UNIVERSITY OF THE CORDILLERAS

College of Nursing
Governor Pack Road, Baguio City, Philippines 2600
(+6374) 442-3316, 442-2564, 442-8219, 442-8256
E-mail: webmaster@bcf.edu.ph
Website: www.bcf.edu.ph

ACUTE MYOCARDIAL INFARCTION; HYPERTENSIVE URGENCY

A Case Presented to the

College of Nursing

In Partial Fulfillment of the requirements in the Course

NCM 112 Care of The Clients With Problems In Oxygenation, F&E, Infectious, I&I Response, Cellular
Abberation, Acute & Chronic

Submitted By:

Benito, Danny
Gesmundo, Lorraine
Limmang, Clarissa Marie
Maigi, Nicalin
Pagadian, Ia Rylyn
Paguirigan, Kryzza Leizel
Pangda, Jaceziel Kaye
Saavedra, Joy
Tucyapao, Irish P.
Villanueva, Jayson

(Date: DAY-MONTH-YEAR )

Noted and Approved for Presentation:

Name of Case Presentation Adviser or Panel/s

Ma’am Hannah Lee Antonio Sir Laudemar Luis

Signature of Adviser / Date Signature of Adviser / Date
 CASE PRESENTATION FORMAT

ABSTRACT

(250 – 300 words only not including title and author information)

TITLE: Approximately 10 -12 words identifying key components of your case report. When applicable,
include components such as primary reason for seeking care, clinical assessment, and/or main treatment. The
title should make it clear the presentation is a case report.

AUTHOR INFORMATION: Flashes Left under the Title. Names should be arranged alphabetically based on
FAMILY name, but FIRST name should be written first followed by FAMILY name (ex. April Anne B.
Bocato, Michael P. Nonog and Eugene Flor L. Ulpindo)

BACKGROUND: Briefly describe the background for the case. Introduce the issue that the case addresses.
Explain why the case is noteworthy and what it adds to current knowledge. This section helps answer the
question “Why should we care?” You may want to end the introduction with a sentence that states explicitly
why the case is being reported.

CASE DESCRIPTION: This section should be longest and most detailed part of the abstract. Relevant
information may include demographics, client’s main symptoms, or other reasons for seeking care, clinical
findings, clinical assessment, treatment plan, and health outcomes. Given the space limitations, include only
the information to the reason for presenting the case.

CONCLUSION: This section should state the main “take-home” lesson(s) from the case. If reporting
outcomes, remember that case reports do not typically demonstrate cause and effect. Be careful not to overstate
conclusion but instead describe the strengths and limitations of the case. You may want to add a sentence or
two about the implications of the case for practice for future research.

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 TABLE OF CONTENTS

I. Introduction..........................................................................................................................................３
II. Statement of Objectives.......................................................................................................................３
A. General Objectives...............................................................................................................................３
B. Specific Objectives...............................................................................................................................３
III. Patient’s Profile....................................................................................................................................３
IV. Chief Complaint...................................................................................................................................３
V. Present History of Illness.....................................................................................................................３
VI. Past History of Illness..........................................................................................................................４
VII. Family Health History.........................................................................................................................４
VIII. Developmental History........................................................................................................................４
IX. Social and Environmental History......................................................................................................４
X. Lifestyle and Health Practices.............................................................................................................５
XI. Health Assessment................................................................................................................................５
A. General Survey.....................................................................................................................................５
B. Head to Toe Assessment......................................................................................................................６
C. 13 Areas of Assessment........................................................................................................................７
XII. Diagnostics..............................................................................................................................................9
XIII. Comprehensive Pathophysiology........................................................................................................12
XIV. Treatment/Management......................................................................................................................13
A. Drugs.................................................................................................................................................13
B. IV Fluids...........................................................................................................................................13
C. Surgery..............................................................................................................................................13
XV. Nursing Care Plans..............................................................................................................................15
A. Prioritization of Problems..................................................................................................................15
a.1. List of Problems...........................................................................................................................15
a.2. Basis for Prioritization..................................................................................................................15
B. Nursing Care Plans............................................................................................................................16
NCP 1.........................................................................................................................................................16
NCP 2.........................................................................................................................................................16
NCP 3.........................................................................................................................................................16
NCP 4.........................................................................................................................................................16
NCP 5.........................................................................................................................................................16
C. Discharged Plan....................................................................................................................................17
XVI. Learning Insights.................................................................................................................................17
XVII. List of References.................................................................................................................................18
XVIII. Appendices...........................................................................................................................................19
Appendix A: Approval/ Request Letter......................................................................................................20
Appendix B: Interview Guides....................................................................................................................21
Appendix C: Others.....................................................................................................................................22

(Spacing from here would be 1.15)

I. Introduction

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 Definition and discussion of SPECIFIED CASE and description and enumeration of common signs
and symptoms. (preferably from textbook)
INCLUDE also relevant STATISTICS (international, national and local statistics) about the CASE.
(could be internet source)

A complete obstruction to blood flow in a cornonary artery may result in a Myocardial Infarction
(MI), commonly called a heart attack. Infraction means the death of an area of tissue because of interrupted
blood supply. Because the heart tissue distal to the obstruction dies and is replaced by noncontractile scar
tissue, the heart muscle loses of its strength location of the infracted (dead) area, an infraction may disrupt the
conduction system of the heart and cause sudden death by triggering ventricular fibrillation. Treatment for
myocardial infarction may involve injection of thrombolytic (clot-dissolving) agent such as streptokinase or t-
PA, plus heparin (an anticoagulant), or performing coronary angioplasty or coronary artery bypass grafting.
Fortunately, heart muscle can remain alive in resting person if it receives as little as 10-15% of its normal
blood supply.(Tortora & Derrickson)

II. Statement of Objectives

A. General Objectives

This case analysis aims to increase the understanding and knowledge of student
nurses on how to care for patients with Acute Mycardial Infarction; Urgency Hypertensive
effectively and efficiently.
B. Specific Objectives

Specifically, this case analysis aims to :

1. Define Acute Mycardial Infarction; Urgency Hypertensive and its
effects to the body as a whole;
2. Illustrate the pathophysiology of Acute Mycardial Infarction; Urgency Hypertensive
and in relation to the signs and symptoms specifically observed in the patient;
3. Describe and identify the common signs and symptoms of Acute Mycardial
Infarction; Urgency Hypertensive
4. Discuss the medical and surgical interventions for the management of Acute
Mycardial Infarction; Urgency Hypertensive
5. Formulate appropriate nursing care plans suited for the patient based on the
assessment findings;
6. Identify care measures to be given to the patient and family to promote continuity of
care and independence after discharge.

III. Patient’s Profile

Name : Patient X
Ethnic Background : Ibaloi
Civil Status : Married
Religion : Roman Catholic
Occupation : laborer

Admitting Diagnosis : Myocardial Infraction: Hypertension Urgency

Final/Principal Diagnosis : Myocardial Infraction: Hypertension Urgency
Date and Time Admitted : November 11, 2022, 4:05 pm

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IV. Chief Complaint

This presents the main complaint/s of the patient; the primary reason consultation was sought and
hence, admitted.
Patient X complains of chest pains and difficulty in breathing.

V. Present History of Illness

Narrative form. This is a brief account of when the patient’s condition started, how it developed, up
to the time of admission. Initial signs and symptoms are described in line with duration,
domain/localization, progression, character and how it has affected the physiological function of the patient.
Any interventions made by the patient to address the illness are to be described (e.g. home remedies,
medications, consultations) and whether these were effective or not. Elaboration of the chief complaint.
The patient’s condition started 3 days PTA, when the patient, while simply doing his homework, felt
a sudden sharp chest pain. Pain rate was with the severity of 8/10. It was not radiating to other parts of the
body but was accompanied by difficulty of breathing, weakness, shortness of breath, and sudden hacking
cough.
A few minutes after the said incident, the patient verbalized that all of the symptoms mentioned
slightly improved and was tolerable and only rest was promoted. No medications were taken nor were
consultations done during the incident. 2 days PTA, he was not feeling anything and verbalized that he was
alright until
One day PTA, the patient has the same manifestation but now the difficulty of breathing was so severe
that the patient decided to seek consult and subsequently admitted in this institution.

