St.

Paul College of Ilocos Sur

(Member, St. Paul University System)
St. Paul Avenue 2727, Bantay, Ilocos Sur

DEPARTMENT OF NURSING

NCM 112: Care of the Clients with Problems in Oxygenetation, Fluid and Electrolyes, Infectious,
Inflammatory and Immunologic Response, Cellular Abberations Acute and Chronic
( RLE)

First Semester A.Y. 2021-2022

Melanio P. Rojas Jr. MAN

Kathleen R. Parel, MAN
(Clinical Instructors)

Name: Aldrin Joaquin Savellano Score: ___________________

Course/Year: BSN-III Date: 01-20-2022

November 22, 2020

10: 00 A.M.
Please admit Ivana Alawi, Jehova’s witness, 18 years old, her room of choice. She experienced
difficulty of breathing, barrel chest, cyanosis, and can relieve on upright position leaning
forward. Attached with the ABG laboratory results: pH- 7.3, PCO₂-50 and HCO₃- 29. Vital signs-
Temperature- 38.8 degree celcius, BP- 120/70, RR-12 and PR- 60.
Admit to the male ward
Secure consent and record
TPR q sheet and record
DAT- high carbohydrates and high protein
Diagnostic: CBC, ECG, Chest X-ray PA
Treatment:
Plain LRS 1 L x 16 hours
D5LRS 1 Liter x 20 gtts per minute
Plain NSS 1 liter 40 gtts per minute
Sulbactam Ampicillin 1.5 grams IV q 12 hours
Azithromycin 500 mg 1 tablet BID
Fluimucil 600 mg 1 tablet TID
Salbutamol + Ipratropium 5 hours x 2 doses then 6 hours
Paracetamol 500 mg 1 tablet q 4 hours PRN
Celexocib 200 mg 1 capsule OD PRN for chest pain
Dexamethasone 4 mg IV now
Salmeterol + fluticasone 250/25 mcg 2 puff TID
Hydrocortisone 100 mg IV q 8 hours
Clonidine 75 mcg buccal q 4 hours PRN
Dipenhydramine 50 mg IV now then every 12 hours
Aminophylline 25 mg slow IV now then OD
Omeprazole 40 mg IV now then OD
Digoxin 0.5 mg IV now
Eperisone 2 tabletsBID
Refer accordingly
O2 inhalation 2-3 LMP
Guided Questions:
1. What is the medical diagnosis?
- Ms. Ivana Alawi experienced difficulty of breathing, barrel chest, cyanosis and
hyperthermia. ABG result shows elevated PaCO2 and elevated HCO3. After complete
examination, the primary care provider concluded that Ms. Alawi has chronic obstructive
pulmonary disease (COPD).
2. What is the ABG result?
- ABG result : Ph: 7.3, PCO2: 50mmHG, HC02: 29mmHG
- pH is in the normal range, so use 7.40 as a cutoff point, in which case it is <7.40,
acidosis is present.
- The PaCO2 is elevated, indicating respiratory acidosis, and the HCO3 is elevated,
indicating a metabolic alkalosis.
- The value consistent with the pH is the PaCO2. Therefore, this is a primary respiratory
acidosis.  The acid-base that is inconsistent with the pH is the HCO3, as it is elevated,
indicating a metabolic alkalosis, so there is compensation signifying a non-acute primary
disorder because it takes days for metabolic compensation to be effective.   
3. Please create a Kardex a tool during nursing endorsement.

KARDEX
Name: Ivana Alawi CC: Difficulty of breathing Attending Physician: Dr. Rojas Date Admission: November 22, 2020

Address: Female/18 years old Room: MALE WARD Category: ID

Intravenous fluids: Laboratory

PLAIN LRS 1 liter x 16 hours CBC

D5LRD 1 liter x 20 gtts per minute ECG

Plain NSS 1 liter x 40 gtts per minute Chest X-ray PA

Medications: Treatment

Sulbactam Ampicillin 1.5 grams IV q 12 hours Plain LRS 1 L x 16 hours

Azithromycin 500 mg 1 tablet BID D5LRS 1 Liter x 20 gtts per minute
Fluimucil 600 mg 1 tablet TID Plain NSS 1 liter 40 gtts per minute
Salbutamol + Ipratropium 5 hours x 2 doses then 6 hours Sulbactam Ampicillin 1.5 grams IV q 12 hours

Paracetamol 500 mg 1 tablet q 4 hours PRN Azithromycin 500 mg 1 tablet BID

Celexocib 200 mg 1 capsule OD PRN for chest pain Fluimucil 600 mg 1 tablet TID

Dexamethasone 4 mg IV now Salbutamol + Ipratropium 5 hours x 2 doses then 6 hours

Salmeterol + fluticasone 250/25 mcg 2 puff TID Paracetamol 500 mg 1 tablet q 4 hours PRN

Hydrocortisone 100 mg IV q 8 hours


Clonidine 75 mcg buccal q 4 hours PRN
Dipenhydramine 50 mg IV now then every 12 hours
Aminophylline 25 mg slow IV now then OD
Omeprazole 40 mg IV now then OD
Digoxin 0.5 mg IV now
Eperisone 2 tabletsBID
Celexocib 200 mg 1 capsule OD PRN for chest pain
Dexamethasone 4 mg IV now
Salmeterol + fluticasone 250/25 mcg 2 puff TID
Hydrocortisone 100 mg IV q 8 hours
Clonidine 75 mcg buccal q 4 hours PRN
Dipenhydramine 50 mg IV now then every 12 hours
Aminophylline 25 mg slow IV now then OD
Omeprazole 40 mg IV now then OD
Digoxin 0.5 mg IV now
Eperisone 2 tabletsBID
Refer accordingly
O2 inhalation 2-3 LMP
4. Please create an IV fluid card from Time Started up to Time Ended

