COLLEGE OF NURSING

INTENSIVE NURSING PRACTICE

RELATED LEARNING EXPERIENCE (RLE)

A CASE STUDY
ON
ACUTE vs CHRONIC PULMONARY CONGESTION SECONDARY TO
PRE-ECLAMPSIA, UNCONTROLLED

Presented by: BSN 4SA - GROUP 1

Submitted by:

CATAINA, ANGEL JOY R. SALVADOR, KAYLA ZHAINE T.

GARCIA, BERNARD VINCE T. TASSIE, RUTH M.
JANDOC, AILA TRICIA S. TUMANENG, VANNESSA J.
OLIDAN, NOVELYN VILLARMA, ALMIRA NICOLE
ORPILLA, ERICA B.

Presented to:
Level 4 Clinical Instructors + Other Panelists

SEPTEMBER 2023
General Objectives

By the successful completion of the course, BSN 4S-A nursing students will know more

about Acute Pulmonary Congestion secondary to pre-eclampsia, Uncontrolled and be able to

produce synthesis based on real circumstances.

In this case study, we'll examine techniques for managing patients with Acute Pulmonary
Congestion secondary to pre-eclampsia and enhancing any nursing interventions that might be
necessary for their care.

The nursing students in BSN 4S-A will be able to define the following after finishing this

case study. The following activities are created with the intention of achieving the general goals

Specific Objectives

 Assess the patient's condition through building rapport, gathering all necessary information
and perform physical assessment on patient to attain baseline data.
 Determine the client's previous and present health history, and how it might impact the
condition they now have
 Recognize how the current illness is physio pathologically represented.
 Discuss the normal outcomes of an Acute Pulmonary Congestion secondary to pre-
eclampsia, uncontrolled physical exam, diagnostic tests, patient signs and symptoms, and
nursing care for Acute Pulmonary Congestion secondary to pre-eclampsia, uncontrolled
 To conduct a drug study to comprehend the purpose, side effects, and contraindications of
the drug given to the patient.
 Evaluate patient’s condition after treatment and establish a home care and health
 promotion plan
OVERVIEW OF THE DISEASE

Definition

- Acute pulmonary congestion secondary to uncontrolled pre-eclampsia refers to a severe

complication of pre-eclampsia during pregnancy where there is the accumulation of fluid in
the lungs due to elevated blood pressure and impaired cardiac function. This condition can
lead to respiratory distress and is a medical emergency.

Causes

- The primary cause is uncontrolled pre-eclampsia, a hypertensive disorder that occurs

during pregnancy. The exact cause of pre-eclampsia is not fully understood, but it involves
abnormal placental development and immune responses. If left untreated, pre-eclampsia
can progress to acute pulmonary congestion due to the strain it places on the
cardiovascular system.

Signs and Symptoms

Signs and symptoms of acute pulmonary congestion secondary to pre-eclampsia include:

 Severe hypertension (high blood pressure)

 Rapid weight gain due to fluid retention
 Shortness of breath
 Persistent cough
 Pink frothy sputum
 Decreased urine output
 Chest pain
 Altered mental status
 Swelling of the hands, face, and legs (edema)

Risk Factors

Certainly, here are some additional risk factors specifically related to the development of acute
pulmonary congestion secondary to uncontrolled pre-eclampsia:

 Delay in Diagnosis and Treatment - If pre-eclampsia is not diagnosed or managed

promptly, it can progress to severe stages, increasing the risk of acute pulmonary
congestion.
 Poor Blood Pressure Control - Inadequate control of high blood pressure associated with
pre-eclampsia can exacerbate the strain on the cardiovascular system, contributing to
pulmonary congestion.
  Severe Organ Involvement - Pre-eclampsia can affect multiple organs, including the liver
and kidneys. Severe involvement of these organs can increase the risk of complications
like pulmonary congestion.
 High Proteinuria - Higher levels of proteinuria (excess protein in the urine) in pre-eclampsia
can be associated with more severe disease and an elevated risk of pulmonary
complications.
 Multiparous Women - Women who have had multiple pregnancies may be at a slightly
higher risk, especially if they've had pre-eclampsia in previous pregnancies.
 Lack of Prenatal Care - Inadequate prenatal care or missed prenatal appointments can
delay the diagnosis and management of pre-eclampsia, increasing the risk of
complications.
 Non-compliance with Medications - If prescribed medications to control blood pressure or
manage pre-eclampsia are not taken as directed, it can contribute to uncontrolled pre-
eclampsia and its complications.

It's important to emphasize that pre-eclampsia is a serious condition that requires close monitoring
by healthcare professionals during pregnancy. Early detection and appropriate management are
key to reducing the risk of complications, including acute pulmonary congestion. Pregnant
individuals at risk for pre-eclampsia should receive regular prenatal care and follow their
healthcare provider's recommendations closely.

Diagnostic Procedure

Diagnosis typically involves a combination of clinical evaluation and medical tests, including:

 Blood pressure monitoring to detect hypertension

 Blood and urine tests to assess organ function and detect proteinuria (protein in urine)
 Chest X-ray or CT scan to visualize lung congestion
 Echocardiography to evaluate heart function
 Fetal monitoring to assess the well-being of the baby

Medical Management

Treatment of acute pulmonary congestion secondary to pre-eclampsia is urgent and may include:

 Hospitalization for close monitoring

 Medications to lower blood pressure, such as intravenous antihypertensives
 Diuretics to reduce fluid accumulation
 Oxygen therapy to improve oxygenation
 Corticosteroids to accelerate fetal lung maturation if early delivery is considered
  Delivery of the baby, especially if the condition is severe or life-threatening

Nursing Management

Nursing care is crucial in managing this condition and includes:

 Continuous monitoring of blood pressure and vital signs

 Monitoring fetal heart rate and uterine contractions
 Assessing urine output and proteinuria
 Administering prescribed medications and treatments
 Providing emotional support to the mother and family
 Educating the patient about the condition, treatment, and potential risks
 Preparing the patient for delivery if necessary, which may involve coordinating with the
obstetric team

Prompt and coordinated care is essential to minimize the risks associated with acute pulmonary
congestion secondary to pre-eclampsia, both for the mother and the baby. This condition requires
a multidisciplinary approach involving obstetricians, maternal-fetal medicine specialists, nurses,
and other healthcare professionals
PATIENT’S PROFILE

o Name: Patient BIBI

o Age: 43 years Old
o Sex: Female
o Date of Birth: October 10, 1979
o Religion: Roman Catholic
o Civil Status: Married
o Educational Attainment: Elementary Graduate
o Occupation: Housekeeper
o Admission Date: September 08, 2023
o Admission Time: 10:35 am
o Chief Complaint: Labor Pain
o Admitting Diagnosis: G5P4 (4004) 38-39 weeks AOG in labor, Pre-eclampsia, Acute
Pulmonary Congestion
o Final Diagnosis: Acute vs Chronic Pulmonary Congestion Pre-eclampsia, Uncontrolled
o Surgical Procedure: Post Cardiac Arrest, Emergency Primary LTCS under GETA Cardio-
pulmonary resuscitation

PATIENT’S MEDICAL HISTORY

Present Medical History

Two days prior to admission, patient claimed that she felt shortness of breath and weakness but it
sub-side eventually, she disregarded it and thought it was just because she is tired from doing the
household chores.

September 8, 2023, In the early morning, while doing housework, she felt abdominal pain,
dizziness and shortness of breath and began to labor. She passed out on their house, and her
daughter brought her immediately to Quirino Province Medical Center with chief complaint of labor
pain and had her emergency cesarian section. After the surgery, the patient had a cardiac arrest,
which led her to be admitted to the Close Monitoring Unit of the hospital.

Past Medical History

According to the SO, the patient sometimes felt body aches, headaches, or coughs, but she
preferred to take paracetamol to lessen the pain that she experienced. She always took her own
medication because she had no time to bring herself to a clinic or hospital. She has no allergies to
anything, and in addition to that, she has completed her immunization since birth and also had the
COVID-19 vaccine with the first booster.

Ob history

- The patient experienced menarche at the age of 16. Menstruation is regular 2-3 days in
duration and uses 3-4 pads a day, patients experienced occasional dysmenorrhea

YEAR
G1 2003
G2 2005
G3 2008
G4 2012
G5 2023

Social/Psychological History

The patient was a mother of five and a good housewife; she did housework and took care of her
children. She doesn’t have any problems in their community, and her husband is a truck driver, so
usually she’s the only one who stays with their children and house.

