SAN PABLO COLLEGES

COLLEGE OF NURSING

DRUG STUDY

Patient Name: Corazon Fundan

Generic – Brand Classification/ Mechanism of Side effects/ Nursing Consideration Patient teaching
name Indication Action Adverse Reaction
(Common/Life-
threatening)
Generic name: Indication: Blocks CNS: dizziness, Assess BP (lying, sitting, Emphasize the importance of
vasoconstrictor anxiety, standing) and pulse continuing to take as directed, even
Losartan Alone or with and aldosterone- depression, periodically during therapy. if feeling well. Take missed doses
other agents in producing effects fatigue, headache, Notify health care as soon as remembered if not
Brand name: the management of angiotensin II insomnia, professional of significant almost time for next dose; do not
Cozaar of hypertension. at receptor are weakness. changes. double doses. Instruct patient to
Treatment of sites, including take medication at the same time
diabetic vascular smooth CV: hypotension, Monitor frequency of each day. Warn patient not to
nephropathy in muscle and the chest pain, prescription refills to discontinue therapy unless directed
patients with adrenal glands. edema, determine adherence. by health care professional.
type 2 diabetes tachycardia.
and Therapeutic Assess patient for signs of Caution patient to avoid salt
hypertension. Effects: Lowering Derm: rashes. angioedema (dyspnea, substitutes containing potassium or
of BP. Slowed facial swelling). May rarely food containing high levels of
Classification: progression of EENT: nasal cause angioedema. potassium or sodium unless
diabetic congestion, directed by health care professional.
Therapeutic: nephropathy. pharyngitis, HF: Monitor daily weight See Appendix K.
antihypertensives rhinitis, sinusitis. and assess patient routinely
for resolution of fluid Caution patient to avoid sudden
Pharmacologic: GI: abdominal overload (peripheral edema, changes in position to decrease
angiotensin II pain, diarrhea, rales/crackles, dyspnea, orthostatic hypotension. Use of
receptor drug-induced weight gain, jugular venous alcohol, standing for long periods,
antagonist hepatitis, distention). exercising, and hot weather may
dyspepsia, increase orthostatic hypotension.
nausea, vomiting. Lab Test Considerations:
Monitor renal function and May cause dizziness. Caution
GU: impaired electrolyte levels patient to avoid driving or other
renal function. periodically. Serum activities requiring alertness until
 potassium, BUN, and serum
F and E: creatinine may beq.
hyperkalemia.
May cause AST, ALT, and
MS: arthralgia, serum bilirubin
back pain, (candesartan and
myalgia. olmesartan only).
Misc: May causequric acid,
ANGIOEDEMA slightpin hemoglobin and
hematocrit, neutropenia,
and thrombocytopenia.
Potential Nursing
Diagnoses Risk for injury
(Adverse Reactions)
Noncompliance
(Patient/Family Teaching)
Do not confuse Benicar
with Mevacor. Do not
confuse Diovan with
Zyban.
Correct volume depletion,
if possible, prior to
initiation of therapy.
PO: May be administered
without regard to meals.
Losartan
PO: For patients with
difficulty swallowing
tablets, pharmacist can
compound oral suspension;
stable for 4 wk if
refrigerated. Shake
suspension before each use.
response to medication is known.
Instruct patient to notify health care
professional of all Rx or OTC
medications, vitamins, or herbal
products being taken and consult
health care professional before
taking any new medications,
especially NSAIDs and cough,
cold, or allergy remedies.
Instruct patient to notify health care
professional of medication regimen
prior to treatment or surgery.
Instruct patient to notify health care
professional immediately if
swelling of face, eyes, lips, or
tongue occurs, or if difficulty
swallowing or breathing occurs.
Advise women with reproductive
potential to use contraception and
notify health care professional if
pregnancy is suspected or planned,
or if breast feeding. If pregnancy is
detected, discontinue medication as
soon as possible.
Emphasize the importance of
follow-up exams to evaluate
effectiveness of medication.
Hypertension: Encourage patient to
comply with additional
interventions for hypertension
(weight reduction, low-sodium diet,
discontinuation of smoking,
moderation of alcohol consumption,
regular exercise, stress
management). Medication controls
 but does not cure hypertension.

Instruct patient and family on

proper technique for monitoring
BP. Advise them to check BP at
least weekly and to report
significant changes.

Submitted by: Alfonso, Allysa Kyle A.