VI. Past History of Illness

The patient had no history of accidents and or trauma, only minor illnesses, such as cough, colds and
fever and was remedied with over the counter medications such as Bioflu and water therapy with rest. The
patient however, was admitted last November 11, 2022 @ 4:05 PM at Benguet General Hospital and was
diagnosed to acute mycardial infarction: Hypertensive Urgency. He received medical interventions such as
medications for hypertension and for pain. The patient has unrecalled immunization status and with no history
of prolonged case of use of medications such as aspirin or NSAIDs. He also verbalized that he did not have
known allergies for foods or medications.

VII. Family Health History

The patient claims to have familial history of Hypertension on his father’s family. Health problems
such as Asthma, kidney diseases, diabetes, or mental illness were verbalized to be absent. No present illness is
currently experienced by any member of the family.

VIII. Developmental History

Narrative form. This portion describes significant patterns of the patient’s behavior in line with his
current stage of development. (Can use other developmental theories like Erikson, Piaget, Sullivan and
others)

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 The patient is the last son out of the other 5 siblings, which are composed of 4 males and a female. He
is a 19 year old teenager with the task of developing his Identity according to Erik Erikson’s Developmental
theory. He has verbalized no problems with self-image and concept and reveals the desire to achieve his goals
in his studies especially in maintaining his place in the dean’s list and hopefully graduating with honors
or having a place in the Local Nursing Licensure examination. He also noted no difficulty in interacting with
people despite his silent nature. He tends to observe most of the time but also recognized a great number of
friends with whom he shared his childhood with. He also loves music. His passion is seen in his ability
to play the guitar with ease and is now learning how to play the piano.

IX. Social and Environmental History

Narrative form. As expressed in the sample below. Social history include relationship of the patient
with family members, to the society, any membership (like senior citizen, women’s club and others) and work
place or school, ethnic affiliation, educational history, occupational history and economic status.
Environmental history includes their house and the environment (water source, ventilation, garbage disposal,
transportation, any health threats like fertilizers and chemical exposure), any threats from school or work.
The patient is a smoker and an alcoholic beverage drinker.However, he is constantly exposed to
noxious fumes from outside air pollution and from second hand smokers. He lives in a rented apartment
together with his three other cousins near the main highway where jeepneys frequently pass. He commutes
daily using the public utility jeepneys for his transport to school.
The patient belongs to a family with two licensed nurses, hence, the value of maintaining a healthy
lifestyle is promoted. The patient with his family visits the local hospital from health problems unresolved by
home remedies and rest. The patient after experiencing the same sudden pain immediately went to the hospital
to confirm the initial findings he had when he was admitted in Sublime City. As a family that belongs to the
middle class, access to health care facilities and interventions is not much of a problem.
The house where they stay is made up of semi-permanent and permanent materials such as wood and
cement. Privacy is maintained with the 4 separate rooms present. Water used daily is being supplied by the
city water district while the source of drinking water is the water refilling stations nearby.
Patient also verbalized that he did not have any direct contact to harmful chemicals nor has prepared
any chemotherapeutic drugs. As a student nurse however, he is able to care for various patients with having
different respiratory health problems such as tuberculosis, pneumonia and cough. The community exposure
they had as a part of the Clinical RLE allows them to travel to different areas where he experiences changes in
the weather and differences in altitude.

X. Lifestyle and Health Practices

Narrative form. As expressed in the sample below. Include also usual patterns or routine of daily life
(including personal habits, diet, sleep/rest patterns, activities of daily living and recreations/hobbies). Any
health practices whether traditional or medical.

As a student nurse, he is aware of the potential health threats associated with lifestyle related vices
like cancer for smoking and liver cirrhosis for alcoholic beverage drinking. He ensures that he receives
adequate nutrients by allowing himself to eat three complete meals in a day with snacks included
specially during his duty times. Food is prepared at home together with his cousins or is bought in fast-food
chains. He prefers pasta dishes and pizza. Fluid and electrolyte intake is a total of 2 – 3 liters a day coming
from fruit juices, carbonated beverages, water and milk. For maintenance he takes Vitamin C for supplement.

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XI. Health Assessment
A. General Survey
This portion presents assessments performed as seen in the example below. The time that you FIRST handled
your patient. Include ht., wt., BMI, body built, posture and gait, hygiene and grooming, body and breath odor,
signs of distress, obvious signs, attitude, affect and mood, speech and thought process.

The patient was received awake, lying on bed with a moderate high back rest elevation. Patient with
ongoing IVF’s of D5LRS I L x 30 gtts per minute and a Tramadol drip (tramal) 300 mg in D5W 250 cc x 24
hours infusing well on the left arm and with oxygen inhalation at 2-3 LPM/ via the nasal cannula. He is
connected to three way bottle system chest drainage with the first bottle having 300cc bloody discharge.
Suction control is applied and there is bubbling noted in the third bottle.
Patient appears weak, needs assistance when assuming activities of daily living like toileting and
feeding or in changing positions. He wears a neat gown, hygiene is fair. Patient is conversant speech is well
formulated, oriented to the self and others around him, able to determine the time and date and is
aware that he stays in a private room for 3 days now.
Patient is an ectomorph. He verbalized that he is 5’6” tall and weighs 51 kilograms.

B. Head to Toe Assessment

This portion presents assessments performed as seen in the example below. You can do FOCUS assessment
especially on the affected area (eg. CHF  focus on Cardiac Assessment) and focus on abnormal findings.
1. Head Normocephalic, hair well distributed, oiliness and flaking noted no
areas of pain or tenderness during palpation.
2. Eyes Able to distinguish colors, with astigmatism, verbalized difficulty to
identify objects 6 feet away, wears corrective lenses, sclera is
anicteric, pupils are equally round, reactive to light and
accommodation, EOM is intact, able to follow penlight with gaze, no
detectable oscillations, mucous membranes are moist and light pink.
3. Ears Able to understand and hear spoken language correctly, with minimal
cerumen build – up in the ear canal, pearly sliver and intact tympanic
membrane.
4. Nose and sinuses Nose is patent, septum is located midline, no flaring noted, able to
distinguish the scent of alcohol and perfume, and no episodes of
epistaxis during the shift, and sinuses are not tender on palpation.
5. Mouth Complete set of adult teeth, pearly white in color, and no mal aligned
tooth, had braces for 1 year and a half year. No dental caries noted.
Oral mucosa is moist and pinkish, no lesions noted, tonsils are not
inflamed, Grade 1 bilaterally present, uvula is located midline.
6. Neck ROM intact, able to change direction of head slowly but with without
complaints of pain, carotid pulse are bilaterally symmetrical, full and
strong pulses, 2+, jugular vein is not distended, superficial cervical
lymph nodes are palpable but non tender. Thyroid is located midline,
no enlargement noted, trachea is located midline.
7. Chest Shape of the chest is elliptical, asymmetrical chest wall expansion
noted, with respiratory excursion best appreciated on the left side of

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 the thorax, decreased tactile fremitus in the right lung area, decreased
breath sounds in the right, no crackles, no wheeze, no stridor,
production of hollow drum like sounds in percussion of the right side
and resonant sound appreciated on the left. Patient with an Axillary
thoracotomy, dressing intact and dry, chest tube draining to a bloody
discharge 300 cc in amount. With limited movement on the right
shoulder. Patient verbalized, “mahina daw ung lungs ko, spontaneous
rupture of the bleb, kaya may pneumothorax ako” “Masakit tlaga ung
sugat, parang 8/10 din, pati ata sa loob masakit talaga, ditto lang
naman sya sa may incision, parang may tumutusok kaya binigyan nila
ako ng analgesic, ngayon, ayos ng konte pero may pain pa din at 6 na
cguro ung scale nya out of 10”. Patient is observed to guard area and
grimaces when a painful stimulus is felt. Diaphoresis noted, hands are
cool to touch. Maintains the supine position with head of bed elevated
to a moderate high back rest.
8. Cardiac Adynamic pericardium; normal rate, regular rhythm, PMI at 50 ICS
LMCL, no murmur noted, no visible pulsations in the precordium,
palpable apical pulse.
9. Breast/Chest Skin color is similar with the rest of the body, nipple is dark colored,
no discharges.
10. Abdomen Flat, with normoactive bowels sounds heard in all the quadrants, soft,
no direct tenderness or rebound tenderness upon palpation, tympanic,
no organomegaly.
11. Genitals Patient verbalized that he had been inserted with a catheter when he
was in the OR. No complaints of dysuria or urinary retention or
incontinence post operatively.
12. Musculoskeletal Muscle strength at the right side is 4/5 while the rest of extremities
are 5/5.
No visible tremors noted no complaints of pain.
13. Integumentary Skin…