Family History

FATHER MOTHER
HTN + +
DIABETES - -
ASTHMA - -
Acute Pulmonary Congestion + -
Pre-eclampsia - +
PHYSICAL ASSESSMENT

PHYSICAL ASSESMENT (HEAD TO TOE)

General survey : Patient BB ,43 years old is in Semi- Fowlers position patient is wearing her
hospital gown .Patient is awake and lethargic ,drowsy sleeps a lot ,but easily aroused with
minimal stimuli but oriented with place or person but not with time .Patient complain of acute pain
in her incision site pain rate of 6/10.
Date of Assesment : September 15,2023
Time of Assessment: 9:00 am
Post-operative date: s
Day of post -operative :
Day of Confinement: 7 days
Vital Signs taken as follow;

Blood Pressure: 130/90 mm/hg

Temperature: 35.6
Pulse Rate: 77 bpm
Respiratory Rate: 23 cpm
SPO2: FIO2 at 6 LPM

REVIEW OF SYSTEMS
 Organ/ Technique  Normal Actual Findings Interpretation
System Findings
Head Inspection  (-) lesion  (-) lesion  Normal
(Facial
features)  (-) areas  (-) areas  Normal
deformity deformity

 Symmetric facial  Symmetric facial  Normal

features features

 (+) Moist skin  (+) Moist skin  Normal

Palpation  (-) tenderness  (-) tenderness  Normal

 (-) masses  (-) masses  Normal

 Evenly  Black, evenly  Normal

distributed distributed
Hair Inspection
 (-) infestation  (-) infestation  Normal

 (-) foul odor  (-) foul odor  Normal

 Pink  Pink  Normal

Eyes Inspection Conjunctivae Conjunctivae

 (-) Periorbital  (-) Periorbital  Normal

Puffiness Puffiness

 White Sclera  White Sclera  Normal

 Eyelashes  Eyelashes  Normal

evenly evenly
distributed distributed

 (+) PERRLA  (+) PERRLA  Normal

 Pupil size are  Pupil size are

equal equal (2mm)  Normal
 No drooping  No drooping
down of eyelids down of eyelids
 Normal
 (-) Same eye  (-) Same eye
color color(black)
 Normal
  Normal

Nose Inspection  (+) Symmetrical  (+) Symmetrical  Normal

 (-) discoloration  (-) discoloration
 Normal
 (+) Nasal  (+) Nasal
mucosa is mucosa is  Normal
pinkish red pinkish red

 (-) discharges  (-) discharges  Normal

 (-) lesions  (-) lesions

 Normal
Palpation  (-) lesions  (-) lesions
 Normal
 (-) masses  (-) masses
 Normal
 (+) patent  (+) patent

Ears Inspection  (-) discharge  (-) discharge  Normal

 (-) redness  (-) redness  Normal
 Symmetrically  Symmetrically  Normal
aligned aligned
 Normal hearing  Normal hearing  Normal
acuity acuity

 Pinna  Pinna  Normal

Palpation immediately immediately
Recoil after it is Recoil after it is
folded folded

Mouth Inspection  (-) swelling  (-) swelling  Normal

 (-) lesions  (-) lesions  Normal

 (-) bleeding  (-) bleeding  Normal

 Lips are Pinkish  Lips are Pinkish  Normal

in color in color

 Gums Pinkish in  Gums Pinkish in

color, color,  Normal
  32 permanent  26 teeth (2
teeth. central incisor  Teeth
and 1 lateral extraction
incisor at upper
jaw (right side)
and first molar
(left and right
side) and canine
at lower jaw (left
side)
(No false teeth)
 Tongue is  Tongue is
pinkish pinkish
 Normal

 (-) oral thrush  (-) oral thrush

 Normal
Neck Inspection  Symmetrical  Symmetrical  Normal
 (-) swelling and  (-) swelling and  Normal
lesion lesion

Palpation  (-)  (-)  Normal

mass,tendernes mass,tendernes
s lumps s lumps

Thorax Inspection  (+) symmetrical  (+) symmetrical

and Lungs expansion with expansion with  Normal
respiration respiration

Palpation  (+) tactile  (+) tactile  Normal

fremitus fremitus

Percussion  (+) resonant  (+) resonant  Normal

sound sound
 Abnormal
Auscultatio  (+) Normal  (+) rales due to
n vesicular pulmonary
breathing congestion
sounds
Heart Auscultatio  (+) regular  (+) regular  Normal
n rhythm rhythm

 (-) Murmur  (-) Murmur  Normal

Upper Inspection  (-) redness  (-) redness  Normal

Extremitie
s  (-) swelling  (-) swelling  Normal

Palpation  Moist skin  Moist skin  Normal

 (-) lesion  (-) lesion  Normal

 (-) masses  (-) masses  Normal

Abdomen Inspection  (-) Scars  Stretch marks  Stretching

of skin due
to previous
pregnancy
 (-) wound  presence of  Cesarean
incision and section
dressings

Auscultatio  5-30 bowel  20 Bowel  Normal

n sounds per Sounds 20
minute bowel sounds of
clicks and
gurgles and
occasional
borborygmus
sounds

 (+) tympanite  (+) tympanite  Normal

Percussion sounds sounds

 (-) tenderness  (+) tenderness  Hypogastri

Palpation c pain due
to vomiting
of coffee
grounds
  (-)  (-)
masses, lesions, masses, lesions,  Normal
swelling swelling

Lower Inspection  (-) lesions  (-) lesions  Normal

Extremitie
s  (-) redness  (-) redness  Normal

 (-) swelling  (-) swelling  Normal

 (-) discharge  (-) discharge  Normal

Inspection  Uniform  Uniform  Normal

Skin complexion complexion

 (-) odor  (-) odor  Normal

 (-) wound  (+) wound  Post-

(incision at operative
hypogastric surgical
region of incision
abdomen )

Palpation  (-) masses,  (-) masses,  Normal

lesions lesions

Inspection  Pinkish  Pinkish  Normal

Nails fingernails and fingernails and
toenails toenails
 Short and clean  Short and  Normal
nails clean nails

 (+) Convex  (+) Convex  Normal

Palpation  1-2 sec capillary  2 sec capillary  Normal

refill time refill time

GORDON’S 11 FUNCTIONAL HEALTH PATTERN

DATE OF INTERVIEW: September 15 ,2023

TIME OF INTERVIEW: 9:00 am

Days of Confinement: 7 Days

LOC: Conscious

FUNCTIONAL HEALTH BEFORE DURING HOSPITALIZATION

PATTERN HOSPITALIZATION
HEALTH PERCEPTION “ang asawa ko ay sa bahay lang Patient was admitted with the chief
AND MANAGEMENT nag ta trabaho. Wala siyang regular complain labor pain. Patient was
na check-up kahit noong nag ordered to be
bubuntis siya” as verbalized by the confined in a close
SO. He also stated that the patient monitoring unit after her CS
often ill and has history of Surgery and due to pre-eclampsia
admissions. She doesn’t take any
vitamins or food supplements as
maintenance. The patient has no
allergies. Patient completed her
Covid-19 vaccines as well as her
booster.
NUTRITIONAL/ According to the SO, the patient Patient has been inserted with
METABOLIC PATTERN consumes 1 ½ cups of rice every
Nasogastric Tube with 1800 kcal in
meal. Before she got hospitalized,
she had a good appetite and had no 6 equal feeding
problem swallowing food. She
drinks water at least 2 liters a day
and she loves to eat fatty and salty
foods such as junk foods and soft
drink.
ELIMINATION PATTERN Before being hospitalized, she Patient is seen with diaper and
regularly defecates. Once or twice a
inserted with foley catheter with
day.
urine output of 200 ml within 2
Feces
hours
 Color: Not stated
 Texture: Not stated
Urine:
She doesn’t have any difficulty in
defecating and urinating.  Color: Light Yellow
 Consistency: Clear
Urine
 Color: Light Yellow
 Consistency: Clear
 Odor: usually unnoticed by
the patient
EXERCISE AND According to the SO, the patient Patient is seen in bed since
ACTIVITY PATTERN
regularly finishes her daily routine. admission with minimal mobility
 She can stretch and exercise her like hand writing and gestures
body by doing household chores
and taking care of her children
SLEEP/REST PATTERN The patient had at least 6 hours of Patient sleep and rest most of the
sleep every day, she goes to bed at time
10 pm and wake up at 4 am in the
morning to prepare breakfast for her
family as verbalize by the SO.
COGNITIVE The SO stated that, the patient The patient communicates through
PERCEPTION PATTERN
speaks Ilocano, she has no hearing hand gestures and writing on the
problem and eye problems, white board

