position. He takes his usual afternoon nap around 1-2 pm. patient sleeps at 8 pm and doesn’t have specific time in waking up.
Self-Perception and Self-Concept Pattern Patient said that he is a responsible husband and father. VII. a happy person. Cognitive-Perceptual Pattern Patients finished his education until grade 6. According to the patient.92 that he is usually awakened during the medication administration. During admission. He said that whenever there is a problem. there’s always a solution. According to patient. person and place. . VI. At home. Remark: Disturbed sleep pattern related to treatment modalities and environmental changes. he has always been a positive thinker and is generally. Directions and instructions are often repeated twice. he is able to follow instructions as well as recall past events. decisions are made by the family members. Patient also mentioned that his family has always been his source of strength. Remark: Disturbed Sensory Perception related to neurological dysfunction (sense of hearing). patient is still able to communicate and understand instructions but still with difficulty in hearing. He is unable to hear clearly but is oriented to time.
the patient claimed that he is not currently experiencing any discomfort with regards to his reproductive organ. VIII. He mentioned that at his age. During hospitalization. patient mentioned a feeling of sadness because he misses his grandchildren. patient claimed that he is extremely saddened with his condition. He has a good relationship with his family and has not experienced any major conflict with anyone of them. he is no longer sexually active. Role-Relationship Pattern Patient values his family very much. Sexuality and Reproductive Pattern The patient was circumcised at the age of eight. Remark: Impaired Cooping related to condition IX. He is often bothered by the hospital expenses and where to get the money to pay for the bill. He has been previously diagnosed with Essential Hypertension. . Patient already stopped working due old age and enjoys the company of his neighborhood residents.93 During admission. During admission. Remark: Powerlessness related to inability to perform role responsibilities. He lives with his married daughter and her family.
Patient said that he didn’t feel uncomfortable with his present condition and asked for means as to how he could cope up with his illness. Value Belief Pattern The patient is a Roman Catholic and attends mass every Saturday in their chapel. He claimed that he already accepted that he has this disease and not to dwell much time thinking about it. He shared that he has a strong faith in God and that he never forgets to pray everyday. During admission. patient said that he had lost interest in praying. Remark: Readiness for enhanced coping XI. . Remark: Risk for impaired religiosity related to depression due to wife’s death and present condition. He kept himself busy with activities such as reading newspaper & watching television programs. Coping-Stress Tolerance Pattern The patient considered his present condition as his source of stress. X.94 Remark: Effective sexuality and reproductive pattern.
as verbalized.95 APPENDIX E SOAPIE Day 1 Universal Self-Care Requisite S. .“Wala kayo ko katulog ug tarung kay init”.
96 O. the patient will be able to verbalize understanding of sleep disturbance. – Arranged schedule to provide adequate periods of rest & sleep throughout the day – – – Arranged care to provide for uninterrupted periods of sleep & rest.Determine patient’s expectations of adequate sleep. Provided and maintained a calm. quiet environment . P.Sleep pattern disturbance related to treatment modalities and environmental changes.After 4-6 hours of rendering appropriate nursing interventions. I. Explained necessity of disturbances for therapeutic monitoring.4 ˚C R–36 cpm P–65 bpm BP–130/60 mmHg A. conscious and coherent – – – – – – – With D5W 250cc @ KVO infusing well at Left arm With O2 @ 2L/min via nasal prong restless and irritability noted perspiration noted frequent yawning noted teary eye noted with the following vital signs: T–36.received patient lying in bed awake.
4 ˚C R–36 cpm P–65 bpm BP–130/60 mmHg A. conscious and coherent. emptiness) avoidance noted with the following vital signs: T–36. I – Encouraged client verbalization of feelings about the situation. the patient will be able to display appropriate range of feelings and lessened fear. Development Self-Care Requisite S – “ Nahadlok ko kai basin nya mu grabi ko” as verbalized O – received patient sitting on chair.Patient understood the reasons of sleep disturbances for therapeutic monitoring.Fear related to unfamiliarity with environmental experience.97 – Promoted client safety and comfort E. awake..g. . P – After 4-6 hours of rendering appropriate nursing intervention. – Utilized therapeutic communication skill of active listening. – – – – – – With D5W 250cc @ KVO infusing well at Left arm With O2 @ 2L/min via nasal prong sadness noted expressed negative feelings (e.
E – Patient responded to treatment and verbalized understanding of his condition. – – – – – With D5W 250cc @ KVO infusing well at Left arm With O2 @ 2L/min via nasal prong weakness noted restlessness noted breathlessness noted . Provided patient with comfort and safety measures.“mag sakit man akong dughan “As verbalized by the patient.Received patient lying in bed awake. – Discussed with the patient healthy ways of dealing with different situation. Provided opportunity for question and answer honestly. conscious and coherent. Health Deviation Self-Care Requisite S. Provided information in verbal and written form. O. Encouraged patient’s involvement in usual activities. relaxation exercise and socialization.98 – – – – – Encourage patient to participate in divertional activity.
