UNIVERSITY OF SOUTHERN PHILIPPINES FOUNDATION

COLLEGE OF HEALTH SCIENCES

DEPARTMENT OF NURSING
SALINAS DRIVE, LAHUG, CEBU CITY

A Care of a Patient Cerebrovascular Disease

Infarct; Hypertensive II

Submitted by:
Quindala Liz G.
BSN4

Submitted to:
Dr. Peter Arnold T. Tubayan

September 2023
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Table of Contents

Content Page

Table of Contents ii

I. General Information and Patient’s Profile

Introduction

Patient’s Profile

II. Pertinent Nursing Health History and Physical Assessment

History of Present Illness

Family Health History

Environmental History

Genogram

Developmental Task

Health Assessment and Physical Examination

Laboratory and Diagnostic Studies

III. Summary of Significant Findings

Summary of Significant Findings

IV. Anatomy and Physiology

Anatomy and Physiology

V. Pathophysiology

Pathophysiology

VI. Nursing Care Management

NCP 1: Decreased Cardiac Output related to obstructed cardiac blood flow

NCP 2: Ineffective Tissue Perfusion related to diminished cardiac output

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NCP 3: Imbalanced Nutrition: Less Than Body Requirements related to

impaired metabolism
VII. Discharge Plan

Discharge Plan 45

VIII. Appendices

Health Teaching Plans 47

Drug Study: N-Acetylecysteine 60

Drug Study: Salmeterol + Fluticasone 62

Drug Study: Trimetazidine 64

Drug Study: Atorvastatin 66

Drug Study: Lactulose 68

Drug Study: Melatonin 70

IX. References

References 72
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INTRODUCTION

Cardiovascular disease (CVD) remains a significant global health concern, responsible

for a substantial number of morbidity and mortality cases each year. Hypertension, commonly

known as high blood pressure, is a major risk factor for CVD and stroke. Despite significant

advancements in medical interventions and preventive strategies, managing CVD and its

associated complications remains a complex challenge for healthcare providers.

According to the Department of Health (DOH) of the Philippines, CVD accounted for a

significant proportion of deaths in the country. In 2019, it was reported as the leading cause of

death, responsible for more than a quarter of all deaths. Heart disease and stroke, both

components of CVD, were major contributors to this mortality.

From January to November of 2022, ischaemic heart diseases were the leading cause of

death with 103,628 cases or 18.4 percent of the total deaths in the country. On the other hand,

cerebrovascular diseases, came in second with 57,411 deaths (10.2% share). Neoplasms were the

third leading cause which accounted for 57,354 recorded cases (10.2% share) from January to

November 2022.

This case study delves into the management of a patient with a cardiovascular disease and

recurrent stroke, who presents with hypertension categorized as stage II. Hypertensive stage II

indicates severely elevated blood pressure, requiring prompt and targeted interventions to reduce

the risk of further complications. The case emphasizes the intricate interplay between

hypertension and its role in exacerbating existing cardiovascular issues.

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The prevalence of hypertension has been steadily increasing, often referred to as the

"silent killer" due to its asymptomatic nature in the early stages. As a result, undiagnosed or

poorly managed hypertension can significantly contribute to the development and progression of

various cardiovascular conditions, including coronary artery disease, heart failure, and stroke.

By understanding the complexities of managing cardiovascular disease, healthcare

practitioners can enhance their knowledge of tailored interventions and holistic care strategies.

This case study aims to contribute to the existing body of knowledge and promote evidence-

based practices in managing patients with intricate cardiovascular profiles, ultimately striving to

improve patient outcomes and quality of life.

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PATIENT’S PROFILE

Name: D.C

Age: 81

Sex: F

Status: Married

Address: Cebu City

Name of Hospital: Cebu City Medical Center

Date of Admission: August 18, 2023

Case No.: 118-495

Ward and Bed No: APW-Bed 10

Chief Complaint: Dyspnea, Slurred speech

Medical Diagnosis: CVD infarct

Hypertensive Stage II
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PERTINENT NURSING HEALTH HISTORY

History of Present Illness

One week prior to admission. Noted productive cough, no associated fever nor,

dyspnea, tolerated condition. Two days ptc. Noted onset slurred speech also with dyspnea

episode. Still with productive cough without sputum.

Past Health History

Patient had been diagnosed with CVD during her 60’s. This was followed by a diagnosis

of Hypertensive satge II soon after. The SO also stated that the patient was admitted 3 months

ago in the ICU. Without maintenance medications.

Family Health History

The patient’s grandfather has a history of diabetes and hypertension, her mother has a

history of diabetes, and both of his mother and father side has a history of hypertension. The

patient also has hypertension.

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Figure 1. Genogram

Environmental Health History

The patient resides in a small community. There is inadequate airflow and poor

ventilation. The patient's living situation, according to SO, is inappropriate for her needs and

therapy.

DEVELOPMENTAL TASK
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HEALTH ASSESSMENT
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(Gordon’s Functional Health Patterns)

Functional Health Pattern Before Hospitalization During Hospitalization

The patient expressed that she

cannot recall if she completed
her childhood immunization.
She has received two dose of The SO stated that
COVID vaccination. Wala man siyay kausaban
The patient also forgot to go miss kay dili man mag tuman
1. Health Perception and on her scheduled check-ups sa I mando sa Doctor or nurse
Health maintenance due to financial restraints. gud.” As verbalized by the
Tungod saka busy sa iayng SO.
mga anak miss, unya na stroke
pajud siya medyo lisud na
gyud nga magpa check-up siya
nga walay kauban.” As
verbalized by the SO.

The patient is in NGT.

“Dri sa hospital miss, since
“Iyang usual nga kaon miss,
ako ra nag bantay niya ma
kay kasagaran dilata, utanon,
hatag ra ang pagkaon niya on
klasi-klasi ra ug unsay ipang
time, and since naka catheter
andam sa iyang mga anak.
ug diaper siya ma monitor
2. Nutritional - Metabolic Usahay dili pd maatiman nas
rasad iyang ihi ug tae,
iyang mga anak kay busy,
kasagaran tag tulo ka adlaw pa
maka inom rana siya mga 2-3
ayha siya maka libang, unya
cups ra sa baso.” As
iyang ihi mo dagan ug mga
verbalized by the SO
500cc.” As verbalized by the
SO
“Gina diaper namn ni siya
miss sukad na stoke siya, then The patient has voided with
tagsa rapud ni siya malibang light yellow urine with
3. Elimination
kada adlaw, kasaragan estimated 50 ml/hr and
malibang siya every 32-3 days defecated once in three days.
pa.” As verbalize by the SO.
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The patient lies on bed and

“Tungod saka busy sa iyang
naps during admission and
pamilya, wala namn kaayu
when she wakes up, she
atiman mag suhol ra ug kinsay
experiences muscle weakness
maka atiman, pero sauna
4. Activity and Exercises and tingling.
katung wala pa siya na stoke
The patient is weak and not in
mag labada ni siya sa mga
a good condition and cannot
balay-balay.” As verbalized by
tolerate simple exercises. With
the SO
difficulty turning to sides.

The patient lies on bed in

The patient sleeps 5-6 hours
semi-Fowler’s position.
every night. She usually sleeps
around 11:00 pm and wakes
“Ni samot iyaha habit nga dili
up around 4:00 or 5:00 am.
matog miss, mag sige rajud
5. Sleep and Rest “ Mag sige raman na siyag
siyag mata-mata, mga pila ray
mata-mata miss, naay usaha
tog ana niya kada adlaw naa ra
dili siya matog.” As
sa mga 5-6 hours.” As
verbalized by the SO.
brbalized by the SO.