SELF PERCEPTION AND Patient bathe once a day and Patient has diminished self-care
SELF CONCEPT
shower in the afternoon, no history abilities
PATTERN
of plastic surgeries or semi-
permanent make-up, as stated by
the SO
ROLE RELATIONSHIP The SO stated that, the patient gets Patient was uncooperative and
PATTERN
along well with her neighbors and seems irritable due to pain in her
family members specially to her incision site and hypogastric region
children. she’s a kind and loving wife due to vomiting
to her husband, the SO also claimed
that the patient always participate in
different kinds of community
activities.
SEXUALITY AND the patient wrote she had her Patient has no problem in her
REPRODUCTIVE
menarche when she was 16. reproductive organs and no sexual
PATTERN
The SO remarked that they had intercourse since admission
sexual intercourse twice a week

COPING AND STRESS If a patient has a difficulty or is Patient seen in bed and sleep most
TOLERANCE PATTERN
stressed because of her worries, of the time to distract herself from
she will just seek the guidance of being anxious
the almighty father and she likes
watching movies, or she will do
 some fun stuff with her children, she
also communicates with her
husband if she had problems. As
verbalized by the SO
VALUE-BELIEF The patient is a roman catholic and According to the SO, they ask for
PATTERN
she believes in any kinds of Gods healing hand
“pamahiin” and ghost.

ANATOMY AND PHYSIOLOGY

Acute pulmonary congestion (pulmonary edema) and pre-eclampsia are two distinct medical
conditions that affect different systems in the body, but they can both lead to significant health
issues.
Acute Pulmonary Congestion (Pulmonary Edema)

 Lung Anatomy - Acute pulmonary congestion

primarily affects the lungs and their associated blood vessels.
 Pulmonary Capillaries - These tiny blood vessels surround the alveoli (air sacs) in the lungs
and are responsible for oxygen and carbon dioxide exchange.
 Fluid Accumulation- In pulmonary edema, there is an abnormal accumulation of fluid in the
alveoli and interstitial spaces of the lungs.

Your lungs are located in your chest (your thorax). Your thoracic cavity is the name of the space
that contains your lungs and other organs. Your lungs rest on a muscle called your diaphragm.

Your two lungs make oxygen available to your body and remove gases like carbon dioxide. There
are many conditions that can affect your lungs. Not smoking may help you prevent some illnesses.

Healthy lungs are pinkish-gray in color. You’ve probably seen photographs that compare the lungs
of people who smoke to the lungs of people who don’t. Damaged lungs are darker gray and can
have black spots in them.

Your triangularly shaped right and left lungs look a little bit like the ears of an elephant.

A typical lung in Adult Human weighs about 2.2 pounds and is a little longer than 9 inches when
you’re breathing normally, and about 10.5 inches when your lungs are completely expanded.

Pre-eclampsia
  Placenta and Blood Vessels - Pre-eclampsia primarily affects pregnant women and is
believed to originate in the placenta, impacting the cardiovascular and renal systems.
 Blood Pressure - One of the main features of pre-eclampsia is high blood pressure
(hypertension), resulting from narrowed blood vessels and endothelial dysfunction.
 Endothelial Dysfunction - Pre-eclampsia disrupts the proper functioning of endothelial cells
lining blood vessels, leading to vasoconstriction and increased permeability.

COURSE IN THE WARD

Date and Doctor’s order Rationale
Time
September  To ICU  For proper monitoring,
08, 2023 management and evaluation
 Monitor VS q shift  For possible deterioration

 Monitor I/O q shift  For fluid status

 NPO  To allow the effects of

anesthesia to subside and to
monitor for any signs of nausea
and vomiting.
 To prevent aspiration
 IVF: L PNSS 1L + 20 ml Oxytocin
x 30 gtts/min  For access of medication
TF: PNSS 1L x KVO
R PNSS 1L x KVO  Oxytocin prevents excessive
bleeding
MEDS
 Ranitidine 50 mg 1V q8 x 2
doses  To reduce stomach acid
production
 Metoclopramide 10 mg IV q8 PRN  To prevent or reduce post-
operative nausea and vomiting
 Paracetamol 1g IV q8 x 6 doses  It is used for pain management
 Ketorolac 30 mg IV q8 x 6 doses  It is used for pain management
 Tramadol 50 mg IV q6 x 4 doses  It is used for pain management

 Hold Nicardipine drip  Blood pressure decreases to

normal range

 Hook to Mechanical Ventilator @  Patient cannot breathe

ICU, mech vent settings c/o ICU adequately on her own

 ICU medications c/o ICU  For patient’s continues

improvement
 Keep patient thermoregulated  To carefully control and maintain
the patient’s body temperature
 Suction secretions as needed  It helps maintain a clear airway
and improve breathing of a
patient
 Refer  For further management
September # Acute Pulmonary Congestion
08, 2023 Secondary to Pre- Eclampsia Severe
12:50 pm  Late entry
Intraoperatively patient had BP= 0 CR
=0 at 12:12 am
1 amp of epinephrine given every 2
 mins
ACLS was started
Patient was intubated
After the 4th dose of epinephrine given
was rated to have ROSC
 Hold nicardipine drip for now

 Refer
 Please admit to HRPU  For further management
 Hook to mech vent  For continuous monitoring
AC mode  Patient cannot breathe
TV 350 adequately on her own
PEEP 5
BWR 14
FiO2 100
 Start furosemide drip 100 mg in
soluset w/ PNSS to fill 100 cc  To help reduce excess fluid.
PRN
Start at 10cc/hr
 Digoxin 0.25 mg IV now then
0.25 mg IV OD  It helps improve the strength
and efficiency of heart’s
 Insert NGT start of 1800 Kcal x contraction
6 equal feeding
 To provide nutrition and deliver
her foods and medication
supplements directly into
stomach

1:39 pm  Apply ice pack over the uterus  To help reduce swelling and
(+) moderate provide relief from pain
bleeding  increase oxytocin drip x 60  To prevent postpartum
gtts/min hemorrhage
 To help control bleeding
 Give Tranexamic Acid 1g IV  It helps control or minimize
push now bleeding
 For crea, SGOT, SGPT, Na, K,  Creatinine
post-CS CBC To evaluate kidney function
 SGOT/SGPT
To assess liver function
 Na, K
To determine if the patient is having
electrolyte imbalances
 Post-CS CBC
 To check the overall
components of blood after the
 operation
September  Hold NGT feeding temporarily  Possible for respiratory distress
08, 2023  For repeat CXR  For comparison of previous
4:20 pm result
 To detect certain lungs and
heart problems
7:06 pm  Hold furosemide drip  The potassium is low
K- 2.5  Start KCl drip: 10meqs KCl in  It is used to treat low potassium
mmol/L 90 cc PNSS to run for 2 hrs for levels in the body
6 cycles
 Repeat serum K post correction  To see if there is changed in the
result
 Refer accordingly  For further management
10:30 pm  Titrate down FIO2 to q 1-2 hrs  Adjusting the concentration of
at 10 % oxygen that the patient is
 Maintain O2 sat > 95% receiving to achieve a target
oxygen level in their blood
 
September 9,  Continue previous  For patient’s progress
2023 management  For further management
Awake  Refer accordingly
Following
command
Can move
all
extremities
September 9,  Start Metronidazole 500mg IV  To prevent infections
2023 q8
Conscious  Continue Ceftriaxone OD  To prevent infections
Minimal  Continue other meds  For continuous improvement of
bleeding health status of the patient
September 9,  Sift mainline to PNSS 1L +  Serum potassium is low so KCl
2023 80mEq Kcl x 18 hrs is ordered to put K in normal
12:20 pm  Potassium Chloride 600mg tab range
Serum K+ = TID  To treat low K
2.7 mmol/L  Repeat serum potassium tom
 For comparison of previous
result
 To check if there is a changed to
the last result
September 9,  Budesonide 250mg 1 neb q12  To reduce inflammation in the
2023 airways
Conscious  It helps lessen the secretion
coherent  Salbutamol 2.5 mg 1 neb q6  It helps to relax the muscles in
the airways
  It helps lessen the secretions
 12-lead ECG (if not yet  To assess the electrical
requested) conductivity of the heart
September  Troponin I (if not yet requested)  To check if there is a certain
09, 2023 heart condition
3:40 pm  Diazepam 5mg IV now then q4  It helps manage agitation and
for restlessness aggressive behavior
6:23 pm  Start these medicines if diet &
Trop I= oral medicines resumed:
0.38ng/L  Isosorbide mononitrate  To treat angina.
ECG noted 30mg half tablet 2x a day
 Atorvastatin 20mg 1 tab OD  To lower cholesterol and
triglyceride levels in the blood
 Captropril 25mg 1 tab OD  To help manage and improve
cardiac function
8:47 pm  Conitnue present IVF
Awake  For repeat CXR  For comparison of previous
Follows result
command  Maintain current mechvent  For continues monitoring and
settings progress
 Continue monitoring
 Refer  For further management
September  IVF TF PLRS 1L x KVO while  It helps correct electrolyte
10, 2023 waiting for repeat serum K imbalances
6am result
 Continue present management  For patient’s progress
 Continue IV antibiotic
September  Omeprazole 40 mg IV now  To inhibit the production of acid
10, 2023 in the stomach
7am