99 – – – – grimaced face noted guarding of affected area noted teary eye noted related pain at scale of 8 in a given scale of 0-10. 0-no pain and 10-severe pain – with the following vital signs: T–36. P. Evaluated pain regularly noting characteristics. 0-no pain and 10-severe pain) I.4 ˚C R–36 cpm comfort: P–65 bpm acute pain BP–130/60 mmHg related to increased A- Alteration in cerebrovascular pressure secondary to myocardial infarction. the patient will be verbalize decrease in pain from 8 to 5 (in a given scale of 0-10.Assessed patient’s condition. . Assisted patient in performing self care activities. location & intensity on a 0-10 scale.After 4-6 hours of rendering appropriate nursing interventions. – – – Monitored vital signs frequently. – Positioned patient in bed in semi-fowler’s position.
100 – Demonstrated and encouraged patient to do deep breathing exercises.Activity intolerance related to generalized body weakness 2° myocardial infarction. O – received patient sitting on bed. conscious and coherent – – – – weakness noted slowed movement noted decreased activity observed with the following vital signs: T – 36. – Provided patient a calm environment and adequate rest periods.5 °C R – 42 cpm P – 60 bpm BP– 140/90 mmHg A. as verbalized. P.The patient verbalized lessening of intensity level of pain from 8 as severe to 6 as moderate. E. the patient will be able to verbalize increase activity tolerance. awake. able to sleep and rest well. appeared to be relaxed.After 4-6 hour of rendering appropriate nursing interventions. . Day 2 Universal Self-Requisite S“Kapoy ako lawas dili ko ganahan maglihok-lihok kay magpanglipong ko”.
101 I.Assessed patient’s condition. O – received patient sitting on bed – passivity noted – lack of initiative noted – restlessness noted – facial tension noted – expressions of concern about current and future events – with the following vital signs: . Developmental Self-Care Requisite S – “maayu pakaha ko aning akong sakit?” as verbalized. Encouraged patient to take adequate rest periods. – – – – Encouraged patient to verbalize feelings Assisted patient in performing range-of-motion (ROM) exercises. – Encouraged gradually. Monitored patient’s vital signs. patient to increase exercise or activity level E – Patient seen moving without any assistance and reading a newspaper.
patient will be able to verbalized reduction of anxiety and identified causes and contributing factors. .Monitored vital signs . as verbalized.Expressed hope to client.102 T – 36. .After 3-4 hours of administering appropriate nursing interventions. . . awake.Established therapeutic relationship showing positive regards for client.Provided a positive atmosphere for client to voice out concerns.Anxiety related to fear of death. P. . E – Patient was able to have a sense of control over the current crisis. I.Encouraged change of scenery. conscious & coherent – – nasal flaring noted tachypnea noted . . Health Deviation Self-Care Requisite S – “Kutasan ku dayun basta maglihok-lihok ko”.Encouraged patient to maintain a positive attitude such as the use of guided imagery as a relaxation technique.5 °C R – 42 cpm P – 60 bpm BP– 140/90 mmHg A.Encouraged patient to verbalize and express feelings and perceptions. O – received patient sitting on bed.Encouraged patient to use coping mechanisms to divert attention.
P. as verbalized.After 4-6 hours of rendering appropriate nursing interventions. . the patient will be able to demonstrate appropriate coping behaviors and a decreased in RR from 42 to 30 or at its normal range (16-20 cpm). I – Assessed patient’s condition – – – Assisted patient in sitting up in a chair.103 – – – using of accessory muscles when breathing noted with Oxygen @ 2L/min via nasal prong with the following vital signs: T – 36. Encouraged patient to assume a comfortable position Demonstrated and encouraged client to follow pursed-lip breathing technique – – – Provided and maintained a calm environment for the client Encouraged patient to take adequate rest periods Encouraged deep breathing exercise E – “ni arang-arang na akong paminaw”. Patient’s RR decreased from 42-35 cpm. as appropriate.Ineffective breathing pattern related to fatigue as evidenced by verbalization of feelings of breathlessness 2° to Myocardial Infarction.5 °C R – 42 cpm P – 60 bpm BP– 140/90 mmHg A.