The patient verbalized that she GCS=15. The patient is

has no problems with her five oriented to time, place, and
6. Cognition and perception senses and memory. She also person. She can comprehend
has no problems in decision and communicate well and can
making. hear and see well.

The patient stated that she is a

7. Self-perception and self-
concept
good and loving mother.
Patient regarded her children
to be of more concern than
herself. She puts her family at
greater priority. She sees
herself as a person with
purpose and goals in life, not
just for herself but also for her
family.
She is very sad and still
concerned about her condition,
but she has learned to accept it
including her changes in
health. Although, she admits
to have felt sad from time to
time for what has become of
herself.
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She no longer has any

8. Sexuality and Patient is not sexually active
intention to engage sexually
Reproduction anymore.
since she became a widow.

The patient is caring and

loving. She has had a close
and good relationship with her
family. All the members in the
family support her journey and
communicate with her from She was admitted and was
time to time. accompanied by her caregiver,
9. Roles and Relationship
since her children were busy
“Busy always iyang mga anak for their work.
miss, pero gina supportahan
rasad siya sa mga tamabal ug
mga gi kinahanglan sa hospital
or sa mga need nga tambal.”
As verbalized by the SO.

“Wala ko kahibaw ug unsay

buhaton niya if ma stress siya
10. Stress and tolerance miss kay mo hilom raman na The patient is not expressive
coping siya dili ra mag sulti-sulti sa towars her feelings.
iyang gi bati.” As verbalized
by the SO

“Mabantayan na nko siya

The Patient is Roman
miss, kanang padung siya
Catholic. “Sauna miss, katung
matog or anytime kay mag
11. Values and Belief wala pana siya ma stroke tig
yaw-yaw siya niya mag sampit
simbahay sad na sila.” As
ug Ginoo.” As vervalized by
verbalized by the SO.
the SO
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PHYSICAL EXAMINATION

Normal Findings Manifested Abnormal Findings

Assessment Data
by Patient Manifested by Patient

General Survey

Skin, Hair, and Nails

Inspection
● Skin is evenly tanned ● Skin dryness noted.

with hair evenly

● Nails are not trimmed,
distributed. No
presence of visible visible dirt noted.

lesions. ● The skin becomes

● Hair is gray and is thinner and more

evenly distributed. No fragile, making it

dandruffs and lice prone to tears, bruises,

Palpation noted. and injury.

● Scalp is smooth and

● Mild tenderness felt
oily and there were no
lesions noted. along lower
extremities.

● Poor skin turgor with

CRT of 3 secs
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Head, Neck, and Cervical Lymph Nodes

Inspection
● Head is hard and smooth. Head size is symmetric, round

and in midline with no involuntary movements.

Palpation
● Temporal artery is palpable (2+) bilateral

Auscultation
● Trachea is midline

● Carotid pulse is palpated with strong bounding pulse

● Neck is in pain

● With swishing sound in carotid arteries

Mouth, Nose, and Sinus

Inspection
● Tonsils are not ● Lips were pale, dry,

swollen. and severely cracked.

● Nose is symmetrical ● Incomplete set of teeth

with the nasal septum with dental caries

at the midline noted. No dentures
noted.
● No lesions and

ulcerations noted on ● Oral mucosa pale and

the mouth dry

Palpation
● Gingivita is pale and
● No lesions and masses dry
noted on the nose

● Nasal tenderness not

noted
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Eyes and Ear

Inspection
● Presence of cataract

● Eyelashes are evenly distributed and curl outward.

Palpation ● Cornea is moist.

● Eyelashes are evenly distributed and curl outward.

● No lesions noted on the ears and the skin is intact.

● Size of the ears are symmetrical and proportional to the

head.

● Ear canal is brownish in color

● No palpable masses noted on the ears

● The auricle, tragus and mastoid processes tenderness not

noted
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Thoracic and Lungs

Inspection
● The thorax is the same ● Orthopnea noted

color as the rest of the

● Exertional dyspnea
body with no presence
of lesions noted

● Side to side symmetric ● Side to side

chest shape asymmetric chest

shape
● Irregular respiratory
● Irregular respiratory
rate & pattern not
noted rate & pattern not
noted
Palpation ● No retractions or
● With adventitious
bulging of ICS noted
sound
● No lumps or nodules
Auscultation
felt upon palpation

● No tenderness noted

● No adventitious sound

noted
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Cardiovascular
Inspection
● Jugular Venous pulse ● Edematous extremities

is not visible and

● Numbness/tingling
distended
sensation on lower and
● No prominent venous
upper extremities.
patterns on the
● Delayed CRT of 3 sec
peripheral extremities
Palpation

● Extremities equally

warm to touch
Auscultation
● Heart rate is 65 bpm

● No blowing and

swishing sounds noted

on jugular arteries

● Audible heart sound

● Absence of extra heart

sound

● Thrill and bruits noted

Breast
Inspection
● Patient’s breast is asymmetrical and pendulous in shape

● The areola is rounded with dark brown in color.

Palpation
● Nipples are round, same size and equal in color.

● No lesions and masses noted

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● Axillary lymph nodes not palpable

Abdomen
Inspection
● Umbilicus is located midline

● Abdomen is free of lesions and rashes

● Umbilical is recessed, midline and the skin tones are

Palpation similar to surrounding abdominal skin tone

● Abdomen is flat
Auscultation

● No masses noted

● No tenderness noted

● Active bowel sound noted in all 4 quadrants

Genitourinary-Reproductive
Inspection
● Genitals and anus are ● Normal

physiologically intact.

Musculoskeletal
Inspection
● No contractures and ● Weak tone noted on

tremors extremities

● No involuntary ● Weakness noted

movements noted at
● Limited ROM and
Palpation rest
tolerance to physical
● No crepitus noted in
activities
joints

● No tenderness noted
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● Sensations are intact

Neurologic
Inspection
● Sensations are intact

● Glasgow Coma Score= 8

✔ Eye opening is No response and is scored 1

✔ Verbal response is Incomprehensible sounds is

scored 2

✔ Motor Response is Moves to localized pain and is

scored 5
Reflexes present (Gag, cough and blink )
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LABORATORY AND DIAGNOSTIC STUDIES

Reference
Test Name Result 9/10/23 Unit Interpretation
Range

Complete Blood Count

Low. The damaged nephrons in
nephrosclerosis produce less
RBC H 9.4 x106 /uL 4.5-5.9 erythropoietin. With less EPO, few blood
components are made (Colbert, 2022).

Low. Due to inadequate erythropoietin

Hct 33.3 % 41.5 – 50.4
production (Colbert, 2022).

Low. Insufficient blood supply towards the

Hgb 10.3 g/dL 14.0 – 17.5 bone marrow affects production of blood
components (Colbert, 2022).

Low. May be attributed to the fragility of

MCV 79 um3 80 – 96
blood components (Russell,2019)

27.5 – Low. May be attributed to the fragility of

MCH 25.3 pg
33.2 blood components (Russell,2019)

33.4 – Low. May be attributed to the fragility of

MCHC 32.2 %
35.5 blood components (Russell,2019)

RDW 12.6 % 11.5 – 14.5 Normal

Platelet 249 x103/uL 150-450 Normal

WBC 9.1 x103/uL 4.4 – 11.0 Normal

Differential Count
Lymphocyt
21 % 20 – 40
e
Monocyte L 0.08 % 2 – 10
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Eosinophil L 0.01 % 1–6

Basophil 0.00 % 0 -1 Normal

WBC Absolute Count

Neutrophil 66 % 1.8 – 7.0 Normal
Lymphocyt
21 % 1.0 – 4.8 Normal
e
Monocyte 10 % 0.2 – 1.0 Normal
Eosinophil 2 % 0.02 – 0.5 Normal
Basophil 1 % 0 -1 Normal

8/20/23 Reference
Test Name Unit Interpretation
Result Range

BUN 3.10 g/dL 3.8-5.0 Normal

Low. The damaged nephrons in the kidneys

become less capable of producing active
Sodium 8.10 mg/dL 9.20-11.0
forms of vitamin D resulting in decreased
calcium absorption (Haberal, 2019).