+epigastric
pain
September  Give furosemide 40 mg IV now  To help reduce excess fluid
10, 2023  Refer  For further management
8:15 am
Input: 2332
Output: 700
BP: 120/80
September  For trial of weaning  To check if the patient improves
10, 3:40 pm  SIMV mode, FIO2 40%, BUN= her breathing
(-) 8, PS= 8, PEEP= 5
desaturation  Shift to CPAP @ 4am tom
Dyspnea (9/11/23)
Chest pain  If tolerated may do possible
Fever extubation
 For ABG at 6am if available  To see how well your lungs are
Fully awake working.

 Continue monitoring
 Refer  For further management
September  Diazepam 5g/IV now  To help manage the aggressive
10, 2023 behavior of patient
8pm  Atropine 1 amp/IV now  To treat a slow heartbeat
(+)  Sudden cardiac arrest
restlessness  ACLS done
 Epinephrine 1mg/IV now then q  To reverse cardiac arrest
Pt. had 3 minutes x 2 doses
sudden  + return of Spontaneous
stiffing of Circulation
upper HR: 120
extremities BP: 120/70
O2SAT: 90-95 %
 S/P reintubation using ET size
7.0 @ lip lines 21
(+) thick  Repeat CXR-AP post
mucus intubation; ABG’s
phlegm with  For ETA AS/CS i  To eliminate secretions of
 Mech vent settings: patient and check if there is a
AC Mode presence of bacteria
TV:350
PEEP: 5
FIO2: 100%
BUR: 18
 Suction secretions PRN
 Diazepam 5g/IV PRN for  It helps maintain a clear airway
seizure and improve breathing of a
patient
 PNSS 100cc in a soluset x 4  It is used to provide immediate
hrs relief during seizures

 For patient’s continuous

 Continue close monitoring improvement
 For further management
 Refer

Add:  It helps control hear rate

 Give Lanoxin 0.25 mg IV now  For prevention of sputum
 Salbutamol + Ipratropium neb plugging
now  For prevention of sputum
  Budesonide nebulization now plugging
then q12
September  Suction secretions PRN  It helps maintain a clear airway
11, 2023 and improve breathing of a
5:35 am patient
 Continue meds  For continuous improvement of
 Continue monitoring health status of the patient
 For change of dressing
11:01 am  IVF TF: PLRS 1L x KVO  it helps restore and maintain
 Decrease FIO2 by 10% every 2 intravascular volume in critically
hrs if tolerated to maintain ill patient
SPO2 > 93% until 40%
 Suction secretions  it helps maintain a clear airway
and improve breathing of a
patient
 Continue present management
 refer  for further management
September  continue management  for improvement of the patient
12, 2023  daily wound dressing  to ensure proper healing and
minimize the risk of infection
(+) BM  refer  for further management
September  to repeat CBC, Crea, Na, K  For comparison of previous
13, 2023  Trial SIMV result
 Continue meds  For continuous improvement of
(+) thick health status of the patient
phlegm  TF: PNSS 1L x KVO  For hydration
 Refer accordingly  For further management
 Suction secretions as needed  It helps maintain a clear airway
and improve breathing of a
patient
 Continue meds  For continuous improvement of
health status of the patient
 VS q1  For possible deterioration

 Tramadol 50 mg q8 x 3 doses  For pain management

 Piptaz 1 g q6  To reduce the risk of infection.

September  MV setting
13, 2023 PSV
PS 8
Possible extubation this pm
6:48 pm  Repeat CXR- AP  For comparison of previous
(+) cough result
BP=160/100  Give Hydrocortisone 100 mg IV  To maintain adequate blood
now pressure
  ET was remained
 Salbutamol + Ipratropium  For prevention of sputum
plugging
 Hook to FIO2 at 6 LPM

 PNSS 1L x KVO  For hydration

 Facilitate BT 2-3 in PRBC  For BT because of low hgb level
properly typed and
crossmatched
 Repeat CBC post BT at 2nd unit  To check if there is a changed in
previous result

 Hold Captropril
 Clonidine 75 mcg 1tab SL now  It lowers high blood pressure
 Start amlodipine 10 mg 1tab  It lowers high blood pressure
now
 Metropolol 50mg 1tab BID  It lowers high blood pressure
8:38 pm  Start nicardipine drip, 10 mg in  To lower blood pressure
BP: 160/100 90 cc PNSS x 10 cc/hr
 Refer  For further management
September  PNSS 1L x KVO  For hydration
14, 2023  Titrate nicardipine drip
5:30 am accordingly
 Continue present management
September  NPO for now; attach NGT BSB  To check the residual coming
14, 2023 from the patient’s stomach
7:52 am  Monitor CBG of 6 hrs; for CBG  To check if the sugar is too low
< 80 give D5050 half vial; for or too high because she is on
(+) coffee CBG < 70 give D5050 1 vial NPO
ground  Omeprazole 80 mg IV as
NGT loading dose then 40 mg IV q  To reduce the acid production in
aspirated 12 hrs the stomach
 Shift IVF to D5NSS 1L x KVO
once BT done  To help maintain fluid balance
and electrolyte level
 To maintain hydration and
provide essential nutrients to the
 Refer body
 For further management
LABORATORIES AND DIAGNOSTICS
Patient Name: Patient Bibi
Age: 43 Sex: Female

HEMATOLOGY
Date: 9/8/23 time: 11:38 am
Laboratory Result Unit Normal Values Interpretation
WBC 9.75 4.00-10.00 Normal
Neu# 7.40 2.00-7.00 The neutropils slightly high
due to the increasing levels of
stress hormones produced by
the body
Lym# 1.79 0.80-4.00 Normal
Mon# 0.43 0.12-1.20 Normal
Eos# 0.11 0.02-0.50 Normal
Bas# 0.02 0.00-0.10 Normal
Neu% 75.9 50.0-70.0 Having a high percentage of
neutrophils in your blood is
called neutrophilia. This is a
sign that your body has an
infection.
Lym% 18.4 20.0-40.0 Normal
Mon% 4.4 3.0-12.0 Normal
Eos% 1.1 0.5-5.0 Normal
Bas% 0.2 0.0-1.0 Normal
RBC 3.55 3.50-5.00 Normal
HGB 112 110.150 Normal
HCT 32.5 37.0-47.0 Lower than normal range
the plasma volume
increases more, result in
a relative anemia
MCV 91.7 80.0-100.0 Normal
MCH 31.7 27.0-34.0 Normal
MCHC 346 320-360 Normal
RDW-CV 12.7 11.0-16.0 Normal
PLT 391 150-450 Normal
Date: 9/8/23 time: 5:21 pm
Laboratory Result Unit Normal Values Interpretation
WBC 23.29 4.00-10.00 Slightly Higher than normal range
WBC count in pregnancy implies that
there is infection in the body.