– Encouraged to do whatever possible and increase activity level as tolerated. P – After 3-4 hours of rendering nursing interventions.104 Day 3 Universal Self-Care Requisite S – “Kapoy paman akong lawas”. as verbalized O – received patient sitting on chair..g. awake. .5 °C R – 42 cpm P – 60 bpm BP– 140/90 mmHg A – Fatigue to confinement and health condition. conscious & coherent – – – – weakness noted decreased mobility disinterest in surroundings noted with the following vital signs: T – 36. the patient will be able to improve sense of energy as evidenced by ability to perform ADL at his acceptable level. I – Assessed personal factors that may affect reports of fatigue level – Instructed client methods on how to conserve energy (e. sitting instead of standing during activities) – Provided patient with comfort measures – Encouraged patient to take adequate rest periods – Planned care to allow individually adequate rest periods.
awake. Developmental Self-Care Requisite S – “ wala nai mu tabang naku.105 – Assisted in self-care needs and assisted in ambulation as needed. the patient will be able to I – Encouraged client verbalization of feelings about the situation. – Provided divertional activities such as socializing with significant others. emptiness) avoidance noted with the following vital signs: T – 36. – – – – sadness noted expressed negative feelings (e.g. . – – Utilized therapeutic communication skill of active listening.Ineffective Family Coping: risk for compromised related to prolonged disease/disability progression that exhausts the supportive capacity of family members P – After 4-6 hours of rendering appropriate nursing intervention.5 °C R – 42 cpm P – 60 bpm BP– 140/90 mmHg A. conscious and coherent.. E – Patient showed an improved sense of energy as evidenced by ability to perform ADL’s within his own limitations. Encouraged patient to participate in diversional activity. biyaan nya ku nila” as verbalized O – received patient sitting on chair.
– – Discussed underlying reasons for patient behaviors with family. O – received sitting on bed awake. problem solving and care of patient as feasible. conscious and coherent – – verbalized reports of headaches and dizziness clammy skin noted . Assisted family/patient to understand “who owns the problem” and who is responsible for resolution. Identify other ways of demonstrating support while maintaining patient’s independence E –Patient and significant others had Involvement in the care and enhanced feelings of control and self worth. Health Deviation Self-Care Requisite S – “Nalipong-lipong ko”. – Discussed with the clients healthy ways of dealing with different situation. relaxation exercise and socialization. Avoid balance blame or guilt.106 – – Provided patient with comfort and safety measures. – Involve family in information giving. as verbalized by the patient. Encouraged patient’s involvement in usual activities.
weakness noted with the following vital signs: T – 36.5 °C R – 42 cpm P – 60 bpm BP– 140/90 mmHg
A – Risk for decreased cardiac output related to increased after load 2 ° to myocardial infarction. P – After 3-4 hours of rendering appropriate nursing interventions patient will be able to demonstrate ways to control blood pressure. I – Assisted patient in doing simple exercises like walking. – Instructed patient to eat diet that is low in both salt and fat like fruits, fish, vegetables. – Encouraged patient to be involved in diversional activities like reading magazines/newspaper to prevent stress. – Instructed patient to be involved in some complementary modalities like massage. – Provided calm, restful surroundings, minimize environmental activity/noise. Limit the number of visitors and length of stay. – Maintain activity restrictions, e.g. bedrest/chair rest; schedule periods of uninterrupted rest; assist client with self-care activities as needed.
Provided comfort measures, e.g. back and neck massage, elevation of head.
Instructed in relaxation techniques, guided imagery, distractions
E – Patient was able to demonstrate ways to control blood pressure like eating the proper foods with law salt and law fat. Day 4 Universal Self-Care Requisite S – “Kapoy man ilakaw-lakaw”, as verbalized O – received patient sitting on chair – – – – alert, awake, coherent slow movement noted decrease walking speed noted with the following vital signs: T – 38.8˚C R – 35 cpm P – 65 bpm BP – 130/90 mmHg
A – Sedentary lifestyle related to lack of interest accomplishing a physical exercise regimen. P – After 3-4 hours of administering appropriate nursing interventions, patient will be able to verbalize an interest in having an exercise regimen and understand its importance. I – Monitored vital signs
– – –
Discussed with the client the benefits of having exercise Encouraged change in scenery Involved patient and SO in making an exercise plan that fits the client’s needs
Introduced activities to client’s level of functioning such as motivating the client to walk around the neighborhood for 15 minutes
Encouraged patient to have ample time for exercise and rest periods
Discussed the importance of adequate fluid intake during hot weather and with activity
Provided a positive atmosphere for client to voice out concerns Encouraged client to maintain a positive attitude such as use of guided imagery as a relaxation technique
Encouraged SO to provide supervision during exercise
E – Patient was able to verbalize an understanding of the importance of having exercise. Developmental Self-Care Requisite S – “ wala nai mu tabang naku, biyaan nya ku nila” as verbalized
Make opportunities for patient to make simple decisions about care/other activities when possible. awake.g.8˚C mmHg A.Ineffective coping related to situational crisis P – After 4-6 hours of rendering appropriate nursing intervention. conscious and coherent. – Encouraged patient to talk about what is happening at this time and what has occurred to precipitate feelings of helplessness and anxiety. – – – – sadness noted expressed negative feelings (e. accepting choice not to do so. with gradual resumption of independence in ADLs.110 O – received patient sitting on chair. the patient will be able to I – Encouraged client verbalization of feelings about the situation. – Allowed patient to be dependent in the beginning. R – 35 cpm P – 65 bpm BP–130/90 .. emptiness) avoidance noted with the following vital signs: T – 38. Self-care and other activities.