Date: 11/22/20
Patient’s Name: Ivana Alawi
Solution: Plain LRS 1L gtts/min:
Time started:10:00am Time ended: 2:00am
Hospital: Ilocos Sur Provincial Hospital- Gabriela Silang

Date: 11/22/20
Patient’s Name: Ivana Alawi
Solution: D5LRS 1L gtts/min: 20gtts/min
Time started:10:00am Time ended: 2:00am
Hospital: Ilocos Sur Provincial Hospital- Gabriela Silang

Date: 11/22/20
Patient’s Name: Ivana Alawi
Solution: Plain NSS 1L gtts/min: 40gtts/min
Time started:10:00am Time ended: 2:00am
Hospital: Ilocos Sur Provincial Hospital- Gabriela Silang
5. Make a medication cards (complete label) starting time is 7:00 A.M. It must be color coded
according to frequency.
- (PDF File)
6. Make a drug study. Please follow the format given

DRUG STUDY
Name of Drugs Classification Mechanism of Indication Contraindication Nursing
Action Responsibilities
Generic Name: Broad-spectrum Interferes with Bactericidal Hypersensitivity Assessment
antiinfective cell wall replica against to ampicillin, or • Assess patient for
ampicillin/sulbactam -tion of Staphylococcus sulbactam previous sensitivity
susceptible aureus, reaction to
Brand Name: organisms; the Klebsiella, Bac- penicillins or
Unasyn cell wall, teroides fragilis, cephalosporins;
rendered Enterobacter, cross-sensitivity
osmotically Acinetobacter between penicillins
unstable, swells calcoaceticus, and cephalosporins
and bursts from Pneumococcus, is common
osmotic Enterococ-cus, • Assess patient for
pressure; lysis Streptococcus, signs and symptoms
due to cell wall Escherichia coli, of infection,
autolytic Proteus including
enzymes; this mirabilis, characteristics of
combination Neisseria wounds, sputum,
extends the meningitidis, urine, stool,
spectrum of Neisseria WBC .10,000/mm3,
activity and gonorrhoeae, earache, fever;
inhibits b- Shigella, obtain baseline
lactamase that Salmonella, and information and
may inactivate Hae-mophilus during treatment;
ampicillin influenzae complete C&S
organisms; use before beginning
only with b- product therapy to
lactamase– identify if correct
producing strain treatment has been
of infection initiated
• Assess for allergic
reactions: rash,
urticaria, pruritus,
chills, fever, joint
pain; angioedema
may occur a few
days after therapy
begins; epinephrine
and resuscitation
equipment should
be on unit for
anaphylactic
reaction
Identify urine
output; if
decreasing, notify
prescriber (may
indicate
nephrotoxicity)
• Assess renal
studies: urinalysis,
protein, BUN,
creatinine
• Monitor blood
studies: AST, ALT,
CBC, Hct, bilirubin,
LDH, alkaline
phosphatase,
Coombs’ test
monthly if patient is
on long-term
therapy
• Monitor
electrolytes:
potassium, sodium,
chloride monthly if
patient is on long-
term therapy
• Assess bowel
pattern daily; if
severe diarrhea
occurs, product
should be
discontinued; may
indicate
pseudomembranous
colitis
• Monitor for
bleeding:
ecchymosis,
bleeding gums,
hematuria, stool
guaiac daily if on
long-term therapy
• Assess for
superinfection:
perineal itching,
fever, malaise,
redness, pain,
swelling, drainage,
rash, diarrhea,
change in cough,
sputum