Neu# 21.54 2.00-7.00 The neutropils slightly high due to

the increasing levels of stress
hormones produced by the body
Lym# 1.04 0.80-4.00 Normal
Mon# 0.68 0.12-1.20 Normal
Eos# 0.01 0.02-0.50 Lower than normal range the
eosinophil counts are low
during pregnancy, reaching their
nadir around delivery, thus
pregnant women may have
falsely low numbers of
eosinophils in response to
parasitic infection.
Bas# 0.02 0.00-0.10 Normal
Neu% 92.5 50.0-70.0 Having a high percentage of
neutrophils in your blood is called
neutrophilia. This is a sign that your
body has an infection.
Lym% 4.5 20.0-40.0 Lower than normal range of
fewer circulating cytotoxic
lymphocytes capable of directly
recognizing and targeting fetal
antigens
Mon% 2.9 3.0-12.0 Low levels of monocytes the
medical conditions that lower
your overall white blood cell
count or disease treatments that
suppress the immune system
Eos% 0.0 0.5-5.0 Low eosinophils level has
several potential causes,
including: acute infections
Bas% 0.1 0.0-1.0 Normal
RBC 4.04 3.50-5.00 Normal
HGB 128 110.150 Normal
HCT 36.4 37.0-47.0 Low hematocrit may due to:
anemia, bleeding, bone marrow
being unable to produce new
red blood cells
MCV 90.2 80.0-100.0 Normal
MCH 31.7 27.0-34.0 Normal
 MCHC 351 320-360 Normal
RDW-CV 12.7 11.0-16.0 Normal
PLT 416 150-450 Normal

Date:9/13/23 time: 6:05 am

Laboratory Result Unit Normal Values Interpretation
WBC 8.07 4.00-10.00 Normal
Neu# 5.92 2.00-7.00 Normal
Lym# 1.54 0.80-4.00 Normal
Mon# 0.40 0.12-1.20 Normal
Eos# 0.19 0.02-0.50 Normal
Bas# 0.02 0.00-0.10 Normal
Neu% 73.0 50.0-70.0 Having a high percentage of neutrophils in
your blood is called neutrophilia. This is a
sign that your body has an infection.
Lym% 19.0 20.0-40.0 Lower than normal range of fewer
circulating cytotoxic lymphocytes
capable of directly recognizing and
targeting fetal antigens
Mon% 5.1 3.0-12.0 Normal
Eos% 2.3 0.5-5.0 Normal
Bas% 0.1 0.0-1.0 Normal
RBC 2.52 3.50-5.00 Lower than normal range the RBC
does not have enough iron and other
vitamins
HGB 78 110.150 Fall hemoglobin levels during
pregnancy is caused by a greater
expansion of plasma volume
compared with the increase in red
blood cells
HCT 23.0 37.0-47.0 Low hematocrit may due to: anemia,
bleeding, bone marrow being unable
to produce new red blood cells
MCV 91.5 80.0-100.0 Normal
MCH 31.1 27.0-34.0 Normal
MCHC 340 320-360 Normal
RDW-CV 12.4 11.0-16.0 Normal
PLT 277 150-450 Normal
CLINICAL CHEMISTRY- A
Date 9/8/23 time: 6:23 am
Test Result Normal Value Interpretation
fasting Blood Sugar 4.10-5.90 N/A
Total Cholesterol <5.2 N/A
Triglycerides <1.69 N/A
HDL 1.03-1.55 N/A
LDL <2.59 N/A
Blood Urea M:3.2-7.1 mmol/L N/A
Nitrogen UV F: 2.5-6.1mmol/L
Creatinine 67 M:58-110umol/L Normal
F: 46-92 umol/L
Blood Uric Acid M:208-506 umol/L N/A
F: 149-369 umol/L
SGOT/AST 49 M: 17-59 U/L Elevated serum of AST in
F: 14-36 U/L preeclampsia is explained by
the effect of hypoxia on the
liver in preeclampsia
pregnancy.
SGPT/ALT 25 M:21-72 U/L Normal
F9-52 U/L

ELECTROLYTES
Test Result Normal Value Interpretation
Sodium 135 135.0-145 Normal
Potassium 2.5 3.5-5.1 Lower than normal range
can cause severe muscle
weakness or
rhabdomyolysis which can
cause respiratory muscle
weakness, which can be
severe enough to result in
respiratory failure.
Chloride 98-107 N/A
Calcium (total) 2.10-2.55 N/A
Calcium (ionized) 1.05-1.25 N/A

CLINICAL CHEMISTRY- F
Test Result Normal Value Interpretation
Albumin 35-50 N/A
Magnesium 0.7-1.0 N/A
Phosphorus 0.81-1.45 N/A
Date: 9/9/23 time: 10:20 am
ELECTROLYTES
Test Result Normal Interpretation
Value
Sodium 135.0-145 N/A
Potassium 2.7 3.5-5.1 Lower than normal range can cause severe
muscle weakness or rhabdomyolysis which
can cause respiratory muscle weakness,
which can be severe enough to result in
respiratory failure.
Chloride 98-107 N/A
Calcium 2.10-2.55 N/A
(total)
Calcium 1.05-1.25 N/A
(ionized)

CARDIAC MARKER
Cardiac Marker Specimen Result Interpretation
CK-MB Serum - -
Troponin l Serum 0.38 ng/ml Higher than normal range
of troponin l is may reflect
the role of cardiac stress

Date: 9/10/23 time: 7:25 am

ELECTROLYTES
Test Result Normal Value Interpretation
Sodium 135.0-145 N/A
Potassium 3.8 3.5-5.1 Normal
Chloride 98-107 N/A
Calcium (total) 2.10-2.55 N/A
Calcium (ionized) 1.05-1.25 N/A

Date: 9/13/23 time: 6:32 am

CLINICAL CHEMISTRY-A
Test Result Normal Value Interpretation
fasting Blood Sugar 4.10-5.90 N/A
Total Cholesterol <5.2 N/A
Triglycerides <1.69 N/A
HDL 1.03-1.55 N/A
LDL <2.59 N/A
Blood Urea M:3.2-7.1 mmol/L N/A
Nitrogen UV F: 2.5-6.1mmol/L
 Creatinine 54 M:58-110umol/L Normal
F: 46-92 umol/L
Blood Uric Acid M:208-506 umol/L N/A
F: 149-369 umol/L
SGOT/AST M: 17-59 U/L N/A
F: 14-36 U/L
SGPT/ALT M:21-72 U/L N/A
F9-52 U/L

ELECTROLYTES
Test Result Normal Interpretation
Value
Sodium 132 135.0-145 Lower than normal range preeclampsia and
nephrotic-range proteinuria together result in
a low effective circulating volume
Potassium 3.3 3.5-5.1 Lower than normal range can cause severe
muscle weakness or rhabdomyolysis which
can cause respiratory muscle weakness,
which can be severe enough to result in
respiratory failure.
Chloride 98-107 N/A
Calcium 2.10-2.55 N/A
(total)
Calcium 1.05-1.25 N/A
(ionized)

URINALYSIS
CHEMICAL EXAMINATION INTERPRETATION

Leukocytes Positive (++)  It could be a sign of

infection
Nitrite Negative  Lack of dietary nitrate,
dilution of urine and
exogenous interference.
 A blockage in the ducts
that carry bile from your
liber or gallbladder to
your intestines
Urobilinogen Negative
 Two plus protein means
Protein Positive (++) that you have protein in
your urine

pH 7.0  A pH 7 is neutral whereas

a pH result below 7 is
acidic
 Blood Negative  A low or negative urine
occult blood test is
normal and healthy
SP. Gravity 1.025 Normal ranges 1.005 to 1.030

Ketone Negative  A negative test result

means the ketone levels
are normal for the
individual
Bilirubin Negative  It may be an early sign of
a liver condition
Glucose Negative  A negative urine glucose
test may be result of a
normal blood glucose
level.

MICROSCOPIC EXAMINATION INTERPRETATION

Pus cells 30-35  Are indication of urinary tract

infection

Red Blood Cells 2-5  There is a problem with the

Type: urinary tract

Epithelial cells Moderate  Sign of condition such

Type: as: urinary tract
infection, Yeast
Infection, Kidney
disease, and liver
disease
Mucus threads - -

Bacteria Moderate Urinary tract infection

Yeast cells - -

CRYSTALS:
A. Urates (acidic)  Hypophosphatemia happens
A. Phosphate when you have a low level of
(alkaline) Moderate phosphate in your body.
CLINICAL CHEMISTRY- F
Test Result Normal Value Interpretation
Albumin 35-50 N/A
Magnesium 0.7-1.0 N/A
Phosphorus 0.81-1.45 N/A