Phosphorus 4.50 mg/dL 2.30-4.70 Normal

High. The impaired glomerular filtration in

nephrosclerosis results in defective excretion
BUN serum 28.0 mg/dL 8.00-23.00
of urea nitrogen making it stay in the blood
(Haberal, 2019).
Low. The sodium-potassium control of the
Potassium 3.4 mEq/L 3.8-5.0
kidneys is impaired (Lewis, 2022).
 19

Reference
Test Name Result 8/19/23 Unit Interpretation
Range

Complete Blood Count

Low. The damaged nephrons in
nephrosclerosis produce less
RBC L 3.7 x106 /uL 4.5-5.9 erythropoietin. With less EPO, few blood
components are made (Colbert, 2022).

Low. Due to inadequate erythropoietin

Hct L 33.7 % 41.5 – 50.4
production (Colbert, 2022).

Low. Insufficient blood supply towards the

Hgb L 116 g/dL 130-180 bone marrow affects production of blood
components (Colbert, 2022).

Low. May be attributed to the fragility of

MCV 85.5 um3 80 – 96
blood components (Russell,2019)

27.5 – Low. May be attributed to the fragility of

MCH L 26.0 pg
33.2 blood components (Russell,2019)

33.4 –
MCHC H 36.2 %
35.5

RDW 13.6 % 11.5 – 14.5 Normal

Platelet 298 x103/uL 150-450 Normal

WBC 6.5 x103/uL 4.4 – 11.0 Normal

Differential Count
Lymphocyt
L 0.17 % 20 – 40
e
Monocyte H 0.24 % 2 – 10
Eosinophil L 0.00 % 1–6

Basophil 0.01 % 0 -1 Normal

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Urinalysis
DATE TEST RESULT

August 25, 2023 Urinalysis

Color YELLOW

Transparency CLEAR

pH 6.0

Specific Gravity 1015

Protein TRACE

Glucose +3

RBC 0-1

WBC 0-1

Epithelial Cells RARE

Bacteria FEW

Mucus Thread RARE

SUMMARY OF SIGNIFICANT FINDINGS

Health Gordon’s
Laboratory & Therapeutic Key Nursing
Assessment & Functional
Diagnostics Management Problem
Physical Exam Health Pattern
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Verbalization of
CRT 3 sec decreased
160/110 mmHg engagement to
Low rbc (4.0) IV Therapy
Dry mucous physical Decreased
Low hct (31.4) Supplemental
membranes activities cardiac output
Low mcv (79.0) Oxygenation
Poor skin turgor compared to
before diagnosis
of condition

Orthopnea
Low Hgb (10.1)
Numbness/ Verbalization of
Low MCH Trimetazidine
tingling sensation intolerance and
(25.3) IV Therapy Ineffective tissue
on extremities resistance to
Low MCHC Supplemental perfusion
Limited mobility physical
(32.2) Oxygenation
Exertional activities.
dyspnea

BMI 29 kg/m2
Verbalization of
Blood glucose
155 mg/dL blood negligence to Imbalanced
155 mg/dl
glucose prescribed Insulin Therapy nutrition: less
Low serum Ca
Edematous dietary Dietary Planning than body
(8.10)
extremities requirements and requirements
Low serum K
medications.
(3.4)
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ANATOMY AND PHYSIOLOGY

Cardiovascular disease (CVD), including conditions like hypertension (high blood

pressure) and stroke, is a complex area of medical study. I'll provide a general overview of the

anatomy and physiology related to these conditions, particularly hypertensive stage II.

The cardiovascular system comprises the heart, blood vessels (arteries, veins, and capillaries),

and blood. Its primary function is to transport oxygen, nutrients, hormones, and waste products

throughout the body.

Heart: The heart is a muscular organ responsible for pumping blood throughout the

body. It has four chambers: two atria (upper chambers) and two ventricles (lower chambers). The

right side of the heart pumps oxygen-poor blood to the lungs for oxygenation, while the left side

pumps oxygen-rich blood to the rest of the body.

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Blood Vessels: Blood vessels include arteries, which carry oxygenated blood away from

the heart, and veins, which return deoxygenated blood to the heart. Capillaries are tiny vessels

that allow for the exchange of nutrients, oxygen, and waste products between blood and body

tissues.

Blood: Blood is composed of red blood cells, white blood cells, platelets, and plasma.

Red blood cells carry oxygen, white blood cells are involved in the immune response, platelets

help in clotting, and plasma is the liquid component that carries cells and proteins.

Hypertensive Stage II:

Hypertension, or high blood pressure, is a condition where the force of blood against the

walls of arteries is consistently too high. In hypertensive Stage II, blood pressure levels are even

higher, typically defined as having a systolic blood pressure (the top number) of 140 mm Hg or

higher and a diastolic blood pressure (the bottom number) of 90 mm Hg or higher. This stage is

considered severe hypertension and requires medical attention.

Blood Vessels: Hypertension can cause structural changes in blood vessels, including the

arteries. Prolonged high blood pressure can lead to a condition called arteriosclerosis or

atherosclerosis, where the walls of arteries become thickened, stiffened, and narrowed. This can

reduce blood flow to various organs, including the heart, brain, kidneys, and limbs.

Heart: The heart has to work harder to pump blood against the increased resistance in

hypertensive individuals. Over time, this can lead to left ventricular hypertrophy, where the left

ventricle (the main pumping chamber of the heart) becomes thicker and less efficient. This

condition can increase the risk of heart failure.

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Kidneys: High blood pressure can damage the tiny blood vessels in the kidneys

(nephrons), leading to a condition called hypertensive nephropathy. Kidney function may

decline, potentially resulting in chronic kidney disease.

Eyes: The eyes are sensitive to changes in blood pressure. Uncontrolled hypertension can lead to

retinopathy, where the blood vessels in the retina of the eye become damaged, potentially leading

to vision problems or blindness.

Brain: Hypertension is a significant risk factor for stroke. High blood pressure can damage the

blood vessels in the brain, making them more susceptible to rupture (hemorrhagic stroke) or

blockage (ischemic stroke). Stroke can result in damage to brain tissue and n

Reference:

Seidman, C. (2021, December 3). Anatomy of Cardiovascular disease (CVD). Pocket Anatomy. /

Caviness, V. S., Makris, N., Montinaro, E., Sahin, N., Bates, J. F., Schwamm, L. H., Caplan, D.,

& Kennedy, D. N. (2002). Anatomy of Stroke, Part I. Stroke, 33(11), 2549–2556.

25
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PATHOPHYSIOLOGY
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NURSING CARE PLANS

Nursing Diagnosis #1: Decreased Cardiac Tissue Perfusion related to tachycardia.