Patient/family
education
• Teach patient to
report sore throat,
bruising, bleeding,
joint pain, persistent
diarrhea; may
indicate blood
dyscrasias (rare) or
superinfection
• Advise patient to
contact prescriber if
vaginal itching,
loose foul-smelling
stools, furry tongue
occur; may indicate
superinfection
• Instruct patient to
use another form of
contraception other
than oral
contraceptives
Instruct patient to
report immediately
pseudomembranous
colitis: fever,
diarrhea with pus,
blood, or mucus;
may occur up to 4
wk after treatment
• Instruct patient to
wear or carry
emergency ID if
allergic to penicillin
products.
Name of Drugs Classification Mechanism of Indication Contraindication Nursing
Action Responsibilities
Generic Name: Antiinfective Binds to 50S Mild to moderate infections of Hypersensitivity Assessment
ribosomal the to azithromycin, QT prolongation,
Azithromycin subunits upper respiratory tract, in erythromycin, or torsades de
of susceptible children: acute otitis media, any macrolide, pointes: assess for
Brand Name: bacteria and lower respiratory tract; hepatitis, patients with
suppresses uncomplicated skin and skin jaundice serious bradycar-
protein structure infections, nongono- dia, ongoing pro-
Zithromax, Zmax
synthesis; much coccal urethritis, or cervicitis; arrhythmic
greater prophylaxis of disseminated conditions, or
spectrum of Mycobacterium avium complex elderly; more
activity than (MAC); Bacillus anthracis, common in these
erythromycin; Bacteroides bivius, Bordetella patients
more effective • Assess for signs
pertussis, Borrelia burgdorferi,
and symptoms of
against gram- Campylobacter jejuni, CDC
infection:
negative coryneform group G, Chlamydia drainage, fever,
organisms trachomatis, Chlamydophila increased
pneumoniae, Clostridium WBC
perfringens, Gardnerella .10,000/mm3,
vaginalis, Haemophilus ducreyi/ urine culture
influenzae (beta-lactamase positive, sore
negative/positive), Helicobacter throat, sputum
pylori, Klebsiella granulomatis, culture positive
Legionella • Monitor
pneumoniae/moraxella/catarrha- respiratory status:
lis, Mycobacterium rate, character,
avium/intracellulare, wheezing,
Mycoplasma tightness in chest;
genitalium/hominis/pneumoni- discontinue prod-
ae, Neisseria gonorrhoeae, uct if these occur
• Monitor allergies
Peptostreptococ-cus, Prevotella
before treatment,
bivia, Rickettsia tsutsuga-mushi,
Salmonella typhi, Staphylococcus reaction of each
aureus (MSSA)/epidermidis, medication; place
Streptococcus, Toxoplasma allergies on chart,
gondii, Treponema pallidum, notify all people
Ureaplasma urealyticum, Vibrio giving products;
cholerae, viridans streptococci skin eruptions,
itching
• Monitor I&O ratio,
renal studies; report
hematuria, oliguria
in renal disease;
check urinalysis,
protein, blood
• Monitor liver
studies: AST, ALT,
bilirubin, LDH,
alkaline
phosphatase; CBC
with diff
• Monitor C&S
before product
therapy; product
may be taken as
soon as culture is
taken; C&S may be
repeated after
treatment
• Assess for serious
skin reactions:
Stevens-Johnson
syndrome, toxic
epidermal
necrolysis,
angioedema,
discontinue if rash
occurs
• Assess for
pseudomembranous
colitis: blood or pus
in diarrhea stool,
abdominal pain,
fever, fatigue,
anorexia; obtain
CBC, serum albumin
• Assess for
superinfection: sore
throat, mouth,
tongue; fever,
fatigue, diarrhea,
anogenital pruritus

Patient/family
education
• Instruct patient to
report sore throat,
black furry tongue,
fever, loose foul-
smelling stool,
vaginal itching,
discharge, fatigue;
may indicate
superinfection
• Caution patient
not to take
aluminum/magne-
sium-containing
antacids or food
simultaneously with
this product; blood
levels of
azithromycin will be
decreased
• Instruct patient to
notify prescriber of
diarrhea stools, dark
urine, pale stools,
yellow discoloration
of eyes or skin,
severe abdominal
pain; cholestatic
jaundice is a severe
adverse reaction
• Teach patient to
take Zmax 1 hr prior
to or 2 hr after a
meal; shake well
before use
• Teach patient to
complete dosage
regimen; to notify
prescriber if
symptoms continue
• Teach patient to
use protective
clothing or stay out
of the sun:
photosensitivity
may occur
• Teach patient to
notify prescriber if
pregnancy is
suspected
Name of Drugs Classification Mechanism of Indication Contraindication Nursing
Action Responsibilities
Generic Name: Mucolytic; Decreases Acetaminophe Hypersensitivity,
Acetylcysteine antidote - viscosity of n toxicity, increased Mucolytic use
acetaminophen secretions bronchitis, intracranial • Assess cough:
Brand Name: in respiratory cystic fibrosis, pressure, status type, frequency,
Fluimucil tract by breaking COPD, asthmaticus character,
disulfide links of atelectasis including sputum
mucoproteins;
serves as a • Assess
substrate of glu- characteristics,
tathione, which rate, rhythm of
is necessary to respirations,
inactivate toxic increased
metabolites in dyspnea,
acetaminophen sputum;
overdose discontinue if
bronchospasm
occurs; ABGs for
increased CO2
retention in
asthma patients

• Monitor VS,
cardiac status
including
checking for
dysrhythmias,
increased rate,
palpitations

Antidotal use
• Assess liver
function tests,
acetaminophen
levels, PT,
glucose,
electrolytes,
BUN,
creatinine;
inform
prescriber if
dose is vomited
or vomiting
is persistent;
provide
adequate
hydration;
decrease
dosage in
hepatic
encephalopathy

• Assess for
nausea,
vomiting, rash;
notify prescriber
if these occur
Name of Drugs Classification Mechanism of Indication Contraindication Nursing
Action Responsibilities
Generic Name: Bronchodilators Binds to beta2- Used as a Hypersensitivity  Assess lung
Albuterol adrenergic bronchodilator to to adrenergic sounds,
Brand Name: receptors in control and amines. pulse, and BP
Accuneb airway smooth prevent reversible before
Salbutamol muscle, leading airway administratio
to activation of obstruction nand during
adenyl cyclase caused by asthma peak of
and increased or medication.
levels of cyclic- COPD. Note amount,
3_, 5_- color, and
adenosine Inhaln: Used as a character of
monophosphate quick-relief agent sputum
(cAMP). for acute produced.
Increases in bronchospasm
cAMP activate and for  Monitor
kinases, prevention of pulmonary
which inhibit the exercise-induced function tests
phosphorylation bronchospasm. before
of myosin and initiating
decrease PO: Used as a therapy and
intracellular long-term control periodically
calcium. agent during
Decreased in patients with therapy.
intracellular chronic/persistent
calcium relaxes bronchospasm.  Observe for
smooth muscle paradoxical
airways. bronchospas
Relaxation of m
airway smooth (wheezing). If
muscle with condition
subsequent occurs,
bronchodilation. withhold
Relatively medication
selective for and notify
beta2 health care
(pulmonary) professional
receptors. immediately.