RADIOLOGY RESULT
EXAMINATION REQUESTED: CHEST
AP
Date: September 8,2023
Interpretation:
Follow-up study to the one done
September 8, 2023 shows further
regression of the previously described
pulmonary congestion.
Same degree of cardiomegaly is
observed.
ET tube is still noted with its tip seen at
the level of the T4-T5vertebra, now more
oriented into the main bronchus. Would
suggest minimal adjustment as per
clinical discretion.
Gastric tube is likewise seen in situ
Other previous findings remain
unchanged.
September 10,2023
CHEST PA:
Follow up film after 09-10-2023, showed interval repositioning of the ET tube, the tip
of which is at the level of T4. The cardiomegaly and mild pulmonary congestion
remain noted. Diaphragm and sulci are intact.
RADIOLOGY
DATE: JUNE 27,2023
EXAMINATION: PELVIC UTZ
EXAMINATION REQUESTED: CHEST AP- ff up
Date: September 8,2023
Interpretation:
Follow-up study to the one done on the same day
at 11:26 am shows significant regression of the
previously described pulmonary congestion.
Concurrent pneumonia cannot totally be
excluded.
Same degree of cardiomegaly is observed.
ET tube is seen situ with its tip seen at the level
of the T4-T5 vertebra.
Gastric tube is likewise seen in situ.
Other previous findings remain unchanged
IMPRESSION:
 SINGLE, LIVE, INTRAUTERINE
PREGNANCY
 CEPHALIC IN PRESENTATION
 PLACENTA POSTERIOR, GRADE 2.
 28 WEEKS 1 DAY SONAR AGE.
 ADEQUATE AMNIOTIC FLUID
 MALE
 NURSING CARE PLAN

NURSING CARE PLAN: PRIORITY 1

NAME: PATIENT BIBI
DATE OF ASSESMENT: September 13,2023
ASSESSMENT NURSING PLANNING NURSING INTERVENTION RATIONALE
DIAGNOSIS
Objective: Ineffective airway SHORT TERM: INDEPENDENT:
1. Presence of clearance related to Within 4 hours of 1. Monitored oxygen 1. Baseline data
rales pulmonary nursing intervention saturation levels and
(bilateral) congestion the patient will be able oxygen 2. Indicative of respiratory
2. Patient is to: 2. Monitored respirations distress or accumulation of
intubated maintain oxygen and breath sounds, secretions
3. Patient is saturation within the noting rate and sounds 3. To facilitate breathing and
seen with target range 3. Elevated the head of lung expansion
nasal the bed to a Semi-
cannula LONG TERM: fowlers position
4. Use of After 3 days of nursing 4. Changed the patients 4. Frequent change in
accessory intervention patient will position every two positioning promotes
muscles in be able to: hours drainage and lung
breathing Report improve ease secretions
(Trapezius of breathing and
muscle) reduced respiratory 5. Encouraged and 5. To mobilize and expectorate
distress. assisted the patients in secretions
Vital signs: Patient will exhibit coughing
BP:140/100 mm/Hg improved comfort and 6. Ensured adequate 6. Help liquefy respiratory
O2: 97% reduced anxiety hydration and secretions making them
related to respiratory administered prescribed easier to clear and alleviate
distress intravenous fluids pulmonary congestion
Patient will be able to
maintain airway 7. Provided education on 7. To enhance lung expansion
 patency deep breathing
exercises 8. Help manage patients
overall fluid balance and
8. Monitored fluid intake prevent complications
and output
9. to maintain oxygen
DEPENDENT: saturation within the target
9. Administered range
supplemental oxygen
as prescribed
10. To manage underlying
10. Administered cause of pulmonary
prescribed medications congestion
such as metropolol
11. Administered 11. Salbutamol is a
Salbutamol bronchodilator medication. It
works by relaxing the
smooth in muscles in airway
12. Performed 12. To remove excess
endotracheal suctioning secretions and maintain
airway patency

NURSING CARE PLAN: PRIORITY 2

NAME: PATIENT BIBI
DATE OF ASSESMENT: September 13,2023
TIME: 9:00 AM
ASSESSMENT NURSING PLANNING NURSING RATIONALE EVALUATION
DIAGNOSIS INTERVENTION
OBJECTIVE: Increased cardiac SHORT TERM: INDEPENDENT: SHORT TERM:
 + output related to Within 5 hours of 1. Monitored Vital 1. Establish a After 5 hours of
restlessness elevated blood nursing signs regularly baseline and nursing intervention,
 Use of pressure secondary intervention, the track changes the patient was able
accessory to Pulmonary patient will be able 2. Placed patients 2. Decreases to demonstrate
muscles in
breathing congestion as to demonstrate in semi-fowlers oxygen absence of
(Trapezius evidenced by Blood absence of position consumption tachycardia, blood
muscle)
 Vital Signs: pressure of tachycardia, blood and facilitate pressure and

 BP: 140/100 140/100 mm/Hg, pressure and breathing respiratory rate are

mm/Hg Heart Rate of 110 respiratory rate are 3. Encouraged 3. Reduce anxiety, close to normal

 HR: 110 bpm bpm and within or close to relaxation conserve range as evidenced
Respiratory Rate of normal range techniques energy and by blood pressure of
 RR: 24 cpm
24 cpm such as deep muscle tension 130/90 mm/Hg,
LONG-TERM breathing Heart rate of 100
GOAL: exercise bpm and respiratory
After 3 days of 4. Created a calm 4. Minimize stress rate of 20
nursing and quiet and induced
intervention, the environment rest LONG-TERM
patients will be able GOAL:
to display
hemodynamic INDEPENDENT: After 3 days of
stability 5. Administered 5. To increase nursing intervention,
supplemental oxygen the patients was
O2 via face available for able to display
mask cardiac function hemodynamic
stability
6. Changing
6. Provided skin
patients
protective
position, help
measures such
redistribute
as frequent
pressur3 and
positioning
relieve
every two hours
vulnerable
areas reducing
risk of pressure
ulcers
formation

7. Measured and
7. To monitor fluid
recorded intake
balance closely
and urine
output
8. Metropolol
8. Administered
(beta-blockers)
Metropolol
reduces the
50mg
force and rates
 of the hearts
contractions
and dilate blood
vessels

NURSING CARE PLAN: PRIORITY 3

NAME: PATIENT BIBI
DATE OF ASSESMENT: September 13,2023
TIME: 9:00 AM
ASSESSMENT NURSING PLANNING NURSING RATIONALE EVALUATION
DIAGNOSIS INTERVENTION
Subjective: Acute pain related Within 1 hour of Independent: After 1 hour of
Patient answered on to surgical incision nursing 1. Observed non- 1. The pain was a nursing intervention,
a whiteboard, rating secondary to intervention, the verbal cues of subjective the client was able
her discomfort 6 out cesarean section patient will be able pain. experience and to gesture pain
of 10 to gesture reduced cannot be felt scale 5/10 from 6/10
pain scale from by others. and demonstrated
Objective data: 6/10 to 5/10 and 2. Monitored skin 2. Are usually relaxation
 Patient is demonstrate color and altered during techniques as
pointing at her relaxation temperature acute pain indicated for
incision site techniques as and vital signs. individual situation.
and was seen indicated for
with dressing individual situation. 3. Encouraged 3. Distract the Goal met.
 facial grimace use of attention from
relaxation the pain.
techniques
such as deep
breathing
exercise. 4. To prevent
4. Encouraged fatigue that can
patient to have impair ability to
 adequate rest. manage pain.

Dependent: 5. Tramadol is an
5. Administered opiod
Tramadol 50mg analgesic,
prescribed to
relieve
moderate pain
to severe pain

DRUG STUDY
DRUG NAME MECHANISM OF ACTION INDICATION & SIDE EFFECT AND ADVERSE NURSING
CONTRAINDICATION REACTION RESPONSIBILITIES

Generic Name: Thought to produce Indication:  Headache Before:

Paracetamol analgesics by inhibiting It is used for pain  Drowsiness  Assess any history
prostaglandin and other management  Rash of allergy with this
Brand Names: substances that sensitive  Nausea and Vomiting drug.
pain receptors. Constipation
Classification:  abdominal pain
Analgesics During:
 Follow the rights of
Dosage: medication
1g administration.
 Instruct patient to
Route: Contraindication: report discomfort at IV
Intravenous Contraindicated in patients site.
hypersensitive to drug.
Frequency:
Q6

Timing: After:
 Tell patient to report
all hypersensitivity
reaction.
 Monitor the patient’s
response to the
medication.