5 ˚C. I.Alteration in thermoregulation: Hyperthermia related to increased metabolic rate 2 ° to Myocardial Infarction.After 4-6 hours of rendering appropriate nursing intervention. P. Reinforce positive adaptation/ new coping behaviors.111 – Promoted safe and hopeful environment.8˚C mmHg A. Identify positive aspects of this experience and assist patient to view it as a learning opportunity. as needed. – Provided for gradual implementation and continuation of necessary behavior and lifestly changes. the patient’s temperature will decrease from 38. E –Patient was ability to cope with current situation and plan for the future.8 ˚C to 37. Health Deviation Self-Care Requisite S – no verbal cues O – received patient lying in bed – – – skin warm to touch flushed skin noted with the following vital signs: T – 38.Assessed the patient’s condition R – 35 cpm P – 65 bpm BP–130/90 .
112 – – – – – Performed tepid sponge bath Monitored vital signs especially temperature Encouraged adequate rest periods Promoted patient’s safety Provided bedside care E – Patient’s temperature has reduced to 37. conscious and coherent – – – – – – restless noted clammy skin noted shortness of breath noted anxiety noted limit fluid to 1L/day as ordered with the following vital signs: . ganahan ko mu inom daghan tubig”.7 ˚C. as verbalized O – received sitting on bed awake. Day 5 Universal Self-Care Requisite S – “ki ohaw gyud ko.
asleep . Discussed the importance of fluid restrictions. P – After 3-4 hours of rendering appropriate nursing interventions patient will be able response to interventions and teaching and actions performed. Developmental Self-Care Requisite S – no verbal cues O – Received patient lying on bed. Promoted early mobilization. – – Restricted sodium intake and fluid intake to 1L/day. Stressed the need mobility and frequent position changes. I – Monitored and recorded input and output. E – Patient understood the importance of restricting fluid intake and complied with the doctors orders. – – – – – Placed on semi-fowlers position as appropriate.5˚C mmHg R – 35 cpm P – 65 bpm BP–130/90 A – Risk for fluid volume excess related to excess in fluid intake. Evaluated for any edematous extremities. Set an appropriate rate of fluid intake throughout 24 hour period.113 T – 36.
114 – – – Passivity noted Lack of initiative noted With the following vital signs: T – 36. P.5˚C R – 35 cpm P – 65 bpm BP–130/90 mmHg A. – Encouraged patient to verbalize and express feelings and perceptions. – – Provided a positive atmosphere for client to voice out concerns. patient will be able to recognize and verbalize feelings of hopelessness. I. Encouraged patient to maintain a positive attitude such as the use of guided imagery as a relaxation technique.Hopelessness related to loss of belief in God. Encouraged attention. – – Expressed hope to client.After 3-4 hours of administering appropriate nursing interventions.Monitored vital signs – – Encouraged change of scenery Established therapeutic relationship showing positive regards for client. patient to use coping mechanisms to divert .
– Provided and maintained a calm environment for the patient.Ineffective breathing pattern related to fatigue as evidenced by verbalization of feelings of breathlessness. awake. as verbalized. P. the patient will be able to demonstrate appropriate coping behaviors.115 E – Patient understood why this crisis happened and had more faith in God. O – received patient sitting on bed. I – Assessed patient’s condition – – – Assisted patient in sitting up in a chair.5˚C R – 35 cpm P – 65 bpm BP–130/90 mmHg A. Encouraged patient to assume a comfortable position Demonstrated and encouraged client to follow pursed-lip breathing technique.After 4-6 hours of rendering appropriate nursing interventions. as appropriate. . conscious & coherent – – – – nasal flaring noted tachypnea noted using of accessory muscles when breathing noted with the following vital signs: T – 36. Health Deviation Self-Care Requisite – “Dali ra ko kutasan basta maglihok-lihok ko”.