C. 13 Areas of Assessment

This portion presents assessments performed as seen in the example below. Follow format on how to do your
13 areas of assessment. GORDON’S FUNCTIONAL HEALTH PATTERNS
1. Psychosocial and Psychological Status

2. Mental and Emotional Status

3. Environmental Status

4. Sensor Status
a. Visual Status

b. Auditory

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 c. Olfactory Status

d. Gustatory Status

e. Tactile Status

5. Motor Status

6. Thermoregulatory Status

Date Time Temperature

10 pm 36.3 °C
November 14, 2022 2 am 36.4 °C
6 am 36.6 °C
10 pm 36.0 °C
November 15, 2022 2 am 38.8 °C
6 am 36.0 °C
10 pm 36.0 °C
November 16, 2022 2 am 36.5 °C
6 am 36.2 °C

7. Respiratory Status

Date Time RR SPO2

10 pm 21 cpm 93 %
November 14, 2022 2 am 23 cpm 95 %
6 am 24 cpm 98 %
10 pm 22 cpm 92 %
November 15, 2022 2 am 20 cpm 93 %
6 am 19 cpm 95 %
10 pm 20 cpm 96 %
November 16, 2022 2 am 18 cpm 95 %
6 am 17 cpm 96 %

8. Circulatory Status

Date Time CR Capillary

10 pm 98 bpm
November 14, 2022 2 am 94 bpm 1-2 seconds
6 am 95 bpm
10 pm 89 bpm
November 15, 2022 2 am 88 bpm 1-2 seconds
6 am 90 bpm
10 pm 87 bpm 1-2 seconds
November 16, 2022 2 am 84 bpm

8
 6 am 95 bpm

9. Nutritional Status

10. Elimination Status

11. Sleep, Rest and Comfort Status

12. Fluids and Electrolytes Status

13. Integumentary Status

During episodes of airway obstruction, the patient’s capillary refill is 2-3 seconds.
However, when managed, he appears to be pinkish in color and with good skin turgor.

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XII. Diagnostics
This shows all diagnostic procedures performed with the client. LANDSCAPE and Tabular form. Content of the table must follow the format below.
For Chest X-ray, Ultrasound and Pathology
Diagnostic
Description of the Procedure
Procedure
Chest X-ray Chest radiography is the first
investigation performed to assess
pneumothorax because it is simple,
inexpensive, rapid, and noninvasive;
however, it is much less sensitive than
chest CT in detecting a small
pneumothorax, blebs, and bullae.
Significance/Purpose of the Procedure
It is used to determine the severity of the
patient’s pneumothorax and to determine
the progress of his medical and surgical
management.
Date of
Findings & Implications
Procedure
April 20, 2009 Follow-up study of the chest taken on the same day, SIP CIT
insertion reveals a relative partial reduction in the size of the
previously noted right-sided pneumothorax. There is however
no significant change in the extent and appearance of the
massive atelectasis of the right lung field. A right sided CTT is
now seen.
April 22, 2009 Follow-up study of the chest since 6/20/2009 S/p Axillary
thoracotomy shows complete resolution of the pneumothorax on
the right with complete re-expansion of the right lung. A right
sided CTT is still seen in SITU. No other internal change of
note.
April 26, 2009 Follow-up study of the chest since 6/22/09 reveals the presence
of confluent hazy densities at the right paracardiac areas,
presenting a pneumonic process with consolidation. There is
now a homogenous opacity with meniscus level seen at the right
lower hemithorax obscuring the right hemi diaphragm and
costrophenic angle representing fluid.
April 26, 2009 Follow-up chest study since 6-26-2009 reveals minimal clearing
of the confluent hazy densities at the right paracardiac area.
10
 There is however, decrease in the volume of the previously
noted fluid in the right HEMITHORAX. A right sided CTT is
still seen in SITU.

No other internal change of note.

Ultrasound Abcdeflkjdlj alkdjf Adfjlskdjf jldkjflasd April 29, 2009 aljkdhfklashdfa

Pathology Kdljfoijuelasldfjm Dgsdgasdufods April 24, 2009 Csalksdjfoi dlfjs;dfsa;fjds

For Blood Chemistry, Serum electrolytes, Urinalysis, Fecalysis and other lab test with quantitative results. SAMPLE not related with previous CASE.

Diagnostic procedure and Description of procedure Significance/ Purpose of the procedure Significant findings Nursing Implications
date done

Complete Blood Count A CBC may be ordered when a person has To determine general health status, Leucocyte (WBC) A low white blood cell count indicates that
Jan 3, 2015 any number of signs and symptoms that screen, diagnose, or monitor any one of a Normal Range: the patient has an infection.
may be related to disorders that affect variety of diseases and conditions that 5-10 x10^ 9/L
blood cells. When an individual has an affect blood cells, such as anemia, Result:
infection, inflammation, bruising, or infection, inflammation, bleeding 0.58- Low
bleeding, a doctor may order a CBC to disorder or cancer.
help diagnose the cause and/or determine
its severity.
Neutrophils Within the normal range.
Normal Range:
0.50-0.70

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 Result:
0.31-Normal
Lymphocytes Indicates an acute bacterial infection.
Normal Range:
0.20-0.40
Result:
0.58- High
No result
Monocytes Within the normal range.
Normal Range:
0.00-0.07
Result:
0.03- Normal
Platelet count Indicates Thrombocytopenia.
Normal Range:
150,000-450,000
Result: 310,000 –low
Urinalysis A urinalysis…
Jan 3, 2015

Facalysis A fecalysis…
Jan 3, 2015

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13
XIII. Comprehensive Pathophysiology
This is a diagrammatic presentation of the course of the disease with emphasis of information relevant to nursing
care. Predisposing factors (Modifiable), Precipitating factors (Non-modifiable), course of illness or condition, relevant
diagnostic findings, signs & symptoms, management and appropriate nursing diagnoses presented must be in line
with actual events that occurred with the patient.
PREDISPOSING FACTORS PRECIPITATING FACTORS

Exposure to 2nd hand Smoking & Pollution Height (tall person), Male, 19 years old

Chemicals (Tar) Gradient of Pleural pressure increases from

lung base to apex
Blocks airway passages and degrade
elastic fibers of the lungs

Influx of neutrophils and macrophages Alveoli of lung apex receives the

is induced greater distension pressure

Imbalanced enzymes (protease & anti-protease)

and antioxidant system

________________Bullae/Blebs Formation______________________

Inflammation-induced obstructions of the airway Shearing forces

Increased alveolar pressure

Leakage to the lung interstitium, hilum and pneumomediastinum Rupture of blebs

Increased mediastinal pressure

Rupture of the mediastinal parietal pleura

_______________Pneumothorax____________________

Disequilibrium in the intrapulmonary and intrapleural pressure

Activation of the receptors that monitor Tidal volume affected Changes in the thoracic pressure
lung volume
Distortion of movement of air
Sympathetic stimulation in and out of the lungs

Tachypnea Air flows out of the alveoli

into the Pleural space

Lung collapse during recoil

Dyspnea Sudden, sharp, stabbing pain

Admission to the Hospital

---INEFFECTIVE BREATHING PATTERN---

Partial collapse of the affected lung

Impairment of gas conduction Air trapping in the collapsed lung Ruptured bleb and lung collapse
in the lower respiratory airways activate inflammatory response