DRUG NAME MECHANISM OF ACTION INDICATION & SIDE EFFECT AND ADVERSE NURSING
CONTRAINDICATION REACTION RESPONSIBILITIES
Generic Name: Inhibits proton pump Indication:  Nausea and vomiting Before:
Omeprazole activity by binding to To reduce the acid  Headache  Assess for possible
hydrogen-potassium production in the stomach  Diarrhea contraindications and
Brand Names: adenosine triphosphatase,  Constipation cautions: history of
Prilosec located at secretory  Back pain allergy to a proton
surface of gastric parietal  Rash pump inhibitor to
Classification: cells, to suppress gastric  Abdominal pain reduce the risk of
Antiulcer drugs acid secretion. hypersensitivity
reaction
Dosage:
80 mg
During:
Route: Contraindication:  Follow the rights of
Intravenous Contraindicated in patients medication
hypersensitive to drug or its administration.
Frequency: components and in patients  Instruct patient to
Q12 receiving rilpivirine- report discomfort at IV
containing products. site.
Timing:
After:
 Tell patient to report
all hypersensitivity
reaction.
 Monitor the patient’s
response to the
medication.

Drug name Mechanism of Actions Indications and Side effect Adverse reaction Nursing Responsibility
Contraindications
Generic Name: Unknown. Thought to bind Indication:  Constipation Before:
to opioid receptors and It is used for pain  Dizziness  Instruct patient to
Tramadol inhibits reuptake of management  Drowsiness immediately report
norepinephrine and  Loss of appetite hypersensitivity
Brand Name: serotonin.  Nausea and vomiting reaction.
 Sweating
Conzip  Muscle weakness During:
Contraindication:  Follow the rights of
Classification: Contraindicated in patients medication
hypersensitive to drug or administration.
Analgesics opioids.  Instruct patient to
report discomfort at
IV site.
Actual Dosage:  Assess patient’s level
of pain at least 30
50 mg minutes after
administration.
Route:
After:
Intravenous  Discontinue drug and
notify physician if
Frequency: sign and symptoms
Q8 of hypersensitivity
occur.
 Monitor the patient’s
response to the
medication.

DRUG NAME MECHANISM OF ACTION INDICATION & SIDE EFFECT AND ADVERSE NURSING
CONTRAINDICATION REACTION RESPONSIBILITIES
Generic Name: Inhibits HMG-CoA Indication: Before:
Atorvastatin reductase, an early (and To lower cholesterol and CNS:  Check physicians
rate-limiting) step in triglyceride levels in the  Headache order.
Brand Names: cholesterol biosynthesis. blood  asthenia  Assess any history
Lipitor GI: of allergy with this
 abdominal pain drug.
Classification:  cramps
Antilipemics  constipation
 nausea
Dosage: During:
Contraindication:
20 mg  Administered the
Contraindicated in patients
right dose at the
hypersensitive to drug.
Route: right time.
Oral  Instruct the patient
to swallow the whole
Frequency: tablet; do not cut,
OD crush, and crew.
 Discussed the side
Timing: and adverse effect.

After:
 Instruct patient to
immediately report
hypersensitivity
reaction.
 Monitor the patient’s
response to the
medication.
 Drug name Mechanism of Actions Indications and Side effect and Adverse Nursing Responsibility
Contraindications effect
Generic Name: Stimulate alpha2 Indication: Side Effect: Before:
receptors and inhibit the For hypertension  Dry mouth  Monitor the patient
Clonidine central vasomotor  Drowsiness BP carefully.
centers, decreasing  Dizziness  Advised patient to
Brand Name: sympathetic outflow to  Constipation take drug exactly as
the heart, kidneys, and Contraindication:  Sedation prescribed and not
Catapres peripheral vasculature  Contraindicated in to stop abruptly
and lowering peripheral patients Adverse Effect: because withdrawal
Classification: vascular resistance, BP, hypersensitive to  Vomiting symptoms and
Antihypertensives and HR. drug.  Loss appetite severe hypertension
 Malaise may occur.
 Weight gain During:
Dosage:  Rash  Administered the
right dose at the
75 mg right time.
 Discussed the side
Route: and adverse effect.
 Administer the drug
Oral without regard to
meals.
Frequency:
After:
 Tell patient to report
immediately all
hypersensitivity
reaction.
 Instructed patient to
consult prescriber if
dry mouth or
drowsiness become
a problem.

Drug name Mechanism of Actions Indications and Side effect and Adverse effect Nursing Responsibility
Contraindications
Generic Name: Enters target cells and
Hydrocortisone binds to cytoplasmic
receptor; initiates many
complex reactions that
Brand Name: are responsible for its
Cortef anti-inflammatory,
immunosuppressive
Classification: (glucocorticoid), and salt-
Corticosteroids retaining
(mineralocorticoid)
Dosage: actions. Some actions
maybe undesirable,
100 mg depending on drug use.
Route:
Intravenous
Frequency:
Now
Drug name Mechanism of Actions
Indication:
To maintain adequate
blood pressure
Contraindication:
Contraindicated in patients
hypersensitive to drug.
Indications and
Contraindications
 Vertigo
 Headache
 Hypotension
 Shock
 Muscle weakness
 Nausea and Vomiting
 GI irritation
Side effect and Adverse effect
Before:
 Assess any history
of allergy with this
drug.
During:
 Follow the rights of
medication
administration.
 Instruct patient to
report discomfort at
IV site.
After:
 Monitor client for at
least 30minutes.
 Tell patient to report
immediately all
hypersensitivity
reaction.
Nursing Responsibility
Generic Name: Inhibits sodium- Indication:  Tachycardia Before:
Digoxin potassium-activated It helps improve the  Headache  Assess any history
adenosine strength and efficiency of  Dizziness of allergy with this
Brand Name: triphosphatase, heart’s contraction  Mental disturbances drug.
Lanoxin promoting movement Nausea and Vomiting
of calcium from Diarrhea
Classification: extracellular to  Anorexia During:
Inotropes intracellular cytoplasm  Blurred or yellow vision  Follow the rights of
Contraindication:
and strengthening medication
Contraindicated in patients
Dosage: myocardial contraction administration.
hypersensitive to drug.
0.25 mg Also acts on CNS to  Educate patient
enhance vagal tone, about side effects.
Route: slowing conduction  Monitor apical
Intravenous through the San and AV pulse for 1 minute
nodes. before
Frequency: administering.
OD

After:
 Instruct patient not
to stop taking drug
without notifying
physician.
 Instruct to report
slow or
irregular pulse, rapid
weight gain, loss
of appetite, nausea,
diarrhea, vomiting.
 Tell patient to report
immediately all
hypersensitivity
reaction.
 Drug name Mechanism of Actions Indications and Side effect and Adverse effect Nursing Responsibility
Contraindications
Generic Name: Potentiates the effect of Indication:  Hypotension Before:
Diazepam GABA, depresses the To help manage the  Dizziness  Assess any history
CNS, and suppresses aggressive behavior of  Drowsiness of allergy with this
Brand Name: the spread of seizure patient  Headache drug.
Valium activity.  Diarrhea  Monitor the patient
 Nausea and Vomiting BP carefully.
Classification:
Anxiolytics
Contraindication:
During:
Contraindicated in patients
Dosage:  Follow the rights of
hypersensitive to drug.
5 mg medication
administration.
Route:  Instruct patient to
Intravenous report discomfort at
IV site.
Frequency:  Educate patient
about side effects.

After:
 Tell patient to report
immediately all
hypersensitivity
reaction.
 Monitor the
patient’s response
to the medication.

Drug name Mechanism of Actions Indications and Side effect and Adverse effect Nursing Responsibility
 Contraindications
Generic Name: Stimulants mobility of Indication:  Restlessness Before:
Metoclopramide upper GI tract, increases To prevent or reduce post-  Drowsiness  Assess any history
lower esophageal operative nausea and  Fatigue of allergy with this
Brand Name: sphincter tone, and vomiting  Lassitude drug.
Regan blocks dopamine  Insomnia  Keep
receptors at the  Extrapyramidal reactions diphenhydramine
Classification: chemoreceptor trigger  Dizziness injection readily
GI stimulants zone.  Anxiety available in case
Contraindication:
 Transient hypertension extrapyramidal
Contraindicated in patients
Dosage:  Nausea reactions occur.
hypersensitive to drug.
10 mg  Diarrhea

Route: During:
Intravenous  Follow the rights of
medication
Frequency: administration.
Q8, PRN  Instruct patient to
report discomfort at
IV site.
 Monitor the patients
BP carefully.

After:
 Tell patient to report
immediately all
hypersensitivity
reaction.
 Educate patient
about side effects.
 Monitor the
patient’s response
to the medication.