Assessment Scientific Basis Planning Interventions Rationales Evaluation
Subjective Data: Cardiac output is Short Term Safe and Quality Safe and Quality Short Term
“bisan ga higda decreased as part Goal: Nursing Care Nursing Care Goal:
siya ma’am niya of the heart Within 4 hours of  Assessed heart  To provide After 4 hours of
naka oxygen mura musculature blood nursing rate and blood baseline data nursing
gihapon siyag nag flow is obstructed interventions, the pressure. interventions, the
hang-gap ug secondary to patient will patient
hangin.” As plague rupture demonstrate  Checked for  To check for demonstrated
verbalized by the and formation of adequate cardiac peripheral weak pulses adequate cardiac
SO thrombus output as pulses. Perform which are output as
(Anumeha, 2023). evidenced by capillary refill present in evidenced by
blood pressure test (CRT). reduced stroke blood pressure
Objective Data: and pulse rate and volume and and pulse rate and
 BP: 130/80 Reference: rhythm within the cardiac output. rhythm within
mmHg Anumeha, K., patient's usual patient’s usual
 HR: 103bpm McKinley, S., cardiologic  Noted skin  Cold, clammy, cardiologic
 Dry and pale Doering, L. V., functions color, and pale skin is functions
lips and skin Riegel, B., parameters. temperature, secondary to a parameters
 Oral mucosa Meischke, H., and moisture. compensatory
pale and dry Moser, D. K., ... Long Term increase in Long Term
 Poor skin & Paul, S.M. Goal: sympathetic Goal:
turgor (2008). Acute After 8-12 days of nervous system After 8-12 days
 Edematous coronary nursing stimulation and of nursing
lower syndrome: what interventions, the low cardiac interventions, the
 Restlessness do patients patient will be output and patient was able
 30

know?. Archives able to display & oxygen to display &

of internal maintain desaturation maintain
medicine, 168(10) hemodynamic (Leier, 2007; hemodynamic
, 1049-1054. stability as Bolger, 2003). stability as
evidenced by evidenced by
stable vital signs,  Assessed  An alteration in controlled BP
especially the oxygen oxygen and stable vital
heart rate. saturation with saturation is signs especially
pulse oximetry one of the the hert rate.
earliest signs of
reduced cardiac
output.

 Administered  The failing

oxygen therapy heart may not
as prescribed. be able to
respond to
increased
oxygen
demands.

 Inspected fluid  Bodyweight is a

balance and more sensitive
weight gain. indicator of
fluid or sodium
retention than
intake and
output.

 Reduced
 Monitored cardiac output
intake and urine results in
output. reduced
 31

perfusion of the
kidneys, with a
resulting
decrease in
urine output.

 In severe heart
 Ensured the dysfunction,
patient remains restriction of
on bed rest or activity often
maintains an facilitates
activity level temporary
that does not recompensation
compromise
cardiac output.
 To decrease
 Limited cardiac demand
physical
activities to
decrease
cardiac demand
 To promote
 Maintained bed adequate
rest with active circulation
range of without
motions increasing
cardiac demand

 To prevent fluid
 Administered volume excess
prescribed which may
dietary and strain the heart
fluid
 32

restrictions  To prevent fluid

retention
 Instructed on
fluid and salt  To promote
restrictions adequate
 Regularly circulation
repositioned
Management of
Resources and
Management of Environment
Resources and  Atrial
Environment fibrillation is
 Placed on a common in
cardiac heart failure
monitor; and can cause a
monitor for thromboemboli
dysrhythmias, c event.
especially atrial
fibrillation.  An upright
position is
 Positioned recommended
patient in semi- to reduce
Fowler’s to preload and
high-Fowler’s. ventricular
filling when
fluid overload
is the cause.

Health Education
 Fluid restriction
Health Education decreases the
 Instructed the extracellular
patient to limit fluid volume
 33

fluids and and reduces

sodium as demands on the
ordered. heart.
Legal
Responsibility
Legal  To adhere
Responsibility practices in
 Informed S/O accordance
about any with nursing
procedures law and other
performed & relevant
obtained legislation
informed
consent  For legal
purposes
 Accomplished
accurate
documentation
in all matters
concerning
client care in
accordance to
the standards of
nursing
practice. Ethico-Moral
Responsibility
Ethico-Moral  To respect
Responsibility patient’s rights
 Rendered
nursing care
consistent with
the client’s bill
of rights  To respect
 34

patient’s rights
 Provided
patient’s
privacy  To respect
patient’s rights
 Provided
confidentiality
to patient’s
data and
records
Personal and
Professional
Personal and Development
Professional  To render
Development updated patient
 Applied learned care
information for
the
improvement of  To practice
care professionalism

 Demonstrated
good manners
and right
conduct at all
times Quality
Improvement
Quality  Questions
Improvement facilitates open
 Encouraged the communication
patient to raise between patient
feedback and and health care
questions professionals
 35

and allow
verification of
understanding
of given
information

 To verify the
quality of care
 Solicited given
feedback from
SO regarding
care rendered Research
 To provide
Research solution to the
 Specified problem
researchable
problems
regarding client
care and
community
health Record
Management
Record  For legal
Management purposes &
 Monitored and ensure holistic
improves & collaborative
accuracy, patient care
completeness
and reliability
of relevant data  For legal
purposes &
 Made record ensure holistic
readily & collaborative
 36

accessible to patient care

facilitate client
care  To provide
accurate data &
 Maintained confidentiality
integrity, safety,
access and
security of
records Communication
 To build trust
Communication
 Built rapport to
patient & gain
patient trust  To facilitate in
understanding
 Spoke with the the words
patient with a
well modulated
voice  Conveying
respect is
 Provided an especially
atmosphere of important when
respect, providing
openness, trust, education to
and patients with
collaboration different values
and beliefs
about health
and illness

 To avoid
misunderstandi
 Ensured good ng & ensure
 37

communication patient safety

within the
healthcare team Collaboration and
Teamwork
Collaboration and  These tests can
Teamwork help indicate
 Reviewed the underlying
results of EKG cause of
and chest X- decreased
ray. cardiac output.

 Routine blood
work can
 Monitored provide insight
laboratory tests into the
such as etiology of
complete blood heart failure
count, sodium and the extent
level, and of
serum decompensation
creatinine.
 38

Nursing Diagnosis #2: Risk for aspiration related to Ineffective cough; Barrier to elevating upper body.
Assessment Scientific Basis Planning Interventions Rationales Evaluation
Subjective Short Term Safe and Quality Safe and Quality Short Term Goal:
Data: Goal: Nursing Care Nursing Care
]  Long Term Goal:
“Bisag ako
siyang I saka
miss, iya Maintain Health
gihapon I Education
attempt ug duko  Fluid restriction
ug luko iyaha decreases the
lawas.” As Long Term extracellular
verbalized by the Goal: fluid volume and
SO. reduces demands
on the heart.
Objective Data:
 To prevent blood
-Presence of glucose level
NGT from rising
- Gag reflex

 To control
blood-glucose
level and reduce
the development
and progression
of complications

Legal
Responsibility
 To adhere
 39

practices in
accordance with
nursing law and
other relevant
legislation

Health Education
 Instructed the  For legal
patient to limit purposes
fluids and
sodium as
ordered.