Decreased tactile fremitus Hyper resonance on percussion Lung asymmetry

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 ---------------------IMPAIRED GAS EXCHANGE-------------------

Transudation of fluid and blood from surrounding Axillary Thoracotomy

blood vessels of the injured lung and Bleb
Excision

-------PAIN RELATED TO TISSUE TRAUMA-------

Pleural Effusion

Transudate accumulation in the pleural space

Further restriction of lung expansion Collapse of alveoli Disequilibrium in pulmonary and pleural pressures

Increased respiratory difficulty Bleeding Surgical Incision and Insertion of CTT

Stasis of pulmonary sections Decreased Hct and Hgb Tissue trauma and injury

Growth of microorganisms Decreased oxygen carrying Pain on the incision site

capacity of the lungs
---RISK FOR INFECTION--- ---IMPAIRED MOBILITY---

---ACTIVITY INTOLERANCE---

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XIV. Treatment/Management
This shows all treatments, including medical procedures, performed with the client. LANDSCAPE and tabular form. Content of the table must follow the format below. But for more COMPREHENSIVE
Nursing Implication, categorize your NURSING IMPLICATION as to Before, During and After giving the medication and each has Dx, Tx and EDx for DRUG STUDY.
A. Drugs
(Follow new Format for Drug Study)
DRUG STUDY 1: AMLODIPINE
DRUG NAME MECHANISM OF ACTION
Generic Name: Binds to dihydropyridine and
AMLODIPINE non-dihydropyridine cell
BESYLATE membrane receptor sites on
myocardial and vascular
Brand Name: Norvasc smooth muscle cells and
inhibits influx of extracellular
Chemical Class: calcium ions across slow
Dihydropyridine calcium channels. This
decreases intracellular calcium
Therapeutic Class: level, inhibiting smooth-muscle
Antianginal, cell contractions and relaxing
Antihypertensive coronary and vascular smooth
muscles, decreasing peripheral
Dosage: 5 mg vascular resistance, and
reducing systolic and diastolic
Route: Oral blood pressure. Decreased
peripheral vascular resistance
also decreases myocardial
workload, oxygen demand, and
possibly angina. Also, by
inhibiting coronary artery
muscle cell contractions and
restoring blood flow, drug may
relieve Prinz metal’s angina.
CONTRAINDICATIONS &
INDICATIONS
Contraindications:
Hypersensitivity to amlodipine
or its components
Indications:
Indicated for the treatment of
hypertension
Drug to drug Interaction:
beta blockers: Possibly
excessive hypotension
cyclosporine: Possibly
increased blood cyclosporine
levelsCYP3A4 inhibitors such
as diltiazem, ketoconazole,
itraconazole, and ritonavir:
Possible increased blood
amlodipine level
fentanyl: Increased risk of
severe hypotension and
increased fluid volume
ADVERSE EFFECTS
CNS: Anxiety, dizziness, fatigue,
headache, lethargy, light-
headedness, paresthesia,
somnolence, syncope, tremor
CV: Arrhythmias, chest pain,
hypotension, palpitations,
peripheral edema
EENT: Dry mouth, gingival
hyperplasia, pharyngitis ENDO:
Hot flashes
GI: Abdominal cramps,
abdominal pain, anorexia,
constipation, diarrhea, dysphagia,
elevated hepatic enzymes,
esophagitis, flatulence,
indigestion, jaundice, nausea,
pancreatitis, vomiting
GU: Decreased libido, impotence,
urinary frequency
MS: Myalgia
RESP: Dyspnea
SKIN: Dermatitis, flushing, rash
Other: Weight loss
NURSING RESPONSIBILITIES
BEFORE:
Dx:
a. Verify doctor’s order.
b. Assess allergy to amlodipine or its components.
Tx:
c. Prepare the medication at the right time and right dosage.
EDx:
d. Educated the patient and SO about the purpose and importance of the
drug.
e. Educated SO on drug therapy to promote compliance.
DURING:
Dx:
f. Verify client’s identity.
g. Assess patient frequently for chest pain when starting or increasing the
dose of amlodipine, because worsening of angina or an acute MI can
occur.
Tx:
h. Administer medication following the 10 rights of medication.
i. Suggest taking amlodipine with food to reduce GI upset.
j. Assist patient when taking the medication.
16

SOURCE:
Jones & Bartlett Learning
(2015). Nurse’s Drug
Handbook. Fourteenth
Edition.
DRUG STUDY 2: ASPIRIN
MECHANISM OF ACTION
Generic Name: ASPIRIN Blocks the activity of
cyclooxygenase, the enzyme
Brand Name: Aspergum needed for prostaglandin
synthesis. Prostaglandins,
Chemical Class: Salicylate important mediators in the
inflammatory response, cause
Therapeutic Class: Anti- local vasodilation with swelling
inflammatory, and pain. With blocking of
Antiplatelet, Antipyretic, cyclooxygenase and inhibition
Nonopioid analgesic of prostaglandins, inflammatory
symptoms subside. Pain is also
Dosage: 80 mg relieved because prostaglandins
play a role in pain transmission
Route: Oral from the periphery to the spinal
requirements during surgery
simvastatin: Increased
exposure to simvastatin
CONTRAINDICATIONS &
INDICATIONS
Contraindications:
Allergy to tartrazine dye,
asthma, bleeding problems
(such as hemophilia),
hypersensitivity to aspirin or its
components, peptic ulcer
disease
Indications:
Mild to moderate pain or fever
including rheumatoid arthritis,
osteoarthritis, thromboembolic
disorders; transient ischemic
attacks, rheumatic fever,
EDx:
k. Instruct SO to report persistent adverse effects such as dizziness,
difficulty breathing, arm or leg swelling, and rash.
AFTER:
Dx:
l. Monitor patient’s BP for postural changes.
m. Monitor drug effectiveness.
Tx:
n. Promote safety and comfort.
EDx:
o. Encourage the patient to verbalize feelings and concerns.
ADVERSE EFFECTS NURSING RESPONSIBILITIES
CNS: Confusion, CNS depression BEFORE:
EENT: Hearing loss, tinnitus Dx:
GI: Diarrhea, GI bleeding, a. Verify doctor’s order.
heartburn, hepatotoxicity, nausea, b. Assess allergy to aspirin or its components.
stomach pain, vomiting
HEME: Decreased blood iron Tx:
level, leukopenia, prolonged c. Prepare the medication at the right time and right dosage.
bleeding time, shortened life span
of RBCs, thrombocytopenia EDx:
SKIN: Ecchymosis, rash, d. Educate the patient and SO about the purpose and importance of the
urticaria drug.
Other: Angioedema, Reye’s e. Educate patient and SO on drug therapy to promote compliance
syndrome, salicylism (dizziness,
tinnitus, difficulty hearing, DURING:
17
cord. Aspirin inhibits platelet
aggregation by interfering with
production of thromboxane A2,
a substance that stimulates
platelet aggregation. Aspirin
acts on the heat-regulating
center in the hypothalamus and
causes peripheral vasodilation,
diaphoresis, and heat loss.
SOURCE:
Jones & Bartlett Learning
(2015). Nurse’s Drug
Handbook. Fourteenth
Edition.
postmyocardial infarction,
prophylaxis of MI, ischemic
stroke, angina
Drug to drug Interaction:
ACE inhibitors: Decreased
antihypertensive effect
activated charcoal: Decreased
aspirin absorption antacids,
urine alkalinizers: Decreased
aspirin effectiveness
anticoagulants: Increased risk
of bleeding; prolonged bleeding
time carbonic anhydrase
inhibitors: Salicylism
corticosteroids: Increased
excretion and decreased blood
level of aspirin heparin:
Increased risk of bleeding
ibuprofen: Possibly reduced
cardioprotective and stroke
preventive effects of aspirin
methotrexate: Increased blood
level and decreased excretion
of methotrexate, causing
toxicity nizatidine: Increased
blood aspirin level
vomiting, diarrhea, confusion,
CNS depression, diaphoresis,
headache, hyperventilation, and
lassitude) with regular use of
large doses
Dx:
f. Verify patient’s identity.
g. Assess patient’s condition.
Tx:
h. Administer medication following the rights of giving medication.
i. Suggest taking aspirin with food or after meals because it may cause GI
upset.
j. Assist patient when taking the medication.
EDx:
k. Instruct patient not to cut, crush or chew the medication.
AFTER:
Dx:
l. Monitor patient for signs and symptoms.
m. Monitor drug effectiveness.
Tx:
n. Promote safety and comfort.
EDx:
o. Instruct patient and SO to notify the nurse if any symptoms of stomach
or intestinal bleeding occur such as black, tarry or bloody stools.