sitting instead of standing during activities) – Provided client with comfort measures .5 °C R –27cpm P – 60 bpm BP – 1430/90 mmHg A – Fatigue related to health condition.g. E –Patients RR decreased from 35 to 29 and verbalized minimal relief. I – Assessed personal factors that may affect reports of fatigue level – Instructed client methods on how to conserve energy (e. Day 6 Universal Self-Care Requisite S – “Kapoy paman akong lawas. awake. lay kai dri sa balay”. the patient will be able to improve sense of energy as evidenced by ability to perform ADL at his acceptable level. conscious & coherent – – – – weakness noted decreased mobility slow movement noted with the following vital signs: T – 36. P – After 3-4 hours of rendering nursing interventions..116 – – Encouraged patient to take adequate rest periods. Advised patient to have rest periods during activities. as verbalized O – received patient sitting on chair.
. O – – – – – – – received patient sitting on bed passivity noted lack of initiative noted restlessness noted facial tension noted expressions of concern about current and future events with the following vital signs: T – 36.117 – – Encouraged client to take adequate rest periods Encouraged patient to do diverstional activities such as watching tv.Anxiety related to cheange in health and socioeconomic status 2 ° to Myocardial Infarction. E – Patient showed an improved sense of energy as evidenced by ability to perform ADL’s within his own limitations. socializing with neighbors.5 °C R –27cpm P – 60 bpm BP – 1430/90 mmHg A. Developmental Self-Care Requisite S – “maayu pakaha ko aning akong sakit?” as verbalized. and going outside for fresh air.
– Encouraged patient to verbalize and express feelings and perceptions. Encouraged patient to maintain a positive attitude such as the use of guided imagery as a relaxation technique. Encouraged attention.118 P.After 3-4 hours of administering appropriate nursing interventions. E – Patient verbalized feeling of relief and seen talking with his daughters and eating their snacks.Encouraged patient to express feelings. awake. Health Deviation Self-Care Requisite S – “Unsa man akong buhaton para mu-ubos akong BP?” as verbalized O – received client sitting on chair. patient will be able to verbalized reduction of anxiety and identified causes and contributing factors. – – Provided a positive atmosphere for client to voice out concerns. I. Established therapeutic relationship showing positive regards for patient. – – Expressed hope to client. conscious & coherent patient to use coping mechanisms to divert . – – Encouraged change of scenery.
P – After 3-4 hours of rendering appropriate nursing interventions. Discharge Plan A case of Mr. patient will be able to verbalize understanding of information gained. I – Verified client’s level of knowledge regarding the illness – – Determined any challenge to client’s learning. Filipino. E – Patient volunteered to take a stroll around the neighborhood and market it as his first step in his daily exercise regimen. widower. Encouraged patient to adhere to teachings given. male. Provided patient with health teachings on appropriate lifestyle changes stressing the importance of diet and exercise – – Informed patient of available community sources. Roman Catholic. Inocencio Tantiado Villaner of 735 Bulacao Cebu City.119 – – – expressed an interest in learning more about his illness behavior congruent with expressed knowledge noted with the following vital signs: T – 36. admitted . 79 years old.5 °C R –27cpm P – 60 bpm BP – 1430/90 mmHg A – Readiness for enhanced knowledge related to illness 2° to myocardial infarction.
S – “Maka uli nadaw ko”. as verbalized by the patient O – received patient sitting on bed – – – – – – – Awake. I -Promotes adherence measures by thoroughly explaining the prescribed medication regimen and other treatment measures. 2009 due to mild myocardial infarction. alert. and advise them to watch the sign and .120 for the first time at Sacred Heart Hospital last August 08. patient will be able to verbalized understanding of the therapeutic regimen for illness or disease condition. – Warn the patients together with relatives about adverse reaction to drugs. coherent Without Ivf Able to perform ADLs Seen packing things With doctors order of May Go Home Full billing done With the following vital signs: T – 37 C R – 21 CPM P – 63 BPM BP–130/70 mmHg A – Readiness for enhanced therapeutic regimen P – After 3-4 hours of administering appropriate nursing interventions.
Carefully monitor daily weight. Provide a clear liquid diet until nausea subsides. provide a list of food that he should avoid. – Instructed patient to return to OPD for follow-up check up. – Review dietary restriction with the patient. A low sodium. this is to lessen the burden of the patient and for immediate action as well as to minimize entertaining negative thoughts. intake and output. low fat. vomiting. or low cholesterol diet and caffeine-free may be ordered. tachypnea. – Don’t stress yourself.121 symptoms of toxic (nausea. walk for 15 minutes. – Encourage participation in a cardiac rehabilitation program. anorexia. and prolonged headache. and yellow vision) – Organize patient care and activities to maximize periods of uninterrupted rest. . – Watch for sign and symptoms of fluid retention (crackles. respiration. Enough. serum enzyme level and blood pressure. weakness. Ask dietitian to speak to the patient’s family. too much exercise. – Encouraged patient to verbalize feelings and needs when presence of chest pain. which may indicate impending Heart Failure. and edema). cough.