 Instructed
patient to cut-
off sugar-
containing
foods Ethico-Moral
Responsibility
 Instructed  To respect
patient to take patient’s rights
oral
hypoglycemic
medications as
directed
 To respect
patient’s rights
Legal
Responsibility
 Informed S/O  To respect
about any patient’s rights
procedures
 40

performed &
obtained
informed
consent Personal and
Professional
 Accomplished Development
accurate  To render
documentation updated patient
in all matters care
concerning
client care in
accordance to
the standards of
nursing  To practice
practice. professionalism

Ethico-Moral
Responsibility
 Rendered
nursing care Quality
consistent with Improvement
the client’s  Questions
bill of rights facilitates open
communication
 Provided between patient
patient’s and health care
privacy professionals
and allow
 Provided verification of
confidentiality understanding of
to patient’s given
data and information
records
 41

 To verify the
Personal and quality of care
Professional given
Development
 Applied
learned Research
information for • To provide
the solution to the
improvement problem
of care

 Demonstrated
good manners
and right
conduct at all Record
times Management
 For legal
Quality purposes &
Improvement ensure holistic &
 Encouraged collaborative
the patient to patient care
raise feedback
and questions
 For legal
purposes &
ensure holistic &
collaborative
patient care

 To provide
accurate data &
 Solicited confidentiality
feedback from
 42

SO regarding
care rendered
Communication
Research  To build trust
• Specified and cooperation
researchable
problems
regarding client  To facilitate in
care and understanding
community the words
health

Record  Conveying
Management respect is
 Monitored and especially
improves important when
accuracy, providing
completeness education to
and reliability patients with
of relevant data different values
and beliefs about
 Made record health and
readily illness
accessible to
facilitate client  To avoid
care misunderstandin
g & ensure
 Maintained patient safety
integrity, safety,
access and
security of Collaboration and
records Teamwork
• To serve as a
 43

Communication baseline and

 Built rapport to monitor for any
patient & gain signs of
patient trust alteration

 Spoke with the • Renal failure

patient with a causes creatinine
well modulated >1.5 mg/dL.
voice Microalbuminuri
a is the first sign
 Provided an of diabetic
atmosphere of nephropathy.
respect,
openness, trust,
and
collaboration

 Ensured good
communication
within the
healthcare team

Collaboration and
Teamwork
• Reviewed
results of blood-
glucose test.
 44

• Monitored urine
albumin to
serum
creatinine for
renal failure.
 45

Nursing Diagnosis #3: Impaired physical mobility related to activity in tolerance as evidenced by reluctance to move.
Assessment Scientific Basis Planning Interventions Rationales Evaluation
Subjective Mobility is simply Short Term Safe and Quality Safe and Quality Short Term Goal:
Data: defined as the Goal: Nursing Care Nursing Care Within 4 hours of
“Kapoy man ability to transfer Within 4 hours of  Assessed Vital  To provide nursing interventions,
daw siya ma’am or move from one nursing signs baseline data the patient he patient
kay dili kaayu place or another. interventions, the will be able to
siya maka lihok2 This involves the patient will be  Assisted patient  To decrease demonstrate
ug siya ra. Mag use of one or more able to reposition self numbness and techniques or
lisud sad siyag modes of transport demonstrate on regular pain in the behaviors tht enable
ginhawa murag such as walking, techniques or schedule from affected area. resumption of
sige ga hanggap utilizing assistive behaviors tht side to side. activities.
ug hangin.” devices, and/or enable resumption
As verbalized by vehicles. of activities.  Instructed pt  Increase blood Long Term Goal:
the SO and SO with flow ti muscles After 8-10 hours of
Phn, A. C. R. B. Long Term active/passive and bone to nursing interventions,
Objective Data: (2022). Impaired Goal: ROM exercise improve muscle the patient with t the
Physical mobility After 10 hours to of affected tone, maintain patient with the
 Alteration in nursing diagnosis 3 days of nursing extremities. joint mobility; guidance of the SO
gait postural and nursing care interventions, the prevent was able to maintain
instability plans. NurseStudy. patient with the contractures/atro increase strength and
Net. https://nursest guidance of the phy and calcium function of affected
 Decrease in udy.net/impaired- SO will be able to resorption from and compensatory
range of physical-mobility- maintain increase disuse. part.
motion nursing-diagnosis/ strength and
function of  Strictly monitor  Improves muscle
 Exertional affected and blood pressure strength and
dyspnea compensatory with circulation,
part. resumption of enhances patient
 Decrease in activity. Note control in
reaction reports of situation, and
time; slowed dizziness. promotes self
 46

spastic directive
movement ; wellness.
uncoordinat
ed  Reposition  Early mobility
movement. periodically reduces
and encourage complications of
coughing / bed rest (e,g.
deep breathing phlebitis) and
exercises. promotes healing
and
normalization of
organ function.
Learning the
correct way to
use aids is
important to
maintain optimal
mobility and
patient safety.

Health Education Health Education

• Instructed the • Fluid restriction
patient to limit decreases the
fluids and extracellular fluid
sodium as volume and
ordered. reduces demands
on the heart.

• Instructed • To prevent blood

patient to cut- glucose level
off sugar- from rising
containing
foods
 47

• To control blood-
• Instructed glucose level and
patient to take reduce the
oral development and
hypoglycemic progression of
medications as complications
directed

Legal Legal
Responsibility Responsibility
• Informed S/O • To adhere
about any practices in
procedures accordance with
performed & nursing law and
obtained other relevant
informed legislation
consent

• Accomplished • For legal

accurate purposes
documentation
in all matters
concerning
client care in
accordance to
the standards of
nursing
practice.

Ethico-Moral Ethico-Moral
Responsibility Responsibility
• Rendered • To respect
nursing care patient’s rights
 48

consistent with
the client’s bill
of rights

• Provided • To respect
patient’s patient’s rights
privacy

• Provided • To respect
confidentiality patient’s rights
to patient’s
data and
records

Personal and Personal and

Professional Professional
Development Development
• Applied learned • To render
information for updated patient
the care
improvement of
care

• Demonstrated • To practice
good manners professionalism
and right
conduct at all
times

Quality Quality
Improvement Improvement
• Encouraged the • Questions
patient to raise facilitates open
 49

feedback and communication

questions between patient
and health care
professionals and
allow verification
of understanding
of given
information

• Solicited • To verify the

feedback from quality of care
SO regarding given
care rendered

Research Research
• Specified • To provide
researchable solution to the
problems problem
regarding client
care and
community
health

Record Record
Management Management
• Monitored and • For legal
improves purposes &
accuracy, ensure holistic &
completeness collaborative
and reliability patient care
of relevant data

• Made record • For legal

 50

readily purposes &

accessible to ensure holistic &
facilitate client collaborative
care patient care

• Maintained • To provide
integrity, safety, accurate data &
access and confidentiality
security of
records

Communication Communication
• Built rapport to • To build trust and
patient & gain cooperation
patient trust

• Spoke with the • To facilitate in

patient with a understanding the
well modulated words
voice

• Provided an • Conveying
atmosphere of respect is
respect, especially
openness, trust, important when
and providing
collaboration education to
patients with
different values
and beliefs about
health and illness

• Ensured good • To avoid

 51

communication misunderstanding
within the & ensure patient
healthcare team safety

.
 52

DISCHARGE PLAN

>Instructed the patient to take her meds as prescribed by the physician.

>Educated the patient about the anticipated therapeutic effect of the
medication
>Advised patient to follow these general guidelines:
Take medication as prescribed.
Do not stop taking prescription medication without talking to the
doctor
Ask what results and side effects to expect. Report immediately
Medication
to the doctor if warning signs and symptoms occur
Some medications can be dangerous when mixed
Talk to a doctor or pharmacist if you are taking more than one
medication. This includes over-the-counter medication and herb
or dietary supplements.
Ask for foods to avoid that could interfere the therapeutic effect
of the meds

>Informed the patient to stay in a sanitary setting to prevent

infections.
>Encouraged the patient to stay in a well-ventilated area
>Advised patient to keep an environment that is conducive for
Environment
rest and sleep
>Encourages patients to ask for assistance from her family and
friends with errands and chores.