 Lab Test
Consideratio
ns: May
cause
transientpin
serum
potassium
concentratio
ns with
nebulization
or higher-
than-
recommende
d doses.
Name of Drugs Classification Mechanism of Indication Contraindication Nursing
Action Responsibilities
Generic Name: Analgesic(nonopioid) Antipyretic: Temporary   Do not exceed
Antipyretic Reduces fever reduction of Contraindicated the
Paracetamol by fever, with allergy to recommended
acting directly temporary acetaminophen. dosage.
Brand Name: on relief of  Use cautiously  Reduce dosage
the minor aches with impaired with hepatic
Tylenol hypothalamic and pains hepatic function, impairment.
heat-regulating caused by chronic  Avoid using
center to cause common alcoholism, multiple
vasodilation and cold and pregnancy, preparations
sweating, which influenza, lactation containing
helps dissipate headache, acetaminophen.
heat. sore throat, Carefully check
toothache, all OTC
backache, products.
menstrual  Give drug with
cramps, etc food if GI upset
occurs.
 Discontinue
drug
if
hypersensitivity
reactions occur.
 Treatment of
overdose:
Monitor serum
levels regularly,
 N-acetylcysteine
should be
available as a
specific
antidote;
basic life
support
measures may
be
necessary.

Name of Drugs Classification Mechanism of Indication Contraindication Nursing

Action Responsibilities
Generic Name: Antirheumatic Exhibits Adjunctive ● Hypersensiti Before:
Celecoxib antiinflammatory, treatment to vity to drug, - Assess pt’s
analgesic, decrease sulfonamide history of
Brand Name: and antipyretic the number s, allergic
Celebrex action due to of or other reaction to the
inhibition adenomatous NSAIDs drug
of the enzyme colorectal ● Severe - Monitor
COX-2 polyps in hepatic complete
familial impairment blood count,
adenomatous ● History of electrolyte
polyposis asthma or levels, creatinine
urticaria clearance, and
● Advanced occult fecal
renal blood test
disease and liver
● Late function
pregnancy test results
● every 6
Breastfeedin to 12 months
g During:
- Instruct patient
to
take drug with
food or milk.
- Teach patient
to
avoid aspirin
and
other NSAIDs
(such as
ibuprofen and
naproxen)
during
therapy.

After:
- Advise patient
to
immediately
report
bloody stools,
blood in
vomit, or
signs or
symptoms of
liver damage
(nausea, fatigue,
lethargy,
pruritus,
yellowing
of eyes or skin,
tenderness on
upper right side
of
abdomen, or
flulike
symptoms).
 Name of Drugs Classification Mechanism of Action Indication Contraindication Nursing
Responsibilities
Generic Name: Corticosteroid, Decreases Inflammation, Psychosis,  Monitor K,
Dexamethasone synthetic inflammation by allergies, neoplasms, hypersensitivity to blood, urine
suppressing migration cerebral edema, corticosteroids, glucose while
on long-term
Brand Name: of septic shock, collagen sulfites, or benzyl therapy;
Baycadvor, Decadron, polymorphonuclear disorders, alcohol, idiopathic hypokalemia
Dexasonea, Dex Pak leukocytes, dexamethasone thrombocytopenia, and
fibroblasts, reversing suppression test for acute hyperglyce-
increased capillary Cushing syndrome, glomerulonephritis, mia
permeability and adrenocortical amebiasis, fungal
 Monitor
lysosomal stabiliza- insufficiency, TB, infections,
weight daily;
tion, suppresses meningitis, acute nonasthmatic notify
normal immune exacerbations of MS bronchial disease, prescriber of
response, no child ,2 yr, AIDS, TB, weekly
mineralocorticoid glaucoma, ocular gain .5 lb
effects. infection.
 Monitor B/P,
pulse; notify
prescriber of
chest pain
 Monitor I&O
ratio; be alert
for
decreasing
urinary
output,
increasing
edema

 Monitor
plasma
cortisol levels
during long-
term therapy
(normal: 138-
635 nmol/L
when
assessed at 8
am),
prolonged
use can
cause
cushingoid
symptoms
(buffalo
hump, moon
face,
increased
B/P)

 Assess
infection:
fever, WBC
even after
withdrawal of
medication;
product
masks
infection
 Assess
potassium
depletion:
paresthesias,
fatigue,
nausea,
vomiting,
depression,
polyuria,
dysrhythmias,
weakness

 Assess
edema,
hypertension,
cardiac symp-
toms

 Assess mental
status: affect,
mood,
behavioral
changes,
aggression

 Advise that
emergency ID
as
corticosteroid
user should
be carried or
worn

 Teach to
notify
prescriber if
therapeutic
response
 decreases;
dosage
adjustment
may be
needed

 Teach not to
discontinue
abruptly or
adrenal
crisis can
result

 Teach to
avoid OTC
products:
salicylates,
alcohol in
cough
products, cold
preparations
unless
directed by
prescriber

 Instruct
patient to
contact
prescriber if
surgery,
trauma,
stress occurs,
dosage may
need to be
adjusted
Name of Drugs Classification Mechanism of Indication Contraindication Nursing
Action Responsibilities
Generic Name: Adrenergics Selectively Maintenance Contraindicated to Assessment and
activates beta 2 treatment for patients with Drug Effects:
Salmeterol adrenergic COPD including hypersensitivity to Assess patient’s
senafoate and receptors, which chronic drug or any of its respiratory
Fluticasone results in bronchitis and components. condition before
bronchodilation emphysema. starting therapy.
Brand Name: and blocks the Caution to
Seretide release of patients who are Assess peak flow
allergic unusually readings before
mediators from responsive to starting therapy
the mast cells in sympathomimetics and periodically
the respiratory and patients with thereafter.
tract. coronary artery
insufficiency. Be alert for
adverse
reactions and
drug reactions

Don’t give drug

for acute
bronchospasm.