NSAIDs: Possibly decreased

blood NSAID level and
increased risk of adverse GI
effects sulfonylureas: Possibly

18

DRUG STUDY 3: ATORVASTATIN
MECHANISM OF ACTION
Generic Name: Reduces plasma cholesterol and
ATORVASTATIN lipoprotein levels by inhibiting
CALCIUM HMG-CoA reductase and
cholesterol synthesis in the
Brand Name: Lipitor liver and by increasing the
number of LDL receptors on
Chemical Class: liver cells to enhance LDL
Synthetically derived uptake and breakdown.
fermentation product
Therapeutic Class: SOURCE:
Antihyperlipidemic Jones & Bartlett Learning
(2015). Nurse’s Drug
Dosage: 40 mg Handbook. Fourteenth
Edition.
Route: Oral
enhanced effect of
sulfonylureas with large doses
of aspirin
urine acidifiers (such as
ammonium chloride, ascorbic
acid): Decreased aspirin
excretion
vancomycin: Increased risk of
ototoxicity
CONTRAINDICATIONS &
INDICATIONS
Contraindications:
Active hepatic disease,
breastfeeding, hypersensitivity
to atorvastatin or its
components, pregnancy,
unexplained persistent rise in
serum transaminase level
Indications:
As adjunct for primary
hypercholesterolemia (types
Ia, Ib), dysbetalipo
proteinemia, elevated
triglyceride levels, prevention
of CV disease by reduction of
heart risk in those with mildly
elevated cholesterol.
ADVERSE EFFECTS NURSING RESPONSIBILITIES
CNS: amnesia, depression, BEFORE:
dizziness, emotional lability, Dx:
facial paralysis, fatigue, fever, a. Verify doctor’s order.
headache, hyperkinesia, malaise, b. Assess allergy to atorvastatin or its components.
paresthesia, peripheral
neuropathy, weakness Tx:
CV: Arrhythmias, elevated serum c. Prepare the medication at the right time and right dosage.
CK level, orthostatic hypotension,
palpitations, phlebitis, EDx:
vasodilation d. Educated the patient and SO about the purpose and importance of the
EENT: altered refraction, dry drug.
eyes, dry mouth, epistaxis, eye e. Educated SO on drug therapy to promote compliance
hemorrhage, glaucoma, glossitis,
hearing loss, lip swelling, loss of DURING:
taste, pharyngitis, sinusitis, Dx:
stomatitis, taste perversion, f. Verify patient’s identity.
tinnitus g. Assess patient’s condition.
ENDO: Hyperglycemia or
hypoglycemia Tx:
GI: Abdominal or biliary pain, h. Provide comfort measures and arrange for analgesics if headache
constipation, diarrhea, duodenal occurs.
19
 Drug to drug Interaction:
Azole Antifungals, Colchicine,
Erythromycin, Gemfibrozil,
LipidModifying Doses of
Niacin, Other Fibrates:
Increased risk of myopathy and
rhabdomyolysis cyclosporine
Digoxin: Increased digoxin
level and increased risk of
toxicity efavirenz, rifampin,
other
DRUG STUDY 4: LACTULOSE
MECHANISM OF ACTION CONTRAINDICATIONS &
INDICATIONS
Generic Name: Arrives unchanged in the colon, Contraindications:
or stomach ulcers, dysphagia, i. Assist patient when taking the medication.
elevated liver enzymes,
flatulence, gastroenteritis, hepatic EDx:
failure, hepatitis, increased Instruct the patient to report unexplained muscle pain, tenderness or
appetite, indigestion, jaundice, weakness, especially with fever or malaise.
melena, pancreatitis, rectal Encourage patient to take medication to the prescribed frequency
hemorrhage, vomiting AFTER:
GU: Abnormal ejaculation; Dx:
cystitis; decreased libido; dysuria; Monitor for therapeutic effectiveness which is indicated by reduction in the
epididymitis; hematuria; level of LDL-C.
impotence; nephritis; nocturia;
renal calculi; urinary frequency, Tx:
incontinence, or urgency; urine
retention; vaginal hemorrhage EDx:
HEME: Anemia, Encourage patient to report any side and adverse effect.
thrombocytopenia
MS: back or muscle pain, gout,
immune-mediated, leg cramps,
myalgia, myasthenia gravis,
myopathy, neck rigidity
RESP: Dyspnea, pneumonia
SKIN: Acne, alopecia, contact
dermatitis, diaphoresis, dry skin,
eczema, petechiae,
photosensitivity, pruritus, rash,
seborrhea, ulceration, urticaria
Other: Anaphylaxis,
angioneurotic edema, flulike
symptoms, infection,
lymphadenopathy, weight gain
ADVERSE EFFECTS NURSING RESPONSIBILITIES
GI: Abdominal cramps and BEFORE:
20
LACTULOSE where it breaks down into lactic
acid and small amounts of
Brand Name: Duphalac formic and acetic acids,
acidifying fecal contents.
Chemical Class: Synthetic Acidification leads to increased
disaccharide sugar osmotic pressure in the colon,
which, in turn, increases stool
Therapeutic Class: water content and softens stool.
Ammonia reducer, Also, lactulose makes intestinal
Laxative contents more acidic than
blood. This prevents ammonia
Dosage: 30 cc diffusion from intestine into
blood, as occurs in hepatic
Route: Oral encephalopathy. The trapped
ammonia is converted into
ammonia ions and, by
lactulose’s cathartic effect, is
expelled in feces with other
nitrogenous wastes.
SOURCE:
Jones & Bartlett Learning
(2015). Nurse’s Drug
Handbook. Fourteenth
Edition.
Hypersensitivity to lactulose or
its components, low-galactose
diet
Indications:
Indicated for the treatment of
constipation
Drug to drug Interaction:
Anti-infectives: decreased
lactulose efficacy
Other laxatives: interference
with response to lactulose (in
patients with hepatic
encephalopathy
distention, diarrhea, flatulence
ENDO: Hyperglycemia
Other: Hypernatremia,
hypokalemia, hypovolemia
Dx:
a. Verify doctor’s order.
b. Assess allergy to lactulose or its components.
Tx:
c. Prepare the medication at the right time and right dosage.
d. Don’t give concurrently with other laxatives.
EDx:
e. Educated the patient and SO about the purpose and importance of the
drug.
f. Educated SO on drug therapy to promote compliance
DURING:
Dx:
g. Verify patient’s identity.
h. Assess patient’s condition.
Tx:
i. Check the solution appears pale yellow to yellow, viscous liquid.
Cloudiness, darkened solution does not indicate potency loss.
EDx:
j. Emphasize the importance of drinking adequate fluids and to report
signs and symptoms of dehydration.
AFTER:
Dx:
k. Monitor the patient's activity and vital signs.
l. Monitor for possible adverse effects of medication.
Tx:
m. Assess the patient and determine unusual changes.
n. Evaluate therapeutic response: decreased constipation, decreased blood
ammonia level, clearing of mental stat
21