>Advised to comply to follow check ups and strict follow up

monitorings
Treatment >Advised to strictly adhere to prescribed treatments for
diagnosed conditions
>Instruct patient on how to effectively manage hypertension and
diabetes at home
>Encourage avoid smoking & alcoholic drinks
Health Teaching >Encourage to religiously comply to dietary plan and comply on dietary
restriction cessations
>Encourage patient to engage in physical activities as tolerated
>Encourage patient to rest as often as needed.
 53

Call for emergency when:

>You have a seizure.
>You have chest pain or shortness of breath.
>Severe, excruciating, vise-like grip chest pain that radiates to the left
jaw, shoulder, and back
Seek for professional help as soon as possible when:
Observable Signs
and Symptoms >Sudden severe weight loss/gain
>Allergy to medications such as itching, redness, difficulty breathing
>Alteration in amount of urine output and frequency
>Severe fatigue or muscle weakness
>Persistent headache, nausea, and vomiting

Advised patient to follow prescribed diet:

>Eat low in sodium, potassium, and protein foods (no processed
foods, no canned goods, and limit bananas, salt, meats, and the like).
>Eat foods that have a lot of fiber in them. Examples of foods with
fiber are fruits and vegetables.
Diet
>Limit oral intake. Write down how much liquid you drink every
day
>Do not drink alcohol.
>Inhibit caffeine and carbonated intake

>Encouraged patient to always put God in the center of the family

>Encouraged the patient to offer prayers for a faster recovery and
Spirituality
continued healing
 54

HEALTH TEACHING PLAN

Topic: Assisted Active and Passive ROM Exercises

General Objectives: After 35 minutes of nurse-patient interaction, the patient will be able to maintain joint and connective tissue
mobility through assistive exercise.

Specific Objectives:
● Explain what Active and Passive ROM exercises are
● Discuss the benefits of physical activity and Active and Passive ROM exercises
● Demonstrate assisted Active and Passive ROM exercises

Learning Learning Time Teaching

Learning Content Evaluation
Objectives Activity Allotted Style
The patient and  Active-assistive ROM occurs when Discussion 10 min Conversatio The patient and SO
SO will be able to you are able to move your injured nal and are able to define
know what is body part, but you may require some Inquisitive active and passive
active and passive help to move to ensure further injury rom exercises.
rom exercises. or damage does not occur. The
assistance that helps move your
body can come from you or from
another person. In a passive range of
motion exercises, the patient does
not perform any movement
themselves; instead, the therapist
moves the limb or body part around
the stiff joint, gently stretching
muscles and reminding them how to
move correctly.
 55

The patient and  Muscle Strength Discussion 10 min Conversatio The patient and SO
SO will be able to Passive range of motion exercise helps nal and are able to verbalize
know the benefits prevent weak muscles or stiffness caused Inquisitive understanding of the
of performing by non-use. benefits when
active- assistive performing active-
and passive ROM  Improve Circulation passive exercises.
exercises. Anyone who is required to spend a lot of
time in a wheelchair or on bed rest may
benefit from a passive range of motion
exercises that help increase and improve
circulation by keeping joints and muscles
functioning and healthy.

 Maintain Flexibility
Without regular movement , the joints in
the body become stiff and unbending. In
some who are unable to move, such as
those who have been paralyzed, muscle
atrophy and contractions may occur,
which literally waste away muscle tissue
and cause the limbs to curl inward
toward the center of the body.

 Reduce Pain
Exercising the joint helps keep them
limber, which reduces pain caused by
stiffness. Individuals who cannot move
 56

on their own or do not have the strength

to do so may benefit from passive range
of motion exercise that prevents
contractures.

The patient and  During active assistive range-of- Discussion 15 min Conversatio The patient is able
SO will be able to motion exercises, the patient moves Demons- nal and to demonstrate
perform active- the joints and muscles with the help tration Inquisitive assertiveness to
passive ROM of the therapist. The therapist perform ROM
exercises. supports the distal joint (the part of exercises with
the joint farthest from the point of assistance.
. attachment), while the patient moves
as much as possible in the instructed
manner.
For passive ROM-

Ankle and foot exercises:

Put a rolled towel under the person's

thigh. For the ankle exercises, support
the person's ankle with one hand, and his
or her toes with the other hand. For the
toe exercises, allow the person's foot to
relax on the bed, and hold only the toes.

 Ankle bends: Bend the person's foot

so the toes point toward the ceiling.
 57

Then bend the person's foot the other

direction so the toes are pointed.
 Ankle rotation: Raise the person's
foot slightly off the bed. Roll the
foot in circles. Then roll the foot in
circles in the other direction.
 Ankle movement, side to side: Tilt
the person's ankle in so the sole of
the foot points toward the opposite
leg. Then tilt the person's ankle out
so the sole of the foot points away
from the opposite leg.
 Toe bends: Curl the person's toes
down toward the sole of the foot.
Straighten them. Curl the toes up
toward the ceiling. Then straighten
them again.
 Toe spreads: Spread the big toe and
the second toe apart, then bring them
back together. Do the same with the
rest of the toes.

Shoulder and elbow exercises:

Support the person's elbow with one

hand. Hold his or her wrist with your
other hand.
 58

 Shoulder movement, up and down:

Raise the person's arm forward and
then up over his or her head. Bring
the arm back down to the person's
side.
 Shoulder movement, side to side:
Raise the person's arm to the side as
far as it will go. Bring the arm back
down to the person's side.
 Elbow bends: Place the person's arm
at his or her side with the palm
facing up. Bend and straighten the
arm.
 59

TOPIC: HYPERTENSION

GENERAL OBJECTIVES: After 25 minutes of student nurse interaction, and with the guidance of the SO, the patient with the
guidance of the SO will be able to understand the proper ways on how to reduce the risk of hypertension.

SPECIFIC OBJECTIVES:
 To define what hypertension is.
 To recognize the signs and symptoms of Hypertension.
 To know what are the behaviors to increase the risk for high blood pressure
 To know what are the preventive measurements to lower the risk of having hypertension.
 LEARNING LEARNING LEARNING TIME TEACHING EVALUATION
OBJECTIVES CONTENT ACTIVITY ALLOTTED STYLE
60
After 30 minutes High blood pressure, I. 10 mins Question and After 25 minutes of student-
of nurse patient or hypertension, is Introduction answer nurse interaction, the patient
interaction, with when the force of the with the guidance of the SO
the guiance of blood pushing on the  What is was able to was able to
the SO, the blood vessel walls is the explain the essence on how to
patient and SO too high. When essence of reduce the risk of
will be able to: someone has high knowing hypertension and and to
blood pressure: The about recognize her practices, on
Explain what is heart has to pump hypertensi how to manage basic healthy
Hypertension ? harder. The arteries on? Does lifestyle and determine the
(blood vessels that it matter, warning signs and symptoms
carry the blood away and why? to watch for.
from the heart) are
under greater strain as
they carry blood.

High blood pressure

usually has no
warning signs or
symptoms, and many
people do not know
Recognizes the they have it. 10 mins One-on-one
signs and Measuring your blood lecture
symptoms of pressure is the only discussion
Hypertension way to know whether
you have high blood
pressure.
High blood pressure II. Lecture
usually develops over proper
time. It can happen  What are
because of unhealthy the signs
lifestyle choices, such and
as not getting enough symptoms
regular physical of
activity. Certain health hypertensi
conditions, such as on?
diabetes and obesity,
can also increase the
risk for developing
high blood pressure.
 61

Topic: How to Manage Hypertension

General Objectives: After 25 minutes of student nurse – client interactive lecture the patient with the guidance of her SO would be
able to learn how to manage blood pressure.