Tell patient to
 take the drug at
about 12-hour
intervals even if
he is feeling
better.

Name of Drugs Classification Mechanism of Action Indication Contraindication Nursing

Responsibilities
Generic Name: Hormone Enters target cells -Replacement Systemic fungal Before:
Hydrocortisone and binds to therapy in infections and known - You should not
cytoplasmic receptor; adrenal hypersensitivity to the use this
Brand Name: initiates many cortical drug or any component medication if
Hydrocortone complex reactions insufficiency of formulation. you are allergic
that are responsible - Allergic states Administration of live to
for its – or live,attenuated hydrocortisone,
antiinflammatory, severe or vaccinesis or if you have a
immunosuppressive incapacitating contraindicated fungal infection
(glucocorticoid), and allergic in patients anywhere in
salt-retaining conditions receiving your body.
(mineralocorticoid) - Hematologic immunosuppressive - tell your
actions. Some disorders doses of corticosteroid doctor about all
actions may be - Ulcerative of your medical
undesirable, colitis conditions, and
depending on drug about all other
use. medicines you
are using.
- Do not give
live vaccines
with
immunosuppres
sive doses of
hydrocortisone.
During:
- Do not give
IM injections if
patient has
thrombocytop
enic purpura.
- Taper doses
when
discontinuing
high-dose or
long-term
therapy.
After:
- Monitor client
for at least 30
minutes.
- Educate client
on the side
effects of the
medication and
what to expect.
- Instruct client
to report pain at
injection site.

- Instruct client
to take drug
exactly as
prescribed.
-Carry an ID
card or wear a
medical alert
bracelet stating
that you are
taking a steroid
Name of Drugs Classification Mechanism of Indication Contraindication Nursing
Action Responsibilities
Generic Name: Antihypertensive Stimulates It is indicated in Hypersensitivity.
clonidine alpha-adrenergic the treatment of Disorders of 1. Monitor BP
receptors in the hypertension. cardiac carefully when
Brand Name: CNS; which pacemaker discontinuing
Catapres results in activity and clonidine;
decreased conduction. hypertension
sympathetic Pregnancy and usually returns
outflow lactation. within 48 hr
inhibiting 2. Advise patient
cardio to take drug
acceleration and exactly as
vasoconstriction prescribed and
centers not to stop
abruptly
because
withdrawal
symptoms and
severe
hypertension
may occur.
3. Instruct
patient to
consult
prescriber if dry
mouth or
drowsiness
becomes a
problem.
4. During oral
clonidine
therapy. To
minimize these
effects,
prescriber may
suggest taking
most of dosage
at bedtime.
5. Instruct
patient to report
chest pain,
dizziness with
position
changes,
excessive
drowsiness,
rash, urine
retention, and
vision changes.
As needed, tell
patient to rise
slowly to avoid
hypotensive
effects.
Name of Drugs Classification Mechanism of Indication Contraindication Nursing
Action Responsibilities
Generic Name: Antihistamine Acts on blood Allergy Hypersensitivity • Assess
Dipenhydramine (1st generation, vessels, GI, symptoms, to H1-receptor respiratory
Brand Name: nonselective), respiratory rhinitis, motion antagonist, status: rate,
Altaryl, antitussive system by sickness, acute asthma rhythm, in-
Banophen, competing with antiparkinsonism, attack, lower crease in
Benadryl, histamine for nighttime respiratory tract bronchial
Benadryl Allergy, H1-receptor site; sedation, infant disease, secretions,
wheezing,
Benadryl Allergy decreases colic, neonates
chest
Dye Free, allergic response nonproductive
tightness;
Benadryl by blocking cough, insomnia provide fluids
Children’s histamine in children to 2 L/day to
Allergy decrease
secretion
thickness

• Monitor I&O
ratio: be alert
for urinary
retention,
frequency,
dysuria,
especially
geriatric;
product should
be
discontinued if
these occur

• Monitor CBC
during long-
term therapy;
blood
dyscrasias may
occur but are
rare

• If giving for
dystonic
reactions,
assess type of
involuntary
movements
and evaluate
response to
this medication

• Assess cough
characteristics
including type,
frequency,
thickness of
secretions;
evaluate
response to
this medication
if using for
cough