Drug name Mechanism of Actions Indications and Side effect and Adverse effect Nursing Responsibility
Contraindications
Generic Name: A selective beta blocker Indication:  Nausea and vomiting Before:
Metoprolol that selectively blocks To lower the blood  Shortness of breath  Assess any history
beta 1 receptors; pressure  Bradycardia of allergy with this
Brand Name: decreases cardiac To decrease intensity of  Rash drug.
Lopressor output, peripheral angina attacks  Dizziness  Monitor the patient
resistance, and cardiac  Drowsiness blood pressure
Classification: oxygen consumption; Contraindication:  Fatigue before and after
Antihypertensives and depresses renin Contraindicated in patients  Headache administering the
secretion. hypersensitive to drug or  Constipation drug.
Dosage: other beta blockers.  Hypotension
50 mg  bradycardia
During:
Route:  Follow the 14 right
Oral of medication
administration.
Frequency:  Instruct the patient
BID to swallow the
whole tablet; do not
cut, crush, and
crew.
 Educate patient
about side effects.

After:
 Tell patient to report
immediately all
hypersensitivity
reaction.
 Monitor the
patient’s response
to the medication.

Drug name Mechanism of Actions Indications and Side effect and Adverse Nursing Responsibility
Contraindications effect
 Generic Name: Inhibits adrenergic Indication:  Dizziness Before:
Amiodarone stimulant and blocks Prevention of recurrent life-  Fatigue  Assess any history
sodium channels, threatening ventricular  Headache of allergy with this
Brand Name: leading to a arrhythmias.  Constipation drug.
Pacerone prolongation of action  Hypotension  Monitor the patient
potential duration.  Bradycardia blood pressure
Classification:  Nausea and vomiting before and after
Antiarrhythmics Contraindication: administering the
Contraindicated in patients drug.
Dosage: hypersensitive to drug or to
10 mg iodine.
During:
Route:  Follow the rights of
Oral medication
administration.
Frequency:  Educate patient
OD about side effects.

After:
 Monitor cardiac
rhythm continuously.
 Tell patient to report
immediately all
hypersensitivity
reaction.
 Monitor the patient’s
response to the
medication.

Drug Name Mechanism of Action Indication and Adverse Effect and Side Nursing Responsibility
Contraindication Effect
Generic Name: Replaces potassium Indication: Side Effects: Before:
Potassium chloride and maintains  To treat low K  Assess any history
potassium levels  confusion of allergy with this
Brand Name:  restlessness drug.
Klor-Con Contraindication:  weakness
Contraindicated in patient During:
Classification: hypertensive to potassium Adverse Effect:  Follow the rights of
Potassium chloride or components of medication
supplement the formulation.  cardiac arrest administration.
 hypotension
Dosage:  vomiting After:
Tab
 Monitor patients’
Route: response to the drug
Oral  Tell patient to report
all hypersensitivity
Frequency: reaction.
TID

Drug Name Mechanism of Indication and Adverse Effect and Side Nursing Responsibility
Action Contraindication Effect
Generic Name: Inhibits ACE, Indication: Side Effects: Before:
Catopril preventing Management of  Assess any history
conversion of hypertension and heart  dizziness of allergy with this
Brand Name: angiotensin l to failure  fatigue drug.
Kaptoepril angiotensin ll, a  headache  Monitor the patient BP
potent Contraindication: carefully.
Dosage: vasoconstrictor Contraindicated in patients Adverse Effect:
25mg hypersensitive to drug or During:
other ACE inhibitors.  hypotension  Follow the rights of
Classification:  dyspnea medication
Antihypertensives  palpations administration.
 chest pain After:
Route:
Oral  Monitor patients’
response to the drug
Frequency:  Tell patient to report all
OD hypersensitivity
reaction.

DRUG NAME Mechanism of Action Indication and Adverse Effect and Side Nursing Responsibility
Contraindication Effect
Generic Name: Reduces the viscosity Indication: Side Effects: Before:
Acetylcysteine of pulmonary Treatment of respiratory  Assess any history
secretions by splitting affection characterized by  Fever of allergy with this
Brand Name: disulfide linkages tick and viscous  Drowsiness drug.
Acetadote between molecular hypersecretions  Vomiting  Monitor the patient BP
complexes.  Nausea carefully.
Classification: During:
Mucolytics Adverse Effect:  Follow the rights of
Contraindication: medication
Dosage: Contraindicated in patient  Flushing administration.
600mg with hypersensitivity to drug  Hypertension  Avoid combining with
 Chest tightness other drugs in the
Route:  Dyspnea nebulizer
Oral After:

Frequency:  Monitor patients’

BID response to the drug
 Tell patient to report
all hypersensitivity
reaction.
DRUG NAME Mechanism of Action Indication and Adverse Effect and Side Nursing Responsibility
Contraindication Effect
Generic Name: Inhibits sodium and Indication:  Nausea and Vomiting Before:
Furosemide chloride reabsorption at For hypertension  Diarrhea  Assess any history
the proximal and distal  Dizziness of allergy with this
Brand Name: tubules and ascending  Increased urine drug.
Lasix loop of henle. Contraindication: output  Monitor the patient BP
Contraindicated in patient  Rash carefully.
Classification: with hypersensitivity to drug  Light headedness
Antihypertensives  Abdominal cramps During:
 Follow the rights of
Dosage: medication
40 mg administration.
 Educate patient about
Route: side effects.
Intravenous
After:
Frequency:
Now  Monitor patients’
response to the drug
 Tell patient to report
all hypersensitivity
reaction.
 DISCHARGE PLANNING
Close Monitoring Unit - Medical
Ward
Medication  Educated the SO about the
medication that the client is
receiving
 Discussed to SO and client
about the side effects of the
drugs for the prepared and
thus be able to cope
Environment and  Instruct the patient to do
Exercise exercise as tolerated such as
walking
 Encourage the patient to
perform some passive range
of motions to promote
circulation
Medical Ward - Home
 Educated the client and the
SO about the name of the
medication, why is important,
what it treats, and the needed
doses
 Discussed to SO and the
client the side effects of the
drug for the patient to be
prepared and thus be able to
cope
 Advised the patient and SO to
take the whole capsule and
tablets if the doctor ordered.
 When it comes to medication
safety, advise the patient and
SO to keep it out from direct
sunlight and heat.
 Discuss with the patient the
importance of rehabilitation
and recovery
 Assist the patient with
cardiovascular exercise such
as walking and other cardio
exercises to improve heat
endurance, maintain healthy
lungs, and improve sensory
perception and motor skills.
 *Assisted the patient with
resistance, exercises for
strengthening muscles such
as wrist curls, wrist and hand
stretch, shoulder openers,
table towel slide, trunk bends,

Treatment  Discussed with the
patient and SO every
procedure she will be
receiving
 Educated the patient
about the therapies she
will be engaging in to
restore her physiology
and the importance of
participating in them as
early as it is
Hygiene  Advised the SO to wipe
patient’s lips to prevent lip
cracks.
 Advised the SO to observed
Nurses on how they clean
the patient’s incision to
practice proper cleaning.
Outpatient
Diet  Advised the client and SO to
give the low salt, Low fat diet
 Informed the SO if the client
would be put on an NPO
diet, following tests, and
explain to them the purpose
knee rotations, hip abduction,
standing knee raise, sit-to-
stands, and hip thrust to help
the patient to recover physical
strength, stamina, stability,
and improve range of motion.
 Aside from educating the
patient on how to properly
take the medicine, she
must also engage in
treatment to restore
mobility.
 Educated the SO on how to
clean the incision
 Encouraged the patient to do
oral hygiene
 Encouraged the patient to
manage self-hygiene to
prevent infection and to
control bacteria
 Emphasized and instruct the
patient on the importance of
follow-up check-ups and
report immediately signs and
symptoms.
 Whole food such as fruit,
vegetables, nuts and seed,
beans, rice and fish
 Avoid processed foods since
they contain a lot of LDL,
sugar, and salt. These foods
 of it
Spiritual and  Encouraged the patient to
Sexual Teaching engage in spiritual practices,
and listen to some spiritual
lectures.
 Advised the patient and the
SO to refrain from doing
sexual activities while in the
hospital
typically come prepackaged
and include options like
cereal, crackers, certain
bread, chips, and processed
meats like luncheon meat and
bacon.
 Generally, the patient should
be engaged in high-fiber, low-
sugar, low-fat, and low-salt
diet.
 Educated the patient and the
SO about sexual activity. A
clear understanding of the
effects of pre-eclampsia on
sexual behavior would be
useful for the client and her
partner in planning sexual
activity.
 Encourage the client to join
groups especially those who
are spiritual. Be it through
religion or simply a strong
sense of purpose and
connection to others, this
lowers the risk of depression
thus the daily living.