Patient was seen lying ob bed. E. of Bulacao Cebu City. has steady gait with upright position. male. 2009 due to mild myocardial infarction. Patient is conscious.4 °C Respiratory Rate: 36 cpm Height: 5”7 I. Filipino. is of medium built. admitted for the first time at Sacred Heart Hospital last August 03.122 – Encourages the family to seek out religious activities. T.Patient and significant others verbalized understanding with the health teachings imparted. Body weakness noted. APPENDIX F IPPAO GENERAL SURVEY: A case of Mr. He has limited mobility. With O2 @ 2L/min via nasal prong. 79 years old. He has proper hygiene as evidenced by clean clothes and well trimmed fingernails and toenails. Integumentary a. cooperative and ambulatory with the following vital signs: Temperature: 36. speaks in a low voice. V. Roman Catholic. Skin Inspection ○ Skin is intact with brown complexion Pulse Rate: 65 bpm Blood Pressure: 130/60 mmHg Weight: 220 pounds . conscious and coherent with ongoing D5W 250cc @ KVO infusing well at left arm. I. widower. pertaining to spiritual issues. coherent. A case of Mr.
Skull Inspection . Head and Neck a. Hair and scalp Inspection ○ Hair is black with hints of white at some areas.123 ○ Skin is warm to touch Palpation ○ ○ ○ b. of moderate thickness ○ Hair is evenly distributed Palpation ○ No masses noted II. follows the normal curve of the finger ○ ○ Nails are smooth and pinkish in color No clubbing noted Skin surface is smooth and soft Good skin turgor Skin is warm which suggest normal circulation Palpation ○ ○ Nail beds are firm and non-tender Capillary refill time was within 2-3 seconds c. Nails Inspection ○ Nails are short and convex with an angle of less than 180 degrees.
Face Inspection ○ ○ ○ ○ ○ Skin color is consistent with other parts Patient was able to show different facial expressions Symmetrical when at rest and upon movement Facial hair evenly distributed Absence of edema and involuntary facial movements No masses noted Palpation ○ No masses noted c.124 ○ Patient’s head is normocephalic with a measurement of 22 inches in circumference ○ Gently curved with prominences of the frontal and parietal bones ○ Hair is evenly distributed Palpation ○ b. Eyes and Ears Inspection ○ Eyes are equally round and reactive to light accommodation ○ ○ ○ Patient was able to open and close upper eyelids Pupils are black and equal in size Eyebrows and eyelashes are evenly distributed .
able to distinguish sour.125 ○ Patient was able to read newsprint but with the use of graded glasses ○ ○ Ears are symmetrical and proportionate with head No discharges noted Palpation ○ No edema noted d. sweet and salty substances ○ ○ Lips are slightly dark and moist Gums are pinkish and smooth . Mouth and Pharynx Inspection ○ Patient is able to chew. Nose and Sinuses Inspection ○ ○ ○ Nasal septum is intact Nasal mucosa is moist and red in color No nasal discharges noted Palpation ○ ○ No swelling noted Sinuses are not painful when palpated Olfaction ○ No foul odor noted e.