• Product should
be discontinued
 4 days prior to
skin allergy tests

Name of Drugs Classification Mechanism of Indication Contraindication Nursing

Action Responsibilities
Generic Name: Bronchodilator Relaxes • Symptomatic Contraindicate Assessment
bronchial relief or d with • History:
aminophylline smooth prevention of hypersensitivit Hypersensitivity
muscle, bronchial y to any to any xanthine
Brand Name: causing asthma and xanthine or to or to
bronchodilatio reversible ethylenediami ethylenediamine
Truphylline n and bronchospas ne, peptic , peptic ulcer,
increasing vital m associated ulcer, active active gastritis,
capacity, with chronic gastritis; rectal cardiac
which has bronchitis or colonic arrhythmias,
been impaired and irritation or acute
by emphysema infection (use myocardial
bronchospasm • Unlabeled rectal injury, CHF, cor
and air uses: preparations). pulmonale,
trapping; in Respiratory • Use cautiously severe
higher stimulant in with cardiac hypertension,
concentrations Cheyne- arrhythmias, severe
, it also inhibits Stokes acute hypoxemia,
the release of respiration; myocardial renal or hepatic
slow-reacting treatment of injury, CHF, disease,
substance of apnea and cor pulmonale, hyperthyroidism
anaphylaxis bradycardia severe , alcoholism,
(SRS-A) and in premature hypertension, labor, lactation,
histamine. babies severe rectal or colonic
hypoxemia, irritation or
renal or infection
hepatic (aminophylline
disease, rectal
hyperthyroidis preparations)
m, alcoholism, • Physical: Bowel
labor, sounds, normal
lactation, output; P,
pregnancy. auscultation,
BP, perfusion,
ECG; R,
adventitious
sounds;
frequency of
urination,
voiding, normal
output pattern,
urinalysis, LFTs,
renal function
tests; liver
palpation;
thyroid function
tests; skin color,
texture, lesions;
reflexes,
bilateral grip
strength, affect,
EEG
Interventions
• Administer to
pregnant
patients only
when clearly
needed—
neonatal
tachycardia,
jitteriness, and
withdrawal
apnea observed
when mothers
received
xanthines up
until delivery.
• Caution patient
not to chew or
crush
entericcoated
timedrelease
forms.
• Give
immediaterelease,
liquid
dosage forms
with food if GI
effects occur.
• Do not give
timed-release
forms with food;
these should be
given on an empty
stomach
1 hr before or 2
hr after meals.
• Maintain
adequate
hydration.
• Monitor results
of serum
theophylline
levels carefully,
and arrange for
reduced dosage
if serum levels
exceed
therapeutic
range of 10–20
mcg/mL.
• Take serum
samples to
determine peak
theophylline
concentration
drawn 15–30
min after an IV
loading dose.
• Monitor for
clinical signs of
adverse effects,
particularly if
serum
theophylline
levels are not
available.
• Ensure that
diazepam is
readily available
to treat
seizures.
Teaching points
• Take this drug
exactly as
prescribed; if a
timed-release
product is
prescribed, take
this drug on an
 empty stomach,
1 hour before or
2 hours after
meals.
• Do not to chew
or crush
timedrelease
preparations.
• Administer
rectal solution
or suppositories
after emptying
the rectum.
• It may be
necessary to
take this drug
around-theclock
for
adequate
control of
asthma attacks.
• Avoid excessive
intake of coffee,
tea, cocoa, cola
beverages, and
chocolate.

Name of Drugs Classification Mechanism of Indication Contraindication Nursing

Action Responsibilities
Generic Name: Proton Pump Reduces Gastric GERD, Erosive Hypersensitivity  Assess Vital
Inhibitor Acid Secretion Esophagitis, to drug, Hepatic Signs
Omeprazole and Shortterm Disease,  Check for
increases Gastric treatment of Pregnancy, abdominal Pain,
Brand Name: mucus and Duodenal ulcer, Children, emesis,
bicarbonate Gastric Ulcer, Posterior Diarrhea or
Omepron production, Pathologic Laryngitis, constipation.
creating hypersecretory  Evaluate fluid
protective Conditions, and intake
coating on including  Watch for
gastric mucosa Zollinger-Ellison elevated liver
and Syndrome, function test
easing Frequent results
discomfort Heartburn  Tell patient to
from excess take 30-60
gastric minutes
acid before a meal,
preferably in
morning.
 Instruct
patient to
swallow
capsules
or tablets whole
and no to chew
or
crash them.
 Caution
patient to avoid
driving and
other hazardous
activities until he
know drug
effects
concentration
and
alertness
Name of Drugs Classification Mechanism of Indication Contraindication Nursing
 Action Responsibilities
Generic Name: Inotropic Inhibits sodium- Heart failure,
Antiarrhythmic potassium- paroxysmal  Contraindicated  Drug-induced
Digoxin Cardiac activated supraventricular in patients arrhythmias may
glycoside adenosine tachycardia, hypersensitive to increase the
Brand Name: triphosphatase, atrial fibrillation drug and in those severity of heart
promoting and flutter with digitalis- failure and
movement of induced toxicity, hypotension.
calcium from ventricular  Before giving
extracellular to fibrillation, or loading dose,
intracellular ventricular obtain baseline
cytoplasm and tachycardia data (heart rate
strengthening unless caused by and rhythm,
myocardial heart failure. blood pressure,
contraction. Also  Patients with and electrolytes)
acts on CNS to Wolff-Parkinson- and ask patient
enhance vagal White syndrome about use of
tone, slowing unless the cardiac
conduction conduction glycosides
through the SA accessory within the
and AV nodes. pathway has previous 2 to 3
been weeks.
pharmacologically  Loading dose
or surgically is usually divided
disabled. over the first 24
 Elderly patients hours with
and in those with approximately
acute MI, half the loading
incomplete AV dose given in
block, sinus the first dose.
bradycardia,  Before giving
PVCs, chronic drug, take
constrictive apical-radial
pericarditis, pulse for 1
hypertrophic minute. Record
cardiomyopathy, and notify
renal prescriber of
insufficiency, significant
severe changes (sudden
pulmonary increase or
disease, or decrease in
hypothyroidism. pulse rate, pulse
deficit, irregular
beats and,
particularly,
regularization of
a previously
irregular
rhythm). If these
occur, check
blood pressure
and obtain a 12-
lead ECG.