 SAN PABLO COLLEGES
COLLEGE OF NURSING

NURSING CARE PLAN

Patient’s Name: Corazon Fundan

Nursing Diagnosis: ineffective Self-Health Management r/t Complexity of therapeutic regimen
Economic difficulties evidence by Ineffective choices in daily living for meeting health goals.

ASSESSMENT PLANNING/GOAL IMPLEMENTATION RATIONALE EVALUATION GOAL MET

Desired Outcome Independent/dependent Reason for the Expected
Nursing intervention intervention Outcome
Pertinent Data: Patient will: Nurse will: Why: Positive result Yes No
Subjective: Hypertension Independent Assist These risk factors The patient verbalizes
Verbalize client in identifying contribute to understanding of
“Nahingi na lang ako understanding of modifiable risk hypertension and disease process and
sa barangay ng pang disease process and factors, such as cardiovascular and treatment regimen.
maintenance sa high treatment regimen. obesity; diet high in renal disease.
blood. Kulang pa ang sodium, saturated fats,
sahod ko para sa amin Identify drug side and cholesterol; The patient was able
ng apo ko.” As effects and possible sedentary lifestyle; to recognize drug side
verbalized by the complications that smoking; alcohol effects and potential
patient. necessitate medical intake of more than 2 complications that
attention. ounces per day on a required medical
regular basis; and a attention.
stressful lifestyle.
Objective: Describe reasons for Changing The patient could
T – 36.1 degree therapeutic actions and Problem-solve with “comfortable or usual” discuss the reasons for
Celsius treatment regimen. clients to identify behavior patterns can therapeutic actions
RR – 18 ways in which be very difficult and and the treatment
PR – 79 appropriate lifestyle stressful. Support, regimen.
BP – 140/ 90 changes can be made guidance, and
to reduce modifiable empathy can enhance
risk factors. a client's success in
accomplishing his or
her health goals.

Lack of engagement
 in the treatment plan is
Reinforce the a common reason for
importance of failure of
adhering to treatment antihypertensive
regimen and keeping therapy. Therefore,
follow-up ongoing evaluation for
appointments. client participation is
critical to successful
treatment. When client
understands causative
factors and
consequences of
inadequate
intervention and is
motivated to achieve
health, the client
typically participates
in treatment
interventions

Monitoring BP at
home is reassuring to
Instruct and clients because it
demonstrate BP self- provides visual
monitoring technique. feedback to determine
Evaluate client’s treatment outcomes
hearing, visual acuity, and helps promote
manual dexterity, and early detection of
coordination. deleterious changes.

Individualizing
schedule to fit client’s
Help client develop a personal habits may
simple, convenient make it easier to get in
schedule for taking the habit of including
medications. antihypertensives in
healthcare
management
activities.

Adequate information
Explain prescribed and understanding
medications along about side effects can
with their rationale, enhance client’s
dosage, expected and commitment to the
adverse side effects, treatment plan. For
and particular traits, instance, mood
such as the following: changes, initial weight
gain, and dry mouth
are common and often
subside with time

Scheduling doses
Diuretics: early in the day
Take daily or larger minimizes nighttime
dose in the early urination.
morning.
Primary indicator of
Weigh self on a effectiveness of
regular schedule and diuretic therapy. The
record. Avoid or limit combined vasodilating
alcohol intake. effect of alcohol and
the volumedepleting
effect of a diuretic
greatly increase the
risk of orthostatic
hypotension.

Dehydration can
Notify physician if develop rapidly if
unable to tolerate food intake is poor, and
or fluid. client continues to
take a diuretic.

Because clients often

Antihypertensives: cannot feel the
Take prescribed dose difference the
on a regular schedule; medication is making
avoid skipping, in BP, it is critical that
altering, or making up there be understanding
doses; and do not about the medication’s
discontinue without actions and side
notifying the effects. For example,
healthcare provider. abruptly discontinuing
Review potential side a drug may cause
effects and drug rebound hypertension,
interactions and leading to severe
discuss need for complications, or
informing healthcare medication may need
provider about onset to be altered to reduce
of adverse effects such adverse effects. Note:
as erectile dysfunction Many drugs used to
(ED). treat hypertension
have been linked to
ED. Drugs may need
to be changed or dose
adjusted.