Tongue is in the middle and can move from right, left, upward and downward
Tonsils are symmetrical and pinkish Mucus membrane are pinkish in color and semi-
moist(almost dry) ○ ○ ○ Uvula is at the center Teeth are incomplete and yellowish Patient has dentures at the upper set of teeth
Palpation ○ ○ No swelling noted No masses noted
Olfaction ○ f. Neck Inspection ○ ○ Symmetrical with range of motion No vein distention visible masses, lesions or swelling No foul odor noted
Palpation ○ ○ Lymph nodes are not palpable No masses noted
III. Thorax and Lungs a. Anterior Inspection
Breathing patterns are irregular Chest symmetrical upon respiration
Percussion ○ ○ Symmetrical percussion sounds noted Areas of dullness noted over the lungs
Auscultation ○ b. Posterior Palpation ○ No masses noted Wheezing breath sounds noted
Percussion ○ Dullness and some flatness noted over the lungs
Auscultation ○ Wheezing breath sounds noted
IV. Cardiovascular and Peripheral a. Heart Inspection of the neck of the pericardium ○ ○ ○ Absence of jugular vein distention & varicosities noted No visible pulsations at the aorta Absence of ulcerations noted
○ Point of maximal impulse is seen at the 4th and 5th
intercostals space at the midclavicular line
No other pulsations noted Pulses have regular rhythm and are equal and bilateral
Auscultation ○ Sound is heard as lub-dub. Lub Is the first heart sound (S1) and dub is the second heart sound (S2) ○ ○ ○ Absence of murmurs or bruits Distinct heart sound Normal heart rate/rhythm
b. Peripheral Vascular System Inspection ○ ○ ○ Warm and dry skin is noted Absence of varicosities noted No edema present
Palpation ○ ○ V. Abdomen Inspection ○ Umbilicus is centrally located; clean without presence of dirt noted ○ Skin is lighter than exposed areas Radial pulse rate of 120 bpm Regular rhythm; weak, equal pulses bilaterally
Breast and Axilla Inspection ○ ○ Presence of fine hair on axillae No discharges noted Palpation ○ No masses noted VII. sige lang ko ug luya” as vernalized Inspection ○ Weakness noted upon standing as evidence by need of assistance in standing and walking ○ Decreased muscle strength on the extremities . lower right quadrant. lower left quadrant and upper left quadrant) Percussion ○ Tympany sound over the stomach (upper left quadrant) and dullness noted in the right upper quadrant and in other areas Palpation ○ Tenderness noted at the right of the epigastrium VI. Musculoskeletal “Wa man ko’y umoy primi. Reproduction ○ No data gathered since the patient does not want to proceed with the physical assessment of this system VIII.129 ○ Hyperactive bowel sound noted every 3 seconds over the 4 abdominal areas in a clockwise manner (upper right quadrant.
dull and soft sensation ○ Facial – expressions are symmetrical – Substances are correctly identified through the sense of taste ○ Vestibulocochlear bilaterally – patient is able to hear clearly ○ Glossopharyngeal – has good gag reflex – Able to identify sweet.130 Palpation ○ Muscle are non-tender IX. Neurologic ○ ○ ○ Olfactory – equal and bilateral sense of smell Optic – good visual acuity Occulomotor. Trochlear and Abducens – Patient uses graded glasses for clear visualization – Complete lid closure and simultaneous opening of eyelids – ○ Coordinated movements of eyeballs/iris Trigeminal – patient correctly identifies sharp. salty and sour substances ○ Vagus – has good swallowing reflex .
131 ○ Spinal accessory – equal bilateral movement and strength of the muscle of the shoulder ○ Hypoglossal – protrusion of the tongue is symmetrical – Enables the cheek to have a puffed-out appearance SUMMARY OF SIGNIFICANT FINDINGS III. Musculoskeletal “Wa man koy umoy pirmi. Anterior Inspection ○ Breathing patterns are irregular V. Thorax and Lungs a. Trochlear and Abducens – patient uses graded eyeglasses for clear visualization ○ Vestibulocochlear – patient is unable to hear clearly bilaterally . sige lang ko ug luya” as verbalized Inspection ○ Weakness noted upon standing as evidence by need of assistance in standing and walking ○ Decreased muscle strength on extremities IX. Neurologic ○ Occulomotor. Cardiovascular and Peripheral Vascular System Auscultation ○ Distinct heart sound VIII.
132 APPENDIX G DAILY TIME RECORD .
133 APPENDIX H DOCUMENTATION .
134 Home Visit .
On the way to the patients house.
With his daughter Lilibeth.
APPENDIX I TIMETABLE
Time Frame/Month April 2009 Activities • • • May 2009 • • June 2009 • • • • July 2009 August 2009 September 2009 • • • • • October 2009 • • • Submission of the proposed title for approval with the Dean Coordination with the Adviser regarding the plans, processes and theories for the study Start of the creation of Chapter 1 and checking with the Adviser Refinements to Chapter 1 and incorporation of changes made by the Adviser Submission of manuscript for the Oral Proposal Hearing Oral Proposal Hearing in the last week of May Incorporations of the corrections made by the panel during Oral Proposal Hearing Submission of the transmittal letters for signing of the Dean Submission of the transmittal letters to the Medical Directors Start of Actual Data Gathering Continue Data Gathering at the specified locale Submission of the raw data to the Statistician for computation Creation of Chapter 2 and 3 and subsequent refinement of the two chapters in coordination with the Adviser Submission of manuscript for the Oral Defense Hearing Incorporation of the corrections made by the panel during Oral Defense Hearing Submission to the Grammarian for proofreading Submission of soft copy as requirement for graduation
APPENDIX J Research Budget
A. Materials Paper/Ink Folders/Ballpens Photocopying B. Services Encoding Grammarian’s Fee Secretary’s Fee C. Miscellaneous D. Oral Defense Fee Total P 300.00 P 1, 500.00 P 500.00 P 2, 500.00 P 4, 200.00 P 13, 000.00 P 2, 500.00 P 500.00 P 1, 000.00
Prepared by: CHERRY JOY H. DATAN, RN Researcher/Student
138 APPENDIX K-1 SAMPLE TOOL GUIDE A. Patient’s profile in terms of: Name Date of birth. weight Race Educational status Mental status Religion Occupation Date of admission Chief complaint Admitting diagnosis Number of years diagnosed with essential hypertension Attending physician Ward Bed number . age Sex Height.