 Monitor
digoxin level.
Therapeutic
level ranges
from 0.8 to 2
ng/ml. Obtain
blood for
digoxin level at
least 6 to 8
hours after last
oral dose,
preferably just
before next
scheduled
dose.
 Alert:
Excessively
slow pulse rate
(60
beats/minute or
less) may be a
sign of digitalis
toxicity.
Withhold drug
and notify
prescriber.
 Monitor
potassium level
carefully. Take
corrective
action before
hypokalemia
occurs.
Hyperkalemia
may result from
digoxin toxicity.
 Look alike-
sound alike:
Don't confuse
digoxin with
doxepin.
Name of Drugs Classification Mechanism of Indication Contraindication Nursing
Action Responsibilities
Generic Name: Muscle relaxant Eperisone HCl Muscle relaxant. History of Weakness, light-
suppresses the Improvement of hypersensitivity headedness,
Eperisone HCl activity of myotonic symptoms eg, to eperisone HCl sleepiness or
afferent nerve in cervical syndrome, and to any of other symptoms
Brand Name: fibers (Ia fibers) periarthritis of the the ingredients may occur. In
from human shoulder, lumbago, etc. of Myonal. the event of
Myonal muscle spindles Spastic paralysis caused such symptoms,
by the following the dosage
diseases: should be
Cerebrovascular reduced or
disorders, spastic spinal treatment
paralysis, cervical discontinued.
spondylosis, sequela of  Patients
trauma (spinal and head should be
injury), spinal vascular cautioned
disorders and other against engaging
encephalomyelopathies. in potentially
hazardous
activities
requiring
alertness, such
as operating
machinery or
driving a car
7. Which of the following doctor’s order must refer immediately? Please justify your answer
8. Which of the following doctor’s order must question by the nurse before carrying out
immediately? Please justify your answer
- Omeprazole 40 mg IV now then OD
- Omeprazole is used to treat certain stomach and esophagus problems (such as acid
reflux, ulcers)
9. What are the ethical considerations before doing an intervention?
- Consent represents the ethical and legal expression of a person's right to have their
autonomy and self-determination respected.
10. Create a sample 2 FDAR ( Follow the format)

Republic of the Philippines

Province of Ilocos Sur
ILOCOS SUR PROVINCIAL HOSPITAL GABRIELA SILANG
VIgan City

NURSES NOTES

SURNAME: Alawi AGE: 18 yrs old HOSP. NO.: 123

GIVEN: Ivana M.I.: SEX: Female WARD: Male Ward

DATE Time FOCUS D= DATA A=ACTION R=RESPONSE

11-22-2020 10:00am Ineffective DATA: Objective cues: Difficulty of breathing,
breathing pattern. barrel chest, cyanosis,ABG result : Ph: 7.3,
PCO2: 50mmHG, HC02: 29mmHG, --------------
10:30am ACTION:Position the client on High Fowler’s
Position. Administer Oxygen inhalation at 2-3
LMP Encourage the patient to do deep
breathing exercise Encourage the client to
alternate activities with rest periods------------
4:00pm RESPONSE:Client observed to have normal
spontaneous breathing------------Savellano,RN
11-22-2020 10:00am Hyperthermia DATA: Objective cues:Temperature: 38.8
10:00am degree Celsius ----------------------------------------
11:00am ACTION: Render tepid sponge bath (TSB);
Encourage SO to let patient wear light
clothing; maintained bed rest. Encourage
limited water intake to 4 glasses or 1L per
day, environmental care done, monitor vital
signs------------------------------------------------------
4:00pm RESPONSE: Client temperature reduced from
38.8 degree Celcius to 37.0 degree
Celcius-----------------------------------------------
Savellano,RN
 St. Paul College of Ilocos Sur
(Member, St. Paul University System)
St. Paul Avenue 2727, Bantay, Ilocos Sur

DEPARTMENT OF NURSING

NCM 112: Care of the Clients with Problems in Oxygenetation, Fluid and Electrolyes, Infectious,
Inflammatory and Immunologic Response, Cellular Abberations Acute and Chronic
( RLE)

First Semester A.Y. 2020-2021

Melanio P. Rojas Jr. MAN

Kathleen R. Parel, MAN
(Clinical Instructors)

Name: Aldrin Joaquin Savellano Score: ___________________

Course/Year: BSN-III Date: 01-20-2022

Scenario: Date: September 22, 2021- Oxygen saturation- 69% and Oxygen saturation-
92%, 11 pm: History of PTB 4 years, intermittent cough, + hemoptysis, + DOB and
SPO2- 98%. On September 23, 2021- SPO2- 98% and BP 90/60. September 24, 2020-
(-) hemoptysis. September 26, 2021- (DOB). September 27, 2021- (+) hemoptysis and
+ (DOB). September 27, 2021 (+) massive hemoptysis and cough. September 29, 2020
– no recurrence of hemoptysis.
Doctor’s order Rationalization
1. Admit to ICU Indication for ICU admission:
 Gas-exchange abnormalities
(respiratory rate > 30 breaths
per minute, oxygen saturation <
88% in room air, or need for
high-flow oxygen [> 8 L per
minute] or mechanical
ventilation)
 Massive hemoptysis (> 200 mL
per 48 hours or > 50 mL per
episode in patients with chronic
pulmonary disease)