Measures reduce
Rise slowly from a potential for
lying to standing orthostatic
position, sitting for a hypotension
few minutes before associated with the
standing. Sleep with use of vasodilators
the head slightly and diuretics.
elevated. Suggest
frequent position
changes and leg
exercises when lying
down.
Prevents vasodilation
Recommend avoiding with potential for
hot baths, steam dangerous side effects
rooms, and saunas, of syncope and
especially with hypotension.
concomitant use of
alcoholic beverages.
Any drug that contains
Instruct client to a sympathetic nervous
consult healthcare stimulant may
provider before taking increase BP or
other prescription or counteract effects of
over-the-counter antihypertensive
(OTC) medications. medications.

Some diuretics can

Instruct client, as deplete potassium
indicated, about levels. Dietary
increasing intake of potassium is desirable
foods and fluids high means of correcting
in potassium, such as deficits and may be
oranges, bananas, figs, more palatable to the
dates, tomatoes, client than drug
potatoes, raisins, supplements.
apricots, Gatorade, and Correcting mineral
fruit juices; and foods deficiencies can also
and fluids high in affect BP.
calcium, such as low-
fat milk, yogurt, or
calcium supplements.
Early detection and
Review the signs and reporting of
symptoms that require developing
the client to notify the complications,
healthcare provider, decreased
such as headache effectiveness of drug
present on awakening regimen, or adverse
that does not abate; reactions allow for
sudden and continued timely intervention
increase of BP; chest
pain; shortness of
breath; irregular or
increased pulse rate;
significant weight gain
(2 lb/day or 5 lb/wk);
peripheral or
abdominal swelling;
visual disturbances;
frequent,
uncontrollable
nosebleeds; depression
or emotional lability;
severe dizziness or
episodes of fainting;
muscle weakness or
cramping; nausea or
vomiting; or excessive
thirst.
Excess saturated fats,
Explain rationale for cholesterol, sodium,
prescribed dietary alcohol, and calories
regimen—usually a have been defined as
diet low in sodium, nutritional risks in
saturated fat, and hypertension. A diet
cholesterol. low in fat and high in
polyunsaturated fat
reduces BP, possibly
through prostaglandin
balance in both
normotensive and
hypertensive people.

A moderately low-salt
Help client identify diet may be sufficient
sources of sodium to control mild
intake, such as table hypertension or reduce
salt, salty snacks, or eliminate the need
processed meats and for drug therapy to
cheeses, sauerkraut, control BP.
sauces, canned soups
and vegetables, baking
soda, baking powder,
and monosodium
glutamate. Emphasize
the importance of
reading ingredient
labels of foods and
OTC drugs.
Omega-3 fatty acids in
Encourage foods rich fish tend to relax
in essential fatty acids, artery walls, reducing
such as salmon, cod, blood pressure. They
mackerel, and tuna. also make blood
thinner and less likely
 to clot.

Besides helping to
Encourage client to lower BP, aerobic
establish a regular activity aids in toning
exercise program, the cardiovascular
incorporating aerobic system. Isometric
exercise within client’s exercise can increase
capabilities. Stress the serum catecholamine
importance of levels, further
avoiding isometric elevating BP.
activity.
Nasal capillaries may
Demonstrate rupture as a result of
application of ice pack excessive vascular
to the back of the neck pressure. Cold
and pressure over the temperature and
distal third of the nose, pressure constrict
and recommend that capillaries to slow or
client lean head halt bleeding. Leaning
forward if nosebleed forward reduces the
occurs. amount of blood that
is swallowed.

Community resources,
Provide information such as the American
regarding community Heart Association,
resources, and support “coronary clubs,” stop
client in making smoking clinics,
lifestyle changes. alcohol or drug
Initiate referrals, as rehabilitation, weight-
indicated. loss programs, stress
management classes,
and counseling
services may be
helpful in client’s
efforts to initiate and
maintain lifestyle
changes.
If the client goal was not met, briefly describe why and what step would be taken next:
If the client's goal is not met, it is necessary to immediately notify the doctors in order to obtain a doctor's order for new treatment and
medication.

Submitted by: Alfonso, Allysa Kyle A.

References:

Doenges, M., Moorhouse, M., & Murr, A. (2014). In Nursing care plans: Guidelines for individualizing client care across the life span
(pp. 41–43). essay, Medicus Media Ltd.

Vallerand, A. H., Sanoski, C. A., & Quiring, C. (2019). In Davis's drug guide for Nurses (pp. 169–172). essay, F.A. Davis Company.