Specific Objectives:
● Define what Blood Pressure is
● Explain and demonstrate how to monitor blood pressure
● Know what measures to manage high blood pressure

Learning Objective Learning Content Learning Activity Time Allotted Teaching Style Evaluation

The patient will be Definition of High I.) Attention 5 minutes Sharing After 25 minutes
able to define what Blood pressure catching Activity of interactive
is blood pressure High blood pressure is -When was the last lecture the patient
when the blood pressure time you had your is able to:
or the force of blood blood pressure Have a general
flowing through the checked and what knowledge on how
blood vessels is was the value? to maintain their
consistently too high. high blood
pressure.

-Stage 1 hypertension is II.) Lecture Proper 15 minutes Interactive Lecture

a systolic pressure -Definition of high
ranging from 130 to 139 blood pressure
mm Hg or a diastolic - Ways to manage
pressure ranging from high blood
80 to 89 mm Hg. pressure
-More-severe
hypertension, stage 2
hypertension is a
 62

systolic pressure of 140

mm Hg or higher or a
diastolic pressure of 90
mm Hg or higher.
-The normal range for
blood pressure is less
than 120/80 mmHg

The patient will be Ways to manage high III.) Learning 5 minutes Q and A
able to know the blood pressure: assessment
measures in -Questioning of
managing high ● Eat a well- the patient about
blood pressure balanced diet the lecture.
that is low in
salt
● Limiting the use
of alcohol
● Enjoy Physical
Activity
● Managing stress
● Maintaining a
healthy weight
● Quit smoking
● Taking
medications
properly
● Checking with
the doctor.
 63

DRUG STUDIES

Drug Study No. 1

N-Acetylcysteine
Mechanism of Adverse Nursing
Name of Drug Classification Indication Contraindication
Action Reactions Responsibilities
Generic: General: Reduce the Indicated as -bronchospasm -tachycardia Before:
N- Mucolytic Agent viscosity of mucolytic -periorbital -edema -Assess for
Acetylcysteine bronchial therapy to angioedema -flushing cautions and
Functional: secretions by reduce viscosity -hypotension -urticaria contraindications
Trade: Mucoactive breaking of mucus in the -renal failure -vomiting -Obtain baseline
Acetadote Agent disulphide cross airway. -liver cirrhosis -nausea serum levels
links between -sensitivity to -pharyngitis -Obtain sodium
Dosage: mucin acetylcysteine -rhinorrhea levels
600 mg/tab 1 tab monomers in the Patient’s components -rhonchi -Obtain baseline
BID lining of the Indication: -throat tightness blood pressure
respiratory tract. Mucolytic -Obtain baseline
Route: therapy for oxygen
PO pulmonary saturation
hypertension
During
-Monitor patient
for signs of
urticaria and rash
-Monitor patient
for hypotension
-Frequently
monitor blood
 64

glucose levels
-Frequently
monitor oxygen
saturation

After
-Instruct patient
to report
symptoms of
nausea and
vomiting
-Raise side rails
and do not leave
patient
unattended
-Monitor serum
levels
-Monitor for
hypotension and
blood glucose
changes

Reference: Lippincott’s Nursing Drug Guide

 65

Drug Study No. 2

Salmeterol + Fluticasone
Mechanism of Adverse Nursing
Name of Drug Classification Indication Contraindication
Action Reactions Responsibilities
Generic: General: Binds to a -inflammatory -severe COPD -oral candidiasis Before:
Salmeterol + Long Acting specific exo-site airway condition attack -pharyngitis -Assess for
Fluticasone Beta Agonist domain of the -bronchospasm -convulsive -bronchitis cautions and
Corticosteroid beta 2-receptor -airway disorder -dysphonia contraindications
Trade: protein to obstruction -hepatic -headache -Obtain baseline
Advair Diskus Functional: produce -asthma impairment -cough serum levels
Beta Agonist continuous -COPD -hyperthyroidism -nausea -Obtain
Dosage: Steroid stimulation of -non allergic -thyrotoxicosis -pneumonia potassium serum
25/250 mg BID the active site of rhinitis -hypokalemia -throat irritation level
the receptor to -viral respiratory -Obtain baseline
Route: reduce bronchial infections oxygen
PO sensitivity. Patient’s saturation
Indication:
Reduces Inflammatory During
bronchial airway condition -Monitor heart
swelling to open rate, blood
up the airway. pressure, and
pulmonary
function
-Monitor for
airway
congestion
-Monitor glucose
and potassium
 66

levels
-Frequently
monitor oxygen
saturation

After
-Instruct patient
to gargle after
administration
-Monitor hepatic
and thyroid
function
-Monitor blood
count and WBC

Reference: Lippincott’s Nursing Drug Guide

 67

Drug Study No. 3

Trimetazidine
Mechanism of Adverse Nursing
Name of Drug Classification Indication Contraindication
Action Reactions Responsibilities
Generic: General: Reduce the -angina -parkinson’s -dizziness Before:
Trimetazidine Coronary expression of -heart failure disease -drowsiness -Assess for
Vasodilator atrial natriuretic -peripheral -parkinsonian -stomach pain cautions and
Trade: peptide, increase artery disease symptoms -diarrhea contraindications
Vastarel Functional: left ventricular -hypertension -restless leg -indigestion -Obtain baseline
Anti-angina high-energy -myocardial syndrome -headache heart rate and
Dosage: phosphate infarction -tremors -anergia blood pressure
25 mg 1 tab BID levels, and -severe renal -urticaria -Obtain patient’s
reduce the risk impairment -renal apical pulse
Route: of arrhythmias Patient’s -lactation impairment
PO in heart failure. Indication: During
Angina -Do not
administer
during
hypotension
-Do not
administer if
heart rate is less
than 60 bpm
-Strictly monitor
for angina
-Monitor pain
levels
 68

After
-Monitor blood
pressure and
heart rate
-Monitor serum
levels
-Monitor for
hyperthyroidism
-Monitor for
indigestion and
constipation
-Raise side rails
-Do not leave
patient
unattended

Reference: Lippincott’s Nursing Drug Guide

 69

Drug Study No. 4

Atorvastatin
Mechanism of Adverse Nursing
Name of Drug Classification Indication Contraindication
Action Reactions Responsibilities
Generic: General: Inhibits HMG- -adjunct to diet -allergy to -asthenia Before:
Atorvastatin HMG-CoA CoA reductase, in elevated atorvastatin -headache -Assess for
Inhibitor the enzyme that cholesterol -fungal -flatulence cautions and
Trade: catalyzes the -reduction of byproducts -abdominal pain contraindications
Lipitor Functional: first step in the risk of -active hepatic -cramps -Assess for
Antihyperlipidemic cholesterol myocardial disease -constipation allergy to
Dosage: synthesis infarction and -persistent -nausea atorvastatin
40 mg 1 tab OD pathway, stroke in patient elevations in -dyspepsia -Assess for
HS resulting in a with type 2 transaminase -heartburn active hepatic
decrease in diabetes levels -arthralgia disease and
Route: serum mellitus -impaired -myalgia acute serious
PO cholesterol. endocrine -cataract illness
function -Assess for
Patient’s -history of liver orientation,
Indication: disease affect, and
Myocardial -alcoholism muscle strength
infarction -Perform
prophylaxis abdominal exam

During
-Monitor lipid
levels and renal
function
-Withhold drug
 70

in any acute,
serious condition
(severe
infection,
hypotension,
trauma, seizure

After
-Monitor lipid
levels regularly
-Monitor for
dyspepsia,
abdominal pain,
and constipation
-Regularly
monitor renal
and hepatic
functions