DRUG STUDY 5: CLOPIDOGREL
Generic Name:
CLOPIDOGREL
BISULFATE
Brand Name: Plavix
Chemical Class:
Thienopyridine derivative
Therapeutic Class: Platelet
aggregation inhibitor
Dosage: 75 mg
Route:
MECHANISM OF ACTION
Binds to adenosine diphosphate
(ADP) receptors on the surface
of activated platelets. This
action blocks ADP, which
deactivates nearby glycoprotein
IIb/IIIa receptors and prevents
fibrinogen from attaching to
receptors. Without fibrinogen,
platelets can’t aggregate and
form thrombi.
SOURCE:
Jones & Bartlett Learning
(2015). Nurse’s Drug
Handbook. Fourteenth
Edition.
CONTRAINDICATIONS &
INDICATIONS
Contraindications:
Active pathological bleeding,
including peptic ulcer and
intracranial hemorrhage;
hypersensitivity to clopidogrel
or its components
Indications:
Treatment of patients at risk for
ischemic events—
history of MI, ischemic stroke,
peripheral artery
disease; Treatment of
patients with acute coronary
syndrome
Drug to drug Interaction:
aspirin: Increased risk of
bleeding
CYP2C19 inhibitors, such as
cimetidine, esomeprazole,
etravirine, felbamate,
fluconazole, fluoxetine,
fluvoxamine,
ADVERSE EFFECTS
CNS: Confusion, depression,
dizziness, fatal intracranial
bleeding, fatigue, fever,
hallucinations, headache
CV: Chest pain, edema,
hypercholesterolemia,
hypertension, hypotension,
vasculitis *With repeated doses.
278 clorazepate dipotassium
EENT: Altered taste;
conjunctival, ocular, or retinal
bleeding; epistaxis; rhinitis;
stomatitis; taste disorders
GI: Abdominal pain; acute liver
failure; colitis; diarrhea;
duodenal, gastric, or peptic ulcer;
elevated liver function test
results; gastritis; gastrointestinal
and retroperitoneal hemorrhage,
indigestion; nausea; noninfectious
hepatitis; pancreatitis
GU: Elevated serum creatinine
level, glomerulopathy, UTI
HEME: Agranulocytosis, aplastic
anemia, neutropenia,
pancytopenia, prolonged bleeding
time, thrombocytopenic purpura,
EDx:
o. Immediately report to the physician, if unusual changes are noticed.
p. Not to use as a laxative long term, to use as prescribed.
NURSING RESPONSIBILITIES
BEFORE:
Dx:
a. Verify doctor’s order.
b. Assess allergy to clopidogrel or its components.
Tx:
c. Prepare the medication at the right time and right dosage.
EDx:
d. Educated the patient and SO about the purpose and importance of the
drug.
e. Educated SO on drug therapy to promote compliance.
DURING:
Dx:
f. Verify patient’s identity.
g. Assess patient’s condition.
Tx:
h. Administer medication as prescribed.
EDx:
i. Instruct patient to notify prescriber promptly if she experiences side
effects such as fever, weakness, extreme skin paleness, purple skin
patches, yellowing of the skin or eyes, or neurologic changes.
22
 ketoconazole, omeprazole,
ticlopidine,
voriconazole: Decreased
plasma clopidogrel level,
decreased platelet inhibition
fluvastatin, phenytoin,
tamoxifen,
tolbutamide, torsemide:
Interference with metabolism of
these drugs
NSAIDs: Increased risk of GI
bleeding, interference with
NSAID metabolism
warfarin: Prolonged bleeding
time, interference with warfarin
metabolism
thrombotic thrombocytopenic
purpura, unusual bleeding or
bruising
MS: Arthralgia, back pain,
musculoskeletal bleeding,
myalgia
RESP: Bronchitis,
bronchospasm, cough, dyspnea,
eosinophilic pneumonia,
interstitial pneumonitis,
respiratory tract bleeding, upper
respiratory tract infection
SKIN: drug rash with
eosinophilia and systemic
symptoms (DRESS), eczema,
erythema multiforme, lichen
planus, pruritus, purpura, rash,
skin bleeding, toxic epidermal
necrolysis, urticaria
Other: Anaphylaxis,
angioedema, flulike symptoms,
serum sickness
AFTER:
Dx:
j. Be alert for signs of GI bleeding signs (abdominal pain, vomiting blood,
blood in stools, black/tarry stools) or other signs of bleeds (bleeding
gums, nosebleeds, unusual bruising, hematuria; fall in hematocrit or
blood pressure). Notify physician or nursing staff immediately if these
signs occur.
k. Monitor the effectiveness of the drug.
Tx:
l. Promote safety and comfort measures.
EDx:
m. Caution patient that bleeding may continue longer than usual. Instruct
him to report unusual bleeding or bruising.
n. Instruct patient not to discontinue clopidogrel abruptly or without first
consulting prescriber.

DRUG STUDY 6: ISMN

MECHANISM OF ACTION CONTRAINDICATIONS ADVERSE EFFECTS NURSING RESPONSIBILITIES

Generic Name: Isosorbide may interact with
ISOSORBIDE nitrate receptors in vascular
MONONITRATE smooth-muscle cell membranes.
By interacting with receptors’
Brand Name: Monoket sulfhydryl groups, drug is reduced
to nitric oxide. Nitric oxide
Chemical Class: Organic activates the enzyme guanylate
Nitrate cyclase, increasing intracellular
formation of cyclic guanosine
& INDICATIONS
Contraindications:
Angle-closure glaucoma;
cerebral hemorrhage;
concurrent use of sildenafil;
head trauma; hypersensitivity
to isosorbide, other nitrates,
or their components;
orthostatic hypotension;
severe anemia
CNS: Agitation, confusion,
dizziness, headache, insomnia,
restlessness, syncope, vertigo,
weakness
CV: Arrhythmias, orthostatic
hypotension, palpitations,
peripheral edema, tachycardia
EENT: Blurred vision, diplopia
(all forms); sublingual burning
BEFORE:
Dx:
a. Verify doctor’s order.
b. Assess allergy to its components.
Tx:
c. Prepare the medication at the right time.
d. Keep isosorbide protected from heat and light.

23
Therapeutic Class: monophosphate (cGMP). An
Antianginal, Vasodilator increased cGMP level may relax
vascular smooth muscle by
Dosage: 30 mg forcing calcium out of muscle
cells, causing vasodilation. This
Route: Oral improves cardiac output by
reducing mainly preload but also
afterload.
SOURCE:
Jones & Bartlett Learning
(2015). Nurse’s Drug Handbook.
Fourteenth Edition.
Indications:
Indicated for the treatment or
prevention of angina pectoris
Drug to drug Interaction:
acetylcholine,
norepinephrine: Possibly
decreased effectiveness of
these drugs
antihypertensives, calcium
channel blockers, opioid
analgesics, other
vasodilators: Increased risk
of orthostatic hypotension
aspirin: Increased blood level
and pharmacologic action of
isosorbide
sildenafil, tadalafil,
vardenafil: Increased risk of
hypotension and death
sympathomimetics: Increased
risk of hypotension, possibly
decreased therapeutic effects
of isosorbide
(S.L. form)
GI: Abdominal pain, diarrhea,
indigestion, nausea, vomiting
GU: Dysuria, impotence, urinary
frequency
HEME: Hemolytic anemia
MS: Arthralgia, muscle twitching
RESP: Bronchitis, pneumonia,
upper respiratory tract infection
SKIN: Diaphoresis, flushing, rash
EDx:
e. Educated the patient and SO about the purpose and importance of the
drug.
f. Educated SO on drug therapy to promote compliance
DURING:
Dx:
g. Verify patient’s identity.
h. Assess patient’s condition.
Tx:
i. Give drug 1 hour before or 2 hours after meals. Give with meals if
patient experiences severe headaches or adverse GI reactions.
j. Administer medication as ordered.
k. Assist patient when taking the medication.
EDx:
l. Caution patient not to crush or chew isosorbide E.R. capsules or tablets
or S.L. tablets unless specifically ordered to do so by prescriber.
m. Instruct patient to take drug before any situation or activity that might
precipitate angina.
AFTER:
Dx:
n. Monitor blood pressure often during isosorbide therapy, especially in
elderly patients; drug may cause severe hypotension.
o.
Tx:
p. Know that patient may experience daily headaches from isosorbide’s
vasodilating effects. Give acetaminophen, as prescribed, to relieve pain.
q. Promote safety and comfort measures.
EDx:
24
 r. Encouraged patient to verbalize feelings and concerns.
s. Instruct patient to notify prescriber about blurred vision, fainting,
increased angina attacks, rash, and severe or persistent headaches.