g:CFCAS) Utilization of other aids to facilitate elimination (e. etc.g: vitamins. amount and usual habits (e. religious. improper waste sanitation.g: laxatives.) Health practices .139 A. fluids. cultural. etc.) Usual activity patterns Adherence to a regular exercise regimen Time and duration of patient’s usual sleeping pattern Attitude towards self and others Patient’s lifestyle (e. Universal Patient’s 24 hour diet recall Patient’s food preference Food preparation Food supplement (e. drinking alcohol) Environmental factors (e.g: exposure to smoke-belching factory. Needs of the patient in terms of the following self-care requisites: 1.g. medical) Usual elimination pattern in terms of frequency. minerals) Factors that influence patient’s dietary modifications (e.g: smoking.
g: family. testicular examination. blood glucose testing. Health Deviation Patient’s vital signs Heredo familial diseases present in both sides of the patients family Current laboratory results or diagnostic tests findings . Developmental Educational status Role in the family and community Perception and satisfaction on the said role Problems with relationship to others (e. friends) Patient’s consciousness and awareness of his own health Knowledge on the performance of self-examination (e. blood pressure. pulse and temperature measurements Experienced any of the following for the past 6 months: ✔ Loss of a family member.g: breast examination.140 1. relative or friend ✔ Loss of possession or occupation ✔ Change of residency into an unfamiliar environment ✔ Any hazardous accident or health threat ✔ Any other disease or illness 1.
141 Medications or therapy used Adhere to the prescribed treatment .
142 APPENDIX K-2 SAMPLE TOOL GUIDE (VERNACULAR) A. Universal Gikaon sa paseynte sulod sa milabay nga 24 oras Pagkaon nga gusto kaonon sa pasyente . katas-un Minyu. Mga kinahanglan sa pasyente bahin sa mga kuwang sa paggam sa kaugalingun sama sa: 1. edad Sex Kabug-atun. Mga personal na impromasyon bahin sa pasyente sama sa: Pangalan Adlaw sa katawo. ulitawo o biyudo Relihiyon Trabaho Petsa sa pagka-admit Diagnosis sa pagka-admit Pila na ka tuig adunay hypertension Doctor nga nagkonsulta Ward Bed number A.
minerals) Mga naka-impluwensya sa pagkaon sa pasyente (pagtuo sa relihiyon) Oras sa pagkalibang Paggamit sa mga butang nga makatabang sa iyang paglibang sama sa tambal o pagkaon Kasagarang buhaton sa pasyente sulod sa usa ka adlaw Pag-ehersisyo sa pasyente Oras sa ting katulog sa pasyente ug pila ka oras kasagaran nga matulog Kina-iya sa pasyente ngadto sa iyang kaugalingon ug sa uban pa Mga bisyo sama sa panigarilyo o pag-inom Mga butang sa palibut nga makadaot sa kalawasan (sama sa mga itum nga aso sa tambutso sa sakyanan. nagkalat nga basura) Mga kasagarang buluhaton sa pasyente bahin sa pagatiman sa iyang kaugalingon 1.143 Pamaagi sa pag-preparar sa pagkaon sama sa bitamina. Developmental Iyahang natiwas sa pag-eskwela .
144 Iyang katungod sa pamilya ug sa komunidad Iyang opinion sa nahisgut nga kahitungod Mga problema sa pasyente sa karon mahitungod sa iyang relasyon sa iyang pamilya ug sa iyang mga amigo Paglantaw bahin sa maayong panglawas Pagbuhat sa mga butang sama sa pagkuha ug blood pressure. . magkuha ug blood glucose Mga higayon nga naigahan sa pasyente sa milabay nga 6 ka bulan: ✔ Namatayn ug paryente. o suod nga higala ✔ Nawad-an ug trabaho o importanteng gamit ✔ Pagbilin sa laing lugar ✔ Mga pasakit o laing gipamati sa kalawasan 1. pagamit sa thermometer. Health deviation Bag-ong vital signs sa pasyente Kaliwat nga mga sakit nga naa sa iyang pamilya Resulta sa iyang mga laboratory Laing gipaminaw nga sakit Gi-mintinar nga tambal sa nahisgutang sakit Pagsunod sa sakto nga pag-inum sa iyang tambal.
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