Reference: Lippincott’s Nursing Drug Guide

 71

Drug Study No. 5

Lactulose
Mechanism of Contraindicatio Adverse Nursing
Name of Drug Classification Indication
Action n Reactions Responsibilities
Generic: General: The drug passes -treatment of -allergy to -transient Before:
Lactulose Laxative through constipation lactulose flatulence -Assess for
unchanged into -low galactose -distention cautions and
Trade: Functional: the colon where diet -intestinal contraindications
Chronulac Laxative bacteria break it Patient’s -use cautiously in cramps -Assess for
down to organic Indication: diabetes -belching allergy to
Dosage: acids that Constipation -renal impairment -diarrhea lactulose
30 mL syrup OD increase the -liver cirrhosis -acide base -Assess for renal
HS osmotic pressure imbalance and liver
in the colon and -electrolyte impairment
Route: slightly acidify imbalance -Assess for
PO the colonic gastrointestinal
contents, disorders
resulting in an -Assess for liver
increase in stool function
water content,
stool softening, During
laxative action. -Give syrup with
fruit juice, water,
or milk to
increase
palatability
-Do not mix with
other laxatives
 72

-Monitor serum
ammonia levels
-Carefully
monitor blood
glucose levels

After
-Ensure access to
bathroom/bedpan
-Monitor for
abdominal pain
and constipation
-Instruct to
report severe
diarrhea,
belching,
abdominal
fullness
-Regularly
monitor renal
and hepatic
functions

Reference: Lippincott’s Nursing Drug Guide

 73

Drug Study No. 6

Melatonin
Mechanism of Adverse Nursing
Name of Drug Classification Indication Contraindication
Action Reactions Responsibilities
Generic: General: Sends messages -sleep disorders -depression -drowsiness Before:
Melatonin Mineral and to receptor -thrombo -bleeding disorder -weakness -Assess for
Electrolyte agonists in the cytopenia -warfarin use -confusion cautions and
Trade: brain and other -tardive -epilepsy and -anxiety contraindications
Circadin Functional: areas of the body dyskinesia other seizure -irritability -Obtain baseline
Mineral and to help control disorders -loss of appetite heart rate and
Dosage: Electrolyte sleep and wake -steroid use -diarrhea blood pressure
40 mg 1 tab OD cycles. Patient’s -autoimmune -blood pressure -Assess
HS Indication: disorders changes gastrointestinal
Sleeping -sedative or -risk for seizures status
Route: problem tranquilizer use -Assess affect
PO and orientation

During
-Provide
conducive
environment for
rest upon
administration

After
-Monitor heart
rate and blood
pressure
 74

frequently
-Monitor
duration and
quality of sleep
-Raise side rails,
do not leave
unattended
-Administer
small, frequent
feedings
-Monitor for loss
of appetite and
diarrhea

Reference: Lippincott’s Nursing Drug Guide

 75

REFERENCES

Bergmark, B. A., Mathenge, N., Merlini, P. A., Lawrence-Wright, M. B., & Giugliano, R. P.

(2022). Acute coronary syndromes. The Lancet, 399(10332), 1347-1358.

Caetano, E. R. S. P., Zatz, R., Saldanha, L. B., & Praxedes, J. N. (2001). Hypertensive

nephrosclerosis as a relevant cause of chronic renal failure. Hypertension, 38(2),

171-176.

Chaouat, A., Bugnet, A. S., Kadaoui, N., Schott, R., Enache, I., Ducoloné, A., ... &

Weitzenblum, E. (2005). Severe pulmonary hypertension and chronic obstructive

pulmonary disease. American journal of respiratory and critical care medicine, 172(2),

189-194.

Dracup, K., McKinley, S., Doering, L. V., Riegel, B., Meischke, H., Moser, D. K., ... & Paul, S.

M. (2008). Acute coronary syndrome: what do patients know?. Archives of

internal medicine, 168(10), 1049-1054.

Emet, M., Ozcan, H., Ozel, L., Yayla, M., Halici, Z., & Hacimuftuoglu, A. (2016). A review of

melatonin, its receptors and drugs. The Eurasian journal of medicine, 48(2), 135.

Freedman, B. I., Iskandar, S. S., & Appel, R. G. (1995). The link between hypertension and

nephrosclerosis. American journal of kidney diseases, 25(2), 207-221.

Gaine, S. (2000). Pulmonary hypertension. Jama, 284(24), 3160-3168.

Hill, G. S. (2008). Hypertensive nephrosclerosis. Current opinion in nephrology and

hypertension, 17(3), 266-270.

Hoeper, M. M., Ghofrani, H. A., Grünig, E., Klose, H., Olschewski, H., & Rosenkranz, S.

(2017). Pulmonary Hypertension. Deutsches Ärzteblatt International, 114(5), 73.

Bass, P., & Dennis, S. (1981). The laxative effects of lactulose in normal and constipated
 76

subjects. Journal of Clinical Gastroenterology, 3, 23-28.

Liao, W. (1994). Lactulose—a potential drug for the treatment of inflammatory bowel

disease. Medical hypotheses, 43(4), 234-238.

Luft, F. C. (2004). Hypertensive nephrosclerosis: update. Current opinion in nephrology and

hypertension, 13(2), 147-154.

Luke, R. G. (1999). Hypertensive nephrosclerosis: pathogenesis and prevalence: Essential

hypertension is an important cause of end-stage renal disease. Nephrology Dialysis

Transplantation, 14(10), 2271-2278.

Makki, N., Brennan, T. M., & Girotra, S. (2015). Acute coronary syndrome. Journal of intensive

care medicine, 30(4), 186-200.

Noordegraaf, A. V., Groeneveldt, J. A., & Bogaard, H. J. (2016). Pulmonary

hypertension. European Respiratory Review, 25(139), 4-11.

Overbaugh, K. J. (2009). Acute coronary syndrome. AJN The American Journal of

Nursing, 109(5), 42-52.

Pohanka, M. (2022). New uses of melatonin as a drug; a review. Current Medicinal

Chemistry, 29(20), 3622-3637.

Reiter, R. J., Tan, D. X., Sainz, R. M., Mayo, J. C., & Lopez‐Burillo, S. (2002). Melatonin:

reducing the toxicity and increasing the efficacy of drugs. Journal of Pharmacy and

Pharmacology, 54(10), 1299-1321.

Rubin, L. J. (1997). Primary pulmonary hypertension. New England Journal of

Medicine, 336(2), 111-117.

Sanchis-Gomar, F., Perez-Quilis, C., Leischik, R., & Lucia, A. (2016). Epidemiology of

coronary heart disease and acute coronary syndrome. Annals of translational

 77

medicine, 4(13).

Santos-Gallego, C. G., Picatoste, B., & Badimón, J. J. (2014). Pathophysiology of acute coronary

syndrome. Current atherosclerosis reports, 16, 1-9.

Shah, S. J. (2012). Pulmonary hypertension. Jama, 308(13), 1366-1374.

Schumann, C. (2002). Medical, nutritional and technological properties of lactulose. An

update. European Journal of Nutrition, 41, i17-i25.

Simonneau, G., Robbins, I. M., Beghetti, M., Channick, R. N., Delcroix, M., Denton, C. P., ... &

Souza, R. (2009). Updated clinical classification of pulmonary hypertension. Journal of

the American college of cardiology, 54(1_Supplement_S), S43-S54.

Zucchelli, P., & Zuccalá, A. (1998). Progression of renal failure and hypertensive

nephrosclerosis. Kidney International, 54, S55-S59.