DRUG STUDY 7: FUROSEMIDE

MECHANISM OF ACTION CONTRAINDICATIONS ADVERSE EFFECTS NURSING RESPONSIBILITIES

& INDICATIONS
Generic Name: Inhibits sodium and water Contraindications: CNS: Dizziness, drowsiness, BEFORE:
FUROSEMIDE reabsorption in Anuria unresponsive to fever, headache, lethargy, Dx:
furosemide; hypersensitivity paresthesia, restlessness, a. Verify doctor’s order.
Brand Name: Lasix the loop of Henle and increases to furosemide, sulfonamides, b. Assess allergy to sulfonamide or its components.
urine or their components vertigo, weakness
Chemical Class: Tx:
Sulfonamide formation. As the body’s plasma CV: Arrhythmias, elevated c. Prepare the medication at the right time.
volume Indications: cholesterol and triglyceride
Therapeutic Class: Anti- EDx:
Pulmonary edema; edema levels, orthostatic hypotension,
hypertensive, Diuretic d. Educated the patient and SO about the purpose and importance of the
decreases, aldosterone production with HF, hepatic disease, shock, tachycardia, drug.
Dosage: increases, nephrotic syndrome, ascites, thromboembolism, e. Educated SO on drug therapy to promote compliance
hypertension
Route: Oral which promotes sodium thrombophlebitis vertigo DURING:
reabsorption and Dx:
EENT: Blurred vision, dry f. Verify patient’s identity.
the loss of potassium and Drug to drug Interaction: mouth, oral irritation, ototoxicity, g. Obtain patient’s weight before and periodically during furosemide
hydrogen ions. ACE inhibitors, angiotensin stomatitis, tinnitus, transient therapy to monitor fluid loss.
II receptor
hearing loss (rapid I.V. injection),
Furosemide also increases the
excretion of blockers: Possibly first-dose Tx:
hypotension, yellow vision
h. Administer medication as ordered.
calcium, magnesium, bicarbonate, ENDO: Hyperglycemia i. Assist patient when taking the medication.
severe hypotension,
j. Note extent of diuresis.
25
ammonium, and phosphate. By
reducing
intracellular and extracellular
fluid volume,
the drug reduces blood pressure
and
decreases cardiac output. Over
time, cardiac
output returns to normal.
SOURCE:
Jones & Bartlett Learning
(2015). Nurse’s Drug Handbook.
Fourteenth Edition.
deterioration in renal
function
aminoglycosides, cisplatin,
ethacrynic acid: Increased
risk of ototoxicity
amiodarone: Increased risk
of arrhythmias
from hypokalemia
cephalosporins: Increased
risk of
cephalosporin-induced
nephrotoxicity
chloral hydrate: Possibly
diaphoresis, hot flashes, and
hypertension
cyclosporine: Increased risk
of gouty arthritis
digoxin: Increased risk of
digitalis toxicity
related to hypokalemia
ganglionic or peripheral
adrenergic blocking
GI: Abdominal cramps, anorexia,
constipation, diarrhea, elevated
liver
enzymes, gastric irritation,
hepatocellular insufficiency,
indigestion, jaundice, nausea,
pancreatitis, vomiting
GU: Azotemia, bladder spasms,
glycosuria, oliguria
HEME: Agranulocytosis (rare),
anemia, aplastic anemia (rare),
eosinophilia,
hemolytic anemia, leukopenia,
thrombocytopenia
MS: Muscle pain or spasms
SKIN: Acute generalized
exanthematous pustulosis, bullous
pemphigoid, drug rash with
eosinophilia and systemic
symptoms (DRESS), erythema
multiforme, exfoliative
dermatitis, photosensitivity,
pruritus,
EDx:
k. Advise patient to change position slowly to minimize effects of
orthostatic hypotension and to take furosemide with food or milk to
reduce GI distress.
l. Report palpitations, signs of electrolyte imbalances (noted
previously), hearing abnormalities (sense of fullness in ears,
tinnitus).
AFTER:
Dx:
m. Monitor vital signs especially blood pressure.
n. Monitor for possible adverse effects of medication.
Tx:
o. Promote safety and comfort measures.
p. Assess the patient and determine unusual
EDx:
q. Encouraged patient to verbalize feelings and concerns.
r. Emphasize the importance of weight and diet control, especially
limiting sodium intake.

agents: Increased furosemide purpura, rash, Stevens-Johnson

effects
indomethacin: Possibly
reduced natriuretic and
syndrome, toxic epidermal
necrolysis, urticaria
Other: Allergic reaction
26
antihypertensive effects of
furosemide
insulin, oral antidiabetic
drugs: Increased
blood glucose level
lithium: Increased risk of
lithium toxicity
methotrexate: Possibly
decreased therapeutic effects
of furosemide
(interstitial nephritis, necrotizing
vasculitis, systemic vasculitis),
anaphylactic reactions,
dehydration,hyperuricemia,
hypocalcemia, hypochloremia,
hypokalemia, hypomagnesemia,
hyponatremia, hypovolemia,
thirst

norepinephrine: Possibly
decreased arterial

response to norepinephrine

NSAIDs: Possibly decreased

diuresis

phenytoin, probenecid:
Possibly decreased

therapeutic effects of
furosemide

propranolol: Possibly
increased blood

propranolol level

sucralfate: Possibly reduced

natriuretic and

antihypertensive effects of
furosemide

27
 thiazide diuretics: Possibly
profound

diuresis and electrolyte

imbalances

tubocurarine: Antagonized
skeletal muscle relaxing
effect of tubocurarine

succinylcholine: Increased
action of

succinylcholine

B. IV Fluids

Name Classification Component/s Use & Effects Nursing Responsibilities

1. Nicardipine Chemical Class: INDICATION: BEFORE:
Hydrochloride Dihydropyridine Dx:
To manage angina pectoris and
derivative a. Check doctor’s order.
Brand Name: Cardene b. Check blood pressure and pulse rate before
Prinzmetal’s angina, to manage
Therapeutic class: nicardipine therapy begins, during dosage changes,
Dosage/Frequency/Route: Antianginal, anti hypertension and periodically throughout therapy.
hypertensive
10 mg + 90 cc PNSS
Tx:
Adverse Reactions c. Prepare the medication at the right time and right
dosage.
CNS: Anxiety, asthenia, ataxia, confusion,
EDx:
dizziness, drowsiness, headache, d. Educated SO on drug therapy to promote compliance.

DURING:
28
nervousness, paresthesia, psychiatric
disturbance, syncope, tremor, weakness
CV: Arrhythmias (bradycardia,
tachycardia), chest pain, exacerbation of
angina (chronic therapy), heart failure,
hypotension, orthostatic hypotension,
palpitations, peripheral edema
EENT: Altered taste, blurred vision, dry
mouth, epistaxis, gingival hyperplasia,
pharyngitis, rhinitis, tinnitus
ENDO: Gynecomastia, hyperglycemia
GI: Anorexia, constipation, diarrhea,
elevated liver function test results,
indigestion, nausea, thirst, vomiting
GU: Dysuria, nocturia, polyuria, sexual
dysfunction, urinary frequency
HEME: Anemia, leukopenia,
thrombocytopenia
Dx:
e. Monitor blood pressure and heart rate continually
during infusion and avoid too rapid or excessive
blood pressure drop during treatment. If there is
concern of impending hypotension or tachycardia, the
infusion should be discontinued.
Tx:
f. Administer nicardipine as ordered.
g. Check and regulate the drop rate.
EDx:
AFTER:
Dx:
h. Monitor fluid intake and output and daily weight for
signs of fluid retention, which may precipitate heart
failure.
i. Assess for signs of heart failure, such as crackles,
dyspnea, jugular vein distention, peripheral edema,
and weight gain.
Tx:
j. Be alert of fluid overload.
k. Promote safety and comfort measures.
EDx:
l. Advise patient to notify prescriber immediately about
chest pain that’s not relieved by rest or nitroglycerin,
constipation, irregular heartbeats, nausea, pronounced
dizziness, severe or persistent headache, and swelling
of hands or feet.
29
 MS: Joint stiffness, muscle spasms