2. Secure consent Consent is essential for any treatment;

routine procedures are covered by a
consent signed at admission.
3. NPO To prevent stomach contents flow into
the lungs of the patient .
4. Monitor TPR q shift and record Provide a baseline data for care. During

5. IVF: Plain NSS 1 liter x 8H
6. CBC with platelet, BUA, Chest-Xray, 12 lead
ECG
7. Budesonide neb now then BID
8. Salbutamol + ipratropium now then every 8
9. Ceftriaxone 2 grams IV + 900 cc PNSS to run
for 4 hours, OD
10. Hydrocortisone 200 mg IV now standby
Intubation
11. Please inform MROD regarding this admission
12. Decreased IVF to 12 hours
13. Shift ceftriaxone to PipercillinTazobactam 4.5
grams IV q 6 hours ( ) ANST to be given 1 hour
infusion
14. D/C Hydrocortisone
15. D/C Budesonide, Salbutamol + Ipratropium
nebulization
16. Start butamirate citrate 50 mg 1 capsule 1 cap
TID
17. Start tranexamic acid 500 mg IV now then IV
every 8 hours
18. Send for sputum examination
19. To isolation
20. May have DAT with SAP
this period of time, complications
(hypotension, shock, pulmonary
edema) may possibly develop.
To replace lost fluid that helps restore
the body normal function.
To check lung status since the patient
complained shortness of breath.
To prevents inflammation in the lungs
by depression of migration of
polymorphonuclear leukocytes,
fibroblasts, reversal of increased
capillary permeability and lysosomal
stabilization; does not suppress
hypothalamus and pituitary function.
To relax and open up the air passages,
making breathing easier and improving
shortness of breath, chest tightness
and wheezing.
It kills bacteria by preventing them from
making their own protective covering.
To threat inflammation in the lungs.
To mentor and give clinical guidance to
the clinical team.
Excessive intravenous fluid
administration can cause electrolyte
balances collections of fluid in the
lungs.
Piperacillin-tazobactam monotherapy is
significantly more effective and cost-
efficient than ceftriaxone plus
gentamicin as first-line therapy in febrile
neutropenic patients with hematological
malignancies.
To prevent synergistic effect.
To prevent synergistic effect.
To threat dry cough.
To prevent excessive blood loss from
hemoptysis.
To study the bacteria or fungi that might
be growing in the lungs and causing the
production of the sputum. This can help
them find the cause of the illness.
To stop the spread of infection.
Maximizes nutrient intake without
undue fatigue/energy
expenditure from eating large meals,
and reduces gastric

21. Shift O2 to NC at 3 LPM
22. VS every 4 hours
23. Transfer to isolation room
24. Please facilitate sputum gene xpert
25. Multivitamins I capsule OD
26. Amino acid + sorbitol 800 cc to run 6 hours OD
as side drip
27. Continue antibiotic
28. Complete 3 doses of amino acid then D/C
29. Continue Tranexamic acid
30. Moderate high back rest
31. Increase tranexamic acid to 1 gram IV every 8
hours
32. Apply ice pack to anterior chest wall
33. Refer to HCAT
34. O2 at 10 LPM via nasal cannula
35. Diamaxin 300 mg capsule OD
irritation.
Aids in correcting hypoxemia that may
occur secondary to decrease
ventilation/diminished alveolar lung
surface.
Baseline data.
To prevent the transmission of
microorganisms from infected or
colonized patients to other patients,
hospital visitors, and health care
workers.
To diagnose pulmonary TB in patients
with negative sputum AFB smear.
To ensure your body gets the vitamins
and minerals it needs.
Sorbitol is provided to supply body
energy, upgrade the turnover rate of
amino acids, promote the synthesis of
tissue protein and improve the
intermediary metabolism as well as
reinforce detoxification function.
It helps ensure that all of the illness-
causing bacteria are killed or prevented
from multiplying.
To promote the synthesis of tissue
protein and improve the intermediary
metabolism as well as reinforce
detoxification function.
To prevent excessive blood loss from
hemoptysis.
Positioning helps maximize lung
expansion and decreases respiratory
effort.
To prevent excessive blood loss from
hemoptysis.
To help patient breathe freely and to
get more oxygen in the body.
To evaluate physical, social, and
economic service structures at the
neighborhood level that support healthy
living and healthy behaviors in our
communities.
Aids in correcting the hypoxemia that
may occur
secondary to decreased
ventilation/diminished alveolar
lung surface.
Inhibits conversion of glucose and
 galactose to sorbitol. Alpha-lipoic acid
in Diamaxin is a mitochondrial nutrient
that helps improve mitochondrial
function thereby improving our body’s
immune response.

36. Referred to Pulmonologist: Possible cause of Pulmonologists specialize in the

MDR-TB respiratory system and treat breathing-
related conditions.

37. For Gene Expert Result To detect if there is a presence of TB

bacteria.

Home Meds:

38. Tranexamic acid 500 mg 1 tablet TID x 1 week To prevent excessive blood loss from
hemoptysis.

39. Butarimate citrate 50 mg 1 tablet TID x 1 week To threat dry cough.

40. Multivitamins tablet 1 tab OD To ensure your body gets the vitamins
and minerals it needs.