RESP: Bronchitis, cough, upper

respiratory

tract infection

SKIN: Dermatitis, diaphoresis, erythema

multiforme, flushing, photosensitivity,

pruritus, rash, Stevens-Johnson syndrome,

urticaria

Other: Hypokalemia, injection-site

irritation, weight gain

Name Classification Component/s Use & Effects Nursing Responsibilities

2. PNSS (Plain Normal
Saline Solution)
Form: IV Fluid
Dosage/Frequency/Route: 1000
ml x 12 hours, IV @ 27-28
gtts/min
Isotonic Intravenous The solution contains 9 INDICATION: BEFORE:
Solution Used because it has little to no effect on
grams of sodium
the tissues and makes the person hydrated, Dx:
chloride (NaCI) preventing
a. Obtain history of the patient’s fluid and electrolyte
dissolved in 1 liter of
hypovolemic shock or hypotension. status before therapy and reassess regularly.
water. At 22 degrees b. Identify the patient before administering IVF.

Celsius, 1 milliliter of Adverse Reactions

normal saline weighs  Fast heartbeat Tx:
1.0046 grams. Because  Fever
 Rash c. Assess vital signs.

30
sodium chloride has a  Joint pain, or d. Check and regulate the drop rate.
molecular weight of  Shortness of breath. e. Change the IVF solution if needed.

approximately 58 grams
per mole, 58 grams of EDx:
sodium chloride equals
f. Instruct the patient not to move her hands frequently
1 mole. The where the IVF was attached.
concentration is 9 grams g. Educate the patient about the IVF solution.
h. Instruct to report if dislodged occurs.
per liter divided by 58
grams per mole, or 0.154
moles per liter, because DURING:

normal saline contains 9 Dx:

grams of NaCI. Because
i. Do not connect flexible plastic containers of IV
NaCI dissociates into solutions in series connections.
j. Vent IV administration sets with the venting the open
two ions, sodium and
position should not be used with flexible plastic
chloride, 1 molar NaCI is containers.
equivalent to 2 osmolar k. Monitor for signs of infiltration/ sluggish flow.

NaCI. As a result, NS Tx:

contains 154 mEq/L of l. Be alert of fluid overload.
Na+ and CI. m. Promote safety and comfort measures.

EDx:

n. Instructed the patient and watcher not to self regulate

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 the IVF to avoid over infusion.

AFTER:

Dx:

o. Monitor for side effects.

p. Monitor fluid intake and output per shift.

Tx:

q. Palpate and inspect site for puffiness, redness,

blanching, skin temperature (very warm or very
cool), wetness,

EDx:

r. Instruct SO to report untoward signs and symptoms.

C. Surgery
(if any)

Procedure Description & Indication Nursing Care/Responsibilities

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33
XV. Nursing Care Plans

A. Prioritization of Problems

a.1. List of Problems

This portion lists the health problems according to priority (No. 1 having the highest priority).

Health Problems are stated as Nursing Diagnoses using the Basic 3-Part Statement : PES Format
- Problem Statement + Etiology + Signs and Symptoms
-
- Ex: Self-Esteem Disturbance related to rejection by husband as manifested by hypersensitivity to
criticism, stating "I don't know if I can manage by myself", and rejecting positive feedback
- Variations to the PES format in order to make the problem statement more descriptive
(e.g. adding "Secondary to") is acceptable as long as the part following “secondary to” is a
disease process
(Ex: High-Risk for Impaired Skin Integrity related to decreased peripheral circulation secondary to
Diabetes)

Problems should comprise AT LEAST 3 Actual Problems and 2 Potential Problem ranked in order of
priority.

a.2. Basis for Prioritization

This portion presents the basis of how the health problems were prioritized. Prioritization should also be
discussed.
NURSING DIAGNOSES JUSTIFICATION
1. PES Format as stated in your Why is it number 1 out of your 5 problem, you can use nursing
list of problem theories or concepts.
2. PES Format as stated in your Why is it number 2 out of your 5 problem, you can use nursing
list of problem theories or concepts. Relate it with number 1 or 3.
3. PES Format as stated in your Why is it number 3 out of your 5 problem, you can use nursing
list of problem theories or concepts. Relate it with number 2 or 4.
4. PES Format as stated in your Why is it number 4 out of your 5 problem, you can use nursing
list of problem theories or concepts. Relate it with number 3 or 4.
5. PES Format as stated in your Why is it number 5 out of your 5 problem, you can use nursing
list of problem theories or concepts. Relate it with previous problems.

34
 B. Nursing Care Plans
The Care Plans for the Nursing Diagnoses shall be presented here.
The format discussed during the Orientation shall be followed. (Follow new Format for NCP)

NCP 1: PES Format as stated in your list of problem

Assessment Explanation of the Problem Objective Nursing Intervention Rationale Evaluation

Subjective
Haan nak unay maka
kuti

Objective

Nursing Diagnosis
Activity intolerance
related to

NCP 2: PES Format as stated in your list of problem

Assessment Explanation of the Problem Objective Nursing Intervention Rationale Evaluation

35
NCP 3: PES Format as stated in your list of problem

Assessment Explanation of the Problem Objective Nursing Intervention Rationale Evaluation

NCP 4: PES Format as stated in your list of problem

NCP 5: PES Format as stated in your list of problem

36
 C. Discharged Plan
Health Teaching
Diet/Nutrition 1. Aaaa
2. Bbbb
3. cccc

Activity 1. aaaa
2. bbb
3. cccc
4. DDD

Medication 1. Aaaa
2. Bbbb

Other 1. Aaaa
2. Bbbb

(Diet, Therapeutic regimens, Take home meds and Nursing education for the client)

XVI. Learning Insights

(Individual and arranged alphabetical order. Includes what you have learned from the case of your
patient, from assessment, diagnosis, planning, implementation or nursing care and evaluation.
PARAGRAPH FORM, express your writing skills.)
A. BENITO, Danny C.
In our three days duty, handling patient X is…
B. GESMUNDO, Lorraine
The case of patient X is…
C. LIMMANG, Clarissa Marie P.
I may not be part of the directly monitoring the patient but I was able to learn a lot
from our case like I’ve learnt more about the patient’s diagnosis and it’s management in more
detailed manner. But the most notable thing I’ve learnt from this group is being able to learn
from my groupmates’ insights and be productive as a group member, which has helped me
delegate tasks more easily and resulted in early completion deadlines. It has influenced my
own thinking and broadened my knowledge, and from our case presentation, I acquired new
ideas that will benefit me in the future as a nurse. I am thankful for the opportunity to work
with and learn from such kind and good people, as well as accommodating fellow learners!

D. MAIGI, Nicalin
Honestly, I am not part of the directly monitoring the patient but I was able to learn a
lot from our case by sharing my insights regarding…
E. PAGADIAN, Ia Rylyn
I was able to see the patient in our second day of duty and helped in the assessment,
so I learned to…

37
F. PAGUIRIGAN, Kryzza Leizel
I was able to see the patient in our second day of duty and helped in the assessment,
so I learned to…
G. PANGDA, Jaceziel
I was able to see the patient in our second day of duty and helped in the assessment,
so I learned to…
H. SAAVEDRA, Joy Anne
I was able to see the patient in our second day of duty and helped in the assessment,
so I learned to…
I. TUCYAPAO, Irish P.
I was able to see the patient in our second day of duty and helped in the assessment,
so I learned to…
J. VILLANUEVA, Jayson
I was able to see the patient in our second day of duty and helped in the assessment,
so I learned to…

38
XVII. List of References
This portion cites all books, journals and other references that were used as shown in the example
below. Use APA Format and as much as possible use updated book source.

39
XVIII. Appendices

40
 Appendix A
Approval/Request Letter

41
 Appendix B
Interview Guides

42
 Appendix C
Others (just specify)

43